I’m sorry I’ve been inactive so long, but I’m happy to say that I’m home from a rather long hospital stay, and then a session in a rehab facility — and now I’m recovering. There’s a lot I could say about how medical institutions work, based on my own experience these past weeks, and on things my friends and family have gone through.
Maybe I could put it this way — try to imagine Gray’s Anatomy combined with Catch-22. Or imagine a version of Gray’s Anatomy (a more truthful one) in which half the communications between people on the medical staff — and between medical staff and patients — are halfway incoherent, or even completely so. You haven’t lived until you’ve been rolled on a stretcher to the OR for surgery, and then hear the OR staff talking about how something new has come up, and you’re not going to have surgery that day. Nobody tells you this — you just hear them talking about it. And then one of the doctors throws a little hissy fit, because he hasn’t been told how things stand. Based on my experience, the confusion this demonstrates might be more typical than not, and I’m not saying that to disparage the skill or caring of the people involved. It’s their administrative processes that need work.
One evening a nurse came on duty, and told me not to eat or drink anything after midnight, because I might be having surgery — again! — the next day. I hadn’t heard anything about even a remote possibility of a second procedure, and was naturally amazed. The nurse assured me that a doctor would come to tell me all about it. But hours later, when no doctor appeared, and I asked the nurse what was going on, she told me it had all been a mistake. Another nurse had told her this news about me — news that wasn’t true at all. There was no formal, written medical order about any surgery coming up. The whole thing had been hearsay. And my nurse, once she realized that she’d just been passing on rumors, never bothered to tell me, until I asked. All this, at a major New York City hospital.
I’ve heard far worse. A few years ago, a friend of mine became a father. The baby was hooked up to various monitors, and at one point — while my friend and the baby’s mother were standing nearby — the monitors began sounding alarms. Two medical people came in, and without a word to the parents, began having an argument about whether this was really a medical crisis, or whether the machinery might be malfunctioning. They actually walked away continuing their dispute, without a word to the parents. Luckily, the machinery was the problem, not the baby, but the way this was handled just sounds sick.
The moral of all this? As a couple of doctors emphasized to me– doctors who see very clearly what’s going on — you, the patient, have to take charge of your medical care. You have to ask sharp questions, complain when something doesn’t seem right, and insist on changes when obvious mistakes are being made. If I and my wife hadn’t done that, I’d have been in rehab for four weeks instead of one, and would have paid hundreds of dollars for a completely unnecessary ambulance ride that my insurance didn’t cover, and (as I correctly insisted) could just as well have been done in a much cheaper ambulette, or even in a taxi. Again I’m not saying that the medical people I dealt with, on all levels, were incompetent. Far from it. But their administrative procedures need lots of work.
First of all, welcome back! Glad to hear of your recovery, and looking forward to your posts.
Your experience with the American medical system recapitulates my experience and that of my friends’. A dozen years ago when helping a friend who was dying of AIDS, I learned that every patient needs an advocate: someone who can ask questions, actively track down information, help make decisions about medical care. No person sick enough to be hospitalized can handle these responsibilities.
After my friend’s death I sent a fruit basket to each of the three nursing staffs. They deserved a token of appreciation for their work. My friend’s physician–once I had a legal medical power of attorney–was also wonderful.
One Sunday morning when the visiting nurse thought that my friend was dying, she talked with the physician managing care, who recommended that my friend be moved to the hospital for tests. I wouldn’t agree, because transporting him was always traumatic for him. I refused to agree until I talked with my friend’s own physician–who called me when he returned home from church.
My friend–alas!–died a week later. And as sad as that end was, I at least could console myself that I had done for him what he could never have done for himself.
Dear Greg: So glad you are on the mend, and doing much better! Have missed your pithy and insightful online comments 🙂 Ms. AM caught me up on your health saga…good fodder for a different sort of book!
Greetings, Deborah
I’ve missed your posts! Glad you’re back.
I would love to hear your thoughts on Gene Weingarten’s article in Sunday’s Washington Post magazine about Joshua Bell performing in a DC metro station. Have you seen it?
Greg,
So sorry about your ordeal and glad you are back.
Sadly, I finally figured out the problem with hospitals (and Emergency Rooms) long ago: they are all like the military: Badly , full of “pork,” or worse.
They communicate with you on a “need to know basis”; change orders at random; order you around; dictate when you have which procedures; and, generally, scare the “sh**” out of you.
Unlike you, I had better luck with nurses than interns/residents—who generally know almost nothing (certainly less than a lot of experienced nurses), and they can kill you faster.
Welcome home.
P
Greg, it’s good to see you back. I’m glad you survived both your accident and the system.
There are groups working on the problems you saw, but I’m sure that’s a hard process that has far to go, as we’ve seen in the news and in what you’ve experienced. http://content.healthaffairs.org/cgi/reprint/21/3/80.pdf and http://www.leapfroggroup.org/ are a couple of pointers into that work.
Take care, and get through your recovery posthaste!
Greg, Again, welcome back, my friend and fellow victim of the collapsing American medical system. I am forwarding this – your post and my comment – to my resident Florence Nightingale and wife of almost forty years, Kimberly. She is preparing to write a letter to all the culprits – for now but not for long they will remain nameless – demanding some satisfaction for the shoddy post-operative and subsequent at-home follow up that I failed to receive after a fall and multiple fracture of my right leg. Yours in misery!
Rafael