first, do no harm

9/22/09

Those of you who are Facebook friends with my mom – a disturbing number of you, I might add – know that she was whisked to the emergency room a few days ago. Here is the story in her own words:

***

Notes from a Medical Gulag

Remember the train station scene in “Gone With the Wind” where the mass of injured, suffering soldiers are laid out in rows on the ground? Replace stretchers with gurneys, and that’s what it looked like in the Emergency Room of the “best hospital in New York City” this past week.

The ambulance paramedics wheeled me in after a scary “episode” at home in the middle of the night. I was going to be fine, with a manageable health issue, but I didn’t know it at the time. And I had no idea what the next 40 hours were going to be like.

I was evaluated, hooked up to monitors and IV saline, “admitted” and told they would take me upstairs as soon as they found a bed for me.

Now in a corner cubicle smaller than my coat closet, still on the gurney. Nothing like a bed, a gurney is narrow, hard, and uncomfortable. And the ER is cold. The lights are blindingly bright, the noise of beeping monitors, calls for help, moans, coughs, retching… I am really looking forward to going “upstairs” to a real (if still hospital-style) bed.

End of Hour 1: Nothing.

Hour 2: “There are no available beds but we’re looking.” (Feeling woozy but OK. Need sleep but waiting for the “bed upstairs “.)

Hour 4: “Still looking for a bed.” (Still awake).

Hour 6: Grateful that Sean has followed the ambulance bringing along one of my own pillows, my iPod full of music and books, and my phone. (Still no sleep.) “We’re still looking for a bed.”)

Hour 9: So many people in the ER that the halls are full, the aisles are full, there are no gurneys left, so people who can sit up are strapped in wheel chairs in nooks and corners. (Sean tells me I’m well off, since I’m next to a wall, and have only one other patient on the other side of my curtain. But she is barfing.)

Hour 12: (I’m a little hungry. But not completely miserable. Both ear buds in, listening to “A Team of Rivals,” alternating with Brahms.) “We’re still looking for a bed.”

Hour 14: (Cheered by Sean who assures me that what ails me is manageable and I’ll be upstairs soon and they are, yes, still looking for a bed.) Barfing lady replaced with moaning man who keeps asking, “What happened? Where is this place? Somebody!”

Through all of this, an inadequate but plucky and compassionate team of nurses, doctors, and helpers are doing their best to keep the place functioning. This includes the young male nurse who blew up a vein in my arm trying to find a place to stick another IV. “Oops! I’m so sorry.. You’re getting a little hematoma there, and I’ll keep an eye on it.”

As good as his word, he is back every half hour or so checking the swelling bulb of black and blue on my arm. “Not so bad. Call me if it gets worse.” Of course in the ER there is no way to “call” anyone. Jordana suggests that I throw my paper cup at the first medico who passes my alcove. Mostly I wait. “We’re still looking for a…”

Hour 17: Still nothing to eat, and nothing to drink tomorrow. Doing tests in the afternoon, but “We’ll find you a bed upstairs as soon as we can.” I call Sean nearly in tears. “My iPod and phone batteries are dying. And I have been stuck on a bedpan for 30 minutes. I’m not doing too well.” (A cleaning crew guy tries to find someone to help and can’t, so he takes the bed pan himself. What a guy!)

The tedium is sometimes relieved by the reality show just outside my little alcove. A huge, jolly African American man says he needs to go home and take care of his dog. (He has been brought in because he has no doctor, no insurance, but fainted on the sidewalk). He is released “against medical advice,” but becomes distraught when he can’t find “my special cane that I brought from Africa.” The overworked nurses promise to contact the ambulance crew.

Several overheard conversations go approximately thus:

Nurse: “Tell me why you are here.”

Patient: “I got sick. I have a bad (fill in blank).

N: Have you seen your doctor?

P: No doctor. No insurance.

(I’m totally miserable, but starting to feel really lucky.)

Hour 20: A weary Sean and Jordana appear with power cords and encouragement. (They are beautiful– better than an enchilada dinner and a feather bed. I can do this.)

Hour 23: I’m cold, but don’t ask for another blanket. They are out of blankets, and I wonder what they are throwing over the newcomers. (I begin to listen to “A Pinch of Snuff” and realize I’ve already read it. Switch to last weeks audio “New Yorker.” My back aches from gurney syndrome, but I know I’m relatively well off.)

Hour 29: A sweet nurse with amazing dimples brings me a cup of tea from the nurse’s lounge. Better than a raisin bagel with cinnamon cream cheese. “We’re still looking…”

All day I have been hearing loud thumps behind my wall. Apparently I’m next to the CatScan room. Not too loud, but who can tell in this din?

Hour 30: Lights are always on full. This is prison. I want a pencil to cross hatch the passing days on my wall. (I have a splitting caffeine headache. But the man in the next slot has cancer, and they can’t find him a bed upstairs. I decide not to bitch.)

Hour 31: “We’re still looking for a..”

Unhooked from monitors and IV’s I can at last walk to the bathroom. WA-HOO! Free at last! (Hematoma on my arm looks like I’ve been in a bar fight, but they say it’s OK.)

Hour 33: (Still trying to get to sleep. Switch to Ravel on the iPod, but even “Lullaby for Babes in the Wood” can’t compete with Catscan thumps, beeping monitors, moans, coughs, loud PA. I switch back to audio books. “Middlemarch.” If that doesn’t put me to sleep…)

Hour 34: Sean wants to know if he should come in. No, there is no place to sit. Almost nowhere to stand. The place is Gone With theWind again. Distracted from sore back and caffeine headache by panorama outside my alcove.

Patient wearing large hat, clutching big purse, sitting up on gurney. (I’m thinking maybe she collapsed at Bloomingdale’s) “My god,” she bellows, “I’ve been waiting TWO hours for a bed!” I think of new patient next door. Cancer man has been taken elsewhere, replaced by cancer/chemo lady who can’t keep anything down. I want to throw my pillow at purse lady.

Elderly lady lying on gurney on the aisle outside my cave. She is surrounded by three very concerned sons, lovely young men, none of whom look racially connected. The mom is old, but lovely. And I’m thinking either the sons are adopted or mom was really busy in her prime. The boys are so protective, so sweet to her that I want to tell her “Aren’t we lucky to have such sons!”

Cancer Lady’s daughter comes to see her, greets her with annoyed “What now, ma?” But she does go find a chair and sit by her. I know it’s hard…

Hour 36: “We’re still looking for… ” (By some miracle, I finally fall asleep.)

Hour 40: ¬†Shake. “We’re taking you up to GI floor for the tests now.”

And an hour later I am pronounced OK and sent home.

Now I know this New York hospital is a victim of other hospital closures, and hospitals elsewhere may not be that spectacularly dysfunctional. I know there is an unimaginably huge national deficit. I know it’s “complicated” and all the other talking points. But I’ve been the beneficiary of free public health care in other countries, both as a resident and a visitor, and those systems are working. I know our own health care system is broken.

I am actually a grateful participant in a U.S, “Public Option”: Medicare. It doesn’t cover everything, so I pay for a supplement. And Medicare isn’t free, either. Around $100 every month is deducted fro my pitiful Social Security benefit.

I am in my mid 70s and still working. I also have an astoundingly wonderful family who are there in a crisis. I’m very lucky. Still, some months, when there are no royalty checks or contract work is slim, my income is down to poverty level.

That said, I’d be perfectly willing to be taxed on whatever I earn to provide universal health care for all the citizens of my country. For the same reason, I think it’s fair to pay for public education, even when I don’t have school-age children. I want to live in a country whose citizens are healthy and well educated.

When I look at some of the mean-eyed, slack-jawed, often unhealthily obese participants in the anti (fill in blank, but currently “health care”) rallies–many exhibiting semi-literate, misinformed, even misspelled, hate-filled signs and T shirt slogans–I feel that we are failing on both counts.

There is no hope of reaching these rally people, especially when they are egged on and misinformed by the wealthy, well-fed radio and TV rabble rousers, and even many of their lawmakers.

I just wish Limbaugh and Glen Beck, insurance execs, and the obstructionist lawmakers, could be forced to spend 40 hours on my gurney in the ER, with lines in their arms, stuck on a bedpan, surrounded by moans and cries, and barfing. Ironically they would be cared for, as I was, by fantastic medical workers who do a terrific job under impossible conditions.

But they, especially the well cared-for lawmakers, would have to encounter, first-hand, in the relentless bright light, the cries, the smells, the pain, the frustration, the need, the broken system they have the power to fix.

If only.

***

LindaLavenderSean(bl).jpg

Linda and Sean unpack at the farm

0 thoughts on “first, do no harm

  1. LFMD

    Linda! What an ordeal! I am not sure how my own parents, who are near you age, would have managed in such a situation. So glad that you are back home and well.

    Reply
  2. Anne

    Ian’s mom: This MUST be submitted immediately to Anderson Cooper’s 360 blog, or the New York Times for an op-ed, or Newsweek (do they still have “My Turn”?). Please do it now.
    Written with restraint, poignant details, wry humor, and irrefutable conclusions. Everyone should have a chance to read this.
    What a horror show. I am so sorry. I know about the piercing bright lights and the chilly cold of ER’s. Thank God you at least had your pillow and iPod. I know the big city hospitals are overhwhelmed at night. But this is craziness.
    Excellent post, Ian. Mom: Hope everything is OK and you’ll not have to return to the ER!

    Reply
  3. CM

    Wow, you look GREAT, Ms. W! It’s also lucky that you had Sean to be your advocate and helper, too. I’m sure many do not.
    Please, please submit this story to the Times Op-Ed page or something…not that it will change the minds of anyone who’s minds need to be changed.
    Glad you feel better.

    Reply
  4. Caroline

    Ian/Ian’s Mom – I’m glad you are OK and home safe and sound.
    Uuuugh. This whole debate is so… troubling to say the least. When I hear someone use the argument of ‘but everyone DOES have access to healthcare’ your story is exactly what I think of. I’ve been to the ER exactly once in my life for 4 hours. I came in with food poisoning masquerading as like a stroke or something and left with emotional trauma at what I witnessed and that was only 4 HOURS!
    Yes, please submit your editorial to a place that has even more reader’s than Ian’s blog.
    And, jeez – What now, ma? Nice. Sounds like she raised her daughter to be just like her!
    Waaaaaa! This post is so depressing on so many levels. Except that your mom is fine and has such a great attitude. Yay for that. Boo for everything else.

    Reply
  5. Annie H.

    I was so relieved to hear via Sean that you were a-ok after your ordeal. Must find you on FB immediately!
    I too agree that you should circulate this excellent piece of writing everywhere you can. My only suggestion would be that you include the fact that you are a grandma. I think it will help more people connect to the piece.
    May you continue to live well and thrive!

    Reply
  6. Bob

    Damn, this makes me so angry.
    According to T.R. Reid, countries that implemented universal health care almost always did one thing first–the citizens agreed that such care is a moral imperative. Then they figured out how to make it work.
    We’ve yet to take that first step. Shame on us.
    Hope your mom continues to do well.

    Reply
  7. John Galt

    Am I the only one who sees the irony in the closing lines of this story? In one breath the woman complains about the healthcare system and says she is, “… perfectly willing to be taxed on whatever I earn to provide universal health care for all the citizens of my country,” and in the next breath complains about the public education system that seems to have failed so many. Do any of you cheerleaders really believe that the government will somehow miraculously be able to any better job of delivering quality healthcare to everyone? Even a barely adequate job? I’m sure you’re all nice people and your hearts are in the right place, but if we go down that road, you can bet your bottom dollar that there will be rationing going on and some government dweeb will be deciding if and when we all get the treatment we need. The problems described in this article will only be magnified. And we’ll all be poorer — health-wise and money-wise — for it.
    New York City has bigger issues than the rest of the country, and those issues are amplified by the sheer volume of people there. The vast majority of people there and elsewhere in the country have health insurance and aside from the occasional hiccup, it works. To hork over the current healthcare system in this country to cover the people who are truly in need of healthcare coverage would be criminal. It’s not so broken as to make necessary the kind of overhaul embodied in the current bill before the House. No way, no how.

    Reply
  8. Ian

    JG, you’ve inspired me to re-study all my Ayn Rand literature, history and philosophy. There’s a blog in there somewhere, but man, it’s pretty dense. I can guarantee you’ll hate pretty much anything I come up with.

    Reply
  9. Rebecca

    Ian’s Mom, so sorry about this horrible experience. I’m thankful you are okay now.
    And John Galt, the Government will not be delivering healthcare to anyone. The exact same doctors and nurses will be delivering healthcare to people. The government will simply be paying for it.

    Reply
  10. kjf

    JG – Ian’s Mom was in the ER for an emergency…and one of the reasons it is a zoo is because uninsured people have to use the ER because they have no other options. if they were covered by insurance they would not be visiting the ER – a very expensive place that should only be used by folks with emergencies. unfortunately it is the “public option” for many people in our country. and that ain’t right.
    and Mom I hope you are feeling better!

    Reply
  11. Neva

    I wish I could say your story was surprising or unique but no, it’s pretty typical.. and not just for NYC John Galt. It is very much the norm around here. Most of our admits from ERs have been sitting there for DAYS before we get them.
    The only positive side to this story (other than you are okay, of course) is that nothing bad happened to you. Most of these stories are also punctuated with a few “and I was never told what was wrong and I’m still hurting even worse” or “they never called my doctor to find out that I already had that test so that just ordered another one” or “I TOLD them I was allergic to penicillin but I got it anyway” or “I ended up with this hospital based infection”..
    I could go on and on.
    I promise you folks, the system is a nightmare. If you have had timely care without a wait and without fighting an insurance bureaucrat you’ve either been well or damn lucky.

    Reply
  12. Caitlin

    John Galt: “you can bet your bottom dollar that there will be rationing going on and some government dweeb will be deciding if and when we all get the treatment we need”
    You somehow fail to notice that there is _rationing going on right now_, only this rationing is done by private insurance companies that increase their profits by denying people care that they need.
    I don’t know how much suffering and death it would take to bend your ideology towards compassion, but I hope there’s room for you to be persuaded. Maybe after you spent some time plucking maggots carefully, one by writhing one, out of a man’s rotting leg, because he didn’t get his wounds attended earlier. Or had a woman show you her massive fungating breast cancer that she never sought care for, because she was uninsured, you’d change your mind. How would you feel signing her death certificate? How about watching a young woman bleed to death and die, jaundiced and moaning, because she can’t get the liver transplant she needs without insurance?
    This argument is not abstract to me at all.
    Ian’s mom, I am sorry to hear your story. Sorry, but not at all surprised. I have taken care of people ‘boarding’ in the ER for up to four days. One of the big problems is that when we can’t discharge people from the hospital — because no insurance, so no money for long term care, rehab facilities, or nursing homes — they fill beds and then we can’t admit new patients from the ER.
    Also I am SO glad to hear you are better. You write with clarity, grace, and good humor despite the circumstances. Thank you!

    Reply
  13. asd

    part of the problem i think is that the hospital’s try to run such a tight financial ship that there is almost never an extra bed or nurse or aide to take care of someone. it is ridiculous. as a physician i am amazed when i call admitting at the hospital to have a patient admitted and they tell me to have the patient go home and wait and (the hospital) will call them and tell them when to come in. hello!!! if I thought they were stable enough to go home I owuld not be trying to admit them in the first place. once a patient waited 36 hours! And this was not during flu season. What would happen if we really did have true flu epidemic?
    I would love to see people start reviewing their ER visit, hospital stay, experience with the radiology department on something like yelp. Hopefully that will make some of these big institutions/hospitals work harder to provide better care.

    Reply
  14. Bud

    Linda, I’m SO glad you’re feeling better! What an ordeal… excellent writing.
    “…countries that implemented universal health care almost always did one thing first–the citizens agreed that such care is a moral imperative. Then they figured out how to make it work.
    We’ve yet to take that first step. Shame on us.”
    You nailed it, Bob. If pain isn’t a problem because it’s happening to someone else, that’s THE problem right there.
    Hard to believe, but history suggests we’ll reach consensus on this and the other critical issues of our time in just a few years.
    Maybe stories like this will help make that happen.

    Reply
  15. John Galt

    There’s a difference between having compassion for those who are suffering and seeing the need for the level of reform that Obama is proposing. And the thing that really gets me is that even if his version of reform is passed today, it’ll be 5-10 years before anybody sees much help, and even then most who are uninsured today still won’t be insured then. Those who don’t identify with your political views are indeed capable of compassion, and show it readily; don’t kid yourself. We just happen to think that we don’t need a governmental acting as an intermediary. The time of indulgences is long gone.
    People forget – or perhaps never thought about – how health insurance works; the people who are insured pool their money, pay it to an insurance company, and the insurance company doles out the money as the needs come up. The money doesn’t magically appear in the coffers of the payer. The insurance co negotiates with the insured group (usually through an employer representative) how much each person pays for premiums and how much the employer pays. At the end of the year the insurance co figures out how much went out vs. how much came in, and either calls it good or renegotiates the premiums. Not sure where people get their info on how much profit insurance co’s make, but last figure I heard (that I trust) is about 3%. If we move to the single-payer system that Obama and the Dems ultimately want, the Fed govt will essentially supplant the insurance companies, and will theoretically run things the same way except without trying to turn a profit, but as a government entity, I have little doubt the administrative overhead will exceed that of the insurance companies. And if our current public option is anything to judge by, fraud, waste & abuse will be rampant, eating up a generous chunk of the cash that’s dumped in, so in a short time the program will need additional funds, provided by premium increases and/or subsidies from other federal tax revenue/borrowing. Obama’s pledge that the program be revenue neutral is little more than vaporware.
    The processes used by any given insurance company to determine what to pay is never perfect and anybody can come up with some personal horror story about they or so-&-so they know who got screwed over, but how is that going to be solved by replacing the bureaucracies of the insurance companies by one monstrous insurance company (aka the Federal Government)? I don’t buy it, and neither should any of you.
    Let me put it to you this way; if George W. Bush proposed the exact same program, would you still support it? I didn’t think so. Neither would I.
    Ian: Can’t wait to read your character assassination. No doubt it’ll be an improvement over last week’s movie.
    kjf: True enough, the ER makes for a lousy ‘public option’, but where is it written that people MUST have insurance to see a doctor? Don’t they have free clinics in NYC? Aren’t there lots of millions of people who already qualify for Medicare/Medicaid? Because a few million people misuse the system and ignore the options that are already available to them, the rest of the three-hundred million people in the country need to have their current plan thrown in the crapper? Just go ahead with that plan & see what kind of revolt will follow.
    dob: Good on the rest of the industrialized world. If you can call what they’ve achieved ‘successes’, they are on a much smaller scale than what the population of the US requires. And if their healthcare systems are so great, why do so many of their citizens fly HERE when they can’t get the care they need there?

    Reply
  16. Druk

    For those in favor of the public health option, when was the last time any of you donated to your local hospital?
    Donate more; use government force (guns) on me less, please.

    Reply
  17. Alan Gerow

    That’s great you’re willing to pay higher taxes to support a national health care program. But I’m not, and I find it disgusting that you would support government violence to see your vision forced on everyone else. By supporting a tax increase, you are forcing financial hardships on more people that risk losing their homes because of foreclosures. And if they can’t pay their taxes to pay for other people’s health care, then the government will lock them up and steal their homes. That’s very generous of you.
    Why don’t you instead simply give money to charities to help people? Why don’t you donate your personal money to hospitals that need it? Why do you need the government involved to help people, JUST DO IT!!! Don’t ruin lives to feel good about yourself.
    I’ve spent most of my life without health insurance. I welcomed my most recent birthday laying in a hospital bed. I do NOT and NEVER would support violence to see a goal met, and as such I would never support a government health care program that forces support through taxes. That would be immoral.

    Reply
  18. Sassy's Mom

    Sadly, many of those currently abusing the Emergency Room will still do it, even with “insurance”, because they cannot or will not plan ahead, follow a physician’s advice, take meds as prescribed, or believe that their chronic back pain isn’t going to kill them before 9 AM, since it hasn’t done so, yet. (Medicaid recipients are frequently guilty of this, even now, partly because there are not enough doctors that accept medicaid outside of ERs.)
    We need more urgent care facilities open 24/7 and need rules in place (and enforced) about how and why people use the ER.
    Health Care Reform must be about a whole lot more than who-pays-for-what and what-gets-paid-for-when. Malpractice insurance and the cost of getting a medical degree are major parts of the problem.
    If the “Government” is the only payer, will it be the one who determines payment levels? If so, will we end up with fewer medical students down the road?
    Certainly, our country’s leaders need to do something, but so do we, as Americans. It’s our money and our health.

    Reply
  19. CD Address

    My wife and I are homeopaths. We do not want to participate in pharmaceutical medicine. We also feel it’s immoral to forcefully take money from someone else to pay for our bills, or to be forced to pay for someone else’s bills.
    What you just experienced would be worse under the ‘Public Option’. The most similar things is Canadian health care, and they have a chronic shortage of doctors and nurses, all services are lucky to be performed within 24 hours in a Canadian ER, and MRI’s take up to 6 months, and hip and knee replacements are limited also.
    As you are still working, you will be eligible for some treatments, but not life extending treatments due to your age.
    The hospitals are in the shape they are due to “good intentions”. Medicaid is what has been bankrupting the hospitals and the federal unfunded mandate to treat any who come to the hospitals. My father-in-law left private practice due to Medicaid disputes and underpayments. That left one less doctor in a retirement community.

    Reply
  20. Bernie Mojzes

    Fascinating. National heath care == guns aimed at the populace. Supporting health care for all == ruining lives.
    I find it interesting that most of the people who rail against public options in health care are perfectly happy to take advantage of the benefits of a National militia, government roads, public water supplies, etc.

    Reply
  21. Dwindle

    Be happy she wasn’t in Canada where it takes over 24 hours just to be admitted into a hospital, or in the UK where she would have been denied care at all because she’s too old. We are not going to destroy the best health care in the entire world just so you can save a couple bucks, buddy. get used to it. Our public roads, electrical grid, and environment are in severe disrepair because you believed the government would fix them out of the kindness of their hearts. You were wrong then, and you’re wrong now.

    Reply
  22. Nancy Navarro

    Wow! On the spot reporting of the miserable state of health care. My sister died of cancer. No insurance. She felt it would be better to die than to fight it. What little she had financially she wanted to leave to her daughters and their families to help them out.

    Reply

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