Wednesday, July 11, 2007

An Insider’s Look at the US Medical System

I recently had the chance to get a 4-day, inside look at a real, functioning emergency room and hospital. I came upon this unique opportunity (actually, it came upon me) when I happened to be the driver of the losing vehicle in an automobile/bicycle winner-take-all grudge match staged at a local intersection. (Please do not try this at home!) In any event, I am fine, thanks, and the experience was most enlightening—even better than watching old reruns of ER!

Now, I know it's always been fashionable among vegetarians to bash Western medicine. I've done my share of that bashing in the past, and nothing in this experience changed my mind about the things that I've written and said. On the other hand, our medical institutions are incredibly good at some of the things that they do, particularly in the practice of "horizontal" medicine. (That's Dr. Michael Klaper's term for what doctors do when the patient arrives in a "horizontal" position.) Here's a sample of the good and the bad that I experienced during my recent sojourn.

  • Security guards are there to keep us safe. I arrived at the emergency room in a bit of distress. (If I had been a car, a mechanic might have said that I had an alignment problem.) Did anyone offer to let me lie down? No. Pain medication? Not for 7-1/2 hours. A bandage for my bleeding elbow or leg? Never. After I'd been there for a few minutes, though, the uniformed security guard on duty came over to me and asked, "Can I get you some ice for that arm?" I was very happy to take this kind soul up on his offer. Obviously, in the US medical system, security guards are a critical link in the provision of emergency services. God bless 'em!
  • Your medical dollars at work. There are two reasons why Americans spend over a trillion dollars a year on medicine, and why those costs increase every year by double-digit percentages: prescription drugs and paperwork. Speaking of the latter, my first night in the hospital I had to give my medical history three separate times—the first two to doctors and the third to a nurse. Any clerk with minimal training could have done this, filling out a database questionnaire on the computer. Such a simple change in procedure would have saved the hospital at least $100 on me that night, and would have substantially lessened the risk of a mistake being made because of incomplete or conflicting data. (Of course, an even better and cheaper solution would be to keep everyone's medical information in a database accessible by doctors over the Internet—but that would be too simple, I guess.)
  • Hospital beds are hard to come by. It was 10 o'clock at night and I'd been in the emergency room for four hours when they told me I was being admitted to the hospital. But then they said I would have to wait for a bed to become available. I thought about that and panicked. "What?!" I screamed. "Who checks out of a hospital at 10:00 at night? A dead person, that's who! You're going to put me in a dead person's bed, aren't you?!" It took me several minutes to calm down, after which I realized that somebody had probably died in every bed in the hospital. By 1:30 in the morning, more than 8 hours after my accident, I was finally tucked away in one of those beds, feeling like the dead person myself. I had Benedryl to put me to sleep, two syringes of morphine in my veins for the pain, and I was still wearing my dirty bicycling clothes.
  • The forms aren't made for vegetarians. I became a vegetarian for ethical reasons alone. But I do have to say that it was awfully nice to say "no… no… no" when they asked over and over again if I had any of the long string of diet-induced maladies on the hospital's charts. (It was also nice to say "none!" when asked what drugs I take regularly.) "You seem pretty healthy …for such an old guy," I was told several times. "I'm a vegan," I would reply, trying to get in a good word for the cause. "You can write that on my chart!"
  • The food isn't made for vegetarians. My first day in the hospital the only thing I was offered to eat was a quart of barium drink (Mmmm!) that would make my organs glow under the cat scan. (By the way, they don't use real cats in this procedure.) The food didn't improve much after that. Indeed, the only thing remotely healthy about hospital food is the small portions. In general, hospital diets are tailored to make patients come back soon and come back often. If you're a vegetarian, expect to eat a lot of eggs and cheese. If you're a vegan and ask nicely, they'll bring you a plain salad and a baked potato. …Kind of like being in Texas.
  • Hospital people aren't necessarily healthy people… I can't tell you how many really unhealthy people I saw in the hospital—and they were working there! It struck me as very odd—kind of like walking into a health club and seeing the whole staff smoking cigarettes. One morning a very overweight and out-of-shape young woman was pushing my wheelchair to x-ray. As she huffed and puffed it was all I could do to keep from saying, "Gee lady, maybe we'd better trade places."
  • …but they do work hard. I saw doctors on rounds at 5 in the morning, and people putting in 16-hour days on Labor Day weekend. And then, of course, there are the people who toil all night long, waking patients up every 2 hours to take their pulse and make sure they're still with us. (I guess these are the folks who phone the emergency room to tell them when beds open up.)
  • Misdiagnoses happen. You always know you're in trouble when they repeat a medical test on you. That's what happened to me. Then, a few hours later, a stern-faced doctor trailing half-a-dozen medical students showed up beside my bed. "There's one thing we didn't tell you about your test results…" he began. "You may have Gilbert's Disease, a really horrible disease of the liver." Immediately I recalled all the stories I'd heard of relatively healthy people going into the hospital and never coming out alive. Then the doctor smiled. "Actually, I have Gilbert's Disease!" Well, it turns out that Gilbert's Disease is a disease without any bad symptoms at all, and in any event I didn't even have it. The official diagnosis, given to me after still more tests the next day, was that I just "beat the crap" out of my liver. (Doctors do love those fancy medical terms!)
  • Sometimes, they get it all right. When you see all the chaos in a modern hospital, see one thing bungled after the other ("What did you say you were allergic to?"), and wait around endlessly for every simple procedure, it's tempting to just write off the entire medical community. But that's often when something extraordinary happens. It happened to me. In my case they found a potentially serious problem (a partially collapsed lung) and fixed it. (They put a tube in my chest and re-inflated the lung—thereafter giving me the perfect excuse for looking like a blimp!) I don't want to sound corny, but it's almost magical to watch up-close (okay, too close) as very smart, very well-trained doctors and nurses use some of the most sophisticated machines science has ever developed to do miraculous repairs on the human body. If I ever grouse about modern medicine again (and I'm sure I will), just remind me of that, and I'll put everything in perspective. I may have learned it the hard way, but I have to admit hospitals are pretty amazing. …Now, as the bills roll in, I just wish I could say the same thing about insurance companies.


tonylococo said...

My wife recently had surgery for prolapse, uterus, bladder, and rectum . She came to her room from recovery in much distress. She indicated she was in a lot of pain so I got the nurse and we discovered that the morphine hose was crimped close. She was not a happy camper and they had to end up giving her a shot so she could get on top of the pain. So much for double checking when someone complains of pain in recovery.

Mark Warren Reinhardt said...

A friend of mine was in the hospital several years ago with a crushed leg. He complained about pain for weeks before they discovered that they were accidently giving him 1/10th of the dose of morphine he was supposed to be getting!

Anonymous said...

I find it shocking an attorney couldn't maneuver better in an ER, and needed to wait 7.5 hours to be treated. Perhaps you had no medical insurance? Also, never go to a teaching hospital, otherwise you are just a guinea pig. While you express compassion for animals and glorify yourself for being a vegan, your comments about the unhealthy hospital staff are truly lacking in compassion. Those overweight hospital workers are usually minimum wage people (especially if they are transporting you), and can only afford to shop in the center isles of the supermarket, buy cheap processed foods, and not at Whole Foods. Hope you are feeling better!

Mark Warren Reinhardt said...

I didn't get a bed until I'd been there 7.5 hours, but I was treated in the ER within an hour or so. No, I didn't mean to insult the people who work lower-level jobs in the medical system. I just find it amazing that medical facilities don't seem to care at all about the health of their employees. Those institutions should be setting the "preventative medicine" example for all of us.

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