I’ve voluntarily traipsed to hospital emergency rooms three times in my life. The first time was when I received a cogent message–about the sixth of such missives in a period of a year–from my gallbladder that trouble was brewing; a pain, I am told, not unlike that experienced by soon-to-be mothers. I had already consulted a surgeon about the pains, and had put off surgery for some time. But the last time that message surged from my right side to my brain, it was cacophonous; an articulation of severe intent, a warning that my brain deciphered correctly: EMERGENCY! Long story short, I had developed an infection at the site (the ducts, the gallbladder itself), and there would be no laparoscopy for me (those little holes they poke in your belly, and conduct surgery by watching a camera image of your innards as they laser cut the offending organ). No, I ended up with a four inch scar at the top of my abdomen…gallbladder gone, no more pain. I had successfully delivered that ornery baby, in a manner of speaking.
The second time I visited a hospital emergency room was when my asthma flared up, and no amount of Albuterol (that thing an asthmatic sticks in their mouth, and sucks in the pressured spray, likely destroying a tiny part of the ozone in the process), was easing the wheeze. So, off to the emergency room. After two “cocktails” of cool mist laced with Albuterol, and maybe something else, my wheezing stopped. I was sent home. Happy and healthy.
The third time, Lawd, the third time is the kicker.
Wednesday, three weeks ago, started out fine. I’d spent some quality time with my horse, Shy, who finally is beginning to settle into a life with people…something he’d not experienced in the scrubby hills of Routt County for the first five years of his life. I worked him fairly hard, with good results. At home I wrote some, did some chores, maintained Sarah’s (our Alaskan Malamute) routine–walkies at noon, ball chasing, dinner around three-thirty. At four-thirty I commenced my routine of walking from our West Highlands home, toward downtown to meet David, my partner, as he walked home after his work day. All was well with the world until I went to bed at about eight (I know, I know… But remember, early to bed, early to rise!). After an hour or so of reading, I turned off the light and settled in for sleep, and, almost immediately, a ferocious ache surged from the lower left portion of my back; below the ribcage, above the hips. Turning on either side, lying flat did not alleviate the intensity of the ache. I, of course, had experienced the gallbladder scenario, and the conclusion I made that Wednesday night was, yes, EMERGENCY! I pulled on the clothes I had worn during the day: shorts, a blue t-shirt lettered with “Kennebunkport ,” my tennies and my New York Giants ballcap. I then shook David awake. He started to pull on his robe. No, I said, get dressed. We have to go to the hospital.
The ride to the hospital seemed an eternity. I kept my eyes closed, not wanting to cogitate on how far the nearby hospital was. The pain in my back roared, bellowing like the robot in the old t.v. series “Lost in Space,” EMERGENCY! EMERGENCY! I believed if I stifled sight of the passing known landscape, the arrival of salvation–a hospital emergency room–would appear, WALLAH!, so much sooner. It didn’t. Indeed, when we reached the hospital, there was no signage indicating the location of the emergency room. (We apparently had not traveled far enough on West 38th Avenue, where, we were told, there is signage.) David pulled our vehicle alongside the main entrance, parked, opened my door and off we went in search of the emergency room. We walked the quiet halls of the place, heading toward signage that indicated we might be on the right track. We encountered a nurse, in scrubs, walking toward us. David asked her where the emergency room was. She replied, Well it’s down this hallway to your left, then take a right, then another left and… Well, we trudged on, taking the lefts and rights and finally arrived at the emergency room waiting area. The area was packed. No chair vacant. Scores of folks, wide-eyed, scrutinized our arrival as competitors in a desperate game of precedence: Don’t EVEN think you’re nudging us out of line, simply because you’re obviously in dire straits.
And, now that I think about it, this was a Wednesday night. Not a weekend when mayhem reigns on the streets. Even though my cognition of the world that Wednesday night was impeded, I did not see in that waiting room full of grim-faced folks, any blood or guts, gushing wounds, obviously broken limbs. Were those folks simply using the ER as the only avenue to health care open to them? Did they all lack insurance? Were they all strangers to the less costly option of making an appointment with a primary care physician? I don’t know. I do have my suspicions, though.
I must admit I was in a pain-induced fog through much of what next transpired. I know we were rather quickly in-processed by the outer-office crew of the emergency room. I know I remained hunched down in my chair–somehow, David had found me a vacant seat–my arm across my eyes; the lights of the place seeming too bright, seeming to exacerbate my pain. Some gracious soul in the outer-office crew must have noticed my severe discomfort, and we were moved from the outer-office to the interior of the triage area of the emergency room. Once again, we were seated in chairs where a nurse soon approached us, asked some questions, then inserted an I.V. needle in the crook of my right arm. She soon administered an injection into the I.V. nipple (Dilaudid, I believe), which did not alleviate the pain, but gave some little comfort that I was being treated, albeit sitting in a chair, slumped over, my arm across my eyes.
Backing up here a bit… We arrived at the emergency room prior to 10:30 p.m. David tells me that we sat within the triage area for at least two hours. I recall the kind nurse who administered the first injection of pain-controlling medication, told us several times that they were very busy, that no beds were available, and that they had identified me as a priority, and I would be put ahead of some who had arrived well before we had. In my state, however, the words meant little. I didn’t care if I got a bed or not. The pain I was experiencing trumped everything. I didn’t care if I got a bed. I simply wanted relief.
After two hours sitting in a chair, I was finally moved to a bed. Actually, it wasn’t a bed, just a cot in one of the curtained cubicles of the triage area. The injections of pain medication did not assuage my discomfort and, with my arm still covering my eyes, I lay–admittedly stoic–suffering the continuing pulse of the ache in my lower back. Soon, blood was taken, x-rays, a CAT scan. I remained in that curtained cubicle until about seven o’clock in the morning. Almost nine hours. Sometime around five in the morning, David left, knowing that Sarah was in the house and probably desperate to get outside in order to conduct her business–pee or poop. He returned shortly thereafter, reporting that when he pulled up outside our home, he immediately heard Sarah singing–howling–from inside the house. He let her out, later discovering that she had peed on the carpet in the dining room. I cannot imagine her angst with the necessity to pee on the carpet. She is that kind of dog. She understands that the house is not the proper place to conduct her business. But she had. And, I will forever after rue the circumstances that necessitated her breach of house rules. She is a precious presence in our lives. I cannot even begin to fathom the discomfort, the horrifying discomfort she must have felt when she squatted on the carpet to relieve herself.
During the fog-filled hours on the gurney in the Lutheran Hospital triage center, folks came and went in the curtained-off space next to me. Even through the fog, I remember distinctly two arrivals and departures. The first was–and I was only hearing this, not seeing it–an obviously young mother with an infant who told the ER physician that her baby had not eaten that day, he was drinking fine, did not have a temperature and was not fussy. My thought then: Not sure what the emergency is. I recall the attending physician pretty much mirrored my thought, and very kindly told the young mother, after checking vital signs, that there was little to worry about, that these things are normal, and if the refusal to eat continued through another day, then she had best make an appointment with her pediatrician. Good advice, I thought. I then wondered if the young mother had any idea, any concept whatsoever about the enormous cost of emergency room visits, as opposed to simply an office visit with a physician. Does anyone teach young mothers these kinds of truths? Oh, I understood the young mother’s absolute devotion to her child. I understood her concern. But, utilizing an emergency room as opposed to an office visit to a pediatrician? My conclusion: No, no one teaches young mothers these things.
The second visitor to my next door cubicle, was a young man and woman. The young man explained to the ER doctor that he was feeling weak and hadn’t had a bowel movement in two days. Vital signs were checked. No fever. BP was fine. Oxygen level fine. When the nurse and ER doctor left the young couple alone, something was said–I couldn’t hear exactly what–and some giggling followed. The young man then told his companion that there was no way he could pay for this. When the clerical rep entered the cubicle to gather information on the young man, he announced also to her, that he would be unable to pay for his care…at least for now. The clerical rep responded, “Oh don’t even think about that. We’ll get to that later.” Uninsured, I thought. I made no conclusions about the young man’s condition: weak and missing two bowel movements. I did wonder, though, if he didn’t pay for the visit who would? Would the premiums I pay for insurance chip in to pay for his inability to pay? Would the cost of my little visit to the ER be inflated in order to contribute to the cost of his visit? I suspected so. Universal health care? Maybe. Public option? Maybe. A certainty, however, that the cost of health care in America needs a wee bit of a fix; that the uninsured need to be insured some way, some how and not to the detriment of folks who work hard, struggle to keep up premiums so that when their time comes to visit the ER, the cost of their care will not see a surcharge, a fiscal piggy-back of sorts because others are either not able or determinably inclined to let others pick up their tab.
I noticed that today, the Senate Finance Committee’s version of a health care reform bill excluded a public option. Apparently five Democratic members of the committee voted along with the “Just Say NO!” Republicans. Tell you what folks, Democrats have got to grow a pair, better sooner than later. I am, to say the least, disappointed in Obama, the Democrats and, I suppose, the whole effing political system. Where the hell has America gone?
I don’t recall who it was who first voiced the imperative that since I was a Kaiser patient, I would necessarily have to be transported to St. Joe’s Hospital, because St. Joe’s is THE Kaiser hospital. In any event, about seven the next morning–after almost nine hours with the folks at Lutheran, a two-man crew showed up with a gurney to take me to St. Joe’s. These two guys were employees of a private ambulance service. They were immediately characterized by me as a Mutt and Jeff duo, cracking jokes and trading insults, one to the other, as if they were on a vaudeville stage performing for the masses, or at least the mass of folks ensconced in the hard-backed chairs of one ancient theater or another. In any event, they loaded me on a gurney, wheeled me to their boxy vehicle and transported me to St. Joe’s Hospital, to roon 814. During the trip to St. Joe’s, Mutt and Jeff opined on the silliness of moving me from Luther (a Humana hospital), to St. Joe’s (another Humana hospital). They informed me that the cost of transport was over $300. They opined that the transport was unnecessary. Costly. That the care I would receive at Lutheran would, most likely, be the same I would receive at St. Joe’s.
I didn’t think much about it at the time, but for most my life I’ve had a silly infatuation with numerology. Later I would realize that the digits 814 added up to 13. Not a good omen for someone who dabbles in numerology. I mean, look… Whenever I’ve flown anywhere, I’ve obsessed about the numerology of flight numbers. Never have I been on a flight with the digits of that flight adding up to 13. I’ve always thought that a good thing; an indication that all would be well, we’d land safely, and be on our way to whatever delights the termination of the flight promised.
Room 814. Horror. (There’s a short story in here somewhere!) My “roommate” had, some time ago, undergone a colectomy….a removal of portion of the colon. Apparently, a tear had occurred at the site of the colectomy, and he had undergone a second surgery to correct the problem. Besides that, he had a bladder infection, was catheterized; had a horrendous cough that erupted every five minutes; belched largely every ten minutes; kept the t.v. on constantly, even through the night; and, incidentally, weighed in at 350 pounds, although he was only thirty-eight years old; and, AND, to top it all off he was a fan of Fox News and did not hesitate to opine on the “truth” of the Fox view of the world. Egads!
My “roommate’s” condition required the movement of nurses to and fro about every ten minutes, through the day, through the night. And, whenever there was a need to drain or “bleed” my “roommate’s” colostomy bag, there ensued a conversation between my “roommate” and the nurse about the consequences of not tending to the colostomy bag regularly. Something I did not know, but, now that I think about it, is self-evident: If a colostomy bag is not “bled” of gas on a timely basis, there is the possibility of an explosion that, no doubt, would send watery waste high and low; a shitty mess, if you will.
Then there was the specter of hearing the nurses dump infected urine into the same toilet I was expected to utilize to do my business, not to mention the dumping of the contents of the colostomy bag into the same toilet.
Let me pause here for just a second. Never once did I not, through this whole ordeal, at the back of my mind, consider my “roommate’s” travails in the context of “There, but for the grace of God, go I.” I could not even imagine what it would be like to, at thirty-eight years old and 350 pounds, suffer through what my “roommate” was experiencing. I could not fathom the pain, physical and emotional, that he was confronting. I prayed for him. I tried, oh how I tried, to let go of my discontent with being placed in the same room with the unpleasantness of his situation. But, please forgive me when I say this, at the same time I considered my own state, my own need for care, for sleep, for a quiet environment to recover from my ordeal. My needs were necessarily obviated by the needs of my “roommate,” reposing there, to my right, not five feet from my bed. The proximity of his state–the constant hacking, the non-stop t.v., the constant in and out of nurses, the conversations about exploding colostomy bags, the splash of infected urine and watery shit into the toilet I was expected to use; all of it encapsulated one of the worst experiences of my life. Indeed, my “roommate” had already gone through two other “roommates” who had been moved to other rooms. I understood why. If I had had to stay in the hospital any longer than I did, I’m sure I would have insisted on being moved. I know. I know. One can’t simply pick and choose his own room in a hospital. But, supposedly, healing is at least one of the important outcomes of a stay in a hospital. How one could possibly even hope of beginning a healing process in the hell of room 814, is beyond my comprehension.
It did not help that the Dilaudid I was receiving at Lutheran, was replaced with Percocet. Due to the ever-increasing distress that room 814 inflicted upon me, I did not realize that the Percocet may have exacerbated a great deal of that distress. It was not until I was finally home and, after popping two Percocet tablets, did I realize that this medication makes me crazy…almost quite literally. After taking Percocet and falling asleep, I awoke after about ten minutes trying to remove myself from the most bizarre, horrendous, hideous dream I’d ever experienced. Back to sleep, awake in ten minutes, shaking off another nightmare of monstrous proportions. Another ten minutes of sleep, another nightmare. Another ten minutes… Well, you get the point. In a follow-up appointment with my primary care doctor, he related that some of his patients see little green men walking on the ceiling after taking Percocet.
Back to the hospital. I was kept in St. Joe’s overnight, even though my level of pain had decreased from about a ten to a four or five on a ten point scale. I’ve already described the “environment” through which I spent that night in the hospital. And, as soon as the Kaiser staff doctor visited with me the next morning, I related to him that I was 100%, that I was ready to go home and, by golly by gee, I felt like a million. He agreed to discharge me. As soon as he left room 814, I quickly pulled off my hospital smock, dressed in the clothes I’d pulled on when the EMERGENCY had first arisen, called David to come get me.
When David arrived, I walked into the nurses station area, stopped a nurse who had taken my vitals that morning, and told her I had been released by the doctor, and I was ready to go; that my ride had arrived. I also asked her when someone would take out the I.V. needle in the crook of my arm. Well, her eyes narrowed to slits, studied me in my Kennebunkport shirt, shorts and ball cap, and informed me that I would just have to wait, that sometimes the discharge process takes quite some time. I told her–and, admittedly, I may have still been experiencing some after effects of the Percocet–that I wasn’t waiting, that I was leaving. Thank you very much. I returned to room 814, pulled out my I.V. needle, placed it in the Sharps container, tore off my wrist band and told David to come on, I was leaving. As I passed the nurses station, the nurse I had confronted had obviously told the bevy of nurses seated in the station that some “nut” was demanding to be released. All heads were turned toward me. As I passed the nurses station, I asked the wide-eyed heads staring at me if I needed to sign something, that I was leaving. It was probably the head nurse at the station who asked me if I was alright, if I needed assistance leaving. I said I was fine. She then informed me that the “release nurse” had to generate some paperwork that I had to sign. I stepped over to where the head nurse indicated, and another nurse immediately printed out some paperwork, and, reading from the computer, confirmed with me all the medications I take regularly. I signed the form she presented to me, turned and walked out, got on the elevator and was on my way home.
God is good!
Conclusions. My back pain–although no medical tests were conclusive–was, most likely, caused by the passing of a kidney stone, or a “spasm,” (Yeah, right!), or just something weird that medical science could not detect. I really didn’t care if modern medical science had identified the cause of my discomfort or not. It was over. Although I experienced quite a number of days of the subtle reminders of what had taken me to the ER in the first place, the relief in being home and away from the horror of room 814 was enough to console my soul that all had become right with the world; that the nightmare was over.
Another conclusion. Avoid hospitals. You’ll get sick, or sicker, in a hospital. Indeed, I came away from the hospital with an upper respiratory issue that, to this day, manifests itself in an ugly, phlegm-filled hack (not unlike that my “roommate” spewed every ten minutes). Yes, think twice about heading to an ER. No, belay that. If you believe you need to go to an ER, by all means do so. Perhaps you won’t end up in room 814; perhaps your ER adventure will be, um, more uneventful than mine.
P.S. Cost for nine hour stay in Lutheran ER: $14,500; cost for 24 hour stay at St. Joe’s about $5,000; cost for transport to St. Joe’s from Lutheran about $450. There were other miscellaneous charges. I have insurance and, of course, was responsible only for a $300 co-pay. Those without insurance, though, but a reasonably good income? Well, methinks the stories about bankruptcy due to medical costs is not a fairy tale bandied about by the left. Methinks such is the all-too-real consequence of the sad state of America’s health care system. At least that part of it that holds no quarter for the uninsured with assets (a home, a car) and a steady income.