Hospitalization

Hospitalization

   Just when you think it could (or would) never happen to you...it does.  A bad cut that won't stop bleeding, an anxiety attack that seems to stop your breathing, a sudden fall.  Before you know it, that cliched blurry Hollywood scene of doors bursting opening and ceiling lights flashing by as you're quickly wheeled into the emergency room becomes reality.  How did you get here?  How did it happen?  And so quickly?  Will you be okay?

   For those of us on the receiving end, the news is almost as devastating.  For both sides, life suddenly and necessarily is disrupted.  Will the person, friend, family member (even dog or cat) be okay?  How serious is the injury?  What's the prognosis?  Should you leave immediately on the next flight, leave work, leave family, end that vacation?  And what about your home...and theirs?  Will things be taken care of?

   This happened recently to my mother when she slipped in her garage.  Nearing 90 and dealing with osteoporosis, the concern is always one of spine or nerve damage (in her case, she suffered a compression fracture).  But she couldn't move initially and before long, was in the ER on morphine.  Then came the waiting and the testing.  Blood work, CAT scans, X-rays, everything to ensure that her vital signs were holding steady.  As the ER doc told me, she was walking (with help) to the bathroom, no nerve damage, and now asleep.  Hours and hours later, she was waiting, and waiting, and waiting.  As serious injuries such as gunshot wounds (in the U.S., 268 people are shot every day, 8 of them being children) and rollover accidents poured in, she was no longer considered an "emergency," the ER's job being the medical gatekeeper to just restore and stabilize life then transfer you out.

   Which begs the questions Atul Gawande (a surgeon and prolific medical writer) posed in The New Yorker on "an avalanche of unnecessary medical care..." in his article, Overkill.  In his article, he said:
The researchers called it “low-value care.”  But, really, it was no-value care.  They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful.  Their list included doing an EEG for an uncomplicated headache (EEGs are for diagnosing seizure disorders, not headaches), or doing a CT or MRI scan for low-back pain in patients without any signs of a neurological problem (studies consistently show that scanning such patients adds nothing except cost), or putting a coronary-artery stent in patients with stable cardiac disease (the likelihood of a heart attack or death after five years is unaffected by the stent).  In just a single year, the researchers reported, twenty-five to forty-two per cent of Medicare patients received at least one of the twenty-six useless tests and treatments.  Could pointless medical care really be that widespread?

   Of course, by the time one is actually in the ER, the situation in one's mind is usually, "of course it's serious; what's wrong with me?; it hurts all over; I don't want to die."  Unnecessary tests?  At that point, one is usually not concerned with insurance payments or coverage or extra tests.  After all, you're being treated by competent doctors working to save you, this latest stranger on a gurney.  Do whatever you think is necessary.  And the odds are pretty good that you are not going to die (in my mother's case, odds-makers place dying from a fall at 1 in 177; the risk is double that for a vehicular accident).  Of course, none of this matters when you're the one on the gurney; and quite likely, none of it matters when you're the paramedic or trauma team trying to stabilize the patient. 

   But on the other side, the family or friend side, the questions also roll in.  Why is there so little information on his or her condition?  Can I speak to the doctor?  What's happening?  ER doc, admitting doc, attending doc, nurse station, discharge station, case worker station.  What's the difference; who can give me information?  Each call diverts you further and further down the list, a good sign of sorts vs. that dreaded face-to-face confrontation with the surgeon, or worse, the phone call from a police officer saying, "I have some bad news."  And finally, some calm.  In my mother's case, an honest assessment that coming to visit at this time would limit me to a few hours of visitation vs. coming at a later time when, back at home, she would really need my help (she wasn't being discharged from the hospital, in other words). 

   Naturally, one (me) feels guilty doing this balancing act.  Support would be both welcome and crucial to her at this time but are phone calls enough?  Should I be up there getting her house ready (but for what, as she's ambulatory and as the hospital says, under pain "management")?  And for my mother (or anyone put in this position as trapped in a hospital bed laden with compression stockings and tubes monitoring her every move), this is a time when she has a lot of time to deal with a swirl of emotions, something no television program can divert from her mind...that was close call; I sure was lucky; will my luck hold out; where is everyone; how's my cat; there's so much to do at the house; there's still so much I still need to do overall.  Likely, we would all have similar thoughts...but not now.  Life goes on normally, day after day, and besides, it'll never happen to me.

   Perhaps that is simply our survival mode kicking in, for to dwell on such matters that may or may not happen would leave us slightly paralyzed in fear.  Yes, fate swerves that car into oncoming traffic or a gunman walks into a prayer meeting...one can't escape the news, news that happens hourly, day after day.  But eventually, the wheel of fate may indeed land on us, be it old age or something premature such as a slip in one's garage.  For my mother, she's been extremely lucky (fate again).  As have I, and my family.  But life is to be appreciated, to give thanks for fate giving you one more day...to have food to eat and water to drink, to move one's arms and legs, to think about mowing the lawn, to write a blog.  So it's a good time to be thankful, in fact, it's always a good time to be thankful, for no matter our condition, there is always much to be thankful for, even in you're in a hospital with a phone...hello?