Military Weekend -- A Taste of Socialized Medicine

This was originally an email message to our children.

Hi, Gang,

I think you've already heard how your mother spent the Mother's Day weekend -- taking care of me throughout another heart attack and medical procedure. I call it our Military Weekend because we spent from 9:20 p.m. Thursday (when I finally concluded I was having a heart attack) until 9:30 p.m. Saturday (almost exactly three days later) in hurry up and wait mode at our Sierra Nevada Memorial Hospital (SNMH) in Grass Valley and then at Mercy Hospital in Sacramento, rushing from here to there only to sit and wait for the wheels of medical care to grind. Almost all of the waiting was because of the overload of patients at Mercy.

After a hurry-up ambulance ride to SNMH we had to wait in emergency for a room to clear at Mercy. We got word that the last available bed was being vacated and cleaned at 2:30 a.m. Friday. I was immediately put into an SNMH ambulance, which arrived at Mercy at 4:00 a.m. Friday just as the cleaning crew was finishing up (their red cones were still in the room when we arrived). I got at most 2 hours sleep before Craig arrived with Mary at about 9:00 the next morning (Friday). They stayed only about two hours, at which point it was clear I wouldn't go into the Catheter Procedures Laboratory (Cath Lab) until 4 p.m. at the earliest.

At 11:30 a.m. that day my nurse arranged for me to have an early lunch in anticipation of my Cath Lab procedure at 4:30 p.m., at the earliest. Just as I finished this lunch, the nurse learned from the Cath Lab that the patient scheduled for noon could not make it and would have switched times with me, but I couldn't go because I'd now eaten. Soon thereafter we learned that the Cath Lab wouldn't be available until either 7:00 p.m. or 9:00 p.m. So I was stuck in bed waiting the entire day Friday. Fortunately, the 7:00 time was available and I was done with my "procedure" at 8:30 p.m. I was kept alive through all this waiting by drugs dripping into me from an IV inserted by our local paramedic here in Lake Wildwood during the ambulance ride to SNMH.

The first thing two nurses had to do when I arrived back at my bed was put their full upper body weight onto a small pad against the catheter insertion site to force the blood swelling into my body (normal procedure). This was painful but bearable. Then they put a five pound weight on the insertion spot and taped it into position such that the tapes provided further force against the insertion spot. This meant that I had to stay on my back as I tried to sleep. As you know, I can't stay on my back even without all this apparatus and an IV in my arm. After a couple hours the pain was so bad that the nurse kindly added morphine to my IV tube.

That allowed me to get a few hours' sleep before I woke up having to relieve myself. Before I went to sleep I was told not to get up until 9:30 a.m., but not told why. No one was there at the appointed time (I couldn't roust a nurse with my call buzzer at the nurse's station). Finally, I just got up to the edge of the bed on my own to relieve myself. All hell broke loose. Buzzers and warning tones went off and nurses came running to put me back into bed. I had "popped" the artery near the insertion point and blood was gushing into a huge swelling. One of the nurses repeated the heavy pushing against my groin to push the blood back into my body (mostly into two huge bruises around my groin and my foreskin, which was now deep purple and hanging loosely). This time it hurt like hell, and it was my own damn fault (sort of). After about ten minutes the nurse felt she'd pushed the swelling down enough to tape the 5-pound weight back in place. Now starts more pain from my lying on my back position. This nurse (the shift had changed) gave me a Vicadin-like pill and I was able to get back to sleep.

Soon thereafter Julie dropped Mary off at Mercy and went back to her friend who lives nearby, to help with a garage sale. After much harassing, Mary was able to get the nurse to estimate I could be released to go home at about 4:00 p.m (now we're well into Saturday). Out of the blue at about 2:00 p.m. an M.D. appeared (Dr. Chang) to discuss my release. He felt a 4:00 p.m. release time would probably be O.K. and said he would be back at that time to inspect the insertion site before my release to go home. The appointed time arrived and no Dr. Chang. About this time Mary was about to burst an artery with all this uncertainty and waiting around. She dunned the nursing staff about where Dr. Chang was and when he would come to release me.

We finally learned that he had gone to the Cath Lab to perform another procedure and wouldn't be available until 9:00 p.m. Mary paced the room and got us both into an anxiety frenzy. She had a chair but was too nervous to sit down so she paced in and out of the room and up and down the short hall outside, getting more and more frustrated and angry. Finally, again out of the blue, a release person appeared at about 7:00 p.m. to tell us we could go home after she discussed the Patient Discharge Instructions with me.

This is a 9-page hodge podge of poorly formatted general release information, less than a fifth of which applies to me. In fact, it's like looking for needles in a haystack to find the few specific actions I should take after release. The release person was able to find the information easily (after having done it hundreds of times) and her verbal instructions were easy to follow. However, in my state it was impossible to remember what she said by the next morning, when I needed to take the actions.

This is way more than you wanted to know about our interactions during our 3-day stay at hospitals. I went into some detail because I anticipate I will use this message as part of my comments on hospital performance. Most of the frustration was the result of poor communications from the MDs to the nurses, specifically keeping them informed of the Cath Lab schedule, which was in a constant state of flux for whatever reason. The MDs couldn't control the changing schedule, of course, but they easily could have kept the nurses informed with periodic phone calls, or a constantly updated computer page.

I'm now feeling well except for the bruises and swelling. It will probably be more than a month before I can take a leak normally. Mary and I can't thank Julie enough for taking Mary to and from Mercy hospital and taking me to a drug store to pick up some of my new medications and then back home. We also thank Craig for taking Mary to Mercy Hospital on Friday morning.

My medication sheet now includes 12 medicines I must take every day! I've attached a pdf of my medication sheet just for kicks. It took me most of the day to find the bits and pieces of information here and there needed for the medication table.

Oh, the Cath Lab procedures on me? An angiogram (x-ray pictures of bypass blood vessels to the heart, highlighted by dye inserted with a catheter) followed by catheter angioplasty and placement of three stents in the clogged bypass vessels (attached to the heart during my surgery in June, 1995). The forth bypass needed no stent. Total time, about 90 minutes by four experts proceeding quickly as in a well coordinated sports team. They were mesmerizing to watch.

Dad (Herb)