A Tale of Two Health Care Systems

by , posted on Sunday, May 17th, 2009 at 6:13 pm

First, an apology – I’ve been incredibly busy since this blog launched, mostly living as a road warrior for work, but also providing necessary grandmotherly support for the birth of not one, but two, new grandchildren. Jane Danger, who arrived in this world at about the same time this blog did, and Joseph (aka “Joe-normous”) who appeared exactly one month later. So since January 1 or so, if I haven’t been hanging out helping their Moms – my daughters – I’ve been on the road in Michigan, Iowa, Oregon, wherever, for work. All of which means I’ve spent about a grand total of ten minutes a day on-line since January 1 – hardly the most efficient way to launch a new blog – so my apologies to those who’ve been checking in and finding me absent.

Which leads me to my “followers,” or in this case my Twitter followers. There aren’t really that many. I think I’ve spent about ten minutes total on Twitter in my life, and don’t think I’ve even uttered a tweet yet, but there are a few followers – mostly people I know. One I picked up very recently particularly caught my attention, considering the juxtaposition between said follower’s occupation and what was going on in my real life at the time.

So follow me, if you dare (and have a fair piece of time to spend – this will be loooonnnng) into the Tale of Two Health Care Systems.

Two weeks ago to the day, I was headed halfway across the country to be on hand for a surgery my son needed in order to have a tumor removed from his neck. This tumor had been growing on his neck for more than a year, and I (along with his then fiancée and a few other people) had been nagging him relentlessly to find out what it was and get it taken care of. He’d been resisting “just until I get health insurance somewhere – soon, I hope.”

Now, my son pretty much never sits still and has his father’s work ethic, so he had at that time one full-time job, and two part-time jobs, but no health insurance offered by any of them, though one of the part-time jobs would offer a pretty basic (i.e. junk) policy if he hung in long enough. As far as he’d gone was to see a doctor who said it looked like a cyst but referred him to surgeon for a biopsy – which he never followed up on – “because I need to get the insurance first.” I pointed out to him that, having seen a doctor, this was now a pre-existing condition and he would most likely have trouble getting coverage for it anyway – or any coverage at all potentially. He was aware of it, but noted there was not much else he could do.

Luckily he now has access to health care and a biopsy showed it was not a cyst, but rather a tumor, and a rapidly growing one, though thankfully benign. Still, tumors of this particular type have a habit of turning malignant if left to grow, and it was already intricately interwoven with his facial nerves, so would eventually paralyze his face at minimum and had to come out – surgeon was insistent about this – ASAP, though my son was trying to argue for a just a few weeks more so as not to derail a particular job-related effort he had underway.

Since my son is halfway across the country at present with no family around I was reluctant to let him undergo what would be a tricky and intricate surgery without any family present, and though it took considerable effort, I managed to arrange to be there. Since I travel so much, I am always aware of exactly when I need to walk out my door to get anywhere, whether by plane, train, bus, boat, or automobile, so can say with definite accuracy that I was thirty minutes away from walking out my door when I got a call from my son-in-law informing me that my daughter Kate was in the emergency room suffering from diabetic ketoacidosis (DKA) and could I come get the kids?

There went that travel schedule.

I headed off to the emergency room to pick up the kids – 8, 6 and 3 months – and find out what was up with Kate. Jon said Kate’s blood sugar had been almost at 400 when she woke up and shot up soon thereafter to 567 and was unresponsive to insulin, which sort of rapidly escalating blood sugar, unresponsive to insulin, usually means DKA, a deadly condition that can be very hard to arrest and can lead to sudden death, and which Kate, a Type I diabetic, has suffered from before – usually when she has an infection of some sort.

I was reluctant to leave the hospital, as Jon has far less experience with Kate’s medical problems than I do, but clearly the kids couldn’t stay, and clearly it would be unreasonable to suggest he take them away and leave his wife’s side, so I took them home, got them settled down and went on-line trying to change my travel plans. Worst part of changing my travel plans for me was the necessity to get there in time to see my son before they put him under – since I’d promised him I’d be there – combined with the utter impossibility of warning him that I’d been delayed (I’ll get to why he was beyond my ability to contact later on).

Kate called me about two hours later to say that they’d given her a bolus of insulin and had rehydrated her with a saline drip and told her to go home, but she didn’t think she should because her blood sugar was still over 400 and what did I think? For those of you who are not aware of the effects of very high blood sugar, well, those effects are exactly why Kate was asking me what I thought – having a blood sugar of 410 is rather like just having done six shots of tequila – your judgment is really that impaired. So Kate was well aware that she wasn’t thinking straight, but also her fuzzy-mind was insisting to her that you don’t leave the hospital with a blood sugar over 400, because it’s immediately, pressingly, life-threatening.

I told her she was not fuzzy-thinking, she was right, and should continue to refuse to leave, then asked her to put Jon on the phone, and repeated to him that he should not take Kate away until her blood sugar was down to 200. He said the nurse practitioner was insisting Kate had to go, I said call Kate’s endocrinologist, but by no means let her leave the emergency room until her blood sugar is down to 200 (about twice normal) even if you have to stay in the emergency waiting room with her testing it yourself.

Kate called me back about an hour later to say her blood sugar was still around 400 and the nurse practitioner was still insisting she had to leave, she was still in the emergency room, not checked in, and had not seen a doctor, though the nurse practitioner said she had spoken to Kate’s endocrinologist. The nurse practitioner said Kate’s blood sugar was coming down, but slowly, and she was not in DKA and was now hydrated, so she should go. I say again: do not leave. Kate says, I know, I have been in several hospitals – including this one – with very high blood sugars before and that is the rule I remember they use: 200 before you can leave, right? She says she knows she is not thinking straight, but is pretty sure about this as she hates hospitals and is usually the one fighting to get out. I tell her, correct, 200. Stay.

About five or six hours later, well into the evening, Kate comes home, says her blood sugar is down to 240 and she just got sick of arguing with them only to be able to stay where she doesn’t want to be, so came home. Plus, she’s remembered that I was supposed to be on my way to her brother’s surgery and was distressed for his sake. No problem, I said, I can get out tonight and still make it. And since Jon was there and she was on her way to normal, I left. But less than two hours later, just before I could leave town, I got another phone call from Jon: “Come over and watch kids? Kate’s blood sugar is back over 400 and I have to take her back to the emergency room.”

There went that (newly revised) travel schedule.

When I got to Kate’s she was on the phone talking to her endocrinologist and giving herself an insulin injection – a surprise since she has an insulin pump. She got off the phone and said to me: “Go, my endocrinologist just figured out in ten minutes over the phone that my insulin pump is broken – and the alarm bells aren’t even going off to warn me it’s delivering nothing. I’ll be fine now – go, go.”

So I go. On my way to my son’s surgery I got a call from Kate, to thank me and make sure I’ll make it in time and to say she’s really better – blood sugar rock solid at 100 – but really concerned and thinking about calling the patient advocate at our local hospital.

“You know,” she said, “I’m fine now, but I was pretty much in the hospital from dawn to well after dark and I never saw a doctor once, just that nurse practitioner. Jon keeps saying there must have been a doctor overseeing her treatment of me, but there was no doctor’s name on my chart at all and she just kept telling me to go home when my blood sugar was still so high.”

“Didn’t she talk to your endocrinologist?” I asked.

“Yeah,” she said. “She told her not to come down, that I was responding well and not in DKA and rehydrated, but she didn’t tell her they wanted to release me – or so my endocrinologist said.”

Then Kate said “It’s one thing if they tell someone like me who has been diabetic for years and coped with episodes of this before and is relatively healthy otherwise, so better able to withstand high blood sugars, but what happens when they tell the parents of some newly-diagnosed ten-year-old, who don’t understand how rapidly this can deteriorate, to take him home with a blood sugar like that?”

“Dead kid?” I asked.

“Yeah, seriously. They’ll take him home and it’s not unlikely at all that the kid will die before they can get him back to the emergency room. Dead kid. So I think I need to call the patient advocate, because this is just so wrong on so many levels. Someone’s going to die.”

She called me back before I got to my son’s hospital to tell me all the patient advocate did was take the info and say something vague about the need to rely on well-trained nurse practitioners for “cost containment” purposes and the probable barrier which her (supposedly excellent) insurance might have represented to keeping her around or checking her in. But mostly, she said, the patient advocate just sounded bored.

Anyway, I got to my son’s bedside just in time to see him for about five minutes before they put him under. The surgeon, an expert in this type of procedure, talked to both of us and explained the procedure in detail, pointing out that they knew going in that they would have to sever the nerve to his left ear, but would spare no effort to save the facial nerve itself as otherwise he would go through life with one side of his face paralyzed. The anesthesiologist, who had already interviewed my son, heard I was there and came back to interview me about whether I could recall any allergies he might have, or knew of any adverse reactions to anesthetics in the family.

I discovered from one of the nurses that they had flown in a second surgeon, also expert in this particular type of procedure, just to be there for back-up purposes, which kind of amazed me, but they said it was a tricky and intricate surgery and they had no one else on staff qualified if something went wrong, so they had to get backup from elsewhere. Then I sat in a waiting room for six hours – three hours longer than it was supposed to take – and found it not hard at all to stay awake, despite the fact that I hadn’t slept in more than 48 hours. I was just too tense.

The surgeon came to find me when surgery was over, said it went very well, my son’s ear is paralyzed for life, but though he’ll never wiggle it again, I’m pretty sure he couldn’t before so that’s no loss – and he can still hear out of it. They had to stretch his facial nerve to the breaking point, so one side of his face is paralyzed, but they didn’t break the nerve, so it’s not a permanent paralysis.

I spent the rest of that day in my son’s hospital room watching the meticulously professional and sympathetic care bestowed on him by the staff there – despite the fact that it didn’t take much observation to note that the facility itself was dated and well-worn. I couldn’t help comparing it to the relatively new and well-decorated and well-equipped local hospital where my daughter’s life had been so recently in the balance. And I couldn’t help finding our local upscale hospital wanting – for decisions about care in this one seemed to be dictated by medical necessity, and I couldn’t feel the same criteria was at play in our local hospital.

And here’s where the whole thing goes back to my Twitter Follower. Because late that night I went and checked into my hotel and, restless and still keyed up, I started going through e-mails and discovered one from Twitter informing me of my new Twitter Follower. I’d never heard of her, and I have so few followers – less than a dozen at that point – so I looked at her profile. Turns out Twitter Follower is a licensed health and life insurance professional, who delights in having a job where she can “help people.”

Oddly enough, Twitter Follower is also based in Springfield, the capitol of Illinois. You know, where we keep our legislature. Maybe I’m just the cynical and suspicious type, but it did cross my mind that perhaps Twitter Follower has chosen this moment in time to follow an obscure blogger, in an obscure Illinois town, on Twitter, precisely because said blogger has been known to blog about healthcare, now and then, and is most adamantly in support of single-payer.

And perhaps Twitter Follower is even being paid to be an on-line advocate for the Death by Spreadsheet industry? But no – surely not? We are talking about a very obscure blogger, with no following to speak of, in a very obscure town, in the middle of the country – surely the insurance industry is not so very worried about a public option that they are meticulously following the every online move of every obscure blogger like me who is out there?

Well, I don’t know what the rest of you think, but suspicious and cynical me thinks it’s the most likely explanation. We have a very determined enemy of public health and well-being out there, boys and girls. But regardless of whether Twitter Follower is following obscure bloggers – who very occasionally blog about healthcare – because she is being directly paid to do it, or merely because the Death by Spreadsheet industry is her bread and butter, I just have a couple of things to add about the Two Hospitals in question.

Dear Twitter Follower, observe if you will that back in the day when my daughter was uninsured and flat broke and walked into emergency rooms with sky-high blood sugars she got checked in and seen by doctors and treated until she was well enough, and lucid enough, to leave in a condition where she could reasonably take care of herself.

Yet now, merely a year or so after her emergence from the ranks of the uninsured, now that she has that “really good” coverage, she is all of a sudden “well enough” to leave the hospital when she has pretty much identically high and lethally dangerous blood sugar levels. Nor is she any longer given the benefit of any doctor at all to “make medical decisions in her best interest.” Odd that, because I could swear I’ve heard your industry rely rather heavily on repeatedly thrusting the “your doctor should make the decision” talking point down the collective throat of the American public as a standard we should strive for.

Yet this is the “healthcare system” (in scare quotes precisely because it does scare me) most Americans are the beneficiaries of: one in which cost containment and the profit motive pervade every healthcare decision. And your industry would have us believe that the very last thing we want is the government making our health care decisions for us.

Like, say, the health care decision that the doctor – let’s just call him Major Surgeon – made for my son.

See, my son’s surgery was at a military hospital, because my ridiculously hard-working college-educated son finally acquired real healthcare by the simple expedient of entering military service. I can’t say getting healthcare was his reason (though it did weigh in) or that I was very happy with his decision, but there it is: he does have government-provided, government-paid, healthcare.

Under which healthcare plan it is apparently possible for the medical professional in question to not only make decisions based on the medical best interest of his patient, but to tell the entire government – and the patient himself, who was not thrilled about the risk of having to restart basic training – to essentially “fuck off” because he was not going to let this medical condition slide until the patient was at his permanent duty station.

Although, ok, I suppose Major Doctor probably did not literally tell either my son or the entire government to “fuck off” – but then I don’t recall hearing that anyone tried to stop Major Doctor from acting in his patient’s best interest: there was no death-dealing accountant standing by with a spreadsheet to interfere with his decision to set aside the needs of military recruitment quotas and divert my son’s time instead to a surgery he needed to avoid a potential risk of malignancy that might take twenty years to develop, nor even to question the expense of his decision to fly in another surgeon to stand by while he operated on some random Private in basic training because he felt they needed another expert rather than just one of the other surgeons there on staff, in order to ensure the random Private’s face didn’t end up looking kinda-sorta funny.

So I am left here, home again, pondering the ironic fact that although I am not looking forward to where my son will most likely be living for the next year, I am reluctantly forced to conclude that there are definite scenarios under which he might well be safer in Kabul or Baghdad than his sister is in the Fox Valley here in Illinois.

But in the end, Twitter Follower, I must thank you. Despite the fact that I have no more time to deal with blogging now than I did last month, your effort to follow me reminds me why I made the time before and will do so again. Continue with your tweets about how much you enjoy “helping people” by all means. I look forward to the opportunity to respond.

For now I am following you.


Tags: , , , ,

2 Responses to “A Tale of Two Health Care Systems”

  1. militarytracy says:

    Thank you for the invite to your site and this posting. Do I see two healthcare systems when it comes to active duty military and civilians? Yup! I even have a bit of insider knowledge as well due to the fact that our poor daughter recently had her nose broken and is insured as a dependent. After going to the emergency room of the local hospital they scheduled her an emergency appointment the next morning with a local ENT. That ENT did an entire workup on her that morning and received Tricare approval to surgically repair her nose the next morning. That afternoon though Lyster military clinic phoned us and told us that she needed to see a different ENT. My husband and I threw a huge fit that ended at Lyster clinic with a patient advocate there explaining to us that the ENT that Tricare authorized is not part of the underwriters network for this region…..who is Humana down here in the South. Because of that the military would be footing the bill for the rest of the followup care on our daughter. Who knew they could do that, do do that when they choose to? We went ahead and allowed them to reschedule everything once they explained to us why they wanted us to go with a different doctor. It meant our daughter had to wait a few more days but we sucked it up, even though because an approval had been already given we didn’t have to. Civilians don’t get the same care though that the military does. If a soldier is stressed out or has family members facing a health crisis they are much harder to deploy. If they themselves are ill they aren’t deployable either. This isn’t a time to encourage deferrments. I’m a priority at the moment but the rest of you….not so much. Try to calm down……we are all going to die anyhow someday so hold the whimpering down and pay the taxes. The military has to be a survival priority though or else we will lose our American way of life? I don’t know whether to laugh or cry at the absurdity of it all anymore.

  2. Downtowner says:

    It is laughable absurdity sometimes, isn’t it?

    Oh, your poor daughter’s nose though – ouch!

Leave a Reply

You must be logged in to post a comment.