Hours before Christmas, at exactly 7:00am on December 24th, I was heading to the Emergency Room at Montefiore Medical Center in the Bronx. Montefiore is one of the largest hospitals and medical teaching institutions in the country and closely associated with the prestigious Albert Einstein College of Medicine - a city within a city with a staff of over 20,000 and a hospital bed capacity of nearly 2,000. "Monte" also has additional facilities in New Rochelle and Mount Vernon in Westchester County, while its main facility continues to expand, setting up medical offices and growing like topsy throughout the Bronx, all run by its staff. These ever-expanding medical complexes are a disturbing new trend throughout our country and are adversely affecting private practice doctors and the communities they serve. In Monte's most recent and ongoing expansion is a proposed eleven story building in a residential part of the Bronx that would bring in 1,000 patients per day to a community already burdened with woefully inadequate resources - including street parking. This proposed expansion has drawn sharp criticism and outright hostility from local residents. Fortunately, the hospital - which, in its defense, has been responsive to the community's concerns - is now talking about a much more scaled down version of the facility.
The reason for my trip to the hospital was an indescribable pain in the back of my leg close to my hamstring, which made it nearly impossible to walk. Upon my arrival at the ER, I was signed in and my blood pressure and other vitals were taken. My BP had reached 199/101, an unfamiliar and frightening number to me. It was a quiet holiday morning with few people waiting to be admitted, yet I still sat for almost an hour before two hospital employees grabbed me and steered me into the ER - a trip during which I nearly fell in staggering pain - and placed me on a bed. I then proceeded to lie there for nine hours, moaning and groaning, as I watched the hustle and bustle that can only be seen in an ER.
Patients came and went throughout the day, with some being admitted to the hospital and others sent home after being seen by the ER staff. This was triage - battlefield medicine where decisions had to be made in an instant - except, of course, in my case. After several hours, the one attending doctor present came over to me and, after a few words, ordered Percocet - an addictive drug containing codeine - for me. Even so, by that point I couldn't have cared less. Other staff was minimal on this holiday, but every bed was taken with some 30 people in need of care. Most had issues that a primary care doctor could have attended to - if these folks had insurance - but because so many still don't, ER's continue to be used as a neighborhood drop-in healthcare resource of convenience, even though convenience doesn't come cheap - my co-pay alone came to $65, plus the $20 cab ride.
There was one lone Physician's Assistant talking with each patient, moving as if on roller skates at amazing speed, stopping just long enough at each bed to make a snap judgment about care or medication. Oddly, there was no attempt to address my dangerously elevated BP. By 4:30pm, the Percocet still hadn't helped and I was admitted to the hospital. My bed and I sailed through the hallways and onto an elevator, finally reaching room K 631, joining the thirty-one other patients already on the floor. Then, at 11:30pm on Christmas Eve, I was wheeled flat on my back through more endless hallways and onto an elevator with corrugated metal flooring and taken to a lower level for an MRI of my back.
The next day, a few specialists appeared in my room, such as a neurologist and a Resident in neurosurgery. Both did some examining and spoke of the results of the MRI, which showed severe stenosis - a narrowing of the spinal canal, which could cause nerves to be irritated and pain. In addition, they noted that there was a two-inch mass located below my back in my pelvis. However, what neither doctor told me at the time is that it was located on an ovary and was as yet unclassified - benign? malignant? The neurologist recommended that additional images be taken, along with physical therapy and acupuncture, which seemed like inappropriate treatments for this as yet unidentified mass, which was my primary concern. And what was causing the pain? No one seemed to have that answer. Instead, the young Resident concluded that "...there is nothing here for us," and he recommended I schedule an appointment in two weeks with the Director of Neurosurgery, Dr. John Houten, whom I had asked the Physician's Assistant, Andrea Kazlas, to call. The Resident, however, never showed the MRI report or images to Dr. Houten.
Meanwhile, my Primary Care Physician ("PCP") no longer has admitting privileges at Monte, so she sent another PCP to take care of me. I can tell you, it does not work for a doctor you have known perhaps for years to send an unknown doctor to care for you in such a situation. Here is a tip folks: do not go to any hospital in which your PCP does not have admitting privileges. How are they supposed to coordinate your care in the hospital and see and examine you? This substitute doctor - who didn't know me from Eve - had no problem marching in on the first day at 6:00pm and doing nothing more than doubling my dosage of Percocet, and then on the second visit not showing up until 9:30pm after I had sat all day in terrible pain. He had absolutely no attachment or sense of responsibility to me, nor did he call my regular PCP and give her updates or report my test results to her. The higher dose of Percocet still failed to relieve the pain, so he then ordered Ibuprofen, Motrin and then Tylenol - none of which had any effect, either. Then, on Friday, he ordered a pain patch for me, which also failed to offer any relief.
By Friday afternoon, I was beginning to think about the mounting bills coming with each test and the sound of the "cha-ching!" of Monte's cash register while my pain continued undiminished. I had already refused a blood test to establish my blood-clotting factor - along with a medication to avoid blood clots - while in an inactive physical state. Why? Because I had been trying for three days to get a simple baby aspirin - which costs pennies - to address that very issue, yet no one responded. Why give me something cheap that has worked for me for years when they can give me something expensive that they can charge for? It even eluded staff that I was taking my own blood pressure medication that I had brought with me, which also cost pennies. On the second day I was there, when a staff member announced that I would receive the same medication at 10am that I had already taken earlier that morning, I responded, "I have already taken my pill at 6am, my usual time." Another tick on the bill avoided.
The "highlight" of every day was the awful, tasteless, unimaginative meals they served, accompanied by even worse decaf coffee. Fortunately, each meal was delivered by a nice, cheerful young man named Jason. The menus on every tray even had your name and room number, a nice personal touch. Come Friday, I was still in the same clothes I had been wearing the day I arrived, and the staff made no issue of me finally changing into a hospital gown. By then I also very much wanted a shower, and so dear, sweet Ms. Parnell - a nurse's aide technician - linked her arm under mine and we walked to the shower down the long hall, with her toting along a fresh, clean gown and toiletries. She gently placed me on a chair under the water and stood there getting soaked while she scrubbed my back and legs with no complaints - oh, how wonderful that shower was, the best of my life.
And so Friday night passed into Saturday, and another pain patch with double the dose was stuck to my arm as the fill-in PCP finally did something I could appreciate, bringing me a sesame bagel with a schmear of cream cheese and a really good cup of coffee from outside. As a New Yorker, I had finally arrived at a very happy place. That buffered me for the two sonograms on my pelvis that followed that afternoon, along with the three hours I waited on a bed outside the procedure room. By then it was 4:30pm - again, I had to wonder if they were stalling to keep me yet another night? After all, who would be there on a Saturday night to discuss the results with me? Perhaps I would even be held over until Monday? These stall tactics are part-and-parcel of hospital care, I've been told. No hospital wants empty beds.
The amazing wheels at Montefiore finally did go into full gear when they sent a terrific social worker named Jerry to see me and their in-house Medicaid office became available to me - as well as a home health aide, if needed. They provided a wealth of information on how I could access the critical help this safety program offers. Monte is truly a one-stop healthcare shop, even bringing in the director of customer service Leslie Bank who promised to check up on me while I am in surgery. Then, within days of leaving the hospital, I was set up with an appointment with an extraordinary gynecologic oncologist named Dr. Nicole Nevadunsky - young and out of Harvard, The Dana-Farber Cancer Institute and Brigham and Women's Hospital in Boston. I have met with her twice in the past two weeks, and she has been remarkably direct and very giving of her time and information.
I have asked for robotic surgery, a less invasive technique that Dr. Nevadunsky can do. In order to finally diagnose the mass, it must be removed with my ovary and Fallopian tube and a biopsy done during surgery. If it is cancerous, the biopsy will define the stage. Cancer diagnosis, treatment and prevention has come so far - and yet still not far enough. Increasing funding for the National Institutes of Health could address these imperatives, while also finding new treatments and cures for a host of other diseases. Even the CA-125 blood test that is a marker for ovarian cancer can produce false positives. Dr. Nevadunsky told me that 60% of these masses are benign, so we really need to cut down on these stressful, costly surgeries. The other day the surgeon and I agreed to go ahead with surgery, which will take place soon. I pray it isn't cancer, for if it is, it will involve removing twelve nodes and a piece of my stomach and a long road of chemo and/or radiation ahead - I definitely like that 60% number better.
During the informed consent discussion we had in her office, Dr. Nevadunsky was quite clear about the eight possible risks of the surgery that in no place appeared in such detail on the informed consent form. Those risks include infection, blood loss and damage to certain organs. She did, at that moment, what doctors in general do not - even though they absolutely must - and that is to detail the risks at least a week before a surgery or other invasive procedure, and not shove a form in your hand while you are going into the operating room while being told you are simply signing permission for surgery. I championed that such a provision be included in the Informed Consent bill S 1424-2015 that was written and introduced in Albany recently by Democratic New York State Senator Gustavo Rivera. This bill must be passed, despite the tough sledding it will face with a Conservative Republican majority ruling the State Senate.
As for the Montefiore staff, I can't praise them enough, especially the nurses like Ms. Anderson and Mr. Lindos, and the P.A.'s like Andrea Kazlas and Claudia Chang and so many others. Monte has been using P.A.'s for seven years now, and this is a harbinger of things to come as they are outstanding can deliver many of a doctor's duties while requiring less time and money to train. The doctor shortage will only increase as doctors must continue to deal with the prohibitive costs and difficulty of dealing with a corporatized medical system in which the insurance-industrial complex makes medical decisions based on their bottom line and not our health. I saw only three Residents in almost four days while I was at Monte, and no attending staff doctors, which raises the question: with close to ten million enrolling in healthcare under Obamacare last year to go along with the ten million expected this year, how will this patchwork system of healthcare be kept together by this dwindling number of extraordinarily dedicated professionals?
When I left the hospital in a wheelchair and was taken out to the street for a cab, I left with P.A. Claudia Chang, who had just finished a thirteen hour shift and was heading home. My journey, however, is just beginning, and I remain committed to seeing in my lifetime passage of H.R.676, an Improved And Expanded Medicare For All. No one should be in a hospital - ill or in pain - having to also think about how they will pay their hospital bills. How can that possibly lead to healing?
- with Jonathan Stone