While we were on vacation last week, my wife and I had the pleasure of meeting up with one of her high school friends and his wife. Conversation flowed easily as my wife and Jack (not his real name) talked about lost high school aquaintances and teachers, but soon it took on a much more serious tone as Jack revealed that last year he suffered a ruptured brain aneurysm. As I listened to his story, I was at the same time appalled at the care he received and completely understanding of how so many things could go wrong. Here are the highlights:
Jack awoke at 11 pm to find his CPAP machine mask broken. He got up and rumaged around in the closet tring to find an old mask. When he bent down, he felt a searing pain in his head which was the "worst headache" of his life. He took 2 motrin, and laid back down. The next morning, he still felt bad, so he called in to work and took a sick day so he could get an appointment with his doctor. His wife went to work but called him numerous times because she said he was just acting a little different. He did get an appointment with his doctor who evaluated him and said he was concerned Jack might have meningitis. Jack was told to go to the ER for full evaluation. Jack's wife was called to come pick him up (as he was now in no condition to drive). By the time she arrived at the doctor's office 10 minutes later, she found him slumped over in a chair in the waiting room holding some papers (apparently his lab results). No one else was around. Apparently, the doctor had left to go to another office and the staff went out to lunch. She stated that when she saw Jack she knew something was really wrong as he was as pale as a ghost and his blue eyes were completely black (from pupillary dilation). She managed to get him to the car and drive to the ER 12 minutes away. Once there, they were told to have a seat in the waiting room even though Jack could barely talk and was leaning dangerously forward. After becoming more emotional than she wanted, Jack's wife convinced the ER triage staff to bring him to the back. Once there, the doc quickly evaluated him and he got a CT scan which showed a brain hemorrhage. Neurosurgery was called. Even though they have an office across the street, a Physician Assistant who apparently does their consults was called in from another hospital to see him. It took hours for him to arrive. When the evaluation was finally complete, the PA felt that Jack would benefit from being transferred to a different hospital. When Jack arrived at the other hospital, it was decided that he should have an angiogram. Unfortunately, it was now after hours on a holiday weekend and no interventional radiologists could be found to do the test. After toying with the idea of transferring him to a third hospital to get the test, someone finally convinced one of the radiologists to come in. The angiogram showed that the bleed had spontaneously stopped. Jack spent 9 days in the ICU and additional time on the ward which included:
1) Not being fed even though he is a diabetic
2) Being left on the toilet for 5 hours as the nursing staff ignored his call light (he was too weak to get up himself)
3) Being told through the door of the bathroom (the same day) by the PA doing the rounds he was going to be discharged
4) Being given a prescription which cost $1500/month without any warning of the cost or discussing other options
5) Being discharged with no follow-up or home health even though Jack could not walk by himself.
After getting home, his wife figured out how to set up PT, and thankfully they helped him regain most of his lost function. He did receive a bill from his primary care doctor, and when Jack protested, the doc admitted he had no knowledge of anything which transpired after Jack left the examining room.
The amazing thing about this story is that it is crystal clear example of what is wrong. Harried doctors, burned out staff, lack of communication and lack of coordination all leading to a system which is unempathetic and dangerous. The only reason Jack is still alive is that his body decided to heal itself instead of waiting for our medical system to do the right thing. Talk about a scary thought.
John
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