Compassion: Where art thou?

I want to rant about the economy and politics….the ugliness of the Congressional debt ceiling deal, the plans to cut social welfare programs, the need for political posturing, the absurd randomness of the stock market, the sadness of what is going on in Britain, the tragedy of the drought in Somalia…….but, something closer to home prompts a different rant. 

This is about my 92 year old Aunt Mimi living in Florida.  She has lived alone for many years since her husband passed away a long long time ago.  When she first moved to Florida she lived in a lovely beach front apartment that, unfortunately, was seriously damaged by Katrina.  This prompted a move to her current apartment, which in typical Mimi fashion is well decorated with items from the past, many of which I have known since childhood.  There is a portrait of Mimi as a young woman; it originally hung over the fireplace mantel in White Plains and now graces the walls of her Florida apartment.  Every time I look at it it reminds me (and surely Mimi as well) of the passage of time.  And then there are the needlepoints, the tables and chairs,,,,,so many items I remember from the White Plains home I knew so well as a child.   

The loveliness of her surroundings belies the poor quality of her life which has changed dramatically in the past few years.  Plagued by a peripheral neuropathy which caused her to fall and fracture her hip and shoulder, my aunt, the non-stop shopper of days gone by, no longer drives and uses a walker at all times (to prevent another fall).  The problem is compounded by atrial fibrillation causing some minor (fortunately non-debilitating) strokes that make use of an anti-coagulant prudent ……but at the same time makes a fall an even more frightening event.  And, she copes with all of this rather cheerfully.  She enjoys TV and reading and, I believe, an occasional Mah Jong game.  She had even expressed an interest in a Kindle and we tried to get one for her, but, unfortunately some of the requirements didn’t work (believe it or not, no e-mail address!!).  But she wasn’t too unhappy, she said she can still go to the library and take out books. 

The new, big, and currently insurmountable problem is back and leg pain from spinal stenosis. And it is last weeks events that both startle and, as a physician, sadden me. 

Apparently, a few days ago,  her back pain was so severe that she called 911 to have an ambulance take her to the hospital ER.  I don’t know what transpired in the ER except that after a few hours they discharged her to home! A friend picked her up and drove her home. She then called my 93 year old father who took her to an orthopedic appointment she had later in the day.  The orthopedic surgeon tried some injections for the pain but these apparently made her worse, so he called her internist.  My father then took her to the internist (third medical visit in a few hours now), who obtained an EKG, identified a rapid heart rate, consulted with her cardiologist and arranged for admission to the hospital.  Again, I think, my father was the transporter!!!

How can this be?  That an elderly frail woman with numerous medical problems needs to visit three medical facilities before she is admitted to the hospital?  What went on in the ER?  An elderly lady who lives alone….is sent back home?  And, this after pain was so severe that she felt the need to call 911?   Even if she responded to pain medication in the ER, one has to know that these medications would not last for long.  So she was sent home to develop pain again?  Where was the compassion?  Where was the treatment of the human being? 

And, what about the orthopedic surgeon?   After his injections she became much worse….nauseated, agitated,,,,clearly not well!  Why didn’t he arrange for admission to the hospital?  Was it really sensible to send her (a lady who cannot walk, who is ill, who has numerous medical problems) with a 93 year old man to yet another doctor’s office? 

I am sure the ER sent her home because “pain”   is not really an emergency ….procedures for treating back pain are often done on an outpatient basis and do not require hospitalization.  But, you might ask,,,,,,what if the patient cannot walk?  What if she cannot drive?  What if she lives alone and is unable to move well enough to care for herself?  Does it make any sense at all to send her home?  Wouldn’t it be kind to admit her to the hospital even overnight for evaluation by the pain service?  Or, do we no longer have room for kindness?

I am equally sure the orthopedic surgeon sent her home because, afterall, she didn’t need an orthopedic procedure.  And this is the only reason for an orthopedic admission.  But still, couldn’t he have taken her pulse?  Identified the rapid heart rate?  Called her internist and advised direct admission to the hospital?  No, instead he sent her on another journey which could have been a disaster.  I have nightmares thinking about my elderly father driving my aunt to the next doctor’s office and the possibility she could have vomited and choked, or had a stroke or had a cardiac arrest in the car……..fortunately she didn’t.  But what was the orthopedic surgeon thinking when he sent her on her way?  Where was his compassion?

But the story doesn’t end here.  After she was admitted to the hospital and her heart rate was normalized (we do know how to treat rapid heart rates even if we ignore pain), her doctor decided that she needed an epidural steroid injection for her back pain…..something that had been done nine years ago by a “spine doctor” in his office.  Since this doctor didn’t have any time for a few days, the plan was to discharge Mimi to a nursing home/rehab facility, let her continue to be in pain…..and to then arrange for transport to the doctor’s office in a few days. 

At this point, I exploded.   Why couldn’t she have the injection in the hospital? Why wait a few days and prolong misery?  Couldn’t it be done before discharge?  Eliminate the need for yet another trip?  Make sure there were no complications (as there had been nine years ago)?  Of course, nobody even thought about the fact that she had been taken off her blood thinner for the epidural, and every day off of this there was a risk of stroke……..seemed like these questions just didn’t cross anybody’s mind…..

So,  after my explosion she did have the procedure while in the hospital and then was discharged to the nursing home for rehabilitation.  But again where is the compassion?  Why did I have to intervene? Why didn’t her caretakers in the hospital think of this somewhat easier and more sensible approach? 

This episode truly causes me to worry about our health care system.  I well know that health care expenditures are enormous and some may even be unnecessary, but are we so concerned about unnecessary hospitalizations and medical expenditures that we have stopped thinking about people.   The medical community often seems to have given up caring.  It has given up compassion.  It has replaced this with cold calculated economically motivated thinking.  Instead of asking whether a patient can use or would benefit from hospitalization, we ask, can the same thing be done as an outpatient?  Often the answer is yes…..we can send somebody home with a followup appointment….But, what if this is more painful for the patient? What if the patient lives alone and does not have a built in network to help him?  I well know that we have to be efficient, but somehow we have to filter our decisions through kinder eyes and ask not only “can it be done” but also “is this in the patient’s interest?”

Seduced by Blogging.......

Blogging is BIG!  Its hard to miss this fact.  There are blogs on the New York Times (politics), blogs on Eventing Nation (horses), blogs about economics, blogs about cooking , blogs about travel, blogs about ourselves……And more and more of us blog.  Wiki says there were 156 million public blogs as of last February.  And since I started a blog last week, there are at least 156 million and one…..

Wiki also tells us that the first blog was likely written by a Swarthmore College student in 1994………However, in looking for information about when the first blog was actually published, I googled the words “first blog” and identified a large number of sites giving advice to us neophytes about how to write our first blog….Clearly, the number of blogs will continue to grow…..

But blogging will continue to grow…not just because it is so easy and so much fun,,,,but because the whole process is seductive!  Essentially, it is the ultimate in narcissism!  You write about what you want and how you see it.  If you are a liberal you can tout those values,,,,if you are a conservative, you say something else.  If you want to brag about an event or critique another….well, go ahead.  There is no editor or publisher who needs to approve……just write, post to blogger.com and, voila, you are done!

Best of all you don’t need a captive audience,,,,,,there are so many people out there to read your blog: the whole of the internet is your readership………last week, I put my blog about a piece of horseback riding equipment (my air vest) on Twitter and Facebook.  Now, I am not one of those folks with huge connections and have no plan to develop a business or expand a personal reputation.  I have a small number of followers (under 50) on Twitter, and merely 250 friends on FB. Within 24 hours over 30 folks had read my blog……a couple days later a couple of websites linked to my blog as did a couple of other folks on FB.  In the past 24 hours, over 400 people from all over the world have read my blog!!!!  And, now, four days later there have been almost 700 hits…..Wow!  This is the most popular I have felt since high school! I’ve been seduced….and, this second blog is the concrete evidence!!!

Vive le Blog!