Wednesday, January 16, 2019

I Now Know What's Wrong With American Healthcare...

"The behavior of any bureaucratic organization can best be understood by assuming it is controlled by a secret cabal of it's enemies." -- Robert Conquest

Let's make a distinction before we begin:

"Healthcare" is what you get when you walk into a hospital or doctor's office.

"Insurance" is (among other ways) how one pays for the service.

I wanted to say that up front for a specific reason: too many dumbasses all over America conflate the two.  These are two different things.

The democratic (small 'd' intentional) party conflates the two on purpose. That purpose is to boondoggle a collection of nose-picking douchebags, welfare queens, sub-room-temperature-IQ Kollege Kidzzz, females (both real ones and those who only pretend to be one for attention because Mental Patient), Old People, Illegal Immigrants, and unionized doofuses (who would most likely never be gainfully employed without an organization to perform an act of extortion on their behalf in return for a kickback) into joining a Collective which has as it's main goals the implementation of Communism under the banner of Altruism, destroying the very concept of Freedom, and keeping democrats (small 'd' intentional) in government continuously employed and overpaid (because they have unions, too).

Why do I need to make this distinction? I'm glad you asked! Pull up a chair, and I shall regale you with the latest Kafkaesque chapter int he continuing drama that is Mrs. Overlord's health.

Two weeks ago, Mrs. Overlord was taken to the Emergency Room with what appeared (to me) to be some sort of respiratory virus. It was the correct call; she had caught a very nasty dose of Coronavirus, which is not particularly lethal to most people, but when you have a compromised respiratory system -- like she does -- is a very serious thing, indeed. That shit, left untreated, becomes SARS or MERS or any one of a dozen pneumonia triggers.

We did not go to the hospital we would normally go to, where they know how to treat her combination of ailments (the aforementioned respiratory issues and Myotonic Dystrophy, a form of Muscular Dystrophy). This is because Mrs. Overlord was thinking with her ovaries -- as women are wont to do -- and refused to climb down a flight of stairs to get into the Nissan Tie Fighter. If...IF?...she were going to a hospital, she said, she was being taken by ambulance or not at all.

This streak of stupid-stubborn is annoying on many levels, and there is not enough Jedi Training to overcome it. Even the Dark Side cannot overcome it.

In any event, the ambulance would not transport her to her "regular" hospital in Manhattan, and we wound up in the local ER, here on Staten Island.

We had a very bad experience five years ago in this very same hospital under similar circumstances. Then, the Chief of Pulmonology, who apparently got his Medical Degree from the same place Alexandria Ocascio-Cortez got her knowledge of Economics, unwilling to take outside medical advice on how to treat a Muscular Dystrophy patient with pneumonia, suggested we start measuring her for a wooden box. Paraphrasing the speech he gave -- in front of her and her family:

"She is not responding to treatment (although she was: he had no experience of Myotonic Dystrophy and would not listen to people who did). I've done about all I can do. You have a choice: if you want, I will give her a trachiostomy, put her on life support and keep her alive as long as you'd like, or, you can halt treatment now, and she'll be dead in about 3-4 days. But whatever you decide to do, make up your mind quickly: I need this bed."

Suffice to say, we got her the fuck out of that hospital.

And so, here we are five years later, under similar circumstances because her vagina told her to ignore my superior judgment. Believe me, we made damned sure that fucking asshole of a doctor did not get within 500 miles of her. However, they say the apple does not fall far from the tree, and in this case it would seem as if the turds do not fall far from the asshole.

For her physicians are all Doctor Asshole's acolytes.

By the way, did I mention that 90% of these drones all have names one would associate with suicide bombing, camel rape, and eating with the same hand one wipes his behind with, possessed of degrees from Universities scattered across the dismal landscape of the Third World, where the need for doctors is so acute that standards barely exist?

Now, giving credit where it is due, they DID manage to stem the infection and prevent it from becoming something much worse. Good job.

However, they have this morbid fascination with sticking tubes into people, and if you aren't riding herd on them, these cowboys tend to get stupid ideas.

I mean like Obama-level stupid.

We're talking Joy Behar-level fucktard.

Approaching Andrew Cuomo-level lackwit.

So, even as Mrs. Overlord recovers, regains her strength and improves before their very eyes with each passing day, at least one doctor a day visits us to talk about trachiostomies or implanting feeding tubes (despite the fact that she's breathing just fine and eats just about anything they put in front of her), and to INSIST that these are medically necessary. We have good medical advice (from doctors in hospitals where the respiratory staff does NOT arrive at the scene in a Clown Car) that not only are all of these things totally unnecessary in her case, they tend to not be necessary in 98.6% of ALL cases...but they do it, anyway.

I get the distinct impression that if I walked into that hospital with a broken leg or ruptured hemorrhoid, they'd insist in sticking tubes in me, too.

She had a panic attack one evening, and they had summoned a surgical team to begin intubation. As it was explained to me by the doctor on the ward, "she meets all the criteria for intubation". They were only prevented from doing so because a rather large respiratory tech (perhaps the only one in that hospital who knows what she is doing) threatened to kick the doctor's ass if he didn't give her two hours to fix Mrs. Overlord up. Which she did, by simply changing the settings on her bi-pap machine. That intubation, even though it "met criteria" would have been totally unnecessary.

Considering what they did to the woman in the next room with an ill-advised intubation (brain damage) you'd think they'd back off on the whole insert-a-tube-where-you-don't-need-one routine, but fuck no.

The talk of feeding tubes, ventilators, intubations,

So, what drives this curious impetus to stick tubes into patients who do not need them, and where the words "Medical Necessity" (even though they try to present this to you as "an option to consider") get thrown around like a intern at a Clinton stag party?

No one knows.

According to a doctor I trust, this became a medical fad about a decade ago.

Judging from the relentless and repetitive nature of the "option" being discussed, I have two ideas, which I cannot confirm at present:

1. It is simply a protocol, the origin of which may be lost to the sands of antiquity (if we can call a decade "antiquity"). The reason usually given for this bizarre behavior is 'the risk of secondary infection via "aspiration pneumonia" (foods and liquids not being swallowed properly, ending up in the airway, becoming fodder for bacteria), but as this trustworthy Medico explained to me, one has a better chance of contracting a bacterial infection from the plaque on one's teeth than you do  aspiration pneumonia. The protocol cannot be broken for some reason, the idea of doctors exercising independent judgment seemingly having gone the way of the honest journalist.

To my mind, if it is "a protocol", then this is indicative of a bureaucratic mindset which sees all patients as being essentially the same, and therefore, they all get the same treatment, regardless of need.

2. If it is a bureaucratic imperative, then it can only have two aims: a) it fulfills some government mandate crafted by a knuckle-dragging bureaucrat at the Department of Stupid Rules, b) it's a defense against lawsuit. b seems the most likely.

But, if the unnatural pre-occupation with sticking tubes in patients for shits and giggles or through bureaucratic direction weren't bad enough, it gets worse.

For example:

Mrs. Overlord uses a piece of medical equipment known as an "In-Exsufflator", or to put it in layman's terms, a "cough assist machine". This is a device which blows air, under pressure, into a patient's lungs. This triggers a cough reflex. When the coughing begins, negative air pressure is applied. In this way, it is hoped that mucous, fluids, and other nasty shit that is lodged in the lungs can be removed without more-invasive procedures. Upon speaking with Mrs. Overlord's pulmonologist and discovering she uses this machine every day, the doctors at Bullwinkle General insisted that I bring the machine in.

Because they do not have one.

In fact, no one in that hospital had ever seen one before. In 21st Century New York City, a modern hospital does not have a single one of these simple machines in it's respiratory ward. So, I brought it in.

Then I had to teach them how to use it.

And when I had, the doctors refused to touch it. The nurses refused to touch it. The respiratory technicians refused to touch it. In fact, no one would give her the all. And then I was told that I would have to administer it to her every day (which is tricky, because sometimes she needs the thing on the fly), and that if I did, the hospital would not be responsible if something went wrong during the treatment. So, what the fuck was the point of bringing the machine in?

Again, a modern hospital in 21st Century New York City.

If all this talk of extraneous and unnecessary tubes, doctors who practice Connect the Dots Medicine, and lack of acumen with elementary equipment were not enough, you run into another problem which is indicative of an organization run by Rhesus Monkeys.

We were told that Mrs. Overlord would be receiving physical, occupational and respiratory therapy in the hospital's "world renown" facilities (that may be Disney World). The only problem was that a bed for her on that particular ward would not be available for a few days. So, they moved her from one room to another for four days until they at least got her to the right floor.

Then they gave her a "physical evaluation" yesterday which consisted of walking from her bedside some 20' to the door of the room and back. That's it.

After which the "therapist" concluded Mrs. Overlord was not "strong enough" to undergo their rigorous -- three hours per day -- regimen of physical therapy, which is a load of horseshit.  She's done that, and then some, before. Therapy would now be denied.

So, are they going to discharge her?

Oh fuck no. That would be too easy.

Why not?

Because we're back to the fucking feeding tube.

She failed a "swallow test", which is a fancy moniker for a process in which a "Speech Therapist" who apparently got her credentials from the Soupy Sales School of Medicine shovels all sorts of dyed shit down your throat while a camera inserted up your nose records it's progress down your gullet. Of course, Mrs. Overlord, suffering from the after-effects of a respiratory illness, with a feeding tube stuck down her throat and Muscular Dystrophy, failed.

Like that would have surprised anyone with three braincells?

If she can't swallow, they tell us, she's not safe to go home and eat regular food. However, we had the feeding tube removed by request -- she's eating well -- and they wouldn't re-test her (I had to throw a major conniption fit to schedule a new test for Friday, so that I can get her the fuck out of here) to re-assess her condition. It's all about this fucking tube and at this point I'm beginning to believe they are so paranoid about a lawsuit (we had the tube taken out against advice, but without signing a release form. Apparently, the doctor forgot), and then about being proven RIGHT, that they just can't let it go.

So, yesterday, I attempted to have her transferred to a rehabilitation hospital. I got the word today that the rehab hospital -- where she has been a patient before -- refused to admit her. Why?

Because no feeding tube!

Guess who owns the rehab facility? The same "healthcare" company that owns this hospital!

Guess where she went for rehab last year? The same hospital (after a full-blown pneumonia that had her in the hospital for a month), where they discovered she had a swallowing problem. But, they didn't insert a feeding tube, then.

Confused yet?

I'm going to get my way, in the end. They can insist on all the tubes they want but she's getting into that rehab hospital, for I have the Force on my side (in this case, I happen to have huge connections there, and when they find out their paper-pushers refused her treatment, someone will be left unconscious and bleeding in a back alley with a pink slip jammed in their anal cavity).

And here we get to the end of our little drama. Because the problem(s) with "The System" are made abundantly clear by this escapade.

We have hospitals that are run by bureaucrats, not doctors. They may put doctors in charge, nominally, of medical decisions, but it is abundantly clear that all those decisions are really no decisions, at all. Doctors -- even the ones who may not have any compelling reason to explode for God -- are hamstrung by a need to play by a strict set of rules which limits their flexibility in treatment.

The doctors, themselves, are either order-following robots, too quick to play God, arrogant fuckwits, or so worried about incurring the wrath of The Gods of the Copybook Headings that they refuse to listen to a patient's experience or to others who may give them good and useful advice. That's when you actually KNOW who "your doctor" is, because she seems to have a new one every other day. I have the business cards of nine (9) different doctors who have worked on her case.

In the meantime, an infection which was beat back in a week, has resulted in a (to date) 15 day stay which has included:

A CAT scan for a bellyache. In a patient with declared and known IBS who had a feeding tube installed against her wishes. A feeding tube, incidentally, which dispensed a disgusting nutritional mixture that resulted in uncontrollable diarrhea for three days before we had it yanked out, and such a severe case of subsequent dehydration that she required two full days of IV fluids to recover.

Accommodations in five different rooms, each with a baffling array of beeping machines that'll keep you awake all night, but which no one often bothered to connect her to.

A routine of waking you up every hour to take vitals (why not just hook her up to the monitor that's beeping over there?), to stick you with a needle, to draw blood, to give you a sedative to put you to sleep.

A meal regime which consists of solid food (for a patient they insist needs a feeding tube because she can't swallow and they fear she will choke or give herself a new infection) and thickened liquids (which actually DO cause her to choke).

Multiple daily visits from the Ghoul Squad, each one suggesting a new and more-exotic tube to be stuck into places you didn't know existed on the human body.

Technicians who do not know how to operate common medical equipment, who refuse to learn how, only to end up refusing to give treatment at all.

A visit from the "Palliative Medicine Group" which consisted of a LPN, some sort of social worker, a chaplain, and two doctors who look like they belong on the back of a milk carton, who claim to be there to help you "co-ordinate" all of the services the hospital has to offer, but who then can't get you the services the hospital initially offers and then retracts. But they wear spiffy white coats that are probably the cleanest you've ever seen.

And now you can see why it gets so terribly expensive and extraordinarily complicated.

Don't get me started on the daily routine of a new stack of paperwork to be filled in every morning.

Yes, you do manage to get well. Often the care -- especially from nurses -- is exemplary, and yes, you will get the full benefit of every diagnostic tool, every medication, every procedure, known to Mankind...whether you really need it, or not, because Protocol. You will have a team of doctors sufficient to replace the Clydesdales on the Budweiser beer wagon, who often cannot agree among themselves, can't read each other's notes, all following different protocols according to their specialty and function. They will measure your food and water intake (because tube) while insisting that eating and drinking without choking to death is not an indication that you are functioning like a human should, who will waste your time with "Team Meetings" to repeat themselves ad naseum about your current state of inertia, i.e. lying in a bed for an extra week because they can't figure out what to do with you, except not discharge you for fear of lawsuit.

And then you thank whatever you hold holy that you have stellar medical insurance that only costs $146 a month (even with a pre-existing condition!), has a reasonable deductible, and caps out-of-pocket expenses at a decent level, and from which you never see a bill, while you're bombarded by news stories about people who pay hundreds or even thousands a month for similar coverage because medical insurance somehow became a human right that required government intervention, and you wonder where these idiots are buying insurance from.

Maybe we ought to stick tubes in them?


Anonymous said...

The administrators are very religious, having several gods they worship. JCAHO, Leapfrog, SCIP. They all have rituals to be followed to get a good score.
The score and grade are what matter, not the patient.

Noto fan & admirer said...

Hospitals treat patients, there’s no money in curing them.

Matthew Noto said...

That assumes every malady can be cured. In the absence of "cure" what else do you expect a hospital to do?

Heh, nice handle...I'm flattered.