• The Daily Progress •
Although a diehard believer in universal health insurance — no one should declare bankruptcy because of a hospitalization — I recently learned of a disturbing irony. While nearly 45,000 Americans die every year because of a lack of access to care, it’s been reported that 200,000 die because they received it.
After spending an unenviable amount of time between C’ville and Beantown either in hospital beds or holding vigils next to them, I get that. Preventable infections, communication problems, and unadulterated institutional dysfunction threaten recovery. Even at the premier, best of the best hospitals, problems are rife.
Cleanliness is an issue. A no-joke big one.
The U.S. Centers for Disease Control are so alarmed by healers actually spreading disease that they’ve posted a podcast about how to bring up hand washing with your health-care provider. A suggested lead-in is modeled by an actor portraying a patient’s loved one who says, “Doctor, I’m embarrassed to even ask you this, but have you… .” Then, when the physician blows her off by saying she tidied up just before coming in the hospital room, the actress switches into hard-ass mode and demands to witness the process.
For the record, even thinking about that kind of confrontation gives me hives. Do I really have to play kindergarten cop in the middle of a family crisis? (And what about the patients who don’t have anyone camping out in hard-backed chairs? Who gets deputized to grill Typhoid Mary, M.D. on their behalf?)
I’ve witnessed a variety of efforts to urge, cajole and reward sanitary compliance. My favorite was the employee Hand Hygiene Superstar campaign featuring photos of very, very good washers hung throughout the hospital.
Illustrating the flip side of the campaign, my sister nervously asked, “Um … shouldn’t everyone here be a Hand Hygiene Superstar?”
Sanitation dangers don’t stop at sleeves end. Centuries after Europeans intentionally used blankets laden with smallpox germs against Native Americans, one study found that more than half of doctors interviewed laundered their lab coats only every two weeks or so. With superbugs like MRSA in our hospitals, bimonthly cleaning is not just gross (imagine, a hotel changing sheets twice a month!) it’s dangerous.
Even physiciansneckties are known to harbor more than polka dots. (Doctor, I’m embarrassed to even ask you this… .)
Then there’s the noise.
During my father’s recent hospitalization, the over-the-bed speaker continuously bleated commands made by an increasingly irate announcer: Phone call at the desk for Nurse Sue. Nurse Sue, NURSE SUE! When I mentioned to the specialist that this seemed the antithesis of restful recuperation, he condescendingly educated me about the importance of reaching staff. (We were equally startled when I suggested his institution might want to investigate the use of cell phones and pagers I’d heard they were pretty effective communication tools.)
And while I’m on the subject of technology I’d like to mention that machines fail. Sometimes with body parts inside. This happened when I was getting a mammogram. The X-ray plates jammed shut with my boob pancaked between them, freaking out the technician and me, both. But that was nothing compared to the faulty machine calibration that resulted in a cancer patient’s death from being over-radiated.
Medicine is an uncertain business, but this is not often relayed to the rest of us. When I was diagnosed with cancer, the intervention hinged on the staging of the tumor. I was stunned when I happened across an article calling for second opinions in the reading of pathology samples. Apparently, pathologists can look at the same slide and see dissimilar things kind of like high-stakes cloud gazing. I may be out of line, but perhaps there should be more of a push towards a regulated standard when body part removal is on the table? I basically flipped a coin and went with the reading that supported my less-is-more approach to treatment for stage zero breast cancer.
It was the small-print treatment side effects that were hardly mentioned by my doctor that set me on my path of resistance. Following the lumpectomy, I was advised to undergo six weeks of radiation as a one-shot deal (there’s a cumulative effect so you can only have a course of radiation once on the same body part) to eliminate any sleeper cells that may have escaped the knife. When I did a little independent reading on the complications that can arise from the cure, I decided the statistical pay-off in terms of longevity didn’t warrant the risk.
As has often been my experience, the contents of the Pandora’s box of medical intervention were not broken down into graspable probabilities. While the potential benefits of being irradiated were all dressed up, the possibility of heart damage, irreversible elephantine arm swelling and radiation-triggered cancers were rarely invited to the party.
Something else I’ve learned is that when you do get hard numbers you must ask what they truly represent. After my vibrant mother slid into a coma following surgery, the ICU staff provided pretty rosy data about the possibility of her waking and graduating off the ward. Six weeks into it, a random resident made an off-hand comment about the definition of a successful outcome. Turns out one measure is basic self-care. Like tooth brushing. (And, I suppose, hand washing.) In other words, a medical victory may not translate into a decent quality of life. But it’s still recorded in the win column. Had Mom woken up with little more than the ability to squeeze Crest out of a tube, I’m fairly sure that while the doctors were high-fiving each other she would have been fashioning the toothbrush into a shank.
And none of this even addresses the actual mistakes. The surgical tools sewn inside wounds. The deadly bedsores from being left in the same position for too long. And the incalculable communication mistakes that are made like the charting error that caused my daughter to be injected with the wrong insulin.
Lest anyone think I’m ready to ditch my insurance card and embrace faith healing, I’m not. I believe (most of) our health care workers are dedicated to improving treatment. And I remain fundamentally committed to the ideal that all Americans deserve health care. We just need to bump it up some.
Erika Raskin is a writer from Charlottesville. She’s married to a physician.