This column has had an ongoing focus on the complexities of health care in our rural county. We have written about the enormous difficulties of medical financing and the frustrations of St. Helenans in dealing with hospital billing. But all that revolves around the business of health care and not the experience of medicine.
So in the interest of investigative journalism a few weeks ago I got myself seriously ill and was admitted to St. Helena Hospital. Anything for a good story.
For me, the system worked. From the ER to the heart and vascular unit, I received outstanding care. That doesn’t mean I enjoyed it or that my patient experience was fun. But as my personal physician wryly observed days later, I was both “very ill” and “very lucky.”
I had been on holiday at a tropical eco-resort in Mexico. But a few days after returning I suddenly took ill with some alarming symptoms. Ironically, theses had nothing to do with the serious problem identified shortly thereafter.
My doctor sent me straight to the St. Helena Hospital ER. It was late morning, the ER was quiet and I was seen within minutes by the estimable Dr. Rodney Look. Whether it was something he saw or something I said, among the mountain of lab tests he ordered was a marker for blood clots. That confused me, as I had no symptoms – leg pain, chest discomfort – that typically characterize blood clots. But the test came back “positive.” Which in medical language is bad news.
I swiftly had a CT scan that revealed many little blood clots in my lungs. That was followed by an ultrasound that found the originating clot behind my left knee. Dr. Look told me he was admitting me to the hospital. There would be no prolonged stay in the ER; nor would I would be held in the medical netherworld of “observation” status. I was going straight to the heart and vascular unit on the fifth floor.
Up until that point I was almost enjoying the experience. The nurses, the technicians, the support staff were all good-humored and reassuring. But then on my way upstairs, Dr. Look scared the hell out of me by carefully explaining my condition. Evidently, having blood clots is not a good thing.
The relative peace and quiet of the ER gave way to the hectic and crowded world of the heart and vascular unit. Days later, hospital CEO Dr. Steven Herber explained to me that this medical unit was just a step down from intensive care and thus – especially in flu and pneumonia season – was full of very sick patients. Herber has a goal of offering inpatients private rooms, but he said that’s unrealistic in this cardiac ward at this time of year.
Herber also confirmed to me that there has been “a paradigm shift in health care.” Inpatients these days are not the property of their personal physicians but of a subgroup of doctors called “hospitalists.” These doctors are responsible for the care and treatment of inpatients. As a medical consumer, I had mixed feelings about that.
Hospitalists know diseases but they don’t know their patients. I was fortunate that my own physician was able to talk on the phone with the two hospitalists who handled me. What I found not reassuring was that these doctors were not locals but long-distance commuters – one from Washington state and the other from Texas. They would fly in for a work schedule and then fly home. Herber admitted that “I don’t think it’s ideal” that they commute. But he also made what he feels is a more important point: “I want good doctors even if they don’t live here.”
The old line is that a hospital is no place to be if you’re sick. It’s noisy and brightly lit 24 hours a day. If you have a roommate who snores, it’s hard to sleep. And your world revolves around your schedule of medicines. I had a shot in my belly at 3:30 a.m.
On the other hand, hospitals are now more family friendly. St. Helena Hospital has done away with visiting hours and family members can be there around the clock. After my 3:30 injection, when I couldn’t sleep, I walked the hallway and noticed in many rooms spouses or significant others sleeping near the patients. I found that reassuring.
Herber is aware of the comfort issues for his patients. He says, “We need to listen to our patients and create a gentler experience for them.” One ongoing problem he’s identified is noise emanating from the nurses’ stations, especially at night.
I was definitely lucky; my hospital stay was necessary but it was also brief. The night after I got home I slept for 12 hours. The previous day and night seemed like an exotic and disconcerting dream.
Mark G. Epstein moved to St. Helena from the East Coast early this century after a career in international business.