Eight Random Observations of Eight Days in a Hospital

I spent eight days at Sacred Heart Hospital in Pensacola, Florida after a Porsche took out my bicycle along a bucolic byway in Alabama. I received uniformly cheerful, prompt, and competent care, which is not necessarily the same as efficient or effective care.

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During my 30-plus year architectural career I designed healthcare facilities. In order to understand the patient experience I observed operations, spent overnights in emergency departments, simulated patients navigating wheelchairs around bathrooms. But none of that prepared me for the actual experience of being an inpatient.

American healthcare is not a coherent system, more like a collection of protocols inequitably applied. There are ample studies and reports that articulate how it’s too expensive, too skewed to disease over wellness, too poorly coordinated, and too concerned with profit. If you want a big picture analysis, go read them. Here, I simply offer eight anecdotes from my eight inpatient days.

  1. One at a time clinical care. Over fifty different people; physicians, nurses, nutritionists, therapists, saw me during my stay. Only once did two clinicians visit me at the same time. I became very good at spinning my medical tale, as I never got the impression any of them read each other’s notes.

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  1. Pain is bad. Patients are not supposed to feel anything. Pain medications are offered early and often. A nurse prepared a morphine shot within an hour of my accident. I stopped her. Due to shock, it took over two hours for me to feel the pain in my shoulder. If I’d been on morphine, would I have felt the pain that directed our attention to that area? All staff delivers the same message: take pain meds in advance of feeling pain because “once the pain starts it’s hard to catch up with it.” Really? Or is it just easier to deal with patients who are numb. I want to feel my pain, so I know where I’m hurt.

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  1. Watch, don’t read. I had 72 channels at my fingertips but no books or magazines. By day five I was able to walk about. No mags even in the gift shop, only The Bible. Ever mindful of the seventh commandment, I ‘borrowed’ magazines from the surgical waiting room and returned them before I left.
  1. There is a pill for everything. I broke my L2 vertebrae, a shock that shut down my digestive track. Three days after admission I received general anesthesia for hand surgery, so my intestines stayed clogged. Nurses gave me three successively more aggressive drugs to loosen my bowels. On day five, I asked the dietician for prunes or bran. Not available. I guess you can’t itemize a bill for prunes or bran.

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  1. Wrapped in plastic. Every pill is administered in a plastic cup, every utensil comes in plastic wrapping. Every bit of plastic is single-use and tossed. There was no recycling bin in my room.
  1. What are you here for? On my third day, the social worker stopped by. She was a circuitous talker. After 10 minutes I asked, “What are you here for?” My question rattled her. She muttered something about a Case Manager to oversee my discharge, then retreated. Odd, since I was scheduled for surgery the next day and not about to be discharged anytime soon.

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  1. Medications are added, never reduced. The clinicians were concerned about me developing blood clots in my legs; an unlikely condition for someone who’d been peddling fifty miles a day. They put on compression stockings, which felt great, and gave me anti-clotting medication. Even after I was walking a mile a day, more steps than the average American, anti-clotting medication was still prescribed. Until I refused it.
  1. Discharge is a black hole. One by one, clinical services signed off on me. I stopped seeing the neurosurgeon, the orthopedist, the physical therapist. But I didn’t get transferred to rehab, either. The weekend came and went. I stayed. By Monday I was walking all over campus; I didn’t need to be in the hospital any longer. I waited for the promised Case Manager. Instead, a flippant intern arrived late afternoon and announced I was discharged to my own reconnaissance. She was flummoxed when I expressed concern. “People are happy to be discharged.” Not when they still need assistance getting in their brace and it’s too late to catch a flight home 1,000 miles away. I had to stay another night. Just because.
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Leap Year Leap

imgresOn February 29 I turned off Alabama Highway 98 to visit the historic town of Fairhope. An elderly Porsche driver took a sudden left turn across my path. I tried to veer away. Surly’s front tire hit the vehicle’s passenger side door. I flew off to the left; my left hand and shoulder landed on the pavement and I winced into fetal position on my right side. Immediately, onlookers surrounded me, cautioned me not to move, called 911, and kept the intersection clear. An off duty medic at the scene checked my vitals. The driver stopped and stood to the side. Our eyes met though we exchanged no words. EMS arrived, police. I was the centerpiece of a small town event.

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I argued with the medic against cutting the gloves off my bloody hand. He insisted. All I could think was they were new since Tucson and would be difficult to replace in a small town. Accident victims focus on the minutia in order to avoid larger realities.

Within half an hour I was at St. Thomas Hospital emergency. I refused the tech’s attempt to give me morphine. “How am I going to feel where I hurt if you shoot me up?” Dr. Sharp ordered a battery of images and tests. A no nonsense nurse debrided my hand with ruthless precision. Everyone parading in and out of the room asked me to move my toes, fearful of paralysis. Except the police officer, who wanted my side of the story.

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The driver didn’t see me. Two witnesses confirmed the man turned too quick. The police report faulted him, though the gentleman didn’t receive a citation. Infractions against cyclists don’t carry the same weight as those against vehicles. Odd, considering the brunt cyclists bear in altercations.

I asked about Surly, who landed outside my field of vision. The officer explained that my bike reared over the car, damaged the side panel and broke the windshield. I’m not so noble that the news didn’t provide a swell of satisfaction. Apparently, my traveling companion broke into several pieces and the police disposed of her. I’ve never been so attached to anything that wasn’t human. I love that bike. We were a good pair; she proved a trusty steed to the end.

I am also broken into several pieces. I suffered a burst fracture in my L2 vertebrate, the fifth metacarpal on my left hand sheared in two, my left scapula cracked like a china plate in too hot an oven; and I popped my AC (acromioclavicular) joint as well. Fortunately, the barium CT ruled out internal organ damage, and my limber toes reflected neurological continuity. Still, Dr. Sharp was concerned about bone fragments infiltrating my spinal column, so he transferred me to Sacred Heart Hospital in Pensacola.

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I spent three days in Sacred Heart’s ICU and step down, where monitoring ruled out anything beyond breaks and bruises. My initial hand set proved unsatisfactory, so the orthopedist surgically pinned my metacarpal. The neurosurgeon’s assessment was hopeful. “Surgery is indicated, but in your case not required.” In the face of trauma, it helps to be fit. I was fitted for a custom back brace. My hand was cast and slinged. Those restraints together immobilized my shoulder as well. Within five days I was walking. Eight days after kissing Alabama blacktop I flew home to Boston, never once setting my eyes on Pensacola’s famous beach.

Recovery at home is smooth. My housemate Paul takes exquisite care of me. My principal therapy is walking to strengthen my back. Two trips around Fresh Pond every day is five miles, usually accompanied by my children or my friends.

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Since April, my primary occupation is physical therapy, first, on my hand, then my shoulder, and finally my back. My manipulations require three 1-1/2 hour sessions per day plus walking. I watch hours of mindless television while rolling putty and yanking pulleys, grateful to whoever invented miniseries and fortunate to be retired.

Today, I am free of casts and splints; I wear my back brace about half time. I have a green light on my hand, but still attend weekly PT appointments for shoulder and back. I’ve added swimming three times a week to my walks and at-home exercises. I hope to be cleared for yoga or the gym or to get on a bike soon. Which triggers the question: am I going to finish my trip?

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My trip has already exceeded any expectations; I don’t need to ride any farther. I cycled 12,576 miles over 246 days. I visited 31 states. I profiled 286 people’s thoughts about ‘How will we live tomorrow?” and published short-form replies from even more. I stayed with 159 different hosts – 134 of them I’d never met before. I was immersed in a United States that is so much more generous, thoughtful, and caring than our political, social, and economic systems can ever acknowledge; that our media will ever report. Even in Pensacola, I received visits and flowers from strangers who’d learned about my journey. In the process I believe I’ve become more generous, thoughtful and caring myself. I do not need to pedal another mile.

Yet, why not finish? It’s so much fun and, I believe, worthwhile. Every one of us who lives authentically today enhances our prospects for a healthier world tomorrow. And I’ve discovered I’m most authentic on my bike.

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Unfortunately, I am not healed enough to know if or when I can return to my journey. I’m not strong enough to ride, and still skittish when I hear a car screech. However, I will continue to work toward the objective of mounting another Surly another day

I will take a hiatus from posting to www.howwillwelivetomorrow.com, though anyone interested reading profiles of the fascinating people I met along the way can find them there. I will continue to post essays about life unrelated to cycling the 48 states here.

I offer sincere thanks to all of my readers, to everyone who’s participated in my cycling project, and to everyone whose helped my recovery. Good luck in all of your endeavors.

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Emergency Room Regression Analysis

The next time you’re in a moving metal object which makes contact with another moving metal object and lands you in the Emergency Room, make sure to get a cubicle near the nurse’s station and leave your curtain open. Ignore the clinicians who slither up to your bedside one white coat after another and relay all manner of fact and opinion to your dazed head. Listen instead to the real truth of what ails you; what the doctors and nurses say at the station because they think no one is listening.

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The medical heads mouthed ‘lumbar compression’ and ‘burst fracture,’ to my face, the sort of words that imply extensive treatment and hefty bills. But nurse-to-nurse, behind the counter, I overheard the more ominous diagnosis. “That guy, the cyclist, broke his back.”

 

A broken back is a fantasy diagnosis. People don’t break their backs; we break our extremities: our big toe, our right arm, our nose. A broken back is a mythical injury, the stuff of childhood games. ‘Step on a crack, break your mothers back.’ Our back is our core, our thickest part. We can survive a dangling limb but we cannot survive being broken in two. The nurse’s schoolyard epithet made me laugh; my cracked ribs ached. I pondered my nursery rhyme condition. Could I be put back together again?

imagesAll ER diagnoses should be couched in fairy tale. A concussion is nothing more than Jack breaking his crown; falling from a ladder is itsy-bitsy spider syndrome. Storybook labels reinforce that being a patient in an emergency room is an infantile experience. Despite rejecting the morphine a mousy nurse tried to pump into my veins, trauma shock alone made me loopy enough to behave like a child.

An ER patient is an infant or a puppy: helpless and in need. It’s an unbalanced relationship with the staff. You have nothing to offer them. Actually, their day would be easier if you’d never arrived. You can gain attention by screaming, or you can smile and coo. I chose to be accommodating and friendly, chatted up every person who came into my room, asked their name and tried to repeat it at least three times. A way to keep my mind sharp while my body was whack; with the side benefit that familiarity might earn me favor.

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I don’t know whether my stratagem worked. I received good and prompt attention. Possibly because I was so docile; probably because I had injuries that trumped everyone in the waiting room. Anyway, at midnight the community hospital slid me back on a stretcher and ambulanced me to a trauma center in Pensacola; Winken, Blynken, and Nod sailing off in a wooden shoe.

Just imagine how my mind would have raged if I’d accepted that morphine.

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Trip Log – Day 246 – Ocean Springs, MS to Fairhope, AL

to fairhopeFebruary 29, 2016 – Sun, 75 degrees

Miles Today: 86

Miles to Date: 12,576

States to Date: 31

 IMG_6436I spent a leisurely morning at the Porter Greenhouse Coffee Shop that my host Jesse owns: coffee, biscuits, and conversation. About ten, I headed toward Mobile, sixty miles away.

By the time I reached the state line the terrain changed considerably; gentle hills and broad farms that could pass for Ohio. Around noon I received a message from my New Orleans friend Elyse that her friend Cathi in Fairhope would like to host me. I was making good time, so Fairhope before dark seemed doable.

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Mobile is a challenging city to cycle. As I approached downtown I realized the primary way across the river was a tunnel; I took an eight-mile detour to cross on a bridge that offered me a great view.

Mobile Bay is immense and the US 90 causeway no more than six inches above sea level. It must flood at the mere threat of weather. But on a clear crisp day it was exhilarating to roll along at water level with the sea scent filling my lungs.

I got to Fairhope about 5:30 p.m. I had heard the old town was extraordinary so I veered onto scenic 98. About a quarter mile in, a Porsche took a sharp left in front of me. Surly hit the passenger side door. Paul flew off his steed and hit the pavement.

Everything changes in an instant. I broke my fifth left metatarsal, my left shoulder, and burst my L2 vertebrae. I have no internal injuries, no paralysis, and an excellent prognosis.

Screen Shot 2016-03-03 at 3.22.06 PMThe goodwill I have found everywhere in our land thrives in Pensacola. I’m locally famous at Sacred Heart Hospital where many staff exclaim, “You’re the bike guy!” Strangers who are now friends visited with cookies and flowers. I’ve received local offers of places to recuperate. I’ll likely remain in Florida through March; it’s easier to rehab at the beach than in Boston this time of year.

I won’t post any more Trip Logs for some time, but will continue to post my conversations as I master the art of one hand typing with my non-dominant hand. It’s never too late to learn new skills.

Screen Shot 2016-03-03 at 3.21.54 PMThanks to everyone who’s contributed love, support, and their ideas along my journey thus far. I have witnessed how great our nation is, not through its strength, but through its compassion. I have had one heck of a ride, which may not be over yet.

Stay tuned, because I think tomorrow is gonna be a good one.

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Trip Log – Day 245 – New Orleans, LA to Ocean Springs, MS

to ocean islandFebruary 28, 2016 – Sun, 65 degrees

Miles Today: 89

Miles to Date: 12,490

States to Date: 30

I rose early, despite my Saturday night partying, and headed to Mississippi. The city of New Orleans stretches far to the east; more than twenty miles along US 90 of mostly deserted highway on a Sunday morning. By the time I reached Lake Catherine, dry land was a narrow isthmus with fishing camps on either side. The lakeshore turned into marsh with flocks of heron. Upon entering Mississippi, I was surrounded by sweet, pungent pine forest.

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IMG_6427I crossed the first of two wonderful causeways at Bay St. Louis, two miles long with a dedicated bike lane: great sign of progress for cyclists. The causeway leads to over thirty miles of beachfront from Pass Christian to Biloxi. The beach at Pass Christian is one of the most beautiful I’ve ever seen; white crystal sand on my right, stately mansions on my left.

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Cycling this stretch was gorgeous but tricky. US 90 has zero shoulder. The ‘boardwalk’ is sometimes only three feet wide, shared by cyclists, roller bladers, runners and pedestrians: scenic but not speedy. It gets more complicated in Biloxi where they’ve built casinos along the shore. It appears to be as big a gambling spot as Reno.

On the far side of the splendid causeway over Biloxi Bay I arrived at Ocean Springs, a scenic beach town. My host, Jessie, took me to a weekly Sunday potluck where her group of friends welcomed me to their community.

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Trip Log – Day 244 – New Orleans, LA

to New OrleansFebruary 27, 2016 – Sun, 50 degrees

Miles Today: 22

Miles to Date: 12,401

States to Date: 29

I’ve been to New Orleans half a dozen times: with family, with friends; to come to Jazz Fest, to build after Katrina. I appreciate New Orleans. I value it. Which is not to say it suits me all that well. I’m a New Englander, by choice and disposition. I am prudent and sensible, perhaps to a fault. I’m preoccupied with time, space and schedule. My wild fantasies are just that, fantasies; I have no need to act them out. New Orleans is a healthy anecdote for me: spontaneous, impulsive, unstructured and unscheduled.

IMG_6389The afternoon I arrived in NOLA I had more ‘potential’ meetings and places to stay than anyplace I’ve visited on my tip. Yet, nothing was firm. I took a Big Easy breath and let it all unfold in a rich, chaotic New Orleans way. I visited Musician’s Village and stayed at Buskers Bunkhouse on Friday. This morning I rose at dawn and made me way to New Orleans East to visit a Habitat for Humanity build site. NOLA has one of the largest and most successful HFH operations in the country. Then I pedaled clear across town to Carrollton to meet a pair of NOLA natives whose fathers’ were musician and musicologist involved in establishing Preservation Hall. Back in Mid City I met with a geotechnical consultant expert in the unique combination of rising tides and subsiding earth that makes Louisiana give up so much land the sea – second only to Bangladesh in coastal land loss.

IMG_6396Finally, after an odd string of texts, I arrived at Gina and Phyllis’. Gina invited me to stay but said they were going out. As a rule, I do not stay in houses where I haven’t met my hosts, so I suggested we get together late afternoon. She thought I was interviewing her to see if I wanted to stay, which must have made me seem like a prick. (She didn’t know I just came off a night at Busker’s Bunkhouse, not a place for the fussy.) No matter. We clicked when we met and they invited me to join their female friends to hear Susan Cowsill, longtime NOLA resident of Cowsill fame, channel Karen Carpenter.

IMG_6412We went out to dinner, where I snarfed down a variation of a Mufeletta called a Frenchuletta. NOLA being nothing more than a really big small town, we met two other women they know and all ate together. We arrived at Chickie Wah Wah almost an hour late, plenty of time before the main show stared. The place was jammed. We heard some good original stuff, a superb double drum jam, and a seven-piece ensemble that did justice to all the Carpenter’s greatest hits in full reverb. It wasn’t Preservation Hall, but it was wicked fun.

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Trip Log – Day 243 – Gramercy, LA to New Orleans, LA

to New OrleansFebruary 26, 2016 – Sun, 50 degrees

Miles Today: 56

Miles to Date: 12,379

States to Date: 29

The east bank of the Mississippi River, which is actually the north side in these parts, is a smidge higher than the west bank, which is in fact the south. My host in Gramercy boasted of being six feet above sea level. Perhaps that is why as industrialization supplanted the plantation economy most factories located on the north side. Oil refineries, sugar refineries, and granaries cover former sugar fields with miles of pipes and towers. Conveyor belts long as football fields span across River Road and the levee to connect riverside docks with the behemoths that turn raw materials into the stuff of contemporary life.

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My ride into New Orleans oscillated between navigating narrow River Road and riding the Mississippi Levee Trail bike path along the crest of the levee. When completed, the trail will give cyclists an elevated approach to the Crescent City. Now, there’s quite a bit of up and down involved.

IMG_6344The Bonnet Carre Spillway is a creepy stretch of pavement. The spillway provides a relief valve to divert the Mississippi directly to Lake Pontchartrain during high waters. The dam proper is concrete, but above is a section of vertical wood slats. I have no idea what they’re for, since light shines between them and would easily let water through. A few timber sections have been pierced by floating logs – whole trees really. The large specimens look like toothpicks against the mammoth spillway. I picked up my pace along the low side for over a mile, feeling a need to get higher than the river ASAP.

Beyond the spillway heavy industry gives way to fabrication and assembly plants, residential neighborhoods and commercial strips. From the top of the levee I realized that the streets of small homes sit quite a bit lower than the river surface, even in February when the mighty Mississippi is relatively low.

IMG_6356I recalled my very first trip to New Orleans. I was ten or twelve years old on some instantaneous family excursion my father concocted. We visited Grandmother Schumacher, a tiny old woman, grandmother to our neighbors, who came to live on our New Jersey street every summer when New Orleans was hot. When the adult conversation grew tedious in her Jefferson Parish home, I snuck outside. I saw a hill at the end of her street. I climbed the steep grassy slope. The word ‘awe’ was created to describe what I saw. The vast Mississippi River, one of the world’s most majestic thoroughfares, sluggish green, cluttered with barges and tugs and tankers, happened to be down the street, and a few dozen feet higher, than Grandma Schumacher’s cottage. My first experience of the Mississippi River was perplexing and magical. It cemented my belief that wonder can lie around any corner.

Although the entire relationship of land and water, monumental and domestic is bizarre in this land where low is dry and high is wet, traversing the top of the levee is different from climbing it dumb. The current was swift. A single tug guided fifteen barges downstream, while it took a pair to push just one up. Pipes and conveyors and service roads and wires connect ships and docks to land. Raw materials from all over the world on my right zoomed over my head to be turned into stuff on my left. I sat on a bench, drank water from a plastic bottle and ate a granola bar. Either of whose constituent parts might have one day been here before.

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I left the levee to pedal down St. Charles Street and around the Garden District, which look fully polished ten years after Katrina, even though the trees and telephone wires still sported beads from last week’s Mardi Gras’ parades. I spent too much time meandering the Convention Center area, all new and overscaled. It takes like five minutes to bike around the carbuncle that is Harrah’s. The French Quarter was packed even on a cold day in Lent.

IMG_6369Finally, I got to the east side and made my way to Musician’s Village, where I’d lent a construction hand post-Katrina. I got a tour of the performance and training spaces, which did not open until 2012. Then I made my way back to Busker’s Bunkhouse, an artist commune run by Ms. Pearl only five blocks from New Orleans most famous side street: Desire. I spent an evening, a fly on a tattered paper wall, among heavy smokers with gravelly voices who sounded profound, though I have no interest in fact-checking their political assertions or conspiracy theories.

IMG_6370The exception being one silent woman who wouldn’t even share her name: she lay in her dark room next to mine with a phlegmy cough. I couldn’t help feeling sorry that she had arrived at the wrong French city, reenacting the tubercular La Boheme within shouting distance of where Tennessee William’s Stanley, Stella, and Blanche raised such a sexually induced ruckus.

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