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.
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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.