http://blogs.salon.com/0003757/ Copyright 2004 Linda Ziskind Tue, 20 Apr 2004 16:52:10 GMT http://backend.userland.com/rss Radio UserLand v8.0.8 lindaziskind@verizon.net lindaziskind@verizon.net rssUpdates 60 There are two private rooms in Intermediate care and both were empty when we made the transfer from CCU. All the rooms are the same size, so that meant that a semi-private room gave you half the space of a private. As David, who is an architect, noted, this was equivalent to the size of a prison cell. I was spending about 12 hours a day at the hospital and had assumed the responsibility of David's non-medical care - changing his sheets several times a day when he sweat through them, staking out the least threadbare patient gowns on the laundry cart, scrubbing his bathroom, bathing him, and bringing in takeout food from the neighborhood for our meals together. This meant that there were two of us sharing his half of the room. A private room seemed like more of a necessity than an extravagance. David's cardiologist had requested a private room for him, so we were surprised when they brought us into one of the semi-privates. The orderlies set David up in the bed by the window and then drew the curtain that separated us from the bed by the door. I surveyed our new accommodations. To the right of the bed was a small unit built into the wall. This held two low drawers that couldn't be opened because they were barricaded by the bed. Above the drawers was a small counter about six inches wide. Actually, calling it a counter is an exaggeration. It probably aspired to counter-hood, but it was really more of a ledge, or a very large chair rail. It was just big enough to deceive you into thinking it could be used to hold things, but for anything larger than a paperclip, it was out of its league. Above our little ledge was a narrow door that opened to reveal a cubbyhole with clear aspirations to closet-hood. Someone had optimistically installed a hanging rod and a hook, but it was too small for a coat, a handbag, or even a hanger. I rolled up David's clothes and stacked them in the cubby. David was still too weak to complain, or even much care where he was, but I was getting annoyed. Surely hospitals have noticed that their staff is overworked, so shouldn't they be reasonably attentive to the requests of a patient who comes equipped with his own full-time maid. They can't have overlooked the fact that their budgets are shrinking while their expenses are rising. On the day David was transferred out of CCU we were told that when he left the hospital he'd have to look elsewhere for a cardiac rehab program because the one at Lenox Hill had closed six months ago due to budget cuts. So it would be reasonable to think that they'd jump on the opportunity to fill a more expensive private room for a week. But reason didn't seem to be part of the equation. Here's what I did to try to secure a private room: I gently reminded David's doctor to look into it, I spoke to the senior nurses, I spoke to the Kiki, the Cardiac Fellow on the floor, I begged David's doctors, I begged Kiki, I made a business case for the advantages of paying the hospital more money than we already were, I waved my checkbook and offered to write a check on the spot. All the while at least one of the two private rooms sat unused, and sometimes both of them were vacant. The little pinches in my chest returned. So why does a hospital let the pricey rooms go empty? I decided to direct my question to the one person who knew the answer, the Director of the cardiac care unit. Of course, he was virtually unreachable, but that didn't seem like much of an obstacle, considering what my week had been like so far. I knocked on his door, left him a voicemail and sent word through Kiki. The Director's lack of compassion was legendary throughout the hospital and we got plenty of stories about his temper and icy demeanor, but we got no reply. Every day Kiki would relay his boss's position, but each answer clarified nothing and only raised more questions: They were keeping the rooms open for emergencies, David hadn't been in the Intermediate care unit long enough, David had been the Intermediate care unit too long, they didn't accept people who were going to stay more than a few days, they didn't accept people who were only there for a few days. I'd had enough. I had nothing to lose - they wouldn't withhold medical treatment from David and I had already taken over almost all of his non-medical care. I marched up to Kiki, checkbook in hand. "A private room has been sitting vacant for 3 days. David has 3 days before discharge. His doctors have requested a private room. We have requested a private room. I will write a check here and now for the difference. Can we have a private room?" Kiki looked up from his papers. He saw that I wasn't leaving without the real answer, and so he gave it to me. "The Director has decided that David won't get a private room. No reasons given. There's nothing I can do about it." And that is why hospitals let the pricey rooms go empty - for no good reason. http://blogs.salon.com/0003757/2004/04/20.html#a7 Tue, 20 Apr 2004 16:36:06 GMT My Friends My Hobbies My Interests My Organization My Profession http://rcs.salon.com/rcsComments/comments?u=3757&p=7&link=http%3A%2F%2Fblogs.salon.com%2F0003757%2F2004%2F04%2F20.html%23a7 Someone once observed that hospitals are no place to be sick. I know exactly what they mean. To be sure, when your life is hanging in the balance, hospitals are exactly where you want to be. The best of them are epicenters of diagnostic skill, cutting edge medical technology, and Hippocratic compassion. But once the drama is over and you've begun the long days of slow recovery, hospitals can be pretty inhospitable. For starters, there's the noise. Beeping monitors, staff hallway conversation, bedside family gatherings, and blaring televisions deliver an unrelenting soundtrack with no volume control. Privacy is non-existent. Semi-private rooms are usually long on semi and short on private, offering an unwelcome proximity to your roommate's most intimate sounds and smells, as well as an embarrassing showcase for your own. Soothing ambiance is also in short supply. The design palette can run the gamut from beige to tan - colors that might make even healthy people start to feel droopy. I can't help but think that, if we could persuade the doctors to make the trek, a suite at the Four Seasons would be a far more comfortable and cheaper alternative. Five days after being admitted to the coronary care unit, David was transferred to intermediate care - a step up in recovery, but a step down in attention. In CCU David was among the sickest of the hospital's patients. As a member of that club he was afforded a small private room, albeit a very open one, and a high level of attention and care from the nurses. Intermediate care turned out to be quite different. http://blogs.salon.com/0003757/2004/04/16.html#a6 Fri, 16 Apr 2004 13:19:55 GMT My Friends My Hobbies My Interests My Organization My Profession http://rcs.salon.com/rcsComments/comments?u=3757&p=6&link=http%3A%2F%2Fblogs.salon.com%2F0003757%2F2004%2F04%2F16.html%23a6 When I was growing up, it was a family rule that my mother was to be shielded from anything medically messy. Hospitals, bloodied knees, and gory stories all had the same effect on her: extreme squeamishness, which would lead to dizziness and, occasionally, a dead faint. I have a vivid memory of her sitting at the kitchen table and pitching face first into a cup of coffee as my aunt recounted a gruesome car accident she'd witnessed. I have inherited my mother's squeamish gene in its most powerful form. In addition to squeamishness and dizziness, I get sympathetic symptoms. If you tell me about your gall bladder operation, it will not only make me woozy, it will make my abdomen hurt. While some might describe this behavior as hypochondriac, I prefer to think of it as extreme empathy. I feel your pain. Literally. This is why, I believe, on the night David was admitted to the cardiac care unit, I developed a chest pain. It wasn't a big crushing pain and I was very sure it wasn't the signal of a cardiac event. It was more like someone was pinching my chest from the inside. A mean, insistent thread of pain that refused to go away. Gary took me to the fifth floor cardiac care unit, where they'd transferred David after the procedure. CCU was set up like a neighborhood, with a long corridor in the middle and rooms on either side as well as off of the cul-de-sac on the end. The whole place twittered with the rhythmic beeps of heart monitors. David was at the end of the corridor in a small windowed room. He was lying in the center of a dense nest of wires and tubes too numerous to count. The heart pump fed signals to a beeping monitor at the foot of his bed. His chest was covered with electrodes that fed information into another beeping monitor near his head. Various drips fed his body liquids and medicine. The little pinches in my chest grew more insistent. David was sleepy, but aware. Adam had arrived and the two of us stood next to David's bed. He told us what he remembered about the procedure, which, surprisingly, was a lot. We told Adam about the EMS angels who'd saved David's life. In the coming weeks we would tell that story again and again and never get tired of the happy ending. Gary stopped by to check up on David and say goodnight. I hesitated to mention my chest pain. There would be plenty of time later on for Gary to validate what I already knew. It was stress-related. It would go away eventually. Sleep and, perhaps, some tranquilizers would help. Tonight I would go home and get some sleep. Tomorrow I would ask Gary for tranquilizers. http://blogs.salon.com/0003757/2004/04/13.html#a5 Tue, 13 Apr 2004 18:28:27 GMT My Friends My Hobbies My Interests My Organization My Profession http://rcs.salon.com/rcsComments/comments?u=3757&p=5&link=http%3A%2F%2Fblogs.salon.com%2F0003757%2F2004%2F04%2F13.html%23a5 The news was good. The angioplasty went well and three of David's arteries were now sporting the latest in cardiac accessories: drug-coated stents that would not only keep his arteries open, they would prevent scar tissue growth that could cause a re-blockage. The heart god spoke frankly. Without a doubt, we'd been very lucky. Time was critical and, for once, we'd beaten the clock. The blockages were fixed, but they had occurred in an area so precarious, that it was necessary to run a balloon heart-pump through a catheter to take some of the burden away from the heart during the procedure. In order to facilitate healing, this would be left in for at least a day or two. And there was the matter of David's EF, or ejection fraction number. This is the proportion, or fraction of blood that is pumped out of your heart with each beat. A normal EF is 55 percent, or higher. In the sub-culture of heart disease, this is an important measure. Serious cardiac patients rattle off EF numbers, LDL levels, and blood pressure the way sports fans talk about at-bats and earned runs. David's EF was borderline-acceptable in the low 30s. The goal was to see enough healing to get his EF into the 40s. This would put him squarely in the "normal life" range. Normal Life. The words blinked in front of me like Las Vegas neon. Everything that had seemed even remotely important pre-heart attack became small. All of our plans seemed silly and inconsequential compared to our new true north: a normal life. http://blogs.salon.com/0003757/2004/04/12.html#a4 Mon, 12 Apr 2004 16:27:14 GMT My Friends My Hobbies My Interests My Organization My Profession http://rcs.salon.com/rcsComments/comments?u=3757&p=4&link=http%3A%2F%2Fblogs.salon.com%2F0003757%2F2004%2F04%2F12.html%23a4 There was intelligence behind the heart god's kind, brown eyes. Dressed in khaki pants and a tee shirt, he could have been any off-duty New Yorker on a Sunday night. But his calm evening had ended as abruptly as ours did and now he and I were standing on the 11th floor of Lenox Hill Hospital with exactly the same goal, to make David well. I believed that he was the guy who could do it. Two maintenance men were in the visitor waiting room watching TV. The room was dim and the television was loud. I headed for the payphone just outside. I would later discover that there are many places in a hospital you can safely use a cell phone. The visitor waiting room is an official one. The hallway between the elevators and the waiting room is an unofficial one. But that Sunday night, nervous about what interference my cellphone would cause, I set to work on the payphone. With a prepaid phone card that my mother had talked me into buying (3 cents a minute!) I dialed the 31 digits (1-800 #, pin #, and phone #) necessary to reach each of our family and friends. It was actually a good way to keep my mind occupied. By the time you get to the 25th number you've invested a pretty significant amount of time. The very last thing you want to do is misdial. Really. About 20 minutes after the procedure started Gary came out to give me an update. It was the beginning of what would be a two week crash course in cardiology. David had 3 blocked arteries. Two of them were minor arteries that were 90% blocked. But these were only the supporting actors in our coronary event drama. The star was a piece of plaque that may have broken away from one of these blockages, and was lodged in a main artery, blocking it 100%. To make matters worse, all of these blockages were located high in the arteries, making them difficult and risky to work on. That was the bad news. The good news was that our heart god was confident that he could fix everything with angioplasty and stents. As a backup there was a sugical team on-call to perform bypass surgery, but our bets were now riding on the magic hands of the man in the khaki pants. I looked at Gary. His face was serious, but his gaze was unwavering. It could be done. "OK.", I said. "Bets are placed. Let it ride." http://blogs.salon.com/0003757/2004/04/09.html#a3 Fri, 09 Apr 2004 13:50:21 GMT http://rcs.salon.com/rcsComments/comments?u=3757&p=3&link=http%3A%2F%2Fblogs.salon.com%2F0003757%2F2004%2F04%2F09.html%23a3 Lenox Hill Emergency Room is decorated in typical hospital bland. Beige. Formica. Plastic. My EMS angels wheeled David in, calling out his status in their medical shorthand as a swarm of activity formed around him, "Male, MI, post arrest." The emergency staff looked at David, incredulous. "Post cardiac arrest?" one of them asked. "This guy?" It was true. David looked remarkably healthy for someone who had just cheated death by a hairbreadth. He was whisked into an examining room while I tried to settle myself outside. I sat. I stood. I answered questions. I paced. I phoned David's son who said he'd drive in immediately from Connecticut. I phoned my best friend who did what friends do when you can't bear the weight of what's happening - she told me everything would be fine. Our family doctor arrived within minutes. Gary, my doctor who has seen me through 20 years of colds, flus, herniated discs, bladder infections, and allergic reactions to the drugs that cure bladder infections. Gary makes every problem seem solvable. I like that. Gary told us that our bad news had some hidden good news. The cardiologist on call at Lenox Hill that night was a god in the world of cardiac intervention. He'd been an important researcher on the trials for a newly released type of stent, the little bridge-like device that holds an artery open after angioplasty clears the blockage. "If I had a heart attack," Gary said, "this is the guy I'd want working on me." We headed up to the 11th floor to meet the heart god. http://blogs.salon.com/0003757/2004/04/08.html#a2 Thu, 08 Apr 2004 21:35:56 GMT http://rcs.salon.com/rcsComments/comments?u=3757&p=2&link=http%3A%2F%2Fblogs.salon.com%2F0003757%2F2004%2F04%2F08.html%23a2 David walked into the living room with his hand over his heart, as if he was planning on doing a quick pledge of allegiance. "I have chest pains." was what he said, though. "I think it could be indigestion." So what exactly do you do when your husband announces, out of the blue, that he's having chest pains that might be indigestion? This is what came to mind in the space of a second: Make chamomile tea, get him some Mylanta, get a taxi to the hospital (but what hospital??), call 911. As I headed to the kitchen to put water on for tea he announced new developments. "The pain is worse and I'm sweating." I dialed 911. It seems the daily rags are always running horror stories about 911. Slow response, inability to move in snarled traffic, EMS/Fire Dept. turf wars, not to mention non-working 911 numbers. I can't say if any of those stories are real or not. What I can say is that EMS and Fire Department heros saved my husband's life last January. Within what seemed like seconds, the Fire Department showed up at our door. 4, perhaps 5 (I was dazed and not recording details) hunks in full gear tromped through our living room carrying axes, walkie talkies, and oxygen. I watched the snow and mud from their boots drip onto our floors and rugs and offered a silent promise that if David was OK I would never worry about people tracking in mud again. The Firemen surrounded David, taking vitals from him and information from me. They were, they told me, going to give first-aid until EMS showed up - which they did a few minutes later. Exit FD hunks, enter the EMS angels. My angels were two men who immediately hooked David up to a portable EKG machine and determined that, yes, it was a heart attack. I paced circles in the apartment, my normally excitable puppy curled quietly in my arms. On some doggy level, she understood the gravity of what was happening and was sitting it out as passively as possible. Good dog. As I was pacing from living room, to bedroom, and back again, I paused in front of the sofa where my husband was seated. The portable EKG had cracked the top of our glass coffee table and I added never again worrying about damaged furniture to my earlier promise. I looked at David and suddenly, in a kind of slow motion and entirely unbelievably, his eyes rolled up and then closed and he slowly slumped sideways on the sofa. The realization of what I'd just seen came slowly. The thought of David dying, just like that, in front of me, was so incomprehensible that I had to parse the information into small chunks in order to understand it. Eyes roll. Body slumps. Face turns purple. Got it. I knew I had to say something, but could only manage a small, choked plea. "Help him. Please help him, he's dying." My EMS angels never missed a beat, never broke a sweat. Without looking up they reassured me. "We are. We're helping him." The portable EKG machine, it turns out, is also a portable defibrillator, which, as I know from medical authorites as respected as Marcus Welby, MD, the good doctors of St. Elsewhere, and the crew in ER, is what zaps you back from the dead. And it did. Within seconds David was sputtering back to life, arms flailing as if he were fighing off death itself. I kneeled next to him, the puppy limp in my lap. "It's ok", I told him. "You're all right." He asked what happened. I wanted to tell him, "You died and some angels brought you back. You scared the living shit out of me. You left me and I thought I would never see you again." Instead I told him he fell asleep for a minute. But he was awake now. http://blogs.salon.com/0003757/2004/04/07.html#a1 Wed, 07 Apr 2004 18:39:29 GMT http://rcs.salon.com/rcsComments/comments?u=3757&p=1&link=http%3A%2F%2Fblogs.salon.com%2F0003757%2F2004%2F04%2F07.html%23a1