Health In Crisis
Deborah Venable
11/01/09
Judging
from the amount of feedback I have received on articles I have written on
healthcare this year, I can’t imagine that I am being taken seriously, but I
must write one more. This is a specific
story. It is currently ongoing and I am
a witness.
My
dearest friend was diagnosed with diabetes over thirty years ago. Her blood sugar has never been stabilized in
all those years, even though she has been under constant medical “care” for the
condition. She must take daily
injections of insulin and maintain a strict diabetic diet. As she got older, the disease began taking
its toll on her via the condition known as neuropathy. This presents with nerve damage so severe
that patients may lose all feeling in their extremities. Now this doesn’t negate deep pain in those
extremities – just the sensation feelings of external touch or even the lack of
signal pain that should flag a severe injury, such as a broken bone or bad sprain. The downside to this disease should be
obvious.
In
severe cases, such as my friend’s, the patient can suffer another debilitating
condition known as Charcot Foot. When
neuropathy is severe, it can cause the bones in the foot to deteriorate, break
down, and become almost useless at supporting body weight. Left untreated, the patient will eventually
lose the foot or even life.
Now,
let’s throw another complication into this mix. Obesity. Not the
self-imposed kind that comes from over eating or not eating a nutritionally
sound diet, but the impossible kind to manage because insulin itself
contributes to weight gain, and the inability to maintain the simple exercise
of healthy walks makes slimming down and staying thin an impossibility. Every diet designed to lose weight works,
but eventually a plateau is reached, and even more weight is gained back. That is the nightmare my friend has endured
since Charcot Foot claimed one of her feet.
She
was lucky in one respect because she opted for orthopedic surgery on that foot
that successfully fused the bones in the bad ankle, and a steel rod inserted
from foot to knee stabilized the deteriorating bone. However, she can never bear full weight on that foot. Doing so could cost her the leg up to her
knee. So she had to assume a limited
lifestyle that included wheelchair, wheeled walker, and remodeling of her home
to accommodate the fact that she cannot stand from too low of a seated
surface.
Ready
for another complication? She also
suffers from CHF, (congestive heart failure), and these episodes leave her with
added weakness, massive swelling of body tissues, and sometimes failing kidney
function. She takes medication for
this, which includes edema reducing drugs and blood thinners – which are detrimental
to the kidney problems and facilitate much bruising and bleeding. She also must sleep with oxygen and a C-Pap
machine because she suffers from sleep apnea.
She
must be extremely careful to avoid any skin irritations, which can result in
open wounds. A simple boil sent her
into a five-month hospitalization and multiple surgeries to remove massive
portions of gangrene. The wound took
several months beyond hospitalization to completely heal.
Now
we get to the real healthcare nightmare part.
In January of this year, my friend suffered a fall in her home. She was in severe congestive heart failure
at the time, so she was rushed to the hospital where she laid on a gurney all
day long with no attention paid to her feet.
By the time they found her a room and removed her shoes, injuries were
discovered on her “good” foot. It was
swollen to twice its size and she had a massive hematoma over much of the top
of that foot. It required immediate
surgery, which left an open wound, (hole) in her foot. After eight days in the hospital, she was
told that she would be discharged if she could stand. Short story – she could not stand after those eight days in
bed.
She
was then sent to a rehabilitations center to learn once again to stand and
walk. That took an entire month. I arrived on the scene at the time she was
first able to stand and take a few steps.
After another week of hard rehabilitation work at the center, we were
able to bring her home.
Thanks
to the miracle invention of a Wound Vac, within a couple of months the wound on
her foot was healed and her mobility improved.
She could get around in her home with assistance of walker and wheel
chair and could get in and out of her car to be driven to her numerous doctor’s
appointments.
While
she was in the hospital, her cardiologist had strongly suggested that she
consider bariatric, gastric bypass surgery to extend the quantity and improve
the quality of her life. We eagerly
investigated the possibility and found a center and a surgeon in El Paso, Texas
that specializes in the procedure. That
was the closest facility to her home in New Mexico that offered the
surgery. We began the process of
securing this treatment for her as soon as her foot was healed.
We
made one trip down to the facility in El Paso in May for her evaluation. She was sent home with a list of required
tests and such to complete so that she could have the surgery. Her cardiologist even sent a letter to the
surgeon telling him that she was at the optimum time and health for the
procedure. She was willing to bypass
all insurance requirements and pay for the surgery herself if they would just
do it quickly, but as soon as we would satisfy the requirements, they would add
more to the list until the delays took her well past that “optimum time” and
her health began to fail again. The
reason? The only one that makes sense
is that the surgeon and that facility wanted her Medicare and supplemental
insurance to pay for it because it would amount to more than the out-of-pocket
cost.
Finally,
when all the requirements for insurance reimbursement were met, she was put on
the surgery schedule. That was to have
occurred on October 20th.
Even though we both knew that her health was failing fast, (reoccurring
infections, swelling, and weakness), we looked forward to her finally getting
the help she so desperately needs. With
this surgery she may well not need insulin any more, which would take care of
so many problems. She could also come
off of many of the drugs she must take for edema and her heart condition. And she will definitely lose weight and be
able to keep it off, which will drastically improve the quality and extend the
quantity of her life. She is more than
willing to put up with dietary and lifestyle restrictions caused by the
surgery.
We
drove down to El Paso on October 18th to make the early morning
appointment for pre-op on the 19th.
We stayed in a hotel that had certain handicap amenities, but not the
one thing she needed most – a bed that she could easily get up from in her
weakened condition. Therefore, that
night she fell in that process. The
result was an immediate rush to the hospital, (the same one in which she was
supposed to have the surgery) and a compound displacement fracture of her
“good” foot at the ankle. That required
orthopedic surgery on the 19th to insert a steel plate and screws to
stabilize the fracture. Although we
begged, and the orthopedic surgeon concurred, they would not agree to do the
gastric bypass while she was there. The
bariatric surgeon refused to do that surgery until her lag is completely healed
and she is mobile.
Her
leg cannot even be put in a cast until some soft tissue healing and reduction
in swelling occurs.
Meanwhile
the hospital doctor discovered mal nutrition, severe anemia, and kidney
failure, and ordered two units of whole blood administered immediately. This doctor first presented herself as a
caring physician that was going to get to the bottom of all my friend’s
problems. She ordered one, count it –
ONE test along with the usual blood workup.
That was an ultrasound of her internal organs to determine any
damage. By the next day, she came
whisking into the room to announce that she would soon be discharging my friend
from the hospital and we needed to decide where she could be “put”. Since she cannot bear weight on either foot,
she could not be rehabilitated right away.
Now,
if I had to guess, none of the technicians or doctors that attended my friend
in that hospital knew the first thing about Charcot Foot, which prevents
anything but very limited weight bearing, because everyone tried to insist that
she bear weight on that foot to move her around and begin immediate rehab. We had to tell the story a minimum of fifty
times to keep them from harming that foot!
The attitude of her attending physician, (the gal that was going to get
to the bottom of her problems), was appalling – for lack of a better word. The attitude of the so-called physical
therapists was appalling. Everyone
looked at my friend with disdain, as if it were her fault that she is so obese,
and that she is just too lazy to help herself.
This is a recently identified problem within much of the medical
profession. Read
this article for more on that.
The
last thing my friend needed was to remain in that hospital, so we made
arrangements to have her moved, (at her own expense) from El Paso to
Albuquerque to a skilled nursing facility and closer to her own doctors. That was accomplished on the 24th.
We
have hope that the broken leg can soon be put in a cast that will allow her to
stand for a brief period of time and take a few steps. When that happens we can bring her home
again. Needless to say, she still needs
the bypass surgery.
My friend’s indomitable spirit is the only thing that keeps her going. She receives little to no respect or “caring” from the medical profession that attends her. Decisions made for her by these professionals and the bureaucrats that rule them leave her health in crisis all the time. The costs for her “care” are compounded unnecessarily by bad or inadequate decisions that do not take her individual case into consideration. She is forced to endure embarrassing, torturous procedures based on rules in place to treat her inactivity, such as sitting up in uncomfortable positions damaging to her feet and legs, when if they could just be allowed to heal, she would heal more quickly. We know. We have seen it. She is perfectly willing to do the exercise regimens that do not jeopardize her feet and legs to gain strength in unused muscles, and she does.
Just
the mere effort to take her from the facility she is in to the doctor’s office
that will treat her leg injury is torturous for her. That will finally happen on November 2nd.
I
write this as an indictment of a bureaucratically-run healthcare system that is
the result of bottom line decisions made by “professionals” who are constrained
by groupthink instead of considerations of the individual cases they administer
to. If the government is successful in
“reforming” the healthcare system in this country to include even more
government controls, cases like my friend’s will be even more impossible to
manage – and that is hard for me to imagine right now.
It
doesn’t take thousands of pages of legislation that no one wants to read or
understand to improve healthcare in this country. What it would take is a brick-by-brick dismantling of the
education system, which includes medical profession education, as it exists
now, and installing an encouragement of individual compassion within each
person who chooses this profession – doctors, nurses, technicians, therapists,
and administrators to care about their patients, and in the words of
Hippocrates, “first, do no harm.”
I
have seen much harm done to my loved ones battling health crisis over my entire
adult life. My father, mother, brother,
and husband are now all dead after much suffering and bad decisions made during
their “care.” I recently wrote about my
daughter’s struggle to survive her crisis just twelve years ago. Yes, I have seen healthcare from the inside
out. I have also had my own personal
battles with the system. In every
single one of these cases, harm was done by professionals who cared little about
the individual they were making decisions for.
It
takes a special person to successfully treat health in crisis. The great majority of people who enter this
profession do so for reasons other than “helping” anyone but themselves. This is the indictment. I dare anyone to prove me wrong.
I
will return to more prompt administration of this website when this particular
crisis is resolved. In the meantime, I
still welcome feedback.