Health In Crisis
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.