Saturday, March 31, 2012

Liberty or Death: Healthcare in America (Pt 1)

ER-phobia and Drug Bliss

The first time I went to the emergency room I was a baby. On a visit to Tampa's smog-gray, pollen-rich, humid landscape my mom said she woke up in the middle of the night to my cries. I  was burning up the sheets with a fever. I struggled to breath. My parents rushed me to the emergency room and I was diagnosed. Asthma could have killed me before my first birthday. Fortunately I was a child and there are a variety of safety nets for young children. 

Twenty years later I made my second visit to the Emergency Room. After several days of what felt like a low-level fever and strange inability to muster any strength, I agonized over the decision. I had heard the horror stories and wondered whether I could just ride out whatever was ailing me. The only problem was that I hadn't eaten in a few days either. The very thought of food made me sick. I made a deal with myself. 

I was going to wake up, grab a nice big breakfast of eggs, hash browns, toast, and OJ. Considering the fact that I hadn't even in days, I should have devoured the entire breakfast. The deal was that if I couldn't finish most of my breakfast, I had to overcome my fear and go to the hospital. There was no other way to convince me to make the trip to the ER. I couldn't see a doctor, as all were booked solid for months in advance. My health insurance was student-level which meant I was one-step above a crack addict. 

After ordering my breakfast, I sat outside. It was an unusually beautiful morning. The sun was shining and I had a nice, protein-rich, carb-heavy feast in my lap. I stared at the eggs and couldn't believe people ate these things. I decided to start with the toast. I stuck a wedge in my mouth and chewed the buttered and burnt slice. It tasted like ash. I tried talking myself through the meal so that I wouldn't have to go to the hospital.

Mmm, this is so delicious. 

Yummy, this congealing, yellow-paste butter is in no way making me want to vomit.

These eggs are fetuses...and that is an appetizing thought.

Next, I looked at the eggs, my main nemesis. They were staring at me, daring me. I scooped up a forkful of the rubbery yellow bumps. I lifted it to my mouth and a burp of nausea fluttered up my throat. Swallowing down the acidic after-taste, I steeled myself. The eggs slipped into my mouth and I had to fight the urge to shot put my breakfast with my tongue. 

The thought of taking a second bite was too much. I threw the meal away and ran upstairs. I know I had a deal with myself but I figured I would wait a bit longer. An hour later, I was sitting and I felt small thud in my stomach, like a cherry bomb had been detonated. Then there was this enormous feeling of peace and ease. My entire body relaxed into this euphoria. I was almost ready to ignore that small thud and take a nice long nap. I could sleep for days. But something urged me to go to the emergency room. No more time for delay. 

I hopped into a cab and made my way to Beth Israel Hospital. This would be my first trip to the emergency room in over 25 years. As the cab pulled up, two ambulance workers were taking out a patient on a gurney. They took one look at me and stopped in the middle of the street. 

Sir, are you all right?

Yes, I just feel a bit sick. It's kind of hot today.

Did I really look that bad? No, maybe that was my imagination. As I walked into the ER entrance I met a man who had that distinctive NYC homeless look of random clothes, wild hair, and a bodily funk of alcohol and sweat. 

You doing okay man?

I've had better days. 

I asked the clerk at the entrance a question. She looked up from her desk and took a moment to stare at me with bug eyes. What is with people today? Do I have a spear stuck in the side of my head?

She directed me to the ER sign-in room. It was a bright Sunday afternoon in New York City. The room was empty. I sat there and filled out the several required documents, trying to remember doctors, coverage plans, and 3rd grade arts teacher. The homeless man from outside staggered in and slumped down on a chair for a nap. 

I sat in the waiting room. It shouldn't be long now. There is no one else ahead of me. I visited the bathroom a few times, trying to induce vomiting, a bowel movement, anything to relieve this growing feeling. I came back into the waiting room and sat down. I tried to read but couldn't focus. I stared at the TV but it sounded like gibberish. A case worker called me to the desk to ask me if I had insurance. This would be a repeated theme throughout my visit. I would assure them that I did and they would suspiciously look at me.

Two hours later, I got to see a nurse. She stuck the electronic thermometer in my mouth and waited.

1-10, how much pain?

I'd say about a 6 or 7.

You have a fever?

Well...maybe a low grade. 

You have a 104 temperature.

Is that even possible?

Yes, that was a dumb question to ask but I don't recall anyone saying that 104 was a living temperature among the human species.  She made me lay down and then she put her hands on my belly and pressed down. When she released her hands, I experienced a pain so severe that I almost hit the roof. 

My appendix had been infected and enlarged the last few days. In fact the thumb-sized divot had swollen up to the size of a baby's foot on my x-rays. And it had began breaking up a few hours ago when I felt that small thud. It was leaking poison into my body, which was reacting with a nuclear fallout-type fever and shutting down all desire to eat or drink. 

Funny, the only thing I remember wasn't the physical pain of that week: it was the psychic fear of going to the emergency room. My ER-phobia was so great, that I had blocked out the extreme pain my body was undergoing.  Now normally, I'm not that tough. Paper cuts make me want to start drinking hard.  But in extreme cases, my mind can shut down pain. I have walked around on shredded ankles, shook off concussions before going back into a football game (something you should NEVER DO), even won a regional wrestling title on two badly injured knees and pure adrenaline. And this was an extreme case. The horror stories of ER were so greatly present in my decision-making that it had shut down the demands of my body which was beginning to go into numbing toxic shock. I was dying and still weighing alternatives to ER treatment at a major American hospital. 

I felt ashamed at myself for being so stupid. The ER doctor looked at my chart and summarized my case succinctly. "If you had waited a few more hours...." His voice trailed off. He didn't need to say anything else. I got it. On August 1, 2004 I escaped death by finally deciding to go to the ER. 

Beth Israel Hospital saved my life. Once I got past the phalanx of desks, case workers, and questionnaires, I was over to the other side of the health care wall: treatment. I was given a nice cool bed and lots of pain killers. Suddenly everything was wonderful. America is the best. I don't care what those Canadians say about their health insurance. France can kiss my ass. U-S-A, U-S-A! The air-conditioner was worth the price of admission. I felt like I was at a spa. 

The nurse asked in my purple haze: you have insurance right?

I nodded and continued humming a slow, soulful, drug-induced Negro spiritual. This orchestra wasn't going to conduct itself as my hands gently swayed out the rhythm. I wasn't trying to make a scene. I was so overjoyed. I felt free and I never wanted to leave this peace. The IV dripped out the sustenance. I wasn't hungry, I wasn't thirsty. I didn't have a worry in my head now that I was in the arms of Beth Israel and their loving staff and, yes I do have health insurance, thank you for asking me once again.  

Laid out on my 7-feet of heaven I sighed deeply into sleep. They mentioned that I had options but I was in another dimension. I could actually hear my body and mind at a deeper level. It wasn't consistent and it would come and go, but I could get glimpses into a deeper thoughts Transfixed by this I began having conversations with myself. I couldn't move my body and I was aware that my mind could leave my body and I could direct it.

This was years before discovering Buddhism, but I lifted my mind up above my body and tried to decide where to go. I was surrounded on all sides by white curtains. There was an elderly Black woman next to me. I could make out her face and body and believed she was wearing some sort of cheap wig. The doctors were trying to advise her on staying. She wasn't well. Something was wrong with her heart, but I couldn't focus on the exact diagnosis. It was bad and the doctor added an ominous tone to his words. 

My mind swooped over to the right side of the curtain. I looked at Grandma and wanted to give her a hug. She reminded me of Mema. A grandmother so innocent, loving, and humble. The doctor was trying to recommend that she stay. But she preferred to go home. On a deeper lever she felt unloved and, therefore, unworthy of this special treatment. Tears began rolling down my face. She felt that her life wasn't worth doctors, nurses, and expenses. Grandma, You are worth it, you are worth it! You have to stay here. If you go home, you're going to die. Suddenly, the undertones of the conversation became very clear to me: she was killing herself through neglect. 

The doctor was trying to save her, but realized he couldn't do anything in the long-run. It was a losing war. So he was negotiating to give her some more time. She didn't see the point in it all. Why won't she listen to him? Is it because he's a man? Is it because he's White? Is it because he's just a human being expressing concern and compassion and she's so unfamiliar with that? I wanted to rip back the curtains and hug her.  Then I remembered that I left my body back on the other side of the curtain back on my 7-feet of heaven. The doctor said he would be back in a few minutes. Left to herself, she began breathing audibly. I couldn't tell whether it was panting from fear, weeping, or a chorus of deep sighs. I wanted to embrace her so badly that it hurt. 

On my left side was a Black man in his 40s. I didn't like him. He was a liar and an addict. He was also a whiner. He was screaming for 'pain pills.' The doctors ripped the curtains back to his room and began giving him the rough treatment. The questions were accusatory daggers of hate.

When was the last time you used crack?

A few days ago.

When did your back and chest pains start?

A few days ago when I fell.

Where you smoking crack when you fell?

...I don't think so.

How long have you had HIV?

Since 1990.

When was the last time you did heroin?

I did NOT like this side of the room. Heroin and crack-addicted, HIV druggies didn't inspire as much love as Grandmothers. Something felt wrong about that, but I knew that morally I was in the clear. Society would agree with me and the doctors did as well. They conferred on the other side of curtain. Their decision was to discharge him as soon as possible. No pills. 

Suddenly I felt sad for him. He deserved love too. I didn't want to give him pills and I didn't want to embrace him. But I felt like he had been kicked out of enough places. Now he was going to get booted from the ER. 

Father past me there was another patient, but her story didn't interest me that much. I struggle to remember her voice and her case was forgettable to me. Plus, my mind-traveling powers were dissipating. I had exerted a lot of energy and I returned to my room.

Finally, a doctor came into my room. He was Asian and very young. I remembered the report from TV that August is the time of year for new hospital residencies. He had the white coat, clipboard, and official glasses. He looked the part of smart, competent, thorough. I could feel his nervousness. 

The young doctor addressed me as "Mr. Squire" which I found funny.  He said I could medicate this and hope the appendix hasn't fully ruptured. But odds, it has and that probably wouldn't be a full-solution. OR...I could have my appendix removed in emergency surgery. 

If you get surgery, there will be a scar.

I had a few waning moments of mental energy. I thought: quick, say something funny before you slip back down into the ether. Say something like...there goes my swimsuit career. Now you are very very 'out of it,' Aurin. So you have to muster the strength to produce these words. But it will be worth it. This will really impress them with how cool and quick you are. They'll like you as their funny patient. So I found some reserve strength and moved it into the direction of my lungs for word output, my lips for defining the sound. This is exhausting but it'll be totally worth it. Neck I'm going to need some support.

There goes my swimsuit career!

The young doctor seemed stunned by my reply and his face broke out in a broad smile. He started laughing and, for the first time, seemed comfortable. He marked something on his chart. There wasn't really a choice. I would need the surgery but they didn't want me to sue in case I didn't like my scar. 

I remembered to call one of my friends at school. I would have to tell them so I could have guests. I was always jealous of people who were visited in the hospital. I  always wanted to have guests visit me in the hospital, but lacked the required hospital bed and illness. My friends would have to be nice to me, maybe even bring me presents. Since I no longer celebrated my birthday with lavish public celebrations, this hospital visit would be like having a party in honor of me that would roll through the day. But unless I told someone, they wouldn't know. It was summer and school was out of session.

I asked a nurse to get the phone from my pocket. She did and I mustered up some strength to focus my eyes on the contact list. No energy for scrolling. I picked the first name: Amy Hemphill.  I dialed the number and got her voicemail. Not it would be very important to enunciate. My lip and face strength were gone from my 'witty' swimsuit comment. I would have to go very slow and take care to note the hospital. Concise, short words.

In my mind I left a message that said "Hello, Amy. This is Aurin. I am in Beth Israel Hospital. Appendix burst. Tell friends!"

Later on, Amy would tell me that the message I left was a confusing, meandering mess. She barely understood anything except hospital and had to go searching around to figure things out. But she did convey the message for my hospital party. Now that the surgery is set, party arrangements have been made, and the drugs have been renewed I could rest. My mind floated off once again.  I expected my surgery would be smooth and that when I awoke there would be a great big scar, a cadre of friends, and a bunch of funny tales about my ER experience. I didn't know that this would be just the beginning of a long, sad, bizarre, infuriating, hopeful tale of health care in America. 

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