Last time in my series about my dad, I wrote about the wonderful nurse who took care of my father the night he was admitted to Leonard Morse Hospital in Natick after he broke his hip. Leonard Morse is tucked away on the short road from town to what residents euphemistically call “South Natick”, which is code for “Not Quite Wellesley”. I live in Wellesley, which is Not Quite Princeton, which is Not Quite Oxford, and so on. I don’t take this stuff very seriously – but people in South Natick do.
I had gone home for the night, expecting a long day tomorrow when they performed his surgery. His break was partial, meaning that the bone was broken and the socket was intact. A total break was the catalyst for my mother’s very rapid decline 6 years ago. Much more on this later. Suffice it to say that this injury is painful, debilitating, and takes a very strong will to overcome. My mother had many gifts, but after many years of unhappiness (and smoking), a strong will wasn’t among them. She lasted 3 weeks.
My father is different. Death has come for him many times, and each time, he has refused the invitation. I’m guessing that Death’s feeling pretty exasperated by now and wondering what he has to do to get this guy to go along with him already. My dad’s version what happened to her includes a strong sense of paranoia about how doctors and hospitals kill people — which they do — but also that she gave up. Already that night he told me that it was not going to happen to him and that after the surgery, he would work hard.
Partial hip replacements, even for the elderly, generally take a little over an hour and are not particularly dangerous procedures. My brother just had a full replacement and wasn’t even under general anesthesia. Leonard Morse, aside from anchoring the road to South Natick, is a hip replacement factory for the elderly who live in and around Metrowest Boston. Without Medicare, it would not exist. Because of Medicare, it is full to its 5th-floor brim with geriatric patients awaiting, undergoing, or recovering from surgery.
I thought my father would be in that 2nd category by the next afternoon and the 3rd category by evening, as we’d been told the night before by the attending the ER. I was wrong. Enter the cardiologist.
I got to know the cast of characters at the hospital a lot better than last time – that’s the next post in the series. Suffice it to say that the cardiologist who performed tests on my father came straight from central casting. His name was Dr. Rosen and he was a six-hundred year old man who stood about 3 feet tall and had a loud gravelly voice and won my father’s confidence instantly. Too bad because he is the one who turned a 72 hour hospital visit into a 2 week odyssey when he found that my father has an irregular heartbeat. On the monitor, I could see it occasionally fluctuate from its usual 75 up to 150, then back to 75, then down to 40, then back to 75, and so on.
That meant no surgery that day, and no definite answer on when it would happen.
From the instant Dr. Rosen noticed my father’s arrhythmia, he turned into the single person who controlled his fate and with it, my family’s. He spoke in complex medical jargon into my father’s bad ear, which I suspect is why he needed to be so loud. Cardiologists are risk averse and are the gatekeepers to actually being able to get any other procedure done. They have no incentive for your loved one ever to leave their watch — that could be dangerous! Also, they see heart problems everywhere in your life. Did you fall asleep once watching Fox News? It’s probably because your heart slowed down so we better run some more time-consuming and expensive tests. Also, you obviously are high risk so you need to stay in the ICU and not on the regular floor where you can at least look out the window and see whether it’s day or night.
Although fewer than one in four thousand Americans are in intensive care at any given time, they account for four per cent of national health-care costs. By my math on 16% of GDP going to health care, that’s almost 0.5% of our entire Gross Domestic Product. Put another way: that’s roughly the contribution to the economy from the state of New Mexico.
By the way, cardiologists round at irregular times, so if you want to wait and have a conversation with them, you’ve lost your whole morning. If you are a sandwich generation man juggling your parent and kids, or you have a job, or you expect the same level of courtesy that you would get at your local Jiffy Lube, you are out of luck.
The whole time my father was on the monitor in this brightly-lit but windowless room, he was trying to ask my him detailed information about his medical condition: doctors, medications, and other critical information that my father has never known. I know the answers, but somehow, he didn’t want to ask me; he preferred to make my father give him a mostly fictional or confused answer, maybe just so that he could observe that. To a cardiologist, or any doctor in the hospital, not knowing your medications cold is a sign of confusion and dementia. How could you not know? Medication is so important!
It is a unique Kafka-esque feature of hospitals that being in them contributes to the conditions that they then treat.
Also remember that my father hadn’t eaten the day before (Yom Kippur), or the night before (because he might have surgery the next day). So in addition to being weak because he had a broken hip and a lot of pain, he was in a disorienting place, hadn’t really slept because of the interminable blood pressure and other testing that woke him every hour, and was anxious about what was to come. It was all I could do to suggest humbly to Dr. Rosen that perhaps these factors might be contributing to his apparent confusion.
Time in the hospital loses meaning. It’s hours of waiting followed by 5-minute interactions with people who mostly have poor people skills, speak an incomprehensible language, and complete certainty in their point of view despite woefully incomplete information. Even the omniscient cardiologist.
So, now we had an indefinite wait ahead of us until my father would be stable enough for surgery. Was the arrhythmia new? Did it cause his fall? Would medication stabilize it? How long would that take? I didn’t know – but I had a sense of dread at the roadblocks that I knew now were coming.