The following includes examples from Lovely Wife's recent surgery. Although this serves only as anecdotal evidence the theories espoused are well corroborated through other experiences of myself, Lovely Wife and Burger. In addition I have second hand knowledge from many colleagues, family members and aquaintances. If you, the reader, have had experience as a patient in a hospital setting there is a damn fine chance that you have experienced much of the same as it appears to be endemic to the industry.

In this article I'll give you a bit of background on me so you will know my perspective. I'll give you a brief explanation of Lovely Wife's condition and her diagnosis and prognosis. I'll then take you through each main portion of Lovely Wife's surgical procedure telling you what was supposed to happen and what actually happened. I'll occasionally expound on how poor performance affected us in an especially bad manner.

Background:

Although I am a software analyst by profession my scholastic training was in medicine. I spent eight years in the US Navy as a corpsman, operating room tech and fleet hospital corpsman. I have worked in Naval Hospital Balboa, Naval Hospital Portsmouth, Naval Hospital Oakland, Fleet Hospital San Diego in Camp Pendleton and Veterans Administration Hospital in Buffalo. I have had personal experience working in patient care, pre-operative care, surgical procedures, recovery and post-op. I know how the entire proces can and should work from front to back.

The Condition:

For several years Lovely Wife has had an acute recurring hyperthyroid condition. This means she would quite suddenly have a thyroid that suddenly and unpredictably put out way too much thyroid hormone. This causes nervousness, weight loss, heart arythmia, raised pulse, blood pressure problems, restlessness and exhaustion. The first couple times when it was noticeable enough to require medical attention were immediately or shortly post-partum. She has been diagnosed with Hashimoto's Thyroiditis, hashitoxicosis, hypothyroidism and post-partum hyperthyroidism. The reason for the many different (and sometimes contradictory) diagnoses was due to her returning each time after a few months to normal or borderline normal thyroid function.

She was problem free for over two years until about 5 months ago when it came back with a vengeance. She went from a thin but healthy weight of 135 pounds to just over 110. Her condition was finally pegged as Grave's Disease. The necessary treatment for this is destruction of the thyroid. This can be done with radiation that kills the thyroid tissue or with surgery to remove the thyroid. There is also a drug treatment that counteracts the overactive thyroid but there are possibly dangerous side effects to this drug therapy so it was eliminated as a course of treatment very quickly. The method we ended up with was surgical removal of the thyroid.

As a side note that won't be expounded upon here, the decision for surgery over the more common and generally safer radiation treatment was made necessary due to monetary considerations. Our insurance coverage made the cheaper radiation treatment too expensive for us to afford right now and her condition made waiting impossible. Yes, that's right. Our insurance pays almost everything for inpatient surgery but almost nothing for outpatient procedures. Sucks, doesn't it?

Pre-op:

Expected - Lovely Wife's surgery was scheduled for 9:30 AM. She was told to be at pre-op by 8:00 AM where she would be put in a pre-op room, an IV started and she would be given a shot to calm her down. The anesthesiologist and surgeon would both see her there to go over procedures again and answer any questions she had before she went in for the operation. Children under 12 would not be allowed. A maximum of 2 people would be allowed with her.

Actual - We arrived at 8:00 AM on the nose. We were told they were not ready for her. They would be ready at 8:30 AM. She was supposed to be there one hour before her surgery, not an hour and a half. We showed them her pre-op instruction sheet that told her to be there at 8:00 AM. Sorry, whoever filled that out made a mistake. We waited in the hallway until 8:30 AM when they took her into pre-op and I booked to the babysitter's to drop off the boys. She was nervous as hell but was not given the shot to calm her down as she had to see the anesthesiologist and surgeon before they could drug her. When she had finally seen them it was only 5 minutes before her surgery so it was way too late for it to be any benefit.

Special Problem - Our plan was to drop her off and I would take the boys to the sitter's. I would then be back in time to be with her for the last 45 minutes or so before she was taken to surgery. As she was not allowed into pre-op until 8:30 AM I barely had time to get them dropped off and get back in time. As there was a decent chance I would not be able to return before she was taken into surgery I had to take all of her personal effects with me. That meant that she spent almost her entire pre-op time with nobody with her and nothing to distract her except her own thoughts and worries.

Surgery:

Expected - The surgery would take approximately 4 hours. When the surgery was done the surgeon would come to me in the surgical waiting room and give me a report on how it went.

Actual - Exactly as expected. Lovely Wife's surgeon is very, very good and has an excellent rapport with his patients and their families. He explained everything clearly and concisely without using med-speak or talking down to me (and no, he was not aware that my background was medical/surgical).

Recovery:

Expected - Lovely Wife would spend about an hour in recovery and then would be taken to her room. One family member would be allowed to stay with her in recovery. Patients in recovery are in semi-private areas provided by rolling curtain partitions. The purpose of recovery is to monitor the patient for post surgical trauma and help them comfortably recover from the effects of anesthesia. Blood samples would be taken to start verification of her calcium baseline (this is a concern in a thryoidectomy as the glands that control calcium absorption in the body are directly behind the thyroid).

Actual - No family members, no visitors period, were permitted in recovery. There are privacy concerns with the other patients. Actual length of stay in recovery was three and a half hours. This was because there were no rooms ready for occupation. No rooms in the Short Stay Ward where they know precisely how long people are staying and exactly who will be coming to the ward days in advance. Lovely Wife witnessed a patient being wrestled down in order to remove his throat tube. She was denied a pillow after having her neck hyperextended for two hours during surgery. A volunteer found me in the waiting room and asked if I could go get her pillow because they didn't have any in recovery. She was ignored and then put off when she first came around and asked to go to the bathroom. They told her she could wait until she got to her room. Remember that she had been on constant IV fluids for almost 4 hours at this point. When you are on an IV you pee constantly and furiously. She was finally given a bed pan. She had never used a bed pan before and was still groggy from drugs and in pain from surgery with a neck that hurt furiously from 2 hours of hyperextension. She struggled into a sitting position by herslef and successfully used the bed pan. She then noticed that the privacy curtain hadn't been closed and she had just given a free show to the throat tube guy across the room. A lab tech came to take the blood sample. She asked him to take it from her right arm as the left was very sore from previous samples and a missed IV insertion. He said it had to be the left because her IV was in the right but he would take it from her hand to avoid the sore area. He took it from the sore area anyway, apparently forgetting in just a few seconds where his target was.

The Ward:

Expected - Lovely Wife would be in a private room with minimal disturbances. She would have the IV removed. Sleep was the most important factor for her getting over the surgery. A sample would be taken the next morning to check the calcium again. Me and the boys could visit.

Actual - She was in a private room but it was very far from disturbance free. For the first 4 hours she was woken hourly for vitals checks. She fell asleep shortly after getting to the room so I told the nurse that I was going to pick up our kids and to make sure that she knew that when she woke up. When she was woken up for vitals check the nurse said she didn't know where I was. She called me on my cell, crying because she thought I just up and left her. Shortly after she hung up with me the nurse gave her the message that I had left to get the boys. I arrived back with the boys and was informed that a maximum of 2 visitors were allowed at a time. I reminded them that the hospital policy said 4 visitors and walked by. We stayed for about an hour until the boys couldn't stay still anymore and Lovely Wife couldn't stay awake any more. The IV was not removed because she had not started drinking again. Remember that she was totally and completely infused with fluids from being on an IV for seven hours by this time. It also was very painful to drink as she had just had her throat operated on. They finally removed it when she told them to bring bandages because she was taking it out herself. She was woken up just before midnight for vitals. She was woken up at 4:00 AM by an incredible ass of a lab tech who was shouting her last name at her to wake her up. This was for the calcium test.

Special Problem - Lovely Wife has a slight curvature in her cervical spine (neck) and easily aggravated neck pain. In surgery the neck is hyperexted (head pulled back to expose the throat). She was in agony from this, far worse than the pains from the actual surgical procedure. No pillows in recovery? No ability to go get a damn pillow for someone who had neck surgery and is stuck on a gurney for hours? Since the surgery the main problem has been the neck pain. In fact, Lovely Wife is at her physician's office right now because of this incredible neck pain.

Post-op/Release:

Expected - The morning after the surgery Lovely Wife would be released from hospital so long as her calcium levels were sufficient. Her thyroid doc and surgeon would both see her before she left to give instructions.

Actual - As expected, with a twist. She was given verbal and printed instructions from 3 sources - her thyroid doc, her surgeon and the hospital itself (nurses). In each case the verbal instructions contradicted the written ones. The instructions from the hospital/nurses contradicted both the thryoid doc and the surgeon on several points.

Special Problem - The day after a surgery when the patient was under general anesthesia is not a good day for verbal instructions. How sharp are you after a night of frequently broken sleep? Add in the mother of all hangovers from the massive drugs that you were pumped up with. Add in that you are not familiar with the field being discussed. Also put out contradictory information from three separate primary sources. Fortunately I was there for the bulk of it and I am familiar with the field and didn't have an anesthesiology hangover.

Summary:

At each step of this surgical procedure we were given incorrect information. There was no evidence of efficient process and communication between the different groups involved. There was little to no consideration of Lovely Wife as a patient and customer, only as a job or commodity. (Exception to the last - both the surgeon and the thryroid doc had excellent bedside manner and both listened when we asked questions and answered clearly and concisely.)

Interpretation:

The advent of the health maintenance system and conglomeration of hospitals has completely changed the way patients are viewed. The patient is no longer the customer, the HMO is. Patient satisfaction doesn't matter because when the bill is sent out the hospital's client is still going to pay. Hospital administration has no incentive to make their hospital the best for patient care because no matter which one you go to in the area you are going to one of their hospitals. Taking care of patients in a manner that the patient wants costs money. More nurses, better training, more collaboration and communication. Our current system makes it less profitable for a hospital to take care of its patients in an acceptable and expectable fashion.

Epilogue:

How do we fix this? I honestly don't know and don't even have any major insights except to go look at the Naval Hospital system. We didn't have any of those problems in the Navy. Systems were worked out and implemented. Departments knew what was happening in other departments - they talked to each other. Scheduling was done on a macro scale with implementation on a micro scale. A Short Stay ward would never be overbooked causing a backup of scheduled surgery patients in the recovery room. The largest apparent difference is that the sole objective of a Naval Hospital command is to make sick people better. They have no concerns over cash flow or accounts receivable. So is socialized health care the answer? There is worldwide evidence that it not only doesn't work but is one of the first steps to a broken economy. So look one level deeper and you see other important differences. Organization, cooperation and the enforced belief that taking care of the patient is the primary goal make the real difference between my Naval experiences and what I've encountered in civilian medicine.

Tell me more:

I'd love to hear anecdotes from y'all. I'm not inviting a bitch session - good or bad, it's the experience that matters. Did you or a loved one have similar encounters with the medicinal kind? Tell me about it. Did you have a good experience with surgery or a hospital stay? Lemme know.