Wednesday, January 4, 2017


The symptoms were flu-like, high temperature and chills.  My impulse was to ride it out, but when the thermometer read 104, my wife drove me to the emergency room late on a Friday afternoon.  Thus I entered the world of medicine, a landscape similar to that of some distant planet.

My experience with emergency rooms was limited to visiting my mother at a downtown Los Angeles hospital near the end of her life.  That one was secured by a uniformed policeman cum sidearm and a metal detector. This one lacked any visible security, but this is Texas, and everyone present may have carried a concealed weapon.  Emergency rooms are all about triage.  A clerk, phlebotomists, nurses, and, finally, a physician gave interviews with annoyingly-repetitious questions (what are your symptoms; when did they begin; are you taking any prescription medications?), listened with stethoscopes (“take a deep breath”), poked and drew blood.  About an hour after we walked in the door, my wife and I were ushered into an examination room where the poking and questioning began anew. Isn’t this redundancy what sharing digital information is supposed to make obsolete?   Finally a nurse terminated the examination and inserted an antibiotic drip. Then we waited, me on a gurney, my wife in a chair. 

Sometime around 3AM, my wife crawled onto the gurney with me.  She had finally reached the end of her heroic endurance, and she was cold.  By this time the antibiotics and extra strength Tylenol were reducing my symptoms.  The fever broke, and a nurse was on the point of releasing me when she witnessed my very shaky walk to the rest room.  I toddled back to the gurney with her aid.  Soon the fever returned as did the antibiotic drip. Tests would reveal that I had contracted something called streptococcus maitis, from a bacterium that resides in the mouth.  I had made myself sick brushing my teeth.

Diagnosis in hand, I was admitted to the hospital.  An orderly issued a hospital gown, socks with nonslip soles, a bed pan, towels and washcloths.  I felt like a GI starting boot camp.  Then a nurse assigned me a room and hooked up an IV pump that administered antibiotics and a saline solution.  Over the course of my stay eight nurses (Jo Jo, Michael, Florence (twice), Rachael, John, Michelle and LaVell) attended me day and night, taking vital signs, refreshing medications, asking for my name and date of birth. Their irritating care and the medication quickly reduced my symptoms and raised my hopes for an early dismissal. I received visitors and read novels for the rest of the weekend.

On Monday physicians began their rounds.  First among them was the infectious diseases specialist who had prepared my wife and me for our upcoming trip to Africa.  After going over my chart, he asked if we had altered our plans.  What he really meant was that, despite my protests, he intended to do whatever he could to convince us to postpone the trip.  In the end, and after getting the same advice from the resident overseeing my hospitalization, our primary care physician, and my sister-in-law, the pediatrician, I gave in.  Apparently, if not completely eradicated, the maitis bacterium can cluster on a heart valve and cause serious pumping problems.

The next evening, as I lay in bed, a technician installed a PICC (peripherally inserted central catheter), a thin, flexible tube threaded through a vein on my upper arm into a ventricle.  This allowed direct delivery of medication to the heart from syringes supplied by UPS.  The next day I was free to go, but not before signing a half ream of forms authorizing release of medical records, acknowledging that I understood the nature of my illness (a stretch) and promising to be good (what choice did I have?).

Once at home, I began a regimen of antibiotics administered through the PICC.  Every day at 11AM sharp my wife used syringes to push medicine and anticoagulants into my chest cavity.  This lasted a month and, apparently, did the job.  To mark the end of treatment, a nurse removed the syringe connection and pulled out the tube.  Therapy ended; billing began.

As a seventy-year-old and a retired academic, the cost of treatment and hospitalization did not affect my financial health.  But trying to deconstruct the billing documents has been migraine-inducing.  There are lines detailing services and costs followed by lines for Medicare, Medicare deductable, sequester adjustment, and finally “Amount You May Owe Provider.”  Some of the numbers are enormous, but through an inscrutable arithmetic, the bottom line is nearly always $0.00.  It is this system that Mr. Trump wants to disrupt; it gives me chills (and fever).