Modern Medicine
I am currently caught up in a Netflix series called New Amsterdam. The series is based on a book that was written about one of the great public hospitals in New York City, Bellevue, located on the East Side just south of NYU Langone Medical Center. It is not unlike ER in that much of the drama takes place in an Emergency Room setting, but it does try to go beyond that by including specialties like Oncology, Psychology (a particular stereotyping for Bellevue Hospital as a looney bin), Cardio-Thoracic and Neurology. The basic storyline that has caught my interest is that of a new Medical Director trying to bring patients back as the first priority of his doctors and to use the setting of a public hospital for that purpose. They try very hard to show ideas about how you can provide better patient care and do it in a way that saves money at the same time. We all know how hard that trick is, but its a worthy goal and they do a fine job of trying to show it. As a typical series, it has an ensemble cast that carry on their personal and professional dramas from one episode to the next. Doctors get sick as much as patients it seems and they screw up almost as much as patients do as well.
I have not spent a ton of time in hospitals compared to some people, but I’ve seen a bit of the action here and there. I remember one day in 1988 spending a day in the ER waiting for a deb to open up on the surgical floor. I was in due to an asymptomatic series of attacks, which turned out to be gall bladder attacks. those nasty buggers present themselves, especially when you are actually passing a gall stone through your bile duct, as though it were a heart attack. All of the same symptoms are present and even the most skilled cardiologist has a hard time telling them apart. Finally, after six months of on and off suffering, I went to the St. Vincent’s ER in Greenwich Village at the direction of my doctor, a well-known cardiologist that had run all of EMS for NYC and was now our friendly bank doctor so that he could reduce the stress of his work, which was literally killing him. During the morning in the ER, they happened to take me to a sonogram at just the right moment when I was passing a gall stone and that evidence locked down the diagnosis. Hence, my wait for the surgical floor room. I already had a surgeon, who had done an endoscopy on me a few weeks before. Now there was an experience. None of this micro arthroscopy we have today. That was when they shoved a black tube the side of a garden hose with a black spalding ball on the end down your throat to get a look at what was going on. Nothing a little Valium couldn’t help accomplish. It had all been very inconclusive, as had the hepatibiliary scan (a nuclear medicine scan of your liver and pancreas system), but now they had a picture of a gall stone so they were ready to roll.
The surgeon was an older man of very slight build. He told me that was a good thing for me as he held up his hands. He said, “you see, I have to be able to get both hands inside of you to get your gall bladder out, so the smaller my hands, the less big I have to make the incision. Thank God for that since I ended up with a diagonal 9” scar across my upper stomach. Nowadays, you get a few laparoscopic drill holes and everything is done by remote control, probably by surgeons with big hands…but who cares, right?
After surgery I was told by the nurse that I had coded during the surgery, and they had to shock me back. You see that all the time on these hospital shows, but you don’t like hearing that its been done to you. I didn’t feel anything the way you might if they had thumped on your chest to get you going. In fact, I remembered nothing. I asked the cardiologist what had happened and he just said that it was probably a drug interaction between the Tagamet I was taking and the anesthetic. He seemed unconcerned and said that these things just sometimes happen. Not to worry. But that’s a hard thing to do when you hear about such an episode.
I then went up to a nice high, sunny floor to recuperate for a few days since I had been sliced open from stem to stern. I had two drain tubes in me to get rid of fluids from the post-surgical recovery process. One day the doctor came in and was checking out the drains when he suddenly grabbed one and whipped it out of me with a flourish. It sent Rich innard juices flying around the room since the drain tube was the longer of the two (it went down my width to my back apparently) at about eighteen inches. It didn’t hurt, but it sure as hell felt funny and surprised the shit (literally) out of me. The surgeon said it was like ripping a bandaid off, best to do it quickly. He then poked at the other drain and I braced myself for a repeat performance and was underwhelmed. That tube was only about three inches long and came out in very calm and normal fashion. I asked about the drain holes and whether he would suture them closed. He said, no need, as they were already closing up by themselves and would be sealed in a matter of minutes. Who knew these things about the human body.
I’ve only been in the hospital a few more times since then. Once was in 2006 when I had my LapBand installed (I was out the same day) and twice for same-day colonoscopies. Now that I think about it, all four of my hospital visits were gut related. I guess I have to say live by the sword, go to the hospital by the sword. One other point about my hospital visits worth noting is that when they do colonoscopies these days they give you Propofol, the Michael Jackson sleep drug, and boy does that stuff work good. It helped me understand Michael’s predilection towards it. You sleep as soundly as you can imagine and you wake up totally refreshed and ready to conquer the world. I guess its still a dangerous and tricky drug to dose properly, but for a twenty minute colonoscopy nap, its the bomb.
I hope never to have to be in a hospital again, but none of us have the ability to predict that very easily. My brother-in-law Jeff is in the hospital right now, having undergone yet another back surgery for three hours yesterday. He will likely get released tomorrow. He says that so far he feels a lot less leg pain than he had before the surgery, but that his left leg functionality is still not right. He is hoping that this procedure will allow him to walk again, which he has only been able to do of late with a rolling walker. Just since I have been out here in San Diego, I have probably been to the hospital 6 or 7 times to pick him up, visit him or deliver him to the hospital for one surgery or another. Jeff has been living with hospitals for four years now and I’m guessing that the one thing he would say about modern medicine at this point is that there is still way too much guesswork and uncertainty. I know its a science, but it so often feels like an art, just like when they were trying to figure out my gall bladder thirty-five years ago. Modern medicine seems much more modern on TV than it does when you are at the wrong end of a scalpel.