Monday, June 12, 2006

What a Difference a Few Days Make

Back in 1959 (when Bonnie and I were all of 10 years old) Dinah Washington recorded a pretty little melody called What a Difference a Day Makes. If you'd like to hear that pretty little melody, visit this site.

During a discussion with Bonnie's doctor over the phone, on May 2nd, I was informed that we needed to meet to discuss Bonnie's refusal to sign the consent required to begin treatments. I agreed to do so, and on May 4th, a Thursday, I fortified myself with medication and drove to the hospital. After having parked in the lot on the south side of the hospital, I crossed the street and headed for the disabled-accessible door that I had used on previous occasions. It was my unlucky day - there was some sort of reconstruction being performed, and the entrance was roped off. I was forced to hobble a block to the east to the next available door, which had a flight of eight steps leading up to it, and in the vestibule, another eight steps leading down. The extra two blocks and 16 steps did nothing to make me feel better.

I made it to the ward at around 9 am. The desk attendants were quite surprised to see me (normal visiting hours are from 3 to 8 pm.) I explained, once I had regained my breath (the walk had consumed most of my small reserves) that I was there to meet the doctor at her request, and they eventually let me in to see Bonnie.

As we had not seen each other since April 19th, you may well imagine the scene that then took place. The doctor came into the room not long afterward to introduce herself, at which point Bonnie curtly asked if she and I could have some time alone. I was a bit nonplussed, as I was eager to discuss matters with the doctor, and I knew that she would be leaving around noon to attend a seminar. After having spent an hour or so talking with Bonnie, I went out to the desk in search of the doctor. We did finally have a short discussion in the small lounge while the staff was cleaning Bonnie's room.

I explained to the doctor that, if Bonnie's consent was not forthcoming, I would be happy to sign in her stead, as I was eager to have the treatments begin. It was at this point that the doctor became slightly evasive, indicating that she didn't think that would be allowable and that, since Bonnie had demonstrated no sign of progress, she had begun making arrangements for Bonnie to possibly receive treatment at the Rochester Psychiatric Center.  At no point did the doctor inquire of me whether this would be inconvenient for me.

The meeting, from my point of view, was rather unsatisfactory and vaguely unsettling. To make matters worse, the haze of pain occasioned by my first real exercise since leaving the hospital on April 21st was interfering with my concentration, and I wasn't quite certain that anything had actually been settled.

Sometime during the afternoon, an attendant came into Bonnie's room , introduced himself to us, and indicated that he would in some capacity (perhaps as nurse) be involved in Bonnie's case once she had been moved to the Rochester Psychiatric Center. This, you may imagine, was cause for dismay, as I had not, I thought, been properly consulted with as to this action, and it seemed that it was being presented to me as a fait accompli.

Over the weekend, I had a discussion with a friend (who accomplished some helpful research for me, and who encouraged me to take action), and on Monday, May 8th, I sent this email -

Dr. Brewer, i am sending this in a small amount of desperation. My wife, Bonnie, who you last treated for clinical depression in early 2000, is once again in the Psych Ward at Strong Memorial. This time, however, despite my assurances and her records, the attending physician seems to want to transfer Bonnie to the Rochester Psychiatric Center.

Since you personally have treated her, you understand how well Bonnie responds to ECT treatments. Bonnie, as on former occasions, is refusing to sign the consent forms. If it is at all possible, as I believe I may have done on the previous occasion, I am willing to sign the forms in her stead, so that her treatment may begin in an expeditious manner.
I am unwilling to see Bonnie transferred, as it would cause a large disruption in both our lives. It would be far easier if Bonnie were to be treated sooner rather than later, and I am unsure that if Bonnie were to be transferred, her records would be transferred with her.
I ask you to please give this matter some consideration, and if possible smooth the way for us.
Any help that you may give us in this matter would be greatly appreciated.
Thank you for your time and attention.
As I explained in a previous post, when next I spoke to Bonnie's doctor, her attitude had altered, and I discovered that Bonnie had been assigned a doctor expert in ECT. What I did not realize until this last Friday was how very close matters had approached to having reached a different outcome. Among the papers that any patient receives upon being assigned to the ward, I discovered an envelope containing this missive, dated May 10th and addressed to Bonnie -
SMH Inpatient Service 2-9200
Dear Ms.          ,
A hearing was held on this date to discuss the recommendation of your treatment team that your care should be transferred to the Rochester Psychiatric Center.
It appears to me that you would benefit from continued inpatient care, and that a transfer to a close facility would not inconvenience your family. I am therefore recommending that your treatment team make the necessary arrangements for your transfer to Rochester Psychiatric Center so that you might receive long-term care that is indicated. (Emphasis mine.)
That's how close it came, my friends. If I had not sent the email on Monday, Bonnie would most likely have been transferred that week, and I might have returned to the ward to discover that she was no longer there (needless to say, no one felt the need to inform me of this letter or the imminent transfer.)
One could wish that, at least here in Rochester, family members were held in some small regard, rather than being treated as something to be scraped off one's shoe.
Bonnie is to receive two more treatments, on Tuesday and Thursday, and one of her nurses indicated that there is a very good possibility that she will be released Friday.
As of today, Bonnie is recovering well, but her powers of concentration leave something to be desired. She had managed to acquire a book from somewhere, and she did make frequent attempts to read it, but it seemed that she was making no real progress. I am going to keep a close eye on this development, and if it continues beyond the end of treatment, I may have to make arrangements for maintenance treatments on an outpatient basis.
When I was released from the hospital back in April, I was told by my friendly and kind (and patient) attendant that unspoken hospital policy is to discharge patients as quickly as possible (I believe I have seen this referred to elsewhere as "treat 'em and street 'em".) If this is true (and there is some basis for believing that it is), it is an indictment of our present health care system that must be investigated in some respect, so that patients are not released before everything has been done to assure that they are ready for release. If you or someone you love find yourself in need of health care, all that I can say to you is, be vigilant.


queenb8261 said...

Good thing you sent that email.  Hope she gets to come home Friday.

mnchickluvsocc said...

Long time no "see" Malcolm (or should I call you Walter? Not sure...I have got so used to calling you Malcolm...but I suppose Walter would do. :) ).

As the daughter of a manager of a very large clinic for a very large health system (that was a mouth full!) I can say that I 100% agree with you about being vigilant about a loved ones, or your own, health care. "Treat em and Street em" has become too common of a practice these days due to patient overload and all the politics going on with HMO's and PPO's. It's sad. I am so glad that Bonnie has you to look out for her and her well being. (As I am sure she would do for you if the situation was reversed). Ask question's...doctors know a lot but not all. Under pressure from insurance companies (ironically the industry I work in..sales of insurance that is) doctors will often times declare patients ready for release or transfer without a thought as to if it is good for them and their families or not and without regard for the fact that they may NOT be ready for release. Is it because they are heartless? I don't think is pressure and politics plain and simple and it is sad. Take care of Bonnie and take care of yourself. Keep questioning and doing what is right for herself and for you.


fitzzer said...

OMG - I often wonder why I'm amazed at hearing yet another such story about our medical system. It seems like only money matters and not the patient. And don't even think about caring about the families feelings. So ridiculous and frustrating. I'm so glad you wrote the e-mail and hope Bonnie is doing well and home again soon.

sunnyside46 said...

and it is so hard when you are under the stress that ensues from the illness of a loved one....and you are not well either.