Tour of Two Flager Hospitals in Florida

Henry Flagler was a great man, and most deserving of the memorials which carry his name. The partner of John D. Rockefeller in Standard Oil (himself future first citizen of Ormand Beach), and railroad builder extraordinaire, his Florida East Coast Railway combined railroad station with destination hotel to attract nascent snowbirders to Florida, first to Jacksonville where he brought his sick wife for respite and renewal, and then, after building a railroad bridge across the St. Johns River, to St. Augustine, Ormand Beach, Palm Beach, Miami, and out to the Keys, all the way to Key West. The Flagler name is associated forever with St. Augustine, Palm Beach and Miami. More than a few consider him the greatest of all Floridians. Whitehall, his home in Palm Beach, now a museum, and the Ponce de Leon hotel in St. Augustine, are personal favorites of ours. As snowbirders actualized, we have enjoyed for many years the plays and public lectures at Flagler College in St. Augustine, a fine, up-and-coming, center of the city, liberal arts college, where Flagler’s Ponce de Leon Hotel now doubles as historical site and women’s dormitory.

While some might argue that two neighboring hospitals should not both carry the Flagler name, it seems right, given the honoree’s many contributions to the area, that the primary Hospital in Palm Coast, in Flagler County and West of Flagler Beach, be so named, and no one would question the same choice for the hospital in St. Augustine, in neighboring St. Johns County, After all, the two hospitals would still have 35 or so miles of space between them. Thus, it came to be, the region is today served by two Flagler hospitals.

If you lived in the area, or vacationed therein, as we do, you might wonder in dire situations which hospital to use, which would be best in an emergency. If you lived near Marineland, at the boundary line between Flagler County, to the south, and St. Johns County, to the north, you would be roughly midway between the two hospitals. If a medical emergency were to happen in that radial vicinity—let’s say on I-95, or on Route A1A—the patient would likely find himself in one or the other of the two hospitals. Which should one go to? Who could help us decide? Well, unfortunately, I can. I’ve recently completed the natural experiment of visiting each hospital’s emergency ward under trying conditions. My wife can be informative too, by sharing her experiences associated with my experiences.

Of course it took time, nearly four years, to pull the feat off. In March 2008, after a near faint at breakfast in St. Augustine Beach, I was admitted to Flagler Hospital, St. Augustine for chronic atrial fibrillation, and spent much time there over the next couple of months, culminating in the insertion of a pacemaker in May, before returning to Maine. We were living at the time in a rented condo just south of Marineland in Flagler County on route A1A. It doesn’t matter for present purposes that the pacemaker site became infected and that the device had to be pulled out upon arrival in Maine, only to be replaced in August with another pacemaker, leading to a repetition of the cycle, and ending in an identical result, its extraction in September. After that, it was decided a pacemaker wasn’t needed at all and I’ve been living just fine with natural equipment ever since. A cautionary tale there, perhaps, but I haven’t figured out what it is. The relevant point, though, is that the emergency care was excellent. The unit was organized, ready, welcoming, purposive, appropriate and motivated. A sense of teamwork pervaded the place; tests were organized and conducted in an efficient way; nurses, aides, and physicians worked in concert; communication was timely and clear. People were friendly. Everything that could be done for us was done. We were impressed and pleased with the care. Obviously an assessment of the medical advice that led to the implant surgery is questionable. Overall, though, we found Flagler Hospital, St. Augustine, top notch and I sent a letter to the chief executive thanking the hospital for their excellent care.

I didn’t know I would have the chance to evaluate the Emergency Room of the second Flagler Hospital, in the City of Palm Coast, until a fortnight ago, on Sunday, the 29^th of January. The opportunity came suddenly, quite by accident. My wife and I had just arrived from Maine at the same rented condo south of Marineland—our fifth straight winter there and seventh straight if two other rented condos are included. I was transporting the last baggage from Jeep to cart when the opportunity came to kick the curb and attempt a half gainer. I ended up with my back against the parking garage wall and my right leg feeling as if it might be broken, or worse, an artificial hip, of which I have two fine ones, displaced. So, what to do? Call over a couple of concerned people, one cleaning his car, another walking her dog, request a 911 call, and ask that my wife Beverly be informed. She was until then happily unpacking our stuff in the second floor condo. I was soon on my way to Flagler Hospital, Palm Coast, Florida.

The emergency medical technicians proved skilled and efficient. The unit, attached to the Flagler County Fire Department in Hammock, a small community and subdivision of Palm Coast where we reside, arrived within minutes. They accomplished the necessary analysis and arranged me for support and transport; we were on the way to the hospital within minutes. The technician who accompanied me in the ambulance was particularly impressive. He had done lots of things in his life and was obviously skilled and competent. He reminded me of the student speaker, an EMS professional himself, at our granddaughter’s university award ceremony this winter where both, as student-athletes, were receiving awards for scholarship. The speaker explained that he had returned full-time to the University at age 39 after a successful first career in Emergency Care. He sought to prepare himself for a second profession and career. He was not only on the inter-collegiate wrestling team, but a front-line wrestler, and leader, winning his share of matches. The guy who accompanied me to Flagler would have had similar success, I predict. He was a body builder, a fitness instructor, a former teacher, a football coach, a good critical thinker, and a very nice man. We hit it off. He had my vitals and background information ready for the hospital folks upon arrival. Probably he had called the information in.

There was an evident problem though. Beverly, who had taken my keys, wallet, and phone for safe-transport, had clarified directions with the ambulance driver before leaving. You’re going to Flagler Hospital, is that right? Yes. You’re going via I-95? Yes. Why, after this clarification, she had taken a hard right north on A1A, just after we turned hard south, was mystifying and disturbing. Oh-oh! I watched through the back window of the ambulance as she drove at a speed in slight excess of the Marineland speed limit as the shape of her vehicle diminished and finally dropped from view. When the ambulance door opened at the Hospital, the driver noted, “Your wife went the wrong way.” “Yes, I know.” It turned out that Beverly was unaware of the existence of a second Flagler Hospital. On the other hand, she could draw a detailed map of the St. Augustine hospital from her many visits there during my 2008 hospitalizations. Of course she went there.

You feel it immediately, upon entering the emergency ward, even before the door closes, a palpable atmosphere of isolation, alienation, resentment, mistrust, and carelessness. I’m an organizational analyst of sorts and have made a modest sum of money in such work. I sense work issues and organizational problems at operation behind a scene like this. No one was talking, no one moved. What’s wrong here, my brain is asking as the gurney is parked to the left of the nurse’s station, just beyond the view of the three silent people seated there. Could this be the improbable moment when an otherwise functional unit is caught in a funk? Perhaps. I hoped so. I wanted the place to be more welcoming than this.

As I lay there musing, I note that none of the three people at the desk has greeted the EMTs, who have stepped back around to the front, where I couldn’t see them, presumably to pass on the required paperwork to a staff person there. Silence. It is five o’clock or so on a Sunday afternoon, there are no patients in emergency—zero, none, only myself. There would only be one other during my several hours long visitation, and he and his family weren’t there long. In attendance are the three desk persons, I assume, the EMTs, and me. Silence. Just then I become aware of two eyes looking through glasses behind a machine at the far left of the short corridor housing five or so patient care stalls. What struck me were those eyes; their utter disdain. Oh! Oh! I hope she’s not going to take care of me. A few seconds later, I heard from behind the order, “put him in 9.” The EMTs did that, transferred me to a gurney, and wished me well, with the question: “how you doing?” “Okay,” I said,” but I have to get to a phone.” One technician pulled the wall phone over, told me to ring “9” to get outside, and then the two of them left. I tried to figure out how to reach my wife. Of course calling my own cell phone wouldn’t come to mind! I’m a terrible decision maker under pressure.

Midgette rescued me from the problem. That’s not her real name, of course, I seek to protect the guilty. She was my nurse, that was clear, and she was the one in charge, she announced directly upon entering the room, and as she returned the phone to its rightful position. She had a wristband for me. Oops, there was a problem, my birthday wasn’t the 13^th of December, it was the 14^th, why had I told them it was the 13^th, that was unfathomable, and now it would have to be done again, She’d be right back. That’s the only time my name came up and was spoken in the emergency ward that day.

Why don’t I just summarize the visit? Good news, nothing is broken, no displaced hip. This is determined first by a series of X-rays, and then, as a special concern for the artificial hip, by CT Scan. Hip Contusion is the diagnosis. Although a severe contusion, I can go home with Beverly when she arrives.

The two X-ray technicians had turned out to be proficient practitioners of their art and even allowed questions and suggestions to influence their transport decisions. They were fine, although—under the sway of the general atmosphere, and still reeling from the Midgette experience, and all too soon to be returned to her embrace—I could not help but note what apt choices these two men would have made for an Alfred Hitchcock movie, perhaps as orderlies in a mental hospital scene. They would have been scary if they weren’t so nice.

The CT Scan technician was another matter; I feel lucky to have survived her transport and gurney transfer techniques, to which choices, in regard to gurney transfer, I contributed my successful step pattern suggestion so recently welcomed by the X-ray technicians. “No,” she replied, as if to convey: not here, not now, not ever, that could never work. She took good pictures though, and she was fast. She ran the cart at a speed and pace reminiscent of the skilled luge sledder approaching take off. A shift change coming up, or  perhaps a date, she was obviously in a hurry; she showed what efficiency could mean. As she approached patient care room number 9, my room, where my wife, recently arrived from St. Augustine, now stood in the doorway, the luge-running CT scanner exclaimed: “Get out of the way or I’ll run you over.” My edgy spouse thought it fit to respond to the words of this out of control, younger, and taller person: ” I wouldn’t try that if I were you lady!”

Paul, the Physician Assistant, who did the doctoring work in my case, was a thoughtful, caring human being. He did his job well. He exhibited the behavior and attitudes expected of a health professional. He communicated the test results clearly, conveyed expectations, noted possibilities, and set out the care plan. He welcomed questions, expressed concern about my wife’s whereabouts, and even volunteered to extend the blanket over my cold feet. He had been in my position himself, he said. He knew how it felt. He made sure the nurse beeper system was hooked up so I could contact Midgette, when wanted. I tried it out seeking a glass of water. Failed.

By this time I’d seen Midgette several times: the bracelet; the extraction of my clothes (complaint: shirt is wet! As if to say, “disgusting.”); installation of blood pressure cup and of oxygen monitor (well done; professional, even informed me of the good pressure reading); and, insertion of IV, this just after PA has told me of X-ray results and that I’d be going home. I did not see two professionals working or talking together while I was there, excepting the X-ray guys of course! Otherwise, it was always one person alone, serial care. It showed up in the miscommunication.

“Why an IV, Nurse?” “Doctor’s orders!” “For what?” “Pain control.” “ Pain control, great, but I thought I was going home.” “Morphine.” “Morphine? I told the EMTs twice that morphine doesn’t work for me. I don’t want it.” “Well, it might work this time!”

Later on, me asking question of Midgette: “What did you do with the morphine?” Context: She had put the IV in anyhow, and expertly, despite my concern and questions. Then, she had inserted something into it. I assume now that she had merely flushed the device, but I thought then that she might have given me the painkiller. She hadn’t said anything to me. My question was taken as an insult, as a veiled accusation that she might be up to something with the morphine. Her response. “You refused it. It’s on the counter. Someone will come to get it.” She was on the way out the door. I stopped her: “Nurse, I have a problem.” “What?” “My wife, she hasn’t shown up.” “Missing, is she, well she’ll show up.” Gone. That’s the last time I saw Midgette.

Beverly did show up finally, after first visiting the emergency ward at Flagler Hospital, St. Augustine. Their staff showed all the concern and gave all the help one might expect for a spouse whose husband is in an ambulance and hasn’t yet shown up at the hospital. After some queries were made, they called Flagler Hospital, Palm Coast, established that I was there, and helped her plan the travel route to get there. The helper did note, not so reassuringly, “this is hardly the first time this has happened.” Oh, is that so? Is it wise then to have two such close hospitals carrying the Flagler name?

When Beverly arrived at Flagler Hospital, Palm Coast, close to two hours after her trip began, and while I was about to be whisked away luge racing through a CT Scan, she went to the nurse’s station, or front desk, where the EMTs had presented my credentials earlier. A young man was on duty. He didn’t look up. Beverly introduced herself and said she was looking for her husband, Will Callender, who had come by ambulance earlier. He pointed to a phone and said: “dial XXXX on that phone and they’ll tell you where he is.” He returned to his own concerns. When the number is dialed, Beverly is informed that Room 9 is my room. The room is two doors, fifteen feet away, and in the line of vision of the man at the desk. And, as previously related, I’m the only patient on the floor. But as ridiculous as it seems, he required her to use the phone when he could have just pointed. He could have saved his breath by manipulating his finger. Beverly waited in the room during the CT scan and was in the doorway to welcome us back as the luge runner bore down on her. And so it went!

At Flagler Hospital, Palm Coast, “intake” is completed at the end of an emergency visit, rather than before care is given. I kind of liked that, particularly because Beverly had all of my credentials and cards with her. Thus, there came a time, about 8 o’clock, when Midgette’s replacement, the evening charge nurse, removed my IV, communicated my treatment plan and prescriptions, and presented Beverly and I at a speak-easy or racetrack size ticket window in a wall of a six-foot by eight-foot sized room. A welcoming person sat well protected beyond the small hole in the wall. We shuffled all the right papers back and forth between us, with notable success, paid our deductible, and agreed our arrangement was now completed. The account clerk then joined us from behind her window to take my wheel chair to the street, through a special door for that purpose. At that point I realized that the medical professionals had discharged me from their care at the point they turned me over to the account clerk earlier, so that this egress was in fact from the business office!

The account clerk obviously knew this and therefore parked the chair high on the entrance apron rather than take me to the car, which Beverly was retrieving from the lot as the clerk locked the brakes on the wheelchair. “If you need help,” she cautioned, “have your wife ask the person at the desk inside.” The account clerk then left! “Goodbye.” Bev did go back inside through the front door—in effect returning to the Emergency unit after I had been discharged in order to secure someone who could complete the discharge. A young man came out promptly and completed this task ably and affably. He was along with Paul one of the people who acted like a full human being that day. Somehow I don’t think the stay experience would have been much better if he had been there to greet me on arrival, but it sure was nice to leave to the accompaniment of a happy face.

After discharge, it was off in search of food and an all night pharmacy to fill the painkiller prescription and pick up a walker. Despite multiple missteps and mild disappointments, we found the right pharmacy and filled the prescription; walker couldn’t be had until tomorrow. What to do about food? Answer: purchase an amazing load of comfort food, AKA junk food, at CVS, forty dollars or so worth! While Beverly made this purchase, I called the family back home to assure them that we had arrived safely, and were well, except for the minor boo-boos of an accident. Yes, Mom had to drive 40 additional miles between hospitals after driving 300 miles to get us there that day. Hah! Hah! Hah! No, don’t worry! Why do we find it irresistible to mislead the ones we love? And so we arrived at the condo for our three month stay, food and prescription in hand, and me “walking” through the use of a plastic lawn chair, a walker equivalent invented by the resourceful Beverly.

The next morning Bev went to Publix to buy us some real food, only to find her Visa Card refused; thank goodness she also had a Mastercharge card in the wallet. It turns out that Visa had shut the card off when some late night fool used it to buy painkillers and forty bucks of food at a remote CVS on a Sunday night! Not like us! Who would do a thing like that? Thus we were able to resolve the metaphysical puzzle of how an innocent stumble one afternoon could cause the termination of a credit card by morning without active human intervention!

That’s the end of our hospital tour for now, the tale of two Flagler hospitals. Here is how Beverly told the story of our exciting trip to family and friends via email the next day:

The start of our trip was a little shaky when we gleefully jumped in the car and turned the key to a dead battery!!!  Happily AAA must have been in the neighborhood and was there in no time; the battery was declared fine (we must have left the rear door ajar when we packed the night before) and we were on our way. Except for an hour’s rain in Connecticut, the weather was clear, warmer than usual and for the first time ever there wasn’t a drop of snow from Massachusetts on! We arrived here at the condo Sunday afternoon happy as clams. THAT lasted about 25 minutes. I was unpacking and Will was about to bring up the last load when he jammed his foot on the car curb between Jeep and cart and took a flip. He fell one way—his leg evidently took another route. A very nice, young Dutchman alerted me. Several people had gathered by the time I got to the garage. Someone called 911, the men threw that last load back in the car and put the bikes back on, while I raced up and down stairs getting stuff, forgetting stuff and checking to see if I locked the door. They were loading Will into the ambulance when I skidded to a stop. They told me they were heading up to Rte. 95 to Flagler Hospital and asked me did I know the way? I sure as hell did and I wasn’t going up to 95 to get there! I was in the ER waiting room for nearly a half hour and they kept telling me he hadn’t showed up on the computer yet, when finally some bright guy asked me where they had picked him up? When I told him Palm Coast, he said “Oh, I bet they took him to the other Flagler; let me call and see.” Another Flagler! Is there one? Well, yes, indeed there is, and yes they had taken him there. I was now over 30 miles away!! The good news when I finally got to the right hospital was that the x-rays showed that nothing was broken and Will was about to have a CT to make sure that the artificial hip hadn’t been jarred out of place. It hadn’t. He JUST had very severe contusions, a badly swollen thigh and quite a bit of pain. They gave him prescriptions for painkiller and a walker and directed us to an all-night pharmacy. (It was nearly 10 pm.) Their directions were wrong—that was NOT the all-night pharmacy, but they had new directions for us (about 15 miles away). We were able to get the painkiller, but no walker. We also had no food and even Walmart closes at 10 on Sunday, so we ended up getting as much edible junk as we could and spent the ride back here trying to think of ways to get him out of the car and up to the condo. A combination of the grocery cart and a porch chair did the trick. The final blow was the next morning when I went to buy about a month’s worth of groceries and my credit card was turned down. VISA had shut it down because SOMEONE was buying drugs and junk food late the night before in FLORIDA!! Visa didn’t think it could be us. (Luckily I had a Sears Mastercard that I’d never used before on me.) Needless to say things are looking up a bit. The swelling in Will’s leg has gone down a little and he’s fairly mobile using a walker we rented. We’re hopeful that he’ll be able to discard it soon. The weather has been perfect! Love to all, Bev

Will Callender©

Beverly Callender©

February 17, 2012