Florida Hospital Flagler, Revisited

Florida Hospital Flagler, Revisited

Ever since the publication of Tour of Two Flagler Hospitals, Florida in this Blog (2/17/2012), I have felt some unease about my unflattering portrayal of Flagler Hospital in Palm Coast, Florida. It couldn’t be that bad, could it? My encounter was after all only one among hundreds and thousands of patient-encounters weekly and yearly at the hospital. I couldn’t claim my experience representative. Besides, the real name of the hospital, I had learned, is Florida Hospital Flagler, which means Florida Hospital in Flagler County.

Therefore, I would welcome the opportunity for a second look at the hospital if one arose. How might that happen? I didn’t know. But then on March 12, at about 2:30 in the afternoon, I stood up from the couch I had been sitting on in our Condo and froze half way up the elevation process with an original thought: “My artificial hip, on the right side, is almost out of its socket!” So I stopped right there in kind of a tent position, my left “good” leg with its own artificial hip fully-extended, and my problematic right leg somewhat extended too, but with my upper body still closer to the table than to the ceiling. I was able to grab my cane and extend it to support my left leg in an upright fashion and also to bend upwards into a more or less straight position, which was my general posture when my wife Beverly spotted me, and wondered why I was mimicking an ostrich. After a rapid explanation and several cogent inductions on her part, Beverly called 911, alerted the front gate of Matanzas Shore Villages of an ambulance arrival, unlocked the front door, placed a chair to my right for hand support, and mused with me on comfort issues and hospital destination. It turns out that it would have to be Florida Hospital Flagler again because the ambulance is a Flagler County service, unless of course we wanted to pay for a trip to the other Flagler Hospital in St. Augustine. We didn’t. We couldn’t. Besides the ambulance needed to stay in the area. It was Bike Week in Florida!

The ambulance service was as good in this intervention as on February 29th, when their services were last required: prompt; fast; intelligent; clear communication; patient inclusion in assessment process; and, excellent decision-making. The “wow” highlight for me: they managed to get my 240 pound body from the ostrich position onto a gurney, into the ambulance, to the hospital, off their gurney, and onto a hospital gurney, all without displacing the hip from it’s “hung up” position on the rim of the socket! That is remarkable! I had displaced this same hip in 2001 within a month of its installation. The pain was so excruciating on that occasion as to exceed comprehension by anyone who has not undergone the experience themselves. The leg hung there like a freely suspended hunk of meat for an hour-and-a-half, and I cursed the world and several guiltless deities for the full term. Thanks to the Flagler County ambulance crew, the hip wasn’t fully displaced this time until under the X-ray machine at the hospital. Of course, the pain of the 2001 displacement experience recalled itself afresh, despite the massive amount of painkiller I had just been given, but the hip’s resetting was nearly at hand. I had avoided most of the pain thanks to the EMS technicians.

These are the ‘highlights’ of my return to Flagler Hospital, Palm Coast, Florida:

– I was lucky to get an ambulance trip as quickly as I did, or perhaps at all. The Hammock Station ambulances had just concluded service at a serious motorcycle accident a mile away on State Route A1A outside of Washington Oaks State Park. A helicopter had been needed to evacuate a person in that accident.

– It was Bike Week. The EMS technician said that over 55,000 cyclists would be going through Palm Coast that week. Route A1A is a lovely route from St. Augustine to Daytona Beach, the Mecca of the Bike Week pilgrimage, and loads of bikers would be taking that route. It was only Monday, but the ambulance crews were already, as we’ve seen, dealing with motorcycle accidents. “It seems like it’s the ones without helmets who get killed or badly hurt,” the technician said. “It’s easy to die without a helmet, even at 15 MPH.” He cycles himself, but not without a helmet.

– The emergency room was busy this time, practically filled. “Busiest day of the week,” a nurse later told me, “Monday is always busiest, and this is Bike Week!” Oh, oh!  The desk personnel, laconic on January 29, were fully engaged now. “Take him to room 27” they ordered the ambulance crew. Off I went down past the place of Midgette’s first sighting, a right, a left, another left, I think, left again into room 27, and there I was plunked, switched successfully to a new gurney, and left to the care of others. This ward is a lot bigger than I had thought, and it’s mostly filled!

– Now here’s something readers will want to know. When an emergency department is full or overwhelmed, triage rules apply. As I understand triage, arriving patients are divided into three classes based on the degree of immediate need: immediate need, next most needy, and no hurry. The no hurry group, category three, includes people like me whose hip is hung up, but not displaced. As I laid in Room 27 a while, quite a duration of whiles in fact, it occurred to me that if category 1 and 2 cases arrive as fast or faster than their predecessors are discharged, then category 3, my class, is a virtually permanent status! (This is the kind of idea an active mind can invent in a hospital.) But yes, high frequency, rotating service to triage classes 1 and 2 patients could mean no service to class three for a long time. You worry that you have passed out of the dominion of the needy! A memory returned of my 86 year old Aunt Anne, a career nurse herself in her work years, being left in a corridor of an emergency ward for most of an afternoon, the neglect ending only when Beverly and I arrived at the hospital to inquire about her.

–  In this  malaise of fear and doubt, a “volunteer” arrives to ask, “How are you doing?” That was definitely a highlight. Her visit and caring intervention meant a great deal to me. She arranged for a Nurse’s Aide to assist in my comfort needs. Soon after that the head nurse arrived, and all the usual and expected things happened. Volunteers make a huge contribution to hospitals, and to many other organizations. What an important and vital form of citizenship. At Florida Hospital, Flagler they even have—I later learned—a valet service staffed by volunteers.

– When Dr. Ingrid Legall arrived, soon after the nurse had completed the platform services, everything moved along smoothly and efficiently, culminating in the return of the hip to its socket, a feat completed under anesthesia. Two large, strong men are widely storied to be needed for this procedure by slip hipsters, but the diminutive Dr. Legall “pulled it off” with ease, all by herself.  As the anesthesia was taking effect, my last image is of Dr. Legall, marking off the place on the gurney where she would be kneeling to gain the necessary traction for the pull! While she was working with me, Dr. Legall seemed to be working with about five other patients at the same time. She helped me overcome the fears I had about the category 3 triage classification. Who knows, perhaps I was really in class 2! Dr. Legall is one of the finest physicians I have met. If you move to the Palm Coast area, you would do well to inquire if she has an opening for your family in her practice.

– At the end of the day’s activities, when due for discharge, Karen, the nurse who had assisted Dr. Legall, helped get my clothes back on and transported me from the ward. We both were delighted to recall that she had performed the same service on January 29th. Yes, she had been Midgette’s replacement. When you’ve just got your leg back in working order, you’re naturally leery of displacing the hip again. So Karen put my shoes on for me. As she did so in her friendly, jocular way, she said she was a Georgia girl who had worked in a shoe store during her high school years. Knowing how to properly put on a shoe is a very helpful skill in working with patients like me.

–  The intake process is the last step in the process, as reported in the previous blog essay: the nurse discharges the patient to the account manager and the account manager discharges the patient from the hospital, after the collection of a co-payment and the signing and passage of legal documents. There are two problems with this: 1. It isn’t clear right away that the nurse is discharging the patient from medical care when she takes the patient to the account manager, and 2. The exit through the outside door to the open air by the account manager doesn’t come automatically with assistance into the car. A further difficulty is that the medical follow-up instructions, while passed to the patient in writing, are not automatically reviewed in spoken form unless the patient requests such a summation. I see lots of difficulties with these processes for non-English speakers, people who can’t read, and patients new to the area.

– Bottom line: Florida Hospital Flagler showed a much finer face this time around. Much of the care was outstanding. Dr Legall’s work was special and extraordinary. Yet, some of the problems with the emergency service noted in the previous essay continue as problems.

The next day I canceled the physical therapy I had been receiving from the Orthopaedic Clinic of Daytona Beach for the January 29th hip contusion. Also, I called the orthopedic physician I had been working with at the same clinic to schedule a follow-up visit. An appointment was made for the upcoming Thursday, two days later. As part of the process, the scheduler asked me an amazing question I would like to share with you in case the like is asked of you someday. How would you answer? Consider yourself forewarned.

“Will you be bringing your attorney with you?” She wanted to know! “Well no.” I replied, “Do you think I should?” I got no response to that question. Obviously, there is an interesting set of background stories behind that question. Stay tuned. I’ll try to find out what it is.

There’s another thing you might want to know in case you have a hip replacement. When I met with the Doctor two days later, he informed me that I was at risk of displacing the hip again, because I had already done that twice. He reminded me of the expected lifetime of the device, and noted that the date had already passed. Therefore, he concluded: “you should call the surgeon to secure the ‘operation list’ for the hip in case I or another surgeon are required to operate on short order.” He explained that the ‘operation list’ is the parts list for the type of artificial hip the surgeon had inserted. Such a list is required by the hospital as well as by the surgeon at the time of the original surgery.

Well, lo and behold, it turns out that neither the surgeon nor our family doctor had any record of the surgeries, or of  the ‘operations lists.’ I was told that doctors offices keep records in Maine for only seven years before discarding them entirely. My devices were inserted in 1999 and 2001. The surgeon had no records of any kind on my care, and our general physician had records only for the last seven years.

The answer to the puzzle, I’ve been informed, is that the hospital hosting the surgery is obliged to maintain a retreivable surgical record. Therefore, I have a submitted a written request to the medical records division of the hospital for the two operations lists.

The vital lesson: Get the operation list for an implanted device before you leave the hospital following surgery and combine this information with all your other important medical information onto a CD that can be taken with you when you travel. Be your own advocate, records clerk, and case manager!

Will Callender©

March 29, 2012

The American People

The American People

Every national politician loves the American People and speaks often of his fealty and devotion: “The American People are my employer.”  “I trust the American People.” “The safety of the American People is my primary concern.” “The American People will not stand for inaction.” “The American People are watching.” “The American People aren’t stupid.” “The American People have spoken.” “The American People are fed up!”  “I know the American People.”  “The American People deserve results.”

Examples of “The American People” (TAP) statements are ubiquitous, so common as to furnish a factual basis for a possible new branch of political sociology. The civics student could, for example, record and analyze TAP references of a favorite politician, government official, or political party over a significant period of time and analyze the results. Special attention would necessarily have to be given to the connection between TAP references and specific issues, and interpreted by context, options, risks, and outcomes. Connections to election outcomes would provide a particularly fertile area of study. Perhaps the types of TAP statements invoked in a fierce political campaign eventually approximate a bell-shaped curve in frequencies of citation.

Despite the cynicism TAP references justifiably earn as political jargon, they on balance are a civic good and a valuable practice. They show, for instance, that the politician is committed to democracy, appears to have the public welfare in mind, claims to be a public servant, and promises to serve the national interest rather than narrow self-interest. TAP references hint also that elections are not far away and that voters—the citizens—are the ones who determine the outcome. TAP references also have utility as stalking horses; letters, calls, and editorials provide a check on the going stock of likenesses that the alert politician might choose to invoke. The candidate is thereby encouraged to desist from some characterizations and to emphasize others, refining the more inspiring and evocative possibilities in transit. Even fatuous acclamations of the qualities of the citizenry thereby attain status as a kind of rhetorical art form. Besides, citizens want to hear what their representatives believe the nation stands for and what its people want from them. The word people itself is well chosen; it conveys inclusion by location within national borders without legal test or consideration of region, employment, wealth, or social class.

All virtues considered, TAP references are best listened to by a suspicious auditor. Pollsters, consultants, and think tanks typically recommend citizen characterizations to client politicians only after considerable study, and embed such depictions within a sophisticated list of “talking points.” Politics is a highly calculative endeavor. The purpose of a TAP reference within this formulaic process is to claim national unity and broad acclaim for one’s views and policies, and to motivate backers. Attention Americans! Listen up! You’ll find your own thoughts, concerns, and interests in my words. You will benefit from these policies. When I speak of the reasonableness of the American People, I mean you.

Such a calculated and manipulative process rarely produces inspiring images of the American People, and looking around at what is presented in the media these days, it isn’t doing so now! We’re all experts on this subject. So make your own judgment. Around the period of the last presidential election, the dominant images on the winning Democratic side were ones that highlighted a war-weary, torture-sick, economically burdened, ready for change, hopeful, yes-we-can kind of people. Since the depth of the financial meltdown has been felt, the economic stimulus bill judged inadequate, and the Affordable Care Act derided as “Obamacare,” the Republican Party has been featuring angry, over-taxed, over-regulated, sick of government, constitution-loving, deficit-hating, tea-partying, we-won’t-take-it-any-more kinds of Americans. In the meantime, academics of varying persuasions are speaking of broke, out-of –work, deep in debt, poor folk, over-weight folks, one percent rich greedy folks, 99 percent over-taxed folks, compulsive consumers, celebrity chasers, and sports enthusiasts. Everyone with a microphone features the fearful, terrorized American, a favored image since the bombings of the pentagon and the twin trade towers. Also, questions have been raised about the future status of illegal immigrants, and whether children born in the United States to such immigrants should retain their American citizenship.

This gets to the nub of the issue: when Americans speak of Americans, they mean all Americans only at times of great national achievement—men landing on the moon, hockey team winning the Olympics—and, the opposite, at times of stunning national disaster—Pearl Harbor, the assassination of President Kennedy, 9-11-2001. Otherwise, Americans mean by Americans: people like me, people like us. My kind is ‘We,’ your kind is ‘They.’ ‘We’ minus ‘They’ is the U.S.A. There are at this moment about 310 million Americans as counted by the Census Bureau.  The estimates for 2009 indicated that 79.6% of Americans were “White;” 12.9% Black; 1% “American Indian or Native;” 4.6% “Asian;” .2% “Hawaiian and other Pacific Islander;” 1.7% “Persons reporting two or more races;” and, 15.8% “Persons of Hispanic or Latino origin.” The Census Bureau also reports that of the 79.6% White Americans, 65.1%, are not Hispanic.”

This curious set of racial and ethnic categories in the latest Census reports suggests some of the historical we-they splits the nation has experienced, but also gives indication of problems overcome and progress made. You can be counted as “White” and also as “Hispanic” because there is intense political concern about immigration from Mexico and other Central and South American countries, and yet thousands of Americans who have been in the country for decades are from those countries. But you can’t be officially counted as Irish, Italian, Hungarian, or European any longer, or labeled “Caucasian;” you’ll have to be “White,” Similarly, you can label yourself as “”Black” or “African American,” but you can’t be labeled “Negroid.” And, thankfully slavery is gone, hopefully forever. In the same vein, you can be “Asian” in this overall summary without being distinguished “Mongoloid,” and whether you’re from China, Japan, Korea, or elsewhere is no longer considered information of the first rank compared to one’s standing as Asian.

These distinctions of race and ethnicity are some of the bases of we-they rifts in American society. Others are gender, sexual orientation, age, education, income, employment, wealth, power, religion, region, incarceration status, and social class. On the one hand, Americans can be thankful for the two-party system since it encourages diverse citizens to pursue common political issues across lines of difference and to be moderate in their expectations. On the other hand, the two party system is working badly these days, and Congress worse yet, lost in a kind of you’re either on my American side or their un-American side, with the corresponding loss of civility and bi-partisanship this two-sided language suggests. The United States is nearing a ridiculous situation in which 50 percent of the electorate rejects the political philosophy of the other fifty percent. President Washington, the first President to speak about the dangers of excess partisanship would be deeply saddened and one suspects offended.

When political factors such as these are considered by partisan politicians, their characterizations of ‘The American People’ refer to fewer and fewer Americans, far short of all Americans. The representative speaker of TAP references means 310 million people minus those people, those people, and those people, equaling some remainder number of “us” mainstream Americans in the U.S. Each of us, for purposes of self-honesty and reflection, would do well to compute our actual number when we drop from our image of Americans the groups we disapprove of.

In other words, we’re dividing ourselves to death and hiding excluded people under the name of ‘All.’ This has been blatant practice in the treatment of African-Americans, Native-Americans, gays and lesbians, the incacerated, and street people. When commercial images are thrown into the mix, with their condescending images of older people, who always need rejuvenation just to handle their grandchildren, middle-aged people who should be asking their doctor about a new product if they are to enjoy life, when the time is right, and images of young adults, who couldn’t live without a beer, game, or party to make life tolerable, the erosion of national identity is palpable.

The problem of TAP references, as these examples suggest, is twofold: 1.) demographic divisiveness:  the practice of evicting some categories of Americans from one’s characterizations of all Americans; and, 2.) the paucity of vision and inspiration in our characterizations of the remaining Americans after the devalued categories have been banished from the fold. The problem of demographic divisiveness is not for a lack of visionary images in our history and literature. Besides the nation’s founding documents, we have Lincoln’s Gettysburg Address, de Tocqueville’s Democracy in America, Martin Luther King’s “Dream,” Roosevelt’s “We have nothing to fear . . .” speech, and much, much else. The problem is that we routinely debase ourselves under the claim of describing ourselves. We don’t seem to want visionary images. We appear to prefer images that keep people who scare us, whether citizen or foreigner, out of our Eden. We want our piece of America, and increasingly that land is behind fences, gates, and guard posts. In lessening our image of the American, we are diminishing our vision of America.

That’s not an issue we should expect politicians alone to solve. It is up to each American to develop in communication with others a vision of the country that is inclusive, benevolent and worthy of our founding documents, institutions, history, and promise. It would be a good start if we determined to always mean all 310 million Americans when we use the term The American People. In the United States, there is only one people and that’s the whole blessed mess of us, with all our wild diversity, lovely colors, and endless ingenuity. Let us take our inspiration from the fact that we share our precious citizenship in common.

Will Callender, Jr.©

March 8, 2012