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
profunditiesandabsurdities 
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