July 30th, 2011 10:14 EST
17 Prescriptions From Five Doctors and No One is Coordinating Them
Prescriptions for disaster
"I want to show you something," the pharmacist said. "I made this chart to help you understand the situation. There are 17 prescriptions here. The ones I`ve marked with yellow should not be taken with the ones I`ve marked with green." These prescriptions came from five physicians: a cardiologist, an oncologist, an internist, a urologist and an emergency room resident.
My mother`s second husband was critically ill with leukemia, congestive heart disease and a number of other ailments. She herself was ill, and I had come more than three hundred miles to care for him, knowing almost nothing of his medical history. A visiting nurse had just advised me to buy a nutrient formula for him, because he wasn`t eating. I stood staring at the pharmacist`s chart in dismay. What to do? Where to begin?
The next day I called each physician`s office. After getting hung up on the telephone tree, I got the usual runaround. I would have to make an appointment. The doctor`s schedule was full for several weeks. No, I couldn`t speak with the doctor. No, no one in the office could advise me. I saved the internist for last, because I believed he would put the situation into perspective. But in each case no one took responsibility for anything more than offering another appointment, an appointment the patient was too sick to keep. So here an elderly man was critically ill, the pharmacist had sounded a dire warning, and not a single one of the patient`s expensive doctors was taking any responsibility for coordinating his care, although they were all eager to run up his bills further with appointments that would probably complicate his predicament even more.
I went to the emergency room of a local hospital. There at least I got some help. An intern told me I should immediately stop giving the patient the drugs the pharmacist had marked. I said the patient was having trouble keeping anything down, and the intern edited the list down to three drugs and told me to bring the patient in. I remember that Coumadin and Digoxin were two of the remaining drugs, and he was having trouble getting them down.
Four weeks later the patient was dead. I had brought him to the hospital emergency room six days earlier. Two days later he fell into a coma and never awoke. He spent his last conscious days calling for help, but by that time he was beyond help. The people who should have helped had absolved themselves of his problems by saying the problems didn`t match their specialties.
When I spoke to one of the hospital doctors, a young German on an exchange program, he told me, I have to tell you that trying to take all those drugs didn`t help and may have hastened his death. " But they were all prescribed, " I said. Yes, " the doctor said, but nobody was coordinating his treatment, and when specialists don`t consult with each other they`re conspiring in the patient`s trouble. " I could tell the young doctor was troubled by what had happened.
Conspiring in the patient`s trouble. That`s about the size and shape of our health care crisis. It`s a giant billing apparatus conspiring to jerk the patient from one place to another, refusing "like our media "to address the big picture. [Indeed just recently when I transferred records from one dermatologist to another I noticed that the first doctor had billed Medicare for surgery that never happened.]
Even if this system did not actually kill my mother`s husband, it made his remaining weeks excruciating and frustrating with its indifference to his plight. And at no time in his long illness was there ever a question of money. He paid each of his rapidly multiplying medical bills on time and in full.
And after he was gone laboratories of various kinds to which urine and blood samples had been sent continued to dun him for charges that had already been paid. In some cases he paid as many as three times, struggling even at the end of his life to be honorable and responsible. In other cases, the laboratories billed him and Medicare, too. And even after I provided them with photocopies of checks and invoices, they continued to send bills and finally to turn over their demands to collecting agencies that threatened the dead man`s credit.
Could there be in any of this clues to our high medical costs, to our inefficiency? Our health care system`s performance is ranked 37th in the world, and yet it is the world`s most costly. What is there to be learned in this sorry story? What, especially, is to be learned by a society that seemingly has consented to the deregulation of industries capable of sickening us?
All this happened in 1989. Has anything improved? I don`t know. But from what I hear things have gotten worse. If Apple or Google ran itself like our medical system they would be falafel stands.
Imagine a sick man struggling to ingest 17 prescriptions from five doctors "no one coordinating, no one cross-checking, no one providing the patient with an overview, no one advising his caregivers or family, no one even talking to anybody between appointments, no one even reachable by phone except secretaries, Is this health care or unconscionable avarice?
But what is worse than of this is the knowledge that millions of Americans can`t afford a single prescription or a doctor to kick their well-being from pillar to post.
Djelloul Marbrook`s first book, Far from Algiers (Kent State University Press, 2008) won the 2007 Stan and Tom Wick Poetry Prize and the 2010 International Book Award in poetry. Artists` Hill, an excerpt from his unpublished novel, Crowds of One, won the 2008 Literal Latté first prize in fiction. Artemisia`s Wolf, a novella, was published by Prakash Books of India early in 2011. Alice Miller`s Room, a novella, was published in 1999 by OnlineOriginals.com (UK) as an e-book, and Bliss Plot Press of Woodstock, NY, recently published his novella, Saraceno, as an e-book. Orbis (UK), Smashwords.com, Potomac Review (Maryland) and Prima Materia (New York). His second book of poems is Brushstrokes and Glances (Deerbrook Editions, 2010). Recent poems were published by American Poetry Review, Barrow Street, Oberon, Meadowland Review, The Same, Reed, The Ledge, Poemeleon, Poets Against War, Fledgling Rag, Daylight Burglary, Le Zaporogue, Atticus, Long Island Quarterly, ReDactions, Istanbul Literary Review, Arabesques Literary and Cultural Review, Damazine, Perpetuum Mobile, Attic, and Chronogram. A retired newspaper editor and Navy veteran, he lives in Germantown, NY, with his wife Marilyn, and has lifelong ties to Woodstock.
Del`s book, Far From Algiers: http://upress.kent.edu/books/Marbrook_D.htm
New review of Far from Algiers: http://www.rattle.com/blog/2009/05/far-from-algiers-by-djelloul-marbrook/
Artists Hill, Literal Latté`s fiction first prize: http://www.literal-latte.com/author/djelloulmarbrook/
His blog: http://www.djelloulmarbrook.com
His mother`s art: http://www.juanitaguccione.com
His aunt`s art: http://www.irenericepereira.com