Go this way and that way…

“Well, hello Mr. Kirkpatrick! I don’t know if you remember me but I saw you -sometime last year I think.”

“Sure, you’re Doctor Peach and the last time we saw each other you were wearing an arm brace.” I replied.

“Ah! That would put it at the end of last summer. I remember you because you were pretty insistent that you didn’t want to stay with us.”

“Well, no offense was intended. The treatment I get is excellent, I just hate hospitals.”

“Then what makes staying so bad?”

“The beds actually hurt me. I can’t find a comfortable position on them. When I do finally get into a reasonably acceptable position and fall asleep, someone wakes me up to take blood, give me a breathing treatment, take my vitals, change my saline IV or bring me food that, honestly, I can’t eat. My appetite and tastes have been wrecked by the chemo I took and it’s still affecting me all these years later. It has nothing to do with your care.”

“Well, that’s good to hear. So, what brings you here today?” he asked me.

“Severe chest pain, seems a little coupled with breathing. It surrounds my lungs like a halo and puts pressure on my sternum. I don’t think I have a heart problem.”

“Well, the EKG backs up your assumption. Your heart seems to be working just fine, but your blood pressure and heart rate are on the low side.”

We chatted about what other symptoms I was feeling and played question and answer for a while until they sent me for a chest xray and a CAT Scan. Then it was a matter of waiting for cultures and other lab results from the various samples they took from me. I was lightly dozing in a comfortable fog when he returned. Four hours had passed since I signed in.

“Have you had any swallowing problems?” asked the Doctor.

“No. I don’t think so. Why do you ask?”

“You’ve got some foam in the lungs that indicates that you may have aspirated some food or saliva. That could cause an infection and produce the symptoms we’re seeing and the test results we’re getting. I’d suggest that you stay here for a day or two to just keep an eye on things but I know you wouldn’t like that very much.”

“Well, if there’s a good reason for me to be here, then I’m okay with staying. But of it is just a matter of keeping an eye on me, taking vitals and handing me my meds, well, I can do that at home where I have a pretty good setup. Full hospital bed with memory foam mattress, a trapeze to help me move, a 50 inch TV to watch movies and stuff on, and it even hooks to my PC as a monitor. My wife is happy to make me food and will produce a menu of things I can and still like to eat and she keeps me company. She’d be coming out here every day to hang out with me so it’s more convenient for her to be at home as well. She has all of her diversions and her own bed and chairs -all a lot more comfy than a visitor chair. Worst of all, your internet here is terrible. Half the time I fails trying to send or receive email. That means I have to brink my iPad and run it in hotspot mode so I can get at least a megabyte of connectivity. Still not enough to stream Netflix, Hulu or Amazon though. My home connection is 120 megabit of business class connectivity.”

“Can I move in with you?” asked the doctor. My nurse was waving and pointing at herself while nodding as if to say ‘me too!’ I laughed and said we had two extra bedrooms, first come, first served and I’d be happy to have my own medical team in house.

In my area, the VA has been working to improve their medical care and patient support. The administrative arm makes that a pretty tough row to hoe. For every little gain in efficiency, the Spokane VA is inundated with more vets to handle.  The load on staff members is pretty heavy yet the face it with a smile. Sure, there are a few bad eggs; some people hate their job no matter what it is and some people are just plain unfriendly. But Spokane tries and it shows.

The patient overload make access to care problematic. Personally, I believe that there should be two levels of care. The first is for people who are, for the most part, healthy. They come in for colds and flu, the odd accident or slowly increasing symptoms that may be indicating something is amiss. The second level is for people who have established chronic need for medical care. People who, like myself, have cancer or other life threatening illness. These people should be assigned to teams who are up to date on the patient’s situation and can get care 24/7. A simple infection for these people can have lethal consequence, so it’s important to be able to bypass much of the redundant testing and get straight to the tests which are relevant to their condition, antibiotics and pain relief. Trying to merge these two levels of care into a single system redoubles doctor’s efforts and multiplies the cost of patient treatment, never mind extending the suffering of the needy patient while following a general one-size-fits-all policy.

The government is famous for cutting off its foot to spite its face. The VA has to stop closing facilities and then updating the abilities of others. This has proven to overload the care system and cause more suffering. Build and fully staff facilities in all areas with a sufficient volume of veterans to warrant a care center, then operate that center with the two-tiered system that gets the type of care needed to the vets in need.