Occam's Razor

I recently spent two nights in the hospital. To say the least, these are rare events. My previous hospitalization was more than ten years earlier. I can expect more of these events as I age. Some like my neighbor Rod become something of a hospitalization champs. Even he can’t tell you how many times he’s been in the hospital but it’s in excess of two dozen times. He’s in his 80s and most recently it was for more back surgery that left a fifteen inch scar.

It was two nights, which was one more than I wanted to stay, but overall I was impressed by the whole experience. I was in the emergency department the day before. They diagnosed my abscess and a surgeon had me under the knife less than a day later. Since I am now on Medicare, I got to discover its benefits too. With Part B insurance and separate insurance mostly for my wife, I expect little or no bills from it all. The private insurance should pick up the copays and deductibles.

We’re fortunate to have a great community hospital just a few miles from our house. But it’s not my first time there. My wife had two knee replacements there and even I have experienced it on an outpatient basis: I had two colonoscopies there. It’s pretty old but nice and since there are no other hospitals nearby has something of a monopoly. Like most hospitals it’s a bit frantic when you are in its system, but the proof is in the pudding: when I needed it, it came through for me.

That’s not always the case, of course. If you have a teenager that needs a pediatric bed for mental health services, good luck finding one. In Virginia there are none available. The same is true around here. The pandemic brought with it a mental health crisis and our system was simply not staffed to deal with it.

I saw some of this when I was in the emergency department the day before my surgery. While I waited for a few hours in a bay, a clearly psychotic patient was roaming the halls making hell for the nurses. It was a long story on endless repeat about how his girlfriend ditched him and how he wanted to go home. I wanted to go into the hallway and slap his face. I commiserated with the nurse about him but they get patients like this every day. The mental health crisis is trying to be treated in the emergency department. It’s not working very well, leading to a campaign to expand the size of the department. They need it. My wife volunteers there. The other day they reached a new record: fifty five ambulances in one day.

On the other hand, when I arrived around noon for my surgery, all ran like clockwork. Within fifteen minutes I was in a bay attended by nurses with an IV going into my arm. The IV had an antibiotic necessary before the surgeon drained my abscess as reinfection was a distinct possibility. The surgeon arrived early; I had a breezy chat with the anesthesiologist who said not to worry because I had sleep apnea. He would be my heart and lungs during the procedure. I don’t remember being knocked out but I do remember the recovery room. I was stable so the nurses were busy elsewhere.

Soon I was in a private room a few floors up, with medical personnel often in my face. My butt was stuffed with abdominal pads because my abscess was draining a lot of bloody puss. Everything seemed to go like clockwork. One IV was promptly replaced by another. At seemingly random intervals blood was drawn and tests were taken, but mostly I was left alone. I was able to hobble to the bathroom by myself and the nurse said I didn’t need help to use it. So I did. The IVs kept me well hydrated and all night long I made frequent trips to the bathroom to flush my kidneys. Only one episode upset me: a 5:30 AM nurse who said “Good morning” who within 30 seconds was taking blood out of my arm. It was pitch black outside and I felt like I had been assaulted. I was barely awake while all this was happening.

The surgeon came by mid-morning and was pleased with my progress but insisted on my spending another night. I agreed but didn’t like it. The view out my window was at least nice with a canopy of trees in golden autumn colors to enjoy. The food was not spectacular but decent and reasonably tasty. Everything seemed well managed and under control, which made me feel relaxed and comfortable. Frequent visits from my wife helped pass the time and after getting discharge instructions we were allowed to just leave, bypassing the normal wheelchair to the door.

It was inconvenient but my suffering was minor at best. At home the one thing I really wanted was a shower, which quickly removed four days of grime and made me feel like a human being again. As for travel, my doctor said no problem but asked me to get aisle seats and walk the aisles during the flight. There was some small possibility of a blood clot complication.

The surgery did result in some oddities. I have a surgical scar in a very intimate area where the abscess was drained. It should eventually close up in time but it resembles a vagina. To deal with the discharge, the surgeon suggested sanitary napkins. So I now have a pretty good idea what it’s like to menstruate. If I were a woman, I’d find going through this every month very annoying. I’d probably want my uterus removed.

Still, the whole thing was well orchestrated and very well done. A hospital is an amazing environment with everything optimized for patient care. The system worked quite well taking care of me. With so many large systems dysfunctional these days, finding one that still works correctly feels notable.