Cynthia Stock

An amazing author for your soul!

Compound Fracture

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I am not a sommelier, but I know what wines I like. I am a retired nurse with forty years of experience in Critical Care. I believe I am qualified to discuss the broken state of our health care system. It suffers a compound fracture. Early in my career, Primary Nursing, a practice in which one nurse agreed to be active in the care of a patient throughout his ICU stay, was introduced on our unit. It facilitated a holistic approach to care. At least one nurse knew more about the patient than his diagnosis and room number and helped that patient navigate the trauma of critical illness. Primary Care did not last long. It was time consuming for nurses already working short-staffed. It was costly, as Primary Care nurses spent time away from task accomplishment addressing the total patient. Now, after a recent short stay in the hospital and a more recent health jolt, I realize things certainly haven’t gotten better. I have had MS for decades and have strived to maintain the highest level of wellness. My PCP encouraged me to go to a local MS specific clinic for care. I went every year. The providers watched me walk, checked my neuro signs, assured me exacerbations declined with age thanks to an aging immune system. I was trusting. I accepted what I was told.  I kept my routine appointments. When my knee began to bother me, I didn’t think about MS. I went to a knee specialist who watched me walk, did an x-ray, saw no arthritis, injected my knee, and sent me on my way. I followed up again when the pain recurred. Another x-ray, another injection. When that shot wore off, I learned to live with the pain. Then, after suffering a Closed Head Injury due to Covid induced hypotension, I switched neuro clinics and ended up at a clinic closer to my home. I saw a new MS doctor. In two visits, he changed my life. He watched me walk. I’d seen my gait in the windows as I walked into the gym. Aging I told myself. “You have footdrop,” the doctor said. Gutpunch. MS finally left its mark, less painful than my burning paresthesias, but so VISIBLE. Yet no one had told me. I bought an ankle brace online. I’ve learned to wear it on the treadmill. My knee doesn’t hurt. My leg is more stable when I walk. Where is the breakdown? The breakdown exists because there is a lack of collaborative practice. Just like the Primary Care concept in nursing, if my PCP, knee doctor, and MS doctor had even had a phone conversation, might I have learned of my footdrop sooner rather than later. Could this type of practice ever happen?  I doubt it. The other part of the breakdown: Who would get reimbursed? What would the billing code be? Who would lose money if I’d just bought a brace? How much is one phone call worth to the practitioner? To the patient? Has medical specialization destroyed the healing art by disallowing the opportunity for a patient to be treated as a whole? What professional do I see to answer these questions?

Collaboration might be needed.

A Slice of the Pie

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I retired from bedside nursing over five years ago. In that time, every medical journey with my body demonstrated to me how broken our health care system is. Medical specialization is one culprit in the fragmentation of care. When I go to my cardiologist, I am the heart with Sick Sinus Syndrome. When I go to my electrophysiologist, I am the dual chamber, MRI friendly, pacemaker. When I go to the dermatologist, I am skin. When I go to the joint specialist, I am the knee not wanting to have surgery, not the septuagenarian with MS who works out six days a week and walks funny. When I go to the MS doctor, nothing more need be said, except that I am blessed. For the most part, my disease is invisible. Maybe that is why it doesn’t come up often in a plan of care.

Every specialist gets a bit of me; no one cares for the “all of me,” I realized this when after working with the same Physical Therapist for several weeks, we discussed my Multiple Sclerosis, which suggested this wasn’t considered when the orthopod submitted orders to treat my bobbling knee.  The therapist didn’t know I had it.

Flash back twenty years and my diagnosis of pulmonary embolism. Although I saw a hematologist, the risk of clotting problems associated with autoimmune disease was never mentioned.

I have a dream for my health care providers. Once a year, I’d like a Zoom meeting, God forbid we could do it in situ, where each one helps put the pieces of the puzzle that is my body together and makes recommendations for my health maintenance. I would come with a list of questions about what the interface of body systems and health problems means for the coming year. I would come hoping I would be recognized in toto.

Has Medical Specialization and the Business Model in Health Care Given Rise to Google, MD?

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As a nurse, my family sought my advice over the years. I never practiced medicine without a license and stuck mainly to my specialty, Cardiovascular Nursing. If people asked me about pregnancy, I used the line “I don’t know nothing ‘bout birthin’ no babies.” I learned more about labor and delivery from Call the Midwives than I did from a clinical rotation forty some years ago.

With time, my advice took second chair to a new pundit, the internet. My mom asked me things, I advised, she argued. She would quote something she “Googled.” When a close relative developed cancer, she prepared for long distance care at a Cancer Treatment Center she read about until I reassured her that for her type of cancer, therapy at home would be more than satisfactory.

I agreed with the doctors at work who disdained Dr. Google or Google, MD. But then I had easy access to talented professionals amenable to “curbside consults.” I felt light-headed at work one day. I mentioned it to a colleague, a cardiologist. I had a stress test within a week.

Now that I have retired, I experience patienthood in an entirely new way. It started with a little light-headedness. No. Not a little. A lot. Bad enough to call 911. The red ambulance rolled up with lights flashing. I never felt so relieved as I did when the gurney rolled into the foyer of the fitness center. By the time they did a blood pressure, a blood sugar, an O2 sat, and looked at my EKG, I felt better, well enough to go to the bathroom and drive myself home.

I did what I would have told anyone. I went to my PCP the next day. He drew labs and did an EKG. My heart rate was, hold it, take it in, thirty-six.  My heart had been bradycardic for years, but a rate below forty scared me. I’d been to a cardiologist before, so I called his office to schedule an appointment. When you imagine your heart might slow to a stop, you don’t want to wait around.

This is where the fun began. Despite the fact that I had seen this doctor and had a near “syncopal” episode, I hadn’t seen him often enough, so I was considered a new patient and couldn’t get an appointment for a month. Imagine me going to sleep at night with my index finger palpating my carotid artery to make sure my heart was still beating. Yup. That was me.

Thanks to Facebook and a few good friends and the fact that health care professionals treat each other like family, my appointment got moved up. I only had to wait a few days. My heart had to behave for a little while longer. However, I was warned that the doctor was extremely busy and that sixty patients were scheduled in the office that day. Whether you’re a nurse or a lay person, when it is your heart that is thinking about quitting, retiring from the rat race, going on hiatus, you don’t give a damn about anyone else’s problems whether it’s a cold sore or an office trying to make a buck.

When the doctor with whom I had worked for years walked in, I knew he recognized me, although he wasn’t sure from where. Yeah doc, I was the one who took care of all your very sick, high risk patients who agreed to participate in the trial of the procedure that revolutionized aortic valve repair. I worked hard with the unknowns and celebrated successes that changed the horizon for cardiac interventions. Guess what? I don’t give a damn about all that. I want you to NOT diagnose me in a five-minute office visit and exam. I want you to let me know you know all of my history, my MS, my anti-phospholipid syndrome, my meningioma, my very bad reflux, my hiatal hernia, the fact I have engaged in some sort of physical training since I was six years old. not just my heart history. But he chose the five-minute route. So, I went home and chatted with Google, MD.

Dr. Google mentioned sometimes a hiatal hernia can cause the exact same symptoms I was having, which was a relief, except it made me wonder if I should visit my GI doctor. I wondered if my meningioma was getting bigger and causing increased intracranial pressure and bradycardia. See my neurosurgeon? I wondered if I had thrown a clot to my lung again. Oh, did you not know about that? It’s on the paperwork, initially labeled incorrectly with someone else’s name. Call the pulmonologist. I had already done that.

You get my drift. In a perfect world, maybe all involved in my care could conference call and coordinate a plan. Since all my health care problems reside in one body, mine, maybe it would be helpful to consider them all before proceeding. Thanks to medical specialization and the business model of medicine, that will never happen. To be the best advocate for myself, I will draw from my experience, consult Dr. Google, and hope I make the right decisions.