Tuesday, June 2, 2009

Caregiving at Duke University Hospital is exhausting

I cannot imagine how Obama care will make our medical care system any more routine and any less patient oriented. IMHO and at least with respect to elderly (Medicare) patients, Duke University Hospital has already embraced a bottom line dollar focus and an insensitivity to the special needs of this population.

My dad underwent ankle fusion surgery on Monday June 1, 2009. The surgery was completed at the Ambulatory Surgery Center at Duke. Great place. The managing nurse is a very caring and professional man (Hatfield).

Moreover, I was not concerned about the surgery at all. The surgery was performed by Mark E. Easley, M.D. I could not trust a doctor any more than Dr. Easley. Dr. Easley has a unique ability to combine compassion with incredible surgical skill. Dr. Mark E. Easley is patient and possesses none of the stereotypical surgeon ego issues.

Dr. Easley also seems like the type of professional that is generous with his knowledge and talent. Young doctors should be grateful and embrace Dr. Easley's willingness to help the wannabees.

Dr. Easley works with many young medical school residents and fellows and provides these young wannabees the opportunity to get real world experience. Dr. Easley creates a clinical atmosphere where he actually gives residents and fellows the opportunity to excel on their own with the direct guidance (but not micro-managing) of Dr. Easley. Dr. Easley is professionally generous to the extent that he does not need all of the accolades - rather, Dr. Easley provides the young doctors the opportunity to "run to home plate after Dr. Easley hits the triple."

That all being said, Dr. Easley arranged for dad to spend last night (the night of the surgery) at Duke University Hospital. My stomach sunk when Dr. Easley gave me this last minute change of plan news. In retrospect I should have told Dr. Easley that I prefer dad be transported to Durham Regional Hospital or Duke Hospital in Raleigh.

Dr. Easley gave a medical student, intern, resident (I was never clear about his credentials) my dad's "case" when he was transferred to DUH. And thus began the nightmare.

While my dad was still in the recovery room at the ambulatory center, the orthopedic surgical resident explained that my dad was able to bear full weight on the leg that just underwent ankle fusion and was fitted with an external fixator. I told the resident that Dr. Easley specifically told me that dad was non weight bearing until a plate was fixed to dad's fixator and that would be done until next week.

The young resident actually argued with me and told me that my perception was untrue and that dad would be able to work with physical and occupational therapy on fwb status while at DUH. I told the resident that dad could spend one night at DUH but that there would be no extended DUH stay nor would there be weight bearing PT. I further told the resident that I absolutely would call an ambulance and have my dad removed from DUH if necessary.

At this point, the orthopedic surgical resident had the absolute audacity to threaten me with some crap about how there would be "financial implications" and we would be "responsible for paying money" if we removed dad from DUH against medical advice. The young resident actually turned red in the face while he was telling me this.

I told the orthopedic surgical resident that if wanted to talk about financial responsibility than we could discuss the fact that dad is having this surgery because DUH ignored an infection and that Medicare considers that a "never event."

IMHO, the young resident should have been professional and maintained enough decorum when I told him that his perception that dad was full weight bearing was in conflict with what the actual surgeon told me. The young resident should have told me that he would double check with Dr. Easley to clarify the weight bearing status.

Dad has been through a lot. And much of dad's suffering has been caused by a lack of communication between Duke Clinic surgeons and physicians and DUH. The lack of communication has never been so obvious and so unnecessary.

I emailed Dr. Easley last night and informed him of the confusion and I asked Dr. Easley to clarify and confirm the weight bearing status orders. Dr. Easley emailed me back and confirmed that dad was NOT weight bearing status at all.

So I spent the night in dad's hospital room at DUH. I hate that place.

This morning at 5 am, dad woke up in significant pain. He looked around the room in a panic and asked where he was. I told my dad that I was sorry but that he was brought from the ambulatory center to DUH. Dad just panicked. And he was made. He is home right now but he is still mad at me for allowing him to be brought to DUH. I promised him that I would never do that.

Also early this morning, I was visited by the resident. He again said that dad was full weight bearing. I was very surprised that the resident did not double check the issue with Dr. Easley.

I told the resident that I emailed Dr. Easley and Dr. Easley immediately emailed me back to confirm that dad was NOT weight bearing. The resident said "may I see that email"?

Sure, I showed the resident the email from Dr. Easley. Then, the resident left dad's hospital room and commented to a nurse "she apparently communicates with Dr. Easley on the side and if that is the way it is then fine."

Communicate with my dad's surgeon "on the side"? What the heck is that about? All I care about is my dad's well being and I will turn Heaven and Earth to make sure that my dad receives appropriate care. Period.

I never saw the orthopedic surgical resident again that day. The resident never even returned a text message question from the nursing staff to find out whether dad was supposed to stay on oral antibiotics post discharge. I guess this is the resident's way of getting the final word and punishing my dad in the process. Shame on the resident. IMHO, at this point in his career, the young orthopedic surgical resident does not possess the professional temperament or maturity to be an effective physician, much less surgeon.

Good thing that Dr. Easley will communicate with me "on the side."

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