Tuesday, August 16, 2011

chronic health problems

"Man invented language to satisfy his deep need to complain."
Lily Tomlin.

This week's list of whinges, without the whining and boring bits:

It all began when... the end.

Play Scenario 1:

In the chook shed in HG's backyard after school, we played "The Flintstones" for hours. No board games or special toys, just an obsession with the weird and wacky world of Wilma and Betty.
The words "upside down Flint-Rubble pineapple cake" emerge from the vaults of my mind. No doubt there is, by now, similarly useful information hidden on the hard drive of my computer.

Play Scenario 2:

The backyard across the road in the street which was once something of a slum but is now way out of my price range.
Too many kids to count, playing "Vic Market". For money, a variety of green leaves from the many different trees or shrubs in the yard.
At noon on Saturdays at the market, bells would ring and prices plummetted as stall holders tried to offload the fruit and veg which would not keep til the following Tuesday. [Was it Tuesday?]

This provided us all with an excuse to call out our bargains, loud and clear, shouting to be heard above the other stall holders: "Queensland Blue, tuppence a pound!" Perhaps I've always been far too serious and boring, for I cannot recall any way of making pumpkin sound like an attractive bargain too good to be missed. But it was a great excuse to be noisy.

Some kids played Doctors and Nurses. Are today's soap operas set in hospitals just a grown up version of the same thing?

Dina drew my attention to the shocking case of young Jacob Belim who died due to the dithering of doctors.

There's nothing like a medical story to unleash a flood of medical stories. Are those of us who like to talk about our operations simply exchanging cautionary tales and useful information, or do we suffer a serious need for one-up-man-ship?

The comic Paula Poundstone says if Martin Luther King Junior stood before her today and said "I had a dream..." she would instantly feel compelled to cut him off and butt in "So did I, only in mine..."

Here are some medical stories wherein I was not the patient:


Case 1.
Many years ago [begins like most of my stories these days] a workmate in her 50s rang one Saturday evening to say she had fallen off a horse and hurt herself. Dutifully drove to her place then spent an hour looking for an after hours chiropractor in her area. Said chiropractor advised "she needs to go to hospital".
Back to her place, called an ambulance, followed ambulance to the Western General Hospital in Footscray. Waited for ever until a doctor finally looked at her and said there was nothing wrong with her go home.
We went home. Then her husband, back from the footy, called an ambulance. There was no revolving door on the hospital but it would probably be a good idea.
Long story short there was yet another ambulance trip, some choice words exchanged and said friend was granted permission to lay on a gurney in a corridor all night til the registrar would arrive the next morning and presumably send her home again.
Next morning, registrar arrived, heard story, transferred her to a bed, tilted her so her feet were higher than ther head. Friend screamed, doctor said "ruptured spleen".

In this case [if you'll pardon the pun], I'd say the emergency doctor on night shift was newly graduated, had little experience, possibly already plagued with self doubt, probably certain that calling anyone else would not make them happy... that sort of thing. It's a good argument for private health insurance. Or moving away from the western suburbs.


The Other is something of a medical whiz, with lots of knowledge, experience and contacts. She is not a doctor, but everyone brings their bumps, bruises and big issues to her.

Aunty E, 92 years old, still tending a garden, feeding horses and living independently, started to slow down. Country doctor said she needed a new hip but was too old. When age is part of the problem the unspoken rule is really "doesn't have private health insurance".
The Other had a family conference by phone, the money was found to pay for a new hip.
Aunty stayed with us for 3 months, we did the rounds, and her problem was resolved with a series of blood injections - all bulk billed.

My mother lived with us for about 8 years. What can I say, maybe I was never curious enough to play doctors and nurses as a child because the people in my family were never shy. The Other often came to me, a look of pain and shock on her face because my mother had "flashed her goods" again. Serves The Other right for being able to diagnose, refer, pull strings and organise cures.
I did ask my mother to ask first. Something like "Would you mind having a look at something for me?" before flinging her robe open would have given The Other a chance to prepare herself, but my mother's memory was already too far gone.

The Other's Mother

A few years ago, The Other requested her sister organise scans for their Mother who lives in Woop Woop. On a weekend, The Other looked at the scans and said "bowel cancer". There followed a week of long distance phone calls from Melbourne, trying to get a surgeon to review the radiologist's conclusion that nothing was wrong. The following week the surgeon rang the other to apologise. He had trusted his new offsider who reviewed the scans and agreed there was nothing wrong.
None of this is a criticism of beginners, only time can provide experience and an exposure to all of the exceptions to textbook rules. But it is precisely because we are all human that it doesn't hurt to have an advocate in your corner.

When poor old Mother J comes to Melbourne for a week it usually turns into 3 months of specialist visits. Last time, we ended up in the emergency department of the Frankston Hospital.

The day started at 10 am. Within two hours she had been seen by two different triage nurses who both seemed to think she should go home and stop wasting their time.
Hour 3, out walks someone who has worked with The Other. This is where it gets interesting:
Said Nurse found a corner and a chair inside the ED, and went off to fetch a trolley of tools. Every single thing she went to use from the trolley was missing or broken. I kid you not, it took 45 minutes for her to do a basic assessment of The Other's Mother.
The Other's friend agreed it was a heart problem, and placed J into a queue for a cardiac bed in ED. One hour later a bed was free. The equipment did not work. Another hour was waited til a second cardiac bed was free.
By 3 pm the Mother was seen by a doctor, who arranged tests etc and agreed the problem was heart related. The Other then rang the private hospital where she works and organised a bed, arranging for her own cardiologist to drop in first thing the next morning.
It took from 10 am Saturday until 1 am Sunday to get J into a private hospital bed.

Being a public patient isn't always the problem; in this case, we went to a public hospital because it was a weekend, because it was urgent, and because at least a public hospital has equipment a medical practice would not.

Because we feel we know people well, we sort of know when to trust that they really are unwell if they say they are. I suspect the people who run the hostel where The Other's Mother lives had put her problems down to an unlikeable personality. The real problem was the flat battery in her pacemaker.

Part of the problem in getting the best care is competition for government funds. As federations go, Australia is a basket case. Health is a state responsibility, but creeping federalism has led to a duplication of ministries, and party political bitchfights which deliver less health care per dollar.

Part of the problem is that Emergency Departments are seen as a cheap GP clinic open 24 hours per day. Maybe we should have separate GP clinics located within hospital grounds. Someone like Dr Gounder should be able to order an ultrasound the way GPs normally do, rather than simply recommend it because an ED is self-governing . [Though I can't believe the registrar didn't order one if she was agreeing there was a bowel obstruction. Insane.]

The Other says our 50s were traditionally known as "the decade of death", though now that health technology has improved it is more like the decade of surgery. Like cars, we all need a major service and overhaul after so many years.

Private health insurance won't always guarantee the best result but I'll keep paying it, even if I have to sell a kidney to do so. And no matter how much doctors might hate people who presume to know as much as them, I'll always be glad to have The Other in my corner.


  1. We don't have public health options for everybody here. I'm sure Obama-haters would love your post and use it as proof that socialized medicine can't work.

    But the truth is...even with private insurance, people get misdiagnosed.

    There's a book here about a girl with Cystic Fibrosis. Her dad is a well-known sports writer. I'm sure they had private insurance. The child's lung collapsed. She knew what was happening because it had happened to her before. She told the doctor and he refused to listen. He was awful...very condescending.

    My sister almost died because the resident at the hospital wouldn't give attention to her alarming brain symptoms. Her main neurosurgeon fortunately showed up. Maybe someone contacted her? Anyway, she saved the day.

    My husband hurt his arm and went to the emergency room. They didn't tell him it was broken. He had to find that out later from another doctor.

    I think the main problem is not insurance and funding. I think it's about some doctors being extremely arrogant. It's like what you say in your last paragraph. Doctors hate people who presume to know as much as them.

  2. While the meek may well inherit the earth, being meek won't get you far with the medical system. If you are not up to batting for yourself, you need a good advocate. Even so, it can still go badly wrong, so badly wrong that Therese wrote a book about what her late husband went through.