I'm Back

There was no IMO column last issue, mostly because I was an unexpected guest at the Boise VA hospital for a few days. On Friday I went down to the hospital for my annual check-up, which is somewhat akin to having a minor tune-up, oil change, and rotating the tires. It seems that I made a error in telling the good doctor that I hadn’t been feeling all that well for the last few weeks, and with that he decided to keep me around for a few days. The next thing I know I’ve been admitted to the ICU “Step Down Unit” which is rather like a half-way house for folks that have been really sick but are preparing to become one of those who make everybody around them ill by constantly talking about their “operation”. Temporarily, and purely in the interest of journalism you understand, I’ll join that irritating group of people who have nothing better to talk about but their seemingly endless medical problems.

I have been examined, measured, poked, prodded, monitored, swabbed, sampled, X-rayed, gamma rayed, ultrasounded, tested, stressed and strained, EKG’d, injected, IV’d, and oxygenated, along with being cussed and discussed no end by a small army of Doctors, Medical Specialists, Technicians, Nurses, Administrators, Medical Students, CNA’s, and probably the FBI, CIA, IRS, and Homeland Security as well, until there’s nothing left to learn! I’ve been starved on a low cholesterol / low sodium hospital diet (I think the powdered eggs were army rations left over from the War of 1812), and for the most part just plain bored to tears for the last few days. About the only indignity I was spared is an enema, and I wasn’t about to mention that little oversight to the doctor or nurses! Somebody would inevitably come along and wake me up every couple of hours all night long so that a happy, smiling, efficient, and disgustingly cheerful nurse could record my vital signs. (WARNING!! If you wake me up at 2 AM, I am NOT inclined to be happy and smiling!) About the time I’d get back to sleep, an equally cheerful vampire would come in and wake me up again so she could draw a few more gallons of blood with a dull needle that I think was manufactured by the village blacksmith from an old 10 gauge shotgun barrel. I’ve been hooked up to more wires and plumbing than a space shuttle undergoing pre-launch tests!

They’ve given me some new medications and taken away some of the old ones. I’ve got a pocket sized “heart monitor” thingy that I’m supposed to wear constantly for the next couple of weeks. I’ve also got a multi-page set of instructions and a mess of general orders (most of which I’ll probably ignore anyway). After all this, and likely a scadzillion dollar dent in the VA’s annual budget, the medico’s still don’t really know what’s wrong. So far their diagnosis pretty well matches my own as I understand things, which is that I’ve experienced a couple of heart attacks in the past, and as a result now have a very slow heart rate which causes a lot of other problems, and that there really isn’t a whole lot they can do about it. I’ll give them a big "E for effort" though.

Considering the horror stories we’ve all heard about the VA medical system over the last few years, most people would be somewhat concerned about being hospitalized there. However, I can honestly say that I have no problems with the VA hospital system, and I really do think that the Boise VA Medical Center staff are a great bunch of people who put a lot of effort into taking good care of us old “high mileage” vet’s. (Well… lem’me think about the vampires a bit…) The nurses in particular are a fantastic bunch, but they run to darn fast for us old codgers to catch! In all, I’m a pretty well satisfied customer of VA medical care.

We’ve also heard about all the people in this country who don’t have access to medical care due to the high cost of medical insurance. That sorry situation is a problem that we as a nation need to address, and socialized medicine isn’t going to be a workable answer either. The first question of course is why are those medical insurance costs so high? Insurance companies try to provide a service to the public for a (large) fee, essentially you send ‘em a big part of your paycheck every month, and in return if you get sick they pay the medical bills, or at least part of ‘em. As insurance companies are stockholder owned businesses, they have to show a profit lest the stockholders get upset and fire the highly paid CEO, which is a really bad day sort of thing for the CEO. Most hospitals are also privately owned, which means they have to show a profit as well, and for much the same reason. Then we have the Doctors, who spend a lot of their youth learning the trade, and generally have some horrendous student loans to repay. If they can’t make a very comfortable living after all that effort, they’re going to be out looking for another line of work, in which case we’d soon have complete amateurs doing brain surgery. The nurses and technicians have a similar problem on an only slightly smaller scale, and there are a lot of people in the various supporting positions that must be paid as well. While I don’t know the exact percentage, I’d bet that payroll is probably by far the largest part of a hospital’s budget.

During my hospital “visit”, I gave the nurses the slip on occasion, and wandered around searching for that secret room where they hide your britches so you can’t escape. I noticed that there are a lot of shiny “gadgets” called medical equipment, scattered around all over the place. Because of my EMT/Paramedic background, most of those fancy gadgets weren’t a complete mystery to me, but there were some items I had to think about for a moment, and more than a few puzzlers that I’d have to ask someone about. Essentially they do the same thing as the equipment I worked with more than thirty years ago. But today’s hospital equipment seems to be highly updated, a lot faster working, and mostly computerized, which I well know raises the purchase price considerably. All this fancy equipment is necessary of course, both to make a diagnosis more accurate, and treatment quicker, which saves lives. Unfortunately, like everything else hi-tech, they become obsolete fairly soon and must be replaced. Thus hospitals are caught up in a continuous arms race to have the newest and most modern equipment (a “keeping up with the Jones’s” sort of thing), so that they can attract more patients and thus show even greater profits. With the modern day “electronic office” available, I often wonder why a hospital, or any business for that matter, needs so many administrative personnel. After all, I once ran an entire rural fire department, without computers you might note, and in addition to being Fire Chief I was the entire administrative staff! ‘Course that was back in the dark ages, before so much federally mandated record keeping and useless reports came along…

Overall our medical services do a pretty good job of keeping us alive and kicking, while the insurance industry does pay the bills, most of the time. But still, medical care is by its nature a quite expensive proposition, and the consumer always gets to pay for everything in the end, including some rather large insurance company profit margins.