Thursday, February 06, 2014

My Wrist as a Metaphor for the Healthcare Delivery System

On December 21, 2013, I decided to get some extra exercise because I was attending a holiday party that evening. I figured I should burn some extra calories before eating 10 beers and 5 pounds of food. So I went to the local tennis center to attend their morning drop-in clinic which features some cardio-intensive drills.

During one such footwork drill I fell backwards (because I have terrible footwork) and put my right hand out to brace my fall.


As soon as I landed I knew I broke my wrist. I tried to hit a few more balls and it was impossible. The wrist was almost locked in place. I realized this could have serious long-term repercussions and that I needed immediate medical attention so I went home, showered, and was in front of a doctor in the ER within 90 minutes of the injury. Here's what happened next:

The doctor in the ER was very young. Older than Doogie Howser but probably not far removed from his 30th birthday. He ordered an x-ray and walked through it with me. He noted that my scaphoid bone was broken into two pieces, but when he poked me in that region of my hand I had no pain.


He concluded "I can't tell if this is an old break or a new one. If it's an old break they you just have a sprained wrist. You need to see a hand specialist." Within two hours of arriving at the ER I left with a hand splint, the name of a hand specialist, and no diagnosis.

Oh, and the flu--I left the hospital with a flu-like virus which reared its head a week later and lingered for 14 days.

I was able to see the hand specialist on December 24. He did not get a copy of the x-ray from the hospital nor did he take one himself. In fact he did not even have an x-ray apparatus in his office. This surprised me, but I figured it might be hard to get a license for devices that use radiation in an office building. He poked my hand in various places and said "You tore the muscle that connects your thumb to your palm as well as a bunch of ligaments in the back of your hand. Wear the splint, take Advil, and ice the wrist for 10 minutes every hour. If it doesn't get better in a couple of weeks come back." Then I paid $150 because he doesn't accept insurance (although they oddly made a copy of my insurance card).

After a couple of weeks the swelling went down but I still had pain and limited range of motion. So I called the hand specialist and got an appointment for the next week. I slogged through a massive snow storm (griping about Audi's shitty windshield wipers the whole way) and when I arrived the doctor said "This is bad! You need an MRI. I'll refer you to my buddy who is a wrist specialist." So he wrote me a prescription for an MRI and told me to call an imaging center to get it done, and my head almost exploded at the idea that my hand specialist doesn't know about wrists. And that he uses the word "buddy." Then he banged me for another $100 for the office visit.

I called the imaging center. Turns out I needed pre-approval from my insurance company. I called the insurance company and they said that the doctor has to call for approval. So I called the hand specialist's office and his receptionist said "Oh, right. We have your insurance information. We'll call them." Eventually I had an MRI appointment scheduled for the next week.

The MRI took about 30 minutes and they gave me a CD with the images, which I FedEx'ed to my hand specialist the next morning. I was told that the report would be ready the next day. But the doctor didn't get it the next day, so I called the MRI center and they said "He'll get it tomorrow." So the day after that I called the MRI center and they said that the report was ready. They said that I could pick it up in person or they could mail it to me. I asked that they mail it to me and called the hand specialist. No one answered the phone (and I called repeatedly) or returned my voicemail so I went to the imaging center to get the report.

The battleaxe of a woman at the imaging center refused to give me the report because it had only been two days. "The doctors typically prefer to see the report first so we usually don't give the report to the patient until 6 or 7 days after the exam." So I explained that I called ahead and was told that I could pick up the report. She replied "Who told you that?!" I said "I don't know, I didn't think I needed to get a name." She said "I don't care what they told you on the phone, you need to wait 6 to 7 days."

Much like Danny Duberstein I am good at two things but math isn't one of them.



Those of you who knew me when I was 18-25 know that in situations like this I am superhumanly adept at dismantling bad logic while demoralizing my victim. I can be mean, I can be an asshole, and I am better at outsmarting people on my feet while simultaneously being a mean asshole than anyone I know. It is not pretty to watch and I am not proud of this skill. But it came in handy sometimes.

A few sharp replies flew to the forefront of my brain: What's the point of having a phone if you don't care what people here say through it to your clients? Are you really telling me that I'm not allowed to review the diagnostic report from my radiologist for almost a week? You know I paid for it, right? You know the radiologist is my doctor, right? You know that disclosing confidential patient information to the patient is entirely permitted under HIPAA, right? Oh wait, you haven't read HIPAA, have you?

But now I'm older and calmer and simply too tired to fight. Instead I said "Look, I hurt my wrist about 6 weeks ago and I want to get it fixed. I left work early to get here before you close and it was a hideous pain in the neck with all the traffic. I just want to know what's wrong with my wrist."

She balled up her face as if I was holding her at gunpoint and making her eat dog shit. Then she asked for my name, date of birth, and printed out the report. I thanked her and as I turned to leave she yelled "I don't care what they told you on the phone, you normally need to wait 6 to 7 days!" It was a "Now go home and get your fucking shinebox" moment.



But I did not call her a mutt or pistol-whip her or tie her up and put her in the trunk of a Pontiac Grand Prix. Instead I walked off a few paces and read the report.

I broke two bones in my wrist. After six weeks and about two thousand dollars in medical costs, I learned that I have a broken wrist.

Pissed but relieved to know the real deal, I called the hand specialist the next day. Multiple times. It was busy, then no one answered, then no one returned my voicemail. At 3:00 the office closed (it was Friday) and I got the answering service.

At this point I was ripshit. I pulled my copy of Castle Connolly off the shelf and found a wrist surgery specialist 2.4 miles from my office. On Monday, in a torrential snow storm, I got an appointment, went over, showed him the MRI report, had an exam that included an x-ray right there in the office, and learned that my scaphoid fracture was indeed a new break. He even explained how you can tell and said that they guy in the ER should have known this. As a result my lunate bone is pointing 45 degrees the wrong way and the scaphoid is healing incorrectly.


So I need surgery. He sent me for a CT scan, the results of which are sitting in a giant envelope on my dining room table (preposterously, CT scan results are only available in hard copy). He also noted that the "hand specialist" the hospital sent me to is a COSMETIC hand specialist, not an orthopedic type.

Before I went for the CT scan the cosmetic clown called me back. He said "You have two broken bones but I'm not worried about them, they'll heal on their own. I'm more concerned with the ligament tear." Note that the MRI report says "Mild DISI but no definite ligamentous tear currently seen." He again mentioned his buddy the wrist specialist, this time by name. I told him that I went to see someone else who is an actual orthopedist specializing in hand, wrist, and arm injuries. He said "Ok great, give me his name and I'll send him the MRI report." I don't know if he did, or if he still has the CD with my wrist MRI pictures. I doubt it.

The point of this rant? My wrist is a metaphor for the healthcare delivery system--both are broken.

I went to the hospital and said "I have a broken wrist." It took six weeks, at least five doctors, and close to two thousand dollars to confirm that yes, I do indeed have a broken wrist. Which I knew the moment I broke it.

This is preposterous. I live in the most technologically advanced country in the history of our planet. I went to a hospital ranked #10 in NJ and #25 in the NY metro area by US News. I have health insurance. I make enough money to pay for these services even without health insurance. I'm well educated--I have two advanced degrees including a degree in public health!! I worked in orthopedic research which required me to take x-ray films and review CT results!! I know how to navigate the healthcare system, I understand what bones are and how they fit together, I know how to interpret radiographic results. So I understand what happened to my wrist and I understand whatever technical jargon the doctors are using, and I can afford to pay for treatment either with insurance or cash. I even own a copy of Castle Connolly's guide to top doctors. And I still got fucked.

How the hell did this happen?

30 comments:

Clarence said...

That is unreal. Sorry you are on the ass end of the health care debacle.

I broke the scaphoid in my left wrist in 1996 playing basketball with Squirrel, Marston, and others. I didn't have anywhere close to this kind of cluster, but I did get a misdiagnosis at the urgent care place with indirectly led to me playing 18 holes of horrible golf in Hong Kong with what I thought was a sprain. The doctors couldn't even agree on what the name of the bone was (half of them called it the navicular), which led to more ineptitude. And then it didn't heal properly and I ultimately had surgery to remove the bone and replace it with a chunk of my forearm. It never really healed and is well on its way to arthritic. Good luck, my friend.

rob said...

the story of how clarence's misdiagnosis led indirectly to a round of golf in hong kong is a doozy, involving a deflated rugby ball, two scorpions, a lufthansa flight attendant, jai alai, and mike tyson with a tiger. you gotta hear it.

maybe he'll include it in the 12th day of gheorghemas.

rob said...

and zedman, i think you're getting at this in your conclusion, but imagine someone who doesn't have all the advantages you've got in terms of education and financial wherewithal trying to navigate that clusterfuckery. i can't even imagine the stress and despair such a thing could bring.

zman said...

That's precisely my point roberto. What if I spoke little or no English? What if I didn't have a job that allows me to leave in the middle of the day to pick up MRI results? What if I had a serious injury? It's frightening.

Mark said...

I work in healthcare and most of the people my company serves are either elderly, poor, lowly educated or some combination of these. They have no idea how to navigate the system and their doctors (as well as the staff in these physician practices) are often just as clueless. Everybody knows our healthcare system is a mess. Few have any idea just how fucked it truly is. Not until its too late for many of them sadly.

rob said...

of course, most americans have better balance than you, so this story is likely not representative. also, adversity toughens people up. having easy access to healthcare might make us a nation of softies.

rob said...

you guys see what happened in the lakers/cavs game last night? the lakers started the game with 8 healthy players, then lost 3 through a combination of injuries and fouls. finally, robert sacre fouled out, leaving l.a. with 4 players. he was allowed to continue play, but the lakers were assessed a technical foul. the lakers won. that's nuts for a professional game.

Greg said...

I recently suffered severe nerve damage in my right hand. I was lifting a car off of a child and it was a large car, Cadillac and there's no feeling. None at all.

Dave said...

that sucks, zman. you should live near "the healthcare city": beautiful new brunswick, nj.

i hurt my hip last year, went to the doctor in new brunswick, and he sent me around the block for x-rays and a possible mri, and they had it diagnosed by the end of the day. somehow my doctor's office and the x-ray/mri/lab are all affiliated with robert wood johnson hospital so things usually work in concert . . .

Mark said...

Is that true? I'm never sure with Greg.

The more important development in the Cavs-Lakers game was the meme gold provided by Chris Kaman as he took full advantage of the ample room available on the Laker bench.

Greg said...

Totally true. Then I had to perform an appendectomy on the Khan's son. I had to get Dr. Julius Greenbaum to do it instead as I instructed. Right before the operation, the Khan remarked, "to die in battle is glorious, to die in a tent is a disgrace". These were the Yousefzai, Afghani freedom fighters.

mayhugh said...

I once broke bones in my hand. It was not officially diagnosed as a broken bone until an ER trip, two specialists, and 2 months or more after it happened. At that time, they advised me a cast would not help because too much time had passed and it would heal on its own. I still feel it when I shake hands with people with something to prove. The break happened 13 years ago.

I mildly dislocated my shoulder (AC joint) in 1996. it was diagnosed, and subsequently treated for six years, as tendonitis. During that time I had probably a baker's dozen incidents where I re-separated it (one particularly embarassing incident was getting into a booth at a restaurant), to the point where my bone is about an inch away from where it should be. I can't throw a football for more than a few minutes now and I need to have surgery at some point that will allegedly require over a year of physical therapy.

Looking back, at least these were bones and not life-threatening issues, but the healthcare system is not always conducive to proper and timely diagnosis.

Marls said...

Not to be a dick, but is this really a metaphor?

Actually, I am being a dick.

Danimal said...

hand bones man. hand bones.

Greg said...

hard bones man, hard bones

mayhugh said...

I should have had Jerry teach me to throw left-handed. Frankly, there's still time.

T.J. said...

http://www.youtube.com/watch?v=zTuD8k3JvxQ

Clarence said...

The only reason z's wrist wouldn't be a metaphor is that the health care system is broken in more than two places.

rob said...

r.i.p. ralph kiner. one of you mets fans should write something about him.

zman said...

Marls is a simile. He's like an as(s).

In other news, I learned that my fracture is so impacted that much like Clarence's story they need to take a chunk of bone from my forearm and graft it into my wrist. Unlike Clarence's story I didn't go anywhere cool or play golf.

zman said...

Mayhugh, come to OBFT and have Weenie teach you how to throw. You'll be squared away in no time.

Clarence said...

Sorry to hear it, Z. Enjoy the pins they leave in there for 6 weeks. Worst part for me was that I don't dig on prescription pills. Gave away my Percocet and drank mightily.

rob said...

percocet tastes good

Dave said...

scraped a parked car today trying to wedge into traffic in the school lot. did the right thing and left a note (though i thought about NOT doing the right thing).

found out later it was a good friend's car . . .

zman said...

A man named Universal Allah used a stun gun to disable the concertmaster of the Milwaukee Symphony Orchestra, thereby allowing him to steal the concertmaster's 299-year-old Stradivarius violin. This fact pattern sounds more like a Charlie Kaufman screenplay than reality.

Shlara said...

Zman--this story is a bummer.
And I know how you feel.

I do have VERY talented team of cancer doctors, but the system is a disaster.

And I thought the same thing when I was being treated--I'm smart, and have money and know how to be an MF-er to get what I need...I can't fathom how most people get proper care--people who are older or living paycheck-to-paycheck or English isn't their first language.

zman said...

Thanks Shlara, your situation was much more severe than mine and had to have been tenfold more frustrating and stressful.

On a lighter note, zson hit me in the head with Hector the coal hopper, probably the pointiest of all of Thomas' friends. He broke the skin!

TR said...

Nobody, and I mean NOBODY, complains with the fervor and eloquence of our own Zman.

In related medical misdiagnosis anecdotes, I hurt my shoulder playing rugby my sophomore year in college and knew it was bad. I was driven to the ER. Doc told me it was a third degree separated shoulder, and that a splint would heal it unless I was a high-level athlete that wanted surgery where they drill a hole through my clavicle and use twine to tie it down. I said no thx to surgery and hung up my rugby cleats.

Fast forward to 2012. I was having shoulder pain and went to HSS, a top NYC orthopedic place. They told me I actually fractured my clavicle back in the day, and it never was reset to heal properly. How does an ER doc botch that? Clavicles are big-ass bones.

Interesting twist - the day I was hurt, I was supposed to go out to dinner w/ my dad and his c*nt of a second wife. They were in town but didn't care to watch me play rugby b/c she wasn't into it. Anyhoo, we had reservations that night at the King George Seafood Buffet (my choice), a big night for my broke, gluttonous self. So when I was at the ER, alone and dealing w/ a fracture clavicle, my only goal was to avoid taking any drugs that would keep me away from rows of scrod and faux crabmeat. So I may have turned down appropriate care b/c I didn't want to miss a free buffet dinner. And I ate the shit out of that buffet that night w/ a sling on.

Not a metaphor, but a microcosm of my college experience.

Dave said...

hey gheorghies!

separated shoulder, parent visit, seafood buffet, rugby, parent's apalled by rugby . . . TR is dredging up a lot of parallel nostalgia.

Dave said...

unrelated but equally absurd injury: cult concert tambourine slicing and blood loss.