04.22.09
Putting the “care” back in healthcare.
I strongly encourage everyone to read E. Michael Dugan’s article, Twin Tiers Perspective: In the U.S., healthcare is serious business, (April 19, 2009). It will make you stand up and cheer. He provides a great discussion regarding David Cay Johnston’s book, Free Lunch. “No other modern country regards healthcare as an insurance business.” As a physician on the front line, I know this to be true. The “business” of healthcare has failed the American people. There is no healing in our present system.
America, we can do better and we must do better. Please tell our elected officials to put the “care” back in healthcare.
A Painful Memory
He always arrived in front of the building with a New York City police escort. I’m certain he had them convinced that he was “helping the poor” when in fact he was breaking the law. “The doctor’s here,” said the first floor neighbor who always announced his arrival. Six to seven middle-aged and elderly women would inevitably line up patiently waiting to give him their requests. My aunt was one of those women. She had recently moved into that decrepit building after falling on hard times.
“I need blood pressure pills,” said the second floor neighbor. “Can you give me something for a cough?” asked another. He always wrote down their Medicaid numbers meticulously as he fulfilled their prescription requests. He never took a medical history; never inquired about allergies to medications; never listened to their heart or lungs. There were no patient charts; no labs ordered and certainly no integrity. At the tender age of 15, I desperately wanted to help my aunt so I boldly asked him to write a letter of support to help her obtain public housing. He paused, looked at me incredulously and then replied with a resounding “no!” I knew he was a crook from that moment on but couldn’t convince my aunt. “He’s a good doctor” she replied. “He makes house calls.”
Memories of that experience reemerged recently after a colleague disclosed that one of the specialty hospitals in my community no longer wanted to accept Medicaid patients for obstetrical deliveries. Yet, when the doors to their multi-million dollar facility swung open three years ago and they were desperate for revenue, these same patients were welcomed with opened arms.
For whom does the bell toll? Certainly not for the working poor.
04.08.09
Decisions Made From the Heart
Celean Jacobson’s article, “Madonna’s African Adoption Part of Growing Trend,” (Associated Press, April 1, 2009), caught my attention, but not because of celebrity. My husband and I became the proud parents of two Ethiopian sons after being childless for eighteen years. When I studied infertility during medical school, I had no idea that I would be directly affected.
Everyone responds to infertility differently. Some choose IVF, others use surrogate mothers and then there are those like me who simply wait. And wait. And wait for the miracle of conception that never arrives. The biological clock begins to tick so loud it deafens you with the reality that if you don’t move your feet quickly, the opportunity for parenthood will be gone.
I had conjured my sons in my mind, long before I met them. I would visualize them running in our backyard and hear their invisible squeals of delight. Yet, I had no idea that they would come from Africa, a place I had traveled to before.
The adage that “When you take one step, God takes two,” held true and thus began our indelible journey. We found the perfect adoption agency; met an online support group of multicultural adoptive parents of Ethiopian children, and prepared for our travel abroad. Yet nothing seemed real until we arrived at our children’s residence and they ran straight into our waiting arms.
I can’t comment on why Oprah built a school in South Africa or what Madonna and Angelina’s agendas were regarding African children. I only know that unconditional love has no geographic boundaries or borders. The most important decisions made in our lifetimes are usually those that come from the heart.
04.01.09
An Untimely Delivery
The adage that medicine is an art as well as a science holds true, except for those among us who are quite adept at making a creative mess.
A patient presented to the labor room with complaints of vaginal bleeding and pelvic pain twelve weeks before her due date and subsequently delivered a baby in a toilet bowl. This type of calamity might be expected to occur in a restaurant or a public facility among unsuspecting lay people but never in a hospital staffed with trained nurses and physicians. This type of abashment makes me want to dust off my scrubs and return to the delivery room in high gear.
If a pregnant woman is experiencing pain and bleeding, the last place she needs to be is in a bathroom unattended. The poor woman rang the emergency bell in the bathroom three times trying to get help from nurses who had deaf ears and misplaced priorities. It was only after she emerged from the bathroom with baby in tow and attached to the umbilical cord, did she finally obtain the attention that she so rightly deserved. Some rushed to cut the cord and get her admitted, while others scurried to get a warm blanket and find a pediatrician. Her placenta also had to be delivered. Although the baby only weighed two pounds and remained in the hospital for approximately a month, both mom and baby are now home and thriving.
A pregnant woman should never be directed to the bathroom without first having a pelvic exam if she complains about vaginal bleeding or pelvic pain. Obtaining a urine sample should be a low priority until someone can document that a delivery is not imminent. Sometimes the best clinical treatment we can offer a patient is the art of common sense.
Premature Deliveries: An Uphill Battle
Of the 4 million babies born each year in the United States, one out of eight will be premature. Minority women carry the greatest risk and are usually caught off guard. Premature babies face multiple challenges and many die within the first year of life. These challenges include cerebral palsy, physical and intellectual disabilities in addition to emotional family trauma. Each year $26 billion dollars are spent taking care of premature babies in neonatal intensive care units and is a public health crisis.
The good news is that there are new methods of diagnosis that can identify women who are at risk and prolong their pregnancy as much as possible. Ladies please take note: Having your cervix measured at 22 weeks can predict who will be at risk for having babies too soon. If your cervix measures 20 to 25 centimeters, treatment with progesterone is offered that has been shown to reduce the rate of premature deliveries that occur before 32 weeks. An awareness of having risk factors can empower you to seek proper treatment early and improve your chances of having a healthy baby.
Please report pressure, back pain or abdominal pain to your healthcare provider immediately. Pain or pressure that occurs four or more times in one hour could indicate premature labor and can be treated if diagnosed in a timely manner. Also get tests for sexually transmitted infections, especially if you have a vaginal discharge, and get treated for urinary tract infections). Bacteria are not your friend during pregnancy however antibiotic therapy is priceless if given in time.
Pregnancy is one of the most important milestones of your life. A healthy pregnancy doesn’t just happen; it takes a SMART mother who knows what to do.
