TAVR Tuesday and Barbecue Thursday

by Steve Haner

Fourteen nights in a hospital, especially if you are fully awake and observant, is very instructive. Here are some things I want to share:

The hospitals are understaffed and otherwise under major stress, to the point that patient standards of care have changed. As nice and diligent as everyone is, nurses or technicians can be with only one patient at a time, and the charting they must do is extensive.

When the order for a vital test is placed at 11 a.m. and it finally happens at 2 a.m. the next morning, with two lonely techs running the CT machine through the dead of night, that’s about staffing. A 3 a.m. room visitor coming to conduct an ultrasound at bedside is a sign that team is also shorthanded.

A slow response on a call button is about staffing, not inattention at the desk. The days when the staff makes sure every patient gets at least cleaned up with wipes and gets clean sheets and a new gown daily are gone. It happens if you ask and happens quicker if a family member can help you.

All the people I asked blamed a staffing exodus during and after the pandemic sieges, backfilling now only slowly. Cynics might wonder if hospitals are enjoying some financial benefit from lower labor costs. I can just testify that the experience differed from previous (and shorter) hospitalizations in the same facility. Those folks they have were all gracious and easy to work with, but swamped.

The hospitals are heavily dependent on immigrants, and a viable legal immigration system and more openness to foreign credentials have to be part of the staffing solution. Screw the professional protectionist urges. Screw the Trumpian nativist nonsense.

Jesus, the friendly surgical tech who chatted me up in pre-op, had been a nurse in the Philippines. Margaret with the lovely BBC accent had been a nurse in Wales. Why do we refuse to recognize their licensing? Perhaps a full third of the personnel I spoke with were immigrants, many who had done their training here. We should accept more of the foreign training.

And then, of course, there are the doctors, some heavily accented immigrants and many probably born into families long here, but the Asian and Indian Subcontinent surnames abound. Being in a modern American hospital must be hellish for racists like that idiot mass murderer in New York. What they call “replacement” is a done deal.

Long COVID is real but sometimes it isn’t long COVID. The symptoms that started in late February seemed cardiac, to me anyway, but an echo test was interpreted to say otherwise, and the operating theory became long COVID. It remained the theory as the symptoms worsened through a useless course of steroids and was still the assumption the day before admission.  This COVID thing has the doctors totally stumped and long COVID may be an easy crutch preventing others from finding out their real problem. Stay aggressive.

Skilled phlebotomists, filling the 4 a.m. vials or placing an IV with one minor stick, should be the best paid techs in the joint. I doubt they are.

If the right cook is on duty, order the pancakes for breakfast instead of the fixed menu. I  think they mentioned the name Isaac. Isaac, those were restaurant quality. And thanks to the unknown decider who allowed pulled pork to count as heart-healthy. I enjoyed it two Thursday nights (but didn’t stick around for the third BBQ Thursday just for the Q).

Forget about getting rest in a hospital. Come on, folks, the monitor will tell you if I’ve stopped breathing or gone into arrest. Why do another vitals check that just confirms all the daytime measures? The medical value of the midnight interruptions that destroy sleep need to be weighed against the value of that sleep in one’s recovery. Show me the study that shows outcomes improve with all the midnight disturbances.

I understand pre-dawn blood draws, to give the docs fresh readings before rounds. The hospital-wide broadcasts that a trauma patient is ten minutes out shouldn’t be necessary, except again because of those staffing issues. The trauma team is scattered around on other duties (as I discovered when a nurse darted out of my room mid-conversation.)

And how nice that the fancy bed shines various multicolored lights on the floor providing useless information no one is there to see, even blinking at times, and helping to light up the room all night. A nurse found me perhaps the only sleep mask on the floor, bless him. They should be standard issue at admission, just as all the airlines give you one as you board an overnight flight.

Rethink it all, people, asking: is this worth interrupting sleep?

Technology saves the day. I was first told about this new heart valve device in 2010, when the surgeon who installed my first replacement valve predicted this would be my second. At that point it was being widely used in Europe, but as always, the U.S. regulators were balking and demanding more data. Now it is becoming commonplace, and this particular device is approaching 500,000 installs.

Had it been approved in 2012, we’d have gotten more years with my father. But it wasn’t yet allowed. All hail the regulators.

The surgeon who did mine lumps all his TAVR (transcatheter aortic valve replacement) patients onto Tuesday’s operating room schedule. Hence, TAVR Tuesday. The job now is for me to set a new longevity record for the widget.

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23 responses to “TAVR Tuesday and Barbecue Thursday”

  1. Stephen Haner Avatar
    Stephen Haner

    And a shout out to no other than Nancy Naive who eventually noticed my absence from the world and emailed to ask if I had gone to Europe. Oh, I bloody wish that had been it!

    1. Nancy Naive Avatar
      Nancy Naive

      Munch on grass, me amigo!

      I was concerned, but apparently they performed an “irasciblectomy”. Don’t worry, it’ll grow back.

  2. CJBova Avatar

    Welcome back! Hope you do st that longevity record.

  3. Welcome back, Steve. I’ll hoist a glass tonight and toast to your full recovery. Here’s hoping you’re back to your old feisty self — maybe even feistier!

    Your observations were interesting and useful for the most part. I just want to take issue with one characterization. I don’t know what “Trumpian nativist nonsense” has to do with the difficulty of recruiting health practitioners from abroad. Trumpian nativism is concerned mainly with protecting the integrity of the border, and I doubt many med techs are hiring coyotes to sneak them across. The overwhelming majority, I’ll wager, come in legally.

    The problem is professional licensure laws, which have been a plague since long before Trump arrived on the scene.

    No question, though, we should make it easier for foreign docs, nurses and technicians to enter the U.S. and practice here. Of course that will contribute to health practitioner shortages abroad… and lead to inevitable recriminations on that score!

    1. Stephen Haner Avatar
      Stephen Haner

      Trump didn’t invent the racist nativist streak that infects too many Americans, but has exploited it from the day he announced in 2015. I see a line from that to what happened in Buffalo, but I’m sure you don’t. Yes, the solution is a better legal immigration systems, but plenty oppose that, too.

      1. Nancy Naive Avatar
        Nancy Naive

        What? You mean calling Mexicans murders and rapists might lead a simpleminded fool to kill people different from him? I’m shocked, Rick. Shocked there’s murderous xenophobia in this establishment.

      2. Matt Adams Avatar
        Matt Adams

        I’m glad you got the needed care, but I honestly laugh at people who spend less than a week in a medical setting and arrive at this opinions.

        The number of foreign Physicians, Nurses and like abounds. It is difficult for their license and is a process. Out of which they sign a contract where they can’t be called of work and if it works out they can get a green card.

        It should also be noted that what you perceive as an American only value of prejudice crosses all spectrums. Physicians from the middle east treat their nurses like garbage, because that’s their culture.

        As for this comment:

        “Stephen Haner James A. Bacon • 2 days ago
        Trump didn’t invent the racist nativist streak that infects too many Americans, but has exploited it from the day he announced in 2015. I see a line from that to what happened in Buffalo, but I’m sure you don’t. Yes, the solution is a better legal immigration systems, but plenty oppose that, too.”

        The Buffalo shooter was a racist, your leap to connect the dots to Trump is pointless and unfounded. Trump was a lot of things and non of them were good, but you’re making a leap that isn’t now nor was it than logical.

        You can’t get a better immigration system when one party refuses to compromise. Amnesty was granted by FPOTUS Reagan in exchange for better boarder security by a specific party, that didn’t happen.

  4. Peter Galuszka Avatar
    Peter Galuszka

    Sorry to hear about the health issues. Hope you are better.

  5. YellowstoneBound1948 Avatar

    I stopped reading at”Trumpian nativist nonsense.” Rant adds nothing to a complicated issue like healthcare.

    The core problem, in my opinion, is the unrealistically high expectations of Americans. We want the best, even when the best is unavailable. And that includes “street people,” who pay nothing into the system.

    If you want the best, go to Italy, where your income will be taxed at an average rate of 45%, whether you have a flu shot or brain surgery.

    I had heart surgery last year. My care was adequate and I had a good outcome. It never occurred to me that I should write about it.

    1. Nancy Naive Avatar
      Nancy Naive

      Which is why something as simple as “repeal & replace” would have killed millions.

      1. YellowstoneBound1948 Avatar

        The usual hysteria.

        1. Nancy Naive Avatar
          Nancy Naive

          Yes, thank god for John McCain… for once.

    2. Stephen Haner Avatar
      Stephen Haner

      The former Brit lady said in that country, with my situation, I’d be on a months-long waiting list for the new valve, taking my chances. Damn right I want the best and right when I need it.

      1. YellowstoneBound1948 Avatar

        And you got it.

  6. LarrytheG Avatar

    Did note Haners absence and suspected medical and glad to hear he got to a better place.

    All kinds of things can go through one’s mind when you’re in the hospital and realizing that you’re life is in the hands of others.

    And yes, the medical realm these days includes many folks with foreign surnames, medical licensure issues not-withstanding.

    It’s the same up Fredericksburg way. If you’re worried about replacement theory, better get your mind right if you’re in need of medical care these days. I do wonder with all the talk about American jobs why we don’t have enough American competing for those jobs.

    And pray GOD the fools who are convinced that our major institutions. like Medical are screwing us and need to be “fixed”!

    I’m betting Steve was not worrying about COPN and his ability to “shop” for the best combination of quality and price and I doubt seriously even if a lower price option was offered, that he’d be interested.

    Anyhow, good to see you back and kicking!

    1. Stephen Haner Avatar
      Stephen Haner

      Immigration has been the American “secret sauce” since the beginning. The phrase on the Statue of Liberty is just as important as the Declaration or the Constitution.

      As to options, now it is a simple question: Do you accept Medicare. 🙂

      1. Nancy Naive Avatar
        Nancy Naive

        Damned nice present the Frenchies gave us. Oh, and the Statue too.

      2. YellowstoneBound1948 Avatar

        You’re talking about two different things. The weak and the poor gravitate toward totalitarian states, too. The governing documents are not “help wanted” posters.

  7. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    Your observations and descriptions of a hospital stay today put a “face” on the frequent laments about staff shortages. You provide the perspective of the patient and what the shortages mean in personal terms. And you write it well.

    Your comments about the immigrants comprising the medical staff and the problems with licensing reminded me of an experience I had long ago. When I first moved to Richmond, the only facility where one could donate blood was MCV. One of the older heart surgeons insisted on using “fresh” blood for open heart operations. They often needed my A- blood. On one occasion I learned that the nice older gentleman that drew my blood had been a doctor in Cuba. Virginia would not let him practice medicine here. I really felt sorry for him. What a waste of training and talent.

  8. LarrytheG Avatar

    So Steve, did you have long covid and it did damage that needed repair or did symptoms for long COVID lead to other discoveries that needed attention?

    1. Stephen Haner Avatar
      Stephen Haner

      No, in retrospect I never had post-COVID issues. Everything I experienced as a lung/breathing issue and possibly COVID was instead the sputtering valve plus a building wave of edema (excess fluid) mainly in my chest and thus pressing on the lungs.

      Learned a new catchphrase from a doc: The brain is a liar, but your body tells the truth. I was listening to my brain.

    2. Stephen Haner Avatar
      Stephen Haner

      No, I never had post-Covid issues. What I took for lung breathing problems were the failing valve and a growing wave of edema pushing on the lungs. I learned a new catch phrase from a doc: The brain is a liar but the body tells the truth. I was listening to my brain.

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