Experiencing our broken health care system...

A crash in the middle of the night, blood everywhere, unconscious, 911, EMTs struggle to get him down the stairs as he vomits again and again before passing out, flashing ambulance lights, emergency room, IVs, CTs, helicopter ride to a trauma center, neuro ICU. 

I couldn't have been prouder of our health care system.  They were quick, focused, they communicated, they listened, paid attention to detail, did the right things at the right time, and for that reason, he came home whole.

Fast forward two weeks.  Two different hospital systems, 4 specialists, 7 follow-up appointments at various places, new medications, new activity restrictions.  I look at my multi-page spreadsheet to be sure I've captured everything that has to happen in the next months to keep him safe, make sure he gets the follow-up care he needs, that gives him a chance at full recovery. 

I think of how our lives have changed in an instant - just two anticoagulant pills, a fall - from peak health to near death.  Whenever he wakes, I wake up.  With every unfamiliar sound, I run to check.  I ask him too many times a day if he's OK.  We check blood pressures, heart rates, write down data for analysis, check that medications are taken on time. We drive hours to doctor's offices in various parts of the county, get repeat imaging tests, and on and on.  I consistently update the spreadsheets to make sure I am communicating all the information across health systems and doctors offices.  I am impatient when they do not know about all the issues I think they should.  I correct misinformation, I review research articles to figure out the right course and I pray I'm objective enough to make sense of it all.  Sometimes I wish I didn't know what I know - ignorance might just be bliss. 

Once you experience the stark transition from acute to chronic care, you learn personally just how hard it is to make things work.  Now our health system feels so broken - even with the best intentions of good, caring people, the broken-ness often wins.  I wonder how anyone who is not a health care professional can do this work with loved ones, family members and friends.  So many times, I've said, "...patients live 99.9% of their lives outside the health care system, and in the .1%, we can make or break their existence".  I think about the abstract terms I've read and talked about with patients and families in a whole new way - caregiver stress, life transitions, advocacy, risk-benefit, side effects, aging, mortality. 

As an internist, I'm sad to think perhaps I really didn't get it. I thought I did the work well.  I cared, I took time, I supported best I knew how, I studied, I read.  Now, I wonder if I did justice to my patients and their families.  Did I get just how much fear goes with it all?  Did I understand the sense of helplessness and frustration when one experiences this non-healthcare system?  Did I see just how hard it was to overcome the sometimes insurmountable obstacles the non-system throws down at every step? 

Now it feels so personal.

Imagine what it is like if you don't have the resources, resilience, support system, or ability to make sense of it.  Imagine not speaking the language, not having health insurance, not being able to afford the medications, waiting until you are so sick that the ED is your only choice. The truth is, the system is rigged.  Health disparities exist because we are not equal in the eyes of our health care system.  Shame on us.