IS OUR HEALTH CARE SYSTEM ON LIFE SUPPORT?

How long before you call 911 and hear elevator music interspersed with a robot voice saying: “Your call is very important to us. Please stay on the line and an operator will be with you shortly.”

That’s what we’re coming to. Some places are there already. Next time you have a medical emergency, you may not get the treatment you need. After waiting for your 911 call to be answered, you might wait a long time for an ambulance. A health care professional who worked in hospitals around the country for the past few years is telling me that our emergency rooms are so jammed, patients they used to be able to save are dying.

There aren’t enough nurses. There aren’t enough doctors There aren’t enough aides. There aren’t enough EMTs. It was a critical situation almost everywhere prior to onset of Covid. Writing three weeks ago in US News & World Report, ER physician Sharon Anoush Chekijian said: “Even before the pandemic, it felt like the emergency department was shouldering the lion's share of primary care: We'd provide treatment for hypertension, refill prescriptions when calls to the doctor's office went unanswered and manage chronically elevated blood sugar. Behavioral health patients with nowhere else to go would arrive one after the other by ambulance… Now COVID-19 has laid bare medicine's house of cards.”

Our ERs are teetering on the edge. The recent vaccination mandate from Maine Governor Janet Mills caused a surge of staff resignations, as have similar mandates across the country. According to the October 1st Lewiston Sun-Journal: “‘It has a huge impact on the existing labor shortage,’ said Dr. John Alexander. Central Maine Healthcare is the parent organization of Central Maine Medical Center (CMMC) in Lewiston, Bridgton Hospital and Rumford Hospital, as well as Maine Urgent Care and a primary care network. ‘In addition, to be honest, a lot of the people, a lot of frontline caregivers who have worked through this pandemic are tired,’ he said.”

I asked the health care professional who first alerted me to the problem why hospitals don’t just hire more staff. She said they’re just not out there and nursing schools aren’t graduating them fast enough either. Neither is there enough staff qualified to teach nursing students. Salaries at all levels are way too low. Hospital administrators. However, are paid well. Ten years ago the CMMC CEO was paid over $857,000 for fiscal 2011. What is it today? I wasn’t able to find data. My guess would be over a million per annum.

The Emergency Medical Treatment & Labor Act (EMTALA) passed in 1986 mandating that emergency rooms treat everyone who shows up. They must be screened, stabilized, then passed on to an appropriate hospital or they stay in the ER.

ER staff see patients suffering and dying every shift for lack of care. They see loved ones grieving too. CEOs do not see these things. They see spreadsheets of profit and loss. Kate Wells of Michigan Radio writes: “Inside the emergency department at Sparrow Hospital in Lansing, Michigan, staff members are struggling to care for patients showing up much sicker than they’ve ever seen.Tiffani Dusang, the ER’s nursing director, practically vibrates with pent-up anxiety, looking at patients lying on a long line of stretchers pushed up against the beige walls of the hospital hallways. “It’s hard to watch,” she said in a warm Texas twang. But there’s nothing she can do. The ER’s 72 rooms are already filled. “I always feel very, very bad when I walk down the hallway and see that people are in pain, or needing to sleep, or needing quiet. But they have to be in the hallway with, as you can see, 10 or 15 people walking by every minute,” Dusang said. …“I cannot tell you how many of them [the nurses] tell me they went home crying” after their shifts.” 

Dr. Chekijian in US News says: “The bottom line is this: The house of medicine in the U.S. is a house of cards that has already started its crashing descent into collapse.” 

I just turned seventy last spring and this is a disconcerting scenario for my demographic, the cohort most likely to need health care. Prone to chronic blood clots, I’ve spent many hours in emergency rooms over the past thirty years, the last few times on a stretcher in a hallway because the ER was overcrowded. I watched nurses scurrying about trying to tend to us all and hated to add to their stress by asking any more of them.

The last time I did that was three years ago. What will it be like the next time? I hate to think.

DOB -- The New ID

None really, except as another ID

What’s your date of birth? That’s increasingly how the world knows you. Mine is April 7, 1951. Even to get meals in the hospital they ask me for my DOB. I spent most of last week there for a chronic medical condition you never heard of: Buerger’s Disease. That’s not to be confused with Berger’s Disease which is a kidney problem. Mine, with the “U,” manifests in blood vessels. I get aneurysms and blood clots —so far all in my left leg — and I’ve had seven bypasses over the past 35 years all in the same place (so far), inside my left knee. 

Vascular surgeons take veins from other places and make them into arteries to get around the clots but I’m running out of suitable veins. Last week, my new surgeon used plastic to firm up an aneurysm and a fabric tube to channel blood. This incision is fifteen inches long. There are scars up and down both legs from groin to ankle. Nearly all of us have something we struggle with. This is my thing.

My brother, Dan

The only other person I ever knew with Buerger’s Disease was my brother and he was dead at 57 by which time he’d lost all his fingers and both legs above the knee. He couldn’t stop smoking and it’s tobacco products that accelerate the disease. I could, so I still have all my parts. For that, I’m grateful. Blood is still getting to my foot — today — so it’s still alive. I’m learning to stay in the day and today is good. I’m getting around with a walker; soon I’ll graduate to a cane; then to a limp. After that I hope to resume running — not too far. I don’t get enough blood down there to go far, but I can still go few hundred yards before cramping up. I hate doing it, but it feels good afterward.

Between three and four million people were born in the USA during 1951. Divide 3.5 million by 365 and you get 9589 born on April 7, 1951. At my 50th high school reunion last fall, I learned that about a third of my class of 1969 are dead. That would be 3164 of the 9589 Americans born on my birthday leaving 6425 — approximately how many Americans born on 4/7/51 are alive today. Darn few of them are named McLaughlin, so, that’s how I’m known: “McLaughlin 4/7/51.” At 68, I’ve lived about 25,000 days. How many more? I don’t go there. I stay in this day.

I’m asked about my birthday so often I’ve started making light of the question. “You don’t have to get me anything,” I answer. “Just a card or a happy birthday on Facebook is fine.” At least dozens, maybe a hundred times lately, I’ve been asked if I’m allergic to anything. “I’m developing an allergy to Democrats,” I’ll quip. Some people chuckle at that, but most declare vehemently: “No politics! That’s off limits.” “Okay,” I say, “How about humor? Is that off limits too?”

Another thing I’ve been asked a lot is: “Have you had any anxiety or depression lately?” First I just look at them for a second, then say, “Only when I watch the debates.” Most let that go without getting upset.

My brother and I were each diagnosed with Buerger’s Disease when we were 33 years old. He was born April 1, 1955 — almost exactly four years after I was. We had identical surgeries by the same doctor at Mass General. We were even in the same room four years apart. I stopped smoking but continued going to pool tournaments at smoky pool halls and my disease progressed. My aneurysms and clots diminished only when I gave that up too. My brother couldn't quit tobacco and ultimately died after enduring 52 separate amputations. From him, I learned the power of addiction.

Me in the middle. Dan second from right.

Near his end, he was contacted by one of the Florida attorneys involved in the multi-billion dollar tobacco settlement of 1998. Though Buerger’s Disease is rare, it’s very easily linked to tobacco in all forms and he wanted to represent my brother in another lawsuit. For him to appear in court minus so many of his parts would, of course, be dramatic, and the tobacco companies would likely settle long before that. He wanted me to join the suit but I refused. That caused a rift between us. I always knew smoking was bad and so did he. No one forced us to do it. The suit was thrown out, but not because of his death. The attorney could have continued on behalf of his estate. It was because of something to do with the statute of limitations between when he was diagnosed and when his suit was filed.

I have a cemetery plot and a stone engraved with my birthdate. Someone else will arrange to engrave the next date. No hurry.