History
Earlier this month I made a trip back to the U.S. for health problems. To take the mystery out of this situation, it turns out (I found out recently on the TV news) that Nelson Mandela and I share the same malady. We both had a bout with TB years ago which left us with limited lung capacity and also very susceptible to lung infections - infections being really gamey when you have limited lung capacity.
I have been hospitalized in Chiriqui Hospital three times this year already. Although I keep oxygen in my home I normally only use it about once a day when I need it. But since my condition is diagnosed to deteriorate over time, I was compelled to go back to the U.S. to obtain a Portable Oxygen Concentrator.
A Portable Oxygen Concentrator (POC) is a mobile oxygen source, about the size of a small woman's pursue that produces oxygen. Since there is no storage tank and the oxygen is not 100% pure, the units are FAA authorized for flight (after a bunch of paperwork). The POC insures not only that I will be able to get 'out and about' in the future, but also that I won't become 'trapped' in Panama unable to travel (or leave).
I had to go back to the U.S. to get a POC because they are an unknown item in Panama. Also, as most of you are aware, Medicare provides no coverage outside the U.S. Medicare requires that a pulmonologist has to prescribe a POC based on a serious of tests, and then the patient orders the specific unit they prefer.
My quest and travel to get a POC went right according to plan right up to the morning I was scheduled to depart North Carolina to return to Panama. Instead of going to the airport I headed to the Emergency Room in the New Hanover Regional Hospital in Wilmington. Lung Infection!
So much for the medical background. The point of this posting has to do with the care and treatment I received at the hospital, not my medical condition. In short I was 'blown away' by the experience. For those of you that have been hospitalized recently in the U.S., this may not be amazing information to you. But if you have not been hospitalized in the U.S. for a while, I think you will be blown away just as I was. What added to the shock for me was that I had been a patient in that hospital about six years ago. What an overhaul. My, what a difference!
The Emergency Room
The young lady at the welcome desk was an RN who was very efficient. It was only
later that I realized that the other two nurses that seemed to be roaming the lobby were funneling people who had 'minor' problems to separate stations in the emergency room and the nurse at the desk was processing people that it appeared were serious and/or going to be admitted. (I guess being in a wheelchair, huffing and puffing even when hooked up to the POC was a dead give-away). So even though there were 15-20 people in the area, I was being processed within 10 minutes of arrival.
The nurse was looking at a big screen monitor with a Windows logo that had to be 24"x24" (more on that later). She proceeded to enter my personal information, insurance details, short summary of medical problem, list of prescriptions, allergies, etc. (Note that in the Chiriqui and Mae Lewis hospitals in David much of this info is collected only after you are admitted and in a room.) When she finished entering the information, she put a bracelet on me, made a call and I was immediately wheeled into the bowels of the Emergency Room ward - into a room crammed with all kinds of electronic equiptment, and put in the bed. That is when the fun started.
A nurse came in and introduced herself and ask some questions as she was cranking up the computer with the big screen and the Windows logo - Yes, every place you went in the hospital that monitor was there, available and used. She scanned my bracelet, which opened my file and then read to me the preliminary steps the Emergency Room physician had already outlined. Within seconds a nurse wheeled in the machine and took vital signs. Minutes later another tech took blood. A third nurse came in and did a quick EKG. The doctor then came in and talked to me about the tests and said we needed a chest X-ray and also called on his cell phone (more on that later) to have a heart monitor hooked up. As it turns out, we did not have to go to a lab for the X-ray, they wheeled a portable X-ray machine right into the room.
Less than ten minutes after the X-ray was taken, the doctor returned and said they were going to admit me because I did have an infection. He also outlined in general terms the treatment protocols and added that a specialist would refine them in a couple of hours after they got the inital processes started. Then, after a conversation with a nurse, he apoligized because my room would not be ready for about twenty minutes.
Needless to say, I was impressed by the efficiency of this whole process! But I was also impressed with the professionalism and safety built into the system. All of the steps that were taken above involved the same process. Every doctor, nurse or technician that came in the door, signed into the computer, scanned my bracelet, documented what they did and then enetered the results if it were a test of some variety. And the same procedures were followed the entire hospital stay - scan the bracelet and enter it into the record. This even applied to administrative types who came to explain things like out-processing.
My 'New Home' For The Next Three Days
I guess one could expect a nice room in the portion of the hospital that is fairly new. But private rooms? The surprises continue. The head nurse explained that private rooms were the norm in recent-year hospital construction.
In addition to the array of mysterious electronics behind the head of the bed and the ever-present computer monitor, the room had a small desk just the right size for a laptop workspace. And a big reclining lounge chair that could be configured for the patient to sleep in. The chair is also available for visitors to spend rhe night - there are no visiting hours. The only thing that changes at night is the exit which are open to allow visitor entry. The sill on the large window was cut low to allow for an unrestricted view of the outdoors from the bed.
On the wall at the foot of the bed is a big plex-glass covered board with lines label Head Nurse, Nurses Assistant, Respirator Tech, Ward Secretary, Hosp. Admin and Doctor, etc. - all followed by a four-digit number. The number is the person's hospital cell number and you are instructed to call any or all if you have a problem (there is a phone hanging on the side of the bed). On each shift change all of those listed people come in and introduce themselves, wipe off the appropriate line on the board and add their name and cell number. The board is also updated by the head nurse every morning after the doctor makes his rounds to make sure your medical goals for the day and the duration are visible documented as a constant reminder.
The TV remote control also has nurse call buttons on it. And the multitude of bed adjustment buttons on the bed rails also includes a clearly marked 'Nurse Call' button and controls for the room lights.
Getting Hungry?
I hadn't even finished trying to figure out all the electronics when a fellow walked through the door and introduced himself as one of the chefs (I'm not making this up!). He was dressed the part, in his chef's white coat, and he was delivering me the menu so that he could answer any questions I might have. I glanced at the menu and realized it would take me about a half an hour to read it all - a menu that in size and professional appearance rivaled those of the TGI Fridays or Ruby Tuesdays. (This is a joke, right?).
The chef also explained that as a safety measure a 'new patient' is on a 'heart-healthy' diet for the first 24 hours and the doctor would extend or drop the designation as my condition warranted. The heart-healthy items were marked with a red heart symbol. As you might imagine, on a hospital menu there are not a large volume of items eliminated by the heart-healthy restriction. It did mean that my first night I could not order from the Mexican or Italian items, and the only Oriental item available to me was a veggie concoction.
Both the menu and the information board at the foot of the bed gave the number to call to order your meals and listed the hour-and-half window for ordering for each meal. By the way, on one occasion I had dozed off and as time was running out, the kitchen called me to remind me I hadn't ordered.
The next surprise was when my first meal (lunch) was delivered. The delivery person was not a little old man in hospital sweats - rather a young man in a 'wait staff' outfit you would associate with a fancy restaurant - black dress slacks, white ruffly shirt with black bow tie and black vest - a tuxedo without the jacket. Plus a big smile and hello!
AND THE FOOD WAS FANTASTIC! I ate nothing off that menu for 3+ days that was anything other than outstanding. I wish I owned a restaurant with that good a product across the board. That franchise would be a mega-million creator.
Let's Get Outa Here!
When it came time to check out I had three important visitors. The first lady was the pharmacist who came in to explain in detail the short-term prescriptions I would be taking for the next couple of days - what they were for, possible side effects, what to do and who to call for any side effects, etc. She also itemized the changes the doctor was making in my normal prescription regimine. And finally, the drugs the doctor was taking me off of and why.
The next visitor was from the discharge office and she had printed out a history of what happened in the hospital so I could take it with me since I did not live in Wilmington. She also had info sheets on my medical condition and possible future treatments available. She had also made an appointment for me with my pulmonoligist as a followup.
The last person was from the hospital's business office (I suspect the legal office although she did not say so). She gave me name's and numbers of administrators in the hospital if I had any problems with my hospital stay or any complaints (that I did not chose to convey to her). She also gave me numbers and offices to contact outside the hospital if I chose to take complaints elsewhere.
Phew!
Finished With The Hospital?
I was further surprised (they just keep coming) when I found out that my release from the hospital was not the end of the story. The day after my release I got a call from the head nurse checking up to see if I was doing OK and checking to see if I had questions. The following morning I got a call from the doctor with a similar inquiry.
The Bottom Line
All in all, one heck of an experience. For those of you familiar with healthcare in the U.S. this may be encouraging. For those of you familiar with the hospital operations here in David (which I have no complaint with!), I am certain you will be impressed with the differences.
I can not help but compare this hospital stay to my recent experiences in the hospitals in David. And I am referring primarily to the flow of information and (for want of a better expression) customer service, not the frills. Although some would speculate that it is a language barrier, I reject that explanation. It is intent to communicate that is missing. There is always someone around who speaks English and I speak some Spanish. My doctor is fluent in English. It is intent, the system, the way 'we do things' that is different.
Till Next Time (Hopefully With a Different Subject). Pura Vida