Livin' in the 90's

Last summer, my then 94-year old father-in-law was gallivanting around Europe with one of his sons. He had always wanted to visit the towns that bore his last name. One was in Germany, one in Czechoslovakia. And he did so. And he was having the time of his life, that is, until one morning while staying in a little inn in Poland, he couldn't lift his head off the pillow. His body wasn't working. An ambulance was summoned and Zaidy was rushed to the small, nearby hospital. He had suffered a stroke.

I'll spare you the terror that went through our minds when we received the phone call. It was bad enough that Zaidy was deathly ill in a foreign country, but this was in the very same country that turned over his whole family to the Germans back in 1943 so they could be transferred to the concentration camps in cattle cars never to be seen again...his parents, grandparents, sister, 9 brothers, their spouses, and children. As a young adult, Zaidy was out of town when it happened.

But now this Holocaust survivor was at the mercy of the Polish doctors to save his life. What a paradoxical situation to be in. What an enigma he must have seemed to them. Trust me. They probably had never seen a Jewish patient in that hospital before, let alone a near-centenarian who survived World War II! He sure got their attention! Zaidy was the talk of the entire hospital, the entire town. And call it collective guilt or old-fashioned medical professionalism, they saved his life.

After a week or so, Zaidy was transferred to a major hospital in Germany to further his recovery and receive physical therapy. He speaks German as well as Polish and though his speech may have been slurred, he could still communicate very well with the staff. Much to our tremendous relief, Zaidy got superb care there too.

Amazingly, although incontinent and unable to walk, our barely 110 pound Zaidy boarded a jet a few weeks later and made the transatlantic flight... ...back to the States and the American health care system. Taken to the ER immediately upon arrival, Kaiser Permanente relinquished him directly to a rehab facility in which he was allowed a maximum stay of 21 days or so. That is, as long as he was showing improvement. Otherwise, we were informed, he'd be discharged sooner.

The day after Zaidy's admission, I arrived to work bright and early for our monthly staff meeting. In addition to our clinic practice, we also visit 60 facilities throughout the city. I looked around the table. I think there were 9 or 10 doctors and nurse practitioners that day. What did they think of this particular care center that Zaidy was in? "Was it good?, I asked, hopefully.

Dead silence. Nobody said a word. They all just starred at me.

Finally, Candy, one of the Nurse Practioners answered. "The truth is," she said, "you never want one of your family members to go to one of those places, if you can possibly avoid it, especially THAT one. But if you have to do it, remember, it's up to the family to make sure that the family member gets the care he needs. They need to be all over it!

Long story, short...in that rehab facility, my family became omnipresent!

And Zaidy got the care he needed. Excellent care, in fact.

And after 21 days or so, he went home back to his condo, albeit fragile and weak.

It was difficult. Lots of physical therapy. Lots of effort and determination on his part. It wasn't long however before Zaidy celebrated his 95th birthday. Soon he was walking again without a discernible limp and cooking in the kitchen. He renewed his driver's license. He was playing golf again.

And just recently, with some amazing tutelage from his eldest grandson, Zaidy started using a computer again. He signed up for high-speed Internet and registered an email address. Now we can hardly break him away from UTube where he watches his favorite Yiddish videos.

What a guy. Yasher Koach, Zaidy!

Medicarelessness

Today our R.N., who cares for all our patients as if they're her own family members, reached into her purse and handed me her personal VISA card. Out of frustration, she decided to pay for a patient's Plavix because he's run out of pills and he's run out of money...and Medicare won't pay for his meds now. Remember that darn Medicare doughnut hole? The one you sink or swim in when you've spent x-amount of dollars on medications in a given year? When it's your time to swim in the doughnut hole, you have to pay 100% out-of-pocket for awhile. Otherwise, you sink.

Sammy, who has been a patient of ours for 30 years, is in his 60's. He lives with his mom, Gladdy, who is in her 90's. She keeps calling us crying because she can't find a way to pay for Sammy's pills. Safeway Pharmacy already called us that he owes them $400. Who knew Safeway took pity on poor people and allowed them some slack paying for their meds. Sammy is out of slack. The R.N. is desperate to find him some medication. She calls his cardiologist and begs for samples. (They’re rationing.) They reluctantly allow one week's worth. They, in turn, promise to apply for Plavix assistance through the generous folks at Bristol Myers. I agree to try to apply for emergency assistance from Medicare...on Monday.

I take the R.N.'s VISA card and click on the link to my favorite Canadian pharmacy and order 3 months worth of Clopidogrel, generic Plavix, which isn't even available in the United States. It's $77.00. In the U.S., the brand name stuff would have cost Sammy about $270. Eventually, the medical practice will end up reimbursing the R.N. and paying for Sammy's Clopidogrel because we don't want him to die.

Lately, we've been paying for some patient lab tests and not charging the health care workers who come in to see us because they work hard and take care of our patients in the nursing homes. Most of them are overworked, underpaid, and underinsured. So, we try to take care of them when they ask, so they are healthy enough to take care of our Medicare and Medicaid patients who reside in those pathetic warehouses that you never want to send your family member to if you can possibly avoid it.

Anyhow, Sammy needs more than Plavix. His mother needs her medications too.

There are a lot of Sammy's and Gladdy's now. Many are just not getting their medications...and ending up in the E.R., where they get meds for a while and recover, which Medicare will pay for. Then they're discharged.

Once back home, some still won't have found a way to pay for their medications and will just sink down into the doughnut hole...never to come up.

MediCARE? or Medicarelessness?

A Taste of My Own Medicine

We see primarily Medicare and Medicaid patients in our private medical clinic....mostly the patients the other doctors don't want to see anymore because the reimbursements keep dropping. I get calls all the time from sick people telling me their doctors are dumping them because they are on Medicare. As far as the Medicaid patients, most were already dumped a long time ago. "Are we accepting new patients?" they ask hopefully. And when I say "yes we are", I can hear the familiar sigh of relief through the phone. But, this is a topic for another blog entry.

Today I am the patient. I have been sick for 2 weeks with a progressively worsening sinusitis. Never mind the stressors in my life that have compromised my immune system and allowed me to become ill from all the infectious bacteria on the doorknobs and elevator buttons I have touched. Those stressors are also topics for another blog as well.

Today I desperately need an antibiotic to treat the infection in my body that my own white blood cells are struggling with. And...drum roll, please....that antibiotic of choice, after much conversation with the R.N., the N.P., the M.D., and the Pharm.D. is..Levaquin! Okay! The script is called into our pharmacy. I retreat to my office and place a few phone calls with my raspy voice that disguises who I am and then race downstairs to pick up my prescription. The cost? Why, it's a mere $148! And that's AFTER the newly implemented Anthem Blue Cross plan health savings account discount (The medical practice recently switched from Humana when we received notice that our monthly premiums were being increased; mine to $1,600). Sticker shock ensues. Suddenly I feel sicker than I already felt...and that was sick enough. Let me sit down please in one of your two chairs facing Suze Orman on Oprah.

One hundred and forty eight dollars for the 7 white pills which will eliminate the thick green snot, the coughing, the sneezing, and restore my sense of smell and taste. Okay, I get it now. The insurance company wants to discourage me from buying medication to treat my illness. Their plan is working. Next time I get sick like this, I may be disincentivized from getting treatment. After all, my premium only costs $1,000/mo for my husband, son, and me with a $10,000 annual deductible. Isn't that great? We only have to pay the first 10 grand (including medication costs), plus our annual premium of 12 grand and THEN any further expenses are covered 100%. I’m still paying off medical bills from 2007 that the insurance didn’t cover.

Who can afford this? I can't. If the doctors who I work for didn't pitch in a little to cover the costs, I know firsthand what the consequences could be. Tragedy.

And that is also a topic I will expound upon in another blog.