Friday, March 16, 2007

Appendix Addendum

This is a personal account of my recent brush with appendicitis and the fun I had getting hospital care...

I had appendicitis, but it took me a week and a half to figure it out. Couple that with my built-in fear of all things medicinal and by the time I had a CAT scan I'd actually beaten the inflammation back from whence it came.

As it turns out, I now know what that funny stomach ache that lasted a week back when I lived in France actually was. That's right. I've had appendicitis TWICE.

So seeing as how I'm this health care report card guy, I decided to put my money where my mouth is and chose a hospital based on the report card I built. Due to the nature of my work I have a better knowledge than most of the hospitals in my area, and I chose Hospital A, high scores for quality and surgical infection prevention, not to mention a nice middle-range $14,000 average charge for an appendectomy.

(Yes, I'm price sensitive. I grasp the fuzzy math that the more I spend on health care, the less my boss has to give me a raise next year.)

The Doctor is Out

I should back up a bit and mention that I called both of my doctors before going to the emergency room, I really didn't feel like I was in an emergency and I simply wanted a doctor to examine me. I'm on the books with two guys in Brooklyn, neither of whom could see me within a day and half of me calling.

I tried, damn it.

One was out for two days, the other had been paged three times in three hours with no reply. The girl at the office suggested his pager might be broken. I've only been to the guy once, in a recent effort to change from my DO to an MD. I like my DO, but no-one else does, the general theory being that DOs suck and MDs are gods. This particular MD was not at all helpful, and managed to lose my head X-rays for a week, but he has privileges at Hospital A so I figured I'd give it a whirl.

Hospital "A"

So off I trundled to Hospital A. It's a nice place, my son was born there, it's in trendy, upper-middle class Park Slope, so I anticipated good customer service also. It's a hike from Bay Ridge, but I felt the thirty minute drive and the potential three days to find a parking spot were worth it.

I got to the ER and wrote my name on a piece of paper and followed the instructions to post it through an anonymous slot. This later turned out to be the triage room.

The ER waiting room was pretty full, and no signs or clocks gave me any indication of how long I would be waiting or how many people were in front of me to see the doctor.

The deli where I buy my lunch can handle this simple task, and they only get five bucks from me. I'm in an ER waiting to spend $14,000 dollars. Come on people!

I waited about half an hour and was methodically seen by a triage person. I told him about my abdominal pain, other uncomfortable and unmentionable GI issues, the mentionable projectile vomiting, and I had my blood pressure taken. Blood was removed from my body with no indication as to why. I assume it was for tests, but still, a few words would be nice.

I was then given a plastic bracelet with a close approximation of my name handwritten on it, and was then directed to the *real* ER waiting room. Up until now I had been in the triage waiting room.


The ER waiting room proper had many more people waiting, along with a TV. I toyed with the idea of turning it off using my universal off button, but felt that this was one audience who needed their network television.

I was registered and my billing details were taken. I then waited another three and a half hours or more until I became so uncomfortable sitting on the plastic chair I elected to leave so I could go home and lie down.

Strike one.


I didn't tell them I was leaving, I simply left; but here's the reason I didn't go whine about how long it was taking: health care is a service industry. My knowledge of service industries tells me that if I get seen out of order or in response to a complaint I make, my quality of service is likely to go down.

The hospital equivalent of the waiter spitting in your sandwich scares me.

If we're talking about sewing buttons on a coat I may make the value decision to be loud and demanding if I think my button sewing service is failing me, as I do not value buttons highly enough to care if the button sewer subconsciously does a crappy job because I'm annoying; however, I refuse to receive service from a health care professional who may be pissed at me.

I'm just not willing to risk it.

Hospital "B"

The next day I cheated and put my inside knowledge to work for me. I knew that Hospital B had recently filed for bankruptcy, had appeared in the infamous Berger Commission hospital closure list and was suffering a large decline in ambulance drop-offs. Plus, it's literally around the corner from me.

The down side was that, according to my report card, Hospital B scores very low on surgical infection, and had a surprisingly high average bill for appendectomies, a whopping $21,600!

However, I was still telling myself this was a bout of constipation and I really just wanted a trained medical professional to rule out appendicitis.

I trudged around the block to Hospital B and my cunning plan proved itself when I saw only one other person waiting in the ER.

Victory was mine!

I was triaged in about five minutes, and the only difference was that Hospital B also requested a urine sample, Hospital A had not done so. More surprisingly, unlike the scrawled, unreadable bracelet I received at Hospital A, I was given a computer-printed bracelet with my name, date of birth and other useful information on it.

I was begininng to be impressed.

A doctor came out within ten minutes, and guided me to the ER. I ran through the symptoms and professed my half-arsed fear that I had appendicitis, but the doctor pretty much ruled it out as I had no fever nor any other signs usually found with appendicitis. However, she recommended I get a CAT scan. I resigned myself to the three hours of Barium digestion and said yes. By now I was in a hospital gown on a wheeled bed.

Over the course of the next three hours I was successively removed further and further from the ER as people with real injuries and worse pain came in. By the time I was sent up for the CAT scan I was at the very end of the corridor. My gut feeling (pun intended) was that most of the staff figured I was fine, I obviously didn't have appendicitis as I looked perfectly fit and healthy apart from the searing stabbing pain I felt when I poked myself in the gut.

I overheard many conversations about the hospital's recent bankruptcy filing, people's holiday pay, new jobs, that sort of thing. I probably didn't help myself much by having brought a copy of Ian Morrison's "Health Care in the New Millennium" to read.

Undaunted, I got my CAT scan and was wheeled downstairs to await the radiology report. That took about another hour, at which time we found out that yes, of course it's appendicitis, here, have some antibiotics, please wait for the surgeon.


The best part was when they came up and just started hooking up fluids to an IV without telling me what they were doing. I had to stop them, get their attention, and have them tell me exactly what they were doing and why.

You can't just walk up to someone and start pumping stuff into them, can you?

Who do these people think they are, and who do they think *we* are? I'm sure the routine stuff gets boring after a while, but seriously, inform me.

By now I was actually down the corridor and around the corner, so I was practically outside the hospital. I sat and read and waited. And waited. And waited.

I was so invested by this point I was resigned to waiting for the surgeon to arrive. However, it turns out that I was by now parked outside the room where you put dangerous folk such as people with tuberculosis.

Of course, what are the odds of anyone turning up at a bankrupt hospital at 7 in the evening with tuberculosis?

Odds on, apparently.

A guy was brought in with full blown TB, a fact I only know because the nursing staff were discussing his dangerous-ness right around the corner from me, well out of earshot of the real patients.

Masks were handed out to the staff and the wife was briefed on her need to be tested. All of which was fine, until they left to go do other nursey things and this TB-ridden moron kept LEAVING HIS ISOLATION ROOM. RIGHT ACROSS FROM ME.

So, considering I had absolutely no intention of being operated on at Hospital B, and given the fact that a family of TB was walking past me asking how I felt, I decided to make a break for it. I wheeled myself down to the ER desk and asked to be discharged. Everyone seemed a little perturbed about that and convinced me to stay. I decided to give the surgeon a half hour, after which I would sign out against medical advice.

My antibiotics had finished a long time ago, and I was just in the middle of trying to figure out how to remove the IV from my arm without anyone noticing when magically, the surgeon arrived.

He was a bit flummoxed I think by the diagnosis, and was in no rush to whip the little bugger out. He wanted me to stay overnight but I could imagine nothing less inviting, so I sweet-talked him into letting me go home under the promise that if all hell broke loose in my abdomen I'd be back around the corner in two minutes flat.

He signed me out under "abdominal pains of unknown origin" or some such safety diagnosis, and I went home, whereupon I alternated between sleeping and eating toast for three days.

I feel gipped by this, I have appendicitis, I'm willing to sign out against medical advice, why stick me with a phony diagnosis?


I am now pretty much 100% better, although a bit gurgly. The pain's all gone, I have a huge new understanding of how medical care is delivered and how hospitals work from a patient's perspective, and best of all, I still own an appendix.

Now, I am not the kind of person who believes in vestigial appendages. It's in there, and it's in there for a reason. I do subscribe to the fact that it's great for digesting grass, and I also subscribe to the fact that I am evolutionally unfit to consume grass or other green leafage, being more genetically predisposed to large chunks of dripping red meat.

Therefore, I am now pronouncing that not only are appendices necessary, mine is different from most everybody else's which is why I want to throw up when I see cabbage or lettuce. Or spinach.

So there.


My next experiment in health care will be trying to schedule an appendectomy without a diagnosis of appendicitis, as I suppose it really should be removed at some point. It's obviously not happy in there, but without a valid reason for having it taken out as part of an emergency, I'm curious to see what my options are.

Seems to me that with my history I should be able to call up a hospital and just schedule an appendectomy, but I've a funny feeling nothing is that easy.

Common sense tells me it would be better to have it removed while it's in a vegetative state (har har) as opposed to inflamed and angry, as then it could be removed laparascopically. But hey, what do I know, I'm just the owner/operator of a human body.

Stay tuned.


Disclosures and Disclaimers


My employer is compensated through funding to provide analytical research, technology solutions, and Web-based public and private health care performance reports by the State of New York, the State of Illinois, the Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality, the Commonwealth Fund and Bridges to Excellence. I am not being compensated by any of these organisations to create articles for or make edits to this Web site or any other medium; and all posts authored by me are as an individual and do not represent my employer or the agencies I work for.