Appendix Addendum

Well, I’m back and I still own an appendix.

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 was 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 New York Methodist hospital, high score for quality and surgical infection prevention, not to mention a nice middle-range $14,000 average charge for an appendectomy.

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.

So off I trundled to NY Methodist. It’s a nice place, my son was born there, it’s on Seventh Avenue in Brooklyn which is in trendy Park Slope, so I anticipated good customer service also.

I arrived only to be baffled by construction, the ER entrance was now all the way around the other side.

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 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. The deli where I buy my lunch can handle this simple task, and they only want five bucks for a sandwich.

I waited about half an hour and was seen by a triage person. I told him about my abdominal pain, other uncomfortable GI issues, and had my blood pressure taken. Blood was taken. I was then given a plastic bracelet with 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 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 chairs 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: 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.

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 shitty job because I’m annoying; however, I refuse to receive service from a health care professional who may be pissed at me. Just not willing to risk it.

The next day I cheated and put my inside knowledge to work for me. I knew that Victory Memorial 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, Victory 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 Victory and my cunning plan proved itself when I saw only one other person waiting in the ER.

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

I was starting 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 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 bankruptcy, 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 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 TB?

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 CONTAINMNENT ROOM. RIGHT ACROSS FROM ME.

So, considering I had absolutely no intention of being operated on at Victory, 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.

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 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 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.

Therefore, I am now pronouncing that not only are appendixes (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 dignosis of appendicitis, as I suppose it really should be reomved 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 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.