Loving My Heart-Against Medical Advice

Leaving against medical advice, a weekend reprieve, the cost of health care astounds.

Pic of the Day

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A Needed Operation Closing in on a Cost of $100,000

So I begin this chapter in my heart saga with a tongue-in-cheek explanation of health insurance.

HEALTH INSURANCE EXPLAINED

Q. What does HMO stand for?
A. This is actually a variation of the phrase , "HEY MOE " Its roots go back to a concept pioneered by Moe of the Three Stooges, who discovered that a patient could be made to forget the pain in his foot if he was poked hard enough in the eye .

Q . I just joined an HMO . How difficult will it be to choose the doctor I want?
A. Just slightly more difficult than choosing your parents . Your insurer will provide you with a book listing all the doctors in the plan . The doctors basically fall into two categories: those who are no longer accepting new patients, and those who will see you but are no longer participating in the plan . But don't worry, the remaining doctor who is still in the plan and accepting new patients has an office just a half-day's drive away and a diploma from a third world country .

Q. Do all diagnostic procedures require pre-certification?
A. No. Only those you need.

Q. Can I get coverage for my preexisting conditions?
A. Certainly, as long as they don't require any treatment.

Q. What happens if I want to try alternative forms of medicine?
A. You'll need to find alternative forms of payment

Q My pharmacy plan only covers generic drugs, but I need the name brand . I tried the generic medication, but it gave me a stomach ache . What should I do?
A. Poke yourself in the eye.

Q. What if I'm away from home and I get sick ?
A. You really shouldn't do that.

Q. I think I need to see a specialist, but my doctor insists he can handle my problem . Can a general practitioner really perform a heart transplant right in his/her office ?
A Hard to say, but considering that all you're risking is the $20 co-payment, there's no harm in giving it a shot .

Q Will health care be different in the next decade ?
A. No, but if you call right now, you might get an appointment by then

Until we moved to Delaware, back when I was working full time and was the one with the employer-provided health insurance, we belonged to an HMO. At that time it was my daughter who required extensive health care. Husband and I were young, in the grand scheme of things. Daughter had mental health issues plus some physical problems that I think she had since she was a child.

An HMO makes health care easy. One only has to call the nurse and boom, appointments are made, referrals generated, x-ray and lab appointments committed. The HMO people do all this stuff, in other words.

Of course one of our major needs when husband and I moved to Delaware was good health care insurance and such was a priority when husband went looking for a job. We were both at the most crucial of ages, the fifties and/or early sixties, when medicare had not yet kicked in but when health insurance is most critical in terms of personal health care issues suddenly coming to the fore.

It was during this experience with my blocked heart that I learned, with a shattering shock, just how much health care costs. I also have come to understand that without easily accessible health insurance a sick person's care could be compromised.

Neither husband or I made much use of his employer-provided health insurance for the first five years after our move to Delaware. One time we both had a severe flu, a flu so bad that I had to fight the light at the end of the tunnel.

We both did, and still do, get the annual flu shots which are so easily and cheaply available in this part of Delaware with an older population. Beyond that, there was not much reason for either of us to access health care although our families might argue that we should take better care of ourselves.

I have always disliked going to doctors. Not that I have anything against doctors. They are fine people and should be allowed to live. I have also always hated taking any kind of medication, especially of the prescription kind. I watch the commercials on the TV and ponder that we live in a country where obtaining medicine is a capitalistic enterprise. On popular shows we are treated to commercials telling us to consult our doctors for relief from depression, acid reflux, asthma and arthritis. I am amazed that the big drug companies are so obvious in their reach for our pocketbooks. I'd always considered prescription drugs something one takes on rare occasions. The notion that we can, boom, ask our doctors for a prescriptions for eating too much greasy food boggles my mind.

I particularly love the depression commercials. Zimbalta I think is the drug advertised.

These commercials show, well I suppose they must be "sad" people. We might see a mature man sitting on the side of a bed while an obviously sullen dog awaits by the bedside, leash in mouth. Or perhaps we see a young woman who looks as if a smile had never crossed her face. She is disheveled in that manner of humans who are down in their cups.

Well damn! These are ACTORS!

These commercials go on and on about depression, how it sucks the life out of us, how we too can find happiness and joy again if we would only ask our physicians for....TADA...Zimbalta.

We then are thrilled to see that mature man happily walking a joyous dog. The young lady has combed her hair and eagerly shops for a new dress. We are to assume that these sad people consulted their doctor, got that prescription for Zimbalta...and boom, they are happy once again.

The commercial's obvious intent is to touch that inner sad child in all of us. For who amongst us hasn't felt sadness for God's sake? Some of us watching those sad actors might be in a particularly blue funk as, at times and as life goes, we lose someone we love, a romance goes sour, a career path veers in a disappointing direction. This sort of sadness, I'd argue, is hardly depression, at least in the clinical sense of the word. But if I'm watching that Zimbalta commercial hey, tomorrow I phone up my doc and make an appointment.

And what does this doctor have to lose by prescribing Zimbalta for my depressed self? He will somehow get paid for my visit, perhaps with a co-pay. At my urging he will scribble me up a prescription for Zimbalta. If I have medicare, Medicaid or health insurance of almost any kind, likely some part of the prescription is paid.

It's win-win, right?

Well I wonder but to be fair, however it all works has no effect on my life besides my rather esoteric musings. But I wonder if all these drugs we get, urged on by the commercials, don't have SOME effect on our overall health later in life.

So I'd never been one to go to the physician on any sort of regular basis but I was not so obtuse as to avoid a necessary visit should health require.

Which was, until my cardiac surgery, once in the entire five years I'd lived in Delaware up until then.

In an earlier post , I elaborated on how my heart pains began and how, as a result of a stress test at the Cardiologist's office, I ended up in the hospital



I was admitted to the hospital on 4/29/08 and this was the first time I'd been hospitalized since 1982 when I had my gall bladder surgery. Before that, I'd only been in the hospital once, when I had a baby. And before that, I'd never been in a hospital except maybe when I was born.

I was informed by my Cardio guy as a result of that stress test in his office when I went into a some sort of painful cardiac event after drugs were delivered to my system to speed up my heart for testing that I had Cardiac Artery Disease. Which meant that the veins leading into my heart were clogged.

I entered southern Delaware's famous Beebe Medical Center via the emergency room where I'd been taken by my daughter after that scary stress test at the Cardiologist's office. It took time to get all the info, then I was taken up to a room in the Cardiac unit.

At some point I was finally in a bed and settled in. I hated it. I hated being in that bed in that hospital more than I hated the mold that attacks my roses. I hated that awful hospital gown and that terrible hospital food and my roommate who continually shouted that she wanted to die.

"There's a 10% chance you will need a bypass. There's a 10% chance that medication will alleviate that blockage. There's an 80% chance that a simple stent will open up those arteries blocking ample blood flow to your heart."

Well I certainly appreciated my Cardiologist's reasonable estimate, complete with percentages he obtained from his vast medical training, as to what might be required to fix my ailing heart. I honed in on that bit about the stent.

In fact, the other various medicos at the hospital were convinced that I would likely need a simple stent to fix my ailing coronary arteries that the night nurse brought me in a TV and a video so that I could watch how an angiogram works and just what was involved with this stent thing.

A stent, as I learned in my sudden and intensive introduction to all things coronary, is a small metal type of device. It looks like what we used to call Chinese handcuffs as children. The pieces of metal were interwoven in a sort of "braid". When this tiny piece of metal was inserted in a clog or collapsed artery it would expand and open up the artery to its original width.

Vice-President Dick Cheney has a couple of stents in his heart. We often hear about a needed trip to the hospital for the VP as the medicos adjust his stent. Of course Cheney had a coronary bypass BEFORE he got those stents but at any rate, Dick Cheney is the most famous person I know with stents in his arteries. I daresay that yon readers probably have loved ones everywhere who have had stents put in their narrowing coronary arteries, perhaps some we didn't even know a thing about. I know once the word "stent" became common terminology in terms of my own familial discussions regarding my health that I suddenly received email from relatives far and wide who informed that this one or that one had a stent. My daughter had a few in-laws that had stents.

Wow. A small piece of metal placed inside one's artery and boom, life is good and the blood flows again. It's better than Zimbalta and is a medical concept that is such an everyday reality....

And I had no idea.

In my endless optimism and perhaps unreasonable avoidance to accept that something might be seriously wrong with my heart, I moved on from my original notion that my heart issues were likely a result of some sort of hormonal imbalance. On that first night in the hospital, with an angiogram scheduled for the following day, I was convinced that all I needed was one of those handy-dandy stent things. Indeed even my own Cardiologist gave me odds of 80% that a stent would cure my heart woes.

If the notion of putting an expanding piece of metal in one's coronary artery doesn't intrigue enough, consider the angiogram.

A coronary artery specialist...in other words another heart doctor specialty, takes some sort of metal thread thing. This Cardio specialist begins usually at the femoral artery, which is that great big thing around your groin. Using this magic rod, the Cardio guy threads it up through that femoral artery all the way up to your heart. Then some sort of dye thing is released into your veins and using some sort of imaging device, the Cardio guy can better look into those veins and see what's going on.

If , after the dye spreads through the body exposing the various veins and arteries for easier scrutiny, it is ascertained that a stent is required to stretch narrowing arteries, right then and there the Coronary specialist can insert the stent by threading it through veins now easier to navigate for the flow from the dyes, and insert it in the arteries as required.

“No, Mrs. Fish. I’m sorry. There’s no way I can repair this blockage with a stent. You’re going to need a coronary bypass.”





I’d been administered a small dose of anesthesia for the angiogram so while I was a bit groggy, I heard those heartbreaking words from the Coronary Artery specialist.

A heart bypass. The term was scary. This final and firm diagnosis broke my already broken heart.

So it was back to my room for me. By then it was Wednesday night. The angiogram was done, the verdict delivered. I would need heart bypass surgery. It was too late to get me on any sort of surgery schedule for Thursday. The angiogram had not been completed until late in the day Wednesday.

Could they get me in on Friday?

It would turn out that I could not be put on the surgery roster until the Monday following that fateful Wednesday. Until that Monday, I’d be a walking time bomb. The angiogram revealed all four of my coronary arteries to be severely blocked. Though none of the medicos said so, the thought hovered” “How on earth has this woman been walking around with such a messed-up heart without keeling over, much less mostly symptom free?”

I’d refer yon reader to my first story on this strange and scary saga. I’d softly suggest that I have a guardian angel who looked out for me. I’d hint that perhaps it was my own actions, based on my own secret, scary suspicions, whereby I’d stopped smoking my three pack a day habit and managed to walk around in my own back yard for over a year before my heart began to complain more forcefully. Somehow, through some unseen impetus, I managed to get myself healthier and against all odds.

Who knows, maybe I was destined to write this story. Perhaps some other female of my same demographic will read it and take an action that would have been avoided but for the reading. My demographic, by the way, mid-50’s, thirty to forty pounds overweight, mostly healthy and active, is quite likely one of the largest populated demographics in our country today. I base that assertion on nothing more than a hunch. I am so ordinary as to be outstanding in my ordinariness. My picture should be under the phrase “50-ish year old American female”. Already I have received much email from the first part of my story.

I’ve so much more to tell.

Well it might sound nice and noble and what better launching point for a new and dedicated life than the rebuilding of one’s very heart?

But what about that long weekend before the surgeons could get me on the table for that much needed coronary bypass?

I’ve already professed a profound hatred for all things hospital. Which is not to cast aspersions on Beebe Medical Center. Indeed not. For my experience with that institution was beyond stellar. In fact, I’d wager that for a person of my demographic in need of some serious heart care I couldn’t do better anywhere in America than southern Delaware’s Beebe Medical center. Much more on this later.

No way, no freaking, living, breathing way, was I going to stay in that hospital through Friday, Saturday and Sunday until they could finally heft me on that table the following Monday.

First, I felt just fine and the medicos already had me on medicine to thin my blood that it may flow around my heart’s many blockages better. Second, I was facing a very serious operation followed by a long recuperation. I had a thousand, make that a million, things to do in my own home. Third, while I might be in a hospital safe from a runaway blood clot that might, against the odds I add, break off and cause a heart attack, you might as well kill me straightaway than to sentence me to three days in that hospital bed.

My Cardiologist, that long ago fellow who’d administered the stress test, was the physician responsible for releasing me. He refused to sign me out.

Hospitals are not jails and patients are not inmates. God Bless America but no one can legally keep a patient in a hospital if said patient does not want to be there. Oh I suppose there’s provisions for the mentally disabled but an individual can, until Barack Obama gets elected President, choose a medical course of their own choice. My Cardiologist was under no obligation to sign me out no matter my pleas. I was under no obligation to stay.

I signed out on something called “AMA”…”against medical advice”.

Hey, I have no problem with my primary physician’s refusal to sign me out. He talked to me straightforward and sincerely. He told me hearts were complicated things and he worried that a blood clot might fell me cold and this so close to the operation that would cure me.

I listened to his concerns. He gave me my prescriptions and he informed me that he would not release me from the hospital. I told him that I was leaving anyway.

Most of the nursing staff and other medicos agreed with my decision. Logic and common sense dictated that it would be a waste of medical resources to keep my very healthy self in a hospital bed all weekend, even if my health insurance would cover me in full. I checked to make sure that this same medical insurance would not penalize me for leaving against medical advice. If that were to be the case I would have stayed. Logic and common sense do not pay huge medical bills.

My cardiac surgery, the surgeon’s fee and my follow-up hospital care were all approved for the week following by my health insurance.

I was free to leave. I just had to take responsibility myself.

That was fine. I was warned. My doctor had every right to take a position that he was wary about letting me out of there. The man knew I wasn’t going to hang around. In fact he hurried from seeing patients far away just so he could write my prescriptions, give me my warnings, before I walked out of there. I waited around for him although I was no under no obligation.

I’ve since gotten the hospital bill for those two days. The total, for just TWO nights, including the angiogram and all medical services administered, was, get this, $17,589.85!

How on earth much would that bill have been had I stayed those extra three days? Not to mention my mental stability at hanging around a place that I hated when I could be home and enjoying those last few days of my un-sliced self?

Next, a weekend reprieve and the big surgery.
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