February 21, 2005

Clara Alice Robinson v. Valley Presbyterian Hospital: On Friday night, Clara Robinson, a 90-year old woman, great-grandmother of six, grandmother of eight, mother of two, and widow of James C. Robinson, fell at her home in Van Nuys, fracturing her right knee cap. When the excruciating pain from her injury made sleep impossible, two of her grandchildren (Cat Ruderman and Steven Smith) called the paramedics at three in the morning. As the closest hospital to her home, Sherman Oaks Medical Center, was full, the paramedics decided to take her two miles away to Valley Presbyterian Hospital in Van Nuys. After several hours of being unattended, a doctor finally examined her, and x-rays subsequently confirmed that her knee was shattered. She was fitted with a full leg cast to her right leg, and released from the hospital Sunday night.

When I first found out that my grandmother's knee was busted, I experienced a hollow, numb feeling of dread. Even more than my parents, she is the one person from whom I always felt gave me unconditional love. For someone who is in her tenth decade, she continues to possess an alert mind and an impish disposition; she reads constantly, her TV viewing habits are impeccable (with the exception of an occasional "Matlock" episode), and her sense of humor is mordant and wry. She has suffered numerous falls in the past few years, including two broken legs and a heart attack, so any injury inflicted on her invariably sucks the wind out of my lungs.

When she told me Friday morning that she was in an incredible amount of pain, I knew this injury was especially serious. Her habit in the past has been to apologize for causing such a bother, and that she would be alright if we just got her into bed. Her tibia might be sticking out of her leg, but she would be loath to admit she needed help. So when I heard about her condition, I knew it meant trouble.

After the ambulance picked up my grandmother, I followed her to Valley Presbyterian. She was taken to the Emergency Room, where she was placed in a cot. I got there a little before 4:00 a.m., and they still had not examined her, or done anything other than attach some gadgets to her to monitor her heartbeat. Other than the Tylenol I had given her earlier, there had been no efforts taken to alleviate her pain, nor did they inquire with either myself or her as to past medical conditions, such as her pacemaker. At about 4:30 a.m., I finally dragooned a nurse, handed him my grandmother's last complete medical exam, and went home to bed. I'm still ashamed that I didn't stay longer, or cold-cock the nearest doctor.

The next morning, she was finally examined, her fractured knee confirmed, and I awaited the worst. The obvious solution, full surgery to repair the knee, was problematic, due to her age and weakened heart condition. The doctors decided the best option, or perhaps the cheapest option, was to put her leg in a cast. She obviously would not be on her feet again for a long time, but it promised to be the least invasive approach to her injury.

Yesterday, the hospital contacted us to announce my grandmother was checking out that day. Since she had seemed in poor condition when I visited her Saturday, I was surprised, to say the least. Needless to say, her house is not normally equipped with full nursing care and a wheelchair, so my family made inquiries as to whether it would be necessary for her to leave that day. The hospital answered in the affirmative: if she wasn't out by midnight, Medicare would no longer pay for her stay at the hospital. The other option offered by Medicare was for her to be placed in a convalescent home, which we immediately rejected. The hospital would, however, arrange for a wheelchair to be delivered to her residence (they refused to let us borrow one of the theirs), and we could pick her up once we got it.

We were supposed to receive the chair before six o'clock. From 5 to 8 p.m., we received several phone calls from the hospital, reminding us that Mrs. Robinson was technically not admitted there anymore, and wondering when we were going to pick her up. Each time, we told them that we were still waiting for her wheelchair, without which we would be unable to get her from the car taking her from the hospital into her house. Still, the wheelchair was not forthcoming. Finally, at about 8:30 p.m., I decided that just waiting around at the house with my aunt and uncle wasn't going to cut it, and that since my grandma perhaps could use some company, I would go down to the hospital.

Those of you who live outside Southern California might know that over the last few days, we have experienced a rainstorm of near-Biblical proportions. Last night was truly the worst of it. Beginning at 8 p.m., and continuing into the wee hours of the morning, the East Valley experienced, on average, two inches of rainfall per hour. Every half mile or so, where the streets intersected, there would be a foot-deep lake (or worse), and the intensity of the showers narrowed visibility to almost nothing. And it was cold, by SoCal standards. It was the sort of weather that might kill an old person just for being exposed to it.

For the next ninety minutes or so, I sat with my grandmother in her room, intermittantly watching "Desperate Housewives" and calling my uncle (her son-in-law) to find out the status of the wheelchair. Every so often, one of the nurses would stop by, asking, in as polite a way as possible under the circumstances, if we were ready to leave. Still, the wheelchair had not been delivered yet, so I asked someone who looked like she might be in charge if the hospital could find out what was going on. A few minutes later, she informed me that the wheelchair would definitely be delivered to our home, "tonight or tomorrow morning". I asked if, due to the late hour, the indefiniteness of the wheelchair's status, and the terrible conditions outside, we could prevail upon the hospital to "readmit" my grandmother for one more night. And again, after consulting with higher-ups at the hospital, she came back a few minutes later, repeating the mantra we had heard all day: No.

Finally, at about ten-thirty in the evening, my uncle calls to tell me that the people delivering the wheelchair were on the way, and that I might as well start the process of bringing her home. She was wheeled down to the outpatient section, and one of the nurses assisted me in the arduous process of putting a ninety-year old woman in a full leg cast into the front seat of a Mitsubishi Eclipse. The Eclipse is a nice, relatively spacious sports car, but it's not the optimal mode of transportation in this situation. For the first time in my life, I'd wished I owned an SUV.

It took about ten minutes to drive/float the two miles from hospital to home. When I got there, I discovered that the wheelchair still hadn't arrived. So my grandmother waited, in the front seat of my car, for about five minutes, while my uncle and I, not wanting to leave her alone, stood ankle-deep in water, waiting for the wheelchair. When it was finally delivered, it took another ten minutes to maneuver my grandmother out of the car, taking great pains not to twist her leg or put any undue pressure on her cast, before we were finally able to put her in the chair and wheel her to the house. It took four of us: my uncle and I, and the two caregivers who had delivered the chair, to complete the task in a driving rainstorm. It was like a scene out of King Lear.

I'm certain that many of the people reading this have had similar, or possibly even worse, encounters with hospitals (and mind you, this was a hospital, not an H.M.O.) The thing that struck me the most was how dehumanizing the entire experience was. The hospital treated my grandmother not as someone who was sick and needed care, but as a thing, a commodity, for whom it provided the absolute minimal service possible before they shipped her on her merry way. The hospital itself was immaculate, its facilities state-of-the-art, its medical practitioners top-notch, and its nurses unfailingly polite and dedicated, but all to a point. Once the patient's needs began to conflict with the bottom line, she was no longer a significant factor, so they got rid of her.

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