A survivor emerges from his health care wars
without answers
I am named after my maternal grandfather, the medical examiner and sole doctor in a small Minnesota town. He died before I was born, and his photograph, on the living room mantel in our house, was almost venerated by his widow and by his daughter and sons, both of whom went into medicine, and admired by his son-in-law, my father, who did as well. I grew up respecting doctors, too squeamish to follow in their footsteps but aware of their significance, in my family and in the world. But never did I, any more than any other healthy child, imagine that one day I would know the medical world from inside, as a patient, nor that I would one day owe my life to doctors–doctors like those who saved mine in the literal nick of time, in 1994, and those who, last fall, did battle (inside me) against a rare form of cancer, emerging from the fray with what I’m told is a score of Brudnoy 1, Cancer 0.
That ought to be the end of the story–naïve faith in doctors vindicated, in spades, by personal experience of the lifesaving power of modern medicine. But it’s not. Health care in this country is, invariably, an issue, and in this issue, I have immersed myself well beyond my own experience. Over nearly 30 years on radio, I’ve interviewed hundreds of doctors and examined no end of medical arcana. What I’ve learned is that we don’t have a medical crisis but, instead, an insurance crisis.
Dictators may rail against America, but when in dire need it’s our hospitals they flock to. Canadians, proud as they are of the low cost of health care to patients–the cost to the taxpayer is another matter; 22 percent of Canadian taxes go to medical care–know that if they require access to a myriad of top-shelf machinery, they scurry here rather than wait their turn and die back home. (As professor Pierre Lemieux of the University of Quebec reports in the Wall Street Journal, the average waiting time from referral by a general practitioner to actual treatment in Canada is more than four months; breast cancer patients wait eight weeks for post-surgery radiation therapy, while the median wait for an MRI is three months and the median wait for oncology treatment is more than six weeks, excluding radiation, which is longer. My own wait from diagnosis to the start of chemotherapy and throat radiation was one week, and that only because I requested time to inform my friends, colleagues, listeners, viewers, students, and employers.)
they’re subjected to such humiliation.”
There’s nothing wrong with medical care here, only how we manage it. And this we have mismanaged badly, starting with a pricing structure that, like the cost of airplane tickets, seems to bear no resemblance to reality. The care we receive is unparalleled, but who can figure out the costs? Perhaps, gruesome though it is to suggest this, our eyes open only when we undergo serious hospitalization. Only from within can patients begin to comprehend what our medical system amounts to. Here, then, is my comprehension.
For no patient is medical care all a matter of dollars and cents. It did not take me long in a hospital to figure out that we have a shortage of nurses; anyone who has implored a nurse to hurry to his room knows that the wait can be interminable–and sometimes embarrassing. A nurse’s work is daunting, and the compensation nurses receive for it comes nowhere near to matching the energies expended and expertise demonstrated. We also have a misallocation of doctors. In Boston, we may wait awhile to see a specialist, but they’re all here, whereas in some parts of the country we suffer a dearth not only of specialists but of generalists as well.
But no patient can understand the rituals of medical procedure and protocol, beginning with that minor but infuriating social chasm that separates physicians, who routinely introduce themselves as “Dr. God”–or they might as well–and patients who, no matter their ages, invariably become “Jack” or “Bertha.” This obliviousness to the barrier of exaltation they erect by insisting upon their title while they reduce their patients to a diminutive name, irrespective of age, can be maddening, if not demeaning. The last thing a patient needs added to his terrifying experience in a hospital–and none but hypochondriacs or women about to give birth come to hospitals filled with joy by the experience awaiting them–is to be alienated from the doctors who, perhaps unwittingly but nonetheless habitually, build a wall of nomenclature between themselves and the wretched souls obliged to wear that hideous piece of “clothing” that opens in the back. The rationale for the repulsive “johnny” eludes me, and few patients understand why they’re subjected to such humiliation. If you’ve spent time in a hospital you know what I mean, and if you haven’t but live long enough, you will come to know.
The indignities begin immediately, but the mysteries arise later. What befuddles most patients is how hospitals and doctors get paid and somebody is… charged. Granted, we live in a world in which inflation has made a tendency to reminisce about the “good old days” into crankiness. A friend born, like me, in the Midwest showed me the hospital bill for his own delivery, a normal birth with no complications. The invoice covered his mother’s 10 days in the hospital–common before people were cast into the streets after minutes in the hospital–including the delivery itself, the doctor’s daily visits to her, and medications and food. The total bill, in April 1940, was $54 (you read correctly: fifty-four dollars). Now, we don’t buy coffee for five cents a cup today either, and a first-class postage stamp, then three cents, is 11 times more today. But is the cost of 10 days in the hospital for birthing and post-partum care 11 times what it was then–a mere $600 today? You know the answer–or, at least, you think you know. The true cost of a day at Hotel Massachusetts General, based on my three recent stays there, will be divulged at the end of this article.
Not that those visits have bankrupted me. Fortunately, I have good insurance. During two long hospitalizations, in 1994 and 2003, I was wonderfully cared for at a cost that far exceeds the money I have put into my insurance. I have the benefit of a good insurance plan through my principal employer, Infinity Radio (a subsidiary of Viacom), and owing to the advice of a friend back in the mid-’80s, I also bought and have continued to fund a private insurance plan, which picks up some of what the company plan doesn’t. Both are costly but nowhere near what my medical care would cost me if I were on my own. It’s no exaggeration to say that if I had had no insurance, I would by now be at or near insolvency. This is a scary reminder of how those without insurance are at great danger of losing all that they have if catastrophic illness strikes.
These days, nobody really sees a doctor’s bill. Mostly, we see statements of what has been charged to our insurance companies, an “explanation,” no matter how mystifying, of what things have cost. Who is that doctor, whose name you don’t recognize, and what did he do for you? What is it, exactly, that happened nine months ago, which the document in your hand is recalling to your memory? My own primary care physician doesn’t know some of the doctors whose names are on these mysterious non-bills. Would it crash some advanced information-technology system if these documents said: “9/14/03, you saw your doctor, Bill Smith, for anemia and fatigue, and your bloods were analyzed by Dr. Sam Jones”? Is it inconceivable that the documentation of your care be clear about who was involved, and what they did to get paid?
What we see in these non-bills may have meaning to hospitals and insurance companies but rarely to patients. If you’ve spent months in hospitals, as I have, and seen dozens upon dozens of doctors in hundreds of office visits over the years, you’ve most likely long since given up trying to figure out who was who and what was what. The health care system today seems to think we ought to wash our hands of such trivialities, and I, for one, am happy to do so. But is ignorance, and disregard for cost, the solution to our health care woes?
Anyone who has spent seven weeks in hospitals in one serious health crisis, as I did in 1994, and a month, in three separate episodes during a two-month period, as I did last fall, comes away with stories to regale the grandchildren, or, in my case, the functional equivalent of grandchildren–at least if one wants to give them nightmares. In 1994, shortly after I was released from intensive care at Mass. General and sleeping soundly in my room, a doctor I had never seen came in, introduced himself as a neurologist, and asked if he could feel my feet. What could I say? He felt them, and mumbled to himself with that “oh my” sort of mumble that alarms any patient. I asked, “What are you feeling my feet for?” He asked me if I wondered why I hadn’t been out of bed in the days since I awoke from my nine-day coma. I said something like, “Well, yes.” He said, “I think it’s unlikely you’ll ever walk again.” And he left.
Great bedside manner. Thank you, Dr. Excellent News. Nice way to interrupt one’s sleep.
I was terrified. I had images of a life in a wheelchair, and began to wonder just how much of this I was strong enough to handle. I decided to turn on Nightline and try to figure this out. I flipped on the TV and there was the tail end of the news on Channel 5–it was Monday and WCVB carries Monday night football, so the news runs late and Nightline even later. Chet Curtis was wrapping up the show and concluded with this: “We have encouraging news about our good friend David Brudnoy. He’s out of intensive care and is now in guarded but promising condition. Get well, David!”
I desperately needed someone to talk to and it was well after midnight, so I called Chet at the station. He said, “Don’t believe the worst, David. There’s always hope.” Something like that, and heartfelt. Chet is a dear man, excellent friend, and he said more than that, but the details are lost. I know only that I was in a panic and I needed the calming encouragement of someone who has known me for decades and, I knew, was not a stranger to adversity.
The next day, after I told this to my doctors, a woman named Mica Rie, a physical therapist and one-time member of the Finnish Olympic fencing team, came in, yanked me up to a sitting position, and gave me a stare of determination and warmth. She said, and these words are verbatim: “Doctors aren’t always right. You will walk again. Know that. Believe that. You will walk again!” Within two days she had me up on a walker, moving me a foot or two–my “stupid human trick,” as I called the maneuver when I showed my friends. In coming days I moved a bit more, then, after nearly a month at Mass. General, was transferred to Spaulding Rehabilitation Hospital. In three intensive weeks of therapy, I learned to walk, first with a walker, then with a cane, slowly, unsteadily, and with apprehension that, skeletal as I was, if I fell, which seemed a likely prospect, I’d break bones and be paralyzed for life. Gradually, over the next two years, I regained my ability to walk. Now, no limp remains, and while I still have neuropathy, a combination of sometimes intense pain and numbness in my feet, no one could tell, watching me walk, that a specialist in neurology had all but condemned me to a life of permanent paralysis and incapacity to propel myself along on shanks’ mare.
On the other side of the ledger, during hospitalizations last fall, I insisted on continuing my daily radiation therapy, which required making clear to everyone that I must be taken to the radiation lab daily, at the appointed time, that I was required to have six straight weeks of the throat radiation and if I had a chance to kill the cancer, this was not something that could be postponed, and that I was not going to miss even one of those sessions, brutal though the treatments were. One day, I languished for over an hour in the radiation area after the treatment, needing desperately to go to the bathroom, throbbing with anxiety and growing alarm that I had been forgotten. The transport department simply did not come for me.
Finally, after dozens of people–nurses, doctors, others–had passed me by and paid no attention to my increasingly shrill requests, then implorings, then demands that someone come get me, I buttonholed a very young woman, who was, she told me, training to be a nurse and had been observing the radiation clinic. I said: Either somebody gets me, on this gurney, back to my room, or I’m getting up, yanking out the IVs, and, if need be, crawling back to my room. (I may seem like an easygoing fellow, but there are times when I am impossibly direct and will not stand to be ignored. This was one of them.) Thankfully, this kindly nurse and a male colleague–I don’t know whether he was an intern, an aide, or what–cheerfully got me back to my room.
Sometimes the indifference, understaffing, and sheer callousness of medical personnel can undo anyone’s general sense of gratitude for, and admiration of, the way a great hospital works. Someone ought to give thought to making sure that an episode like that never happens to a patient. The next day I asked one of the nurses on my floor if she would stay with me during radiation and get me back to the room. I was hooked up to so many machines, I couldn’t go by myself. She did so, and in coming days no one made me wait for this daily therapy. Although I probably was not the most popular patient on my floor, I had become tiger-like in my determination. Passivity will get you nowhere in a hospital setting, of that I’ve no doubt.
I don’t know what the solution is for the cost of medical care in America. The fantasist who imagines that some socialized medical system will provide the same level of care yet still be cheaper ought to look into the taxation rates of countries that have these systems and why, in many of them, people who can afford to do better eschew governmental systems and entrust their care to doctors whom they pay directly, often in the United States. (In Canada, it is illegal to buy private medical insurance, so the wealthy pay for first-rate care cash on the barrelhead.) Maybe some form of single-payer system would do the job, but no one in America has figured out what that system ought to be. Bemoaning the complexity and inefficiency of our system has become as addictive as The Apprentice, but no one has come up with a better approach, at least not one that has convinced a critical mass of movers and shakers, much less a significant number of ordinary Americans, that they’ve got the answer.
Those of us who find ourselves critically ill generally survive hospitalization, unless our condition is hopeless or we are in that critical last half-year of our lives, when the end of the road, metaphorically, becomes the end of the road literally. Our doctors are terrific–mine have been, and you know yours are, though we wonder about everyone else’s–and our nurses are angels of mercy, albeit underpaid and shorthanded. We’ve every machine available to our diagnosis, our care, and the prolongation of our lives. We cannot do better than in our country and –I’m not a mindless Massachusetts booster saying this–we cannot do better than here in the Bay State.
But paying for what we need is beyond the means of most of us, excepting the rich or those who have the best insurance plans available. Our medications, certainly, have become extraordinarily expensive. After each of my four weekends of chemotherapy infusion, from October to December, I injected myself with a tiny dose of something costing $2,500 each, and that’s just for starters. Providing for prescription drug coverage for the elderly and the poor seems to have become like defeating terrorism–a worthy goal that’s apparently unachievable. The costs accelerate in a gruesome imitation of the inflation of the Deutsche mark in early 1920s, beyond any reason or sense. These costs–not necessarily directly to each patient, but to this Platonic concept, The System–shoot up and show no sign of ever hitting a ceiling.
But who am I to complain? In 1994, I was minutes away from death when rushed unconscious to a hospital, suffering from cardiomyopathy and Pneumocystis carinii pneumonia occasioned by HIV, and later visited by the added horrors of shingles and a number of other nasty things that make me shudder to recall. Last fall, I was treated for a rare cancer, metastatic Merkel cell carcinoma, by chemotherapy combined with throat radiation. This was gruesome; getting well involved grappling with bouts of terror that made me wonder seriously whether I could endure the treatments themselves.
Well, to paraphrase W.C. Fields’s famous remark about Philadelphia, on the whole I’d rather the alternative–in this case, being alive. I cherish those who carried me through these hideous periods and, in gratitude, I’ll advocate for physicians and nurses the rest of my life.
I’m not a specialist in medical care, but I’m not uneducated and have an at least average ability to comprehend the things that swirl about me. But I don’t understand why health care costs what it costs and, talk show know-it-all I may be, I never even try to come up with an answer to the question I’m asked repeatedly: What can we do about all this?
I just don’t know. Do you?
By the way, one day at Mass. General, for “R/B,” which I presume means room and board–board meaning weeks of “food” received intravenously, since I couldn’t swallow and hence couldn’t eat; this charge does not include blood transfusions, doctors’ visits, procedures, machinery, tests, and medications–amounted to just over $5,000. Five thousand dollars a day. I was in the hospital for 31 days in November and December. Do the math.
If you’ve even the glimmer of a sensible idea about how we can contain these costs and continue to receive the first-rate medical care that this country provides, shout it from your rooftop, or call my show and shout it at me. The lines are open.
David Brudnoy is a professor in the College of Communication at Boston University, a WBZ radio talk show host, and the film critic for Community Newspaper Company’s chain of weekly and daily papers.