Tech Thoughts from a Hospital Bed

After emergency surgery, a few observations on the clinical narrative, the value of the medical record in any form, and the small miracles that make our healthcare system hum.

On Monday, June 16, I was preoccupied, preparing to head to the annual Computer-Physician Symposium run by AMDIS in southern California. But I had a scheduled doctor's appointment to tick off my to-do list first.

Fortunate thing.

A block from my doctor's office, as I was crossing a street in Alameda, California, I felt like my guts had been sliced open. I doubled over in pain and, with effort, continued to my doctor's doorstep.

In the exam room, my doctor found my abdomen distended and me generally feeling like I wasn't going anywhere but the emergency room.

The staff called me a taxi, and 15 minutes later, I was at Alameda Hospital, gladly accepting a wheelchair ride. The pre-op history report told the story: "CT scan shows acute appendicitis."

So, that night, into surgery I went. Initially, the surgeon detected "no sign of perforation" and I remained "alert and oriented" going under anesthetic. But, once inside, he found a "gangrenous appendix with perforation" and what should have been a 30-minute procedure took two and a half hours.  It sounds just about as awful as it felt.

[If you're really curious, here's a video of a laparoscopic appendectomy of a ruptured appendix.]

I awoke Tuesday with a drain in my side and no appendix. By Friday, I was also down one leather jacket. I had changed rooms twice since my surgery and forgotten I had even had the jacket when I arrived at the hospital. A check the following Monday yielded sympathy from staff, but no leather jacket.

But who am I to complain when I had just survived what can be a life-threatening condition? A month previously, I had embarked on a marathon cross-country business trip. To have this happen when I had safely returned home, a block from my doctor's office, has to qualify as a blessing.

My care at the hospital was attentive and responsive. I am so impressed by what nurses accomplish day after day, night after night. I was one of the younger patients on the floor, and some there naturally had much graver conditions than mine.

Although I've often advocated for patients, something about being near them and their suffering makes me open anew to their experiences and needs.

Thoughts on Tech
At Alameda Hospital, technology is present but not omnipresent. The 281-bed hospital, which sports 100 acute care beds, 35 sub acute beds, and 146 skilled nursing facility beds, recently became part of the Alameda Health System, a major public healthcare provider in the East Bay region of the San Francisco Bay Area.

Mostly I was smitten by the hospital's location, nestled between two lagoons on the island of Alameda, set back from the main street, with windows that opened, barely the sound of a siren, or even a car alarm. Twice a day, someone on a PA system asked for those with cars blocking the portable MRI van to move them. But that was made up for by the occasional sound of a passing ice cream truck.

As technology editor, of course I wanted to know everything about my condition as soon as possible. But the healing process isn't helped by checking one's online medical record every five minutes.

Those things that truly helped me heal often boiled down to things like the kind advice of a nurse to take ten deep breaths an hour, or my willingness to get up out of bed and walk, as determined to use my feet to improve my condition as if I were trying to induce labor.

Someone, I don't remember who, also cracked wise that under Obamacare, if I liked my appendix, I could keep my appendix. I smiled wanly and suggested that I was not as fond of my appendix as I used to be.

Just the Fax
That following Monday, as I tried to retrieve my lost jacket, I also was able to obtain a paper copy of my medical record, and to send a copy of it along to my primary care physician, via that old reliable, the fax machine.

The narrative of the laparoscopic operation itself reads like something of a cliffhanger. I will spare you its entirety, but this passage will give you an idea:

"…There was evidence of perforation. The appendix was tenaciously adherent to the surrounding tissues. These adhesions were taken down carefully…"

To me, no ICD-10 code will ever be able to capture that near-poetry. 

After discharge, a week's rest was just what the doctor ordered. During that time, I saw some things pass my radar that made my eyebrows rise—still ten years to achieve healthcare interoperability? Really? Do we have that long?

But for now, I am glad to be on the mend, with a fresh perspective on the practice of medicine, the value of the medical record in whatever form, the value of the clinical narrative, the many small miracles that make our healthcare system continue, and the tireless work of so many to fulfill the promise of our system.

I have a new appreciation for just how important it is that we find a way to continue to modernize this system without losing those small but substantial things that give patients hope, dignity, and the best possible care.