Preface:

A NEW LAC USC MEDICAL CENTER HAS BEEN ADDED TO THE ALREADY EXISTING MEGASTRUCTURE BUILT MANY YEARS AGO. THERE ARE PROBLEMS...

“LAC USC is one of the busiest public hospitals in the Western United States, with nearly 39,000 inpatients discharged, and one million ambulatory care patient visits each year. The Emergency Department is one of the world's busiest, with more than 150,000 visits per year. LAC USC operates one of only three burn centers in Los Angeles County and one of the few Level III Neonatal Intensive Care Units in Southern California. LAC USC is also the home of the Los Angeles County College of Nursing and Allied Health, which has prepared registered nurses for professional practice since it’s founding in 1895.” Wikipedia

Introduction:

 This article is based on three years of being an outpatient and short-tern in-patient at LAC-USC Medical Center, and through direct observations, and interviews with doctors, nurses and staff. Departments that I have focused on are: Emergency, Triage, LAC-USC Hospital, Orthopedics, Eye Clinic, Hematology (Blood Lab), Pharmacy, and Doctor’s Clinic.

This story has been on my back burner for three years. This is one of the most difficult articles I’ve ever written.

I owe a debt of gratitude and thanks to the medical professionals at LAC-USC Medical Center for their amazing care.

There are more heroes than villains at “County”.

Sadly I also must report there have been some serious flaws in medical building design/environment and in the delivery of medical services. At times I have been cofounded by the seemingly endless rules, regulations, and bad procedures at LAC. The procedures are Byzantine bureaucracy with some rather thoughtless and mean workers. 

In the process of writing this story I have spoken to dozens of patients, nurses, medical techs, and doctors. I was invited and accepted an invitation to speak one-on-one to the LAC-USC Medical Center leadership, Dr. Stephanie Hall, Chief Medical Officer, Dr. Nicholas Testa, Associate Medical Director, and Teri Smith, RN, CPHQ, Asst. Nursing Director, Adm., and Quality Improvement Manager, who listened for almost two and a half hours to my story. It was the first time I actually cried in any meeting. I could see on their faces concern. Had they never known about the problems at LAC? I had kept a lot of my emotions deeply inside me, there was now no holding back. The people that needed to hear my story were hearing it. And they were very concerned, but they were years late in their interest in what LAC patients actually encounter. It was all sort of anti-climatic. What would change?

Background

My mother and grandmother were both Registered Nurses. My grandmother was a non-reservation Cherokee Native American holding an RN specialty in Psychiatric care. She worked for over 40 years as a private duty RN for rich families with mentally ill family members. My mother worked for the French Hospital in what was LA’s "Little Italy” now “New Chinatown”. I have 3 cousins who are physicians.

From time-to-time my mother and grandmother spoke in almost hushed tones of “<LA>County Hospital” as some dank monstrosity of a building filled with patients who were Winos, drug addicts, and the extremely poor. I remember hearing my grandmother say “A poor person worth their salt wouldn’t go there!” She never bothered to say why a poor person should not go there for medical treatment. It’s how most people thought of “County”, it was the LA political line of the day in majority White LA, it was mainly about classist racism. Being poor was almost seen as un-American.

In the upper-class White community, people had private physicians, no HMO’s and no PPO’s. Doctors came to your house when you were sick, not the other way around. And we always knew the families of our doctors because they lived in our community. The relationship with our doctor was seamless and based directly in community and relationship. My childhood friends included the children of my own private doctor.

In California, medicine really changed in the late 1960's and 1970’s. Doctors did not provide “house calls” and you might well have been a member of one of the emerging HMOs, PPO’s or community based local clinics providing urgent care. Blue Cross/Shield took off in medical services delivery. More and more businesses provided employees HMO care. Over the subsequent years people saw private doctors less and less, instead opting for the more affordable PPO’s or HMO’s, like Kaiser Permanente of which I have belonged to for half my lifetime. I actually came to like their “clinic” setting. The doctors were personable and the facilities were good. I was satisfied. I have always thought of Kaiser as the model of what good Socialized Medicine should look like.

The Great Recession of 2008

The Great Recession started for myself in 2008-9, taking its toll on income, short and long-term “solid” investments, my financial advisor of 20 years was in serious trouble with the "Feds", and I lost my health coverage; Kaiser. The fear and anxiety of what would happen if I got sick became real. The world as I had known it, the self sustaining, self-supporting, and well off life came crashing to an end with no let up in sight. Our savings became depleted and work was cutting back in every possible manner. Survivability became the real question for both myself, and my life-partner who had just been let go from a very long-term private banking job as a Personal banking manager. We were adrift and waiting for the next shoe to drop.

Watching the Shoe Drop

I noticed one afternoon that the bottom of my foot hurt and had a small open sore on it. There was a bump too. It was like that for weeks. I assumed that I had some how bruised my foot or even possibly stepped on a rock or piece of metal while walking or exercising. It was hard to walk. The sore began to ooze and was paralleled with a midgrade fever and deep physical malaise. I took to bed and kept the sore clean and bandaged. We had so little money we had no idea how we could afford even bandages without a major struggle; we now were trading money budgeted for food for bandages. It was horrific and we were getting more desperate by the day. My one sore turned ulgy and "sprouted" through-out the bottom of my foot. I now had a serious infection. I could possibly die. We had no place to turn except the emergency room of LAC-USC Medical Center. 

My infection was spreading on my foot like a crimson puff of oozing reddish slime.

County hospital, the supposed “Horror Hospital” of my youth, was the last resort. We had known that the wait at “County” would be a long one, but that a doctor would see me. Little did we understand that an emergency visit to “County” would turn into an 11.5 hour ordeal of pain, frustration, and being accosted by emergency room guards as if we were sitting in a prison cell.

After registration for the Emergency room, which was an easy, quiet, and friendly process I was told to wait in the large sprawling waiting room. The Waiting Room looked as inviting as an unairconditioned Greyhound bus station in 1957 Tupelo Mississippi on a hot and sticky Summer night. It’s nightmarish, simply an inhumane environment, with interior medical design making the room mockingly and tragically uninviting and physically difficult for the patients. There seems to be little thought into how the patient feels waiting 9-17 hours to see a doctor in "That" environment. One feels abandoned and lost sitting in pain, waiting and waiting. I started reciting the rosary in my head... just in case.

 If you really want to know what it means on the Statute of Liberty regarding “Give us your huddled masses” you have it at LAC-USC emergency room. The human smells of illness and cold sweat hits your nostrils when entering the ER. Spanish is the sole language of most ER patients. The shocking cold of the air conditioning mixes with the noxious human smells of the many unwashed, diseased, sweating, and fevered bodies. 

A thought entered, "Every new doctor should be made to sit in ER for 12 hours, before entering any ER training. (Perhaps Dr Stephanie Hall should do this asap along with LA County's CEO.) 

The ER Police

PART 2

  I felt claustrophobic and trapped sitting close together with so many seriously ill people. Either a PA (Physician’s Assistant) or NP (Nurse Practitioner) inspected my foot, and in a matter of seconds I’m being wheeled off to the real Emergency Room: Triage.

Triage is a high-powered intense place. You can physically feel the energy. Nurses and doctors are tirelessly in a medical ballet. I sat on a gurney waiting to be put into a treatment room. I felt alone, scared, and after not sleeping for so many hours “dopy” from fatigue.

A gray haired man in a white clinical jacket came up to me with a smile; he looked at my foot and winced. “Ouch!” He said. He leaned over and rubbed my back smiling and said, “You’re going to be okay,” My stress and tiredness seemed to respond to his words. I became oddly relaxed and comfortable.  After the many hours of depressing pain and anxiety, the doctor's presence was like God lifting the sinner from purgatory. I felt redeemed. His reassuring manner and how he looked into my eyes and spoke to me not “at me” made all the difference. Tears filled my eyes; I grabbed his clinic smock and just tugged on it with a “Thanks”. As he left me I was being whisked off to treatment. I was wheeled into a smallish treatment area. A African-American NA or PA came in with an amazingly welcoming smile, “We’re going to take care of you” she said with a smile. She was told to clean out my wound by a doctor who acted as though I were not present. Somehow being busy in ER at times seems to translate into not acknowledging the patient. Doctor error. “You know you’re staying with us today” my NP/PA said to me in a serious tone. I looked at her with a smile.

My wounds were dressed. They took me to a post Triage room where I would be until they could find me a hospital room. I was hooked up to an antibiotic drip. Sadly and irresponsibly LAC Hospital architects’/designers only built half the rooms really required for the LAC patient load. A skinny and nervous male nurse first words to me were: “You don’t look your age, you’re still cute.” I was in no mood for that nonsense.

I saw that others in post triage were being served lunch. I had not eaten in a long time so I asked a person walking by with food if I could get a tray. “I’m diabetic so I’ll need a low carb meal.” She looked at me oddly and walked away. She brought me a meal that consisted of spaghetti and meatballs, a roll and salad. I told her the meal was not for diabetics, she responded, “You provably know more about that than we do” and she walked off. I sat on the bed still bleeding from my foot as I ate the three small meatballs and salad.

I asked the nurse for a “bedpan” and he said, “I don’t do that.” I responded, “Can you unhook me (from the IV) so I can walk to the bathroom?" He pretended to ignore me, then got up from his computer came over and disconnected me with little or no interest in me or my serious condition. He was just passing time. Painfully and slowly I got off the bed and dragged my bad foot behind me. Blood stained the floor. When I returned I mentioned that my blood was all over the floor to the nurse. He looked at me then glanced away irritated and got back on his computer. 

I watched as the food delivery lady walked through my blood. It was so weird and terrible; I had visions of being back in Balak Bak jungle clinic in the Philippines where the clinic sewage runs down an uncovered channel on the open-air side of the clinic. The memory came and left me. After many minutes I asked the nurse to re-hook me to the IV. He glanced up and said, “Yeah.” It took him 20 minutes to get to me; he was too busy on his cell phone speaking loudly in Tagalog.

Part 3 

Accosted By The LAC Hospital 

‘God Squad’

            The smallish young Latino man came into my room without a knock or hello before walking in. Crossing the room to my bed he said, “Hi I’m with (I forgot the name of the church) in San Fernando Valley, we are Bible believing Christians. I’ll be taking you to your doctor visits and other help you may need.” I just looked at him for a moment wondering what this was all about. Coming closer the man said, “Do you have a personal relationship with our Lord Jesus Christ?” Now I was shocked. “I’m Catholic and just don’t discuss religion,” I snapped back at him. He gets a little smirk on his face and asked me, “Do you really know what Catholic is?” I now had had enough. Half yelling at him I told him to “get out of the room before I call a nurse”. He laughed at me. I said it again and he slowly walked out. It seems more than obvious to me that Christian fundamentalists use volunteerism at LAC+USC Hospital to try to convert the patients. What total bullshit. Who allows this? Who approved this? It was upsetting and I felt intimidated by this aggressive person inquiring about my religion. “Would I be treated better if I just let him rant on about his personal ‘salvation’?”  This became especially concerning to me, since when I checked into my room one of the first things I told the nurse was: “I need to take communion tomorrow, I’m Catholic, can you be sure a priest knows?” my nurse wrote something on her pad and smiled at me. Well Sunday came and went no priest, no communion but to my total satisfaction also no evangelical Christian crazy Latino boy bothering me. Thank God for small miracles.

The 5am Visitor

             I was asleep when she walked through my room and sat down on a chair by the window. I turned and opened my eyes, she said “Good morning.” She was a dark haired woman; it was hard to figure her age by her looks. Her face was kindness. She told me she was a medical student and “Would you mind taking a survey?” She asked me everything about my life not just a medical history but a real profile. When we finished it was 7am. The two hours passed quickly, she was warm and friendly, engaging on a personal level. I don’t remember her name but our visit and her manner was so appealing and oddly healing. The last time I saw her was when a ‘gaggle’ of newbie young doctors surrounded my bed like a “White Wall”, (Making their ‘rounds’), and of course speaking about me but not to me. So I just chimed in loudly: “60 year old, Gay male, in long term relationship, mixed race Native American and white, Doctor of Clinical Psychology, presented with complications/abscess due to symptomless diabetes and a fractured foot bone”. They all turned to me with the oddest looks, and then started speaking with the attending physician Dr. Nguyen. It was like a TV show moment, or Dr Kildare. Only Dr. Nguyen had a smile and he winked at me.  There were no “Good-byes” as they walked out like a line of baby ducks. In passing it was good to see at least one African-American doctor towering over a sea of much shorter East Asian and Middle-eastern doctors. I had an urge to give him a “High 5” but the impulse passed as rational thinking set in. I grinned to myself. My early morning visitor walked over to me and said, “I hope everything is ok” she had tears in her eyes. She walked out with Dr. Nguyen. I thought, “Oh my God” , I wonder if she knows something I don’t?

Someone Let Me Out of Here!

             Sunday Morning: Finally the words I was praying to hear, “You will be released today” about 2pm”, nurse Ho said.  I sat up in bed with a big smile on my face. “We’ll need to get your prescriptions filled and find someone to take you downstairs, that might be difficult to do today.” I began to worry. Ah indeed there was neither Orderly, nor meds for the longest time, no wheelchair, no medical instructions, nothing. After some time nurse Ho came in and said, “I’ll take you out myself”. She seemed angry and frustrated at there being no staff to do this. She had to leave her patients to take me. It seemed to take forever for her to find a wheelchair but she got it! She instructed my partner on how to dress my wound and gave us some much-needed bandages, gauze and tape; without that help we would not have been able to afford it. Nurse Ho came in with the wheelchair and took me downstairs. Before I got in the car she gave me a big hug. I said to her, “I’ll never forget you, honest,” She smiled and said nothing. As we pulled away she waved. For me and I am sure for many LAC+USC patients nurse Ho is a hero, as only dedicated nurses can be.

Home Again

             I arrived home to meowing cats that knew me but were frightened of the distinct hospital smells I carried. It had been a truly emotional and physical adventure, where so many medical professionals came together in one place to help me. I left the hospital with the foot I almost lost, I felt lucky indeed! I sat in our den crying hard, thanking God for being alive and intact. I gave thanks for all the people that helped me. My partner’s dedication to my well-being was an amazing act of love and compassion. He’s like that, it’s one of the reasons I so deeply respect and love him.

Epilogue

              My foot healed rather fast, about 2.5 weeks. My partner changed my bandages daily with no complaints and a smile regardless of the fact my foot looked like chopped liver. I was dependent on another person for pretty much the first time in my adult life. I was humbled. I had always been the caregiver, even at the end of my last partner’s life, a relationship of over 30 years.

Needed Assistance  

            I would now have to apply for county help “ORSA” to continue my visits to the LAC+USC clinics and for my medicine. It was at times an unbelievable hardship: county procedures are just clearly insane and inane, with endless red tape, application redoes, faults, problems, and exceptions. Information was never easy to come by. County workers would say one thing, then another something else, no one seemed to know policy; never a clear policy to follow.

             We were now without a car so here we are getting off a bus in pouring rain, my partner wheeling me down a hill to the small LA County bungalow in back of the old LAC Medical building to get my ORSA/County help finally approved. Pushing me back up that hill took everything out  of him; exhausted, wet and cold.

If the Three Stooges created a medical center’s policies and procedures, The LAC+USC Medical Center would have been the outcome.