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Where The Care Is Still In Health Care


Letter From Miami

WHERE THE CARE IS STILL IN HEALTH CARE

It was past 9 p.m. when my doctor stopped by the hospital on his way home after a full day of office visits, surgeries, and delivering babies, just to check on me. Even with the dosages of intravenous solutions, injections of muscle relaxants, and pain-dulling Demerol, I could feel the contractions tightening across my abdomen. He reached over the hospital bed and clasped my hand. It was a simple gesture, but one I shall always remember, for it gave me comfort, transferred strength and calm, and bolstered my confidence that we--my unborn baby and I--would get through this.

In an era where even heart bypass patients are discharged within days, it's rare to have a prolonged hospital stay. But, because of premature labor, I'd already been hospitalized on two occasions totaling five days. Now, at 32 weeks, I was back. It was deemed too risky to send me home. So I took up residence on the labor and delivery floor of the 513-bed Baptist Hospital of Miami. My goal: to reach 35 weeks, when my baby's chances of complications from a premature delivery would be markedly reduced, and with luck, 37 weeks, which is considered full term. Having written about PPOs, HMOs, and the alphabet soup that permeates the health-care system these days, I got a look at medicine from a very different perspective--supine. And I learned firsthand that high-tech, "hurry-up" health care can still make room for compassion.

NIGHTMARE. There may be conditions more painful than premature labor, but few are as frightening, because the worry is not only for yourself but for your unborn child. Treatment for premature labor is its own nightmare. An intravenous solution of magnesium sulfate is used along with injections of smooth-muscle relaxants. I concentrated on staying calm, on ignoring the burning in my eyes, ears, even the hair follicles on my scalp, from the IV solution. I swallowed sobs as injections seared my upper arm, and a cortisone shot scorched my thigh in a bid to develop the baby's lungs, in case I delivered early.

The nurses, the unsung heros of health care, sustained me, my husband, Shawn, and our son, Kyle, 3, who was confused and scared by mommy being "sick." They dispensed hugs and dried tears. When the situation looked especially bleak, a few even shared prayers. One contacted a priest at my request and stopped by my room one morning to take communion with me. Another gave me a medallion of St. Jude, the patron saint of desperate causes. I awoke one morning to see a ceramic angel on my nightstand--a doctor's gift.

Baptist has had a reputation for quality since it opened in 1960. Rare among city hospitals, it has resisted the pressure to be swallowed by a chain and remains a not-for-profit institution with a community orientation. In 1995, the four-hospital Baptist Health Systems provided $9.6 million in charity care and $31 million in uncompensated care.

Faced with competition from the chains and pressures of managed care, Baptist has cut the average cost of admission by 6.4% since 1992. But it has done so without laying off employees. In fact, it has increased the nursing staff, boosting the percentage of registered nurses to 74% from 65%. The key, says the hospital's Chief Executive Fred M. Messing, is "to challenge people to provide care most effectively but never compromising quality." Baptist's service orientation is a prime reason it's rated first in overall quality and personalized care by Dade County residents.

I learned about that focus on service as I adjusted to my new "home." Because of the high levels of medication, I had to be monitored constantly and couldn't stay in the wing with other preterm patients. I became a mascot ef sorts on the delivery floor, with everyone from cleaning crews to meal delivery personnel cheering each day that passed without my baby making a too-early appearance.

Nurses shared their own life stories as well as favorite labor and delivery tales, including one about a delivery in the hospital elevator. They decorated a cake with straws as pretend candles for a birthday surprise, trooping into my room singing "Happy Birthday." One lent me movies. Another dressed up our three-year-old as a "doctor" in surgical cap, rubber gloves, and mask, an exercise that took away some of his fear.

While always busy, the nurses nonetheless took time to help me maintain perspective--that this was a temporary condition and each day that passed was better for the baby. They moved an IV higher when the medicine burned too much and apologized for the blood tests they took so frequently.

The little things touched me. A recreational therapist gave me a baby T-shirt to decorate and a picture frame to paint. At first I was incredulous, since I hardly felt up to doing arts and crafts. But the activity helped keep me busy; I couldn't read on the medication, and television was tiresome. Given the $37,000 hospital bill for three weeks' stay, it may be the most expensive baby outfit and picture frame ever made.

GLITCHES. I don't know yet how much of the cost will be picked up by insurance, in my case, a managed care organization that had someone monitoring my chart daily. But my doctors assured the carrier that it would be less expensive to treat me than a premature infant.

There were a few glitches, of course--occasional missed calls for nurses and food mixups. And one morning the nurse on duty asked me to clear out the nightstand where I'd stocked toiletries. The Joint Commission on Accreditation for Health Care Organizations (JCAHO), which evaluates hospitals, had scheduled an inspection. One of its myriad requirements is a lock on drawers where syringes are kept. Never mind that they hadn't been locked up as long as I'd been there. A lock was installed, but the key misplaced, so the drawer stayed locked, and empty, for the rest of my stay.

I was told that the JCAHO committee--which gave the hospital a solid A, by the way--might want to interview me since they look for unusual cases. Besides, I'd been around long enough to make a few observations myself. But circumstances dictated otherwise, and Matthew made his arrival at 35 weeks, on Saturday, Apr. 20, at a healthy 7 pounds, 2 ounces.

Still, it would have been nice to meet with that committee. I would have told them that in their efforts to quantify outcomes, mortality and morbidity rates, and all the other factors that go into judging a health-care facility, there is one that is so important and yet elusive to measure: compassion. Medicines and machines can do their jobs, but it is a hug that breaks fear's grip and a clasp of hands which banishes the darkness.EDITED BY SANDRA DALLAS By Gail DeGeorge


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