Travels with Lizbeth Page 16

  I took the Vicodin. I had had all of the hassles I could deal with that day.

  A tech came to draw my blood. All the routine lab work that had been done in the ER was to be repeated on my admission to the hospital proper, and the specimen for the HIV screening that had been drawn in the ER had been lost. I noticed the tech was not gloved. I warned him that I had a history of hepatitis B—as he had the lab slip for the HIV screen I saw no point in belaboring the point because the precautions for hepatitis B and HIV are the same. He told me the policy of the hospital was now universal precautions; everyone was supposed to be treated as if he were known to be HIV positive. Still the tech approached me with the needle and his hands remained ungloved.

  “The gloves are not made of steel,” he said. “If I am careless enough to poke myself with the needle, it will go through rubber gloves as easily as it goes through my skin.” I was drawn again at midnight and at four in the morning. That and the Vicodin assured me of no sleep at all. I did learn that the night nurse slept on duty. My infusion ran out in the night and the alarm on the pump went off. As the alarm continued to sound I pressed the call button on the console by my bed. The voice that responded was clearly that of a person roused from a deep sleep. This suggested to me that when this nurse was on duty I might unplug the pump and use the bathroom, for the alarm would bring no response. I had only to learn to reprogram the pump once I reconnected it. That could not be a great mental feat if nurses did it.

  I picked at breakfast, avoiding the stuff with much fiber—which was practically all of it. That would be a nasty note in my chart. As things progressed and I ate little or nothing and did not call for the bedpan, they upped the ante. One of my last meals at the hospital consisted of stewed prunes, prune juice, a mound of lettuce, an apple, and whole wheat toast. Naturally I ate none of it.

  I made another stupid and regrettable remark. When a nurse came to turn up the rate of my infusion, I said something about increasing the amount of rat poison they were pumping into my body.

  I thought I was receiving Warfarin, an anti-coagulant often used in the treatment of thrombophlebitis. It is also the most common rat poison used in the United States. The rats eat it and bleed to death internally. Evidently they can detect and avoid many other poisons.

  I regretted making this feeble joke as soon as it escaped my lips. In fact I was receiving Heparin, another anti-coagulant, but I seriously doubt the nurse would have appreciated my point in any event. I could imagine the chart note: “Patient expresses the belief we are trying to poison him.”

  * * *

  THE SOCIAL WORKER called on me. He came right to the point: “How many fifths do you drink a day?”

  I explained that if I drank a fifth of whiskey in a week I would be drunk the whole week.

  Another uh-oh. Saturday afternoon I had gone into Sleazy Sue’s. In the hottest part of the afternoon the pew where Lizbeth and I spent most of our days was in the sun. I often spent those hours in Sue’s, for it had a powerful air-conditioning system. The owners of the bar were kind enough to allow me to remain there on one of the carpeted benches away from the bar, and they would even go so far as to offer to take some ice out to Lizbeth at her station under a shady tree. The bar did not have many customers at the times I went to sit in it. I had little difficulty in staying out of the way in the dim, cool bar.

  A very rare thing had happened the afternoon before I went to the hospital. Someone sent me a frozen margarita. As the drink had already been prepared, I drank it. Had my urine toxicology come back positive for alcohol?

  I did not think one cocktail would show up twenty-four hours later, but if it had, convincing the social worker I was not an alcoholic would be impossible. Social workers have a little saying: Alcoholism is a disease of denial. And so it may be. Unfortunately social workers take this saying to mean that anyone who denies being an alcoholic must be one. Of course anyone who admits to being an alcoholic is also an alcoholic.

  It would have been greatly to my advantage if I could have admitted to being an alcoholic or a drug addict. The social workers have no way of assisting someone who is sane and sober. My interview with the social worker made it clear that only three explanations of homelessness could be considered: drug addiction, alcoholism, and psychiatric disorder. The more successful I was in ruling out one of these explanations, the more certain the others would become. Professional people like to believe this. They like to believe that no misfortune could cause them to lose their own privileged places. They like to believe that homelessness is the fault of the homeless—that the homeless have special flaws not common to the human condition, or at least the homeless have flaws that professional people are immune to. They are glad to go through the motions of helping the homeless—and some, like the social worker, depend for their livelihood on there being homeless people to pretend to help—but on the ladder of being, homeless people are not quite up to the level of professional people.

  The social worker had programs for alcoholics, programs for drug addicts, and programs for the insane. If I would admit to belonging to one of these categories—and if I would have my dog destroyed—then something might be done for me. Unless I were a drug addict, an alcoholic, or a lunatic, the best he could offer me—if I would have my dog destroyed and if I would destroy my conscience to the extent necessary to participate in a religious organization that often refused to agree to principles of nondiscrimination—was three nights’ lodging at the Salvation Army.

  The social worker prolonged the interview after it was clear he could not offer me any material benefit. He wanted me to apply for a program that would allow the costs of my hospitalization, including his services in advising me that he had no services to offer me, to be defrayed by the federal government.

  This is of course all that social workers exist for: to keep the funds flowing to the institution, thus to preserve their own salaries. Otherwise they are just about as helpful as the average high school guidance counselor—to put the matter in terms that anyone who has attended a public school can readily understand.

  I asked the social worker to explain what additional benefits I would receive if I filled out the forms he wanted me to fill out. Although he could not think of any way the forms might benefit me, he seemed genuinely surprised when I told him I would take the matter under advisement. The forms remained blank and the social worker remained in an agitated state until our interview was concluded.

  * * *

  I COULD SEE it was about time for me to have a look at my chart.

  Someone who has never worked in a medical environment may think it is a rare thing for a positive pregnancy test to be reported in the chart of a seventy-four-year-old man, or for drugs—each relatively harmless in itself—to be prescribed in a lethal combination, or for several shifts of nursing notes to be so utterly fabricated that patients on leave from the facility are described as having slept well. But I have commonly seen such things. One of my duties at the state asylum was to review medical charts.

  Face it. The employees of a public hospital are, despite being doctors and nurses, public employees. Public employees run the postal service, the military, and United States foreign policy. I know very well that some dedicated and competent individuals can—rarely—be found in public employment. And I sympathize with them. But I know, and I think they know too, their valiant struggle against Chaos is doomed from the outset. Perhaps you are willing to trust your life to a system run by public employees, or perhaps you are helpless to read your medical chart. As for me I began to demand to read my medical chart.

  The patient’s bill of rights at almost every hospital in America says that a patient has a right to read his or her chart. But in fact that right is very difficult to enforce. I was told that, in spite of the patients’ bill of rights, the policy of the nursing staff was to prevent patients from reading their charts.

  I asked if there were an ombudsman in the hospital. The person I spoke to had never heard the term, and m
y use of it may have been recorded in my chart as a neologism—a privately coined word, often taken as evidence of a psychiatric disorder. But eventually I discovered that the person charged with enforcing patients’ rights was the director of nursing.

  Oh? Wasn’t it the policy of the director of nursing that prevented me from seeing my chart? Yes, it was. And the director of nursing was the person charged with enforcing my right to see my chart? Yes, that too.

  If I were arrested I might expect sooner or later to have an attorney appointed to represent me, but in the hands of the medical system, I was on my own.

  Dr. Stalin came into my room accompanied by a large number of nurses—including a couple of suspiciously burly types—and Dr. Velasquez. She flipped through my chart, reading such excerpts as she chose. She said as far as she was concerned I could read my chart whenever I wished. She still did not put the chart in my hands, but I took her at her word that I could examine the chart for myself later. Things calmed down. I asked that the Vicodin be changed to Naprosyn—another nonsteroid pain reliever and anti-inflammatory drug comparable in effect to ibuprofen. Eventually a nurse brought me some ibuprofen. Perhaps if I had asked for ibuprofen I would have got Naprosyn.

  They were pumping Heparin into my body at an ever-increasing rate. Still my clotting time had not increased to the desired level, or so I was told.

  By Tuesday night I was accustomed to the hospital routine. Dr. Stalin’s apparent willingness to allow me to view my chart had reassured me that there was nothing in it of a diabolical nature. But it was time, so it seemed to me, to make a routine review of the chart. After all, I knew there were fictitious vital signs on my admitting chart. Every patient ought to make a routine review of his or her chart. Most patients, of course, will be in no position to make sense of the information in the chart. But anyone who will look carefully can spot a misfiled lab slip or report.

  In many charting systems, lab slips are affixed to the chart so that they overlap. The results of the lab work are then available at a glance. But the name stamp on a slip is covered by the succeeding slips. Once the name stamp on a misfiled slip is covered by the next slip the chances of the error being discovered by the medical or clerical staff, applying their usual diligence, are vanishingly small. A patient who can do no more, can at least check to see that every piece of paper in the chart bears the correct name. This alone will enhance a patient’s chances of survival. Patients who can do more for themselves should. One who can read medical orders should verify that the correct medications are supplied at the correct times, and so forth. So I called for my chart on Tuesday evening, suspecting nothing and desiring only to make a routine review.

  The war began all over again.

  Doctor Stalin was not in the hospital. Dr. Velasquez was. He claimed he would have to sit with me while I read the chart in case I encountered some medical terminology I did not understand. He claimed not to have the time to do that. I pointed out to him that the medical history I gave him had been written in medical terms and that we had always discussed things in medical terms. He knew I was perfectly familiar with medical language.

  I pointed out that he had been in the room when Dr. Stalin had said I could look at the chart whenever I wanted. He claimed he had been called out of the room and had not heard her say that.

  Of course he had not been called out of the room. I knew for a fact he was there. He was lying and I was certain of it. He had flimflammed me into agreeing to the HIV test; I had learned from Dr. Stalin that HIV status had nothing to do with the treatment of thrombophlebitis. And there was much else about my hospitalization that seemed to me vaguely dubious. But until Dr. Velasquez lied to me I had no real evidence that anything was amiss. The lie was a fact, and it renewed my suspicions that there was something in my chart that the staff did not want me to see.

  A nurse had accompanied Dr. Velasquez into my room. She had been present for Dr. Stalin’s remarks. The nurse corrected my recollection. Dr. Stalin had said, “As far as I am concerned you can look at your chart whenever you want.” But, you see, it was not Dr. Stalin’s concern. It wasn’t up to her. The policy that prevented me from viewing my chart was a nursing policy. The director of nursing could not be bound by Dr. Stalin’s remark.

  I could think of no reasonable answer to this. Fortunately, Dr. Velasquez could not accept the nurse’s argument—he could not admit the principle that a nursing policy could withstand a doctor’s order to the contrary. As he insisted on this wedge, I calculated to drive it home.

  I threatened to leave the hospital against medical advice. Dr. Velasquez asked if it would satisfy me to be allowed to view the chart for five minutes. I said it would. Dr. Velasquez said he would let me see the chart for five minutes after he had finished his rounds, which he expected to do within a quarter of an hour.

  I was very pleased with this result. Evidently Dr. Velasquez had forgotten, if he ever knew, that I once had a job that entailed reviewing thirty charts in an hour. If there were a smoking gun in my chart, I could easily find it within five minutes.

  Curiously, I never thought that anything the staff desired to conceal might be removed temporarily from my chart. In my job I had been thoroughly indoctrinated that nothing may ever be removed from a chart—even the most erroneous entry may be corrected only by a subsequent entry, and parts that must be corrected are struck out with a single thin line that leaves the error legible. Evidently the staff was as indoctrinated as I, for otherwise they might have brought my inquiries about my chart to an expedient conclusion.

  Twenty minutes passed. When Dr. Velasquez returned to my room he reported that he had talked to Dr. Stalin by telephone. The deal was off. I said I was leaving the hospital against medical advice. I asked that my infusion be discontinued. Dr. Velasquez said that it was up to me. He left my room. I called Billy to arrange a getaway car.

  I stood. My leg hurt worse than ever. At least the Lasix had reduced the swelling in my ankle. I pulled on my pants and put on my shoes and got one arm into my shirt. I supposed that when Dr. Velasquez had said it was up to me, he meant it was up to me to remove my IV. I had to do so in order to get my shirt on. I hobbled down the hall and into the elevator.

  The elevator doors closed. The elevator descended a few feet and lurched to a stop. Dr. Velasquez had gained control of the elevator system. The elevator returned to the landing and the doors opened.

  Dr. Velasquez wanted me to sign the AMA (against medical advice) form. I told him I would sign nothing. He asked why I had discontinued the IV myself. I recalled to him that he had said it was up to me—but now I realized he had meant that as a response to my previous remark that I would leave the hospital and not to my request that the IV be discontinued.

  When he at last released the elevator, he shouted at me that I could have a pulmonary embolism on the street. Although he had claimed to think I might be unable to interpret medical terminology, he knew I knew what a pulmonary embolism was.

  Hospital security detained me in the lobby. They had no trouble doing so. I was barely able to walk. Besides, I knew they were not private guards, but city cops. My failure to obey their orders would be grounds for my arrest, and if I were arrested I might be returned to the hospital as a prisoner.

  After a long time they let me go.

  * * *

  BILLY ARRIVED QUICKLY and whisked me away to his apartment. After a shower, not to mention the use of the toilet, I felt like a new man. Except for my leg. I had a good night’s sleep on Billy’s sofa. Lizbeth warmed my leg at least as well as it had been warmed by the hospital’s heating pad. In the morning Billy returned Lizbeth and me to the park. Of course the things I had stashed there had been stolen.

  That was Wednesday morning. I believed it very likely that I would die at any moment and considering the pain in my leg I almost hoped I would. I made a sign and slowly, painfully made my way back to the hospital. I concealed Lizbeth in a shady place in the park across the street from the hospital. I left her wi
th her bag of food and a large bowl of water. It was the best I could do for her. I bade her a tearful farewell, for I believed I would die before I could return to her.

  I picketed the hospital. The side of my sign that I kept toward the hospital building read, DEMAND TO READ YOUR CHART. The other side said something like, DR. STALIN DENIES PATIENTS’ RIGHTS. I did not attract much attention. I did not expect to until I dropped dead.

  After a couple of hours I could no longer put one foot in front of the other reliably. I made my way back to Lizbeth. Then in tears I called Billy.

  With uncommon good grace Billy agreed to pick us up again. I got another good night’s sleep at his place. Lizbeth, who had been on a hunger strike since we were first separated, began to eat again. Thursday morning things seemed very different. I did not, after all, want to die.

  Billy saw the change in my attitude and revealed his plot to me. It was why he had so readily agreed to pick me up the day before.

  He had called the hospital Wednesday and spoken to Dr. Stalin. She was, according to Billy’s report, livid. She told him that I had a very serious medical condition. She was furious at Dr. Velasquez for allowing me to leave the hospital. She told Billy that she had arranged for a psychiatric SWAT team in the ER to be on the alert for me. If Billy could get some friends to wrestle me into the ER, the psychiatric SWAT team would then take custody of me and my life might yet be saved.

  When I called him on Wednesday, he had seen it as very fortuitous, for he had not yet decided how he might lure me back to his apartment.

  Tim was then in jail, but he was released to go to a job he had found at a nursing home. He was supposed to ride the city bus to work, but in fact he rode his motorcycle, which he kept hidden near the jail. The time he saved in transit—some two or three hours a day—he spent at Billy’s apartment. Tim and Billy had discussed me and formed a plan. If Billy could get me to his apartment, he would wait until Tim was available. Then Billy would propose to go to Sleazy Sue’s for a drink and would offer to take me too so I could check my mail. He knew it would be hopeless to try to wrestle me into the car, but if he got me into the car voluntarily he could go toward Sleazy Sue’s by a route that brought us very near the hospital, and he hoped the ruse would stand up until I was brought to the door of the ER. Then he and Tim would wrestle me into the hands of the psychiatric SWAT team.