Health Care in America: An Intimate Glimpse

I am an obese 75-year-old man. I recently had a large cyst removed from my spine, along with some bits of bone for which the surgeon said I had no need. The surgeon, trained at the University of Pennsylvania and Harvard, had an impressive resume and came highly recommended. He was, in addition, a very likable fellow. He looked about 18 years old.

I had last had surgery 30 years earlier in Switzerland, where I had a large room with a window overlooking the Alps in a hospital that boasted a splendid wine cellar. The nurses, efficient and caring, even brought drinks for visitors. When I experienced a bit of postoperative trauma, the surgeon was at my bedside within minutes with a sizable glass of cognac. I speculated recently on how patients were now cared for, more than a quarter of a century later, in the United States, my native land. Rather differently, I discovered.

The operation itself, as far as I could tell, went very well. I had naively assumed that I would have a private room, but perhaps all of them were occupied; it was not offered as an option. I awoke to find myself on a narrow bed in a small room that I shared with another patient. A curtain separated me from my fellow sufferer, whom I never saw. He enjoyed the window overlooking the parking lot. I was able to note his television preferences, which were limited to cartoons and basketball. I also saw his many friends and relations of both sexes and all ages, who, perforce, had to squeeze past my bed to reach the toilet, of which they seem to have had frequent need.

The room was stuffy and uncomfortable. Although the weather was not inclement, the window remained fast shut; not a whiff of fresh air was admitted. In Britain during the mid-19th century, a scandal arose when it was learned that the standard for soldiers' barracks was only 800 cubic feet of air per man. I mentally tried to gauge the amount of air space available to me. Not that much, I reckoned.

My new habitat was a world of women: registered nurses, practical nurses, nurses' aides, student nurses, technicians, cleaning women, and women who brought and removed trays of food. Most of the nurses were saints. Certainly they were during my first night after surgery, when neither the do-it-yourself painkiller kit with which I was provided nor the shots of who-knows-what narcotic relieved my “discomfort”-the physician's word for excruciating pain. A brave nurse dared wake the surgeon at midnight, and the surgeon kindly increased the dosages of painkillers so that they eventually brought me relief.

The next day, my do-it-yourself painkiller was removed from me. When told what was to replace it, I expressed doubts to the nurse about its efficacy, for it had been tried before my operation without success. To my astonishment, she reacted as if I had personally insulted her. (Is the nurses' pension fund invested in a pharmaceutical company?) She roughly removed all the tubes from my wrist and slapped on a bandage. As she dismantled the gadget from which the bags hung, she said, “I'm not going to reinsert this.” And with that she marched out.

Within minutes blood oozed from my wrist, then gushed. I rang for a nurse, but when no one responded, I hailed a nurse passing by in the hall. (There was, I discovered, an advantage in having a bed by the door rather than the window.) She grabbed a sheet, bound my wrist, and dispatched an aide to fetch proper bandages. She did her job efficiently and then cleaned up the bed, by now thoroughly blood soaked. A real saint. I do not know that my regular nurse was made aware of this incident.

Food at the hospital was provided by cooks who had failed to qualify as airline chefs. No salt was allowed, and the hospital appeared ignorant of salt substitutes. It scarcely mattered. The food was served tepid at best, arrived at odd hours, and always appeared unappetizing, except to the resident fly who seemed to find dried baked beans with a piece of desiccated turkey delicious. I ate only some fruit. No one noticed whether I ate or not. I suppose it was an added bonus if I lost a few pounds.

I was never cleaned up. When I felt well enough to clean myself, I requested a wash rag and hand towel. I thus managed to scrub off some of the dried blood and remnants of adhesive tape.

The major concern of the staff was to see that I urinated-or, to use the medical term favored by the nurses, “peed.” Nurses propped me up beside the bed and held out a urinal, asking me if I could perform. Standing between two young women who watched carefully, I said I thought not. As I found myself unable to provide urine under any circumstance, a catheter was inserted in my penis. However uncomfortable and dignity-deflating this procedure seemed, it was done quickly and professionally. Such was not the case the second time.

It was hands-on day for the local nursing school, and fresh-faced young female students came to take my blood pressure, feel my pulse, and stick needles in my buttocks. I was no longer a mere patient but a warm body on which budding Florence Nightingales could practice. Any remnant of human dignity I possessed was shredded when a pretty teenager was called on to insert a catheter. The student and her tutor bent over the bed to examine my genitalia in detail. The student appeared never to have seen such a sight and handled my penis gingerly while her instructor explained the organ and what she was supposed to do with it. I had become an exhibit in a sex education class.

When the time came for me to be discharged, a nurse or an aide (impossible to tell which since nurses stopped dressing like nurses) held up a plastic basin full of toilet articles-a small tube of toothpaste and a toothbrush, a bottle of baby powder, a small plastic comb, and other items, with a total worth of about $12.00-and asked if I wanted them. When I said I had never seen them before, she brightly replied, “Yer payin' for'em.”

She was right. When the first bill came, I was charged $890.20 for “pharmacy.” Of course, a few other items were included, as I noticed when I received an itemized bill, perhaps, all told, as much as $40 at hospital prices. Hospital bills are difficult for the uninitiated to read, filled as they are with abbreviated, arcane medical terms. But I did see allopurinol on the list. I was charged $1.45 for one allopurinol pill (local retail price, 2.4 cents), a medicine effective only for gout. Actually, the bill listed four pills, but three, perhaps in a spasm of guilt, had been removed.

In the automobile business, such practices are called “add-ons.” Car dealers who try this stunt often end up in court. How does a hospital get away with it? Not long ago, The Washington Post carried an article on credit card companies that had to pay the Federal Trade Commission $292 000 because they charged people for services they had never agreed to buy. Has no former hospital patient, I wondered, ever complained to the FTC?

It was like returning home from another planet when at last I was discharged. It was still a female world, but it was inhabited by a loving wife and our two tail-wagging dogs. It was a familiar world, a comfortable world, with fresh air, edible food, and a drink in a large chair before the fire, where I could contemplate the problems of health care in America and deplore the cost of airline tickets to Switzerland.

• Copyright ©2004 by the American College of Physicians