Vol. 73 September 1, 2012 Two American Medical Care System Miracles

Yesterday a friend told me about his own recent medical care “miracle”.

He and his family were finishing up their last day of a two-week vacation on a remote New Hampshire pond (the one, I believe, where the fish called Walter once resided). He was designated to perform an essential rite of passage at the end of their annual visit, the trip to the dump. The dump, of course, is at the outer limits of their township, more remote than their cabin and out of cell phone range.

When he returned to the cabin from the dump he felt the first chest pains. Over the next few minutes they increased, and he didn’t feel or look well. In response to their 911 call the local ambulance raced out on the dirt road and whisked him off to the hospital in Plymouth, NH.

A few minutes after arriving in the ER he received an intravenous “clot-buster” medication and suffered a cardiac arrest! CPR was started immediately, during which he had a seizure. Resuscitation was successful, and a helicopter was called in from a Manchester, NH regional referral hospital. He barely remembers the helicopter ride, but thinks he heard the helicopter pilot getting “clearance to land in 23 minutes” even though the air space was restricted for President Obama’s visit. My friend is a certified pilot and not a supporter of Obama, so, of course, he WOULD remember that.

In the Manchester hospital an immediate cardiac angiogram showed one coronary artery with two narrowed segments, one after the other with a normal segment in between. A stent spanning the two narrowed segments was inserted via his radial artery.

Five hours after the onset of his chest pain and about four hours after his cardiac arrest, he was sitting up comfortably in his hospital bed, fully awake and hungry with a very sore chest from the CPR.

The next day his echocardiogram was normal, he passed his treadmill stress test with flying colors, and he was discharged home.

A week later his chest was still sore as he humbly showed his “before” and “after” angiograms to close friends and colleagues.

What a marvel of electronic communication, modern transportation, presence of trained clinical personnel, and access to state-of-the-art diagnostic and therapeutic equipment and processes.

What superb medical care.

My friend is over 65 years old and is covered by Medicare. He probably won’t even see a bill.

He is the father of three, the grandfather of five, a founding elder of a community church, the medical director of a clinical research center, a retired general surgeon, a member of several non-profit boards of directors, and a so-so pool player. What is the gain in quality-adjusted life years (QALYs) of this event? How could you even begin to calculate it?

How could anyone be against making this kind of medical care available to all Americans?

I heard this story Sunday night as an “oh, by the way” when my friend called to ask my help in arranging a second opinion with a pediatric neurologist for a visiting family.  Their five-year old child had been evaluated elsewhere for left-sided weakness and incoordination. The parents had his medical records, CT scans, and MRIs in hand, and they were looking for a second opinion about prognosis. The only problem was that they were visiting from the U.K. and were returning there in two days.

During my  phone calls to a pediatric neurologist I knew, the Urgent Appointment clinic for pediatric neurology at Boston Children’s Hospital, and the Pediatric Neurology Department at Boston Children’s hospital, I related the short story behind this request for an “urgent” second opinion, and left a few phone messages.. The best I could get, not surprisingly, was a referral to the International Medical Care office of Boston Children’s Hospital for an intake process and a future “second opinion” appointment in a month or two.

I reported this result to my friend on Monday afternoon and remarked how difficult this request would be to fill on such short notice. Later that day he got a call from the BCH Department of Pediatric Neurology with a request for more clinical details. The caller left her cell phone number to call that night after hours, since the family was not then available. The net result: the family went up tp Boston Tuesday afternoon, and received a thorough, reaffirming, and comforting second opinion about their son’s condition from a senior pediatric neurologist. They left for England the next day.

QED: The second American medical care system “miracle” of the week.

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One Response to Vol. 73 September 1, 2012 Two American Medical Care System Miracles

  1. Miracle #1 is a common occurrence in the US. It is truly amazing that our EMS and cardiology capable hospitals can get a patient to the cath lab in 90 minutes (http://en.wikipedia.org/wiki/Door-to-balloon). Unfortunately, not all hospitals meet the mark — that indeed would be a miracle.
    Miracle #2 is interesting: A patient from the UK can get care in the US but will pay out of pocket — the physicians in the US probably thought having a cash paying patient was a miracle. The UK typically has very good neurology and neurosurgery services — unlike the US there is no shortage of neurosurgeons. The UK neurosurgical community makes significant use of videoconferencing between specialized centers (with full resolution digital radiology images). The family may not have realized the behind the scenes consultations that may have happened. It’s a miracle the US doctors did not repeat all the x-rays — bravo for Boston.

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