So it is now Sunday night at 7 pm, and my doc has come in to check me out, and we agree that I am doing very well in recovery from knee replacement (Of course, "very well" still involves a great deal of agony late at night when the knee stiffens up). I say that I would prefer not to go to inpatient rehab and he concurs that it is not necessary. So he says that I can go home tonight! I ask if I can use the walker and brace in the room to get home and he says sure. He then goes out to write the discharge orders.

Back in the room, my wife, Linda, and I are very relieved and happy. She has been staying in my room with me on and off (mostly on) for six days, with she sleeping in a recliner, and this will be a great relief for us both. She's approaching dog tired. Who wouldn't be?

So the charge nurse says they will be getting the paperwork ready. We settle back to wait, watch a little TV, read, etc. Then someone returns to the room, I think the charge nurse, with papers for me to sign. I say again, "The doc said I could use this walker and brace to get home."

She responds, "You can take the brace, but the walker belongs to the floor" I say, "Then, how am I going to get home and into the house and through the house safely--without breaking my leg?" She marches doggedly on with words, "No, you can't take the walker." 

Meanwhile, it begins to dawn on me that arrangements have not been made for my own walker for transport. She says that they can see about ordering one now for me, but it it is getting late. I say, "Can you just loan me this one for tonight to get home. We'll return it tomorrow." She repeats, "No, you can't take it. It belongs to the floor." (This is the same walker that has been sitting in my room for six days, untouched by anyone but me. I say, "but the doctor said we could use it." She says, "He had no authority to say that."

So I give up that argument, and we settle back to wait for my own walker to arrive from the medical equipoment facility. We pass ten o'clock, then ten thirty and are approaching eleven. Linda is growing more sleepy by the minute and I buzz the charge nurse tell her that Linda is too sleepy to drive me home (We live an hour away, at the other end of a dark country road). She has to be at work by seven the next morning, so I say that it would not be safe for her to drive now, and could we just sleep until six am and then leave? She says okay.

The after a while she comes back and says that the floor's case manager wants to speak to me on the phone. I hear her say, "You understand, Mr. Frank, that if you leave past midnight, we will have to charge you $1000 extra and it will likely not be covered by insurance."  I say, "You mean I must leave now with no walker and unable to ambulate or pay a thousand dollars extra for six hours of sleep?" (I am growing agitated) She says in what I perceived as her cold and bureaucratic voice, "yes."  I say, 'You are telling me that you are willing to either send me out of the hospital  now, with a driver who cannot stay awake and no walker to assist in ambulation, or let us sleep in the room for six hours and as a result charge us a thousand dollars?"

She says yes. (Deep breath) Then the charge nurse hands me a form on which is printed a number I can call to complain to Medicare. She says, "You can call this number."  I do so, immediately, finally reaching somone, who subsequently informs me that she cannot help me with my individual situation; my reporting what is going on is just to aid in research, so that they can improve the hospital system, for next time. (Again, deep breath. I am losing it) I cannot believe we are in this Catch 22.

I talk to the charge nurse again, tell her how disturbed I am by the care I am receiving during this discharge phase. I think I get back on the phone with the case manager (The details of this narrative may be confused. I have been on a pretty heavy dosage of medication).

I say, "Look, the doctor said we could take the walker. Then you said we couldn't." (I should have asked them to call the doc back immediately, in hindsight, but did not realize three plus hours would pass, my wife would approach lack-of-sleep-oblivion, and that this thousand dollar threat would arise).

"Then three plus hours passed with no walker. Then the walker arrived. By that time Linda had grown dangerously too tired to drive me back. Then you said we can leave now (presumably, with no walker and Linda unable to drive safely). Then I asked if we could sleep in the room for six hours and then leave. Then the case manager said we can do that but would could be charged an extra thousand dollars. My question is why could not the hospital have show some flexibility by either loaning us a walker (Do you really think we are going to steal it?) or let us sleep in the room and write off those six hours?" No answer, or if there was an answer, it was basically, "Rules are rules."

Finally, the charge nurse gets in touch with her nursing supervisor. (My anxiety and anger levels has gradually increased in the course of these four nightmare hours). After getting off the phone, she comes back (It is 11:30 or quarter to twelve by that point) and says that the nursing supervisor said to tell me that she would take care of the situation and would "take the heat." I asked for clarification of what that meant exactly. The charge nurse said she could not say, but repeated back to me what the nursing supervisor told her.

I gave up at that point. Linda has been trying to sleep in the recliner for three and a half or four hours. It was, of course, a fitful and disturbed sleep. I finally told her we are going to stay here till six am and deal with this in the morning.

And that's what we did.

After arriving home the next day, I started to make calls back to the hospital, to Medicare, and to attorneys offices. The other case manager for that floor struck me as equally cold and bureaucratic on the phone. I tried to call a nursing supervisor or patient advocate but neither returned my call (Since then, they called back, and I have lodged my protest with both of them). The attorneys' reps I spoke to were not helpful, all of the ones I reached saying that they don't handle "that type of case."  I called the Medicare number back and again their person said that they cannot get involved with my individual case. Blue Cross said that they cannot address any part of this till they get a bill.

I spoke with my doc during the week and he was upset with the hospital, saying that he would call administration. He said he has run into the problem before, when prior arrangement had not been made for a walker and the hospital was unwilling to loan a walker for the patient to get home. He said, "It's ridiculous; that walker probably costs about $30 anyway."  When I saw him in my office he blamed "Obamacare" for the problem.

So finally yesterday I reached the patient advocate and a nursing supervisor and lodged my formal complaint. Both apologized, and the nursing supervisor said she would write a note to the head of administration. I told one or the other or both that I have been talking to attorneys offices but that what I want from the hospital is a simple apology and to write off that $100o for six hours of sleep.

How are we doing, otherwise? It is slow progress, in any case, recovery from total knee replacement. But the PT person says I am making good pregress, and so did my doc when I saw him in the office, as well as the home health nurse. Linda has pretty much recovered from her ordeal.

Thinking back, I think I am most upset by what I perceived as a cold bureaucratic attitude. Of course, I am upset if we end up paying an extra thousand dollars that we do not have. And I am upset with the Medicare reps I reached. I am not upset with my doc or Obama. (When I say doc I mean my surgeon and his brother, both of whom saw me in the hospital; they have a joint practice). I am not upset with the charge nurse, who I now think was caught in the middle, between the case manager and me.

I think my surgeon was somewhat miffed that I changed my mind about inpatient rehab when his brother was filling in, but both concur that I am making good progress, anyway.

Hopefully, this individual matter will be fully resolved by next week. But how many others experience bureaucratic inflexibility and insensitivity, in the health care system? How many others must cope with this type of nightmare series of events, and worse?

As I said, I was under pain and other medication the whole time, so some of the details of this narrative may be confused. But fortunately, my wife, Linda, was with me the whole time, and can verify at least the broad outlines of the story.

Now it's the middle of the night. I was awakened from sleep by pain and stiffness in the knee so decided to blog this. And now the pain level is down. Basically, I'm ok, though somewhat stressed.

Now I'm taking another deep breath, and getting sleepy again...I will resume dealing with this matter next week.

Think we need some health care reform?