Thursday, June 17, 2010

The Penguins are Gone

Dr. P. Tatineni expressed surprise when he learned I’d lived three-quarters of a century without spending a single day as a patient in a hospital. So were several nurses and other caregivers at Borgess Medical Center in Kalamazoo after my health winning streak ended on June 9.

One nurse suggested I might be forgetting something, perhaps intentionally. “Oh, you must have been born in a hospital,” she said. Not so, I was born at home with Dr. William McCormick presiding. He and other doctors routinely made house calls 75 years ago. Dr. McCormick was said to have delivered a good share of the population in northern Lincoln County, Wisconsin, during a long career. He went where he was needed, to a farm, a home, or to the delivery room at Sacred Heart Hospital.

Dr. Tatineni mused about changes in hospital care during our brief conversation. He said he was a student of the history of medicine in the United States. He pointed out that hospital use has come full cycle. Early in hospital history, almost no one was born or died in them. Those two important events most often occurred at home. Now, a great many Americans are born and die in hospitals, although the cycle may be heading in the other direction lately as ancient birthing practices and hospice care become more popular.

I would not have had the pleasure of talking with Dr. Tatineni, or the displeasure of an unscheduled visit to his workplace, had June 9 been routine for me. It started normally. A little computer work and play was followed by some light yard work helping wife Sandy with a landscaping project. The day was hot and humid, but I took frequent breaks. Nonetheless, I felt more tired than usual in the evening, and went to bed early.

A few hours later, I awoke with a little problem. I was struggling to breathe. Breathing is fairly fundamental to the human condition. I thought my visit to earth was about to end. I felt the way we felt as kids at the end of a sprint when we needed a rest period to “catch” our breath. My trouble the evening of June 9 was I couldn’t catch it, and it felt like I never would.

Sandy and son Lee and his fiancée Karen were my first caregivers. They rushed me to the nearest emergency room five miles from our place very quickly. We arrived at 11:30 p.m., and a nurse had me connected to an oxygen supply within minutes.

After two hours of tests and treatments, the presiding doc decided I needed a hospital stay. He gave me a choice of two in Kalamazoo, about 15 miles away. I picked Borgess Medical Center because Sandy had good experiences there earlier. The nurse made some calls and I soon was strapped to a gurney and on the way, monitored closely by two paramedics.

The paramedics said it was their fourth consecutive trip to Borgess in what had been a long day. A nurse at the hospital said such trips cost $1,500 each (when the bill came weeks later, it was slightly more than $1,000). In a big country like ours, the sheer distance between facilities contributes to high health care costs, a factor seldom mentioned when we discuss the quality of care versus the expense.

I roomed at Borgess for three days. The experience included many revelations for a first-time hospital resident. I intend to describe some of them, here and later. Now, before you click to another site after observing that this neophyte is going to babble about a lot of stuff we already know, or any boob can discover by watching medical shows on the boob tube (I watch “House,” one of the few entertainment shows we bother tuning in on), let me elaborate. I’ll try to compare important, but not dramatic, situations you usually don’t observe on the TV shows with my recollections of hospital activities 60 years ago.

Whoa. How can this instant hospital expert know anything about conditions 60 years ago? He never was a patient. Well, I have a few qualifications in that regard.

As a younger man, I became very familiar with how things were done at Sacred Heart Hospital in Tomahawk, Wisconsin, my hometown. I visited many times to see friends and family members. My grandmother, father, and mother were among the patients I spent time with. Also, my family was very much in tune with medical practices in those days. One aunt spent her entire working life as a sort of business manager and general helper in the offices of Doctors Baker and McCormick, serving three of the four doctors who practiced in the city during most of her lifetime. An addition, members of the Baker and McCormick families were good friends of ours.

Sacred Heart and Borgess have a common heritage. Both were founded by nuns. Hospitals thus created have been one of the great voluntary contributions to American society. Andrew Carnegie built libraries to nurture our minds; Roman Catholic (and Episcolal) nuns established hospitals to minister to our bodies. Both types of institutions were open to everyone; most were from the start, all became so as racial segregation diminished in America.

As irreverent youths, we referred to nuns as “penguins,” but only at a discrete distance. The Tomahawk variety wore uniform, cumbersome, black habits. The more portly sisters tended to waddle a bit, and the net effect indeed was a certain resemblance to the Antarctic birds. The flight of these wonderful “birds of mercy” at Sacred Heart and Borgess over the years roughly parallels the changes in what is most important to every patient—the nature of the caregivers and how they deliver their services.

At Sacred Heart in the 1950s, nuns handled almost all the nursing and administrative duties. They wore their habits at all times on the job, and everywhere else in public. A few “civilians” staffed kitchen and maintenance positions and performed some aspects of patient care. The latter, as I recall, all wore white uniforms. The nuns were in full command of hospital activities. That was very clear. Three doctors performed surgeries, prescribed treatments, and made rounds at the hospital. I remember seeing them attired in business suits, often with vests, during routine visits to patients.

It seems reasonable to assume staff composition, appearance, and duties were similar at Borgess years ago, although the scale of things was much different. Sacred Heart had 25 beds. Borgess, serving a much larger population, has hundreds today and probably always was larger. It is likely, however, at both places most nuns were extremely dedicated to their vocation. At Sacred Heart, they lived together in a building right next door to the hospital. Running that hospital was their major mission in life, and they had only to walk a few yards from their home to their workplace to get on with their daily business.

The hospital nuns mirrored what my Catholic friends said nuns as a group were like in the 50s. A few were cheerful and jolly. More tended to be reserved and severe, especially in dealing with youths. Discipline had high priority. Visiting hours at Sacred Heart were strictly enforced. Visitors and patients were expected to quietly follow all rules. Borgess in 2010 has the same “general visiting hours” and lots of suggestions about behavior in a guidebook, but nurses were willing to arrange all sorts of exceptions and nobody seemed a bit concerned about minor rules violations, unless they interfered with patient care.

Sacred Heart had no guidebook. The nuns told you what the rules were, or assumed you knew. In the 50s hospital, it was somewhat difficult to get answers to questions, including reliable reports on patient condition. The whole area of communications has changed greatly in hospitals. I paid attention to that at Borgess; communications has been my vocation.

Like television, hospital uniforms progressed from black and white to full color in 60 years. The black habits and all-white outfits have disappeared, with very few exceptions. Medical programs on TV show that, usually by treating us to views of heroic surgeons wearing colorful caps. But you have to spend a little time in a modern hospital to appreciate the full spectrum of costume color.

Personnel even are color-coded. The Borgess guidebook devotes a full-page chart to the codes. As examples, volunteers wear purple, occupational therapists dress in burgundy, and housekeepers wear light green. Only doctors have become more uniform, they all wear white lab coats nowadays, rather than business suits. I didn’t worry much about who was wearing what during my stay, but the color diversity added some welcome pizzazz to the place.

A more important kind of diversity contributes much to the ambience at Borgess. In the old days at my hometown hospital, every staff member was Caucasian. A few of the nuns spoke with pronounced accents, I think German in all cases, indicating they were immigrants. Other than that, there was no ethnic or racial diversity. All the doctors were men.

There were virtually no opportunities for Sacred Heart to have any staff diversity. The small city’s population included only one African-American family, and its members had good jobs with the railroad company. None of the Native Americans in the area lived within the city limits; as far as I know, none worked at the hospital. The commute from where they lived would have presented problems in those days, when not everybody had a car.

Sixty years ago the population in the Kalamazoo area no doubt was not nearly as diverse as it is today; it has diversified gradually. It’s safe to say the Borgess staff followed suit. Dr. Tatineni emigrated to the U.S. from India. A no-nonsense respiratory disease expert, a female African-American doctor, popped in to check on me in the middle of my first night at Borgess. One of my caregivers was an Asian-America, a young lady who was super-efficient and sported a perpetual smile. Many registered nurses (RNs) and other staff members appeared to be African-Americans, but they came in so many shades of color that heritage was not always apparent.

The difference in hospital staff competency between the 50s and now is vast. The early nuns probably got almost all of their training in convents or on-the-job. Older sisters taught and showed the younger ones how things were done. The “civilian” nurses’ aids I knew about also had little or no formal training. My aunt, with no medical training whatsoever, did things like taking x-rays and giving injections when she worked in a doctor’s office. The doctors taught her. We can assume that sort of thing occurred in hospitals as well.

However, I doubt the doctors who practiced at Sacred Heart had much time to devote to teaching nuns or anyone else about medical techniques. They had demanding schedules. A separate post will focus on that in the weeks ahead.

The Sacred Heart doctors in the 50s all had medical degrees. All were general practitioners; specialization just occurred over time. The townspeople had some opinions on that score. If you wanted excellent attention during pregnancies and at baby deliveries, or diagnosis by a doc with a kindly bedside manner, you went to Dr. McCormick. Dr. George Baker was your man for serious surgery. His son, Dr. Rowe Baker, was more of a jack of all trades. He was very efficient, and when urgency was important, he was the go-to guy. After Dr. George retired, before I got to know him other than by reputation, Dr. Rowe took over the complete Baker practice.

Some sophisticated procedures simply could not be done at Sacred Heart. At Borgess, staff doctors have special advanced training in caring for hospital patients, and many advanced procedures feature highly trained specialists. Borgess has a brain and spine institute and a heart treatment center, among other things, on its campus. A whole lot more medical brain power is available than in the old days.

I was around long enough for numerous shift changes to often bring new caregivers to my bedside. Shifts changed daily and once again with different people on the one weekend day I was there. Every RN I talked with had a four-year college degree. Every Personal Care Associate (PCA) who appeared in my room had a two-year degree. Every specialist (a respiratory therapist was available to me at all times) had at least a two-year degree. Several types of specialists were part of the staff. The day before I was released, an occupational therapist spent a solid hour running me through some tests and giving lots of good advice on how to cope with breathing problems in the future.

You might think with all that education the Borgess caregivers would be somewhat of a hoity-toity bunch. Not true at all. With one exception, to some degree all exhibited friendliness and good cheer almost all the time. The most mundane questions were answered, a few jokes were told, and a little time was taken for general chitchat, although all obviously had busy schedules. I think the level of dedication to their work was at least equal to that of the nuns in the 1950s.

The sole disappointment for me was a PCA who seemed somewhat too detached from her work and showed minimal interest in caring for me or my roommate (he was a soft-spoken gentleman who had been in the hospital for three weeks recovering from major surgery). Perhaps the PCA merely was having an off day. Or, perhaps she might find a different line of work more pleasant and rewarding. No organization is perfect. Generally, the Borgess people were terrific.

Despite the high levels of education the Borgess staffers had attained, they wanted more. I think this is another major difference between them and the Sacred Heart personnel in the 50s.

The Sacred Heart nuns were not known for personal ambition. After all, except for those who might aspire to becoming administrators, they had reached their career goal the day they dedicated themselves to their vocation. Other staff had high school educations, or less, and seemed content with their status in life. Going on to college was not considered as important in those days as it is today. The doctors were firmly established in the community as family physicians; they were highly respected and fairly wealthy citizens. They had no particular motivation to complicate their busy lives with advanced training.

It’s altogether different at Borgess. One RN was completing a master’s degree and intended to pursue a PhD so she could operate a high-level business in the future. Most of the PCAs I talked with were working on four-year degrees, or expressed a strong desire to do so. A nice young man doing housekeeping work was earning cash to help him along the way as he studied at a local college.

A whole lot of Borgess staff members I met were interested in higher education as a key to their personal advancement, and not just the youngsters. Several taking courses had ten or more years experience as caregivers. Incidentally, that attitude of valuing education permeates the Kalamazoo community to a remarkable degree. Some think much of it is motivated by “The Kalamazoo Promise” to public school students. I promise to write some about The Promise at a future date; it’s an unusual, unique actually, financial assistance program that has national implications for community improvement. If this aside arouses your curiosity and you don’t want to wait, check out The Promise with a web search.

Put a flock of intelligent, highly educated, ambitious and culturally diverse people together in often-stressful situations and interpersonal conflict is likely. Yet, I never heard any sniping at colleagues or back-biting during my stay at Borgess. Things got a little tense once in a while, but the RNs stepped out of their role as friendly consultants into an order-giving capacity, and when the crisis was over the whole crew returned to normal. Normal seemed to be friendly coexistence.

The closest thing to competitiveness was a comment by one of the PCAs who talked with me several times because she was finishing up a college writing course, learned I dabble in discourse, and wanted to compare notes. With a mischievous grin, Amy said she would be pleased to answer some of my questions about her work at the hospital, but only if I agreed to write, “Amy was the coolest PCA.”

Amy was finishing the last writing assignment in her English course; she was happy about that. We agreed that writing is not a particularly easy chore. But if she could concentrate on it in her limited spare time, I can make a little extra effort, too. I intend to tackle at least six topics related to my hospital stay and earlier experiences in my hometown. One, dear to every patient’s heart, will be the food. Others will be staff communication networks, effects of computerization, patient-staff communication, caregiver pay, and suggestion systems.

One future topic has some political importance in these parts. The question is about the merits of expensive duplicate services when two major hospitals coexist in the same area. My stay at Borgess completely changed my mind about that. Other things interest me, so the duplication discussion and the other hospital stories will be interspersed with other items on this Blog.

But if you want a chance to agree or disagree with the views of one mature adult about hospital care, past and present, check in here once in a while and see what’s posted. I hope a nun or two will read this, and do that. I want to conclude this piece of the picture with a little message for all of them.

The last time I visited Sacred Heart Hospital, when my mother was a patient there during her final days, I saw only one nun. She was in modern, attractive attire, not wearing a habit in the traditional sense. She was not working as a nurse or personal care provider.

There may be more than one nun on staff at Borgess Medical Center now, but all those I talked with could name only one off-hand. She is not serving as a nurse. Her coworkers admired her good work as a spiritual counselor and patient confidant.

Sacred Heart Hospital is no more. Labor costs as the number of nuns available to staff it declined surely were a factor in its closing. What now is Borgess Medical Center overcame that and other obstacles to grow and prosper as part of Borgess Health, a huge health-care organization in southwestern Michigan. Although very few nuns work in day-to-day Borgess operations, the Sisters of St. Joseph continue their involvement as sponsors.

The penguins have flown away. Hospital care is in the hands of the Amys of the world and their associates. And they are pretty cool. But those nuns gave a great gift to many hometowns across America, whether the hospitals they founded ultimately died or flourished in other forms.

The nuns I’ve encountered over the years were rather secure people. They didn’t really need morale boosts to keep them going—especially from a fairly impious Lutheran who was raised as a Christian Scientist and has been told his name is on the rolls in a Mormon mountain vault whether he wants it there or not. But they deserve great amounts of appreciation, whatever the source.

Bless you all, hospital sisters, wherever you may be.


Anonymous said...

You are the coolest patient ever! I think I could learn a lot from you. Nice writing, especially the part about Amy being the coolest PCA! I intend to check back frequently to read your blogs. I am so glad I got to meet you! Thank you :)

Amy, Borgess PCA

Dick Klade said...

Wow. Thanks, Amy. Being named the coolest anything is good for the old ego! However, I would like to avoid any further competition with hospital patients.

My advice: Stick with health care and move up the ladder. There's no money anymore in writing, unless you learn how to dispense large helpings of sex and violence.

Anonymous said...

lol, I can not blame you there. Guess what?! Essay 3: 197/200, and Essay 4: 198/200! Yay!

T.Amelse said...

Thanks for taking me back to Sacred Heart Hospital, the nuns and back into the 50's. I remember the Klade name and where you lived, as I lived just a block away, and the 50's were wonderful. Just by chance I got on to your blog and found it interesting and entertaining and want to read more of your stories.

Dick Klade said...

Good to know another fellow Hatchet enjoys some of these little stories. I well remember Connie Amelse, who I think was a senior in h.s. when I was a freshman. I met Al Amelse many years later attending a party at his home. His wife, Dede (Hufschmid) was in my h.s. class.

Of course, I remember where the Amelse family home was.