The cardiologist and the three C’s

I sat on the sofa in Zung’s room and waited. I kept checking my watch . At 31 minutes I started thinking about how many more minutes I would wait until I went out to find Veronica if she did not come in. At 40 minutes a doctor-ish looking man came in. Think Mexican soap opera doctor. He had on jeans and a long white doctor coat. I didn’t see the angel wings this man clearly had.

He was probably in his late 30’s, maybe early 40’s (good, I don’t like really young doctors and too many of them are already younger than me as it is.). I jumped up and he said, “I am Dr. Basave (remember that name in case you ever need a cardiologist in Mexico). I am going to take you to see your husband in the ICU. I am sorry to tell you he has had a Myocardial Infarction – a heart attack.”

Now, go back and read that again and take note of the order in which he said things. First he told me he was going to take me to see Zung, then he told me he was sorry and then he told me what Zung’s diagnoses was.

I need to speak here to my feelings about doctors in general. I don’t like them. I have had too many confrontations with them when they were wrong and I was right and they wouldn’t admit it and I think that is because I am “only” a nurse and they are “the” doctor. They too often won’t admit when they don’t know something. They will insist I provide evidence based information for my practices but too often fail to practice evidence based medicine themselves. They ignore compelling research. They make me crazy. And sometimes they are just plain jerks.

If you are a doctor and NOT like this, I apologize for this generalization. If you are a doctor and ARE like this, get a clue.

I didn’t realize yet that Dr. Basave was not like most of the doctors I knew. I didn’t realize how rare he was. But what he had said and how he had said it kept level of terror and panic from increasing. I stood and listened to the words he said, yet not understanding them and it had nothing to do with a language barrier. His English was very good. But it just didn’t make sense. I explained that Zung was the healthiest person I knew. How could this be? He talked as we walked to the ICU about how it’s fairly rare for someone like Zung to have an MI, but it does happen. Zung’s Troponin level was elevated – this is the enzyme that indicated an MI, and the second EKG indicated that as well. He explained that Zung needed a cardiac catheterization and a stent placed to open up the blocked artery. He was very calm. (That’s not one of the three C’s however).

I held it together until we got to Zung’s bedside and then I burst into tears again. He actually looked okay, but I had never seen him in a hospital bed and it just wasn’t jiving with my perception of the world spinning correctly on its axis.

Zung said maybe I should call a cardiologist at Kaiser. Kaiser is our medical insurance and doctors all rolled up into one. I immediately stopped crying. I realized I had to take control if this situation.

“Zung, we are HERE. We need to do what the doctors are recommending HERE.” (Yea, I’m gonna get on the phone with a dr a gazillion miles away who has never seen Zung and then I’m gonna argue with the doctor standing in front of me about how he should treat my husband – I’m thinking not).

Zung thought maybe we should check with Kaiser just in case any pre-authorization was needed. Then he asked Dr. Basave how many cardiac catheterizations he had done.  With just about every medical procedure and technique, competence increases with experience. Unfortunately Dr. Basave gave what I considered to be a vague answer. He talked about how many were done at the hospital he was at in Mexico City – about 1500 a year. I immediately thought to myself – he didn’t answer the question.

When Zung brought up the insurance issue Dr. Basave offered to have me talk with the “Public Relations” people. I would soon learn that this is a euphemism for “the people who make sure you can pay.”

He took me down to the “Public Relations” office, which was down on the first floor, just to the left as you came in the front door. I don’t remember the lady’s name. I will never forget her though. She explained that Dr. Basave would make a budget and then I would need to pay the estimated cost and then they would do the procedure.

It’s Mexico. This is the way they do things. It is what it is and it’s not going to change and throwing a hissy fit or temper tantrum just uses up your energy. I had a limited amount of emotional energy and I knew I wasn’t going to use any of it on this. I said I wanted to call my insurance and she looked me squarely in the eye and said clearly, “We will not work with your insurance company.” I looked back and said, “I know. I still want to call them.” She then explained they would allow me one courtesy call, but if I needed to make any more I would need to establish a credit line and the calls would be charged to that. I really wanted to say, “F#*@ you, I’ll use my cell phone.” I didn’t want to antagonize anyone before they saved Zung’s life though.

I called Kaiser and explained what was happening. I think I got an “advice nurse” who quickly transferred me to a doctor. He told me we should do what the dr’s here were recommending and got a bunch of information and then he asked if Zung had any risk factors. I said no, he was the healthiest person I know. He said, “Well, he has two risk factors.” What? This man had never seen my husband. What was he talking about? “His age and his gender.”

iI will say, Kaiser called every single day to check on how Zung was doing and they saw him the day after we got home.

I got off the phone and the “lady who makes sure you can pay” said Dr. Basave would do the budget and then I could pay. Dr. Basave was waiting just outside the office in the lobby. He came over and started to explain that he would do the budget and he thought Zung would only need one stent. I started thinking about his vague answer when Zung had asked him how many caths he had done and I said, “How many of these procedures have you personally done?”

He looked shocked. I don’t think he would have looked more surprised if I had asked him how often he has sex. He was thinking and I was thinking, “What’s the right number? How many is enough? I asked this question, what will I do with the answer?”

He replied, “Three thousand.”

“Okay.”

Lesson # 11 – 3000 cardiac catheterizations is enough.

Some doctors would have been condescending with their answer. He just gave me the information (even though the question clearly surprised him).

Then I waited for the PR lady to come get me and my payment. I waited, and waited, and waited. It was probably an hour. I thought, “This is taking way too long and this wait is not doing Zung’s heart any good.”

I went to the PR lady and said, “I really want this procedure to be done as soon as possible. I have an American Express card with a $25,000 limit. Is that enough?”

She replied, “We will need $20,000.”

Okay, just let me call AE and tell them the charge is coming through. The AE rep was sympathetic and asked if there was anything they could do. Just make sure the charge goes through.

I handed over my AE card and the PR lady took me to the cashier and they ran the charge. I don’t know if it was an actual charge or a “hold” and don’t think it really makes any difference. I just wanted them to freaking save my husband’s life.

I will tell you, in a moment like that you think back on all the irritating stuff your spouse does. After 29 years Zung had certainly done a lot of irritating stuff. And it no longer matters at all. This was the grandfather of all “keep it in perspective calls.”

Lesson #12 – Don’t wait for the “keep it in perspective” call. Toss that irritation out with the trash. Life is short. Make each and every day matter.

A word here about Dr. Basave. This man had the very rare combination of competence, confidence and compassion. As I tell the story, that should be apparent. I have worked in health care for 33 years and that combination is exceptionally rare. As I said, when he first walked in to that room, I didn’t see the angel’s wings he clearly had. I am so grateful that he was Zung’s cardiologist.

After I paid the $20K I returned to the ICU. The wait for him to be taken for the cath was much longer than I expected.

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