Archive for the ‘Hospitals’ Category

Yesterday was something new, totally unexpected, and yes, rather frightening. Picture this, if you will; I had finished my workout and was heading to the counter to grab some Tootsie Rolls and to say my goodbyes to the young woman behind the counter. As I put the candy in my pocket, I started to get dizzy…again. “Oh, shit,” I said to nobody in particular, “not again!” You see, about a week before, I had a slight dizzy spell at the same counter, performing the same ‘grab the Tootsies,’ and say goodbye. Evidently, I hadn’t learned my lesson, whatever lesson was being taught by whom or what was doing the teaching. This time, the dizziness did not pass, and I woke up in an ambulance headed for God-only-knows-where.

Waking up in an ambulance isn’t necessarily a bad thing. The most important is that you wake up. I’ve been trying to figure just how long I was out, and it appears that it was one hell of a lot longer than I first calculated. Figure it out: I fainted; they had to call an ambulance service; the service had to arrive and check me out. They then had to load me into the ‘bus,’ strap me in; start an intravenous line, and start on their way…that’s when I woke up…with a mouth so dry that desert sands would blow through and leave not a grain. That’s the way I remember it…not a friggin’ grain of sand would have stuck inside my mouth. Oh, and of course, I pissed my shorts…that was a lovely end to all things that were happening.

Now, when something like this happens, gym personnel are to notify your emergency contact. That’s all fine and dandy except the only number the gym had was my cell phone. Later in the day I listened to the message. “Hello, this is Planet Fitness calling. Richard Bishop fainted and an ambulance is taking him…where are you guys taking him…oh, they don’t know where they’re taking him, but he’s going to some hospital, somewhere and he’s talking.” I’m quite happy it was my phone on which the message was left. Can you imagine getting a message like that when you’re at home? Juli doesn’t panic but even so, I consider that to be the message from hell.

The “I don’t know where we’re going guys” finally agreed that Beth Israel Deaconess Health Care (BIDHC)  hospital in Needham would be a good place to drop their bundle. I must have passed out again because the next thing I knew I was laying in the emergency department of a hospital where I had only been a visitor on other occasions. It’s a small community hospital…or it was a small community hospital. It still has only 29 beds, but since it became part of the BIDHC, construction is going on daily…upward, downward, and outward. I was surrounded by nurses, residents and who-knows-who-else and being asked to tell my story over and over and over again. It must be wonderful to be able to tune out if it’s not your question that’s being answered. Of course, it could also be a sneaky way to learn rather or not I’m actually compos mentis…still sneaky.

It appears that I answered everything to the satisfaction of the group, most of whom I didn’t see for the rest of the day, but who cares. The nurse, who was mine for the day – isn’t that a great way to put it – was Erin, but to protect the innocent, we won’t use a last name. Let me just say that the hospital is blessed to have someone with her degree of professionalism and with such a wonderful personality [She doesn’t know it yet but I will be crashing her wedding reception]. The ER doctor on duty was Edward Ullman, M.D., and I give you his last name because it’s one of which to be proud. Doctor Ullman loves the emergency room; he lives for the moments of excitement when he can stabilize a patient and pass them on or send them home. His dedication to his task is enviable. He’s witty without being condescending; he’s thorough without being pompous; he’s everything you want to see and hear when you go into an emergency room situation. Throughout the day, as I waited for this test or that test, in corridor after corridor and in room after room, the staff was terrific. Having to wait even a few minutes for a test to begin brought apologies for the delay. One cardiac test required the injection of thallium. Thallium is a chemical element with an atomic number. It’s a minor radiation makes it, at least at this hospital, something you order only when you need it.  Mine had to be schlepped in from Attleboro, some miles away. This particular wait was worth it because the technician was a lovely Japanese lady named “Mako.” It seemed to shock the daylights out of her when I thanked her in formal Japanese. I may not know much, but there are certain things you learn when accepting gifts at a college, and one of them is how to say “thank you” in many, many languages!

I could go on and rave about Mike who transported me all over the hospital, first on my gurney and later in a wheelchair; or talk about the professionalism of Doctor Meghan York, the cardiologist who never appeared to stop moving. There was Philip, the retarded desperate child of Satan – he had the initials RDCS, after his name but I never did learn what they meant. All-in-all, the people I met during my lengthy stay at BIDHC were the same folks I’d like to have sitting in my house, drinking a few beers and just chatting away an evening.

Did they find my problem? No, they did not. However, they eliminated so many potential problems that I left there feeling a whole helluva lot better than when I was wheeled in. Doctor Ullman and I identified potential problems, and I will be following up with my primary care physician. As a piece of advice, I would offer the following: If you work out be sure to keep yourself hydrated. I’m not saying it was the cause for my fainting; I’m not saying it wasn’t. Who knows, but from now on, I will finish an entire bottle before leaving the gym.

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Republican members of Congress scream for smaller federal government involvement in the rights of states and the rights of citizens. Know what, they are absolutely right. We, the American people have allowed the federal government to become too much a part of our lives. There are too many living off the government teat and, in the long run, everyone suffers.

Yes, I collect Social Security and I have Medicare. So what? The Social Security program was started under Franklin Roosevelt. Like everything else about the federal government, it has become too large and too bureaucratic. It appears that every federal program has become a dumping ground for someone’s brother, sister, aunt, or uncle. While the federal – and the state governments as well – claim that they are streamlining and getting rid of red tape and bureaucratic bullshit, the tape line grows longer and longer and the bullshit piles higher and higher. Bureaucracy breeds caution and contempt at a time when the country should be throwing caution to the wind and acting a little more humble in its dealings with the average American citizen.

The scandal at the Veteran’s Administration is nothing new. In 1929, Herbert Hoover proposed bringing the agencies that were administering veterans’ benefits together under one roof. On July 21, 1930 the three agencies, the Veterans Bureau, the Bureau of Pensions, and the National Homes for Disabled Volunteer Soldiers were brought together as the Veterans Administration. Remember when this was, i.e., the period of the Great Depression. I am willing to bet everything I have that not one person in any of those three bureaus lost his or her job when the consolidation took place. From that point on, the Veterans’ Administration did nothing but grow. It was Topsy reincarnate The Selective Service Act was passed creating more members of the military. The Japanese attacked Pearl Harbor throwing us into World War II and creating greater need for veterans’ services. How does America solve this greater need? Throw more money and more people into the mix. It doesn’t matter that the people may not know their butt from a hole in the ground, they will learn by doing. The bureaucracy just grows and grows and grows. It is not dissimilar to the Massachusetts Bay Transportation Authority. Started over two centuries ago, It was an amalgam of railroad companies often chartered by the state legislature, and anyone knowing anything about the Massachusetts state legislature will tell you that one of the key words to describe it is ‘patronage.’  In 1947, the MTA was created. Government agencies began to take on transit services, consolidating many separate routes into unified system.  In 1964, the MTA became the Massachusetts Bay Transportation Authority, serving a greater number of communities and creating an even larger bureaucracy.

Perhaps the best way to describe the Veterans Administration, the MBTA, and many other organizations that have expanded rapidly without closely examining needs is to use the old cliché, “There is never time to do it right, but there is always time to do it over.” When it’s being done over, a new layer of bureaucracy is added to ensure that it’s done right.  Once whatever the task to be completed is finished, the layer of people, money, supplies, buildings, vehicles, etc. remains even though they are no longer required…”Well, we might need them again and if we get rid of them, we’ll never be able to justify bringing them back.” Eventually, the original purpose of the entire organization grinds to a halt because no one remembers precisely what the original purpose was in the first place. That is, without question, an oversimplification of the situation. However, in the case of the Veterans Hospital Administration, putting off the treatment of veterans appears to have taken a back seat to saving money in order to pay bonuses to the major decision-makers in the organization. The VA has identified the wrong problem for solution. At some level in the VA, the decision has been made that rather than solve the problem of increasing service to the customer, we have to solve the problem of appearing to increase the service to the customer without actually doing so. If we make the problem appear to go away, it will do so by a process of attrition. The hospital will look good and those eligible will receive bonuses because the hospital will appear to be well managed. In other words, “If you can say smoke and mirrors, you’re hired!”

Will firing Eric Shinseki solve this problem? No, it will not. The bureaucracy is already too ingrained in veterans’ hospitals across the country. Problem solving 101 says that the first step is to identify the actual problem. There may be many perceived problems, and everyone employed by the VA will have his or her own idea of what that problem is…and they will be right…and wrong. It will take an independent management group to determine the first problem to be solved; how to solve it, and then determine the next steps to be taken to solving the second greatest problem. Right now, General Shinseki is sitting atop a pile of bullshit surrounded by red tape that is not of his making. One might say that he is the heir to the bullshit and red tape fortune. By not knowing how to cut through the red tape and not knowing how to dissolve the bullshit or by being blind to both, he does bear some responsibility; however, to lay the entire mess at his door is unfair. There are a number of criminal layers between him and getting his job done. If his subordinates have been keeping him in the dark, it may well be because they have been kept in the dark. Somewhere in this vast bureaucracy that we call the Veterans Administration, there is a criminal layer. That layer has put its own welfare before the welfare of the customer, the veteran. The same has been true of the MBTA. CEO upon CEO upon CEO has been hired to “clean up” the MBTA and the job has yet to be completed. It’s one of the great truisms of bureaucracy: “Bureaucrats in numbers can generally beat down any attempt to destroy them.” They will lie, cheat, steal, and yes, they will commit murder, if their fear is great enough.

Republican leader of the House of Representatives, John Boehner, says that he is withholding judgment on whether or not General Shinseki should be forced out. I’m with Congressman Boehner on this one – don’t faint – Shinseki just might be the solution once all of the facts are known. His military background could be the key to eliminating long-time bureaucrats who feel protected because of their tenure. Shinseki knows that if the job isn’t done properly on the battlefield, soldiers die; the same could be said here…if the job isn’t done correctly, former soldiers, sailors, marines, airmen, and coast guardsmen and women will die. No military man worth his salt is ever going to let that happen, not on his watch!

Perhaps it is time to take a hard look at every government agency and to pare them back; force them to do more with less; eliminate all of the red tape and bullshit. Yes, it will cut jobs and it will inflate our jobless rate and no one, no one wants to see that. I would argue that it’s more important to be doing the job correctly than having a bunch of people collecting pay checks for doing nothing or for emasculating the jobs they are supposed to be doing.

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[When last we left out intrepid senior citizen, he was becoming well acquainted with the ‘Johnny House,’ doing what all colonoscopy preppers do in the porcelain cloakroom.]

Sunday has come and gone. After a restless night’s sleep, I arise early to begin the task of consuming a half gallon of the lemony oil we call ‘go lightly,’ a charming name for a viscous and vicious liquid that, as has been said before, must be consumed by 9:30 am.

To describe this right of preparation in detail would definitely be TMI, so we will skip all of the ugliness…use your freakin’ imagination!

Midway through the morning, Juli has an epiphany. Instead of driving to the hospital, we should take a taxi. Following a discussion of the economics of such a move, a few bouts of dizziness, and more trips to the ‘Necessarium,’ I am finally convinced that this is probably the better move for this afternoon’s adventure.

For those of you living in the Norwood area, I heartily endorse Family Taxi. On time, reasonable prices, a cab that was spotless…and I intended to keep it that way…and a ‘good guy’ driver who was a wonderful conversationalist at a time when I really needed some friendly chatter…well, I need something; let’s just say that we got along.

It’s wonderful to sit in the passenger seat of a car and see all of the things you miss when you’re driving. Truly, it’s an eye-opening spectacle; the tree colors are more vivid; other drivers appear to know what they’re doing – we hardly came close to anyone, but then I couldn’t see what damage we might have left in our wake. The remarkable thing was that we pulled up to the hospital surgical center three and a half minutes before we actually left; I didn’t realize we were moving that quickly although the one time I looked at the speedometer it was registering somewhere between 85 and 90. As I say, It was all pretty much a blur; perhaps the trees were going by so quickly the colors lingered; perhaps the other drivers were just making way as we approached at warp speed.

After completing some paperwork, my nurse, Mary Ann, who was a character, issued a four-word directive: “Take it all off!” Hospital johnnies are stored in freezers – you should know that in case you are planning a trip to your local medical facility. Blankets, however, which are available seconds after you don the arctic wear, are kept in a 212 degree oven. I’m not certain why this practice is allowed. There has to be some deep psychological reason that hospitals do this…freezer-broiler; freezer-broiler… it must make sense to someone.

Once I was comfortably situated on the trolley, came time for the IV.  At the end of a long hose attached to a bag of some kind of liquid; I kid…this was saline, the nurse attempts to find a vein of sufficient size into which she can stick a hollow harpoon. As a lad of 40, my veins were like sewer pipes, huge and just popping out beneath the skin. Nurses loved them for their “poppiness” and availability…just one little tap and veins would jump, almost shouting, “Stick me; stick me.” At nearly 80, the veins (along with a number of other bodily items) have gone into retirement. Today, they timidly weep, “Not me; not me,” and they’ve been suck enough that I can understand their pleas. Suffice it to say, the first stick, puncture, stab, or whatever you wish to call it, did not work. As much and as quickly as Mary Ann wriggled that needle under my skin, my old veins were quicker. I don’t know whether they’re just getting back at me for having them stuck so often in my youth – giving five gallons of blood, you idiot; nothing else – or perhaps they’re just plain tired. After twisting and turning the needle for about five hours – it was probably less than 15 seconds but I’m a coward about such things – Mary Ann called an IV nurse who arrived, found a vein and started the IV without any pain or problem.

While all of this was going on, the gastroenterologist came in, dressed in his usual black turtleneck and sport coat, appearing as if he was off for a trip to the museum. “Hey, how’re you doing?” he asked and before I could say, “Shitless,” he was pulling the curtain aside and leaving. I kid about him, but he is a highly respected professional and a very funny man who has the ability to put patients at ease in what otherwise might be viewed as an embarrassing situation.

Looking down at the IV after the doctor’s quick visit, I noticed that there were four little ports where needles could be inserted. Mary Ann was fussing with one of the ports and after a moment, asked, “Sleepy yet?” I responded – and this I remember – “Did you put something in that port?” She replied with a grin, “Yes, I did,” and she drew that last word out so that it sounded like “diii-iiid.”

Waking up in the recovery room with absolutely no memory of what has taken place over the last hour or so is just a bit mind-boggling and terrifying. “Hi, I’m Pat, your recovery room nurse; can I get you anything?” was said about three inches from my face. Had I been forty years younger and single, I might have made an unintelligent comment; however, seeing that I’m 79, have just had my empty colon prodded, poked, and snipped, I asked for graham crackers. It’s a poor substitute for what briefly flashed across the frontal lobe, which by the way was now laughing hysterically at my presumed abilities, but graham crackers would have to do.

Half an hour in the recovery room appeared to be all that was allowed. I want you to know, however, that in that half hour, I damn near emptied their supply of graham crackers which, as Pat reminded me, probably tasted like filet mignon after my fast…dammit, she was right.

Once more, Captain Kirk was there to drive us home. Once more, the foliage was fantastic, and once more, cars just seemed to disappear before us. This time I really did not dare to look behind us. Safe and sound – as much sound as possible – we arrived at our door. The Domino’s pizza arrived about five minutes after we did…damn, that Juli is good; she’d ordered from the hospital or the cab…nah, had to be the hospital…our cab was traveling at warp nine!

Next time your doctor says, “You probably should have a colonoscopy,” don’t run for the hills; just think that you can call Family Taxi and learn what the time travel is truly like; you can lay on your side in a hospital johnnie, freezing your ass off; you can be enveloped in a blanket that will heat up the johnnie and burn your butt; you can get stabbed, probed, and offered graham crackers…but remember, one slice of that hot pizza will make the whole damned thing worthwhile!  

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This really sucked! The day and my mood were running along parallel tracks. As for the day, the temperature had dropped to somewhere in the low to mid-thirties from a high of about seventy the day before – that sucked – and the clouds were so low it looked like you could hit them with a rock. Drizzle interspersed with a few snowflakes reminded me that the better days of this year were far behind. If you can translate all of that into my mood, you might just understand that this wasn’t going to be one of the better days of my life. Even after turning the clocks back – daylight savings time was over; another indication of how dark things were becoming – I still slept an hour later than usual. Maybe I just didn’t want to face the prospect of apple juice for breakfast, lunch, and dinner…not to overwork the word, but that also sucked.

Tomorrow is colonoscopy day…unplanned colonoscopy day. At my age you gotta figure that a few things are going to get somewhat fucked up with your body but when you haven’t had a bowel movement in over a month and the emergency room doc freely admits that you’re FOS, you just know that you’re in for a bad time to come a calling over the next week or so. In a telephone call the night before, my own doctor had suggested that I might want to get to the emergency room for an x-ray to see what was going on in my gut; I’d already told him that I hadn’t shat – is that really a word – in a month, but that just seemed to sail over his head; either that, or he wasn’t surprised that my blue eyes now had a brownish tint…who knows?

I went to the ER the next morning after my workout at the gym – a weak workout because of the way I felt – arriving just at shift change. Do you have any clue what happens at shift change in an emergency room? The doctors, nurses, and techs who have been there since the evening before want nothing more than to haul ass to the warmth of their beds, and the crew coming on wants nothing more than to hope that all of the ER beds are empty and remain that way. Thus, the former attempt to procrastinate bringing in a new patient for fear of getting stuck in the ER beyond their time, and the latter would like to have their ‘cuppa’ before they have to begin the day’s work. I’m kidding, of course, but I really did have to wait for about half an hour before I was taken to an ER bed.

First to my bed was a don’t-talk-to-me-I’m-not-awake-yet-nurse. She was nice enough I guess, yet largely lacking in a sense of humor. She never saw my eyes – so she didn’t notice the brown tint – because her face was glued to the clipboard she held while asking inane questions. She was followed by a fourth year medical student who asked the same questions – I guess they didn’t know one another – but with a sparkle in her blue eyes. Next came the doctor who, thankfully, was one I had known for ten years. We talked about his children, now 8, 6, and 3, and about my situation. He sent me for an x-ray that showed nothing of consequence and then he told me to check with a gastroenterologist – GI, not to be confused with a soldier by the same initials – as soon as possible. I guess I didn’t expect a whole hell of a lot more, but his ‘diagnosis’ certainly didn’t help my mood to any positive degree.

A visit to the gastroenterologist is always an experience. People in the waiting room avoid looking at one another because there’s something about having a problem with your asshole and upwards that creates a certain amount of embarrassment or tension or something. Thankfully, I was the only one in the waiting room when I walked in. The child behind the counter – she has two degrees and is working on a third – looked to be about ten years old, took me into an examining room and began asking the normal questions that one would be asked when they are FOS – you haven’t figured that one yet? It means full of shit, and surely, I am – and she was talking about these things as though she was asking about the weather. It’s difficult for older people to talk about these things with children whom they do not know and who appear so blasé about the whole thing. I was just thankful she didn’t tell me to drop my drawers while she stuck a finger up my butt…ouch…yuck…holy crap! “The doctor will be in in a minute,” she told me, rousing me from my horrific thoughts. Whew, just the memory of it leaves me weak.

The doctor is Swiss; he’s a wonderful man…funny, brilliant, and completely at ease with everyone. What the hell, he sees more assholes in a week than any of us do in our lifetime. He explained to me that my symptoms warranted an immediate colonoscopy. The thing is that you don’t walk into a doctor’s office and just have a colonoscopy. This is a process that requires preparation. The doctor indicated that the procedure would take place on Monday. He explained this as I was sitting in his office on Saturday. Guess what this means, sports fans? Tomorrow will be prep day; today in this case since this is when I’m at the computer. No food all day and at noon, the preparation will begin; twenty plus minutes ago since it is now 12:22, and I am already feeling the effects of having drunk ten ounces of citrate of magnesia.

Let me tell you about citrate of magnesia. This is not your normal Exlex, Dulcolax, Miralex, or any other ‘lax’ which you may have taken. If you can picture swallowing a very large fire cracker to break the dam, while having a cherry bomb explode just inside your butt, you have some sense of citrate of magnesia. It is a nuclear weapon as compared to a BB gun….and you have to drink thirty ounces of this stuff [I was going to say “shit” but that would be overkill]. In addition, you should know that this stuff is not your gentle, stool softening agent that works overnight. Oh, no…I’m back at the computer now having just launched the first of many citrate of magnesia bombs into the bottom of the porcelain war god. I told you this stuff was fast.

The frequent trips to the toilet will continue throughout the afternoon and evening. Eventually, I will crawl into bed, wearing Depends and praying that being in a horizontal position will prevent any accidents. I know, however, having been down this road before, that sleep will not come easy. Tomorrow morning – the procedure is scheduled for 1:30 pm – I will further prep by drinking have a gallon of slime known in the trade as “Go-lightly.” What a horrible fucking name! And I must do this before 9:30…aaarrrggghhh!

End of part I…

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What, you think it’s easy coming back from shoulder surgery? Like the operation was on a Monday and I should be writing on Tuesday? Give me a break. I hadn’t had greater readership on Wednesday since the first time I said “fuck” in an article…geez, what a bunch of sickos!

It should be noted that since I’m having some problems with a couple of the kids right now, I decided that I would spend a bit of their inheritance by treating myself to and from the hospital. I hired a livery service to escort me in style…and style it was; bottles of water; snacks, and drivers in little black-visored caps. Oh, man, I pulled up at the entrance to the surgical center and all eyes were staring at the tinted glass? You know the drill: “Ooh, is that someone famous? A movie star perhaps? Certainly, a celebrity of some kind.” Then I climb out in my ratty shorts and a big old PMC shirt, and I could feel the disappointment in the crowd. Perhaps if I had worn dark glasses and a baseball cap pulled down just above my eyes, but, you know, 20/20 hindsight and all that nonsense; I just wanted to get in and get it over with.

Anyway, I guess from the surgeon’s point of view, all went well; from my point of view, I’ve known several days that were quite a bit better. Don’t get me wrong; everyone was very solicitous and smiling. One nurse – not attending me – came by and said, “I know you,” and we recalled another time I was in pre-op and she had been my nurse. She remembered that my name was Dick because that had been her late husband’s name. They called him “Big Dick.” At that point there had already been some “relaxation juice” administered and, I really didn’t want to go there. You never know what’s going to come out of my mouth at the best of times and I just wasn’t going down that road for love or money. My nurse, Kat, was laughing so hard she was shaking, and Suzanne, the widow, was on a rant trying to get me to make a fool of myself. It’s easy enough to do that when I’m fully alert; never mind tempting me when I’m groggy!

While I cannot remember the ride to the operating room – rather like on television when the ceiling tiles and the fluorescent lights are whizzing by – I do remember being asked to roll on to a table in the “OR.” The way my little brain was working, I figured if I got rolling, it was going to take a hell of a lot more than a few nurses and doctors from stopping that train from going right off the track. The analogy I’d use would be, “See that 44-pound curling stone hurtling down the ice. Why don’t you just go out there in your leather-soled shoes and grab the handle.” See ya! After they’d schlepped me onto the table, it was lights out until I woke up an hour or so later feeling better than I had in a long time. One of the drugs used in anesthesia today is Versed. Its principal benefit is one of amnesia; you wake in the recovery room asking, “How did I get here?” Terrific drug!

Going home was even better. The driver was standing by his Cadillac Escalade with a sign that had my name on it, and I was being wheeled to the chair by a perky young volunteer. If that isn’t an ego boost for a 78-year old, old fart, I don’t know what is. And a Cadillac Escalade…you take a freaking elevator just to get into the front seat; hell, you look down on the drivers of those cross-country 18-wheelers! I think we drove over a few Porches’ and never scraped their roofs!

The first day home was great. I had completely forgotten that it takes anesthesia some time to wear off, particularly if you’ve had general anesthesia plus what they lovingly call a “block” in the area on which they are going to operate.  I ate drank Pepsi, had some ice cream, and even chowed down some chocolate covered raisins…mmm, good.

Tuesday and Wednesday were spent putting everything I had eaten on Monday evening back…onto the sheets; into the toilet; almost into the toilet; into a waste basket by my bed, and; at one point, all over my shirt. Oy vey, such a mess! I didn’t believe I had eaten quite that much on Monday evening; it felt like a family vomit. Okay, enough of that. Let’s just say that by Sunday, I was back to soda crackers and room-temperature water.

That was a few weeks ago. The memories of the first few days are still very fresh in my mind. I’d like to think that if I need more surgery, I would just ask to be given a bullet on which to bite, but who’s kidding whom? The biggest surprise of all came a week after the surgery. It was during a “follow-up” with the surgeon’s physician assistant. Jokingly, I asked when I could resume my gym workouts…”Today, if you feel like it,” she said. Suffice it to say that it was the following Monday that I went back to doing some cardio, but think about it; one week you’re getting cut, and two weeks later you’re back to a routine; today’s surgical procedures are  truly remarkable. It makes one wonder just how far can we go in terms of a) repairing the human body; b) doing it with a minimum of disruption, and; c) doing it without the entire process costing damn near as much as a year’s salary. I can hear it now…two workers discussing lunch and the first one says, “Sorry, can’t make lunch today; having the knees replaced on my lunch hour.” Somehow, I just don’t think I’m gonna be around for that one.

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I said that I wouldn’t be writing for a while….however…

…The sun hasn’t quite hit the horizon yet; who the hell am I kidding; the sun hasn’t even begun to approach our horizon at 1:30 in the morning. Yep, that’s right; I’m actually writing this scary piece just on the am side of midnight.

I have had eleven surgeries in my life, the last one just last year…and that was to put a stent into a triple ‘A.’ That’s what they – you know, the ones who are known as ‘professionals’ – call it. We laymen refer to it as an abdominal aortic aneurism. It’s the tenth leading cause of death in the United States, largely because it often goes undetected. Unless you happen to be having an ultrasound or some test that includes an inside look at your gut, chances are you wouldn’t even know if you have one…ain’t that a bitch! But, anyway, that’s behind me. That one was done in the morning, but I didn’t lose any sleep over it. This one’s different.

I can’t sleep. I went to bed around 7:30 last night because I wanted a good night’s sleep;  are you kidding? I lay there  tossing and turning like a bloody dredel at Christmas time…wait, those two just plain don’t go together; ah, what the hell; let’s be ecumenical about this. Anyway, around 12:30 I woke up from my less than satisfying sleep. I figured that if I couldn’t get back to sleep by 2:00, I’d get up. Two’s not a bad time, right? Toss, turn, toss, turn; are you seeing a pattern here?

At 1:30, I said…you don’t need to know what I said; let’s just say that I got up. Evidently, the computer would like to sleep also, because I couldn’t win a damned solitaire or any other kind of game…the computer was “against me’” it was “out to get me.” Paranoid, me, paranoid? Nah, nothing like that. A little ‘tetched’ in the head, maybe but paranoid, hell no!

At 3:30, I finally said, “That’s it!” Of course, no one was awake to ask, “What’s it?” but it was it. My significant other is a light sleeper…snores like a freight train, but is a light sleeper. I tiptoed into the bathroom, stripped, and turned on the shower; waited for the water to become reasonably warm and stepped in; damn, it felt good. While it was exceedingly difficult to restrain my operatic excellence, I managed to control myself and soaped up, rinsed off and was out in about ten minutes – I told you it felt good; a ten-minute shower for me is like the 45-minute showers the kids used to take; gimme a break, will ya? I even toweled down as quietly as I could.

“Ya’ll right?” I heard as I slipped on underwear and shorts. “Sorry, honey,” said I. “Shhh, I’ve gone back to sleep,” she responded, and I swear that in less than ten seconds, the train was back on the track and speeding away. I figure I’ll shave around 5; have to look good, ya know?

By now you’re probably thinking you know what’s going on, right? Yes, I’m going for the big dozen in surgical procedures this very day. You see, my right shoulder has been bothering me for over a year. Upper body workouts have been a bitch, but two Alleve in the morning and a couple at night had been keeping things relatively calm. Several weeks ago, they stopped working. I went through the traditional x-ray and MRI “stuff” and then went back to see the orthopedist. When he pulled the MRI up on the computer, I said, “Uh-oh, looks like it’s time to sand and sew.” He agreed. I have a number of bone spurs in my shoulder; one that is pushing up under the clavicle and another that seems to be tearing away at a tendon. Can you ask, “Hey, stupid, how come you were continuing to work out?” or any other derogatory questions that will embarrass me no end? Whatever it is, you’re right; I violated Voltaire when he commented, “Common sense is not all that common.” Thanks, “Volty;” rub it in a little more.

I have no idea why I’m concerned about this. Same doctor worked on the left shoulder five years ago. He’s just switching sides. How do I know he’ll be doing the correct shoulder (notice I didn’t say “right shoulder,” because it is the right shoulder but if I just left things…ah, ta hell with it!). I’ve even requested an anesthesiologist I know, and I have great faith in my surgeon. What could go…oh, no, no, no, one never, ever says that. It would be the kiss of…whoops, can’t use that one either. Well, you get what I mean.   As I said last week…”See ya when I see ya!”

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Generally speaking, once you past the age of 70, the bulk of appointments in your day-planner, Android, Ipad, smart phone, or whatever electronic device you may use begin with “Dr…..” Once you past 75 – hope ya make it, dude – You begin to add such things as “radiology, blood lab, GI lab, cardiology department” but, hopefully, not “chemo pr radiation.”  There is no humor in having a calendar filled with these appointments. It’s a bitch to get old. Everyone talks about the Golden Years; about the only thing that’s golden about these years is your pee, and it just means you should be drinking more water so you can obey one of the Boy Scout mottos, i.e., pee until it is clear and copious.

I’ve been to my local hospital so much that I wind up giving directions to people who appear lost. Doctors and nurses greet me by my first name when we meet in the hallway. It’s rather awkward if Juli is with me…she’s all over me like a cheap suit after we leave. It’s so bad that I can request a particular IV nurse by name. If Michelle isn’t on duty, I can go two deep on names. That, I believe is when you know you’re in trouble. I don’t believe it hurts but if I’ve had a good experience during one of the many surgeries I’ve had in the hospital, I will take a minute to write a letter to the hospital administrator, complimenting people by name that took care of me. Once, I was waiting to go down to surgery and a nurse glanced in as she was passing the room; she stopped, came back, and said, “You’re Mr. Bishop, right?” I acknowledged that I was, and she said, “Thank you for mentioning me in your letter. It made me feel good.” Hospitals like supermarkets and department stores and who-knows-what-else are always receiving letters of complaints. Few people take the time to compliment someone who went out of his or her way to help them.

All of the above being said let me tell you about my most recent visit to one of U.S. News & World Report’s 100 best communities. My first appointment was at one o’clock and the second at two. Because it was required that I “prepare” for the exam, I could not eat any solid after nine in the morning. The first test was a contrast angiography. A laboratory technician inserts a needle through which will be pumped a contrast dye. Unlike a regular angiogram in which a catheter is inserted through the femoral artery and x-rays are taken of the areas of concern, the angiography uses magnetic resonance imaging and no catheter is required (whew). After the third attempt – I kid you not – at sticking a needle in my tired old arms, success was finally achieved. Well, that’s not quite right; the sticker had used the wrong sized needle on the stickee. Therefore, it was back to await an infusion nurse…at somewhere around three-thirty. Being concerned about my second appointment for an echo cardiogram in another department, I had asked at about 1:30 that a call be made to say I’d be late. Having been assured that I would not be late, I asked again that the call be made; this was at two o’clock. This time, a lab tech said she would call. The tech called every half hour and when I left the radiology lab. I would call this a comedy of errors but for one thing; getting stuck by a large bore needle is not the same as getting stuck by a small bore needle…IT FREAKING HURTS!

My knowledge of the hospital came in very handy as I was about to leave. The lab tech directed me in a way that would have been so round about that I couldn’t possibly arrived at cardiology within an hour (Note: slight exaggeration…but not much!). Instead, I took a couple of shortcuts and was there in about seven minutes. Walking to the receptionist’s window, I merely said, “Hi, Judy; I’m home.” To say that I was whisked away in one hell of a hurry is something of an understatement. The test lasts about half an hour on a normal day. I think that I was in and out in about 35 minutes. I stopped by a couple of offices on the way out just to say, “Hi,” but the biggest problem was that I left the hospital at the height of commuter traffic.

To say that this was an unpleasant visit would be like saying that yes, it’s been warm in Boston for the past couple of days…master understatements, both. Will I write to the hospital to complain? No, probably not. To do so would be to cause problems for some people I’ve known for some time. Screw-up’s happen and this was a beaut! Had things gone perfectly, I wouldn’t have written. These were people trying to do their jobs and having a very, very bad day. It’s easy to write when it’s right, but if you write when it’s wrong, hold your letter for a couple of days and think about it.

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Here comes one of those blogs that you read and go, “Ugh, I cannot believe I read the whole thing!” But you will…c’mon, you know you will. It’s raunchy without sex. It’s the dark underbelly of life without guns, knives, succinylcholine, or some other exotic poison, and without car chases and gun fights in dark alleys.

This story begins in a nearly deserted parking garage on a late Saturday morning – better it should be a dark and stormy night but what the hell, this is all true. Naturally, yours truly has to be the protagonist in this story, driving my ’99 four-door, silver gray Camry (isn’t that a great description?) into a vacant spot next to the third floor of my destination. Taking the elevator to the fifth floor, I arrived at office of “Big Al.” I rather doubt that anyone in their right mind would ever call him that; I think he’s probably around five feet six inches tall…but he is an intimidating presence, particularly when he’s dressed all in black as he was this day. I won’t tell you his real name. I could, but then he’d kill me…not, “have to,” mind you; he just would.

“Big Al” is a gastroenterologist. Go ahead; say it three times fast and then fart! For those of you unfamiliar with the term, it’s supposed to cover problems from the mouth to the butt, but as I understand it, more often than not, it’s bowels to balls…or just above. I cannot imagine what “Big Al” is like at a cocktail party but he probably has a bunch of shitty jokes at the expense of others…”Now that’s a colon!” Naw, I’m just kidding; he’s a true professional.

Yes, as you have by now guessed, I have a bowel problem and was venturing into this new world of actually seeing a doctor in his office on a Saturday afternoon. “It happens about once a month,” his secretary slash wife told me. “He just gets so backed up (oh, what a poor choice of words for me to be hearing) that we just come in to see patients he can’t see any other time.” The horrible part of this whole visit was that everyone in the office looked like they were on their last legs. One man was on a walker with a canister of oxygen and two people to help him; another needed assistance to get up and walk slowly into the office. I was beginning to feel like maybe I should stop at the undertaker on the way home and start making arrangements!

He advised me to take a stronger laxative and to see him Monday for a “sigmoidoscopy.”  That one gotcha buffaloed? Well, you know what a colonoscopy is, dontcha? That’s the thing Katie Couric had done on TV several years ago. We’ll talk more about it later, but this isn’t it. Putting it politely, “You don’t have to be as well prepared for the sigmoidoscopy,” and that’s being really, really nice about it.

I left the hospital feeling much better about my problem. “Big Al” was going to get to the bottom of things – oh, I do this to myself, and then feel so stupid! The single thing that I had forgotten about was that when one visits a hospital or medical environment, one must learn never to breathe. It takes training, but you must never, ever breathe in this environment. You must learn to speak without breathing; stay seated for long periods of time without breathing, and exhale only after you are a minimum of one mile from the medical area. “Why is this?” you ask. Germs…germs, germs, germs. Somewhere, between parking the car, entering the building, riding the elevator both up and down, and sitting in the doctor’s office, I inhaled…extremely bad move on my part…extremely bad!

Sunday morning, I awoke with a horrendous cough, a nagging headache, a nose that could have given Niagara Falls a run for its money and, worst of all, bowels that were still in gridlock. I hadn’t felt this rotten in years – actually, Juli informed me it was last year and went on to say that my memory was shot to hell. By noon, my beloved was also feeling just as badly as I and thanking me profusely for bringing a little virus into our lives.

By three o’clock in the afternoon, in addition to having the head cold from hell, the medicine I was taking for my ‘other’ problem decided it was time to go to work. There is no other way to describe it than to say that Sunday, Monday, and Tuesday, were the shittiest days of my life! Every time I coughed, the brain sent a message to the other end….”let it fly, baby; we’ve got him on the run.” Sometimes my brain can just be downright cruel. Thank God for Dylsum. It’s a cough syrup that really works. I was also thankful that we’d had the foresight to have Depends in the house….no, not the peach color for women; just the standard gray for men. We’re such whoozzes, we don’t deserve color!

Now that I’m feeling better (until the next cough), I figured to let you know what’s been happening. After all, a blog is part of the social network…although, I’m not really feeling all that social. Oh, well, the good news is that gridlock seems to have broken – yes, I knew you’d want to be kept informed – and the head cold is slowly departing. Unfortunately, “Big Al” and I are still going to meet next Friday so he can stick his flexible sigmoidscope where da sun don’t shine. I swear, if I look over my shoulder and see him smoking a cigarette and smiling, he’s gonna get hurt!

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Doggonit, I really don’t like getting pissed! Congress irritates me on a regular basis because they are about as useless as tits on a bull. The Occupy movement drives me nuts because (a) they don’t know what the hell they’re doing; (b) there’s a group in there who just want to ‘rumble’ with the cops, and (c) their campsites have become hangouts for druggies and predators. Obama bothers me because he doesn’t seem to have a pair of balls big enough to stand up to his critics. And people bother me because in one way or another they behave like assholes on a daily basis. In addition, at 77, I guess I’m just becoming one of those old, edgy, curmudgeonly types who get a hard-on over the smallest of things.

Let me give you just a single example of how people irritate me; then we’ll get on to the main reason I’m writing this little essay….other than the fact that it allows me to vent. This morning we went to Lowe’s. I sat in the car because Juli knew exactly what she wanted and where it was located. There is a stop sign at the exit from Lowe’s. It’s at an intersection where cars are zipping down a ramp or zooming around a curve right by the sign. I sat there for 20 minutes – ya just can’t let Juli loose in a hardware store, but that’s another story – and watched car after car, truck after truck whip through that stop sign like they just owned the freakin’ road. Were there any close calls? There was only one incident that could be called close, but dammit, if there is an eight-sided red and white traffic sign, imprinted with S.T.O.P., the law says you’re supposed to stop, not get a running start with a couple of quick glimpses and then go like hell. I’m not certain that traffic laws mean a hell of a lot anymore. What if you’re at a red light and nothing is coming, do you just sail on through; sure; why not; what the hell; nothing was coming officer. Just don’t say, “I’m entitled,” because (a) you’re already in deep doo-doo, and (b) that cop may feel that he or she is then entitled to start rapping you around with a baton!

Compared to my major problem, the one above is less than a piss hole in a snow bank, so let me continue. Today, I received a bill for emergency room treatment at my local hospital. It was actually for two visits eight days apart and for the same problem…a cracked rib. On the first visit, the cracked rib didn’t show up on the x-ray and the diagnosis was simply “a chest bruise.” During the visit, I had four nurses. The first one drew three vials of blood which were still sitting on a table in the room when we left about two hours after arriving. The other three explained that they were relieving their predecessors, two actually saying it from the doorway without ever entering the room. Other than to say that I was not impressed, the physician’s assistant and the doctor were somewhat less than empathetic or explanatory. That visit cost my insurance company over $3,000.  We learned more in 15 minutes on the second visit than we had in the two hours of the first. This time, the physician’s assistant and the physician carefully explained that the rib was cracked and what we should be doing about it. This second visit cost the insurance company just under $2,000.

The only obvious difference between the first and second visits was the blood draw. However, if it costs over a thousand bucks for three vials and a butterfly needle, I want in! What a way to make money. By the time we left, that blood was, I later learned, useless for testing. The other possible difference is that the first time, we arrived shortly before shift change…everybody wanted to go home…but everybody wanted a piece of the pie, ergo four nurses and a doctor who never came within six feet of me.

For the most part, my care at this local hospital has been outstanding. I have, on a couple of occasions, written letters commending the staff and the care that I received. I won’t write to them about this. It will do no good. I just hate to see my health care provider’s insurance company get such a short end of this deal. We wonder why medical insurance costs so much. Here you have it….a one thousand dollar difference for basically the same care. It’s wrong. You want to put a few more people to work. Train them to become medical insurance investigators. Medical insurance costs may go up in the short run, but in the long run, I believe everyone would benefit.

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It never fails to amaze me that Americans who commute by automobile longer than ten to fifteen minutes to their jobs get anything done. No, no, no, not done all day, but certainly anything done during the first hour after their arrival and the last hour of their workday.

I will grant that there are people who commute opposite the bulk of the traffic. I guess we should call them the lucky commuters. There are also those who do shift work which may or may not allow them to commute during off hours…although I haven’t seen an ‘off’ hour on Massachusetts highways in many a moon. We appear to be adding lanes just in time to find that those lanes are also full. It’s something of a new way to look at Parkinson ’s Law: “Traffic expands to fill the space available.” While states are looking ahead and planning for what they truly believe the needs will be, more and more people are coming into the workforce and opting to drive alone because they feel that they can accomplish something productive while on their way to work. At least that’s one explanation. The alternative one is the states don’t really know what the needs will be and therefore are unable to plan correctly. Should flying cars someday become an option, they will still have to land somewhere and this will create an even greater problem.

I’m getting way ahead of myself here so let me go back to the first and last hours of the commuter workday and give you one classic example of how I was directly affected in a rather potentially dangerous manner.

If you are a commuter at normal commuting hours, heading into “urbanity” from whence all workings flow, you will hit a traffic jam…blanket statement…it’s gonna happen. It doesn’t matter if it’s caused by an accident, an asshole, or whatever; it-is-going-to-happen. And, unless you are on highway-to-heaven happy pills, you are going to feel some stress. How much depends on (a) your position in the company, (b) how much you care about your job, (c) how understanding your boss really is…and in today’s employers market probably not that understanding, and (d) whether or not you are independently wealthy and can tell everyone to, “Take this job and shove it!”

Let us assume that you are just the average Joe or Jane who has to be at work by 9:00 am. From your place you plan on an hour’s commute, more or less. With a traffic screw-up, you arrive half an hour to an hour late. If you are a normal human being, you are (a) pissed that your late, (b) stressed because you know you’ve missed something important, and (c) you are in dire need of a stimulant, be it coffee, tea, or – heaven forbid – a good strong ‘belt or something more powerful.’

It has long been my contention that the first hour at work, following a stressful commute is damn near useless. “Oh, it excites me and gets me ready to tear into my job,” I’ve heard said. I’m sorry but that to me is the most unadulterated bullshit I have ever heard. You’re still thinking, subconsciously perhaps, but still thinking about the idiot who cut you off; the guy driving one-handed, reading the newspaper propped against the steering wheel while drinking a cup of coffee, or the woman who is putting on her make-up while looking in the rear view mirror and smoking a cigarette with her left hand…yes, she’s steering with her knees. All of these little and very minor distractions are bouncing around in your brain, vying for space with what you are actually supposed to be doing for your company. Don’t kid yourself; the first hour for major artery commuters is a lost hour of the day. Instead of an 8-hour workday, you’re talking about seven productive hours.

If you get an hour for your lunch – I haven’t worked for a while, but I don’t ever remember a full hour for lunch – you are now looking at a six-hour workday. Lunch may or may not be a productive time, but generally speaking, you just look at it as a time for eating and thinking. The latter may be about company business or it may be about the problem your kid is having at school, how you’re going to pay all the bills this month, etc., etc., etc.

Around 4:00 pm, you begin to think about the ride home. This time, it’s strictly in your subconscious. You aren’t openly saying, “Oh shit” to yourself; not quite yet…but it’s there. This is a time to be really careful about whatever the work is you’re supposed to be doing. This is the time to watch everything you do and everything you say with great caution. The closer it gets to ‘get-in-the-car-and-get-the-hell-out-of-Dodge’ time, the more difficult it become to stay focused on what you should be doing. Some bosses will call meetings at four or four-thirty just to try to keep employees minds focused and also to attempt to keep their minds from concentrating on what’s going to happen to them at five.

Does this sound like a bunch of baloney? It isn’t. What is supposed to be an eight-hour workday is often reduced to a five or five and a half-hour day. Better roads aren’t the answer. Car pooling isn’t the answer. Relocating the company to the suburbs may be a short-term answer, but I have no experience with that. Changing business hours to avoid the commute isn’t an answer because the commute now seems to start around one-thirty in the afternoon and go until around eight o’clock in the evening. I can remember shopping with Joan at 11 am, and having her ask, “Who are these people; why aren’t they working?”

I promised you an example, and here it is. A few weeks ago, I had a fall while getting out of the car. I have no idea what happened. One minute I was stepping out; the next minute I was flying through the air and landing on my left side. A week later, I went to the emergency room. It was about twenty minutes before shift change. A nurse came in; drew blood, and left the three vials on a table. Another nurse came in and said she was taking over because the shift was changing. “What about the blood,” I asked.

“Don’t worry. We’ll take care of it,” she responded.

A few minutes later a physicians’ assistant came in. His questions and his exam were cursory at best. He indicated that they were going to take an x-ray; that the doctor would read the x-ray, and that a diagnosis would follow.

A third nurse came in, explaining that she was relieving the second nurse. Again the question about the blood and again the same answer.

After the x-ray was taken and read, the physicians’ assistant returned and said that no bones were broken and that I had a deep muscle bruise. The nurse came in with two Vicodin and I was told I could leave after I had been seen by the doctor. When the doctor came in, she never got within five feet of me and seemed more concerned about washing her hands and getting out of the room.

One week later, I returned to the hospital. The pain, instead of decreasing, was increasing. New physicians’ assistant, new doctor, after the shift change had taken place. The result was another x-ray, diagnosis of a hairline fracture in a rib, a prescription for pain killers, instructions for addition medication, a breathing apparatus that I’m to use five times a day. We learned more about my injury in 15 minutes than I had learned in all of the time I had been in the ER the week before. The difference? On the first visit I was catching them at shift-change-time; on the second visit, it was after the shift change when the job was the job.

Time as a factor in work productivity has just not been studied sufficiently. Better highways won’t help. Nothing will help until we look at this as a genuine work problem and study and implement realistic solutions.

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