A few insights on health care

I’ve been trying to decide what, if anything, to write about this week’s unexpected health problems. This blog is part travelogue, part essays about politics, culture and sports, and part just musings about my interactions with the world. That last part can be called a diary, and I’ve no illusion about the world needing to know anyone’s innermost thoughts (though I would make an exception for Einstein and Hawking). So I’m trying to vector away from being a diarist.

But this was a BIG experience for me. Most likely life-changing. So it deserves some storytelling.

One big lesson/insight was the availability of health care facilities in our remote CA home – it’s not good. There are no hospitals in our little town of Fallbrook and the urgent cares nearby are awful and close at 9pm. The only places I would want to go for urgent care or ER are 30 to 60 minutes away, respectively. Not good as you age and need more care more frequently.

Another insight is that the Kaiser Permanente healthcare system is fabulous, especially as you get closer to its center – hospital care. Their outer rings – education, preventative care, lifestyle training, are all excellent and designed to minimize the odds of their patients needing care deeper in the system. KP really gets it – spend a little money keeping you healthy and out of the inner, more costly rings of care, is good for them and good for me. Win-win. Their middle ring – the primary care docs and specialists – are still good, but are more bureaucratic and harder to get access to. Scheduling is a pain. This is the part that gave managed care a bad name, and Kaiser is till working to find a better balance for everyone.

The next ring, urgent care and ER, I’ve only had the one interaction – this time in the ER. It was actually quite good, though it was an hour away from me, meaning I had to wait until K got home from camping to get her to take me to the ER. I was too sick to try and drive an hour. The Kaiser ER was spacious, efficient, clean, and after I got there, VERY crowded. I arrived before the rush, so I was checked in and triaged in about 30 minutes, received an initial consult, a CT scan, urine sample acquired and blood drawn for tests in another 30 minutes. After a 45 minute wait the ER docs were ready to give us the news. So about 2 hours after arrival, a very somber MD told us that I had a serious kidney infection and needed to be admitted to the attached hospital. That was a bad surprise. He went on to describe the procedure they recommended and its possible complications in fairly nauseating detail. His delivery was almost funny, as he would pause a while in the middle of a sentence, leaving you wondering what the punchline was going to be. “Mr. Nichols, one option is for us to not perform the surgery and treat the infection with strong antibiotics. We don’t recommend that course, as it has a high risk of poor outcomes, including…<long pause>…kidney failure leading to removal, sepsis, even more severe pain, and…<another pause>…well, a significant chance of death.”

I was amused, and answered “Well, that all sounds like fun. Let’s not choose that option.” K was horrified and had gone pretty white. The discussions around the recommended option – inserting a stent into the urethra and up into the ureter (the pipe that connects the kidney to the bladder), allowing the kidney’s accumulated wastes and infection to drain – were fairly graphic. The possible complications included significant mangling of the unfortunate wrapper around the urethra (the penis), long-term urinal and/or sexual dysfunction, potential for needing a urine bag on the outside for weeks or months, etc. These are all low-probability complications, in the 1-2% range, but they needed to be discussed. I was less amused, being the subject of said complications of the recommended procedure, and K was once again horrified. This consult was much harder on her than on me.

All that said, we made the decision to take KP on on the recommended course of action and I was swiftly admitted into Kaiser’s inner ring of care, their hospitals. Kaiser’s new hospitals are simply amazing. Spacious, efficient, luxurious, and very high tech. My room was large with floor to ceiling windows, a gigantic TV that functioned as entertainment and their way of communicating with and educating me, complete access to my medical record and test results via the TV. A spacious bathroom and shower was attached to the room. And the system of care around me mirrored that high tech/luxury approach. I asked if my room was so nice because this was a med-surge floor, and the nurse told me nope, every single patient room in the hospital was just this nice. I have limited experience in such things, but based on my experience if I’m going to need hospital care, I want it to be in a KP hospital. Good news – a brand new one is opening up in San Marcos this summer, only 30 minutes away. Bad news – Kaiser has no services in Kentucky or Indiana. That’s a problem to be solved another day.

So that’s probably enough for one blog post – the insight about Kaiser’s ring of health services and the extremely high quality of their inner core, their hospitals. My surgery occurred that same night, went very well, no mangling of tender bits, and I was well enough to be released at noon the next day. So far so good, and I can’t say how thankful I am for their expertise.