Wednesday, May 5, 2010

From The Health Care Blog: The Makings Of A Great Outcome

The Makings Of A Great Outcome

Last week my wife and best friend, Elaine, had massive abdominal surgery. We fully expected her to be an inpatient for a week, but she was home in four and half days. To watch her recover was to see what happens when everything converges: the deep knowledge and skills of excellent, humane physicians; a capable, caring clinical staff; wonderful new technologies; and a lifetime of eating right, being fit and tending to one's health.
She lost two units of blood during the operation. It was four days before she’d be allowed any fluids by mouth, except ice chips, and 5 days before she’d have any food, which started with broth and Jell-O.

But the day following surgery, she moved from her bed to a chair and sat vertically for an hour! Twice! The first time she was dreadfully nauseous. The second time was better.

The second day, she circumnavigated the rectangular halls of the floor - probably an eighth of a mile - twice!

Several things made all this possible. One was the good judgment of her physician team, that did not assume that all was well, and methodically explored until they discovered the deeper problem. In this case, if they had waited, the damage would have been much more significant and the outcome much worse.

Another was great technologies that non-clinicians do not often see and typically aren't aware of. For example, just before surgery, Elaine's anesthesiologist explained that, in addition to the anesthesia during surgery, an epidural block could provide significantly better post-operative pain management than a general anesthetic, while allowing the brain to remain clear.

She agreed and the results were astounding. Even after this traumatic procedure, with an 8 inch traditional incision that goes down the center of her belly, she told a nurse the day following surgery that her pain was "1" on a 10 point scale. And she proved it in her flexibility in the following days. The elimination of pain and the stresses it creates as barriers to recovery are beyond value, and miraculous advances in medicine.

And then there are simple advances that make care dramatically better. Elaine was bedridden, so she was fitted with pneumatic leggings that go around the calves, and massaged the muscles in different rhythmic patterns. This prevented clotting and helped preserve muscle tone, which speeded total recovery.

There is Elaine the patient, who has eaten carefully, worked to be fit and nurtured her own health as a lifestyle for her entire life. When confronted with a difficult situation, her body responded overwhelmingly in her favor. It was clearly payback time, with an incalculable reward.

And finally, none of this would have been possible without wonderful resources like Baptist Health System here in Jacksonville, FL, with its great patient care, overseen by a truly top tier quality officer, Keith Stein MD. This kind of care is available nearly everywhere in the country, and its important not to take it for granted.

In a time that is so cynical, we should celebrate when things work so well. This is not to ignore flaws. As many of you know, I spend plenty of time focused on those.

Elaine and I had a tough week, but it’s worth remembering and being grateful for the fact that our this process was about solutions. And that her care resulted from the cumulative contributions of many important but different sources, allowing a woman ravaged by a disease to succeed beyond our wildest imaginings.

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