The PRI screening is supposed to be done before applications are made to nursing homes. What if the hospital is trying to get me into a nursing home for which I am not qualified? What if I am only qualified for assisted living? According to Karen, I’m not qualified for any higher level of care than at home. Wouldn’t it be a really good idea if we actually had a certified nurse do the PRI? Stevie the Wonder POA and I think so, so Karen says she will request it. Next day, it still hasn’t been done.
Meanwhile, I am talking to the nurse practitioner from Palliative Medicine. Palliative care is for when you receive a diagnosis that is really terrible and for which you will be receiving long term treatment. Hospice care is for when you’re going to be dead in six months and are eschewing all treatment; palliative care is for still-taking-drugs and not-dying-fast. Also, palliative care only exists in hospitals. At Upstate Medical Center, St. Joseph’s Hospital and Crouse Hospital, the palliative care directors are all female. I guess the guy-physicians just aren’t up for taking the long walk with you—they just want to get in, get a cure, and get out. Sans cure, they’re not interested.
One of the Palliative Medicine team leaders—possibly Crouse’s—told me that palliative care really should be provided in the community and she foresees that time coming but, meanwhile, you only can get palliative care in the hospital. St. Joseph’s has a four-bed unit; Crouse has a “concept.” Included in that concept are five team members, three of whom are nurse practitioners, each of which has at least thirty years’ experience. Yea, old folks! Trust me, if you are looking at dying, you don’t want to be tended by some 25-year-old kid who’s never birthed a baby, bought a house or buried a parent. You want a seasoned person who’s got a lot of life experience.
Before 9/11, a guy went to the counter in an airport to buy a ticket. The ticket seller asked him if he wanted first-class or tourist. He chose tourist. Did he want a window or an aisle seat? He chose aisle. For his meal would he prefer chicken or roast beef? And so the questions went until she came to the last one: Did he want a young pilot with fast reflexes or an old pilot with lots of experience? I say always go with the old guy—think of Captain Sully who put a jetliner down in the Hudson River without killing anybody.
So my “old guy” (he’s younger than I am) from Palliative Medicine is Peter Sinatra—to whom I am connected through my friend Amelia and the Syracuse Peace Council. Peter, true to Crouse’s “concept,” has been coming to see me every day. Yesterday we were talking and I asked him for a ballpark figure—just a guess, an estimate—of how much time I have left. He chewed on that for a moment and then replied, “I’d say it’s a matter of months.” Not days or weeks; months. Not years; months. This is probably my last spring.
Damn. I love spring so much—and this is going to be my last one. And I’m spending it indoors.
In regard to Question 28 “Is this person seriously physically ill?” Karen probably should consider checking “yes.” Peter is going to ask Dr. McMinn, who is medical director of the Palliative Medicine team and “board certified in both Family Medicine and Hospice and Palliative Medicine” to take a look at my chart, crunch the numbers, and see how it looks to her less-experienced but better-trained eye. Meanwhile, what bothers Peter most is that I now have two urinary tract infections. Untreated infections, hm, that would be a problem. How about if I just go totally septic and we get this over with?
Meanwhile, Stevie the Wonder POA is out looking at nursing homes for me. This is what all the classy web sites say to do: have somebody who really cares about you go out and look at nursing homes and see what looks best. AARP and Medicare are two of the organizations that post on-line nursing home checklists: http://www.medicare.gov/nursing/checklist.pdf
So Stevie goes to the Iroquois and then calls me up. There was a shortage of nursing home beds in Onondaga County a few years ago which meant that patients were taking up acute-care hospital beds because there weren’t enough nursing home beds to move them to so the hospitals got together and built their own nursing home. The participating hospitals—which include St. Joseph’s and Crouse—have first call on the Iroquois beds. Theoretically you can’t get to the Iroquois except from a participating hospital. And I’m in Crouse, a participating hospital. And the average cost per day of being on a med/surg floor in this hospital is $1,639. The daily charge at the Iroquois is $260. So I have been here for about $13,000, about $10,000 of which is because the women of Care Management don’t know what they’re doing.
And you, the God-loving citizens, are paying for it.