Joan Rivers will be buried tomorrow, eleven days after her last performance. By next week, or so, we should begin to hear more about the outpatient procedure during which something happened that ended her life.
Some might say, that at age 81, such things are inevitable, well, death is inevitable. That was true of my dad at 91. But both, in my view, were victims of the societal need to push way too many medical procedures into the out patient arena. I have wondered whether there are any statistics on how many people, and in what age ranges, are lost because they should have had their medical treatment in the hospital, or, if they made it through the procedure, were sent home and then developed a crisis that got treatment too late.
Had Joan survived the procedure proper, she would have had enough folks around her to care for her at home. But there are many people who either don't have that safety net, or if they have a family member or friend, the designated person is not skilled enough to spot a problem or to handle the intricacies of say, changing a dressing, or a catheter. Yes, you can get someone say, through Medicare, but with all the paperwork and the restrictions, by the time you got someone, the patient is no longer in need, assuming survival.
Over the years, for myself and others, I have uttered the phrase, "You're kidding me. That's out patient?". In 2007 or so, I had to have a salivary stone taken out through my neck. I have a more than two inch scar. The number of nerves in the neck and face, never mind the proximity of the carotid artery, made the consent for this "simple" procedure as scary as the idea of having to do it in the first place. But I was in pain, the inside of my mouth and tongue were swollen, and I sounded like a person with cotton balls in her mouth as I yelled at my internist that I couldn't wait for him to bring in an "in network" doctor to do the surgery. (Another long story). This was my first anesthetic experience and I woke up, apparently after some difficulty although I was never given the details, crying. I had a lift home from a friend, and my dad, who no longer drove, came over with various provisions (he had worried through the whole procedure sitting with my friend in the waiting room), to make me comfortable. But I had to sleep sitting up with a drain in my neck for several days. As I live alone, any emergency was between me and 911. Seemed to me that an overnight stay in a hospital would have been a good idea. But as things worked out for me, I wasn't really worked up.
Then my father had an outpatient procedure to replace kidney stents which to this day I do not believe he needed in the first place. He did have a slow growing bladder cancer, but once the original stents were put in (in an outpatient procedure), he started to lose weight. By the time of the need for the change of stents, he was skeletal. I tried to warn the doctors that I thought this "procedure" he would not survive. But the doctor said it was necessary, because of potential infection, and so in he went for the out procedure. Now, to be fair to the doctors, which I am not inclined to do truth be told, my dad wanted to go home. But both before the procedure and after, he was cold, which, if you are a doctor, should raise the red flag of infection. And his blood pressure was low. And given my concern over his weight and frailty, and the fact I yelled at dad's internist about his manner of doing business and demeanor (arrogance personified), you'd think they would I picked the up, but I don't recall in the few hours in which things changed dramatically, if he got to take them. Had he been in a hospital overnight, they would have been intravenously provided. I changed and checked the catheter (a distressing event for both of us) and dad fell asleep, something he had been unable to do in the days before his surgery. He seemed disoriented. I called my uncle but since dad was sleeping there appeared to be no emergency. But of course, one was in the making, and when I checked the catheter a few hours later when I heard dad stir, there was indeed a problem. And I called 911 for him as I had not They had to do for myself. Four days later, after aggressive antibiotic treatment, he died. He had had a fever of 104 when I brought him in the night of the outpatient procedure that I had worried dad would not survive. He didn't.
I never got to talk to his primary doctors after dad died, as they avoided me assiduously. I considered my legal options, but I am the least litigious lawyer one might meet on personal issues, and given dad's age, and his lack of earning power at this retired stage, I settled for writing a couple of letters that outlined my thoughts on dad's medical care. Naturally, I never heard back from them, as their own lawyers might well have advised. I do believe that had dad been in the hospital for the procedure or after it, he would well have survived into what would have been his 96th year. Dad had had many scares over the years and surgeries for things like bladder polyps. He had his first fairly major heart attack at 51. A couple thereafter and a quadruple by pass at 79, It took an outpatient procedure to do him in.
About Joan. 81. We are hearing that she worried about some heart problem. Was that taken into account by the clinic and her doctors. They usually do. As one article said, with all that prior plastic surgery was she a good candidate for out patient procedures?
On thing we know. Joan had continued earning power. She might not have needed it, but she had the power, and was going to appear somewhere the day or so after the "procedure", relaxed to her vocal cords. The first thing I heard was that it was an endoscopy. But I am not clear any longer. When the crisis occurred, it is clear they did not have the facility to deal with it, or they would not have had to send her to the hospital.
What is the solution? I don't know exactly but I think the medical industry (and that is what it is) needs to reconsider how many people are shunted and shuffled to out patient, and their ages certainly need to be taken into account, more, if it is at all now. And when someone doesn't have automatic professional home help, well, at least a day in the hospital seems reasonable.
Out patient procedures for non-serious conditions or tests, that's a good idea. But as with all things in human affairs, we go overboard and what is serious is redefined, foolishly, as non-serious. That's the kind of things that have to be looked at in the days to come. Joan has certainly given the impetus to that necessary review. It is unfortunate that her death had to do that.
And when doctors say that a patient should ask his or her questions, they need to mean it, not look like they have someplace else to be. . . .
Here's a link to a Fox News article on such reconsideration of out patient clinics:
Www.foxnews.com/health/2014/9/05/joan-rivers-death-puts-spotlight-on-outpatient-clinics/
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