About 4 years ago, I discovered that I had a blockage of about 70+ percent in my right carotid artery which I managed to handle with diet changes, exercise, and a little medication for something like 4 1/4 years. But annual scans showed that the blockage was steadily increasing despite marked decreases in my serum cholesterol, blood pressure, weight, etc. So a few months ago, I made the decision to have the blockage removed via the endarterectomy process which laymen sometimes describe as a "rotorooter" on the artery. This involves making a fairly major incision through the skin and muscles of the neck to expose the artery, clamping the blood flow at both ends of the artery area to be cleared, and, as I understand it, literally scraping the accumulated cholesterol plaque out of the exposed inner surface of the artery. This is not a surgery to be taken lightly. But, due to the way I had generally behaved since the blockage was first diagnosed, my doctors conceded that I was in generally better physical condition than the great majority of patients who have such a surgery. I also trusted my surgical team at the University of Kentucky Hospital absolutely and, if I had not, I would never have consented to allow them to play among my arteries.
My decision was not taken lightly since my wife has been in a wheelchair for more than twenty years and, in the event I had any kind of major catastrophic outcome from the surgery, either my wife alone or both of us together would most likely spend the rest of our lives in a nursing home which is a fate to which no one I know aspires. This issue was further complicated by the fact that I would have to spend at least one night in the hospital if all went according to plan and would have about two weeks of limited physical activity which would make it impossible for me to provide my wife the care she must have on a daily basis. But her sister, who lives in Sheboygan Falls, Wisconsin, volunteered to come and stay with her/us for a little over two weeks if the surgery could be postponed until after her twelve year old son was out of school for the summer. My doctor, David Minion, M. D., agreed to the plan and we scheduled my admission and surgery for June 14, 2022, which gave us a few days for my sister-in-law and her son to arrive here and for me to train her in the usage of a Hoyer Lift and the other issues of assisting my wife in and out of bed, shower, toilet, etc. She adjusted smoothly to the task and I felt safe in leaving Candice at home alone.
On June 14, 2022, I was admitted to UK Hospital at about 5:30am and the surgery was over by about noon, lasting roughly four hours in the operating room. The next twenty four hours I had a lot of pain involved in my neck and throat but I was released from the hospital the afternoon of June 15. I got home uneventfully with massive swelling in my incision area, went to bed as usual about 10pm but couldn't get to sleep. About 11:30pm, I got up, looked in a mirror, and saw even more swelling in my neck, and came to the conclusion that I had a minor leak from the artery. Since I couldn't drive at that point, it would have been necessary to have my sister-in-law drive me to the hospital I preferred in Morehead, Kentucky, thirty miles away. Candice didn't feel safe being left at home in bed when it was impossible to get out and asked me to take an ambulance to the local ARH Hospital in West Liberty where I have not trusted the medical providers and management for several years now. Against my better judgment, I agreed to go there by ambulance. I called 911, an ambulance arrived, and I was transported to ARH-ER shortly before midnight June 15, 2022. ARH has adopted a policy quite some time in the past to contract their ER doctors from some national medical service. Additionally, about 3 years ago, they ran off the three best prescribing professionals working in that institution, closed the Home Care Store which my wife had used regularly for years, and replaced the medical providers with providers with less experience, credentials, and, in my opinion, at far less pay and benefits which I believe was the primary object of all these actions. I was admitted, put on an ER bed, hooked to monitors, and left in the room for quite an extended period of time before I was even seen by a doctor. That doctor finally came in, stood at the foot of my bed looking at me for about 15 seconds, stepped beside the bed and touched my neck, said "that's wonderful surgery", and walked out without saying another word or introducing himself. Shortly after I arrived, my blood pressure began jumping up and down much like Roy Acuff's yoyo, and little to nothing was done about it. Finally, after some extended period the doctor came into the room again, looked at me for a few seconds, and left without saying a word. I was eventually seen by the nurse manager in the ER that night and the next day and she told me that they were seeking a bed for me at UK. They gave me one or two injections of some short term blood pressure medication which only lowered my blood pressure briefly before it spiked again. I spent the night in the ER in that cycle with my blood pressure sometimes reaching levels of 190/90 and going as low as 130/60. Nothing ever came of the alleged referral to UK. Finally about noon on June 16, I had an exchange with the nurse manager in which I told her I had no faith in the doctor of the upper level management of the hospital and I was considering leaving AMA, Against Medical Advice, since nothing seemed to be happening to improve my condition. She and the doctor came in at some point for his third encounter with me and I confronted him in her presence about the fact that he had done little or nothing to help me which he denied, stated "you're not going to die", and claimed that the machines could do a far better job of watching my condition than people. I made a phone call to the Nurse Manager of the vascular surgery team at UK to see if she could facilitate my transfer and she stated she could do nothing. I then called the office of my primary care provider at Saint Claire Clinic in Sandy Hook, Kentucky, to ask if I could be seen there and she stated, through her nurse, that I should go to UK ER. At that point, I made up my mind that I was leaving AMA and called my cousin Jack Terry in Louisa, Kentucky, to ask if he could transport me to UK which he agreed to do. I got out of bed at about 3pm, disconnected my electrodes from my body, walked to the nurses station and asked to have my IV removed, and signed the AMA papers. I walked out of the ARH-ER after 16 hours of absolutely useless time and traveled to Lexington to the UK ER.
I signed in there at about 6pm, since it took Jack quite a while to arrive from his house. The ER at UK is in a major expansion and part of the building is unfinished but in use with patient cubicles on the ground floor with blue tarpaulins for doors and exposed ceilings showing concrete beams, copper pipes, HVAC pipes, no cell phone service in that area, etc. But the UK-ER team is doing a helluva job in rough circumstances and I respect them a great deal. They retested every test which had ever been done on me, consulted with the vascular surgery team, and finally I was admitted to a room in the hospital about 4:30am after about 9 hours on site. They immediately put me on IV antibiotics, and medication to lower my blood pressure. The nursing staff, lab staff, food service staff, and the members of the vascular surgery team are all wonderful practitioners each of their own personal profession. They took great care of me, got my blood pressure under control in just a few hours, kept me at least part of four days, and discharged me on June 19, 2022, to return to home. During the time of my stay at UK, I was told by three different members of the vascular surgery team that I had "done the right thing" by leaving ARH against medical advise. That is a rare occurrence in health care today to ever hear any member of a medical profession state that other members of their profession have delivered less than exemplary care to a patient. I really do believe I would have been likely to die if I had remained at ARH and unless I have absolutely no choice, I will never darken their doors again. What is really sad about this whole situation is that a few years ago, I would have just as strongly defended ARH and their practitioners against all criticism. But those practitioners are no longer there and most of them left against their will leaving hundreds, probably a few thousand, patients without the quality of medical care they had been receiving from those providers. I do still have several providers in that hospital in other departments whose work I respect. But, I have little doubt that they also are on thin ice if they are being paid what they are worth.
This entire episode is an example of how healthcare has often failed in Appalachia. In this region, we often are served by providers who do not understand our culture, our people, how we think, believe, and live our lives. Many small regional hospitals in our area are understaffed, underfunded, under governed, and unsafe. In many ways, large numbers of these hospitals are similar to what was once said by Ralph Nader about the Chevrolet Corvair. They are "unsafe at any speed". It is also sad that in the early history of what later became the ARH hospital chain, they were actually owned and operated by the United Mine Workers of America and were shining examples of how health care should be delivered to a depressed area. In explanation of my willingness to openly criticize so large and powerful a corporation, I would point my readers to these two articles on the website of the American Counseling Association which I co-authored with Dr. Heather Ambrose, Ph. D., both of which are rooted primarily in my own work in graduate school. One of these articles we delivered at the 2005 National Conference of The American Counseling Association and it is included as a chapter in a book from the ACA on cutting edge advances in counseling. The other is about culturally appropriate supervision of counselors in Appalachia and is on the ACA permanent website for professionals. Both articles are frequently cited and quoted in professional articles, books, and graduate school dissertations. I know whereof I speak both from a personal and a professional viewpoint when I discuss healthcare in Appalachia.
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