American Currents: Two-Plus Days in the Hospital (When You Become the Lead Story, part 4)

Carole spent most of Sunday afternoon in the Emergency department. She underwent a CT scan and at least two rounds of X-rays before being formally admitted to the hospital roughly six hours later and given a bed in the Emergency General Surgery department.

Late that afternoon we learned that she apparently had four cracked ribs on the left side (the side the cyclist hit as she was crossing his path from right to left), a separated left shoulder (the representative X-ray at right is not hers), and a chipped “wing” of the first or second thoracic vertebra. That last should be of no concern, the trauma physician told us, because it would either float in place or be reabsorbed by the body.

The thing to remember with the ribs, she was told several times, was to keep breathing deeply and filling the lower end of her lungs, even if it hurt a bit, to prevent infection. Health-care professionals no longer brace or bind cracked ribs for healing because people would breathe shallowly for fear of the pain and contracted pneumonia in their lower lungs.

Superficially, her right knee was swollen and dark. She had a bloody abrasion across the bridge of her nose where her glasses had scraped it, presumably when her face hit the pavement (the right pane of her spectacles had scrape marks on the top front edge); another on her upper lip; and she could taste persistent bleeding inside her mouth. There was also an ugly scrape on her left elbow, and a nasty red wound on the outer base of her right thumb.

More worrisome were the spells of vertigo every time she turned her head to the right or tried to rise from the bed. The room seemed literally to spin, she told me. The impact may have jarred the crystals in her inner ear, which would affect her sense of balance.

It could have been worse. One of the cracked ribs might have punctured her lungs. If her head had hit a curb when she fell, Carole could have suffered a concussion -- even a mortal one. Two pedestrians were killed by cyclists in New York City’s Central Park in 2014. An essay in the New Yorker by Samuel Freedman talked about the deadly self-righteousness of cyclists in New York.

LESSON NO. 3: A COLLISION THAT’S “ONLY” BETWEEN A BICYCLE AND A PEDESTRIAN CAN STILL CAUSE VERY SERIOUS INJURIES.

I was with Carole at the hospital most of Sunday afternoon, and reserved a Zipcar for the following afternoon in the expectation that she would be released and I would transport her home. That didn’t happen. Because she suffered nausea and vomiting Sunday due to the combination of pain meds (though she hadn’t eaten all day; the collision occurred before her morning coffee and breakfast), and she continued to suffer dizzy spells, the hospital kept her a second night for observation.

I spent three hours with her Monday afternoon, read 26 pages to her of Andy Weir’s novel The Martian (whose movie version starring Matt Damon had just hit theaters) aloud, and made a run home to walk and feed the dog and fetch clean underwear, toothbrush and toothpaste, and hairbrushes.

She had the room to herself on Sunday and most of Monday, but late Monday night another patient was rushed in to the bed near the door. Lots of noisy exam equipment was wheeled in and operated, which kept Carole awake. Also, a brace of physicians and nurses came in and quizzed Carole’s roommate extensively.

When you go to a pharmacy, you know how there’s typically a sign near the counter that says something about standing back until your name is called? That’s a response to HIPAA, the Health Insurance Portability and Accountability Act of 1996. It’s intended to protect your privacy at the counter so strangers don’t overhear the particular medications you’re being given. Hospitals and medical clinics follow many procedures and train their personnel in protecting patient privacy.

While lying helpless in her bed Monday night, however, Carole could not help hearing the questioning of her new, temporary roommate. She learned the woman’s name, ongoing health conditions, current medical complaint (which made Carole suspect the patient had suffered a misdiagnosis at the hospital from which she had been transported), siblings’ names, the conditions at her home, and many other things that HIPAA is in place to shield. So much for patient privacy.

I’d imagine the situation is much the same nearly everywhere else. I’ve seen double-occupancy rooms in every hospital I’ve ever visited, so I suppose (as is the case in so many other situations) only the very wealthy can afford to preserve their medical privacy, the law notwithstanding.

LESSON NO. 4: PATIENT PRIVACY IN ACCORDANCE WITH HIPAA, NO MATTER HOW CAREFULLY OBSERVED IN MANY AREAS, IS NOT CONSISTENTLY SHIELDED ACROSS ALL OF THEM.

Carole wasn’t released until Tuesday about 3 p.m. A bouquet from her siblings made it to her room with only an hour or two to spare, and rode home with her meds, a spirometer, the bag containing the clothing she had been wearing when she was hit, and all the other paraphernalia that had collected in her hospital room.