Which is Better? The World-Class Hospital Near You--or Your Modest Local Hospital?

Something to think about when contemplating surgery or any other hospital procedure is whether a so-called "world-class" hospital is really better than your local hometown facility or the general medical center in a nearby city--like Akron for us. We live only 45 minutes from Cleveland Clinic, world famous for its state of the art medical treatment. World leaders and millionaires as well as ordinary people from all corners of the globe fly to Cleveland for treatment. It's also the go-to place for many locals and when Paul needed treatment for lung disease followed by lung cancer, the Clinic was first choice. The surgeon was top of the line and the operation a success--and yet the after care failed to impress us. Doubled with another patient in a small room after a day in the ICU, Paul was constantly exposed to people coming and going--professional and housekeeping staff attending both patients, plus friends and relatives visiting both. Who knows how many germs were walking right into the room as well.
A couple weeks later I had to rush Paul back to the Clinic where he was treated for pneumonia and kept there for several days. Hardly had we got him home than breathing difficulties, a temp of 102, and general weakness, recurred necessitating a trip in the Granger rescue unit to Medina Hospital where they eventually decided that what he had was C-Difficile, an infection contracted in hospitals! A disease specialist called in from Southwest General Hospital in South Cleveland identified the C-Diff--an infection that is virulent and often very hard to quell. Now, after a couple of weeks, Paul appears to be winning the battle and his strength is returning.
Cleveland Clinic didn't identify C-Diff. The Medina doctors did. Perhaps, because they were so focused on his lung, the Clinic did not look elsewhere to solve the problem. And Paul says the food at Medina Hospital is much better than the dreck they serve in Cleveland. Thank you Medina General Hospital!

Cirrhosis of the Liver Confirmed

Nearly a month gone since my last post. Time for an update. We are still alive. It's been two months since Paul had the cancer removed from his lung on April 15. Today it's hard to find any evidence that surgery took place--the incision is completely healed and has disappeared. But we were really such innocents when we tripped off to the Cleveland Clinic for that procedure. We anticipated that after about eight weeks of recovery, he would resume his normal life. We didn't take into account other factors but they did appear in the form of pneumonia, return trip to the Clinic, and then an ER rush to Medina Hospital for what we thought was another bout of pneumonia, only to learn (through the intelligent resources of a Southwest Hospital disease specialist) that what Paul had was C-Difficile--an aptly named infection because it's difficult to oppose--an infection contracted mostly in hospitals and passed most often by hand contact. C-Diff has a way of draining the patient's strength, stamina, and imune system and can only be combatted by one or two powerful anti-biotics. As of now though, Paul's made a lot of progress especially the last few days.

Medicare has provided him with visiting nurses and a physical therapist and they come twice a week. They report to his doctor on his progress and help him remain optimistic. Three days ago the tide seemed to be turning when he helped Philip build a railing from the house to the garage--one of those jobs he had put off for years--but really needs it now. Paul stood and supervised while Phlip did the carpentry work. We're all pleased with the result.

In the meantime, a visit to the Clinic last Friday confirmed that I do have some form of liver cirrhosis. The first sign of something wrong was from a blood test done earlier by fam physician who found elevated liver enzymes in the blood sample.Then a local specialist diagnosed from observations that it's liver cirrhosis. Also, a Clinic gastroenterologist, after doing an endoscopy, suggests in a letter to fam physicial that it's cirrhosis. Following that, Dr. David Barnes, Clinic liver and hepatitis specialist. sent a series of blood tests to the lab and read the MRI screening that seems to confirm the diagnosis. But the cause is still a mystery and more tests will be done. I'm not an alcoholic and I don't have hepatitis, and I'm not in pain. Autoimmune? Feel the same as I always have done.

The confirmation of cirrhosis stunned me to the point that I wasn't too swift in asking questions, but as soon as I hit the highway questions came up in my mind thick and fast. I was able to reach Dr. Barnes over the next couple of days and he was able to set my mind at rest to a large extent. Here are the things we discussed:

Liver cirrhosis doesn't equate with liver failure. I could die of something else before liver failure caught up with me.
He will continue to work and follow it.
Pain isn't typical.
Will arrange for a vaccination against hep A and B.
A biopsy can be given--it's the gold standard for diagnosis but he prefers not to unless necessary.
A cirrhotic lung's tissue is scarred. the tissue separates into nodules--spheres--looks like marbles in a bag.
Liver transplant at my age is not an option, although I got the feeling that he doesn't rule it out. I have a feeling though that the liver has to have failed before they do that?

Good Recovery for Paul After Lung Cancer Surgery

Paul is showing a very good recovery today after undergoing four hours' surgery at the Cleveland Clinic yesterday. This morning his color was good and he chatted with Philip, Kim, and me quite readily. He asked me to print off crossword puzzles and bring them along next. This afternoon they removed him from the ICU to a room up on the ninth floor in the thoracic step-down constant nursing unit . There they will re-introduce him to getting back on his feet.
He had in effect two procedures. The first surveyed the lymph nodes in his right lung. Fortunately, they were fine. The second op opened his chest, spread apart the ribs, and removed the cancerous growth at the periphery of the left lung. In doing so, they took only ten percent-of the lung--a good outcome. Phil and Wendy spent most of the day with me yesterday and P and Kim visited this morning. We're very happy with the way things are going right now.
Because the Cleveland Clinic campus is so large I did a lot of walking yesterday and today--and don't feel any the worse for it, either! Last evening when I walked in front of the lobby of the Inter-Continental Hotel, I saw a group of people surrounding an elderly middle-eastern couple who were climbing into a large, black European-looking car. They looked very regal. (A lot of gold glistened about them). One chap in a long, black raincoat stepped menacingly toward me--a bodyguard I guess.
I fell into bed gratefully last night in the Guest House. License plates on cars in the lot came from nearly every state in the union, and while waiting around yesterday I talked with people from San Francisco, Idaho, Kentucky and places in between. I thought, well, Cleveland is a gloomy town much of the time, and the weather is nothing to write home about, but we have the Clinic right here--and that's worth a thousand blessings.
The TV in my room brought in Abu Dubai, Saudi Arabia, Kuwait--and a Syrian movie was playing on another channel.
A cousin, whose wife is recovering from a cancer removal under excellent British National Health care, expressed the following sentiments in an email today:-
"We have found that talking about the illness somehow lessens its bogeyman severity. Forgive me for doing so when you have your own concerns. "

(Thank you David. I agree and I think we share some of the same verbal genes).

Now I'm back home this evening caring for the cats. They don't seem to have missed me at all.

Love, and forgive me for running on, but it's good for my sanity and system.
Stephanie

Paul's Visit to the Cleveland Clinic--April 2, 2007

Yesterday, April 2,we kept a full day's worth of appointments at the Clinic.

As it looks now, Paul will probably undergo lung surgery within the next two or three weeks at the Clinic's hospital.

Yesterday's tests included a molecular imaging procedure in the nuclear medicine department at the Main Hospital followed by a CAT scan of his brain in the radiology department . The afternoon was taken up first with three pulmonary function tests in the Crile building including a walking function that showed a need for oxygen, which the technician who walked with him supplied.

In the latter part of the afternoon we visited first Dr. Sudish C. Murthy, thoracic surgeon, and later Dr. Gildea, pulmonary disease specialist--he has been seeing Paul since 2004. Both have extensive biographies online at the Clinic website and are regarded as tops in their fields. They were liberal with their time, friendly, compassionate, and welcomed our questions and concerns. They were the exact opposite of the stereotypical arrogant specialist one finds in literature, movies and sometimes in real life!

Both had reviewed Paul's case file and earlier scan results (done in Medina), as well as the results from the morning's tests. Murthy's first concern was finding the exact spot on the left where Paul's cancerous growth is located. (The Medina scans weren't that good, and he has ordered another scan taken at the clinic next Tuesday). The options for Paul appear either surgery or radiation, or both.

As Murthy put it, in surgery we can't give up much lung tissue for an operation, and if the growth is in the middle of the lung it will present a difficulty because not only must the growth itself be removed, there must be enough lung tissue surrounding it to ensure that the cancer is removed properly. The result could be that the whole lung might have to be removed. If the growth is near the edge of the lung, it can be removed together with surrounding tissue, but even this would take some of the lung away. Any amount of lung tissue removed is serious for a patient suffering from interstitial lung disease

Radiation can burn away the growth, but collateral damage to the lung is a possibility.

Murthy wants Paul to have another CAT done at the clinic next Tuesday--to zoom in on the growth's position--and also a heart stress test on a treadmill to gauge the ability of the heart to handle the surgery. He pointed out that whichever therapy is chosen, we mustn't do the wrong things for the right reasons. We must expect Paul to have a reasonable chance to get through the therapy and have an expectation for an effective recovery with half a lung if that's what the picture turns out to be.

Our final visit for the day to Dr. Gildea yielded a difference in opinion. He is absolutely against radiation. for Paul's diseased lung. As he put it, "it could set off a firestorm in Paul's diseased lung." But he will conference with Murthy and they will bring other specialists into the debate and will come up with their best possible option.
For surgery, Paul will be in the hospital for about a week and recuperation time will take about eight weeks.

The Clinic resembles a small city. It has its own Intercontinental Hotel (God knows how much it costs to stay there--affordable anyway or the Saudi princes who come over for their regular checkups). We took used their own bus service--the greenline, blueline and whiteline run regularly between buildings. There are also indoor skywalks between buildings and for our last appointment I pushed Paul in a wheelchair from one building to another. Parking spaces for handicapped tags are close to the building and cost just $5 for the whole day. A Bon Pan cafe in the Crile building (where the pulmonary department is located) offers delicious food all day long.

Our next step is to keep the appointments for next Tuesday (April 10) for cat scan and heart stress tests. After they've been reviewed, the doctors should be able to come up with their next step.