A Homeless Insight into Medical Care in New York by Julie Cipolla
A Homeless Insight into Medical Care in New York
 New York, NY
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 by Julie Cipolla
 
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This is the story of my accompanying a homeless man to a city hospital and the treatment that he received there, during the 17 hours that I stayed with him.  

Timeline:

4 a.m.   Arrival by cab to Bellevue Hospital.  I asked the guard for a wheelchair for Mr. Raffel as he could not walk unaided the distance from the entrance to Bellevue Hospital to its Emergency Room.  The guard refused to get a wheelchair, saying he could not leave his post.  I  helped Mr. Raffel to the ER and he sat down, while I waited on line for the triage nurse.  When the triage nurse saw Mr. Raffel's condition, she immediately provided a gurney and he was wheeled into the room before the ER proper and asked a few questions by a medical person who was not a doctor.  The look of contempt and disgust on her face was in no way disguised or concealed.  Mr. Raffel was asked which medications he routinely took and the woman began writing, but then stopped and I  saw that she had not written down any of the names of the medicines that Mr. Raffel was telling her.  He showed her his medical referral sheet from Beth Israel, but she didn't want to look at it.  Then, Mr. Raffel was wheeled into a corner of the ER proper, where Mr. Raffel was instructed to take off his shoes, socks and pants and long johns so that the legs could be examined.  (Luckily, his gurney was near one of the supply drawers, so I grabbed an extra gown and sheet and plastic bag for Mr. Raffel's belongings).  Mr. Raffel put his wallet, his referral sheet with list of his medications from Beth Israel and his coins and paper money into a white plastic bag and then put that into his black plastic bag, which he then put under his head like a pillow to prevent theft.  (There were no pillows in the ER, at least none available for Mr. Raffel.) 

4:40 a.m.  Two nurses suited up in medical protective gear, and peeled away the old bandage that had been put on by Beth Israel on Saturday March 8, 2008.  (Actually, Beth Israel staff had refused to bandage Mr. Raffel, and they insisted that he take the bandages they provided and go into the men's room and put them on his leg himself.)  Now Mr. Raffel had two ulcerated legs; his right leg looked like a piece of raw meat from the knee to the ankle, where there was green discharge coming out.  His ankle was swollen as was the calf of the other leg.  One look by any lay person and you could tell that he was in excruciating pain.  Mr. Raffel described his pain as +12 on a scale of 1 to 10, with ten being the worst pain.

Aside from the ulcerated legs, Mr. Raffel had a broken shoulder as a result of being attacked and beaten up and thrown to the ground unconscious outside of the Food Emporium at Union Square.  The attack took place on February 3 and the ambulance took him at that time, to Beth Israel Hospital where he was admitted for 20 days.  The medical staff there told him that they could not operate to repair the shoulder because it was in an inaccessible place and nothing could be done except to give him a sling for 30 days.

5:20 a.m. Dr. Kuglo examined Mr. Raffel, who said that the right leg would have to be x-rayed to make sure that there wasn't "involvement with the bone." 

6:30 a.m. examination by Dr. Erlich, who indiscriminately poked and prodded the most painful areas and asked the same questions all over again that Dr. Kuglo and the nurses had asked.  This prodding was most painful for Mr. Raffel and the same questions being asked over and over again while he was in so much pain felt like an "interrogation" to Mr. Raffel.  Dr. Erlich's bedside manner left a lot to be desired.  He did say that Mr. Raffel would be admitted to the hospital.  Mr. Raffel turned to me and told me that it was because I was there that he was being admitted; that his past experience was that he would have been discharged even with his leg so badly wounded.

7:30-8:30 Mr. Raffel was wheeled down to x-ray and spent the hour there, while I remained waiting for him in the ER cubicle.

8:30 I had breakfast waiting for Mr. Raffel and he and I ate egg sandwiches and drank juice and coffee.

8:50 a.m.  Dr. Kuglo took blood for lab testing.  The drawing of the blood was very painful for Mr. Raffel because the doctor could not get the vein to issue forth the blood the first few times he tried it, so he kept having to reposition the needle, which was very painful.  I asked the doctor how long it takes to get the labs back, and he responded "20 to 30 minutes."

About that time, Dr. Kim, an Asian doctor was briefed by Dr. Kuglo on Mr. Raffel's condition.  Mr. Raffel kept asking for his regular dose of Methadone which was 150 m.g.s..  He had not had his regular Methadone treatment since Friday March 14.  His Saturday dose had been stolen, along with all his clothes and his guitar when he lay sleeping in a subway car. Dr. Kim told Mr. Raffel that in the ER they only give 10 mg. of Methadone, which was their policy.  Dr. Kim further told Mr. Raffel that once he was admitted onto a floor of the hospital, they could verify Mr. Raffel's dose and then administer that amount, but that this could not be done in the ER. 

9:50 Mr. Raffel needed to use the bathroom, a urinal was not sufficient because he needed to make a bowel movement.  So He asked for a bedpan and said he needed it in a hurry or he would have an accident.  I rushed over to the nurse's station and asked for a bedpan and they were busy at the computer and said "give us a few minutes," and I told them that Mr. Raffel didn't have a few minutes, that he needed a bedpan right away.  Meanwhile, another nurse looked at me as if she had never heard of a bedpan and was hostile and unhelpful.  Mr. Raffel staggered to the bathroom and when he was done staggered back towards the gurney, but couldn't make it.  I grabbed his arm and he tried to take a few more steps but couldn't.  A very helpful nurse, Denise, who was African American and the only angel down there in the ER who showed the slightest bit of concern or sensitivity to what Mr. Raffel was suffering, had not only changed the bed sheets while Mr. Raffel was in the bathroom, but seeing that Mr. Raffel couldn't make it back to the gurney on his own, moved the gurney towards him so he didn't have to walk the last few steps.  He collapsed onto the gurney and we both thanked Denise profusely.

At every opportunity, Mr. Raffel asked for pain medication and he was denied it.  He showed his Methadone clinic card with his unique federal id number and the name and address of the clinic where he received his methadone, to medical personnel a total of 7 times during the 17 hours that I was with Mr. Raffel at the hospital.  They continued to deny him any pain medication. 

At 10:10 a.m. Pedro, an orderly began to pull at the gurney to move it and I asked if he was being brought up to a room, and Pedro said that Mr. Raffel was going to x-ray.  I told Pedro that Mr. Raffel had already been to x-ray and I went to speak to Dr. Kim.  I asked him why Mr. Raffel had to go back to x-ray and I was told that the x-rays that were taken earlier only x-rayed the knee and the ankle but not the tibia, which was where the main ulceration was. I asked him why this was so, and he told me that the order had been written incorrectly and Mr. Raffel would have to go back to x-ray again.   In the meantime, Tylenol and 10 mgs. of Methadone were promised but did not seem to materialize.

I pleaded with Dr. Kim, that couldn't Mr. Raffel have the Tylenol at that moment, before he was brought down for x-ray and Dr. Kim acceded and the Tylenol was given.  It was clear if I had not asked that the Tylenol be given at that time, who knows when Mr. Raffel would have received it.

10:30 a.m. First administered pain medication, despite pleading by the patient and myself for Mr. Raffel to receive pain medication, and despite being in the ER over 6-1/2 hours, with a possibly gangrenous leg.  He received 1 gram of Tylenol, which the doctor said was "a lot" of Tylenol.  They refused to give Mr. Raffel any of the medications on his referral list from Beth Israel, that were his regular meds.  They said they were against giving Mr. Raffel any opiods or benzodiazepine because they wanted to see what he would be like without taking them and they did not want him to be sedated.

There was one patient ahead of Mr. Raffel waiting for x-ray, and I waited outside when Mr. Raffel was being x-rayed.  A group of volunteer trainees who were on a tour of the hospital happened by the x-ray department just then.  Later, I saw the same group touring the ER.

12: 00 noon Denise brought Mr. Raffel and myself each a tray of lunch, for which we were both very grateful.  The food tasted lousy but we both ate to keep our strength up.

12:20 A nurse came in and said that Mr. Raffel would be admitted upstairs very soon.  I asked if it would be about two hours, she said that it would be much sooner. 

12:35  A nurse (African American) with orange hair asked whose belongings were on the floor and I responded that they were mine and she kept repeating the word "nasty, nasty," like she was chastising a small child.  She was most hostile and unhelpful.  I don't know who she was or where she came from, because she was not involved in Mr. Raffel's care.

At about 12:45 a nurse came in with a pink form that she filled in as she asked Mr. Raffel questions that he had already repeatedly answered already.  She seemed to take Mr. Raffel seriously when he told her the medications he was on and she duly wrote down the names of the medications and their dosages.  Finally!  I thought, this information will be conveyed upstairs to wherever he is going to be admitted and they will start giving him what he is supposed to have.

1 p.m. Mr. Raffel was brought up to the 15th floor, 15 North and the orderly deposited Mr. Raffel in front of the nurse's station.   We met a nurse, Ms. Ford who seemed annoyed that we had arrived and complained that 3 other admissions on that floor had just occurred and that there was nowhere for Mr. Raffel to go.  Finally, after waiting in the corridor for about 5 minutes, Ms. Ford told the orderly to move Mr. Raffel's gurney to room 47a on the 15th floor. Her tone indicated annoyance.  When the orderly brought Mr. Raffel to the room, he left Mr. Raffel in the gurney in the middle of the room, and left without putting Mr. Raffel to bed.

1:15 I went to the nurse's station to find out who Mr. Raffel's nurse was and who his doctor was and when they were going to put Mr. Raffel into bed in the room.  A thin, petite Asian nurse with straight hair to her shoulders said her name was Flora and that there was another Flora who was a nurse on the floor as well.  The first Flora said she didn't know who was Mr. Raffel's nurse or doctor and seemed annoyed with me and wanted me to wait.  So I waited another ten to fifteen minutes, while mercifully, Mr. Raffel slept in the gurney. 

1:40 a.m. The other nurse named Flora (the chubby, wavy-haired, eye-glass wearing Asian woman) put Mr. Raffel into the bed.  She was clearly enraged at Mr. Raffel and myself, and never looked either of us in the eyes and spoke with such hostility that you could cut it like glass. When questioned why he was not put into bed sooner, she said she was on her break and that she had just come back.  I asked her how long her break was and she responded "1 hour."  I then said: "So you were on the floor for at least 20 minutes before going on your break when Mr. Raffel was brought upstairs from the ER. And you left him waiting in the gurney for 1 hour and 40 minutes while you went on your lunch break" Flora was very angry that I'd pointed out her neglect of Mr. Raffel.

3:10 p.m. Flora rushed into Mr. Raffel's room, like she was afraid someone was going to get her into trouble, and thrust the pain medication into his hand.  When I asked what it was, she mumbled so I couldn't hear.  When the doctor covering Mr. Raffel's case came into the room, I asked her what the pain medication was that was given.  Dr. Schneider replied that it was Norcon, 25 mgs. of ____ and 100 mgs. of Tylenol

3:15 p.m. Dr. Schneider examined Mr. Raffel and made the following recommendations:

  1. a wet-to-dry bandage would be applied to the right leg wound
  1. 70 mg. of Methadone would be given
  1. She would try to call the clinic who administers Mr. Raffel's methadone on Sunday, even though it might be closed, to verify his daily dosage
  1. She would order pain medication every four hours
  1. IV antibiotics would be immediately given
  1. Shots of morphine to be given immediately
  2. She would check with her supervisor re: Mr. Raffel's request for 1 mg. of a benzodiazepine (Clonapin), but that she was only an intern and did not have the authority to order it herself.

    We waited and waited and waited until finally at 3:50 p.m.  I asked Flora to page Dr. Schneider to the floor to answer why the orders she had given had not been followed through and whether the benzodiazepine had been approved by her supervisor.  I waited by the nurse's station until Dr. Schneider called back and I spoke with her.  She said the benzodiazepine had been denied.  Meanwhile Flora had just stated that only 20 mg. of Methadone was allowed to be given on the floor until Mr. Raffel's dose could be verified.  I also asked what was taking so long for the IV antibiotics and the bandages.  Flora said that these had to be ordered from the pharmacy downstairs and that it takes about 2 hours to get it onto the floor.  I asked Dr. Schneider about that and she said that Bellevue was like a dinosaur that it "gets there, it just takes a long time."

    5 p.m.  Flora came into Mr. Raffel's room and attached the IV to his arm for the first time.  The bottle for the IV antibiotics was attached.

    5:30  The IV ran out of liquid.  I said nothing to the nurse, because Mr. Raffel was so exhausted from the pain and anxiety that he slept and I did not want to disturb him.  He had begun to speak in his sleep and gesture with his hands a little, which I know from when my father was overcome with pain after his back operations means that he is delirious with the pain.

    5:40 Dr. Schneider came back to the floor and went into Mr. Raffel's room and I pointed out that no bandage had been applied to Mr. Raffel's wound yet.  She was surprised and concerned about that. 

    6:40 p.m. Was the first time a bandage was applied to the wound on the right leg – Mr. Raffel had been in the hospital for over 14-1/2 hours.

    7:10 p.m. I sought Flora, Mr. Raffel's nurse and reminded her that it was time for Mr. Raffel's pain medication and she took her time about getting it from the closet.  She walked into his hospital room without turning on the lights, and again, in a very hostile manner, woke up Mr. Raffel and thrust the pain meds and the water at him.  (If she could have thrown the meds in his face and gotten away with it, she would have done so, there was so much hostility emanating from her).

    7: 25 p.m. I left for the night, after reminding Flora that his next dose of IV antibiotics was due at 11 p.m.  Flora said he would get it at 12 and I said "he got it last at 5 so six hours later is 11 p.m."  So Flora said that Mr. Raffel would get the IV meds at 11 p.m.

    I had made sure to be polite to all the medical personnel and staff at the hospital and thanked each one for their service, even if they were unhelpful and/or hostile.

    I had to leave, I was exhausted after having been awake for over 30 hours and with Mr. Raffel for 17-1/2 hours under very stressful circumstances.  The hospital staff, nurses and doctors were clearly not happy that I was there, but I was glad I had been there to help a fellow New Yorker. 
     


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Last updated  New York, NY 09.10.04  by Julie Cipolla

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