Facing the Grim Reaper, Once Again: Buddha, Galileo and the Hospital Industry
By Roger Burbach
On the Ides of March I awoke in a cold sweat from an apocalyptic nightmare in a hospital bed at the University of California, San Francisco medical center. I trembled and could not suppress a cry as I recalled my dream of General Augusto Pinochet rising from his tomb as a skeleton. Donned in his military cap and cloak, he looked like the skeletons that are prominently displayed in Mexico on the Day of the Dead. He carried the scythe of the Grim Reaper and began marching through the streets of Santiago, Chile, slaughtering those that crossed his path. He went to the chambers of Judge Juan Guzman who had prosecuted him, hacked him in half with the scythe, then proceeded to the offices of Juan Pablo Cardenas, the editor of the leading resistance magazine during the dictatorship, destroying desks and typewriters before cornering Juan Pablo. He next sought out my friend Fernando Zegers, a lawyer who worked at the Vicariate of Solidarity, a human rights organization founded by Cardinal Raul Silvia Henriquez. Seeing a picture of the now departed Cardinal on the wall, Pinochet cursed at it saying “you hid Communists under your bed.”
Desperately I called on everyone I knew in Chile and abroad to help resist the General’s onslaught, but to no avail. Even when my comrades managed to break his bones, the skeleton reassembled. Finally Pinochet spotted me and as he approached with his raised scythe I awoke from my traumatic nightmare.
I had entered the UCSF hospital ten days before. Afflicted with multiple myeloma, an incurable blood cancer, I had undergone a stem cell transplant in late December, 2010 that placed me in remission until August of last year. Then I began taking targeted-therapy cancer drugs and medical steroids to contain the malignancy, but these drugs took a toll on my physical well-being. My hemoglobin counts dropped precipitously and virtually every month I needed a red blood cell transfusion. I joked with my friends that I had become a vampire.
On the morning of March fifth, I awoke at my apartment in Berkeley feeling exceptionally weak and feverish. I called my oncology doctor at UCSF, Jeffrey Wolf, and he made an appointment for me to have another blood transfusion. Managing to get into my wheel chair accessible Honda Odyssey mini-van, I drove to UCSF where I collapsed in a hospital bed and got the transfusion. Staying overnight, I felt even worse the next morning. Dr. Wolf ordered a battery of tests, and when the results came back, they revealed that in addition to my three existent maladies, a spinal cord injury, cancer, and Parkinson’s disease, I also had pneumonia, a urinary tract infection and histoplasmosis, a fungal disease.
I was given antibiotics and additional transfusions, but my hemoglobin counts continued to decline and I lapsed into a state of semi-consciousness. Delirious, I could not even articulate a complete sentence and had begun to act irrationally. Dr. Wolf asked me a few simple questions: Did I know where I am? What year is it? Where did I live? I had no answers.
Dr. Wolf feared that the histoplasmosis had spread to my brain and decided to do a spinal tap to find out. Knowing I was incapable of making decisions (I refused to take vitamins), he turned to my son Matt to get his approval. The results of the tap indicated I only had histoplasmosis in my bone marrow and it could be contained with medication. But my mental state did not improve.
My friends and family feared for my life and rallied around me. Allie, my daughter who is finishing nursing school at Napa Valley College, sat by my bedside, using her smart phone to research my new maladies and the drugs I was taking. Matt’s mother, Patricia Flynn, who works at the ACLU in New York called me. Separated for many years, we are still very close. She declared in a strong, assertive voice, “Roger you have faced similar challenges in the past and I know you will persevere this time.” Cecile Earle, my long time friend who was away in Florida, called and talked slowly and clearly, trying to help me reconstruct my ability to converse, but to little avail.
As in the case of my collapse after the stem cell transplant, Dr. Wolf saved my life. One of the outstanding hematological doctors in the United States, we have become friends over the years. Unlike many doctors who tell their patients what to do, he engages in a dialogue with me, discussing my condition and my own research on novel therapies for multiple myeloma. During my stay at UCSF, he checked in on me virtually every day, and gradually my condition bottomed out as the antibiotics kicked in, bringing the pneumonia and urinary tract infection under control.
But my mind had been devastated and my synapses were firing at a lethargic pace. I could remember little and had difficulty carrying on a simple conversation. I also needed physical therapy as my body was wasted. The only way I could get out of bed and my room was if someone plopped me in a wheel chair and pushed me around.
To restore my health I needed to go to a rehabilitation center. In past physical crises I had gone to the Alta Bates Herrick rehabilitation hospital in Berkeley. This time however, a representative of the Jewish Center hospital located in south San Francisco appeared, arguing forcefully that I should come to her hospital. Someone from Herrick also weighed in and I made it clear I would rather go to Herrick because it is near my home and friends. But Herrick backed off, conceding to the Jewish Center, saying I could come to Herrick during the last stage of my rehabilitation. I felt like the rehab centers were bidding for my body.
On Friday, April 11, I was put on a gurney and driven in an ambulance to the Jewish Center on Silver Ave., a block from San Francisco’s bustling Mission Street. I was given an ample private room with a big window and a pleasant view of ornamental plants and trees. The architectural design of the part of the hospital where I stayed is extraordinary. The door of my room opened on to a large circular walkway with a sky lit atrium in the center. I felt like I was living in a light palace.
I still had hallucinations in the early days of my stay at the center. Around dawn as I hovered between sleep and waking, I would enter into a trance and imagine that I was in an enormous corridor of light that started in Managua, Nicaragua where I had been several months before, visiting my old comrades from the days of the Sandinista revolution. We organized a small seminar to discuss utopia and politics. I lodged on the fourth floor of an apartment-hotel with a spectacular panoramic view of the city and Lake Managua. From there the light corridor extended to my apartment in Berkeley, which has a southern exposure with windows opening on to a courtyard. Next, it flowed to the place where I was staying, and then extended far out over the Pacific Ocean. I did not feel I was in the Jewish center. I felt I was on a Utopian island off the coast, resting and relaxing before I began my next journey along the corridor of light.
The physical therapists, the nurses, the staff administrators, indeed the entire work force at the Jewish Center was a potpourri of diverse ethnic origins, reflecting the more general trend in the United States of an aging white population benefiting from an immigrant work force. The largest contingent had Philippine roots, while there were also Central Americans, Mexicans, Russians, Ukrainians, and even Nepalese. For the majority English was their second language. I felt as though I was in the Tower of Babel, as many reverted to their native language when they talked among their particular national or ethnic group. My physical and occupational therapy went smoothly. My biggest challenge was reconstructing my mind and memory. Always good at recollecting phone numbers, some from over forty years ago, I began by dialing the numbers of my current friends and by going over the numbers, names and email addresses listed in the electronic address book on my ASUS laptop. Amazingly whole blocks of my memory began to fall into place. Before I went to sleep I also read a few pages of Kim Stanley Robinson’s Galileo’s Dream, an historic science fiction novel I had started reading at home prior to my medical crisis. Galileo, often considered the first scientist, used mathematics to calculate the orbits of the planets and four moons of Jupiter to prove the earth circles the sun. In response, the Catholic Church threatened to burn him at the stake for denying that God had placed the earth at the center of the universe. In response he declared: “Mathematics is the language with which God wrote the Universe.” Although I am a non-believer, I opine mathematics is the language of the brain.
It is generally accepted that a glass or two of wine is good for your health. The hospital offered a glass with dinner, which I requested. It was an undrinkable Manischewitz, a sweet kosher wine. I had my son bring me a bottle of Chilean Cabernet Sauvignon as needed. One evening a nurse walked into my room and saw me pouring a glass of wine. The next day, Eric, a hospital administrator came to see me. He said “I hear you have alcohol in this room.” I crossed my fingers and said “No, I do not.” The same day he called my daughter Allie and told her: “Your father is unruly and drinking in the hospital.” Allie responded: “That’s my father. Thanks for telling me.”
At the beginning of the last week of April, Summit Alta Bates called to ask me if I wanted to go to their Herrick rehabilitation facility. I responded with an enthusiastic “yes”, and a week later I was set to leave for Berkeley. According to the rules, I was supposed to be transferred in an ambulance, but Alta Bates and the Jewish center argued over who should pay the costs. I offered a solution. I would have a friend take me there in a wheelchair-accessible van and, reluctantly, they agreed. He showed up at the hospital just before noon to help gather my few possessions, and when we got outside he handed me the keys to my Honda Odyssey.
I first drove to my apartment at Redwood Gardens in Berkeley to check my mail and to put my finances in order. At about 4:30 I received an anxious call from Herrick asking what had happened. I told them the truth – that I was taking care of my financial affairs and would be there shortly. Using my power chair because there was no long-term parking for my van at the hospital, I hung my tablet, laptop, and a few clothes in a couple of backpacks on the back of my wheelchair and took a 25-minute trip in fourth gear down to Herrick. When I arrived, the staff and nurses were still a bit miffed, but those who knew me from my previous stays were glad to see me, saying they had reserved my old room with a great view of the Berkeley hills.
My rehabilitation immediately kicked into high gear. Herrick has an excellent staff of physical and occupational therapists and I worked closely with Michael Mack, an Asian-American who I believe is the best physical therapist in the world. I was also assigned a speech therapist, Joanna. My first thoughts were why do I need a speech therapist? Joanna patiently explained that even though I have a slowly advancing Parkinson’s, my voice will get lower and my sentences tail off. Vocal exercises to raise my voice tone and strengthen my diaphragm could mitigate and even prevent these symptoms. I accepted, but jokingly told her “I already have a commanding way of speaking, and if my voice gets any louder, I’ll lose all my friends.”
On a warm sunny afternoon, we went outside to practice next to the parking lot. One of my exercises involves starting at a low pitch, raising my voice to the highest tone possible and holding it for ten seconds. I speculated people might think I’m crazy, but Joanna said “this is a hospital after all.” Sure enough, after about three long crescendos, a driver with an ambulance with the back door open came up to us and said, “Can I help you?”
One day when I was working out in the rehab gym with Mike, an impeccably well dressed man walked into the room accompanied by four others who were similarly well dressed and all-business like. He introduced himself as Chuck Prosper, the Chief Executive Officer of the Alta Bates Summit complex that includes the Herrick and Oakland campuses as well as the main facility located at Ashby Ave in Berkeley. He explained he was there with other board members to survey Herrick. While we talked, my mind flashed on a recent article in the New York Times pointing out that the CEO’s of insurance companies and hospitals receive the highest pay and compensation packages in the medical industry, followed by hospital administrators, and finally doctors who are the most highly trained in the medical world. “The biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine,” says the Times. Prosper, I have since learned, earned $843,402 in 2012 after receiving a 40 percent increase in 2011. Since then, no figures are available, although it is reported he received double digit increases in 2013 and in the current year.
Prosper has slashed the medical work force and services on the Summit campuses. On January 15 of this year, the militant California Nurses Association led a picket line at the Ashby hospital to protest the number of layoffs, job restructuring, and service cuts. In my stay at Herrick, I found the nurses, the therapists, and even the floor mopers, to be incredibly hard workers. Miranda, an elegant looking Latina nurse who I befriended, told me that in her shift from 7 am to 3 pm, the number of patients she has to take care of has jumped from 8 to 11. “The call button lights from the patients are continually on as they need medications, toilet care assistance, bed sheets changed, help getting out of bed, blood pressure and pulse taken, and meals served.” She noted that management has resisted unionization at Herrick, although the main Ashby campus and the one in Oakland are unionized.
Prosper and other CEOs are following in the policy footsteps of August Pinochet when he ruled Chile. In the name of neo-liberalism, the dictator cut health care spending, closing public clinics and hospitals, and in those that remained open, slashing the salaries of the medical personal including doctors. Health care insurance was privatized, with people offered a “choice” of companies, much like the United States does. No single payer option was offered just as it is not in the United States today.
Pinochet would be envious of how US hospitals have engorged their revenues, often charging high fees and billing Medicare. Another New York Times article headlined: “Hospital Charges Surge for Common Ailments, Data Shows.” Using the most recent data available it says, “Charges for some of the most common inpatient procedures surged at hospitals across the country in 2012 from a year earlier, some at more than four times the national rate of inflation … Charges for chest pain, for instance, rose 10 percent to an average of $18,505 in 2012, from $16,815 in 2011. Average hospital charges for digestive disorders climbed 8.5 percent to nearly $22,000, from $20,278 in 2011.” The Summit Alta Bates complex is in the forefront of these increases. Astoundingly, it billed Medicare for procedures in 2012 at almost twice the national average.
My final experience with the hospital industry came on the day of discharge from Herrick. As I live 1.2 miles from the Herrick campus, I offered to take my power chair home and return with my van to pick up my belongings. I pointed out that if I took an ambulance there would be no room for my power chair. The discharge manager said that it was contrary to official hospital policy. On April 22 a driver from ProTransport showed up in my room saying he had a wheel chair accessible van awaiting me down stairs. Accompanied by Miranda, we went down to the van. On our way she received a cell phone call saying that the same company had sent a gurney to my room to take me home in an ambulance-like van.
I refused to go back up stairs and as I was driving up the ramp two men with the gurney showed up. The muscular looking driver insisted I had to transfer to the gurney and get into the ambulance replete with oxygen tanks, electrical heart shockers, and blood pressure units. A medic would sit next to me to insure I did not croak on the way home. The driver called company headquarters which backed him up, demanding that I take the ambulance. The accessible van would take my wheel chair separately.
Now locked down in the van in my wheelchair, I refused to budge. As a last gambit, the driver asked me the same questions as Dr. Wolf did during my delirium; Where did I live, what day of the week is it, etc. Passing with flying colors of course, I was home in ten minutes. I later found out the van cost $80 while the ambulance ambulance would have cost $270. Dave, the parking attendant in front of the hospital who I have known for years, says, “most of the medical vans that show up are from ProTransport. It appears the management of Summit has a special contract with the company.” As one might expect, the employees are poorly paid. Starting pay for ambulance drivers and medics is only $10-12. The company grosses $40 million dollars a year. I could find nothing on the owners or the salary of the CEO. This is not so much an age of ambulance chasers, referring to lawyers who profit from bringing suits over injury liability, as it is a time of ambulance profiteers as part of the hospital industry.
During the last week of my stay at Herrick I began planning to follow the light corridor I had envisioned over the Pacific Ocean, to Hilo, Hawaii to coincide with my birthday on June 18. I am accompanied by my sister Ann, whose companion of over a decade. Jon Busateri, died in February of a heart condition in a Milwaukee hospital. We are both recovering from our traumas. In Hilo, Tom Wright greeted us, a fellow high school classmate from Watertown,Wisconsin who has retired to Hawaii after teaching for thirty-five years at the Buddhist Ryukoku University in Kyoto, Japan. Who knows here out in the middle of the Pacific Ocean I may become an atheist practicing Buddhist searching for an inner light after spending my life in quest of the “light” of an utopian revolutionary society. Or perhaps I will do both if I can keep my blood cancer and other maladies at bay.
*Some of the identities of the individuals mentioned in this article have been altered to protect their privacy.
To read more about Roger Burbach’s travails, get the prologue and first two chapters of his forthcoming book: Fractured Utopias: A Personal Odyssey With History. Receive this and help defray the editorial and promotional expenses by donating $3.00 or more to CENSA, a non-profit organization. By making a small donation to CENSA, you can get the prologue and first two chapters of Roger Burbach’s forthcoming book: Fractured Utopias: A Personal Odyssey With History. Receive this and help defray the editorial and promotional expenses by donating $3.00 or more to CENSA, a non-profit organization.