Three years ago, Medicare's penny wise and pound foolish policies discharged me from HealthSouth. This was one of several occasions when Medicare decided that the improvement I was making was not worth it despite the fact that the Superman t-shirt daughter Amelia Altalena had given me. Where are the preventive rehab of last year? How much taxpayer money was spent unnecessarily in emergency rooms and hospital stays that could have been avoided if only? Consequently, the beard I have grown since hides the tracts of my tears.
. https://www.youtube.com/watch?v=OYLSvXYp_5U
Sisyphus and me
I am overdue for a shower.
Tomorrow is my last day of occupational therapy at HealthSouth. Last week, I completed the 28 weeks of physical therapy Medicare allows. I asked HealthSouth C.E.O. at Pleasant Gap PA yesterday as she prepared for a meeting and I for a 10th cup of coffee, how Medicare came up with the number 28. Susan Hartman said she thought it an arbitrary number. I speculated Medicare consulted with a palm reader.
++++
Sisyphys (1548–49) by Titian, Prado Museum, Madrid, Spain ++++ “You have already grasped that Sisyphus is the absurd hero. He is, as much through his passions as through his torture. His scorn of the gods, his hatred of death, and his passion for life won him that unspeakable penalty in which the whole being is exerted toward accomplishing nothing. This is the price that must be paid for the passions of this earth. “ –Albert Camus http://dbanach.com/sisyphus.htm
++++
The issue matters because I experience considerable pain over the course of the day. Last weekend, I figured the level (on a scale of one to ten) was over 7.
Two years ago, I would have dialed 911 and waited until the ER physician injected me with morphine. Not that I would get enough morphine. Not that it would be injected quickly enough. The principal relief was not the medication. Rather, the sense at least I was doing something rather than nothing.
A little over a year ago, I had a spinal stimulator surgically implanted. The device is manufactured by Medtronic of Minneapolis. Medtronic also manufactured the pacemaker which studies have shown my heart relies upon to keep me alive.
There have been times over the past three years pursuing specialized surgery in New York when, I thought I would rather be dead than experience the pain which on several occasions had me rolling on the floor in agony.
April 8th will be cause for celebration when my granddaughter reaches her second birthday. Ever since Juliet appeared in my world and hers, the idea of premature death (however relieving) has been replaced by a commitment to persistence whatever the cost.
I need to be alive for Juliet—at least until she graduates from college and architecture school and begins designing airports and wheel chair accessible jets.
In October 2016, I celebrated my 69th birthday at HealthSouth recovering from the surgery which has since kept me out of the ER. The sophistication of Mount Nittany Medical Center has reached the point where surgery once available only in New York and at sophisticated centers such as Johns Hopkins, MD Anderson, and of course the Silicon Valley’s facility in Stanford (where the Corporate Angel Network flew me a seeming lifetime ago for the expertise that resulted in my being on this planet and not in the world to come).
++++
Three years ago, Medicare’s penny wise and pound foolish policies discharged me from HealthSouth. This was one of several occasions when Medicare decided that the improvement I was making was not worth it despite the fact that I was wearing the Superman t-shirt daughter Amelia Altalena had given me. Where are the preventive rehabs of last year? How much taxpayer money was spent unnecessarily in emergency rooms and hospital stays that could have been avoided if only? Consequently, the beard I have grown since hides the tracts of my tears. https://www.youtube.com/watch?v=OYLSvXYp_5U
++++
Now, sophistication has reached river city. Last year I received at State College the surgery that makes regulating pain achievable. However, the value of a vibrator in my spine reducing dependence upon opiates is most effective when coupled with physical and occupational therapy.
It helps reduce pain when I move my body—especially at those moments when I delude myself into believing lying in bed in a fetal position is preferable to transferring to my scooter, navigating to the kitchen sink, and standing safely. Standing is better than sitting. Using the parallel bars (not available at home) helps build strength and reduce pain.
Now that I have achieved the Biblical-described age of three score and ten, Medicare will pay for something.Given Medicare, the insurance feels happiest when it pays too much for relief best achieved at lower cost preventatively.
I paid into the trust fund with extremely well-paid consultancy fees from Silicon Valley companies for my expertise as a senior technical writer. I can resume well-paid employment to compensate HealthSouth for the $300 or so cost of an hour of physical therapy. I would rather do that than complain about Medicare. However, putting myself back on the money-making track requires patience and persistence—convincing potential employers reluctant to pay a 70 year old paraplegic.
The consequence of my not having access to 36 hours of physical and occupational therapy between now and January—when the arbitrary 28 weeks of rehabilitation resume—might very well mean that because of a penny wise and pound foolish Medicare, your tax dollars will pay for expensive hospital care that could easily be avoided.
Liz Beaulieu, my editor at HME (Home Medical Equipment) News, has commissioned me to resume my published work for HME News with a 750 word article on the subject of Medicare’s reimbursement policy on rehabilitation. Although Liz is a fan of long New Yorker articles (appreciation she sneaks into her editorial notes), I will need to be brief.
First, however, I need to be comprehensive. I have requested a formal interview with the able Susan Hartman, C.E.O. at HealthSouth’s Pleasant Gap facility. Naturally, I will be descending upon the press office of the Centers for Medicare and Medicaid Services in Baltimore. I will start at the top seeking an interview with Seema Verma, President Trump’s choice to run the agency (who is pals with Vice President Pence).
I also will be seeking interviews with Mark J. Tarr, who runs the HealthSouth empire from its headquarters in Birmingham, Alabama. On its Securities and Exchange Commission 10-K form, HealthSouth (eventually to be renamed EncompassSouth) notes: ““We are the nation’s largest owner and operator of inpatient rehabilitation hospitals in terms of patients treated and discharged, revenues, and number of hospitals. We provide specialized rehabilitative treatment on both an inpatient and outpatient basis. We operate hospitals in 30 states and Puerto Rico, with concentrations in the eastern half of the United States and Texas.”
I will be arranging interviews with Senators Casey and Toomey. Next step is to follow the advice of Rep. Thompson’s excellent press officer Renee Gamela who wrote yesterday, “Hi, Joel! Yes, you should contact Barbara Ives in GT’s Titusville office.” Then, I will interview Rep. Thompson, who was a physical therapist before his election to Congress.
My current (ever changing) plan is to report all (in my customary dribs and drabs work in progress publication) in a posting on my website where my webmaster is the excellent Kathy Forer. Sarah, my one and only sister who knows me all too well, says writing long is my default. Hence, I will write long then boil it down to 750 words and submit to HME News.
Continually hat in hand, it would help if you were to send me $18 given the paltry state of my checking account which tomorrow (after checks are cleared) will contain $16.34. Yesterday, I had to pay Harvey Israel, my wonderful dentist, for emergency work. Yes, I have set up a crowd funding proposal. Need to set up more. The $18 figure is based on Jewish tradition. In the Hebrew alphabet, each letter has a number value. The alphabetical equivalent of eighteen is the Hebrew word for life—Chai. When my late mother Miriam (a Hebrew school teacher) wanted to donate to a cause, but did not have enough money to do so as she liked, she donated $18.
I have to run. Unfortunately, I became so distracted that the eggs, hard boiling on the stove, blew up. Exploded hard boiled eggs are messy.
I have to run. Unfortunately, I became so distracted that the eggs, hard boiling on the stove, blew up. Meanwhile, as time goes by, I will be posting this and that here and there.
The pretender to the Emperor’s throne [1] stood in the innermost sanctum of the deposed ruler’s palace [2] and listened, beaming with pride, as the younger of his ten-year-old twin daughters finished reading the framed poem aloud. The poem had been left behind on the wall when the deposed ruler fled into the night.
“‘Yours is the earth and everything that’s in it,”‘ she read, “‘And–which is more–you’ll be a man, my son.'”
The ten-year-old girl had read Kipling’s “If” with what at one time was called expression. The Filipinos in the line behind her applauded enthusiastically. She turned, curtsied prettily–despite the jeans she wore….
“Very, very nice,” said [her father] Artie Wu who stood six foot two and three-quarter inches and weighed 249 pounds….
His younger daughter made a face at the poem on the wall. “God that’s dumb.”
“Mr. Kipling had an unhappy childhood,” Agnes Wu explained. “To make up for it he sometimes became a trifle optimistic and overly sentimental.”
Her daughter nodded wisely. “Mush, huh?”
“Mush,” agreed Agnes Wu….”
The older of the twin daughters (older by 21 minutes) turned on her sister. “It wasn’t as dumb as ‘Invictus’ that you got out of and Mrs. Crane made me memorize last year. You want mush? ‘Out-of-the-night-that-covers-me-black-as-the-pit-from-pole-to-pole-I-thank-whatever-gods-may-be-for-my-unconquerable-soul.’ That’s mush.”
++++
Did Rudyard Kipling (the first English-language author to receive the Nobel Prize in Literature https://en.wikipedia.org/wiki/Rudyard_Kipling) really have a rotten childhood?
Footnotes
Ross Thomas created Artie Wu to be the kind of hero who runs away from a Methodist orphanage with his self-respect so firmly in tact that he humorously refers to himself as next in line to be Emperor of China (even though China does not have an empire).
This scene takes place in the Presidential palace of Ferdinand Marcos, a garish dictator of the Philippines who was removed from office in 1986. After Marcos fled, tourists (as in this vignette) flocked to his palace to see how he lived.
I know. Footnote three does not refer to anything.
++++
Getting from there to here is an abrupt transition. The transition is easier with planning and intention. Yet there is where I was grateful to Ross Thomas for making the packing to HealthSouth easier. Now here I am, my goal posted on a chart in my bedroom. Have to scoot quickly. This photograph posting is a launch pit stop between physical therapy in the morning and occupational therapy in the afternoon.
Regarding: Pleased to be back at physical and occupational therapy
This is the abrupt transition I warned you about. I was reading Ross Thomas as I packed and prepared to arrive at Health South, a for-profit hospital in Pleasant Gap, Pennsylvania nine miles northeast from my apartment. I began writing this post after checking in to my mountain view room on Sunday night April 24th.
I took this photograph from my hospital room at dawn on Monday.
I have been in a state of physical decline following my return home to State College, Pennsylvania after spinal surgery in New York City. This state of decline (despite periodic ups and downs) has persisted from December to the present. My admittance to HealthSouth, I hope, marks a new beginning.
Background: My Previous Hospitalizations at HealthSouth
This is my third hospitalization at HealthSouth in the last 12 months. Below is a video I made in October. I spent three weeks in hospitals that month. My first stay was a consequence of breaking my left ankle. Mount Nittany Medical Center transferred me to HealthSouth where I learned to transfer from the bed to my scooter without putting weight on my foot. Essentially, I was hopping as I saw the rabbits do on Monday night while scooting around this building.
My second stay at HealthSouth followed my hospitalization for a dangerous MERSA infection. At Mount Nittany Medical Center [where the food–surprise surprise–is superb] the doctors saved my life. They did so my draining the puss from oozing wounds on my body and providing massive doses of antibiotics (first through an IV; then pills).
The drive from State College to HealthSouth.
Susan Hartman is the C.E.O. of HealthSouth at Pleasant Gap. “As chief executive officer… for the past nine years, Susan Hartman oversees the day-to-day operations of the 70,000-square-foot, 73-bed inpatient rehabilitation hospital,” writesTown & Gown Magazine. “Located at 550 West College Avenue in Pleasant Gap, HealthSouth Nittany Valley serves patients across the region, offering comprehensive inpatient and outpatient rehabilitation services designed to return patients to leading active and independent lives.”
I met Susan on the last day of my first stay at her hospital. I suggested that HealthSouth consider working with companies constructing housing for the elderly and disabled. I was impressed by the skill of occupational therapists (OT) on her staff especially in their use of activities of daily living (ADL).
Following my hospitalization at Mount Nittany for MERSA, I was released from the hospital, but was unable to bandage my wounds adequately. At a loss for how to take care of myself, I wrote my children expressing pessimism. I copied Susan in my email. The following day, a HealthSouth administrator called to tell me that my admittance had been approved. What a relief!
Digression: How Healthcare Expertise Is Useful in Designing Housing
Here I will digress on the significance of activities of daily living. In the kitchen, for example, ADLs are useful for breaking down into definable units how to make breakfast. With my work with Dr Sonali Kumar using virtual reality for elderly and disabled residences. ADLs are essential for building design.
“Experienced-based design” is the term of art for an approach to architecture where the residents requirements determine how a building is constructed. I am hopeful that a consequence of my meeting with Susan that HealthSouth will form an alliance with the Penn State Department of Architectural Engineering where I work.
Today (April 28, 2016) Occupational Therapist Diann Dougherty helps me understand how ADLs can be useful in my writing a chapter on designing a kitchen accessible to residents with a mobility disability.
++++
Yes it helps me to know that in HealthSouth’s occupational therapy kitchen, the distance from floor to sink is 36 inches. My experiences during my three times as an in-patient have ranged from the useful to the dramatic. It was dramatic for me to have a near-death/out-of-body experience when my second stay at HealthSouth came to an abrupt end.
I had awakened on a Thursday morning with chest pains. HealthSouth’s compassionate Medical Director Richard Allatt ordered an ambulance. Doreen, my nurse held my hand until the attendants came with a gurney. As I watched (mistakingly believing I was going to die from a heart attack), I felt myself to be a third-party observer as I was being loaded onto the ambulance en route to the emergency room. I marveled at the beautiful early morning mountain scene saying to myself, “This would make great video.”
At the time I had been making videos. At first I produced elaborate architecture videos as enhancements to my column for e-architect UK. At HealthSouth, I made cinema verite videos (yes, I know this sounds pretentious) to provide short unedited perspectives on the mobility disability experience.
Leaving HealthSouth, I was thinking about Megan Brown, the “star” of the above video. I was filled with a sense of profound gratitude to Dr. Allatt, Doreen, Megan, and the other physical and occupational therapist and staff at HealthSouth. Consequently, months later after I found my health to be in distress. I was pleased to be back here.
My April 24th to May Second stay at HealthSouth
The single most significant aspect of my stay is the time I have been spending on the parallel bars.
On the second day of my stay, I published the following on Facebook: “These are the parallel bars in the East Wing Therapy Gym. I photographed the bars early this Tuesday morning hoping the picture would provide the sense of excitement these bars evoke. Yesterday, attached to a harness, I “walked” upright. The pain I feel this morning evokes hope. I am here at HealthSouth to manage the crippling pain in my spine. The pain in my muscles is a different kind of pain. A good pain when transformed into strength will help me defeat the bad pain. It is too early to discuss good and evil–not before breakfast. Suffice it to say, I look forward to this day because I will be walking upright again.”
Standing is special for me. So is “walking” upright, even if walking simply consists of moving between two parallel bars–using the strength in my arms to keep me upright and get from here. I wrote that I hoped my stay at HealthSouth would reverse the decline in my physical health. Central to achieving my goal is a broader range of mobility and the necessary strength.
In the report I have been writing on designing housing for the mobility disabled, I emphasize the notion of transparency. Access in the home should be so readily available that the resident is reminded as little as possible that she or he has a disability. For example, for a two-story house an elevator or a wheel chair lift is far preferable to a stairlift. For a stairlift one has to transfer, and the less transferring the better.
This plastic brace (a.k.a. orthotic device) is evidence of my laziness. Twenty years ago it was prescribed for me to use in conjunction with fore-armed crutches. However, through neglect I have lost the arm-strength and balance necessary to use crutches safely. This is something with training and persistence I can do again. The photograph shows how my muscles have decreased in size through lack of use.
Transparency relates to my physical therapy goals. For the past 21 years as a paraplegic, I have managed to compensate for my disability by relying extensively on mobility devices such as scooters and power chairs. These are extremely helpful tools. When I first used a scooter I was in my forties. Working was essential for paying the mortgage and supporting my family. The speed and appearance of the scooter made my disability seem less disturbing. My employers, co-workers and children regarded the device as a neat technological solution.
A few years ago, I teamed up with a local supplier of mobility equipment to show disabled members of my synagogue the freedom these devices provide. One elderly woman expressed concern. Her inability to walk trapped her in her home. She worried that dependence on the scooter would result in her losing what mobility she had. I pointed out that while exercise is important fatigue is counterproductive.
Four years ago Alicia J. Spence at Phoenix Rehab helped me walk using fore-armed crutches.
I was correct (of course). Mobility devices do provide freedom. Any physical therapist will tell you that fatigue is debilitating. Yet my argument was fallacious because I had failed to be moderate. I was lazy. I did not exercise. Twenty years ago, a year after I lost the ability to walk, a physical therapist prescribed fore-armed crutches (above) and braces (photo above crutches).
Through lack of use, I have lost the strength and balance to use the crutches. The braces prevented my toes from dropping–I had dislocated my right shoulder when I tripped over my toes. The braces also kept my legs steady. As the photograph shows, through lack of use my leg muscles have shrunk.
My major accomplishment at HealthSouth was my ability to use this tool. I am not strong enough to use a walker. This platform above a standard walker made it possible for me to cross the floor from one end of the room to the other.
++++
Senior Physical Therapist Steven Uberti
HealthSouth’s Pleasant Gap facility has a number of excellent physical (PT) and occupational (OT) therapists.
Steve took this photograph of me holding myself upright on the parallel bars.The absence of a harness means that Steve observed that it is safe for me to move along the bars without concern that I might fall.
Hic Haec Hoc
Orientation for new patients
This sign was prominent when I checked into my hospital room on Sunday night.
To be discussed is the especially significant “happy wheels” designation.
Meanwhile, in an unrelated event, nurse Sydney pushed me in a wheelchair and weighed me. Minus the weight of the wheelchair, I weigh 143 pounds. I have lost over 30 pounds in the past year. Dinner will arrive shortly. Then a friend. Tomorrow is another day.]
This is tomorrow
Tomorrow is today–Wednesday; 6:30 AM. I am sitting on my scooter waiting for it to finish charging. The doctor came and went promising to discuss the muscles in my thigh with the therapist–muscles than require strengthening.