Entering the empty hospital.

by Hugh Gilmore

You’ll probably be curious, but I’m not going to mention any doctors by name nor the hospitals they work in. Human ailments are hardly uncommon, so it took me a while to decide whether to write about my family’s recent misadventures with American medicine. After thinking about it, I’m going ahead in the hopes that what I have to say may benefit someone else.

Here’s the fundamental lesson I learned: Reduced to fundamentals, a hospital stay is a battle between a retailer and a customer for information, both before and after the purchase of a product or service. In this case, treatment for a stomach malady. Life and death potentially lay behind the drawn curtain, but only the sellers were allowed to look back there and know the odds. And how the recovery was going after the patient took the gamble.

The story begins with a small hiatal hernia my wife, Janet, developed years ago. (Her stomach had pushed up through her diaphragm a bit.) Heartburn, gastric distress, and discomfort resulted. Her gastroenterologist gave her a pill to relieve the acidity of the gastric juices that backed up on her. That’s not a cure, but an alleviation of symptoms.

A few years later, another endoscopy revealed the hernia to be medium-sized. Another pill was added to the pharmaceutical regimen. Last year, the scoping procedure showed a large (one report said “giant”) hernia – 30 percent of her stomach bulged into her chest. More pills prescribed. No interest in helping her find a cure, next patient please.

In the meanwhile Janet could not lie down to sleep at night without her stomach fluids flowing back into her esophagus as though a beaker had been tipped over. Though the pills had neutralized the heartburn, she’d wake up several times a night coughing as though she were drowning. The loss of sleep took a toll on her general health and the various sleep potions she tried left her lethargic and cobwebbed during the day. Each of her several symptoms was being treated separately. A tangled web was weaved.

We decided to go “downtown” to a very eminent gastroenterologist – the sort of physician one must book in kindergarten in order to see by high school. This doctor was wonderful in nearly every way. Nearly. After several tests confirmed what was suspected, the specialist recommended that Janet have surgery. She referred us to a surgeon she often worked with. We met him. He dazzled us slightly with his manner and his mixture of the highly specific and the deliberately vague. He would perform a “fundoplication” – the stomach would be pulled back below the diaphragm and the lower esophagus would be firmed up, making for a better valve, thus keeping stomach contents from leaking back up. This work would be done with a da Vinci robot. That’s about all we came out knowing. Despite the time we’d put into researching websites maintained by Harvard, the Cleveland Clinic, the Mayo Clinic and the National Institute of Health we still didn’t know what further questions to ask him.

It probably wouldn’t have mattered: the lack of sleep back home, the confusion, the generally run-down spirits we’d had been experiencing, all made us inclined to say, “Let’s get this over with.” Though the surgeon was a general surgeon and not a specialist, he’d been highly recommended by our top-shelf gastroenterologist. We left his office with our fingers crossed and a surgery date scheduled for 6 a.m., Oct. 30, the day that bleeds into “Mischief Night.” The procedure would take place in a center-city hospital we’d had no prior experience with. Sometimes you just have to trust the grownups when you’re in over your head.

The day came. Nothing reduces a married couple to two lonely units of humanity more than entering a hospital in the morning darkness together, riding an empty elevator to the surgery floor, seeing one of them get onto a gurney, watching a whirling troupe of hospital-garbed people coming in and out of your small tented space in pre-op, observing that they all knew their action roles, while you wait passively, smiling as a means of asking for mercy. And then the moment of separation comes ... a hand-squeeze, a light kiss goodbye, and the couple make mutual departures, one on a wheeled cart, IV portal in the back of her hand, the other walking to the elevator to go up to the Family Waiting room. “Okay, I’ll see you soon.” The eyes burn recalling this scene. The body wants to shiver with fright, but appearances must be maintained. Confidence, son, confidence.

I went up to the family waiting room. I was first one in there, a long narrow room with about twenty cold metal office-style chairs around the perimeter. I’d brought my Kindle and a newspaper and a snack. Good thinking, except I’m not the type to submit to distraction when worried. I sat and waited, emotionally suspended in that Neverland of not feeling anything except the slow drip of time. Surgery was set for 7:30. She should be down to the recovery room by 10. That’s nothing. I can do 2 1/2 hours in a breeze. If only.

While I waited, one of the robotic arms downstairs “nicked” Mrs. G’s liver on its journey toward her stomach. The consequences would be awful.

Continued next week.

Hugh Gilmore lives and writes and runs a rare book business in Chestnut Hill.