With no wife and no children nearby, Gerald Altman, 86, is on his own.
He lives by himself in a studio apartment in Baltimore. He receives meals and light housekeeping, but he is responsible for managing his health — a daunting responsibility given his multiple conditions: thyroid cancer, gastrointestinal problems and heart disease.
Gerald is fine with that — he wouldn’t entrust his care to anyone else who lives nearby — but he just wishes his providers would talk to each other so he could avoid unnecessary trips to the doctor’s office, repeat procedures and an overall sense of concern about his health and frustration with the health care system.
If his doctors had communicated with each other, he believes he might not have been subjected to a series of unnecessary colonoscopies, for example.
This particular complaint has roots in an open-heart surgery he underwent nearly three decades ago. The surgery went well, but plaque has built up over the years and now endangers his life. Gerald was put on an anticoagulant about five years ago, but the blood-thinning medication caused rectal bleeding and chest pain.
When he first experienced these symptoms, Gerald dialed 911 and an ambulance arrived and took him to the emergency room at the nearest hospital. When the doctors ordered a colonoscopy, Gerald told them he had undergone a colonoscopy recently at his cardiologist’s office. But instead of taking the time to find out the results of the most recent colonoscopy, the ER doctors simply wanted to repeat the procedure.
But before he agreed to the test, Gerald asked the doctors to consult his cardiologist. They initially refused. But Gerald — a retired air force colonel and an attorney by profession — is not accustomed to taking ‘No’ for an answer. He demanded that the doctors talk to his cardiologist, and they finally acquiesced. Still, they were reluctant to talk to him about the details of their conversation, even though he was the patient.
“Getting my doctors to talk to each other — and to me — was like pulling teeth,” he says.
Gerald underwent the colonoscopy and was diagnosed with hemorrhoids. He was discharged from the hospital, the bleeding eventually stopped, and the chest pains subsided. But while his symptoms had been treated, he still had concerns about his underlying condition and what to do if he experienced the symptoms again.
Well, those questions arose again — on multiple occasions — and he never got what he considered a satisfactory answer.
He would experience rectal bleeding and chest pain, call 911 and be rushed to the nearest hospital. There, he would be given a colonoscopy despite his initial objections, ignored when he asked his doctors to consult his cardiologist, excluded from discussions about his health and then discharged after his symptoms were treated.
“It was the same pattern over and over again,” he says. “The details may vary slightly but it was the same experience, and my condition did not improve.”
Gerald finally spoke to a hospital manager about the problem, but his complaints fell on deaf ears, he says. On one occasion when he experienced bleeding and chest pains, he even thought about skipping the hospital visit, but then he reconsidered. “I’m told if you have chest pains and you’re a cardiac patient, you don’t sit there and think about it.”
The repeat visits became so frustrating that Gerald’s cardiologist eventually took him off the blood thinning medication. The rectal bleeding and chest pains have stopped, but Gerald doesn’t know whether the price of that will be an eventual heart attack.
Despite these challenges, Gerald knows his situation could be worse. He has health insurance that covers most of his medical needs — something his daughter could not get because she had pre-existing rheumatoid arthritis. She died in January.
But Gerald also knows his situation could be better. When he is treated at The Johns Hopkins University Hospitals, he feels his care is “infinitely better.” That’s in part because he comes under the care of a coordinating nurse, who keeps tabs on Gerald’s multiple medical conditions, communicates with his many doctors and makes appointments for him. “She’s aware of all of the pieces of my health puzzle and she will deal with all the doctors if I have a question,” he says. “She’s been invaluable to me.”