“They Paved Paradise, Put in a Parking Lot”

My local hospital has been petitioning the local city zoning board for permission to build an on-site parking garage for years now.  The city zoning board is very strict about the height of buildings and has turned the requests down repeatedly.

This past fall, the hospital administration announced that it needed a capital partner to expand and stay solvent.  Most of the members of the hospital medical staff have absolutely no idea if this is true and accurate or not.  We do know that several weeks after agreeing to a relationship with a well-respected health care system as a capital partner, they received permission to build that garage.

Construction is set to begin in March so it was no surprise to receive a three page email announcement that the physician hospital parking has been moved from adjacent to the hospital to an area that will make it significantly easier for me to get my daily 10,000 steps in. The construction will take a year. Florida’s sudden onset of torrential downpours will present a challenge but, that’s what umbrellas are for.

I bring this up after making rounds on my affluent patient, whose hospital identification information identifies him as a VIP Benefactor with a yellow star, upstairs in the spectacular VIP section known as the Rockwell Suites.  The operators have gotten used to us staff members calling in and asking the operator to connect us to the nursing station at the Rock and Roll Suites.

His room is the size of three to four rooms with dark wood paneled floors and walls. There are three big screen TVs in this room along with two computer screens. The floor has its own chef available to make a meal for a patient or family member anytime of the day or night.  There is a surcharge for this type of room not covered by insurance.

When I left this patient’s room, and had adjusted his medications at the nursing station, I went downstairs to the general medical telemetry floor.  My patient on that floor also is a benefactor but is in a semiprivate room being evaluated for a fainting episode.  I reached up behind his bed for a blood pressure cuff to check his blood pressure in various positions and there was none. I walked out to the nursing desk and asked the charge nurse for a blood pressure cuff and, after five minutes of going from room to room, she found one that didn’t hold the pressure load and was not working very well.   A digital one was finally located so I could measure the patient’s blood pressure myself.

My community hospital was built by neighbors and philanthropic donations after two young children died of a poison ingestion and there was no local hospital to bring them to. It was controlled by a lay community board, a community medical staff that represented the patient’s through the physician staff and a separate administration.  Addition of new doctors to the staff required the approval of a lay community council that first looked at the need for that specialty based on the population and the number of existing doctors already here practicing that specialty.  They were concerned that too many doctors would lead to many unnecessary tests because everyone needed to generate income.

That community hospital is now a “regional “hospital with a board filled by CEOs of Fortune 500 companies and doctors who are employed by the hospital. The pediatrics wing has been closed down because it lost money.  There is no geriatrics wing despite a plethora of senior citizens. There is little or no relationship with the student health programs at the two local universities.  There are no blood pressure cuffs in most rooms and no otoscopes or ophthalmoscopes in most rooms in the emergency department.  But, there are three big screen TVs in the Rock and Roll Suites and a parking garage in the works.

I wonder who now represents the health and medical needs of our community?

Fight Doctor – A Rich Experience in a Non-Traditional M.D. Role

I received a phone call from the Broward Sheriff’s Office Police Athletic League Youth Boxing Program asking if I would help them out on short notice and be the fight physician at their large youth boxing tournament. Their usual physician, a member of the Boxing Hall of Fame, had another commitment.  He was willing to train me in advance and show me the ropes on the day of the event but had to leave before the matches got started.

State law and the Boxing Authority require a physician to be at ring side and perform the pre and post fight exams.  I have worked with athletes in contact sports at all levels during my 32 years of medical practice but have no experience with boxing. It had been years since I have worked on a sideline so there was a bit of anxiety over wanting to have the skills, experience and expertise to help them and be able to make judgments and decisions that would help not hurt the participants.  I agreed to meet the fight doctor.

To help me with the project I enlisted my niece, a medical student who had just completed her second year and happens to be a fifth degree black belt in one of the karate disciplines. She was thrilled with idea.  We filled out applications and were accepted into the US Olympic program boxing medical team.  We then did a literature search to bring ourselves up to date on the latest articles on evaluation of head trauma in competitive youth sports.  Then, with some trepidation, it was off to Deerfield Beach High School and the bouts.

The Broward Sheriffs had done a remarkable job of transforming a gym into a regulation boxing ring with seating for about 1,000 people. As the fighters marched into the training room, we performed the fight physicals on enthusiastic and polite 8-14 year olds.  It was an opportunity for a medical student, my niece, to examine healthy patients for a change and be exposed to an unusual area of medicine that is certainly not discussed in the four year curriculum.

Dr. Allen Fields, a surgeon by training and board member of the Association of Professional Fight Doctors, was on hand to explain our duties and the fine points.  This gentleman, in his mid- seventies, clearly had the trust and respect of all those in the boxing program. Despite his easy going down to earth manner, it was apparent he was current and up to date in his knowledge of the medical aspects of evaluating and treating athletes at all levels of competition.  He is a source of experience and knowledge that my niece and I took full advantage of.

When the physicals were completed, we were off to ringside where we met numerous champions and Olympic boxing team members who were present to assist in the program. We were shown to our ringside seats. The National Anthem was played by a saxophone player and the show began. The referee prepped the first boxers, turned to the judges and timer and then turned to the fight doctors and asked our permission to begin the match.

At the conclusion of each bout, the participants shook hands and hugged. When the decision was announced it was difficult to distinguish the winner from the other boxer. There were no losers. The sportsmanship and camaraderie instilled in these youngsters by their coaches was apparent.  As they left the ring, we met them at courtside for the post fight checkup followed by a handshake and a hug.

The adults organizing and supervising the tournament could not have been warmer or nicer. These were high risk disadvantaged children using “Gloves Instead of Guns.”  They were expected to excel in school, be disciplined and play by the rules.   Six hours later the last bout was completed.  All the participants fared well with no injuries and no need for our intervention.  I can not express just how appreciative all the organizers and participants in this event were for my niece and I spending a day with them so that their tournament could take place.

It’s a funny thing; I think my niece and I are far richer for the experience and exposure to these wonderful volunteers trying to give these kids an opportunity to succeed in their lives. It was a pleasure to again see the value of a physician in the society working with healthy individuals in a nontraditional role. For as much as we gave, we received much more in return.