The Best of Care

Concern for Patient Comfort a Hallmark at Mayo Clinic

By Marilyn Bates

Little ribbons of husked cornstalks thread the flat fields along highway I-90 on our drive to Rochester and the Mayo Clinic. Bare hickory looks like matchsticks stuck into an occasional slant of hillside, but mostly the plains of Minnesota have been swept clean by harsh winters.

The austerity of landscape is as intense as my mission. A guide wire left in my heart from an old angioplasty threatens to accumulate clot-forming material that could cause a stroke. During bypass surgery, the doctor chose not to remove the wire, which extends from my heart through the arch of the aorta, almost to my leg. It was only after changing physicians that I discovered what a danger the wire presented. Since no one in the Pittsburgh wants to inherit a problem caused by another, I was referred to the Mayo Clinic, where I'm hoping for a miracle.

I'm braced for the fast-food care I've already experienced — I've been in a lineup of beds waiting for surgery, separated by a thin curtain from the patient next to me, hearing every detail of his upcoming prostate surgery. I've been the practice dummy for the trainee who blows two veins trying to put in a IV. I've had the "bag of rags," a no-rinse, dry-on-the-skin morning cleanup.

I'm in for a surprise when I get to Mayo.

There are no grand entrance ways; the buildings are pleasantly modern, yet prim. A subterranean system reaches Mayo's 14 buildings from any hotel in the area. Patient appointments are amazingly prompt in spite of huge waiting rooms that can accommodate as many as 400 people. My physician is one of a team that performs angioplasty, stent placement and catheter ablation, a treatment for heart arrhythmia.

As Dr. Rick Nishimura greets me, I notice that his suit is elegantly understated, yet he wears a plastic watch that I find out later is part of the Mayo dress code — suits, ties, no ostentatious jewelry, conservative haircuts, no facial hair or earrings. Even the pharmacists at Saint Marys Hospital, a hospital within the Mayo Clinic system, wear coats and ties.

Dr. Nishimura has reviewed my records and has a plan to work with Dr. David Holmes, head of the cardiac catherization lab who has invented many methods of retrieving foreign objects from the heart. Dr. Holmes will attempt to remove the wire, using both the right and left femora arteries in my groin.

On Wendesday I arrive at Saint Mary's Hospital at 6 a.m., A nurse assigned to stay with me during the entire procedure informs me of every stage of readiness so that waiting does not turn into anxiety. Admittedly, I am anxiety-crazed about the process. The very thought of a tube inserted in my groin, making its way up the femoral artery into the aorta, then into my heart, brings a specter of complications. As a diabetic, I have to be cautious about the effect of the dye on my kidneys, or that heparin might cause a retinal hemorrhage and blindness.

The wire is so thin that special equipment is needed to see it. Dr. Holmes will work with another specialist using a small microphone dropped down my esophagus behind my heard, transmitting a picture of the guide wire on a screen. Both physicians will coordinate the device with a retrieval instrument inside the coronary arteries.

Everything is done for my psychological comfort. A specially designed paper sheet insulates me from the chill of the lab. Everyone involved in the procedure is unfailingly pleasant.

As I float in the delirium of anesthesia, the laboratory looks as if it were illuminated by a blue flame. I drift in and out of prayer to survive.

After the procedure, Dr. Holmes calls my sister in the waiting area, telling her that the wire was successfully removed from the thoracic aorta. A CT scan the next day will determine if any wire is still projecting out of the left main artery. The he adds, "Thank you for coming to Mayo." My sister is taken aback by the understatement; inherent is the notion that the doctor, too, has benefited, a far cry from the haughty attitude of some care-givers who see themselves at the center of patient care and don't realize that both have been enhanced by the patient's recovery.

Back in my room, two nurses come to care for my incisions. Exhausted from the ordeal, I lie immobile and distressingly awake. To ease my discomfort, nurses roll me on my side and give me a back rub.

This is one of many well-thought-out, patient-centered services that local hospital strangled by HMOs can no longer provide. Indeed, everything seems "engineered" for patient comfort, because each nurse is assigned all the duties related to a patient's care. The various tasks of the staff are not fractured into one person to take your vital signs, another to give medication, a third to fill your water pitcher, with each one making a different entry into your room just as you drift off to sleep. A good night's rest for patients is a priority.

Personnel appear to address needs without asking. I had only to mention that I was thinking about an insulin pump when a staff member of the diabetes management department emerges with a videotape and a packet of information. Trays appear instantly, as soon as I'm able to eat after my procedure. Two ladies show up the next morning to assist with a shower. A row of sparking sinks lines the hallways to encourage rigorous hand washing.

The treatment seems luxurious in light of today's spartan hospital care. but it is not without cost. The Mayo Clinic is not held hostage by insurance companies and does not compromise patient care by accepting as payment in full an insurance carrier's "usual and customary" reimbursement. Even though Mayo has signed agreements with HMOs, it appears most of the patients are senior citizens or foreign-born who must arrange for payment in advance of treatment. Even though my bill will be negotiated between Minnesota and Pennsylvania Blue Cross, I expect to assume some of the cost for the valuable, life-saving experience I received there.

Mine was a good tenure at Mayo, beginning with the nurse who held a gown in front of her face so that I could put mine on, unseen. When I thanked her for her honoring my unspoken anxieties about privacy, she confided, "I'm conscious of my weight; I know how it is to feel exposed." Exposure, discomfort, are the very elements everyone has tried to eliminate. Compassion is the healer here, one person's reaching out to lift a little of the suffering from another.

Pittsburgh Post-Gazette, January 4, 2000
Used with permission of the author