Assume the Position: Memoirs of an Obstetrician Gynecologist (23 page)

     One early summer day while poking around outside our mountain home wearing my old smooth soled boat shoes from years earlier in the Virgin Islands, I decided at that moment I had to go up on the roof. It wasn’t unusual for me to be on the roof of my home.  I tinkered, cleaned gutters, cleaned sky light windows, fixed loose shake wood roof tiles, in the winter broke up ice dams and snow raked the roof.  In general, my philosophy was that if I could do it myself there was no reason to pay someone else to do it.  I enjoyed caring for our property and being outdoors anyhow, rain, snow, sunshine or sleet.  I extended the ladder, placed it squarely against the back roof, and up I went.  The roof itself, at its lowest point, wasn’t that high above the ground from the back, maybe 10 feet or so, but from there up to the top of the vaulted ceiling where the sky lights were was a pretty good shot up.  I remember poking around the skylight, and I remember looking down at my boat shoes. They were probably slipping at that point.   The next thing I remember is being inside the CT scanner at the Telluride Medical Center.  I remember bits and pieces of the ambulance ride to St Mary’s hospital in Grand Junction, two and a half hours away.   I vaguely remember yelling at some doctor whom I didn’t know as she removed me from the operating table without performing the surgery that my wife had authorized.  Clearly I was not in control, and I later was told that I was not nice about it.

     My youngest son was in the kitchen watching television and eating breakfast at the time I flew by the dining room window, head first aiming for the ground.  He will tell you that I would do anything to avoid having him beat me in racquetball, which he has done once in his lifetime.  We had a match scheduled for later that day.  He was predictably quite distressed to see me plunge head first down in front of the kitchen window and was first on the scene to find me slumped on my back, unconscious and moaning.  He immediately called 911.  My wife trailed the ambulance up to our house, wondering the whole time where it was going. She was rather distressed to find it drove into our driveway. The paramedics apparently reassured my wife and son that I would live.  As for me, I was clearly in neurogenic shock with a concussion, unconscious for most of the next several hours, and heavily sedated with narcotics.  My memory of the whole event was clouded so that when I retell the story, I don’t have the same fear as those who saw me.  I don’t think it was pretty, though, and left a traumatic visual image for my son as I plunged downward headfirst.  My right wrist was shattered, my ribs were broken, and my right hip was fractured at the acetabulum.  Obviously I was concussed. The good news was my neck was not broken.

     Upon my arrival at the hospital, a pediatric orthopedic surgical physician was on call for orthopedic surgery. She determined that wrist and likely hip surgery would be necessary. She was about to prepare me for the wrist surgery. While on the operating room table, I was bumped in favor of a more serious emergency.  Of course I didn’t know that at the time, but in my lifetime I had never put a patient on the surgical table prepared for surgery, then took them off in favor of someone else.  So I got angry.  My excuse was the narcotic, although my wife continues to tell everyone it was just my personality because I wasn’t in control.  Whatever the case, the decision worked out for the best because the next day I got a specialist hand-surgeon who did a marvelous job, piecing me together with a metal plate and 11 screws.  It took them some time to decide whether to operate on the hip, and eventually they decided it would heal best on its own without surgery.  They made the correct decision.  So I celebrated our son’s birthday that year while sedated in the hospital.  I went home after two weeks with a cast and a specialized walker and wheel chair.  Getting me in the house was a challenge since I couldn’t negotiate the steps. Once inside, I didn’t go out for weeks.  It wasn’t fun but it was good to be alive.  Our oldest son came to visit a few weeks later. The two ‘boys’, big as they were, managed to get me outside and push me down the driveway and down Rocky Road for an outing in my wheelchair.  It was good to get outside.  They pushed for quite awhile. I think we all forgot that pushing me back up the hill at 10,000 feet was going to be a struggle, clearly not for me but for them.  It gave me some pleasure, though, to watch them struggle and fight for air as I sat in the chair.   I admired their determination when there wasn’t much choice.

    When friends came to visit or called, I frequently heard: “What were you doing on the roof? Jews don’t go on roofs”. I related the story to my brother, who in his own way with his dry sense of humor said, “What do you mean Jews don’t go on roofs? Haven’t you ever heard of ‘Fiddler on the roof’”? I smiled and felt validated.

     The CT scanner at the Telluride Medical Center has served the community and my family well.  After living in town for over a year, I had been asked by the Medical Director of the Telluride Medical Center to consider sitting on the Board of Directors.  The facility was in dire shape physically and organizationally. It was in huge debt to the Montrose Medical Center, which administered the clinic and emergency department. The emergency department was supported by a mil levy tax assessed on real estate in the Telluride Hospital District, essentially all of San Miguel County. Most if not all of the medical referrals from the clinic went to Montrose Hospital at the time, so it was in their financial interest to administer the Telluride facility. This facility was an old building owned by the Idarado Mining company. Board certified emergency medicine physicians had not yet been hired to the emergency staff.  There was no private money being raised on a regular basis other than sporadic donations to support the Center.  The Telluride Medical Center was the only medical facility in town and was an hour a half from the nearest larger hospital, and two and a half hour drive from the nearest trauma center with good cardiac and neurosurgical care. X-rays were inexplicably taking weeks to be read.  I learned that it wasn’t uncommon for someone to walk around town for weeks thinking they had a broken limb. Weeks later after the films were officially read in Montrose, the patient would receive a call that they could take their sling or cast off because the limb was not broken.  This kind of treatment didn’t foster confidence on the part of the locals.  This is the way medicine was practiced when I was asked to join the Board of Directors.

     There was a need for a Board of Directors because the mil levy generated substantial yet insufficient dollars from taxation to support emergency services. Community oversight of those tax dollars was necessary by law.  Interestingly there had never been a physician on the Board of Directors.  The Board members were all well -intentioned volunteers yet help was needed. So I volunteered to fill a vacated seat.  During my first Board meeting when I saw the bottom line numbers of the business spread sheet, I asked a question that evidently had never been asked before. I was curious as to how the bottom line debt on the books to Montrose Hospital was going to be paid back. No one had been concerned about it and there was no clear answer forthcoming to a growing monthly debt applied to the Telluride side of the ledger. There was also no accounting for the value of the referrals to the hospital going in the other direction.  No one was happy with the way the emergency part of the clinic was operating.  In general the place was not in good financial or physical shape. The carpets were worn and old, the walls and floors were in need of repair and paint.   Competent as the staff was there were too many of them for the volume being seen. Expenses to revenues generated were quite high.  Fortunately or unfortunately for some, I stirred the pot, which clearly needed stirring.

     About three months after joining the Board, Montrose Hospital exercised their right to withdraw from management of the clinic. The contract expired, and they chose not to renew.  It was unexpected and put the facility at risk for having to close its doors, despite skiing and head injuries, broken bones, heart attacks, car accidents, and just about everything else in the way of emergencies.   In addition they expected compensation for the bottom line figure of hundreds of thousands of dollars that clearly the Clinic did not have. If bankruptcy were declared it would leave the ski mountain and the town without medical services. Backs against the wall, medical communities feuding with each other, Montrose pulling out demanding money and leaving the facility with no internal administration, being on the Board suddenly became a full time challenging and uncompensated job.  It was the epitome of community service but it was also a service that the community could not survive without.

     The first order of business was to go through the hoops of applying for a mil levy increase on real estate taxes, which took time and some expertise to get the initiative on the local ballot before November. Then we had to find an administrator, and figure out what kind of staff changes needed to be made by year-end.  The mil levy funds, if successful at the ballot, could only be applied to the emergency services and not to the clinic.  So clinic staff had to be cut, a most unpleasant and unpopular task, but the volume of business wasn’t there to support the number and expense of all the personnel, no matter how talented and popular some of them were.  So cut we did, and the Board took the hit.

     Getting people to vote to increase their own taxes is always fraught with difficulty and usually failure. After all, who wants to vote to tax themselves for any thing?  For whatever reasons I became the public face of the campaign. I stood at the local post office corner day after day passing out flyers and talking to people about why the mil levy was critical.  Simply put, if defeated there would be no emergency care in Telluride.  Lives would be in jeopardy and lost. Who knew what would have happened to the ski mountain, the lifeblood of the town?   Everyone showed up at the post office almost daily since there was no mail delivery; people got their mail through boxes at the post office.  I began to be recognized as the Med Center guy.  I was on the local radio, in the newspapers, and at public election forums speaking out.  My fellow Board members said I had a silver tongue so I should just keep doing what I was doing.  I know I stopped the same people more than once to discuss the issues because it was easier for me to recognize everyone’s dogs than the people themselves.  When the final vote was tallied on Election Day the mil levy increase generated over a million dollars annually and won by 88% favorable vote.  The Denver newspapers picked up on the fact that of all the statewide mil levy questions on ballots in all the localities in the State this one won by the biggest margin. 

     We began to hire board certified emergency physicians.  A good group of concerned locals of whom I was a part started the Telluride Medical Capital Fund, which began as an annual wine dinner cooked by local chefs and a live auction.  Over the next few years due to generosity of many locals, we were able to raise another million dollars for much needed equipment, including the CT scanner, digital radiology and emergency room equipment.  This allowed us to send our x-ray films to Nighthawk in Australia where they were read instantly.  Even Montrose Hospital didn’t have digital radiology at the time.  We enlisted the help of a second homeowner cardiologist who volunteered his expertise and saturated the town and ski mountain with AED’s (defibrillators) paid for with donated funds, establishing Telluride as a shining example of how a ski mountain should be equipped in case of cardiac emergency. As a result, lives were saved.  It distressed me to read how cardiac deaths occurred in other ski areas because they lacked the installation of AED’s, or head injuries were managed incorrectly because they did not have availability of a CT scanner like we did. In short, the facility turned around and became self-supporting, sustainable, and continues to this day to provide excellent medical care to locals and visitors alike.

     So we got the CT scanner that has saved lives and made countless difficult diagnoses for townsfolk and visitors alike. I had no idea that I would someday be inside of it when it came to town.  My daughter wound up inside of the machine as well. From the time she was a little kid we used to race on the mountain.  If for no other reason than size and momentum I won for many years.  But with determination she kept trying and trying.  When she got older and became an excellent skier herself, she got closer and closer until one year when I was going as fast as I could and was on the edge she blew right by me.  I lost control.  I could hear her laughing with glee as she flew by. She missed me slamming on my brakes and flying off the side of the run into the trees in a great cloud of snow.  When I gathered myself up from one of my worst face plants ever, put my gear back on and crawled up the side of the run through trees and boulders, I realized how lucky I was to still be alive.  No more racing for me. She, on the other hand, progressed to Air Garden to tackle the jumps. On one occasion, competing with her brothers, she got so airborne that it was obvious to me while she was airborne that she was not going to land on her skis, which she didn’t.  Fortunately for her, a trip to the emergency room and inside the CT scanner revealed only a concussion and nothing more serious, although to this day she still says her wrist is not quite right.

     Although not actively practicing medicine but still with an active medical license in Colorado, and the only Board Certified OB-GYN in the County, I wanted to be called by the ER doctors if they ever had a need in the emergency facility for my obstetrical services. I volunteered for any obstetrical emergencies at the Medical Center. I had no malpractice insurance since I was not practicing clinical medicine, but I figured that in an emergency and acting as a Good Samaritan I really didn’t have too much to worry about.  My presence for deliveries was only needed twice during the years.