Face to face with the horrors of the U.S. health care system

"I think I have the swine flu, " I told the admitting nurse in the emergency room of a Las Vegas hospital two weekends ago.

The nurse stuck a thermometer under my tongue and clamped down my left arm with a blood pressure monitor strap.

"It is painful when I breathe," I said.

"Where do you feel the pain?" she asked. I told her it's right in the middle of my chest. "The pain traveled from the top right side of my ribcage," I told her, "and on my back directly behind it, until it traveled to the center of my chest. Then the pain in the other places was gone."

The nurse hurriedly wheeled me into one of the emergency rooms and then I saw Nurse Ratched of "One Flew Over the Cuckoo's Nest" masquerading as a doctor. "You don't have swine flu," she sternly corrected me, "you don't even have a fever."

She ordered an ECG (electrocardiogram) on me and soon a young Filipina technician was wheeling in an ECG machine and fitting me with its wiring. A phlebotomist came in to stick a needle in me, then I was rushed to the x-ray department, which I had all to myself - there were no other patients there at 4:30 in the morning.

About half an hour later, Doctor Nurse Ratched came back and told me I was not having a heart attack - all the tests were negative.

I could have told you that, I thought. Who said anything about a heart attack? "I have all the symptoms of swine flu, including the diarrhea - except for the fever," I told the doctor. "It never felt like I was having a heart attack," I said in triumph.

I thought I would put the doctor slightly to shame. Instead, she said: "We'll admit you anyway for a one-day stay just to be sure. We also want to do a nuclear stress test on you this morning."

The controlling Dr. Nurse Ratched was at it again. Was she being cavalier with the people's money, knowing that Medicare had my back?

I was brought into a private room on one of the higher floors, given a tranquilizer and was out till about eleven.

I was released that day with the doctors knowing that I did not have a heart attack. They still did not know what was wrong with me. They suggested I should see my primary care physician right away.

As I should have expected, my primary care physician was on vacation, so his assistant - a physician's assistant (PA), not a doctor - saw me. She recognized right away that I had had an asthma attack and I was still having one right there at her office.

Asthma was my second choice, after swine flu. After all, I had taken my wife Paulita and Paul to Zion National Park in Utah, where there were a lot of trees and strange high-desert plants. I must have picked up some strange allergens in Utah, I told my PA, whom I actually liked. She's a very likable person. She has a ready smile, in sharp contrast to my primary care doctor who has personally seen me only twice since I moved my family to Las Vegas two years ago. Both times, he saw me for two minutes - including the time he spent writing my prescriptions.

I filled my asthma prescriptions at my favorite Walgreens and went to work. I started taking the Prednisone pills, started using the Advair inhaler, and every time I felt tightness in the chest I puffed in a couple of Albuterol inhaler puffs.

I noticed that I had begun to have occasional skipped heart beats, but I was not worried because my medication, Sotalol, had reliably been my ally every time I had those occasional missed heartbeats.

Four days later I was in the emergency room again, this time at the St. Rose Hospital. I didn't want to go back to the first hospital to be treated by Dr. Nurse Ratched again, with a full-blown atrial fibrillation episode. For those who are not familiar with atrial fibrillation, it is when you feel there is a tiny mouse that is going around and around in your heart. The upper portion of your heart is out of rhythm with the lower portion because that upper portion is beating faster than the lower portion.

I was not scared because I'd had those episodes before and I always came out of those like I had just gone ten rounds with Mike Tyson, but having already taken a four-hour nap. No big deal, just an honest day's work at the office.

I am not telling you this for your sympathy - though that might be unavoidable - but to illustrate to you what is wrong with the American health care system.

The doctors at the first hospital that admitted me, knowing that I was not having a heart attack, should have tried to reach a correct diagnosis. They didn't. They had already done all those expensive procedures on me so they knew the hospital and the doctors, lab technicians, x-ray technicians, etc., were going to be paid. Plus they had their behinds covered. I could not later come back and sue them for not being thorough.

Our health care system compensates doctors and hospitals and laboratories for procedures done, not for actually having cured or helped the patients. It's like we all went to school and got A's for effort, not for having actually demonstrated that we had learned anything.

I don't usually agree with former President George Bush, but I like his tort reform idea. I think there should be a limit to jury awards and settlements in medical malpractice cases. The main reason doctors order many unnecessary tests is to protect themselves from malpractice lawsuits. Some doctors have had to pay tens of millions. The limit should only be $1 million for the most serious malpractice cases.

If I were President Obama, I would suggest however that a special court shall be set up to try cases where there is evidence of gross misconduct to determine what the proper compensation to the victim or the victim's family should be. But those cases should be the rare exceptions.

The physician's assistant who prescribed all those asthma medications, which were all steroids, should have known that deep in my medical history was evidence that steroids had caused irregular heartbeats that progressed to a full-blown atrial fibrillation.

If as President Obama has suggested medical records in this country had been computerized and available on the Internet - but only to authorized persons - my physician's assistant would have known that there was a better than even chance that my heart would go into a full-blown A-Fib condition with the use of the asthma drugs. Perhaps, my PA would have temporarily increased the dosage for my maintenance medication for irregular heartbeats. Or, she might have changed my medication to something stronger to counteract the asthma steroid medications.

Or, sensing the very real danger, she might have given me a different set of asthma medications - ones that may not be as powerful, but are not based on steroids.

The doctors in New Jersey, where I spent 30 years of my life, all knew my special sensitivity to steroids, but because medical records are not computerized, there was no way my PA or my doctor could have known that. I guess I should have told them, but it did not occur to me to tell them because I wanted the asthma drugs and was willing to take a chance.

I was happy with the treatment that I got at St. Rose Hospital, especially since I was assigned a cardiac nurse who not only knew what she was doing but had cardiac issues herself and was clearly empathetic.

I had some anxious moments, but on reflection the doctor at St. Rose did all the right things and controlled costs by not ordering unnecessary procedures that would just increase the cost to U.S. taxpayers without adding to the treatment. The St. Rose doctor waited till my blood pressure sufficiently rose (it had been very low throughout) before giving me a brand-new medication (Metoprolol Tartrate) to put my heartbeat back in rhythm. She also gave me a Xanax to put me to sleep.

When I awoke a couple of hours later, my heart was in sinus (normal) rhythm.

Ten Most Embarrassing Moments in Cesar Lumba's Life

By Paulita T Lumba

My husband, known to his friends as "Chay" and to his acquaintances as "Cesar," can be an Inspector Clouseau in social situations. Part of the reason, I'm sure, is that he is so confident of himself and is used to getting away with a lot of things that most people can't get away with. He seems less careful than most about his behavior even in certain very sensitive circumstances.

He doesn't get embarrassed easily, but does so upon reflection. Many of his embarrassed reactions are delayed reactions. It is only after he asks himself - or me - if what he did was embarrassing that he actually feels embarrassed. Once he gets into his self-analysis kick, he can't let go. Every time he remembers his embarrassing moment, he literally shivers like electricity passes his body.

1. The fried chicken. The wife of one of the prominent Filipino doctors who lived in Westchester County, New York, invited us and a few Filipino community activists for a merienda meeting. On entering the family room next to the kitchen, Cesar saw that there was a dog sitting on the sofa. As the guests sauntered in, the dog rose from its slumber and left the room.

Cesar put some fried chicken and potato salad on his plate and sat on one of the chairs in the family room. As soon as he sat on the chair, Cesar took the drumstick on his plate and started to smell it. Not satisfied, he looked at the soles of his shoes and started sniffing, very obviously trying to find out if he had stepped on dog urine, or worse, dog poo.

Everybody in the room was looking at him. Some were mortified. Nobody was eating.

The community-activist wife of the prominent Westchester county doctor never invited us to their house again.

2. The carpet or the dress. I did not witness this, Cesar just told me this story. Once, when his first wife threw a party in their house, Cesar got so tipsy that his judgment was impaired. He was holding a glass of wine when he lost his balance. He had a choice - would he let the wine spill on the carpet, which was brand new and gleaming white, or on the dress of one of the guests, who was sitting nearby? He chose to let the wine pour on the guest's dress.

Later, Cesar's wife asked him why he let the wine pour on the dress instead of on the carpet? His reaction was, "Was it obvious?"

The poor guest never went to their house for any subsequent parties ever again.

3. The "world famous" buffet at Palace Station. My close friend from way back was sent by Philippine Airlines to Las Vegas for training. She and her husband had hosted a very expensive dinner for us when we were in the Philippines the previous year, so we showed my friend the town and I had taken her shopping.

Cesar suggested that our dinner should be at the Palace Station, where O J Simpson had been caught in a hold-up fiasco, and which advertised "the best buffet in town" for only $6.95 per person. Cesar felt that our guest should get the real flavor of Las Vegas by having dinner at a buffet restaurant.

When we got there, a part of the restaurant was under renovation, and there was hardly any food left. Even our son Paul thought the food "sucked." I was so embarrassed I made it a point to take my friend the following day to one of the more expensive restaurants in town. This was one time Cesar's embarrassment was not a delayed reaction. I saw that he was very uncomfortable throughout the meal.

4. The Tank Top at a Business Meeting. Cesar and his friend Dong Guinto had a scheduled meeting with a large printer in the Philippines whose printing facilities the two were examining because they had an order to print hundreds of thousands of copies of prospectuses.

It was so hot in the Philippines at the time, so Cesar decided to go really informal. He wore his favorite blue tank top - "sando" to Filipinos - and his khaki shorts. He and Dong talked with the owners, had a meeting with them in the conference room all while Cesar was in his tank top and shorts.

Later Dong related to me that Cesar's armpit hair was sticking out all through the meeting and the tour of the facilities and that Dong was embarrassed for him. It was only then that Cesar felt the embarrassment. To-date, every time he remembers his blue tank top, he makes a smacking sound with his mouth, and he hits himself in the head.

5. The "I've Got You Under My Skin." Cesar has talked about this many times. He was introduced as the Frank Sinatra of La Salle in one of the largest gatherings of his alma mater's alumni association. He started off his "I've Got You Under My Skin" quite well, even got a huge ovation, but as he kept singing, it became clear to everyone that his singing was not in sync with the melody. When he stopped, the music was still playing.

The audience didn't know whether to clap or boo. Cesar was nowhere to be found. He let many minutes pass before sneaking back into his seat next to me in the auditorium.

6. The Hawaiian shirt. I was out of town when the mother of Cesar's sister-in-law passed away, so my version of the story is only from what I could piece together. At the Catholic Mass prior to interment, Cesar showed up in Church wearing a Hawaiian shirt. Everybody was wearing a dark suit or a black dress, Cesar had on a green Hawaiian shirt.

His nephew and niece came up to him and asked him why he was wearing a Hawaiian shirt and Cesar said when he left the house that morning, he had forgotten that he was going to a wake. He thought he was going to a prayer session for someone who had already been buried.

7. Wynn or Nanay Gloria's. My heavy-hitter friend and her husband were in town. Since we had been taking them around Las Vegas for the last couple of days, they decided to treat us to the very expensive and famous buffet at the Wynn.

I don't know what got into Cesar's head, but he suggested that we should try Nanay Gloria's instead, a Filipino turo-turo (buffet) restaurant. When we got there, it was packed and there was no place to sit. We had to wait for people to leave before we could find a place for ourselves. Our guests did not like the food and got very little food for themselves.

Our son Paul hated the place and refused to go inside, so Cesar every now and then had to go outside and check on Paul. It was our last meal together with our friends and instead of having a memorable one at the Wynn hotel and casino, we ate like the Japanese did during the 2nd World War, when American bombs were raining on Tokyo. We gulped down our food and were out of there in a minute.

8. The "pregnant" client. When Cesar was still in the insurance business, he had a husband-wife client who had been recommended to him by one of our close friends. The woman was our friend's niece.

When Cesar saw the niece, he asked her if she was pregnant. She said no, she wasn't pregnant, just fat.

9. The third-place finish. Cesar thought he had a great speech, many of his Toastmasters teammates thought it was a great speech. When the judges' decision was announced, Cesar's name was called first - a third-place finish in a contest where there were only three contestants.

Cesar literally sank in his seat, didn't rise until his name was called again. It was his most embarrassing moment in his Toastmasters career and the only one of his contests that I and our daughter Natasha attended.

In his speech Cesar talked about how proud he was whenever he saw his father cleaning and polishing his father's long-nosed 38 caliber pistol at the window of their house in Santa Ana, Manila when Cesar was growing up. The massacre at the Columbine happened on the day of the contest, and I don't think the judges liked the fact that Cesar's speech seemed to glorify gun ownership.

10. The bubble. This one happened when Cesar was thirteen. It was the first dance party he had attended. He was dancing the slow drag with this cute little girl in the middle of the living room. He remembers telling the girl a joke that he found very funny. He laughed at his own joke and a bubble grew and grew from one of his nostrils.

He turned around and walked away while the girl stood in the middle of the room.

I'm sure that Cesar has had many more embarrassing moments in his life because he can be klutzy and careless, but I'd say those were the top ten.