Spaulding Rehabilitation Hospital

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Responding To Relman: ‘Spaulding Gave Charlie His Recovery’

Yesterday we linked to Dr. Arnold Relman’s gripping near-death story of breaking his neck last summer, and the medical odyssey that followed. In it, Relman, the former editor of The New England Journal of Medicine, lavished superlatively high praise on Massachusetts General Hospital, where he was initially treated, but was much more critical of Spaulding Rehabilitation Hospital in Cambridge, where he spent about a month recovering.

That critique left some Spaulding patients (and their families) feeling perplexed and a bit slighted. Jeanette Atkinson, the wife of former Spaulding patient Charlie Atkinson, asked for space to offer another perspective.

Charlie Atkinson, 78, at home, is still recovering from West Nile Virus. (Courtesy)

Charlie Atkinson, 78, at home, is still recovering from West Nile Virus. (Courtesy)

Charlie was the subject of a recent CommonHealth post: West Nile Story: 400 Days In Hospital, A New View Of Health Care (And Life)

Jeanette submitted this “rebuttal” after reading Relman’s piece:

My husband, Charlie Atkinson, and I are in a particularly good position to respond to Dr. Arnold Relman’s article, “On Breaking One’s Neck,” since Charlie recently spent five weeks at Massachusetts General Hospital and thirteen months at Spaulding Long Term Acute Care Hospital in Cambridge and received spectacular care at both.

MGH saved his life. As Charlie (age 76 at the time) fell into a deep coma in August, 2012, doctors there inserted a breathing tube, started a ventilator, administered oxygen and drugs, inserted catheters, ordered tests, and worked around the clock to diagnosis his illness – which turned out to be West Nile virus of the most devastating kind.

After three weeks in Mass General’s intensive care unit and two in the respiratory acute care unit, he was stable enough to be discharged – but to where? He was tethered to respiratory machinery; he was almost completely paralyzed; he knew his name, but not where he was; and he would never have been able to maintain the rigorous physical therapy schedule at a place such as Spaulding Rehabilitation in Boston. He was still far too sick to be admitted to a regular nursing home/rehabilitation facility.

Spaulding Hospital, Cambridge, gave him his recovery. We’d never even known of the existence of “LTAC’s,” or Long Term Acute Care hospitals. Their range of services is much more limited (and far less expensive) than those of full service hospitals such as MGH, and much more focused on helping patients achieve a maximum quality of life while treating their on-going medical problems. Spaulding, Cambridge does that superbly. Continue reading

Must-Read: Dr. Arnold Relman On Lessons From Breaking His Neck

Dr. Arnold Relman on YouTube in 2009.

Dr. Arnold Relman on YouTube in 2009.

Dr. Arnold Relman, former editor of the New England Journal of Medicine, has long played a rare role in the health care sphere: He’s an exceedingly senior and authoritative Harvard figure willing to speak out about what’s wrong in American medicine, from financial conflicts to the need for health care reform.

Now, unfortunately, Dr. Relman has new, first-person lessons to share. In a powerful and compelling piece in The New York Review of Books — On Breaking One’s Neck — he describes the stairway fall that nearly killed him at age 90, and offers his assessment of the care he received at Massachusetts General Hospital and Spaulding Rehabilitation Hospital in Cambridge during his time as a desperately ill patient.  Among the lessons he shares:

What did this experience teach me about the current state of medical care in the US? Quite a lot, as it turns out. I always knew that the treatment of the critically ill in our best teaching hospitals was excellent. That was certainly confirmed by the life-saving treatment I received in the Massachusetts General emergency room. Physicians there simply refused to let me die (try as hard as I might). But what I hadn’t appreciated was the extent to which, when there is no emergency, new technologies and electronic record-keeping affect how doctors do their work. Attention to the masses of data generated by laboratory and imaging studies has shifted their focus away from the patient. Doctors now spend more time with their computers than at the bedside. That seemed true at both the ICU and Spaulding. Reading the physicians’ notes in the MGH and Spaulding records, I found only a few brief descriptions of how I felt or looked, but there were copious reports of the data from tests and monitoring devices. Conversations with my physicians were infrequent, brief, and hardly ever reported.

What personal care hospitalized patients now get is mostly from nurses. In the MGH ICU the nursing care was superb; at Spaulding it was inconsistent. I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.

Read Dr. Relman’s full piece here. One personal reaction: I felt a bit defensive for Spaulding; my late mother received excellent care at their Boston facility. But then I thought: If every patient — particularly patients with as much authority as Dr. Relman — routinely reported publicly on where the nursing care was great and where it was inconsistent, that could help lead to constructive change at the places where it’s needed. We often talk about care that falls short in personal chats, but hospitals need that feedback — and perhaps some of it should be public — to help them improve.

Readers, thoughts, reactions?

100 Days Later, Marathon Bombing Survivor Leaves Rehab

BOSTON — After 16 surgeries that included 49 procedures, Boston Marathon bombing survivor Marc Fucarile, of Stoneham, is going home.

Police rushed the 34-year-old to Massachusetts General Hospital 100 days ago. His skin still smoldered. Blood gushed out of both legs.

“His injuries include amputation of his right leg above his knee, multiple fractures of his left leg and foot, burn injuries to his legs, trunk, back and pelvis,” said Dr. Jeffrey Schneider, one of Fucarile’s physicians after he moved to Spaulding Rehabilitation Hospital. The list also includes a fractured spine, ruptured eardrums and multiple shrapnel wounds to Fucarile’s extremities and torso.

Marathon bombing victim Marc Fucarile speaks before departing Spaulding Rehab Hospital Wednesday. (Martha Bebinger/WBUR)

Marathon bombing victim Marc Fucarile speaks before departing Spaulding Rehab Hospital Wednesday. (Martha Bebinger/WBUR)

“Wow, I forgot how much it really was,” Fucarile said Wednesday, shaking his head.

When he arrived at Spaulding, Fucarile couldn’t even sit up in bed for any length of time. On Wednesday, he hobbled on crutches into the hospital lobby. Spaulding staff and Fucarile’s family members applauded. Fucarile smiled, but sobered as he recounted his ordeal.

“It’s just been tough, real tough, especially when my son’s home sick, Jen’s not sleeping,” he said. “At times I just want to check out.”

Fucarile glanced at his 5-year-old son Gavin and his fiancée Jen Regan. Their support, he said — along with all the cards taped to his wall, donations and hand-knit blankets he’s been sleeping under — have helped him through many nights of pain and motivated him to stretch new skin and shriveled muscles.

“I know that I have the rest of my life, thanks to the people who were there that day who helped me and saved me,” he said. “I’d go through 100 more procedures as long as I can be there to go home with him.”

Gavin smiled and giggled through most of Fucarile’s press conference. Regan, Fucarile’s longtime companion, joked that she’s been getting the house ready for his return. “We got a frontload dryer and washer so he can do the laundry in his wheelchair.” Continue reading