Example essay

I show up for my patients. Commissioners Cagle and Ramsey, show up for Ben Taub.


A few months ago, while working night shifts at Ben Taub Hospital, I received a page from one of the internal medicine residents I was supervising. Night shifts have their busy times and their lulls, and the resident surprised me during a quiet period. On the phone, she told me that one of her patients kept calling the nurses, telling them he was having a heart attack. The man had been admitted for an entirely different problem, a urinary tract infection.

The resident quickly relayed to me the patient’s history, the quality of his symptoms — including the fact that the pain started immediately after his last meal — and the results of the electrocardiogram and blood tests. At the end of his presentation, I asked for the evaluation. “I’m not too worried,” she concluded. Finding nothing to fault with his reasoning, I agreed, and so we both quickly came up with a plan of care for the rest of the night. “I’m a few floors down in my office if you need me,” I told him. I hung up the phone and immediately turned my attention to the computer screen on my desk in Ben Taub, from which I had been streaming an episode of “Better Call Saul.” My heels fell into their usual place next to the monitor as I began to settle in for the rest of the night.

It is easy in such a circumstance to evade one’s duty. My job was to be available to the resident throughout the night, which meant checking with my own eyes and hands that the patient was receiving the proper care. But in medicine, as in all professions where you are responsible to people, you can forget the essentials, or even harbor illusions. During the residency, one of my colleagues said to me, “You can speak as you wish.”

Earlier this month, two Harris County commissioners, Tom Ramsey and Jack Cagle, talked each other out of showing up for a budget meeting. In doing so, they effectively vetoed a measure that would increase the budget of our county’s public health system, Harris Health, by approximately 2%. Harris Health
provides more than $2 billion in health care
locally in clinics and hospitals like Ben Taub, which is the flagship of the public health system. Property taxes provide $780 million of the health care system budget. Commissioners Ramsey and Cagle argue that the resulting $45 million shortfall would not affect patient care at Harris Health. In reality, such a drastic reduction would cripple the system’s ability to provide quality care to the thousands of residents who depend on it for emergencies, for routine medical visits and everything in between.

We have been here before. In 1964, County Judge Bill Elliott, a Republican, found himself caught in a similar dilemma. At the time, the budget for Houston’s charitable hospitals, Jefferson Davis Hospital and Ben Taub Hospital, was split between the city and the county. Neither of them wanted to give an inch. Conditions in hospitals have deteriorated so badly that one of Jefferson Davis’ volunteers, Jan de Hartog, a playwright and former Nazi resistance fighter, wrote an exposé called “The Hospital” that chronicles the effects of underfunding.

When the dire conditions became public knowledge — de Hartog reported staph infections in the maternity ward and a cockroach crawling around a patient’s tracheostomy tube, among other violations — Elliott could have toed party lines and denied that something was wrong with the hospital. Instead, he visited himself, incognito, as a volunteer. What he saw shocked him enough to support a new taxing authority to fund a hospital district. In 1965, after four earlier referendums were defeated, Houstonians voted in favor of a property tax to support those who could not afford private health care.

Much has changed since Elliott’s visit to Jefferson Davis Hospital. Our public hospitals are no longer decrepit. Harris Health has become one of the nation’s leading safety net systems. In 2014, Ben Taub Hospital recorded the nation’s fastest average ‘balloon gate’ time in treating heart attacks. “Door-to-Balloon” measures the time it takes for a hospital to identify a heart attack in the emergency room and open the blocked coronary artery with a balloon or stent; the shorter the time, the better. The hospital has also been praised for its treatment of strokes and trauma, while having to provide care for more patients. Houston’s rate of uninsured is the highest in the nation, a trend worsened by the pandemic and the
state reluctance to expand government-sponsored Medicaid
. Add to that the increased demand and spending on nursing during COVID and it’s clear that Commissioners Ramsey and Cagle are asking for the impossible: that our public health care system provide high-level care to more people with the same amount of funding.

Harris Health already operates one of the most airtight vessels in the country. A New York Times report ranked its hospitals as the
second cheapest
nationally. Asking Harris Health to cut costs further risks shooting itself in the foot. Take the example of kidney disease.
A 2007 study performed at Ben Taub and published in “Texas Medicine
” showed that dialysis treatments in the emergency room cost four times more than when scheduled three times a week in a dialysis center. Patients whose dialysis sessions are canceled end up going to the emergency room to receive the treatment. They have to do it to survive. In fact, it is their right: the Emergency Medical Treatment and Labor Act, or EMTALA, guarantees everyone, regardless of nationality or ability to pay, the right to receive emergency medical care. in a life or death situation. Without a budget increase to offset rising costs, Harris Health says it could be forced to close clinics that help prevent emergency room visits and save county funds. Not only would we be putting these people at risk, but we would also be wasting taxpayers’ money.

Ramsey and Cagle aren’t the first politicians to doubt the importance of our public health care system to the city. In 2001, then Texas Attorney General John Cornyn
Harris Health for providing health care to undocumented immigrants who could not afford private health care. A year later, while visiting one of Harris Health’s clinics during his campaign for the U.S. Senate, Cornyn
resumed his words
“It’s only humane and more cost-effective to provide preventive care in clinics like this than to simply have [undocumented immigrants] clog emergency rooms after they have become much sicker and much more expensive to treat.

It’s time to put politics aside and think about the economic and social benefits that a publicly funded healthcare system like Harris Health brings to our community. We all have our political leanings. For example, my wife works as a communications consultant for Harris County Judge Lina Hidalgo, who supports the increase. However, I happened to vote for Ed Emmett in the last election, partly because he
visited the medical area of ​​the NRG Center
set up to help survivors of Hurricane Harvey. One of the reasons I intend to vote for Hidalgo this time around is that I fear his opponent, who has a background in corporate finance, will
follow the example of other local governments
and sell Ben Taub and LBJ to a private equity firm. There is no doubt that this budget increase is impacting me, not necessarily financially – Harris Health does not pay me directly – although an increase would give me a more stable environment in which to practice medicine.

On the other hand, I am also a property tax payer who does not hesitate to pay more each year. In the final calculation, I don’t mind paying more taxes to an institution like Harris Health. I have chosen to work there for the past 12 years because I believe in its value to the community. I have witnessed its impact on lives. I know that people who cannot afford healthcare receive solid scientific and personal help at Ben Taub. Assertive African American and white patients tell me they only visit Ben Taub because they trust the doctors and staff, a far cry from Bill Elliott’s visit to Jefferson Davis. Harris Health is exactly the type of institution we should support with our tax dollars.

And so, I would like to invite Ramsey and Cagle to come with me on a visit from Ben Taub. I would show them around the nursing units so they could see how friendly and professional the staff are towards each other; the cleanliness of the hospital; how a very high level of medicine takes place here. I also showed them the patients who were temporarily boarding the hallways and how full the emergency room was. I’d be sure to point them to the “Code Purple” and “EC Saturation Level One” ads, not to mention the 10-second recording of Tina Turner’s “Simply the Best” every time a COVID patient leaves the clinic. hospital while breathing. I would highlight the travel nurses and those who worked seven days in a row. I would take them to the Riverside Dialysis Center, the busiest in town run by Harris Health, and ask them which of these patients we should ask to visit the ER every four days. I would let the hospital speak for itself.

And if a resident called me to check on a patient with chest pain, I wouldn’t hesitate. “Wait here a second, Commissioners,” I said, so I could get hold of the person, as I had done with the patient with chest pain that night. Showing up at his bedside made a difference for him, especially when I explained why I thought he wasn’t having a heart attack. Your presence, Commissioners, would make all the difference for taxpayers. It is our job, after all. We would do our duties together.

Ricardo Nuila has been practicing medicine at Ben Taub Hospital as a hospitalist and teacher since 2010. He is an Associate Professor at Baylor College of Medicine, where he directs the Humanities Expression and Arts Lab. His opinions do not represent those of Baylor. His book ”
The People’s Hospital: Hope and Danger in American Medicine
will be published by Scribner in March.

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