Sunday, November 18, 2012

On mixing religion and medicine

Chaplain’s uninvited appearance
poses issue in hospital care

Does ministerial access violate privacy?

It is a few minutes before the scheduled 1 p.m. surgery, and I’m sitting in a private patient-prep room – hospital gown on, a warmed blanket over me from chest to knees, the IV line in my left arm secured by tape as I wait out the clock.

If there’s a time to be tense,  perhaps it is these last minutes when you wonder – is this the right decision... will the surgeon find something unexpected as he fiddles around inside the abdomen... will the anesthesiologist hiccup? Really, surgery is a crap-shoot. The odds are very good you’ll wake up afterward just fine, if groggy from the sleepy drugs and a little morphine, and go home three or four days later.

And that’s when the unexpected happens. It’s about five minutes before one when the man in a dark suit appears in the doorway, looks down at the folder of patient paperwork and then at me, inquiring: “Is your name David? David Ettlin?”

“Yes, I am,” I reply, wondering who might be this stranger whose immaculate suit set him apart from the scrub-attired medical team.

He introduced himself as the chaplain on duty. Politely, I hope, I told him, “No religion, please.” And he departed.

Friends who kept up with my Facebook posts know which hospital this is, but for now I’ll skip the name. Suffice to say it is an institution operating under the umbrella of the Roman Catholic Church – and which I chose largely because that’s where the excellent surgeon I wanted happens to practice, and I’ve heard good things about its quality of care. (A few years ago, before completion of its modern high-rise patient tower, a friend spent two weeks there and had excellent care, although that came after an agonizing three-hour wait to be seen in the emergency department as his appendix ruptured.)

My quibble is about the religion part of this – about which a new patient evidently has no advance knowledge – and I’m curious how others see it.

I sent a carefully-worded letter of concern to the hospital CEO and its senior vice president for operations which read, in part:

[This] is, of course, a hospital operated under the umbrella of a church, and religion has a desired place for many of its patients. But I would not expect an uninvited visit from a chaplain in a restricted medical area, or that he would have felt entitled to look for my name on the patient folder. If I had signed any paperwork that allowed for such an intrusion, I did not notice – for I would never have consented to it.

I have no doubt the chaplain meant well.  But perhaps the hospital needs a specific way for patients to knowingly request -- or refuse -- the presence of a chaplain in areas that are otherwise restricted except for patient-care staff and designated personal visitors, and particularly in such a place where a patient is at his or her most vulnerable.

Another chaplain stopped by my room a day or two later. I also told her, “No religion, please.” Her presence  was  unnecessary, of course, had the hospital noted patient preference. But at least it seemed a little less intrusive, given the place and time – a private patient room during a normal recovery after surgery. And it was less surprising in that context – my having experienced (and rebuffed) chaplain inquiries many years ago in a few stays at other hospitals.

Not being a legal scholar, I have no idea how such practices may fall under the federal HIPAA rules that over the past decade have changed procedures at every level of the health-care industry and wrought a burden of paperwork. I got dizzy trying to comprehend the HIPAA rules governing “incidental uses and disclosures,” but suspect the uninvited presence of a chaplain in a restricted treatment area could be problematic.

Two weeks later, I have received a reply – not from the hospital CEO or operational vice president, but from a nurse whose title is “risk manager” in its Office of Risk Management and Patient Safety. She offered an apology “if you feel we were not sensitive or respectful to your wishes not to utilize pastoral services, as I can assure you that was never our intent.”

But my concern was not about sensitivity – it was about privacy, and the expectation that anyone taking a role in patient care in a treatment area would be part of the medical staff: Doctors, nurses, technicians. The hospital sent a chaplain who, five minutes before surgery, appeared in the doorway and looked at my file.

Here’s what the hospital said on that subject:

The chaplains... are an integral part of the healing team and participate in multidisciplinary/interdisciplinary team meetings. This is done to enhance patient care and patient safety as we are a faith-based organization and believe that healing happens at all levels of mind, body and spirit. Our chaplains are assigned to patient care areas and visit all patients within that specified area regardless of religious practice.

As a patient at [the hospital], you and your family have the right to decline a chaplain’s visit. But as [hospital] employees, with a primary role of patient care, chaplains do have access to patient charts and patient information and do serve in all patient care areas of the hospital.

Under HIPAA,  your rights would have been violated if your patient information was shared with any [non-hospital employee] or person not involved with patient care. But again, the chaplains at [the hospital] are a part of the patient care team so no HIPAA violation occurred.”

Well, I wasn’t going to make a complaint to the government about this – just to the hospital to raise the question and suggest it might be better to ask the patient in advance about authorizing chaplain access. The hospital said in the reply that patient and family have “the right to decline a chaplain’s visit,” but that “right” was not offered before the chaplain showed up – and in my opinion the chaplain service should not have had access to my patient information without my explicit approval.

That said, I add that the hospital otherwise far exceeded my expectations in its quality of care – except, of course, in the food. There is nothing to recommend in the liquid diets, and the eventual upgrade to real food was less than inspiring.

But from the most senior nurse to the community college student delivering the food tray, everyone had a patient-focused upbeat attitude and friendly smile. That, better than prayer, facilitates healing.

Wednesday, November 7, 2012

On buying a presidency

Ten bucks at a time,
my political donations
prove well-spent

I donated $58 to the Barack Obama campaign.

In return, I received three bumper stickers, a VoteObama car magnet, and a barrage of email messages thanking me for my support – and asking for more.

I also got this: The re-election of a president who largely shares my values and will, I believe, make the United States and the world outside it a better place.

I have never met Barack Obama, or even seen him in the flesh – and don’t expect to.

 But I got more bang for the buck than any of the millionaires and billionaires who pumped far more money into the campaign of Mitt Romney – although their financial backing of some conservative causes on local ballots around the nation may not have been so futile.

Money can buy an election, no doubt. That’s why, a few dollars at a time, I joined millions of other small donors backing Obama. The suggested minimum donation in most of the emailed appeals was $13 – although many had click-on options starting at $10. And by “saving your payment information,” the process would be a lot quicker – and, trusting soul, I let the campaign site have my credit card number.

Not that rich folks weren’t backing Democrats. I’d love to know the statistical breakdown in the money behind the two campaigns, through both reportable direct donations and the hidden money funneled through Super PAC organizations.

My $58 was a droplet in the hurricane of cash that blew well beyond a billion bucks in the cost of the 2012  presidential election.

The emails asking for money landed almost daily in my in-box, the senders varying – campaign officials Jim Messina,  Yohannes Abraham, Jen O’Malley Dillon, Rufus Gifford. Sometimes it would be Joe Biden (my favorite email subject line was his one-word “Malarkey”), Michelle Obama, or Barack himself.

At 12:45 this morning, 10 minutes before Romney’s concession speech and about 45 minutes before Obama’s victory speech, I received my last email from the President:

David --

I'm about to go speak to the crowd here in Chicago, but I wanted to thank you first.

I want you to know that this wasn't fate, and it wasn't an accident. You made this happen.

You organized yourselves block by block. You took ownership of this campaign five and ten dollars at a time. And when it wasn't easy, you pressed forward.

I will spend the rest of my presidency honoring your support, and doing what I can to finish what we started.

But I want you to take real pride, as I do, in how we got the chance in the first place.

Today is the clearest proof yet that, against the odds, ordinary Americans can overcome powerful interests.

There's a lot more work to do.

But for right now: Thank you.


Obama probably didn’t write that message. But I like to think that’s what he would have said – and I hope he keeps the promise, and keeps in touch.

Friday, April 6, 2012

Baseball: Hope Springs Eternal

At least in Double-A,
the home team
shows much promise

Baltimore beats Washington through
minor league proxies in season opener:

Bowie Baysox 4, Harrisburg Senators 2

Play Ball!

Yup, it’s that time of the year – when an old newspaperman’s fancy turns to baseball, and temperatures plunging through the 50s aren’t cold enough to keep him away from “opening night” at Prince George’s Stadium where the Bowie Baysox launched their 20th season and a couple of homeruns in a 4-2 win over the Harrisburg Senators.

It’s Double-A baseball, made memorable this cold early April night by the debut at this closely-watched level of Manny Machado, the shortstop of major league Baltimore Orioles future. In his first at-bat, on the first pitch he saw in Double-A, Machado powered a homerun over the fence in left-centerfield. He also hit a line-drive single in his second appearance at the plate, and stole second.

The Baysox starter, Tim Bascom, pitched six strong scoreless innings – handling a Harrisburg lineup that included two powerful Washington Nationals hitters on rehab assignments after being injured in spring training: Rick Ankiel and Michael Morse.

Ankiel, as designated hitter, walked on four pitches in the first inning – the toughest for Bascom, as he had already given up a one-out single and a stolen base to Jeff Kobernus. But Morse looked at a third strike, and Destin Hood grounded out to end the inning.

Ankiel and Morse both were replaced after the Senators batted in the sixth inning – each with three plate appearances and a pair of strikeouts. Ankiel twice struck out swinging, while Morse went down swinging in the fourth inning and grounded to short in his final appearance. They accounted for all of Bascom’s strikeouts. He ended the evening having given up a walk and three hits – although the Baysox defense prevented at least two others with diving catches of sharp, low line-drive hits to third and center.

Another top Oriole prospect, Jonathan Schoop (whose name was pronounced “Shope” by the P.A. announcer), who is making an adjustment from short to playing second base, handled the position well as he made several outstanding catches.

The Baysox did not make a single error, but catcher Caleb Joseph was charged with a disputed passed ball that accounted for the Senators’ first run in the eighth inning. Hard-throwing relief pitcher Stuart Pomeranz had given up a walk to Josh Johnson, an infield single to Kobernus and a stolen base to each of them when Jesus Valdez came up with two outs. He appeared to have tipped a foul ball smack into the home plate umpire Andy Dudones' face mask. After the ball caromed away, the baserunners moved up – Johnson scoring from third.

The call was questioned by the Baysox and, vocally, a smattering of fans in the box seats along the left baseline, who thought the ball had ricocheted back like a rocket from Valdez’ bat, but the umpire saw it as a swing and miss that got past catcher Joseph.

Then Valdez struck out swinging to end the inning.

The Baysox had their big inning in the fifth, with two runs in Schoop’s first hit – a double to right-center – and a bunt by speedy Antoan Richardson, who beat the errant throw from losing Harrisburg starter Robert Gilliam that allowed a run. Richardson then scored on a sharp single up the middle by Robbie Widlansky.

Bowie’s fourth run came in the seventh, on a solo homer over the fence in right by Buck Britton that hit the bottom of the Corona Beer sign. (Hope he had one after the game!)

Closing out the win for the Baysox was Ross Wolf, who had the remaining fans from the sparsely-attended opener worried as he gave up a lead-off homer to Chris Rahl and a one-out double to Tim Pahuta before retiring the side on a grounder and a pop-up.

So there you have it – after some 45 years in journalism, my first baseball game story... a few years after my brief stint writing Oriole player features from spring training for the short-lived Baltimore Examiner. When you try to actually write the game story, you get a keen appreciation for the folks who do this day after day and manage to keep it interesting.

Of course, they’re focusing on major league games.

This was just Double-A, on a chilly opening night in a pretty little ballpark between the two teams’ major league partners in Washington and Baltimore.

The baseball scribes will be writing about Ankiel and Morse, of course, as they finish their rehab assignments and return a few miles south to beautiful Nationals Park. And it might not be long before Machado reaches Baltimore’s Oriole Park at Camden Yards, a little to the north in a career that’s on the fast track upward.

A Player of Baysox Past

Local prospect Chorye Spoone – local, as in having grown up six miles from my outpost in Pasadena, Maryland – who pitched his way through the Orioles’ minor league system and overcame shoulder surgery with assignments at Bowie and the Triple-A Norfolk Tides last year, is wearing a new color.

He was signed by the Boston Red Sox, and made four relief appearances in spring training games that included a save in Tuesday’s preseason finale against the Washington Nationals. According to the opening day roster, he’s been assigned to the Red Sox’ Triple-A team in Pawtucket.

As a kid who dreamed of pitching for the Orioles in Baltimore, his best shot now is a chance of playing in Boston’s Fenway Park – if all goes well.

As much an Oriole diehard that I am, Chorye is a Red Soxer I could root for.

Speaking of Oriole Park

The Orioles open their season at home on Friday, hoping to reverse the string of 14 consecutive losing seasons.

Sportswriters have not been very optimist, but my old and very entertaining Baltimore Sun colleague Kevin Cowherd offered up a column a few days ago elaborating on “seven things to like — no, really — about the Orioles this season.”

First up was the stadium, where the Orioles are celebrating their 20th year of occupancy:

Are you sick of all the 20th anniversary hoo-ha already? OK, me too. But there's no denying the Orioles play in a great little ballpark, the best in baseball. And there's no minimizing the impact it's had on the city and on stadium architecture throughout Major League Baseball.

Watching baseball there on a warm summer night as darkness falls and the city skyline lights up is still one of the great experiences in life.

Too bad the Hilton hotel beyond left field blocks so much of the view. My buddy Rob Kasper (also a former Sun colleague) is right: the looming off-white fa├žade offers all the charm of Eastern European public housing.

Now I love Cowherd, but I have never loved Oriole Park – which I consider overhyped.

When the stadium opened in 1992, I attended the inaugural game – an exhibition between the Orioles and New York Mets a day before the season was to begin. It was a stadium shakedown cruise, testing everything from the plumbing to the concessions operation with a crowd that was limited to thousands under capacity.

I didn’t like what I saw. And when I returned to the Baltimore Sun office, I offered up a 15-inch-long critique that had not been planned for when the stories for the day were budgeted and pages for them laid out in advance. The editors, in their wisdom, decided to run one negative story on the new ballpark – mine. But it was cut in half.

Now, 20 years later, amid talk of another round of improvements making their debut at Oriole Park, I sent this note to Cowherd in response to his column:

Nice column, as you got 6 out of 7 correct. But Oral Park is not the best stadium for a fan to watch the game -- wasn't when it opened, and isn't now.

It was built as a low-rise to incorporate the city skyline, at the expense of game visibility for the fans. Row by row, the shorter elevation forces fans to view the game between the shoulders of those in front of them. And its seats toward the back end put fans further from the field than does a steeper stadium bowl. The upper-deck overhang renders a fly ball invisible to nearly anyone in the seats beneath it, and there are seats from which the right-field corner does not exist. Seat angles, despite improvements after the horror of the left-field sections, tend not to focus on the center of the diamond.

Human traffic through seating area entrance ramps and section aisles blocks the view from many seats, as do the vendors using them throughout the game. The section entrance ramps, in particular, have an obstructive design.

The skyline tradeoff for the low-rise design was obliterated, as you noted, by construction of the high-rise Hilton, from which you can see most of the baseball field from the $900-a-night rooms with upper-floor balconies. I wonder how often those rooms are occupied.

I will acknowledge that the best 15,000 seats are very, very good. If you can't afford them, try to sneak down from the cheap seats around the fourth inning.

Stadium acoustics are miserable. Unlike shabby but fan-friendly Memorial Stadium, where fans could hear each other -- and anyone with enough enthusiasm could ignite crowd response -- Oral Park depends on blaring boom-chucka music (which most often seems to serve as rally-killing music) to cue fans when they should show some enthusiasm. It doesn't "rock" anyone. It's old and lame. Bring back the cowbells, O's fans! Or maybe the team management should finally show a little personality, and install an organ and musician to add to the fan experience. (Your colleague (Sun columnist Dan) Rodricks was long an advocate for this -- has he given up hope?)

When the stadium opened to acclaim with an exhibition against the Mets on the eve of the 1992 season, I wrote the only negative story -- you can look it up. Actually, I was so dismayed that I wrote 15 inches about what I found wrong with the stadium. But nearly every inch of the paper had been laid out in advance with designated story lengths, and my unbudgeted vent was cut in half.

I was sorry then that the stadium hadn't been named Boondoggle Park. Still am. Maybe part of its problem was being the first in a new generation of baseball stadiums. Later versions were probably better. Among them, I've been to Coors Field in Denver (opened 1995) -- and it was terrific.

Kevin disagreed, politely, in his reply:

Thanks, Dave. OK, we'll have to disagree on the ballpark. My response to you would be: picky, picky, picky. I fell in love with the place right away. And if there are seat-angle issues and upper-deck overhang issues and acoustics issues as you say, they just never bothered me that much. And I've sat everywhere in the stadium. Hey, to each his own when it comes to ballparks and everything else in life.