Tomorrow You Will be Executed--Whoops!

Yesterday I received this curt, poorly proofed letter from UCLA Transplant Services:
"The patient was seen in Kidney/Pancreas Evaluation Clinic on 4/16/09. Patient current status is: Inactive. The patient is not a candidate at this time and will not be placed on the UNOS Wait List. Patient was seen as a consult only. Patient was seen as a consultation only. The patient is not a candidate for kidney & pancreas transplantation at this time due to inoperative, 3-vessel coronary artery disease. Pleasae see the dictation for detail. Other: Patient was hypertensive at the time of evaluation(170/100 bpm). Please follow-up with your physician."

I immediately got on the phone. I wasn't crying; I was angry. I didn't raise my voice, and I didn't use foul or offensive language. I was firm and direct, not accepting any PC, bullshit answers.

I had seen the UCLA cardiologist last Friday, and she had ordered another test, which I have scheduled for May 26 and 27. "I have a new heart," I told her, as I have told at least five other doctors. "Please don't judge me on the basis of an angiogram done years before I started dialysis." I also asked her not to judge me on the basis of my clinical blood pressure, as my twice-daily, at-home readings are in the neighborhood of 100/60. She said that patients are often nervous about these visits, and consequently, their BP shoots up. Nervous? My God, who wouldn't be! These people are deciding whether I'll live or die!

First I talked with the in-take nurse. How could UCLA send out a letter like this when I had been told by the cardiologist that her decision was dependent upon the results of a test I have not yet taken? She couldn't answer this question and went off to find someone who could. This meant quite a long time on hold. When she got back, I asked to speak with the cardiologist. Of course, one can rarely speak directly to a doctor! Oh, my God, we couldn't have patients talking directly to doctors outside of office visits! The whole system of elitism might come tumbling down. The nurse said the head nurse, Melissa Forest, would review my records and call me.

Melissa said the letter had been sent out prematurely. It had been based on the transplant surgeon and the director of the transplant program's recommendation--even though these two had referred me to the cardiologist. They had told me they would base their decision on the cardiologist's recommendation. Why, I demanded, had this letter been sent out? "Is this part of the psychological testing?" I asked. "Do you mess with patients and see how they handle it?" That question shocked her, and she didn't answer it. I persisted: "Because if messing with patients is part of the workup, then I've passed because I'm not crying and I'm not taking this sitting down."

I explained how I was feeling: "I'm on Death Row. I get a letter saying that my execution is tomorrow. 'But my lawyer has my case in appeal,' I say. 'How can you go ahead with the execution when my case is in appeal?'" She said she understood. I countered with: "So you've been a transplant patient?" She didn't answer. I asked again. "No, I haven't," she said. "Well, then you don't understand," I said.

I said that I am just starting out with UCLA, and if this lack of attention to detail is present at the onset, I'm concerned that such carelessness may pervade the entire process. I am concerned about the carelessness that seems to have gone into sending out this letter, without concern for accuracy or the patient's feelings. I said I worked as an editor and alluded to the carelessness with the language of the letter. Though I didn't specifically cite the errors, here they are--"pleasae," "follow-up" (no hyphen when used as a verb), two cases of redundancy, and the switch from third to second person. "If there is carelessness in the little things, it makes me wonder if there will be carelessness with the big things." I repeated this to help it sink in. Yes, the big things--making sure the organ is a good match and making sure the surgery is successful.

Melissa apologized, but I wanted to know what she was going to do to correct this problem. I asked if this matter would be taken up at a staff meeting. Perhaps people should think before sending out such letters. She assured me she would bring it up. Who knows if that will actually happen.

Now, I must attend to some important business--getting a match and burning the letter.