A CRISIS IN HEALTHCARE – Kalikiano Kalei – Medium

(The high drama of differential diagnosis captured in all its excitatory soporiferousness, Highland General Hospital, 1979)

Highland Hospital as a micro-economic predictive model of a pressing reality we’d all like to overlook and dismiss

Very recently, I stumbled across (I’m a peripatetic stumbler, it seems) a documentary film made in 2012 about my old alma mater (Highland General Hospital). Its title is The Waiting Roomand it consists of an hour and 22 minutes of video depicting the unending medical crisis that is the Emergency Department of Alameda County Medical Center (AKA: Highland General Hospital), in Oakland, California. This film, produced by Peter Nicks, has been critically reviewed by a number of different individuals and journals and if one had to summarise them all in a single brief remark, that remark would have to be ‘a compelling and poignant insight into the economically driven medical realities of poverty’.

And why, might you well ask, is this film of especial interest to me? If you’d followed the story of my illustrious medical career (‘A High-grade Chimp’) you would know the answer to that rhetorical question already, but for those who didn’t acquaint themselves with it, I was associated with Highland General Hospital for a number of years back in the 70s & 80s in the capacity of ‘Cardiopulmonary Program Coordinator’.

That rather florid title means I was in charge of the day-to-day operations of both the hospital’s cardiac catheterisation and pulmonary function labs. As I explained in my previous blog, I was actually a ‘one-man-show’, since I wore several hats and juggled a number of duties pertinent to both diagnostic services. Highland has always been moderately short of funding, even as a major county trauma center, teaching hospital and community health care resource. I am sure if it weren’t for massive infusions of Federal monies and fiscal exemptions for Hill-Burton charity from all quarters, Highland would have been even more chaotic back then than it has now become. Certainly, the wealthy uppermost percent or two of the city’s taxpayers could not possibly fund its operations to any appreciably adequate degree and the 80% or more of lower-class (impoverished & disprivileged) residents who are seeking treatment there definitely aren’t queuing up at the Highland ER door due to having gobs of disposable income.

For some important backstory on Highland, let me suggest a quick visit to the previously referenced account, but suffice it to say that I was at Highland from about 1973 through 1983, a decade that provided me a wealth of experience with both the facility, its mission and its clients.

As the County of Alameda’s primary clinical care center and principal medical trauma treatment site, Highland was and is a beehive of activity, day and night. Since I was going with one of the female residents, I was privy to an inside view of both the workings of the hospital and the quality of care undertaken at Highland. I well recall ‘Lin’ (my girlfriend, who completed her internship and subsequent residencies there) coming home each evening (when her grueling schedule permitted such ‘luxury’ as actually physically leaving the hospital grounds) with new versions of what we called ‘the case of the week’. In actual fact, although the ‘case of the week’ was a loose term describing a particularly remarkable patient presentation, it seemed as if there was a ‘case of the week’ almost every day! Most of these were walk-in ER presentations.

Two such cases I distinctly recall among the many. One involved a 400-pound female who came in with severe pain in her inguinal area (groin). Upon examination (a pelvic exam), it was found that she was so morbidly obese that even with two orderlies holding overlapping folds of fat out of the immediate field of view, the ER resident (my girlfriend) had extreme difficulty just finding her groin! At the risk of appearing a bit salacious, I recall an old joke whose punchline (to the question “How do you make love to a fat woman?”) was “Go for the wet spot.” Believe me, it was far worse than that! [I should hasten to state that my unbridled candor here calls for an apology to weight-challenged females everywhere.]

The other case involved a homosexual male who was admitted quite drunk, highly embarrassed and with severe rectal discomfort. After Lin finally induced him to open up to her about what his problem actually was, he pointed to his buttocks. Radiograms quickly revealed that someone had inserted a Coca-Cola bottle into his anus, neck first, and it was firmly lodged in there, unable to be removed without surgical intervention. There were many, many other presentations of even more startling substance, I assure you. But then, this was the San Francisco East Bay, where everything was (and likely still is) possible.

And so it went, as the Highland Hospital emergency room received and treated bizarre case after bizarre case, day after day and night after night. This was, of course, in addition to the usual superfluity of of gunshot and knife injuries from all over Oakland brought in by ambulance with police escorts, drug-induced overdoses and substance-facilitated suicide attempts (to just name a few).

The impact of all this upon the Alameda County Trauma Center was tremendous and unrelenting. Meanwhile, the stream of ER admissions that came in on a ‘walk-in’ basis also constituted an undiminished flow of people requiring medical assistance. It is this latter category of patient, all without any medical insurance of any kind, that the 2012 film ‘The Waiting Room’ devotes itself to. These people therefore were required to wait until the more serious ER cases had been dealt with, since treatment is predicated upon triage assessment of severity, and the wait time for walk-ins is accurately depicted as lasting hours and perhaps even more than a day.

Seeing this film, which was made about 38 years AFTER I left Highland, illustrates a number of things that would not be readily apparent to anyone not having had previous familiarity with Highland Hospital. First of all, things were NEVER calm, orderly and problem-free in the ER at Highland. As each year passed, the already heavy influx of patients seeking medical attention (mostly indigent, often homeless, long-term substance abusers, et al) simply increased exponentially. By the time ‘The Waiting Room’ had been filmed, the burden on an already and continuing overstretched Alameda County health resources establishment had increased by an order of substantial magnitude.

In that 38 year period, substance abuse incidences had also grown to the point where it was rare that a patient wasn’t just using illegal and harmful substances, it was most unusual if they lacked recurrent histories of admissions and readmissions for substance-related health problems.

Although I don’t have the precise Alameda County demographic and economic stats at hand (and am a bit too lazy to look up the actual numbers), in those 38 years since I’ve been on the active staff at Highland, I’m certain that use statistics have grown substantially, not least due to rampant levels of increased urban poverty and the relatively ‘new’ factor of much-increased illegal immigrant health care needs.

All of these factors conspire greatly to hide what most people in our part of the state (or any other part, for that matter) are blissfully unaware of, the fact that our already grossly burgeoning, medically indigent population has grown way beyond any municipal medical treatment facility‘s reasonable ability to provide an approximation of adequate response. The existing county-wide system is overtaxed way past the breaking point, and yet, as the ER admission patients all fail to grasp in this film, there’s really nothing more that can be done other than what is already being done to attend to their perceived (and real) medical needs.

To add to this dilemma, a disproportionate number of simple-minded souls on the left of center have adopted the popular notion that health care is not a privilege, but a ‘god-given’ right. That has to be, aside from an indication of one’s being totally out of touch with economic reality, a most flagrant indictment of how little the common folk know about the real cost of health care today.

In saying this, I am not being callous, hard-hearted, unkind or any of a dozen other states of uncaring. It is simply the cold, harsh and ugly reality that we face in America. Most recently, when the whack-a-doodle political geniuses of the New California Left decided that the state needs universal, single payer health care coverage, it was conservatively estimated that the costs would be in excess of 400 billion dollars! Of whose money? The taxpayers, of course: the wage-earners most definitely not on the receiving end of all these pie-in-the-sky financial grand schemes.

Mind you, we’re not talking about the national health care cost, but merely California’s! Not to be unkind to people I do not know personally, but when I watched ‘The Waiting Room’ several nights ago (after purchasing the DVD), I was struck by how blissfully naïve and unaware all of these ‘poor patients’ are in believing that all they have to do is present themselves to Highland’s (or any other hospital’s) ER to be ‘fixed’ on the spot…despite the fact that they have neither funds nor health insurance to address their needs. When they are told (in the film) that there are cases more serious than their own ahead of them, they are puzzled and even belligerent (depending on how ‘wasted’ they are at the time).

Equally, I am stunned by how so many earnest people delude themselves into believing that our ‘system’ owes everyone good health. That this simply flies in the face of any given reality of social or economic good sense appears to be either completely incomprehensible to them or so far above their ability (or inclination) to understand basic ‘Economics-for Dummies’ that they persist in wallowing in the muddle-headed ignorance of left-of-center progressive ‘victim’ rhetoric like flies on dog s*it.

This sense of entitlement that was sparked by and further encouraged by the civil rights movement of the 60s has morphed beyond the legally right and proper (e.g. equal opportunity for all citizens and equality in the eyes of the law) to the point where the United States is today regarded by the poor and disprivileged alike as a ripe cornucopia of wealth and plenty for everyone, regardless of whether they are dues-paying (taxpayers) citizens or not. This is particularly true for non-US citizens here illegally.

Thus we have the tidal surge of illegal immigrants that keeps pouring illicitly across our borders to claim what they have been led to believe is their own ‘right’ to the same standard of living that legal citizens have achieved through their own hard work. And we have the increasing number of major urban centers of population (such as San Francisco, the city of my birth) declaring themselves as ‘ride-for-free’ sanctuaries for refugees of all kinds and persuasions.

What is so infuriating about this is that that element of privileged, upper-class members of our society who already enjoy a decent lifestyle, good healthcare and all the perks of legitimate citizenship stand behind these newcomers who eschew mandatory protocols to become citizens in solidarity and empathy. I speak here of all those lefty-liberal progressives in Hollywood (who often make obscene incomes off the ignorance of simple-minded fans who regard them as stars and heroes worthy of emulation), the lefty-liberal progressive nerds in the tech sector of our economy (hello, Silicone Valley) and all the bleeding heart ‘lib-symps’ who affect liberal causes merely because they perceive them to be politically correct.

The truly sad fallout from all this unreality is that people who are purely and simply parasitic organisms on the economic body have been conditioned to believe the popular myth that money is simply printed and distributed as needed (it actually is, but that’s beside the point). No one needs to be employed, no one needs to stay clean and sober and no one should have to suffer even the slightest sense of deprivation in our gravy-saturated American culture, since there’s enough to go around for all…whether they are productive or merely a dysfunctional economic drag.

To all of these grievously deluded and simple-minded souls I say: ‘wrong, wrong and wrong again!’

In America, we have at all levels of society grown accustomed to a life of relative ease and luxury. I look at all those Highland ER admissions in ‘The Waiting Room’ who wear pop-trendy clothes and all seem to have Bluetooth earpieces connecting them with their smartphones, while pulling long and often angry faces over being denied what they feel is immediate attention to their many (most often self-inflicted) ills, and think: “What alternate universe are these pitiable fools from?” Money either grows on trees or it doesn’t, and right now all the hard economic evidence strongly suggests it doesn’t!

There is no question in my mind that America is an aberration, a fluke, an experiment that is still going on, but in its creation we have nevertheless fostered a spirit of exceptionalism, a socio-economic singularity that defies several thousand years of Darwinian development. We now have an entire nation that fails to understand the basics of what capitalism is all about from an individual’s functional viewpoint: trading labor for financial wherewithal. We also have a nation that collectively fails to understand the most basic fundamentals of economics, thanks to the grossly dumbed-down curriculums of American public schools.

That lesson wasn’t lost in America of the 30s. It wasn’t even threatened with loss until the 60s with the rise of widespread sentiment that not everyone was being treated equally or fairly (they weren’t). When efforts were made to address those (at the time gross) inequities of social sentiment and law, somehow or other the entire nation slipped over the slippery brink of the Twonk-Zone into a limbo of radically unrealistic wish-fulfillment thinking and living…a state of permanently suspended belief that we as a nation have been suffering from ever since.

I propose we take this lamentable state a step further in pointing out the fact that there are certain facts that no order of disbelieving or evading the question can ever hide or make disappear. Consider the following.

The world is a finite entity with a finite capability of supporting (human) life, given that in our ‘free and open’ society there can never be emplaced any absolute limit on certain privileges popularly misconstrued to be ‘rights’. Chief among these ‘rights’ is the ability and/or desire to breed.

It has been shown time and time again, in any number of erudite academic studies demonstrating that the greater the level of education and intellect, the lower the birthrate. Conversely, the greater the level of ignorance and illiteracy (read this as a blanket term for all kinds of academic learning), the higher the birthrate. Translated into simple, unabashed terms, what this means is that ignorant, unmindful people are bringing children into the world an order of magnitude beyond that maintained by well-educated, highly reflective individuals. In an even shorter summarization: we are being overwhelmed by ignorance that will sooner or later result in the complete trashing of our beautiful planet: if not by rampant ignorance, then by the highest level of rapacious capitalists who profit obscenely from exploitation of the general ignorance of these masses.

It doesn’t take a Harvard graduate degree in economics to understand the potential consequences of this unavoidable predicament: nature favors (seemingly) ignorance over applied superior intellect. Continued as the present rate of human procreation, the world will soon reach the point where it can no longer sustain the number of human lives that populate it. Food sciences and technology, regardless of their level of sophistication, will no longer be able to artificially compensate for the overall draw being made upon the world’s resources by all the hungry mouths and empty bellies.

At this time, the United States is being swamped (as are a number of European nations) by individuals from Middle Eastern and Hispanic nations. Potentially, given its dismal economic and socio-political history, the entire South American continent (along with the whole population of Mexico) could ultimately decide it wants a slice of the US pie and flood in even greater numbers past a border that was traditionally almost ‘open’ in terms of stringent border protections (certainly not as open as that between Canada and the US, certainly, but still not like the DMZ in the Koreas).

Watching the film ‘The Waiting Room’ I am reminded that scenes like those recorded at Highland Hospital in 2012 are the direct result of this trend. With few exceptions, the clients shown in that film are suffering from self-afflicted (sic) health conditions (usually substance related). Not well-known by so many is the fact that chronic substance addictions (as with heroin) often result in severe systemic infections (such as heart valve vegetations), that without surgical interventions can be mortally life-threatening. In Oakland, substance abuse (whether from chemical or alcoholic abuses) is epidemic. Combine that with the levels of morbid obesity that can be seen among many of the patients (indicative of intake levels…read: portion size…of far too much grossly unhealthy food, as in ‘fast food’) and you quickly understand that our relatively cushy American lifestyle is resulting in people preferring to defer personal responsibility and instead indulge in a lifestyle of ‘being the victim’ (“I’m a victim! He/she/it made me do this!”, etc.). It’d the same old blame-game, reinvented with a new socio-political twist.

Back in the 30s, at the height of the so-called Great Depression, those same ‘Northern European White People’ that so many lefties just love to hate these days well understood that there were no free rides in life. Either you found work and survived or you didn’t. My own dirt-poor Irish ancestors certainly understood this hard, cold fact of life. Then along came FDR with the first of the great progressive economic subsidy programs that intended to help eradicate poverty, raise employment levels and assure a better quality of life for everyone.

While well intended, this new ‘welfare’ism’ was destined to have bad results as the nation’s population grew exponentially. Then along came World War Two and the United States alone had the singular fortune to be the only combatant that never suffered an attack on its own soil (if one excludes Pearl Harbor, since the United States essentially cold-bloodedly annexed Hawaii without that nation’s desire or permission, back in 1898), emerging as the world’s leading economic superpower.

Meanwhile, the relatively prosperous 50s and 60s enabled even the classes lowest on the social stratum to flourish and multiply. With all classes merrily cranking out babies, it didn’t take long before those in the lowest third of the economic classes were starting to put a strain on the nation’s wealth (which was either being squandered on horrifically expensive things like the ‘Cold War’…with its penultimate lunar race…or the equally costly ‘Vietnam war’).

Another poorly understood lesson of basic economics is that when it regards human lives, supply can quite readily be outstripped by demand. That is to say, if more impoverished, uneducated and genetically dulled-down people are creating babies than the more well-off, more highly-educated classes, a recipe has been created for a complete collapse of the layer-cake that is dividable national economic potential.

Although lefty-liberal progressives refuse to acknowledge these unhappy facts, we are at that point today. Just go to any Wal-Mart and survey all the overstuffed (grossly fat) people shopping there for absolutely useless non-necessities that they have been conditioned to ‘need’ by commercial marketing. There is usually a string of equally portly kids in tow and…surprise, surprise…none of them appear to have the makings of a little Einstein!

Additionally, there are no checks to keep this state of affairs from burgeoning totally out of control, since human procreation is now regarded even less seriously than before by these hordes of consumer-ignoramuses. Babies created out of marriage by young blacks are at an all-time high and so also, probably, are the number of babies being created (either within or without marriage) by many poor Hispanic families. Poor white people also contribute to this problem, of course, since education and personal responsibility are the quantifying markers of this dilemma. Single parent families are fast becoming status quo in poor communities (like Oakland)!

No one wants to face the real facts implicit behind this façade of cracks in the founding walls of the Great American Experiment (and make NO mistake, it IS an experiment and it cannot last forever). In failing to do so we have become a nation of deniers and self-deluding myopics. Naturally, since the ultimate, final and cataclysmic catastrophe that all these trends portend is not yet upon us (or the world), no one wants to advocate taking any preventive steps towards curtailing that final, awful and unavoidable denouement.

Yet, some sort of proactive involvement is required, and the sooner the better.

At the turn of the century, before Hitler had taken the American (and yes, it was a uniquely American development, my friends) concept of eugenics and turned it into the big bad bogeyman that it is regarded as today, some worthwhile ideas were discussed that dealt with determining how best to enhance the general level of intelligent life and reduce the dregs. [For more on this very timely subject, refer to James Q. Whitman’s excellent book ‘Hitler’s American Model: The United States and the Making of Nazi Race Law’, Princeton University Press 2017]

Sterilisation (which was one solution proposed) certainly would have helped stem bad genetic stock from further perpetuating its own low-quality DNA lines; the question that no one seemed able to get around was exactly how to bring this into effective application with any sense of ‘fairness’. Since overt racial bias against blacks was at that time still firmly entrenched in American culture, there were few who protested or were excessively shocked by the idea that marginally intelligent (or mentally deficit) individuals should be prevented from procreating. Much later, when the US civil rights movement was in full swing, and the horridly cruel memories of the German National Socialist experiments were still fresh, all of these ideas were summarily tossed out the window as both inhumane and impracticable.

Of course, the practical result of this state of regard became that rather than proactively working towards stemming the coming demographic disaster by taking certain steps now, the matter was shelved for the immediate future. In other words, we will all continue to hide our pointy little heads in the sand like good little ostriches until the flash point is reached (still some years off in the future, fortunately or unfortunately) and then we shall all perish together, equally and fairly in that great American tradition of being ‘uniformly equal’, all sharing the avoidable fate for which our voracious biological proclivity to mate has programmed us for. Isn’t that a warmly inspiring thought? I think so.

Naturally, others do occasionally think about such things from time to time, even though it is politically incorrect to do so (let alone actually discuss them). One example is the farcically misguided effort to pretend that ‘all children need to go to college’, surely one of the greatest educational hoaxes ever perpetrated by white lefty-liberals on certain non-white members of their leftist political stripe. This totally ignores the fact that perhaps as many as two-thirds of all the marginally bright or capable kids who today clog the colleges (and who have, by their presence in these supra-HS institutions reduced the quality of a college degree to that of a 1940s era high school diploma) are simply not intellectually equipped to pursue and/or complete a truly challenging course of college-level study. Or at least not a demanding S.T.E.M founded curriculum in the hard math/sciences subjects. [A book that perfectly illustrates the sheer folly of such theories may be found in Bryan Caplan’s astutely written book, ‘The Case Against Education: Why the Education System is a Waste of Money’, 2018 Princeton University Press]

Creating such wonderfully wonky & irrelevant major areas of study like ‘African-American Studies’, ‘Women’s Studies’, or even more esoteric and uselessly irrelevant areas of the more arcane liberal arts does not effectively prepare anyone to enter the real world of serious mental challenges and most of that academic drivel is immediately forgotten after the sheepskin has been passed, anyway. [One further book that makes equally valid sense, as long we’re on it, is that by co-authors Greg Lukianoff and Jonathan Haidt, titled ‘The Coddling of the American Mind: How Good Intentions and Bad Ideas are Setting up a Generation for Failure’. Penguin Random House, 2018]

Unfortunately, the words ‘freedom and equality’ have long become so distorted and aesthetically twisted in American common usage (thanks to the mushy/fuzzy logic of the liberal progressive left) that the inevitable effect is the continued lowering of all standards of academic excellence to that which the least educated, least-intellectually prepared & disciplined person can comprehend. It is one of the reasons (along with the persistent and all-pervasive effects of rather simplistic religious faith that is unique to America) why America as a singularly distinctive and promising national entity is not destined to endure much longer than ancient Rome or Greece were (and certainly not Hitler’s grandiose ‘Thousand Year Reich’).

At any rate, when I watched the film ‘The Waiting Room’ all these many thoughts flooded my mind like the recent wave of Hondurans presently assaulting the US southernmost border. I also found myself checking any vestige of ‘awwww, gee!’ sympathy for these people depicted in the video at the door, since their generalized ignorance of how the ‘system’ works (or doesn’t) is not really their fault, other than due to a general lack of mental acuity, perhaps. The left has brilliantly succeeded in leading them to believe that, as Orwell so famously put it with his Fordian ‘Doublespeak’, ‘Yes is no, black is white, up is down.’

It is quite amusing to me to realise that what Orwell set forth in his classic ‘1984’ has now become codified by the same left that would have common people believe anything means whatever they tell them it does (regardless of the truth). But my amusement suddenly ceases when I hear patients describe the excesses that led to their sad health status, their near-total eschewment of any self-responsibility and their utter disbelief when (gently and oh-so humanely) told by the Highland ER staff that everything that CAN be done IS being done for them. Based both on my own experience and on that of seeing how the Highland staff interact on the patients’ behalf, I think it is safe to say that Highland Hospital has its share of saints working for the facility.

This film, which has been critically reviewed and lauded for its documentary skill and production qualities, falls short of making any direct statements about the rightness or wrongness of the present medical/healthcare meltdown that afflicts almost all American public healthcare facilities (and particularly those serving, like Highland, as the sole primary medical trauma center for an extremely violent, savage and brutal city like Oakland, CA). Not that I would expect it to, but a messaged ‘opinion’ may be still incorrectly be misconstrued in that it tends to make lefties even more sympathetic to the rampant self-abuse and lack of responsible resolve that makes social victims of all these poor, ‘suffering’ people who simply cannot believe that the entire medical system should grind to an instant halt and plug up their bullet wounds and knife slashes injuries.

Many, many years before the United States came into being, life was a harsh, often brutal process wherein people died each and every day solely through the whims of fate. It was social Darwinism at its purest: sh*t happens and people don’t always survive under the most favorable conditions.

Only with the rise of erstwhile, uniquely American ‘equalities’ (thanks to the French and their philosophical antecedents, to no small extent) did this hard and fast formula of life become substantively reworked into what is today the worst and most subtle nightmare our nation presently faces: the reduction of logic and reason to its lowest common level, ipso facto, that makes everyone ‘exceptional’ and the victim of something or another.

Of course, we can also thank the American ‘slavers’, who helped precipitate all our modern woes by fostering and encouraging the idea that some human beings are only suitable as slaves for the privileged classes. Not even Rome & ancient Greece got that one right, either. That is, regrettably, a history we cannot undo and now we are paying the consequences for that extreme lapse in what was otherwise a marvelous concept: American freedom.

I’ll close by suggesting that you all obtain a copy of ‘The Waiting Room’ and view it, if for no other reason than to see what sort of a place I worked in for a number of years. At a little over 82 minutes it isn’t terribly long and it is most definitely worth sitting through. Keep in mind that the facility that existed at Highland in 2012 (and now) is a new one; when I was there (in the previous facility), we had to deal with far more cramped accommodations and perhaps an even higher level of general chaos than the film suggests is common on the trauma front lines at Highland.

Oh yes, and forget all that schlock-drama you see on modern popular television doctor-opera programs. Hollywood makes a great number of serial television programs with its brain firmly tucked up its ass (in fact Hollywood would make a GREAT ‘case of the week’, IMO) and reality in those films never quite takes on the frankly brutal face of humanity that real life at Highland assumes in anything Hollywood is involved with.

I like to remember the following observation made by Ralph Waldo Emerson whenever I think about any or all of the above circumstances: “The end of humanity will be that it dies of civilization.” Think about that one for a solid minute or two…

— — —

Postscript: If my sentiments about the futility of humanity’s efforts to contain its demographic and economic excesses seem a bit harsh to some, let me suggest an interesting book that investigates the subject from what we might term a ‘compassionate’ perspective. I refer to author Marvin Olasky’s book, ‘The Tragedy of American Compassion,’ Regnery Gateway 1995.

Olasky is, among other things, a person who believes firmly in Christian compassion, a condition that sets him off from myself (being an atheistic pessimist, or at least a ‘non-believer’). However that may be, his observations are quite cogent and well worth reading and may even prove to be an effective counterpoint to some of my own more extreme attitudes and opinions on humanity’s failings.

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