Doc Ernie's Blog : Doc Ernie's Blog : Ernie Franz M.D. : Spinal Cord Injury, Disability, and Rehabilitation

At the press conference during which Dr. Jurkovich and Senator Murray spoke, I was asked to share my personal experience as a physician/patient and to relate just how vital it is to each of us that centers like Harborview remain financial viable and open.  As I found out, you simply do not know when you too will need the services of your nearest trauma center.

Thankfully Harborview is not in a financial crisis mode as best I know.  Yet allow yourself to imagine for a brief time just what life in the NW would be like if Harborview had to close.  That would mean not a single level I trauma center between Alaska, Montana, Idaho and Washington.  Either critically injured patients would need to be taken care of as best as possible locally, or moved to trauma centers in Oregon or California.  In my case I would have been sent south to such facilities, out of reach with family, friends, church and others who were so very vital to my recovery process.

Though it may seem impossible that such an institution like Harborview would someday face closure, once you read the Grady Hospital story you can begin to see how it all could unravel.  Without outside funding from the state or federal government, or with only minimal funding at best, an institution must depend more and more on those with insurance.  Trauma is a disease of those generally under age 35, in fact the leading killer of those under that age.  With nearly 50 million uninsured in the US, and trauma striking most often at an age when those injured are least likely to have insurance, one can begin to see the economic burden placed not only on those injured, but also upon the facilities that care for them.  Yet in an institution like Grady with 33% of patients having no insurance and only 8% having private insurance (generally the best payor), eventually things begin to fail.  Costs must be controlled, which impacts staffing levels, equipment repair and purchase; working conditions deteriorate, staff including physicians become disenchanted and look for jobs elsewhere with better support, staffing, equipment and pay.  Once the exodus begins, it only seems a matter of time before closure will come and another hole in the safety net appears with no clear means to repair it at all.

That said, I would urge you to read more on this subject, beyond even the NY Times article I have linked to.  Certainly I support Senator Murray's Trauma Bill, yet this too may only be a brief stopgap or respite for many trauma centers who have otherwise entered the cycle leading to insolvency already.  I don't know the long term solution, beyond perhaps national healthcare.

I welcome your thoughts.

As of this date, I am not yet "working" in the typical American sense, but rather have thrown myself into various service activities.  Those volunteer opportunities keep my mind active and enable me to give some of myself and my experience to others, whom in many cases are going through much of the loss and change in identity that I found to be initially depressing.

• Thanks to the invitation and kindness of my spinal cord rehab physician, Dr. Barry Goldstein, I have been involved as a teaching assistant with the University of Washington medical students for the past three years running.  Currently I volunteer as an assistant senior faculty member in 3 classes each Winter/Spring.  Those are specifically Musculo-Skeletal Anatomy with 2nd year students, including assisting in gross anatomy dissection lab.  Also working as a tutor in Problem Based Learning where I work with 9-10 students in a small group setting in which they discuss medical cases; beginning the transition from scientific medical head knowledge to actual problem solving involving clinical scenarios.  With a variety of medical issues to work through in addition to finding a diagnosis, they will touch on refusal of care, cost effective medicine, end of life issues, medical malpractice, and various ethical situations.  As this is in a small group setting, I thoroughly enjoy getting to know each student over the course of those two months.  Lastly, I serve as a senior faculty member in Introduction to Clinical Medicine for first year students as they learn basic physical examination skills.  These three classes are a highlight of my year.  It is extremely satisfying to pass on some of my knowledge and approach to patients that I had learned during my time "in the pit", or the ER.

• I am also part of the Patient Advisory Board at Harborview Medical Center in Seattle which is a group composed of former patients or their family members.  We are involved in everything from patient/family/hospital staff communication, to the layout of the gift shop, to giving opinions regarding artwork chosen for the new hospital wing, to re-evaluation of hospital literature shared with patients and the public.  What is currently termed Rehab Night @ HMC is also an idea formed by this group.  Once a month between 2 to 5 of us meet for a panel discussion, information sharing time with newly injured patients and their families on the Rehab floor at Harborview.  There we share our experiences and attempt to coach others whose lives, like ours, have been completely interrupted and seemingly destroyed.  As a group we have found that the transition time between hospital discharge and re-establishment of life is the most difficult period to process.  My intent is that in sharing our group experiences we can bring some hope to those patients and their families.  We work primarily with those who have a SCI (Spinal Cord Injury), TBI (Traumatic Brain Injury), Stroke or Amputation.

• I also make myself available to mentor to SCI patients, generally those like myself who have sustained incomplete injuries.  By sharing my story with them, and spending time alongside them I intend to bring some encouragement and hope for their own future.  Every single person with an incomplete SCI is very different in many ways; from their level of injury, to which specific spinal cord tracts were dinged and damaged.  So there is no "usual" or "anticipated" level of recovery to be expected or guaranteed for anyone with a SCI; each of us has our own story and our own specific injury which will not only vary from a microscopic level, but also will depend upon numerous other factors at the time of injury.  Every factor and many more including your age, mechanism of injury, potential rapid steroid and/or hypothermic administration, your own support system around you and your personal motivation - ALL these factors, and many many more play a key part in what level of functioning you may come to realize in time.  

• I serve on the NextStepsNW Board of Directors; a non-profit organization which works to rehab those with SCI, Stroke or other forms of paralysis through exercise therapy.  A link to their website is also provided on the right margin of this page.  As a board we concern ourselves with how best to support those with disability and with fund raising strategies for facility maintenance and new equipment procurement.  We have had much success in enabling clients to regain the ability to walk, gain strength and provide exercise/conditioning all in a supervised setting with trainers who themselves desire to bring new movement or strength to weakened or paralyzed limbs.  Our current focus of planning is to purchase a Lokomat, the current state of the art mechanized robotic treadmill support system, which should help many to re-learn to walk again.

• Lastly, I am part of our church's Stephen Ministry team.  The training for this, and the involvement with others in our local community who have experienced loss seems a good fit with all else that has happened in my life.  The purpose of being a Stephen minister is to come alongside those who are experiencing divorce, cancer, family stress, job loss or anything else that may impact your life at a time in which a friend can help by actively listening and bear some of your burdens.  It is sad that so many of us attempt to carry our own burdens and pain at a time when we truly most need the prayers, compassion and support of someone who could come along side us and offer the love of Christ.  This training has been a perfect complement to my work with everyone from medical students to those with SCI or other life traumas.