Twenty-One Bones. One Healthcare System.
by Jon Davidson
“Hello, Jon. I’m Dr. Sandquist’s physician’s assistant, Tim,” the voice on the other end of the line calmly said.
“Hi! Thank you so much for returning my call,” I replied, the excitement palpable in my voice.
I’ve been waiting for spinal fusion surgery for weeks for my broken, unstable thoracic vertebrae. Waiting on insurance. Waiting on surgeons. Waiting on scheduling. My hopes were high that this telephone call would, at long last, provide the answers I had been desperately waiting for.
My name is Jon Davidson. I’m a 36-year-old writer, musician, mixologist, and consultant from Portland, Oregon. Eleven weeks ago, I fell eighty-plus feet off of a cliff in Mexico when a boulder dislodged from a rock face on Volcán de Tequila, the mountain I was climbing, and took me down with it.
I suffered eight broken vertebrae in my neck and back, as well as a broken sternum, scapula, knee, thumb, finger, and eight broken ribs. Twenty-one broken bones in all. Throw in a collapsed lung, a concussion, 30 stitches in my scalp, and lacerations all over my body, and one would think that I would be treated as somewhat of a priority patient upon returning to the United States.
I have been in constant, cruel, crippling pain for seventy-seven days.
For weeks, I had been calling Dr. Michael Sandquist, a neurosurgeon with The Oregon Clinic, pleading for answers as to why, first of all, my spinal surgery hadn’t been sent to my insurance for approval, and, once finally sent, why the procedure to fuse my dangerously unstable broken vertebrae hadn’t been marked as urgent.
Earlier that same morning that Tim called, I had phoned twice, checking on a surgery date, but also begging for more information about the compression of my spinal cord at my T4 vertebra, a fact that I read in my latest MRI results, yet my doctors had apparently failed to notice.
I was ready for answers. Unfortunately, Dr. Sandquist’s PA didn’t have any. Instead, he said he had been trying to reach me to get me to take down a picture of Dr. Sandquist and myself from Facebook and Instagram, as the image violated The Oregon Clinic’s in-house policy prohibiting photos of providers or the inside of their facilities. The picture and associated caption painted Sandquist in an overwhelmingly positive light. Yet, a policy is a policy. They had to go.
This. This sums up all that is wrong with our healthcare system.
It seems that Dr. Sandquist’s office staff members had been spending their time browsing social media instead of doing everything they could to schedule and expedite my surgery. Tim said he would look into the answers to my pressing questions and call me back within a couple hours. Needless to say, it’s now been seven days, and I’ve heard nothing but radio silence.
Why should I have to be paralyzed before anyone cares?
I have been back in the United States for eight weeks. After my accident, I qualified for the Oregon Health Plan/Medicaid for the first time in my life, due to my inability to work and the nature of my injuries. As an entrepreneur who has paid for health insurance out of pocket for my entire adult life, I was extremely grateful, from a financial standpoint, for my government-funded insurance. Through HealthShare, I picked Providence as my health plan, because I’d been self-insured with Providence for the last five years. However, after the absolute frustration of dealing with such a broken system for the past eight weeks, I’m wishing I would have either kept my private insurance, or simply stayed in Mexico.
After a harrowing 12-hour rescue outside the town of Tequila, I spent ten days in a hospital in Guadalajara with my lady, Kathleen Royal. My dad and sister flew down for a few days, as well. After being discharged, I was unable to fly for two more weeks due to my collapsed lung. Finally, my doctors gave me clearance, and after an excruciatingly painful five-hour flight, I arrived back in Portland on July 19. Upon returning, I saw a couple Providence specialists, appointments I’d set up while still in Mexico. At my July 22 appointment, Dr. Heather Merry, a thoracic surgeon and one of the aforementioned specialists, urged me to go to the ER to get more scans, including a chest CT which confirmed my broken sternum.
Dr. Merry took a rather laissez-faire approach to treatment during the 30 seconds that she, rather than her assistant, was actually in the room, saying she’d rather wait and let everything heal before discussing surgical options, even though the second opinions I subsequently sought outside the Providence network said the complete opposite. My spine, despite my eight broken vertebrae, was deemed stable, and another one of Dr. Sandquist’s PAs reaffirmed this during my July 31 neurosurgery appointment.
My thoracic surgeon wanted me wearing a brace for my broken sternum, but she couldn’t put me in one because of my broken back.
My neurosurgeon wanted me wearing a brace for my broken back, but he couldn’t put me in one because of my broken sternum.
So, I was told to exercise caution, not lift anything or make sudden movements, and keep my fingers crossed.
Day in and day out, I lived with excruciating pain. Back pain, chest pain, knee pain, hand pain, shoulder pain. My spine and sternum caused me nonstop agony, regardless of position, regardless of prescription.
X-rays of my knee and hand revealed nothing, even though both areas caused me excruciating pain and were severely swollen. I had to fight for referrals to knee and hand specialists. Dr. Jeffrey Mercer, an orthopedic surgeon and my favorite Providence doctor to date, ordered an MRI, which revealed the fracture in my knee. His PA also saw me for my broken scapula, and provided excellent, prompt care.
Dr. Tina Jenq, my hand specialist, on the other hand (no pun intended), refused to even read my chart or listen to anything coming out of my mouth, especially the part where I’d fallen 80 feet down a volcano. She diagnosed me with trigger finger and trigger thumb, and told me to take ibuprofen. I had to virtually shout at her to get her to even refer me for an MRI. I called her office at least twice a day for what amounted to ten days before she even sent over the MRI referral. Not surprisingly, the scan revealed a broken thumb and finger, even though her initial referral listed my index finger on it, the only finger in my left hand that doesn’t actually hurt.
On August 6, I was rear-ended in my car on I-84 with Kathleen behind the wheel. We immediately went in to the emergency room, where new X-rays found that I had a fractured C7 vertebra in my neck. Interestingly, my ER doctor went back to the initial scans I’d had done two weeks prior upon returning to the States, and found the same broken vertebra present. No one, it seems, had spotted it. Seems like a big deal to miss, but I’m no doctor.
Sometime around August 12, a radiologist took a look at my existing CTs and X-rays, scans that several doctors had already looked at. Until that point, I had been informed by numerous specialists that my thoracic spine was stable and in no need of surgery. This radiologist, though, found a three-column chance fracture in my T8, one that ran all the way through my vertebral column. This meant that the only things holding up my spine were my (broken) ribs and my muscles.
Once Dr. Sandquist got word, someone from his office called me on August 15 and told me that I needed an urgent thoracic spine CT. I rushed to the nearest Providence imaging center and got it done that same day. Every subsequent business day, knowing the urgency of this matter, I called Dr. Sandquist’s office and begged for results. I was always given the same response: “Dr. Sandquist is busy in surgery and clinics today. He’ll get to them first thing tomorrow.” I asked if one of his PAs or another physician could read them. “No, it has to be the prescribing doctor,” I was told, time after time.
In the meantime, on August 19, I had an appointment with Dr. Emily Nguyen, a cervical spine specialist at Orthopedic & Sports Medicine Center of Oregon, regarding the broken vertebra in my neck.
On the day of the appointment, her office called and cancelled, saying that I needed to go to the ER. Interestingly, it was the ER doctor, during my last visit, who took a look at my scans and recommended I see a cervical spine specialist.
The next day, I learned that the reason Dr. Nguyen canceled is that she doesn’t see trauma patients. Seems that during the referral and scheduling process, the broken bones, collapsed lung, and concussion on my online chart, as well as every other specialist’s notes, would’ve been a dead giveaway that a bit of trauma occurred, but what do I know?
Finally, a week after I’d gotten my “urgent” CT, after I’d put in around three calls a day to his office, Dr. Sandquist himself returned my call. “I need to see you in Newberg tomorrow morning. 8 AM. It’s urgent.” I know it’s urgent, I thought to myself. I wish some of this urgency would have translated into you taking a look at my CT in a timely fashion.
So, we woke up at 6:30 AM to drive 90 minutes, fighting traffic, to finally meet Dr. Sandquist face-to-face. He was thoughtful and kind, and told me that due to the nature of my fracture, surgery was the only option. He prescribed several pre-surgery tests, including more lab work and two more spine MRIs. Kathleen snapped the policy-picture. We drove home.
I upheld my part of the bargain, getting my blood drawn the following day, and my MRIs that Saturday, the earliest I could get them scheduled. Lying motionless on a hard bench for an hour with a broken back and neck is no easy task, but I soldiered through, knowing that the promptness of my surgery depended on, in no small part, me getting these tests done.
Since I knew that doctors’ offices are typically closed on weekends, I called Dr. Sandquist early on Monday, August 26. His receptionist told me that the surgery had been submitted to insurance. Knowing that Dr. Sandquist had submitted it as urgent, and knowing that insurance could take up to 72 hours to approve it, I didn’t think to contact my insurance directly. I called again on Tuesday and Wednesday, and was given the same answer: “It’s been submitted. We’re still waiting on insurance.”
Finally, frustrated, I gave my insurance a call on Wednesday afternoon. “We haven’t received anything from Dr. Sandquist,” I was told. My heart sank. I immediately phoned his office back, and was given the usual “it’s been submitted” response. I asked to speak with a supervisor, an office manager, a surgery scheduler, anyone. I was transferred to his surgery scheduler, who answered the phone. After explaining my situation politely yet firmly, and explaining how her office staff had told me, three times, a blatant falsehood about the status of my surgery referral, she curtly responded, “I don’t like the fact that you’re calling my receptionists liars.” I explained that though I didn’t believe their intent was malicious, that was what they had done. She virtually came unglued, berating me for my impatience with the process. “I know you’re in pain. You’ll be fine. I understand what it’s like to be in pain,” she snapped. “I’m in my 50s.” Yes, the natural aging process is virtually akin to having a myriad of broken bones after falling off a cliff.
Welcome to a healthcare system where it’s easier to point a finger than to lift one and get things done.
It’s hard to describe the pain of 21 broken bones. It’s a pain that few of us will ever have to experience. It’s harder still to explain the pain of a broken healthcare system, yet sadly, many of us have come to know this pain firsthand.
Almost in tears due to my frustration with my situation and with Dr. Sandquist’s surgery scheduler’s utter lack of compassion, I hung up. I left messages with higher-ups at The Oregon Clinic and Providence, but never heard anything back. In searing pain, I took an oxycodone for only the second time during this whole ordeal and went to bed.
With each and every moment and each and every movement, fear continued to creep in, and I wondered if each time I moved could be my last. Having a dangerously unstable spine did little to help me get more than the two hours of sleep I averaged each night.
Thursday, August 29, rolled around, and after many more calls to Dr. Sandquist’s office and insurance, I finally received a call from the doctor himself. “I’ve seen to it that your surgery has been submitted, and it’s marked urgent. I’m hopeful that we can get this done as early as next week.” Relieved that Dr. Sandquist himself, at least, was advocating for me, I hung up and went to get a few more pre-surgery labs drawn that he had just ordered.
The following Monday, of course, was Labor Day. No self-respecting doctor would work on such an auspicious holiday, so I called early on the morning of Tuesday, September 3, sure that my surgery referral would have been approved by now, due to its urgency.
I was wrong.
Insurance informed me that they had indeed received it, but that it was marked “elective.” It could take up to 14 days to approve. I called Sandquist. His office informed me that if I wanted it resubmitted as urgent, Dr. Sandquist would have to start from scratch, and his office informed me that he was far too busy to do so until the following Monday. They also informed me that there was no way to change the coding on an existing surgery referral, and that insurance could potentially deny it based on whether or not they deemed it urgent. Basically, whether I waited out the 14 days or waited for Dr. Sandquist to resubmit it, I would be waiting quite a long time.
At this point, it had already been 71 days since my accident.
Unsure of what to do next, I called insurance to see if I could switch health plans to OHSU, Portland Adventist, Legacy, anyone. They said I could, but that it would take three business days. I placed a call to Senator Wyden’s office to see if they had access to any strings they could pull. I reached out to several contacts in local television. I posted desperately on social media, and several of my friends, including one who pretended to be my angry uncle, called Dr. Sandquist’s office on my behalf, pleading for them to have some sense of urgency with my future at stake.
In the midst of all this, Tim called. I took the offending photo down. I cried.
On Wednesday, I reached out to my friend Joyce Newmyer, president of Adventist Health, who immediately put me in touch with Dr. Jeff Boskind, a thoracic surgeon at Portland Adventist Medical Center. He got me in to see Dr. Bret Ball, a neurosurgeon with Northwest Spine Surgery, that same day. Even though his day was packed, he recognized the urgency of my case and squeezed me in. He said that he could get me in for surgery as early as the following Tuesday, as long as insurance complied. He also informed me that there are codes he can employ that will easily get an urgent or emergent surgery approved on the same business day, and that it baffled him as to why Dr. Sandquist hadn’t utilized these.
It’s interesting how some in healthcare sit idly by, blaming the system, insisting their hands are tied, while others proactively take it upon themselves to help someone who is desperately in need, even when their schedule and the system technically don’t allow for it.
At long last, on the morning of Thursday, September 5, perhaps through a combination of the pressure applied by myself and all the other aforementioned entities, Dr. Sandquist’s office called, saying that they had magically been able to change the surgery coding, even though they had originally deemed this to be impossible, and that my surgery had been approved. Unfortunately, Dr. Sandquist didn’t have any openings in his schedule until September 17, almost a full two months after I returned home to Portland.
I called Dr. Ball’s office back. They graciously explained how they were going to get me in for surgery on Tuesday, September 10, a mere 6 days after my initial appointment, by bypassing insurance protocols and making me an urgent hospital admit. This is a procedure that Dr. Sandquist’s office also had at their disposal yet chose not to utilize, for reasons I will never know nor understand.
Next Tuesday is now tomorrow. I just left my pre-op appointment with Dr. Ball, and everything is in place for surgery. Six of my vertebrae are going to be fused, so I’ll have no choice but to have impeccable posture going forward.
I’m hopeful that come tomorrow, I will finally be able to put an end to this cycle of misdiagnosis, apathy, pain, and frustration, and that at long last I will be on the road to recovery. Dr. Boskind will be performing my sternal reconstruction surgery two weeks afterwards, since Dr. Merry doesn’t seem to have any sense of urgency in getting my badly broken breastbone repaired.
I’m also hopeful that my story can, in some small way, inspire lawmakers and policy makers to make changes to our broken healthcare system, changes that will put the patient first, not red tape, bureaucracy, or dollar signs.
It’s going to be a long road to recovery, but each painful step down this road is one step further away from this holding pattern of pain and frustration that I’ve been in. It’s also going to be a long road to overhaul our current healthcare system, but I hope that my story can change even just one policy to make things a little easier for those who are unfortunate enough to follow in my footsteps.
To be clear, I am not sharing my experience in an effort to denigrate Dr. Sandquist, Dr. Jenq, or anyone else. Both of the aforementioned doctors are empathetic, skilled professionals whom I would trust to operate on my body. I understand that specialists are busy, and that every case is a life that is important.
It’s clear that the problem is the system, not the surgeons, in most cases. A system that requires too much of each specialist, stretching them thin across an impossible workload of too many patients in need. I’m not writing to point fingers at specialists; I’m simply writing to tell of the abject inefficiency I’ve encountered, the delay in reading urgent scans, the misdiagnoses, the rude and dishonest office staff, the blame game, and the obvious difference in insurance and admissions protocol when someone actually takes the time to recognize the urgency of your case, versus when someone does not.
I’m also aware that I am not alone in this struggle. In fact, there are those who have fared far worse at the hands of an inept healthcare system. Some have even lost their lives as a result. I’m grateful for the fact that I’m able to share my story when others have not, because they can not.
I don’t pretend to have the answers. I am not a legislator nor a lawmaker. I do know that the quality of American healthcare simply doesn’t match up to its cost. I also know that dollars, not people, are what matter to HMOs, to pharmaceutical companies, to clinics. I have been faced with a life-threatening condition and told to wait. I, like so many others, have been the victim of a flawed system. One that must change.
While the pain in my body persists, the pain in my heart has been alleviated, knowing that there is a light at the end of this tunnel, and hoping that my story can help someone else get the care that they deserve in a timely manner.
My broken bones will heal. This broken healthcare system won’t, unless we do something.