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In the Community of Single People, we have been discussing ways in which hospitals make things unnecessarily difficult for single people. Cathy Goodwin sent me an essay that was so insightful and so important, that I asked if I could share it with "Living Single" readers. Happily, she agreed—thanks, Cathy! She has been a great source on this topic for a long time. Back when I wrote Singled Out, I quoted her observations on singlism in the medical world.
By Cathy Goodwin
When my outpatient minor surgery is scheduled, I figure it’ll be a cakewalk. I’m in excellent health with good insurance.
But soon I discover that’s not enough. I also have to demonstrate an acceptable level of sociability and integration into mainstream society.
In other words, I need to prove that I’ve got sufficient connections to get myself a ride home. As a single self-employed person, newly relocated, with no relatives living nearby with time on their hands, this requirement becomes more stressful than the surgery itself.
By federal law, patients who are cognitively impaired after anesthesia must be discharged to a “responsible” adult. In their zeal for liability protection, hospitals have escalated these requirements to include patients who are ambulatory and alert when they’re discharged. They’ve also tightened the requirements for what counts as a “responsible adult.”
I am reminded of psychiatrist Sally Satel’s story from The New York Times almost a decade ago, recounting her search for a kidney. By law, body parts must be donated, not purchased. Without a family and a network of close friends, you’re denied access to all the wizardry of modern medicine.
I need just a few hours of someone’s time, not a body part, but the resemblance is scary. In a world where people beg their employers for time off to care for a sick child, my kindly transporter must block out a whole day to give a healthy acquaintance a 10-minute ride.
A whole day for a 10-minute ride? My hospital won’t know when I’ll need a pickup till 4 p.m. the day before. Some hospitals would require my escort to remain on the premises for several hours during my surgery, sitting in a crowded, noisy waiting room, trying to get some work done over a blaring television set.
This sacrifice seems small when compared to losing a kidney. Additionally, I’m not constrained by the need for a compatible donor. Still, when I put out feelers, I encounter what Satel calls the “treacherous intimacy.”
Just asking the question tests a relationship. Friends feel guilty when they can’t help or when they just don’t want the hassle of what seems to be not a very big deal.
Who do I ask? The friend who’s a great coffee buddy isn’t necessarily someone I want to see standing at the foot of my post-op bed, learning all about my private life from the post-op nurse. The friend who says, “Call me if you need anything” goes on vacation to California. The friend with a client-driven business just looks at her calendar and sighs.
Unlike someone searching for a kidney, I can pay for a ride without committing a felony. However, most hospitals rule out commercial solutions. They shudder when I suggest a cab or car service, suggesting an official medical transport service.
Medical transport services require me to reserve the service ahead of time and pay $50-$200 for aides who are “very nice.” Eight dollars would get me a ride with a cab driver who’s been fingerprinted, background-checked and driver-tested.
Some hospitals go even further. You must leave, they say, in a “personal car” with your presumed friend or relative.
“Call one of those senior transport services,” an online post suggests, “or the hospital social services department.”
If these services exist, they’re for Medicaid patients. A friend in Texas, the veteran of many medical chauffeuring rides, says, “Community groups have emerged to help people in need. If you’re a working person with assets, you’re on your own.”
Someone from a New York Times forum advises me to, “join a church, any church. That's where the good people who like to help others and have the time to do so tend to be found.” Do I conveniently get religion just in time for the ride home? And does it have to last after the surgery?
When I Google “ride home from hospital no relatives,” I am surprised to find no research and no news reports. Instead, hundreds of stories pour into online forums. People say they were forced to remain in pain, postponing procedures or foregoing them altogether. Several were denied colonoscopies at the last minute, after going through the full prep, because their rides home didn’t meet hospital standards. Others were new to a community where they knew no one, or simply were private people who didn’t want to share their medical history with colleagues or casual friends.
Alarmingly, some of these people desperately turn to Craigslist or public bulletin boards, paying total strangers to pose as friends or relatives. They’re putting themselves at risk way beyond the level of hailing a cab or hiring a limo service.
The most painful posts shared tales of medical professionals who responded to their concerns with sarcasm: “What’s the matter with you? Don’t you have friends?”
On a forum for ER staff, someone claiming to be an ER nurse wrote scathingly of people who “had plenty of time to find a ride; now they can just sit for hours in the waiting room till someone shows up.”
What’s at stake here is more than just a ride home from the hospital. It’s a harbinger of what’s in store for a tsunami of over-65 boomers. Millions will be like me: living alone, fiercely independent, and lacking support systems to get through even a simple medical intervention.
Already one in seven adults lives alone and the trend is increasing. More of us have chosen to be single and childless. Social networks have become virtual rather than face-to-face; when I say, “Some of my best friends are people I’ve never met,” I’m only half-joking.
Meanwhile, the medical world remains firmly rooted in the 1950s when people got married and one spouse stayed home to take care of the kids, who were then available to help their aging parents.
Even worse, for people of any age, these requirements seem as irrational and arbitrary as a fraternity hazing ritual.
First, the medical community’s focus on risk seems skewed. If I sneak a cookie before anesthesia, I could suffocate, go into a coma or even die. I’m trusted to remember not to eat, and to follow a complex schedule of pre-op and post-op meds, but I’m not sufficiently responsible to figure out how to get myself home.
Second, we need to consider the risk of not having a procedure. If the danger of dying from colon cancer is less than the infinitesimal risk of being attacked by a maniacal cab driver, why bother?
Finally, since my escort doesn’t live with me, I can’t prevent her from sleeping through the alarm clock, responding to distress calls from her boss, or even changing her mind at the last minute. I lose the benefit of having the procedure. The hospital loses operating room time—a scarce, expensive resource—from last-minute cancellations.
Ultimately, what seems a simple, no-brainer policy represents a discriminatory method of rationing medical services based on social connections and sociability. Why should I be denied care if I’m single and new in town? For that matter, why must I be a friendly, sociable person who attracts dozens of caring friends? Can’t I be a curmudgeonly hermit and still get medical care?
The hospital administrators are not unkind. They tell me they’re hearing from more and more people in my situation. They just haven’t figured out what to do with us.
In an ideal world, I would sign a release and make my own going-home arrangements. I’m not stupid. If I’m walking into walls and tripping over my own feet, I won’t run out into traffic and hail a cab.
In the end, I get lucky, possibly because I refuse to be dismissed as a social misfit. I ask the scheduler, “Could you get time off to take a close friend home from this surgery?” She immediately says, “No, I have to work.” She gets me the first appointment of the day, so I can schedule a pickup in advance.
Then I hire my dog walker. “Think of me as just another Great Dane,” I say, “and reserve time for a two-hour walk.”
“And,” I can’t resist adding, “if you can’t come, don’t bother calling ahead. I’ll sneak out the back door and hail a cab when nobody’s looking.”
About the Author: Cathy Goodwin, Ph.D., is a former b-school professor who now works online as a copywriter and marketing strategist. Her business website is CathyGoodwin.com. She is the author of Making the Big Move: Relocation As A Life Transition, and she is working on a book about preparing for getting old before you get there. She is proudly single in Philadelphia with a dog and 2 cats, all rescues.
