IT BEGAN THE way these things often begin.
“Sarah threw up in the car!” my daughter Hannah announced brightly one evening as she and her sister got home from the performing-arts class they were taking. Hannah is in third grade and three years older than her kindergarten-age sister, but the mythic status of the Kid Who Pukes In An Inappropriate Place transcends time, space and age gap. I know this not only because of my daughters, but because it has been 35 years since I was in third grade, and I can still conjure up both the names of the kids who heaved in our grade-school hallway and what it smelled like. (Hope you’re feeling better, Linda U.)
My wife Kate and I figured that our usually spirited five-year-old was suffering from a run-of-the-mill stomach bug, so over the course of the next day and a half, Kate did what she does so well: gave Sarah lots of TLC, read to her, played with her, watched Barbie DVDs with her. By Saturday morning, Sarah was feeling better — or at least I thought she should be feeling better, which is why, in a decision that will undoubtedly be part of my father-of-the-year nomination, I announced that Sarah should walk with me to an event at Hannah’s school, a short distance from our house.
“But my tummy hurts,” Sarah whimpered, still in the prone position she had taken up on our living room couch.
“Sarah,” I began, dropping into my deep "I am your father therefore I am very wise therefore you would do well to heed me" voice, “you probably just have a little gas. Taking a walk will actually make your tummy feel better.”
Within a couple of blocks, it was clear that Sarah’s “gas” wasn’t going anywhere. “It hurts,” she wailed, doubling over in front of a neighbor’s house. So I finally relented and told her that if she insisted on acting like a little girl about this, fine, we didn’t have to go to Hannah’s school.
Then, naturally, I made her walk home.
As the hours passed, Sarah didn’t get better; she got worse. By five o’clock, my wife was on the phone with our pediatrician. Standing in the kitchen, I listened as she described Sarah’s circumstances — she left out the kindergarten version of the Bataan Death March I’d led my daughter on — and nodded before hanging up.
“He says we have to go to the hospital — now,” Kate said. “It’s probably her appendix.”
I’ll spare you any more suspense. At 3 a.m. the next morning, nine hours after we’d arrived at the emergency room at Children’s Hospital of Philadelphia, after various exams, X-rays, ultrasounds and IVs, a very cool surgeon named Peter Mattei made three tiny incisions in my daughter’s belly and slid out her minute, misbehaving appendix. Over the next couple of days, with the help of my wife, who never left her side, and a team of wonderful doctors and nurses, Sarah recovered the way most surgical patients recover: a good hour here, a bad one there, a burst of energy here, a three-hour coma-like nap there. On Tuesday afternoon, three days after we’d rushed her to the hospital, Sarah came home — lacking one appendix, but having gained two Webkinz stuffed animals, which made her older sister jealous enough that she was clearly trying to figure out how she could land in the hospital.
On one level, I — and, I think, my wife — look at Sarah’s appendectomy as something of a miracle. In the broadest possible terms, something went haywire in the belly of our little girl, and over the course of several days, dozens — and I mean dozens — of highly trained, highly capable people worked together to fix it. They did such a remarkable job that within a week of coming home, Sarah was once again climbing the apple tree in our backyard, and showing off her three tiny scars to anyone who wanted to look.
But on another level — and maybe I say this because as Sarah’s dad, and a nonmedical professional, I felt this was the only part of the process that was my responsibility, that it was my job to be on top of — my daughter’s appendectomy opened my eyes to the nightmare that is our nation’s health-care system. Because when the bills and insurance statements started rolling in — a snow squall of papers featuring incomprehensible phrases like “patient encounter summary” and “allowed amount” and “core network” and “out-of-pocket cost” — I struggled to understand any of it. And this wasn’t a case where coverage was being denied, or the doctor had left his BlackBerry inside my daughter’s belly. No, this was a case where everything went right.
Which is why I set out to understand it — not just Sarah’s bill, but why what I was being asked to pay for her care, what the insurer was paying, what we were paying for — was so hard to figure out. I discovered two things: first, that much of the cost of our health care is determined behind smoked glass, where patients are never invited to look. And second, that in trying to make sense of a single simple case where everything went right, you can learn a lot about what’s wrong with health care in America.