As a rule, small hospitals have a really nice feel to them. Probably because everyone knows each other. The housekeeper is cousins with the charge nurse, the security guard is in night school with the cafeteria worker, and the laboring patient in room three is the surgical tech's daughter-in-law. I hear "good morning, Dr. Stone" ten times between my car and the hospital.
Like any critical access hospital, there is a basic lab and radiology department. But ordering anything beyond that requires us to transfer the patient or send out the lab. It's good training in resourcefulness. Patients with a cough require a bit more from my stethoscope and from my brain than they would at a big university hospital. An automatic knee-jerk xray isn't feasible when the technician needs to be called in from home, and ordering a CAT scan will get me laughed out of the hospital.
In addition to the usual small hospital charms, Holy Cross has its own set of eccentricities. It was built in the 1960s, and working there can feel like going back in time. The patient care areas have the usual modern equipment, but there's a strange little wing off to the side of the hospital where the call rooms and offices are.
The first thing you'll notice is that it's carpeted. You just don't see that in hospitals, and for good reason. There's a bathroom in each office, and a shower at the end of the hall. It feels like a college dorm, minus the college. The wing seemed completely out of place in the hospital, until I realized that this isn't just any hospital. It's a Catholic hospital built when they still had convents attached to them. So I am, by far, the most sinful person to have slept in these halls.
The Catholic element brings another uniqueness to Holy Cross. Working in a big university hospital teaches you to be mindful of a wide variety of patient beliefs. But when it comes to medical advice, we're trained to present all options as objectively as possible. So, calling on that training, I checked up on my first few moms the day after their deliveries, and asked each one of them my standard list of questions.
How are you feeling?
Good.
Are you still bleeding?
No.
Has your appetite returned?
Yes.
What would you like to use for birth control?
(Crickets)
Birth control is an important part of helping a new mom's body heal and recover. Prescribing it is just what you do. Except when you work in a Catholic hospital.
In all fairness, the vast majority of the OB patients here use birth control, and most of their pregnancies are planned. But the patients just don't seem comfortable talking about birth control in God's house.
And this is very much God's house. As you pull up to the front entrance, the door to the hospital is on your right, and the door to the chapel is on your left. Choose wisely.
Some other apparitions:
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| Your nurse today will be Mary. |
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| What would Jesus eat? |
Culture shock aside, Catholic hospitals play an important role in the US healthcare system. It's far too common for patients to lack any type of health coverage--citizens and migrants alike. And although Catholic hospitals are increasingly being run like other large health care corporations, the Church has joined government and private hospitals to find room in their hearts and in their budgets to provide care for people who just can't get it anywhere else.
Another unique aspect of Holy Cross is the role that it plays in emergency healthcare. The term Critical Access Hospital isn't just descriptive, it's financial. It signifies to government payors (Medicare, Medicaid, etc.) that this hospital plays a more outsized role in the community than its numbers might imply. A big university hospital can care for hundreds of patients each day, and even if some of them don't have insurance, the income from the ones that do can pay for the hospital staff, laboratory, radiology equipment, etc. However, a Critical Access Hospital may only see a few dozen patients each day, but the hospital still needs to pay the bills that keep the doors open. Even though the hospital may not be financially viable within a strict fee-for-service model, it's role in the community is very important, and its loss would be devastating. So clearly there's a value to that service that requires a slightly different funding method.
As the political dust settles around the Affordable Care Act, it's pretty clear that most of the provisions are doing a lot of good for a lot of people. But there is one part of the ACA that is having an unintentionally adverse effect on Critical Access Hospitals. The extra funding for CAHs was significantly decreased by the ACA, with the expectation being that the funds would be less necessary as more of their patients were covered by insurance. But the increasing amount of insured patients isn't keeping up with the decreasing amount of federal funding, especially at hospitals along the border. But thankfully, the funding cuts have been pushed back until next year, and this is an area of active debate.
And speaking of the border, that's another one of the more striking differences between Holy Cross and most every other hospital in the US.
I took that photo while standing on hospital grounds. If we were any closer, I'd need a Mexican medical license.
I'll go into detail about the border in a later post, but it's one of the more amazing parts about being down here. Holy Cross is a very interesting place to work.
