Saturday, September 19, 2009

CrossCourts Pro Invitational Squash Tournament in Boston, USA

By Sarah Cortes

Most of you know me primarily as a technology writer, covering information security, compliance, risk, surveillance, privacy and privacy law, cybersecurity and the White House cybersecurity program for TechTarget Media and other publications. Readers of this blog know I write on a variety of other topics of personal interest to me. I also liveTweet a number of events, where the hand is quicker than the eye. For non-Twitterers, liveTweeting is just using the Twitter platform to report events live.

Yesterday I liveTweeted the excellent matches at the CrossCourts Pro Invitational Squash Tournament at Natick, just outside Boston, Massachusetts, USA. In order, we were offered some remarkably fine matches: Sharplin vs. Chaudhry, Palmer vs. White, Quick vs. Kenny, Razik vs. Illingworth.

Between 6pm and 11pm reporting consisted of 56 tweets, rife with typos reflecting the speed required of live reporting, about half of which covered the final match between Julian Illingworth, USA and Shahier Razik, Canada. This predictably reflected the approximate proportion of time all players spent on court: the Illingworth-Razik match consisting of five games stretched over and hour and 20 minutes.

Each match had its own flavor. Sharplin vs. Chaudhry pitted a hugely popular local coach, Daniel Sharplin (local- via New Zealand) against the Chaudhry, the reigning collegiate national Champion from, where else, Trinity.

Palmer vs. White, two foreigners now making the US their residence, a contrast in styles, periods, and fitness in a match conveying a flavor of longtime tourmates.

Quick vs. Kenny, the US's longtime highest-ranked player and Boston resident vs. the classic Irishman. 5 tweets total.

Then, finally, Illingworth vs. Razik. Illingworth, currently world #33, the highest-ranked US men's player ever. Razik, #27, current Canadian national champion, a highly experienced and respected player, known for punishingly long matches. Last night's match went to Ilingworth, his second win over Razik in their 5-match history. CrossCourts invitational is not PSA, so the win is welcome for Illingworth, but not official.

In interviews afterwards, both players voiced the standard expressions of mutual respect we have come to expect from world class athletes who spend their lives traveling the world more or less in a pack. Illingworth laid out the focused goals we expect of a younger player climbing the ranks. Politely appreciative of the media coverage afforded in a sport where the skill and effort are all out of proportion the the media attention received, Illingworth explained candidly his limied experience thus far with twitter. To wit, two Tweets. Gamely agreeing to participate in this livetweeting experiment, he will attempt to review the livestream in retrospect and make constructive suggestions for tonight's matches. He wasted no time continuing his warmdown during the interview. Explaining why he skipped Egypt, where the rest of the squash world is now gathered, he referenced the high quality of the matches on offer for him and the cost/benefit analysis of travel time vs. training time.

Shahier Razik, as expected, displayed the polite professionalism for which he is known, among other things, and echoed his appreciation for his squash media coverage to date in a world where coverage seems to be shrinking while the sport is expanding. He provided the same refined cost/benefit analysis when explaining his own absence from Egypt last night. As evidence, his charming wife Jacqueline was onsite to express her appreciation for Razik's support of her brief, albeit highly successful squash career to date. Razik also confessed his lack of familiarity with Twitter, but grasped the value of the experiment and graciously agreed to provide his feedback when reviewing the livestream before tonight's events.

Boston is thrilled to host these world class professionals and the liveTweeting experiment, which we will continue shortly in the final matches.

copyright 2009 Sarah Cortes
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Sunday, September 6, 2009

Social Media and my Escape from Spinal Surgery in Rural Pennsylvania

By Sarah Cortes

ZDNet/CBS link to Mark Krigsman's article about this story

Everyone wants to know why I'm wearing this Darth Vader outfit. The truth is, I’m smiling, but I'm still in shock from what happened to me a few days ago in Ithaca, NY and rural Pennsylvania. The short answer is that I fractured my spine, thanks for your concern. So then the question is, how did it happen? I mean, I'm wearing this big, scary-looking Freddy Kruger torso brace. How in the world? And why do I seem so happy?

I explain that Twitter (I'm @SarahCortes) helped save me from entrapment and unnecessary surgery in rural Pennsylvania, and that I still feel lucky to have escaped unparalyzed. Compared to which, 4 months in a torso brace seems like a stroke of luck. To add insult to injury, I was robbed of my money and credit cards while helpless, immobilized, and far from home. Astonished when Beth Israel Deaconess police officer Kevin Carroll relentlessly tracked down my property and obtained the return of every dollar, that’s the part that leaves me smiling. Officer Carroll, Dr. Paul Glazer, Dr. Lars Richardson, and Beth Israel Deaconess, you've proved that excellence in health care still exists. I'll never be able to thank you enough.

But more than that, mine is cautionary tale of seeming victimization due to my exceedingly comprehensive health insurance. Not only fully insured, I am lucky to happen to carry the most comprehensive possible coverage, despite my excellent health. It never occurred to me that carrying high-level heath insurance would mark me as a candidate for unnecessary surgery. I found out otherwise while helpless, immobile, and far from home.

You jumped from a 50’ bridge?

UPENN Students Bridge Jump in SchuylkillImage by Vincent J. Brown via Flickr

Injured jumping from a 50’ bridge with my son Cody into a quarry pond at Cornell University in rural Ithaca, NY, during a squash tournament, I lay helpless and still, unable to speak, on a high ledge by the shore where I had dragged myself out of the water and collapsed. I was taken by ambulance to Packer trauma center in rural Pennsylvania, where a second nightmare began. With a fractured spine, but otherwise excellent health and no medical problems, Packer staff, upon learning I had top-of-the line health insurance, prepped me for immediate “reconstructive spinal surgery” and a lengthy recuperation in Pennsylvania.

I requested instead to be transferred to my home in Boston for treatment. Boston hospitals had more experience and a higher volume of this complex surgery, I pointed out, a fact with which no one could disagree. But more importantly, they were asking me to leave my son for what seemed like an extended time. Out of the question, and very upsetting, to say the least.

At first appearing to concede to my request and agreeing to order a helicopter for my transfer, Packer staff changed suddenly and turned hostile when, with the help of Twitter, I made actual progress effecting the transfer. Twitter helped me get the word out to the outside world what was happening to me.

I have been Twittering for about a year. I’m a technology consultant, and I Tweet about information security, surveillance, IT compliance, data privacy, cyberstalking, and the White House cybersecurity plan, which I cover as a writer for TechTarget Media. I never imagined how important Twitter would be to me outside of professional interests. My followers and my regular doctor helped me obtain an “accepting” neurosurgeon in Boston at Beth Israel Hospital, and encouraged me not to give in. That's @JoselinMane in the picture with me at @SteveGarfield's BostonMediaMakers, who took some of the pictures and encouraged me to tell my story to help others avoid a similar fate.

The costume of the science fiction character D...Image via Wikipedia

That neurosurgeon, Dr. Paul Glazer, upon consulting with me and my regular doctor by phone, rendered the opinion that since I had swum independently, however painfully, to shore, and stood up briefly, and had full sensation everywhere, that it was modern protocol that I should next be given a mobility test. “You’ve already passed the mobility test when you swam to shore and stood up,” he explained. You are likely able to walk and leave that hospital now with a brace.” He advised immediate medical transport back to Ithaca so I could collect my son and return to Boston for less invasive treatment. It was 7:45pm, only 6 hours after the injury. My ordeal had only just begun.

Packer staff insisted I still needed immediate spinal surgery. They then declared that because they were “qualified” to perform such surgery, the question of whether they were best was irrelevant, and they would not authorize transfer. Sympathetic nurses quietly mentioned I was one of few patients who had any form of health insurance and tried to help me obtain release. “This is about the money,” I thought. Not just the money, they said. Rural trauma centers need to keep up their numbers of severe cases like mine to maintain their accreditation. I was beginning to get the picture.

My pleas with Packer staff that I could not leave my son and undergo such a potentially lengthy ordeal at an inexperienced facility far from home fell on deaf ears. They tried numerous maneuvers over 48 hours to hold me there against my will. Unbelievably, tactics included:

Threats that my insurance would not pay any expenses if I did not accept their treatment. My bill was already in the many thousands of dollars, they informed me.
Intimidation that if I did not stop resisting their treatment I could be paralyzed
Impeding my communication with Boston doctors by needlessly limiting my phone access. Thank God for Twitter and iphones.
Initially refusing to speak with my Boston neurosurgeon themselves, claiming they were unavailable
Eventually upon my insistence, refusing to make the Packer neurosurgeon available to my Boston neurosurgeon for consultation, instead making only the first-year resident available to him, on the grounds that “this is a training hospital, so we have the most junior person possible handle the cases so they can learn.”

The Corinth CanalImage via Wikipedia

Stating falsely to me that my neurosurgeon was in agreement that I should be treated at Packer, necessitating me paging Dr. Glazer 4 times in the middle of the night to discover the truth, that he had not even spoken to the Packer neurosurgeon. This was because when he called, he was told Dr. Thompson was at first, “unavailable,” and later, he was only able to speak with the resident.
Attempting to cut off my access to Twitter and phones. Requested to bring a phone as the first nurse had done, a second shift nurse briefed by staff as to my supposed intractability snapped, “that’s not happening.”
Blocking insurance authorization by attempting to wrongly characterize their facility to insurance as “the best to provide this procedure,” over Beth Israel Boston. A losing battle for them in the end, but that didn’t prevent them from trying.
Contradicting my Boston neurosurgeon’s information that they were failing to follow modern spinal injury protocol, which called for giving me a mobility test
Refusing myRoosevelt Dam Bridge from Arizona Trail Boston neurosurgeon’s advice to give me such a mobility test, keeping me needlessly physically restrained, immobilized and helpless “to prevent paralysis”
Questioning Dr. Glazer’s competence. He is, among other qualifications, an assistant professor at Harvard Medical School.
Ignoring my information that I had swum independently, however painfully, to shore, and stood up briefly, indicating my mobility
Attempting repeatedly to medicate me with 8cc of morphine when I adamantly refused narcotics, insisting my pain was not great
Isolating me needlessly in the Intensive Care Unit to prevent my communications with doctors and insurance representatives
When I insisted on transport, presenting me with forms to sign in the middle of the night agreeing my medical transport was voluntary and taking personal liability for thousands of dollars in medical transport costs
Claiming the brace-fitter, required to enable my transport, was tied up for 2 days. A stretcher attendant unwittingly revealed upon my questioning on the way back from the MRI that the fitter was immediately available with nothing else to do, and brought her into the trauma room. After discovering staff was angry this had happened ahead of their schedule, the attendant pleaded with me not to explain how I had gotten the brace so quickly, “I could lose my job.”

Other elements of Packer’s care included:
Refusing me food or glucose after I objected to immediate surgery, first explaining I could not eat before surgery then refusing any explanation
Leaving me alone for hours in the Trauma Room. After I stood up for myself, nurses and medical personnel would no longer respond to my calls for help in my immobilized state. “This happened to another woman from Texas not long ago,” one of the staff whispered at one point. Stick to your guns. Her surgery went badly and she was here for two months recuperating. They refused to authorize her transport and she ended up taking a commercial flight to get back to her doctors in Texas.”

At this point Dr. Glazer advised me he was “uncomfortable” with Packer staff, and advised me to “get out of there.” I told him how they were trying to prevent me from leaving, and suggested that I was so desperate that I wanted to simply rip out all the tube and wires, call a taxi, and struggle out back to Ithaca. He advised that they were taking an astonishing chance by not sending me in an ambulance, but encouraged me to depart by whatever means necessary. It was midnight.

I repeatedly rang for a nurse, sat up, and ripped out my monitor wires. The nurse appeared, and I asked for the resident. He appeared and I asked him to substitute a female nurse for my male nurse, since I wanted my catheter removed and my IV out. Whereupon residents and medical staff came flying into the trauma room from all directions.

“Who will be liable if you leave here against medical advice?” a doctor asked, trying to intimidate me into obedience. “Yes, who, indeed?” I demanded to know. He fell silent, aware of the real answer. “If you leave against medical advice, your insurance will pay nothing of your bills so far, and it is in the many thousands! Your transport is medically unnecessary! We are the best qualified to operate on you! If you go to Boston, it is up to you to pay the expense, we cannot authorize it!” All lies, I would later learn. Unable to contact my insurance company at midnight, “I will stay here only until they answer the phones in the morning,” I conceded, exhausted, and lay back down for them to re-wire and re-immobilize me. I thought of Cody in Ithaca, with my friends for the night but without his mom.

I had to battle all the next day before succeeded in obtaining medical transport to Boston at 4pm. The ambulance attendant was one of the only people who was kind and helpful. It was a small town, he explained, with not much to do. Hospital staff had regaled him for two days with the tale of the unbelievable crazy woman from Boston who stood up to the doctors and insisted on transfer.
The Golden Gate Bridge and San Francisco, CA a...
Turns out he was friends with the Packer case manager, a former EMT, who finally helped get me out. The gossip that had rippled all over Packer, about the woman who fought with the doctors while in the Trauma Room and refused to follow their orders. At that point, I wondered if I even had a spinal fracture at all. The ambulance attendant obligingly pulled my MRI and together we checked and saw the shattered vertebrae 12 clearly outlined.

Upon arriving 7 hours later in Boston, Dr. Glazer reviewed the records, gave me the mobility test, ordered a custom torso brace, and I was released shortly thereafter.

Since that time, people on both sides of the health care debate have listened to my story and pointed out it supports their views, both pro and con. I am still trying to sort out what it all means. If you figure it out, please let me know.

Oh right, I forgot the part about the robbery. Imagine my surprise when Officer Carroll of the Beth Israel Police solved the case and got back my cash and credit cards. "Do you remember the ambulance company?" he asked.

Tell me more? You've got to be kidding.
So many of you have written and asked more questions. So here are details of the story...

What happened to me is really frightening, although comical in parts. I took my 13-year-old son Cody to play in a 4-day squash tournament at Cornell University in Ithaca, NY, the North American Jr Open. It is probably the 500th squash tournament my children have played at various locations around the globe, from Egypt to Edinborough, and many familiar friends and faces met us at Cornell's impressive squash facility. 50 juniors commenced match play Monday morning.


By Tuesday noon, kids were hot and needed a break. Someone suggested families try out the local quarry pond where generations of Cornell students relax by diving into the cool water. Upon arrival at the quarry behind two dozen families, we were the last to climb up on the bridge, where moms, dads and kids had already jumped several times.

Looking down, Cody and I contemplated the drop. Later measured by police at 50 ft, it was not the quaint experience we had imagined. "Not fun" I thought, jumping back down into the bridge, and Cody looked terrified. "You don't have to jump," I told him. But the other, bigger boys already in the water were teasing him about being scared, and he wanted to make friends. So I got back up on the bridge ledge, thinking that if Mom jumped, it would give him the courage to follow and join the boys below. Squash moms know, nothing is more important to overall athletic competition enjoyment and recidivism than the friendships carried from one tournament to another. Cody's older sisters, varsity squash players at Harvard and Princeton, are the result of years of similar social engineering. Bracing myself and avoiding glancing down, I jumped.
Updated image from this image at Japanese Wiki...
Bystanders explained that although I went into the water in the expected upright position, it appeared I arched my back oddly as I hit the water. No, it was not too shallow, several dozen moms and teenagers splashing happily below testified to the ample depth. It was the force of hitting the water that caused a searing pain in my back as I plunged deep below the surface.

Opening my eyes underwater to find the direction of the light, I could barely move. Twisting helplessly underwater, after a few seconds, my options were: swim, or...drown. My dive had not looked noticeably wrong, and help was not forthcoming. My first thought was of Cody on the bridge above, and how to prevent him from jumping and hurting himself like me. Images of him falling to his death flashed across my mind and I struggled to reach the surface to prevent him from jumping. I tried to recall the direction of the shore, and paddled weakly as I rose slowly to the surface. When I finally popped above the surface of the water, I could barely breathe and could not speak. Onlookers asked if I was OK, and I was unable to answer. Onlookers assumed I was ignoring them and continued their activity. The image of Cody plunging to his death or permanent disability kept flashing through my mind, and I felt a panic... I had to prevent that.

"Can Cody jump?" called down a mother from somewhere above? "No!" was all I could shout, drifting weakly to shore. "No, no, no." "Do you need help?" someone asked. I was unable to answer, but still no one realized the reason for my silence. Struggling, I pulled myself up on a rock. "No big deal, "I told myself, "You’ll be fine in 5 minutes." "Do you need help?" someone asked again. “No, I'm fine," I said, struggling to my feet. I didn't want Cody to know I was hurt and worry. I wanted him to have fun. I pulled myself up on a narrow stone ledge, on the other side of which was another 30 ft. drop. It was the last time I would move independently for 48 hours.

An ambulance appeared within 2 minutes. I would later learn that this ambulance had been called earlier due to 3 other injuries sustained minutes before my jump. The driver mistakenly assumed I was the caller, fortunately for me, and my predicament began to attract the notice of the rest of the squash families and Cody. Barely able to speak, I stared up into the sky while medic after medic and police arrived at the scene. I was braced, and loaded into the ambulance. Insisting I would be fine but anticipating a long, boring, and ultimately, I imagined, pointless emergency room ordeal, I cheerfully insisted Cody stay with our friends and the rest of the kids and refused all offers for friends to accompany me to the hospital.

That is where the real nightmare began.
Three bridges from another angle

"Where are you taking me?" I gasped, gathering my wits. "Do you have a preference?" they responded." I looked from face to face and reflected on my location in rural upstate NY. "I have excellent health insurance, where is the very best place?" I replied. "Sayre, Pennsylvania trauma center," they replied. Running through my options, it seemed that was my only viable one. And so I left the state, apprehensively.

Well over an hour later, I was rushed into an enormous trauma center and surrounded by dozens of medical personnel. They ran through a prescribed spinal protocol with military precision. I was a "Code," classified as a hi-urgency situation. Restrained to prevent any movement that might cause paralysis or permanent injury, I lay helplessly and waited for the ordeal to be over. With full feeling in my arms, legs and neck, I was cleared of immediate paralysis concern. My bathing suit was snipped off and I lay, still helpless, while my body was minutely examined for further signs of trauma. I thought of Cody back in NY and closed my eyes.

Minutes later, I headed for CAT-scan and MRI. If I needed surgery, they explained, I would be fitted with a body brace to temporarily prevent any movement while I was prepped. If I needed transport elsewhere, I would need the brace prior to helicopter or other transport. I sent out my first tweet since the morning when I got a signal in the corridor. Jumped off a bridge, in a hospital in PA, I tweeted. No one in the hospital noticed. I texted Cody that I was fine, not revealing my actual location lest he worry.

The neurosurgeon rendered a swift diagnosis. "Spinal fracture confirmed, V-12." The impact of the water surface had traveled up the fluid part of my spine and exploded on vertebrae 12, the first one fixed at the base of the rib cage. "Reconstructive spinal surgery," were his words, along with a lot of other confusing ones. I asked the nurse to write them down on a paper towel so I would understand what was happening. Because the doctor had already disappeared.

Alone with a nurse and a first year resident in the Trauma room, they explained I would be prepped for surgery. I would not be able to climb stairs, maybe for 6 months, they explained. I would have to get a porta-potty and move into my living room for a many-months recovery from the surgery. I saw their lips moving and I heard the words come out, but I could not comprehend them. These people were not real, I concluded. If there was any talk of surgery, I will have it in Boston, I stated firmly. "They'll transport you in a helicopter," the nurse explained, "They use it for just about any injury. We had a simple ankle fracture a few days ago and they gave her a helicopter. So they'll definitely give you one." "How soon can I get the helicopter?" I asked. All I had to do, they explained, to start a transfer to a Boston hospital, was get an "accepting neurosurgeon" to agree to accept my case.

I sent out my second tweet on the way back into the trauma room, "Trapped in hospital in rural Pennsylvania, fractured spine. Need a neurosurgeon in Boston," I tapped into my iphone on Tweetie. Frantically texting my non-twittering friends at the tournament, I arranged for them to look after Cody. As I reentered the Trauma Room, the signal cut off.

I would learn later that the doctors and staff never expected in a million years that I would get an "accepting neurosurgeon" within the hour. Even my own doctor could not believe it when I told him later. "How in the world did you get an accepting neurosurgeon so fast?" she asked. "Is that hard?" I asked back? "Well, more like, impossible," she explained.

The answer was a combination of Twitter and the squash world. Twitter friends sent me advice and expressed their concern and support, which I could only receive in snatches when I was moved from one test area to another. Mainly stuck in the trauma room, which no signal could penetrate, a sympathetic nurse conspired to bring me a phone from her station.

Lars Richardson, MD, of Meeks & Zilberfarb, PC is orthopedist to the top athletes in Boston, including many professionals as well as college varsity athletes. He has been on call for my family of little athletes since they were 10 years old, the age at which today's mini-athletes develop their first knee problems. Consulting my iphone and encouraged by my Twitter followers, I placed my first call to Meeks & Zilberfarb, orthopedists, at 4:45pm, about 3 hours after the accident. "I'm in a trauma center in rural PA and I need Dr. Richardson to refer me to his neurosurgery partner," I explained. "Dr. Richardson is busy. You'll have to ask your family physician for a referral," dismissed the receptionist. "No, this is a serious emergency. Dr. Richardson can just refer me to your neurosurgery partner in 30 seconds. I need to get out of here as soon as possible." "I'll send him an email and he will try to get back to you by the end of the week," she replied. "I need him paged now," I said. She put me on hold. The nurse kindly waited on hold for me for 30 minutes before giving up. I later realized she was quietly determined to help me help myself.

Frustrated, alone, immobilized, and cut off from the rest of the world, I turned to Twitter and asked again for neurosurgeons. The names of top doctors at MGH came back. I started the difficult process of calling new neurosurgeons. Later, after offices closed and the receptionist went home, I paged Dr. Richardson. He responded immediately. "Dr. Paul Glazer, Beth Israel," he said. He called back within 5 minutes, having obtained his partner's "acceptance" of my case. Thank you, Dr. Richardson. I'm sure you never expected when you go that call you would make such a tremendous difference to the direction of my case, and the next several weeks, months and years of my life.

Dr. Glazer called me seconds later. With information and encouragement from my Twitter followers, and Dr. Richardson, I had my "accepting neurosurgeon" and my ticket out of hell. But it would be days yet before my ordeal was over.

Could I move my arms and legs? I had swum to shore, I told him. The protocol in these cases is for them to sit you up slowly and give you a mobility test, see if you can walk, he said. The protocol they are using on you, total immobility, that is an old protocol, not used anymore. Today's treatment calls for them to give you a mobility test."

"Dr. Glazer wants to speak with the neurosurgeon here," I told the only person I could find, the first-year resident. When he returned, his attitude had changed. Accompanied by the 3-year, his senior, I was informed that Dr. Glazer had agreed I was best treated in Pennsylvania. "What?" I laughed. "Not possible." I would later learn, after another page, they had refused to connect Dr. Glazer with Packer's neurosurgeon. The nurse defended this, on the grounds that "we're a training hospital, so the most junior person handles each case to train them." I demanded of the 3-year resident why Dr. Thompson was unavailable when mine in Boston was responding to 4 pages throughout the night from his dinner table. Summoned the 3rd year resident, who hurriedly contradicted this, and stated that no one had ever said Dr. Thompson was unavailable. He repeated this over and over.

I paged Dr. Glazer for a 3rd time that night. He was finally connected with Dr. Thompson. The nurse was fiddling with my IV. "What are you doing?" I asked. "We're giving you morphine," he explained. I refused, and the nurse argued with me. I don't want narcotics, I don't need that. 8cc they were preparing for me, a 115 lb woman. I twittered and texted my friend. "Hold firm. Refuse morphine if you can stand it" was the advice.

11:25pm, 3rd year resident again. "Dr. Glazer agrees you are best treated here. That is final, there is no arguing. If you want to go to Boston, that is elective, we will not authorize your insurance for the transport and it will cost $20,000 for the helicopter. It will be available at 1am." I told them to send for it.

Midnight, 4th page to Dr. Glazer. He is "uncomfortable" with the medical staff there and advises me to "get out of that place any way you can." More to follow...

September 11, 2009 - I have followed readers' advice and reported this to the Joint Commission, which provides accreditation for hospitals. I'll keep you posted on what happens.

copyright 2009 Sarah Cortes

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