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March 7, 2012, 2:37 pm, When Hospital Visitors Get Sick

By THERESA BROWN, R.N., Columnist

The young woman was waiting for her mother to be discharged from the hospital
when the pain started. “My chest is hurting,” she told me.

This is a phrase nurses hate to hear, since we immediately start to worry about heart
attack. But this woman was young, and didn’t look unwell. The chances of her chest pain
being cardiac trouble, rather than indigestion or some other minor problem, seemed slight.

I asked the standard next question: Had she had this kind of pain before?

Her answer startled me. “When I had my heart attack,” she replied.

The alarm bells went off in my head, but I couldn’t react the way I usually do when a
patient complains of worrisome chest pain. This woman was not a patient. She was a
hospital visitor, the daughter of a patient getting ready to leave.
In the hospital, people who aren’t employees fit into one of two categories: patient or
visitor. But when visiting family members or friends become ill on a hospital floor, it’s not
easy to care for them. We don’t know anything about them or their health history. We
can’t offer standard inpatient care because they aren’t registered in the system. They are
here, and they are sick, but they are not yet patients.

Should one of my patients complain of chest pain, there is a specific set of

procedures I would follow. I would call the intern, get an EKG, maybe draw blood to
measure a blood chemical that shows the level of cardiac injury. I would also take vital
signs to make sure the patient was stable and consider putting her on a heart monitor,
until the doctor arrived. It would be a flurry of activity, but I would be calm. As long as
the patient stayed conscious, and her vitals were acceptable, the chest pain wouldn’t be an
emergency.

But now I found myself in a completely different situation. This woman had chest
pain and a history of heart attack, but she was a visitor. There was no doctor assigned to
her case to come see her or order an EKG, no mandate for sticking her and drawing her
blood, and no medical record number for processing lab work. Her vital signs could tell
me whether she was stable, but without her full medical history, I had no context for
interpreting them.

Under the circumstances, I had three choices. I could wait and see how she did over
time, I could call a code and bring in a rapid response team, or I could take her to the
hospital’s emergency room.

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Waiting struck me as a very bad idea. Time is muscle when someone has a heart
attack. If the woman was having a second heart attack, then faster treatment would limit
the permanent damage. Calling a code seemed like an overreaction that might take needed
care away from patients on the floor. The woman was uncomfortable, but she wasn’t
crashing. Hurrying, I snagged a wheelchair, and headed to the emergency room six floors
down.

Riding down in the elevator, the woman started to feel worse. She began crying and
complained that the pain in her chest was increasing. Suddenly I worried that not calling
the code had been a mistake. I knew so little about this woman. My assumption that she
would stay stable during our short trip to the emergency room had been based on
intuition, not knowledge. Bringing in a rapid response team would have covered our
bases.

We reached the E.R. without her crashing, and I burst into the triage area. “Patient’s
daughter, sudden onset of chest pain, history of M.I.,” I said warningly, raising the specter
of the woman’s past myocardial infarction — her heart attack. The triage nurse glanced at
me with a mix of irritation and gentle sympathy. “O.K.,” she said, barely looking up as she
handed me a clipboard of patient forms.

Suddenly I understood. The emergency room specializes in turning people into

patients, deciding what is a true emergency and what is not. It’s what they do every day.
The young woman’s chest pain felt like an emergency to me because I couldn’t help her in
the way I know how. But in the emergency department, a little chest pain doesn’t get them
worked up. Taking care of people they don’t know is their job.

In the book “Illness as Metaphor,” Susan Sontag wrote that all of us have “dual
citizenship in the kingdom of the well and in the kingdom of the sick.” She described
illness as an existential crisis in which we reluctantly enter “the night-side of life, a more
onerous citizenship.”

That day, with my patient’s daughter, I realized that illness can be a bureaucratic
crisis as well. Even inside a hospital, a sick person is not a patient if she doesn’t have an
admitting physician, a diagnosis and a numbered plastic wristband.

Fortunately, my patient’s daughter wasn’t having a heart attack, but her cardiac
rhythm was abnormal. She was admitted, and she stayed a few days while the doctors
figured out what was wrong.

Meanwhile, her mother was ready to leave the kingdom of the sick. She got her
discharge paperwork from me and went home, or perhaps she returned to visit her
daughter in the hospital.

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In the Region | New Jersey - Warm Winter, Cool Sales, By JILL P.

CAPUZZO - Published: March 8, 2012

SKIING down the mountain in the morning and golfing on the fairways in the
afternoon, with just a five-minute drive in between? How can that be possible?

And yet it is exactly what some intrepid sportsmen are doing in the northwest
corner of New Jersey, where the Crystal Springs/Mountain Creek resort in Sussex County
continues to produce artificial snow, but has also opened its golf courses a full six weeks
earlier than normal.

“We call it the ski-and-tee package,” said Bill Benneyan, the vice president for
marketing at Mountain Creek. “It’s 50 degrees out, and there’s still snow on the
mountain.”

Nevertheless, Mr. Benneyan said, ski business is down 15 percent at Mountain

Creek this winter, which has been particularly mild, especially compared with last year’s.
With almost no natural snow, the task of enticing people to spend the day at the ski resort,
formerly known as Great Gorge and Vernon Valley, not to mention invest in real estate
here, has proved challenging.

“It’s been a tough winter,” said Jason Brinker, a sales associate with the McCullough
Group at Re/Max Connection in West Milford. “But buyers realize it’s a gamble every
year. But our buyers are a different breed. They’re not looking to go to Killington, Vt.
They’re coming here because of the easy commute to New York.”

Those trying to market the hundreds of condominiums, town houses and single-
family homes in close proximity to the ski resort have had to adjust their pitch somewhat,
first by letting prospective buyers know that Mountain Creek has some of the most
sophisticated snow-making machinery in the country, and second by promoting the area’s
four-season appeal.

To that end, Crystal Springs and Mountain Creek’s new owners, a group of
investors led by Eugene Mulvihill, have been enhancing the area’s amenities, not only
opening a 55,000-square-foot ski lodge and increasing the number of tubing lanes to 35,
but also planning a zip line and a roller coaster for the summer. The area already has
seven golf courses, a water park, downhill bike trails and two spas.

When prospective buyers come to visit, Mr. Brinker said, he gives them the grand
tour — the ski trails, the lake communities, the spas. While admitting that the scarcity of
snow has had an influence on clients’ impressions, he said, “They have to realize, I make
them realize, it’s been a bad winter here.”

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Still, snow or no snow, this area is considered one of the most depressed real estate
markets in the state — so the main driver of sales lately has been fire-sale prices. Kevin
Detwiller, a broker at Mountain Resort Properties, which handles most of the sales at the
several developments connected to the resort, said business had been brisk of late.
Returning from vacation recently, he said, he found three offers awaiting him on
condominiums in Great Gorge Village, a 1,400-unit mountainside development.

“I’m feeling a percolation at the bottom of the market,” Mr. Detwiller said. “As
prices come down, people are starting to buy.” (He also said it had been a fairly good ski
year, “albeit, no natural snow.”)

Prices are down significantly from what they were six or seven years ago, after some
of these developments opened. For instance, Mr. Brinker said, he sold a one-bedroom one-
bath condominium unit in the Appalachian Hotel in November for $42,000 on a short sale.
A similar unit sold for $275,000 in 2004, he said.

One attraction, at least potentially, is that as a condominium-hotel, the place allows

owners to “bank” their units and rent them out for about $175 a night. Nigel Cunniffe, a
broker/sales manager at Mountain Resort Properties, said he had had offers on nine town
houses being sold as short sales at Black Creek Sanctuary, a gated community whose units
once went for more than $500,000 and are now selling in the mid-$100,000s.

But inventory remains high. The town of Vernon has 350 homes for sale, with 49
sold in the last three months, according to Mr. Brinker. Neighboring Hardyston has 141
houses listed, with 21 sold since early December.

“There are a lot of homes on the market,” he said, “and not many people are buying
them.”

Mr. Cunniffe estimated that half his recent business had been in short sales. Prices
will remain relatively low until the excessive short-sale inventory is sold off, he predicted.

Still, “a lot of people are deciding it’s a great time to buy,” he added. “People are
buying multi-units, either to put into the rental market, or for the appreciation they’re
going to see. If someone is paying $150,000 for one of these places, you can’t even build it
for that much.”

Richard Blas of North Bergen, interested in getting back into skiing after a hiatus,
decided he wanted a ski house for his family, and in December 2010 ended up buying a
two-bedroom bilevel condo next to the mountain in Great Gorge Village for $95,000. He
said he had been out on the trails only twice this season, noting, “It’s been nothing like last
year.” But he isn’t complaining about the mild winter, because it has allowed him, his wife
and two children the chance to take advantage of other amenities at or near the resort.

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“You can get a ski place anywhere,” Mr. Blas said, “but what are you going to do if
there’s no snow? Here you can go to the pool, go horseback riding. They’ve got the lodge
and the nightclub. It’s like being on a cruise ship. You can go out and have a couple of
cocktails and not have to worry about driving home at night.”