Monday, October 4, 2010

A Medical Adventure

A human in my circle who wishes to remain anonymous and does not want his recent renal failures shared with the public has been dealing with a kidney stone.  Having felt the knife in in the back pain once before, he was able to self-diagnose and, bypassing the Primary Care Physician, he called the urologist directly.  By the time X-rays and CAT scans were able to be scheduled and taken, the pictures revealed no evidence of a calcified mass anywhere in the human's ureter or kidney or bladder.  Perhaps the world's-longest-urination the night before the tests was a result of the passage of the blockage.  Perhaps not.  In any event, the pain was diminishing and the patient was weaning himself off opiates and beginning to resume his activities of daily living - thus allowing his long-suffering spouse the opportunity to resume her normal life as well.  An appointment for follow-up care for a suspicious collection of fluid in the lower left lung (observed on the scans and of some small concern to the urologist, whose bailiwick is somewhat lower) was secured with the PCP, but the patient seemed to be on the mend. 

The new day dawned and off they went, each to their own pleasures. Arriving back at the garage door simultaneously in the mid-afternoon the story took an ugly turn.  For there she was with her arms full of groceries and sundries, and there he was with his face contorted in agony.  So much for the rest of her day; "I am sooooo glad you are home.... I feel worse than ever," is not a sentence which can be ignored. 

When his attempt to see the physician was thwarted by an officious office staff, she called back and worked her magic - show up in 40 minutes and the Physician's Assistant will take a look.  She drove him to the appointment and was flabbergasted to find that there had been no attempt to share or secure the pictures of his innards.  He was left to describe the effusion in his lung, trying to remember the urologists' words.  His anxiety grew and grew, his pain doubled and redoubled, and suddenly the examining table was doing the charleston as he shook from head to toe.  They'd never seen anything like it.  Suddenly the PCP was in the room.  And the nurse was in the room.  And the Physician's Assistant was watching the scene in horror. 

No, she did not want to drive him to Emergency Room.  She wanted to arrive via ambulance and bypass those waiting in the lobby.  She followed the bus at a safe distance, wondering why the lights weren't flashing and the traffic signals were being obeyed.  There had to be some benefit to this mode of transportation after all.  Careening into a parking space, she stood forlornly outside the closed red doors of the medical transport machine, awaiting her patient.  Time passed and the doors remained shut.  And then, in a whirlwind of activity and noise, he was unloaded from the vehicle and she was forcefully directed away from the electric doors of the ER and around to the main entrance to the department.  She'd be allowed back when he had a room.  Til then, the hard-back chairs were hers to enjoy, along with all the sights and sounds of an Emergency Room in the late afternoon.  Emesis buckets and swollen ankles and grandmas in bathrobes were hacking and sneezing and moaning and retching and she wanted nothing more than to be out of there. 

Five minutes which felt like an hour passed, and then they were reunited, he on a plastic covered mattress and she busily writing down the names of every nurse and physician who entered their cubicle.  Kidney Stone?  Pnuemonia?  A lump?  An anxiety attack?  Electrodes and IV lines were attached to his body in a curiously impersonal manner.  Pair after pair of plastic gloves were used and abandoned as each color coded worker bee entered and acted and departed.  Though they never spoke their own names, each one asked him his name and birthdate before beginning to work on his poor achy body.  There would be no mistakes made in this Emergency Department, at least where identification of the patient was at issue. 

Though an X-ray and CAT scan had been taken less than 24 hours before, they were locked in an office far from the ER ... and it was after business hours to boot.  The bedside X-ray machine rolled into the cubicle and she went out to the hall to avoid exposure.  Then they rolled him to the MRI machine, leaving her behind once again.  The fact that his guts were being bombarded with radiation twice in 2 days didn't seem to bother any of the technicians.  She wondered why that was the case. 

Once back in his cubicle, with a saline drip in one arm and a growing bruise from the EMT's blundering attempts to draw his blood as the ambulance bounced over potholes in the other, he began to shake.  Actually, it was more that his body was twitching uncontrollably, rhythmically, forcefully and painfully.  Back rubs and deep cleansing breaths and foot massages - she tried them all to no avail.  The gentle Irish nurse sat by his side, injecting Valium into his IV line and wondering if he was feeling anything at all.  The quivering had stopped, and his face had a delightfully goofy aspect as he denied any impact at all.  She and the nurse smiled over his abdomen.  He was calmer even if he didn't know it.

The diagnosis was pneumonia, a bag of antibiotics was pumped through the IV, prescriptions were written and personalized computer printed instructions were given and 8 hours after arriving at the PCP's office they were back at home, having been told to see the doctor the next day.

That was a pretty good plan, except that the PCP's office, though ostensibly on the same computer system as the Hospital, had no information about the ER visit.  They didn't want to see him until they had that information.  They didn't want to call and try to get the information.  She called the hospital, spoke to Medical Records, and was told the information had been faxed.  Calling the PCP's office once again, she was told that the lab records had indeed been faxed but there were no doctor's notes or plan of care and the PCP couldn't do anything so come in on Monday at 3:30.  She called Medical Records again, but after 10 minutes of listening to Tex-Mex-Muzak she hung up in frustration. 

So he waits 96 hours for an appointment which should have happened within 24 hours.  They wonder why he wasn't given a pneumonia shot at his annual physical just a few weeks prior to this event.  They don't understand how records can be so compartmentalized when all the entities share the same computer system.  They wonder about the safety and necessity and wastefulness of repeating tests... and will the insurance company pay for the duplications?  They had no real choice in the matter - how can you deny a physician when he asks if it's okay? They really didn't think it was okay, but what could they do?  They signed all the forms and paid the $150 Emergency Room Access Fee their insurance requires, and they will wait for the bills from the various departments and doctors to come in over time. 

He's recuperating and well-medicated and breathing more easily.  It was quite a day.

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