J + A : July 2013

A very rare post from J:

This past week, I had the fortune of getting an insider's look at the American healthcare system. Most of it was while I was on my back, occasionally in great pain, and often on some form of awareness-altering medication. I won't bore the internet with the unpleasant details of my experience, but it went something like this (all times military):

Sunday, 2300: not feeling great.
Monday, 0900: Took the day off from work, went to primary care doctor. Excellent availability. Diagnosis: "virus." Feeling good about my decision to stay home from work.
Monday, 1500: Feeling better about my decision to stay home from work. Personally feeling worse.
Monday, 1800: Advised by primary care doctor to go to emergency room, since her office was closed.
Monday, 1900: Short wait at the ER (~1 hour), pleasantly surprised. Given an IV of fluids and some anti nausea meds. Cumulative blood draw count: 1. Cumulative saline bag count: 1.
Monday, 2100: Drinking Crystal Light lemonade-flavored barium. Taste 4/5, mouth feel 2/5. Would not buy again.
Tuesday 0000: CT scan negative, blood tests negative. Sent home with a prescription for anti nausea meds. Diagnosis: "Probably still a virus."
Tuesday, 0600: Feeling decent. Ate a banana.
Tuesday, 0800-0900: Realizing that something is amiss. Contemplated that the banana was actually a disguised chestburster from Alien.
Tuesday, 1000: I'm now shivering uncontrollably, unable to walk without assistance, and in severe pain. Admitting that I can't man my way through this one, we go back to the ER. By the time we get there, I've been reduced reduced to a quivering mass in a wheelchair making pitiful noises. I'm hyperventilating from the pain and my hands are turning purple due to lack of oxygen. Holding true to a first-come, first-serve attitude, I am called back after another gentleman's billing issue is addressed.
Tuesday, 1015: In the treatment room. Fever is ~104 (in retrospect, I should have been concerned that I wasn't sweating). IV of fluids is started. Given my first dose of Dilaudid, which wikipedia helpfully informs me is 3-5x more potent than heroin. At the moment, this was not sufficient. Also given ibuprofen and Tylenol to try and break the fever. As I later learned, at this point A was warned by the ER doctor to not touch me and wash her hands. Had I heard, I would have pointed out that was generally good advice. Cumulative blood draw count: 2.
Tuesday, 1100-1600: Still in the ER. Given a chest X-ray and ultrasound. The technician was not amused when I asked if it was a boy or a girl. In my defense, I'd just had my second dose of Dilaudid. Stared at the ceiling for a couple of hours, not thinking about anything in particular other than how utterly high I was. Given an injection of Benedryl to counteract face itching, a side effect of Dilaudid. Ate some graham crackers. Slightly sweet, but satisfying. (5/5, highly recommended. Would buy again.). Waited for transfer to the hospital. Cumulative blood draw count: 4. Cumulative saline bag count: 4.
Tuesday, 1630: 10 minute ambulance ride, part of which is explaining how I found out I was allergic to mango, not "mango flavoring" as my chart indicated. Waited at the door to my hospital room while they got my roommate's stuff off of my bed and changed the sheets. Yes, it was a double. Met my roommate. He is almost 77, is in the hospital for everything, and wonders why I'm there because I'm "walking, for Chrissakes."
Tuesday, 1800: Met my attending. Ate a bowl of jello. A came to visit and got a special wristband for all-hours access. Settled in for the night.

At this point, it became a waiting game. My treatment plan was to stay hydrated and be carpet bombed with antibiotics until the cultures came back (24-48 hours) because they'd probably kill whatever was making me sick. The scientist in me understands that attitude can lead to drug resistant bacteria through antibiotics overuse, but I could now never expect somebody in my situation to not take antibiotics if there was a decent chance it would help them. As it turns out, I tested negative for all of the common culprits that cause what I had, so waiting for a definitive diagnosis would have delayed my treatment for several days while more samples were cultured.

The hospital was mostly concerned with keeping me from dying but not especially interested in making me better and sending me home, which made it pretty frustrating for a mostly alert, not-too-sick, needs-an-IV-for-fluids patient. A simple, regular update on what was happening to me/for me would have been a big morale booster. As it was, I would ask the nurse a question, they would go look at the computer and tell me the answer in an hour. Except for one nurse, who printed out my lab results for me when I asked about them so I could read all of the comments. I understand that the typical hospital patient isn't a 28-year old data-obsessed PhD, but it would be nice to have the option for more involvement.

I was finally released on Thursday afternoon, after I told my attending I didn't want to stay another 1-2 nights for procedures that might give more information but were not directly related to making me better. I love data, but I have my limits. End result: I'm home, I'm getting better, I don't want to be in the hospital again any time soon, and I'm very thankful for all of the people who wished me well. And a special thanks to A, who held things together on the home front and kept my morale up by bringing me a "Get Well Soon" balloon and fresh PJs. Times like this make me appreciate her all the more.

Final tallies:

Trips to the ER: 2.
Nights in the hospital: 2.
Different nurses: 4.
Blood draws: 6.
Bags of saline: 12 (est)
Different medications, including over-the-counter: 8

Random thoughts:

Bedside manner is important. My attending could use some remedial lessons.
Dialudid is terrifying and wonderful at the same time. Fantastic in the ER when I was in agony and frightening when I was (overdosed, I'm now convinced) in the hospital and the room's geometry started changing.
Many thanks to my old friend J for coming out and visiting for an afternoon. Thank you for holding a can of ginger ale so I could sip on it when you weren't sure my fingers would work properly (see above thought).
My nighttime nurse woke me up from an Ambien-induced slumber and told me, "I'm here to take your blood." My response, after I realized she wasn't going to exsanguinate me was, "That's a heck of a way to wake somebody up."
Observation: a primary function of hospital staff seems to be keeping poop in its proper place. That's probably not what most nurses envision when they enter school.
You want things the most when you can't have them.