Friday, February 11, 2011

Health Care Update

Spent a good deal of the morning being worked up and lectured by my primary physician and a resident. They still "suspect" I have TB and claim the skin test I demanded from the ER isn't "valid" because it wasn't "officially read." In fact, it was my primary physician's office that said -- on Monday -- it didn't need to be "officially read." Needless to say, I had some choice comments about doctors who think they're gods and can't be bothered following the simplest procedures.

The lecture had to do with the fact that TB is a public health issue -- which I was pretty sure of -- and that if I continued to refuse treatment (which I never have done), they would be forced to report me to the County PHS and have them follow up. By law. Etc. Etc. So I explained, again, that I was not refusing treatment, I was refusing hospitalization, and that my experience in the ER had been deplorable, yadda yadda. This does get old after a while. He wasn't there, he knows nothing. Too bad, so sad. CYA.

Well, things seemed to settle down, and the physician actually calmly and coherently -- and (I think) truthfully -- explained that he didn't know and couldn't tell what was wrong with me, but he suspected pneumonia (since I was responding to antibiotics) on top of another condition which, given my history of smoking and asbestos exposure, was quite possibly cancer. There was a clearly anomalous mass in my lung -- which could be cancer, TB, or simple pneumonia. But the blood I keeepcoughing up was a sign of something serious, but what, he couldn't be sure. I gave them a sample for culture. They want two more.

He scheduled me for a pulmonary specialist this afternoon and an infectious disease specialist in a week. Clearly, the TB diagnosis is low priority.

There will be a number of tests more, including a likely biopsy.

It's a strange sensation at this point. I am really angry at their continued inappropriate suspicion that I have tuberculosis, when I haven't even been exposed to it -- according to the very obvious negative results of the skin test, which was never "officially read" because the doctor's office staff assured me it didn't have to be. How dare they threaten me over it. How dare they?

On the other hand, I'm rather sanguine over the potential of a cancer diagnosis. It wouldn't really be that much of a surprise. Not something I want, to be sure, but if that's what the gods will, then that's it.

So, more update after I see the pulmonary guy.


That went well. Surprisingly, given what I've been through to this point. The pulmonologist was not alarmed in the least, said as far as he could tell, what I had was incipient emphysema -- from past smoking -- and "simple" pneumonia. The blood I'd been coughing up is most likely a consequence of the pneumonia and nothing more. He said the CT scan showed that all the airways were open. He said the other doctors probably couldn't tell because they weren't trained to read lung scans the way he was and their alarm was probably overdone. He was annoyed that my primary physician didn't bother to read the TB skin test within 48 - 72 hours of administering. But he accepted my description of negative results (no reddening, irritation or bumps). Since he does not suspect TB in any case, he isn't too worried about it. I may have to get another test, however, when I see the infectious disease specialist next week. I need to provide two more sputum samples (good luck!), but there is no rush. I'm scheduled for a chest x-ray next Wednesday. The chest guy thinks it will be pretty clear. If it isn't, I'll be scheduled for additional followup, but if it is, then that's pretty much it.

What a difference from what I'd been through earlier. Doing the necessary exams and tests as an outpatient may take a little more time, but it's been my experience that outpatient medical services are usually better for the patient than in-hospital service. Too much can go wrong in the hospital for one thing, and for another, issues tend to be treated as crises, all the time. The patient is nothing but an object under the circumstances, and that severely affects the ability to recover. Recovery may be completely impossible in the hospital.

A week or so more, and this episode should be resolved. I'm hoping.

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