Saturday, February 5, 2011

New Mexico? Not This Week (end)

Clearly Ché has messed where one doesn't mess, and he's not going to New Mexico this weekend.

Oh no. As I was putting the finishing touches on my packing and such last evening, I started coughing up blood, and I spent the rest of the evening until well into the early morning hours in the emergency room of my semi-convenient Kaiser Permanente hospital.

I got there 6:15pm or so, was given a face-mask by the reception desk, was ushered into the triage nurse promptly, was then shown a "positive pressure" room in which to disrobe and await (a few minutes I was told) treatment. I waited two hours before anybody came at all, a nurse who read back what I'd told the triage nurse, only they both got it wrong. After correcting the record, the nurse went away. I saw no one else for another hour or so, when the first physician arrived, did a cursory inspection, ordered up a chest x-ray and blood work. Said if the chest x-ray was inconclusive, they'd do a CT Scan for positive diagnosis. Soon enough, he showed me the chest x-ray, and behold: there was a mass in the upper right quadrant of my lungs. He could not tell what it was; I was taken for the CT Scan, protesting loudly about my allergy to the dye. Doc says, "No dye! No dye!" And when I get to the scanner, the operator asks if I am allergic to anything; I tell him what happened the last (and only) time I was CT scanned, and he cheerfully says, "I guess we shouldn't give you any dye, hm?" We agree. The scan is done fairly quickly and I am transported back to the "positive pressure" emergency treatment room. "The doctor will bring you the results shortly." And I wait. For hours and hours.

Finally, long about midnight, a doctor I've never seen before bustles in, introduces himself, says, "We're admitting you for observation...." I tell him I'm not good in hospitals, and the preferable course is to "observe" and "treat" as an outpatient. He says he's concerned about the blood I'd coughed up. He was worried I had burst a pulmonary blood vessel, and it would be best if I stayed overnight at least. I could leave "early in the morning." Remember it is already long about midnight. They were concerned that I might not have pneumonia after all, but it may actually be TB (because, he said, I'd been making all these trips back and forth to New Mexico -- he was the first one to get that right, all the others had said "Mexico), or even cancer.

I told him that all the observation and tests he wanted for me could be done as an outpatient, that I really didn't want to stay. He said the blood I coughed up was the main issue, and it wasn't "safe" for me to go home without them doing some more observation and tests in the hospital. After discussing it further, I said -- reluctantly -- OK.

An hour later, a new nurse arrived to do BP and such. She said they were getting a "special room" ready for me; she didn't know how long it would take. Almost an hour after that, Admissions arrived with paperwork. By this time, I had decided I wasn't going to stay, no matter what, and told her that I was refusing hospitalization. She wasn't too flustered, but said of course I would have to discuss it with the nurse and the doctor.

Yes, well. More time went by, the nurse came back, and I explained I didn't want to stay, all the observations and test could be done as an outpatient. Half an hour later, another doctor arrived who apologized for the wait. I'd already been in the ER for close to eight hours. I explained again that I wanted to go home, all the to-ing and fro-ing in the ER, and the interminable waits without resolution of my condition and without getting me a hospital room, either, convinced me there was no point in staying. If this was a sign of the kind of treatment I would receive as an inpatient, I would much rather stay an outpatient.

He at least told me that their real concern was that I might have TB, and they wanted to be sure. Do a skin test, etc. I said, "You know, you could have done that hours ago. You could have done most of the tests and observations you say you want to do now hours ago while I was waiting for any kind of treatment at all." He apologized again. I told him again I was not refusing treatment, I was refusing hospitalization. He assured me that "treatment" included hospitalization. We went around again, and finally he agreed I could go home, with antibiotics and a specimen cup in case I hawk up another bloody hairball, and that, yes, they could do the majority of the tests they wanted to do while I was in the ER or as an outpatient.

More time passes, someone comes and does a TB skin test, someone comes with "against advice" paperwork, someone comes to do semi-final discharge. One more step, then get some meds at the pharmacy, and I'm free! Free at last! Got home around 4:00am.

Sigh. There will be some outpatient followup, to be sure, and I have agreed that if I hawk up a "lot" more blood, I will return to the ER pronto.

I realize they were just doing their jobs as it were, following an elaborate protocol, and that there was a shift change half way through my ER stay, meaning that the new staff had no idea what was going on and had to get themselves up to speed before they could address any patient in the ER, let alone someone as cranky and perhaps foolhardy as me. I know that's how hospitals operate these days. I've spent enough time in ERs and hospitals the last few years shepherding patients through the intricacies, delays, miscommunications, treatments and so on. It didn't used to be like this, believe it or not.

In my case, the protocols they were following had to do with suspected TB, which they wouldn't even test for until I made a stink. If the skin test turns out positive, you bet I'll bee-line it back. But at this point, I think they were overdoing it, in an excess of caution. In the end the last doctor I saw admitted that the chance that I had picked up TB was actually very slight, that I probably had a particularly stubborn case of pneumonia. They just wanted to be sure, that's all. And I only really fault them for following protocols rather than paying attention to the patient.

So. We'll see. No trip to the frozen East Mountains, though. Not this weekend


  1. hope the diagnosis is not too grievous and at worst is just a bad chest infection, ( there has been alot of that going around calif of late - according to a doc in the family in SF - talked to her two months ago about that, as my wife's uncle - his wife had a bout with it ).

    get well soon.

  2. Whoa, Ché. How'd that happen? I thought you were on the mend from the last ughly bout. Ugh. That shit is scary, made all the more so by being in a hospital. Pneumonia is nothing to mess with or take lightly. Hope you didn't pick up anything else while you were in the holding tank. I assume you have someone running interference for you. Please take care of yourself. So you can go back to beautiful New Mexico.

  3. From Orb @ LA: Take care of yourself, my friend. I went through similar a few years ago with the dreaded chest pains (that I knew were NOT a heart attack and which THEY knew were not a heart attack but to CtheirA they had to perform every test known to man- and womankind).

    Take it easy, take care of yourself and (sigh) you MUST go back if it gets worse. I know, I know; you already know all this. Positive vibes being sent from LV :)

  4. Thanks for the kind words.

    It was a nightmare! I say only half-jokingly. I was on the mend, I felt nearly recovered. And then, boom.

    The blood scared me to death -- as I guess it did the physicians. What caused it, they don't know. It has not recurred, thankfully, but I have a nice specimen cup to collect anything more that comes up.

    Eventually, we'll figure out what's going on.

  5. Che, when something like this happens it makes me realize once more that Obama being a slug and half the country being worse is just fluff. I am tipping one up in hopes that you heal up fully and soon.

  6. Bless your heart, eb. And hoist one for me, too. Sounds like a real good plan.

    I've been feeling a lot better today.

    Oh, and no, I was not alone in the ER contending with hospital bureaucracy and protocols. In fact, I was being backed up superbly. Grateful for that, I am.

  7. Hey Che,

    Hope you get this resolved soon and without too much pain in the ass doing it. From your description I was wondering why the hell they didn't do the TB test straight away, it's quick and easily confirmed or dismissed. Having had my share of hospital experiences over the years I empathize with your frustration.

    Hoping for the very best outcome for you.

    Dave (From LA)

  8. Dave,

    I'm still pondering the mystery of it all. I realize now that the whole affaire ER, almost from the moment I first contacted the advice nurse on the phone, was being driven by their concern that I had TB.

    They never made that clear, and they never tested for TB until I made a stink about it. They only discussed TB as a possible diagnosis -- along with others like cancer and/or relapsed pneumonia -- and they never emphasized the seriousness of TB, nor how long it would actually take to confirm or exclude a TB diagnosis. Nor could they clearly say why they suspected TB. (It was the coughed up blood combined with the New Mexico connection -- which they kept confusing with "Mexico".)

    To me, these are all very straightforward things, and you tell the patient straight out what the fear really is and what they need to do to get a confirmation of the diagnosis (or not, as the case may be), but I had to Google and read lots of TB literature before I understood clearly what they were so concerned about.

    They never made it clear at all.

    That is just bewildering and bizarre.

  9. Living relatively close to the border and San Diego, the TB mini-hysteria is alive and well.

    All they needed to hear were the words "coughing", "blood" and "Mexico" to immediately know they needed to screen out TB. So terrorized by the "infected immigrant as typhoid Mary" disease model that they couldn't hear the word "New" coupled with "Mexico".

    What it sounds like to me is there was no competent doctor directing what diagnostic tests you should receive. Perhaps that's because of the shift change you mentioned, perhaps its due to some unreasonable commitment to admitting you or maybe, just maybe you fell into their system at its most dysfunctional and there's no real explanation for the bizarre manner you were treated.

    At any rate, best wishes and good luck!

  10. Dave,


    Now that I recall, the listed ER doc never showed up at all. When the nurse finally showed up -- 2 hours after I was put in isolation -- she was surprised the doctor hadn't been to see me yet. She said she would try to find out what was going on. An hour later, another doctor altogether showed up. He ordered up standard tests -- blood, chest x-ray, CT scan -- and followed up till the CT scan when he just disappeared. As did nurse. Hours later, the admitting physician came by. Pretty sure you're right, there was no one supervising exam and treatment. They were flying blind and incoherently, dazzled by the possible TB diagnosis based on incomplete (and badly misinterpreted -- "Mexico! Mexico!") information. It was a complete cock up from the get-go. They freaked.

    They weren't even doing the TB protocols right. Until I made a stink, they didn't even bother with specific TB tests.

    Oh, and I checked TB stats in NM. The rate is half that of the US as a whole, and there were a total of 48 cases in 2008. In the whole state. Panic!!!