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