Meanwhile: Medical Update

Today's results are... ambiguous.

Pulmonologist says X-rays show marked improvement, however... there are signs of scarring. He's concerned as well that the pneumonia is not completely cleared up, so he's put me on another ten day antibiotics course. He says it could take yet another 10 days beyond that to kill it, given the way he (and I) believe I acquired it [Note to self: do not aspirate stomach contents!] But on the other hand he says there is no sign from smears and blood tests that I have TB, and he doesn't suspect it at all. He wanted another blood test and a chest X-ray in a month.

So this afternoon, I see the infectious disease specialist for the first time. He's quite bemused by the whole affair which tends to lighten the mood somewhat. He says there is no sign -- at all -- that I have TB, but he can't rule it out completely because the skin test was never "officially read." Yes, he says, I clearly have pneumonia, and yes, it is responding to treatment though it is stubborn as heck. Instead of waiting a month for another X-ray, he says that I should have one as soon as I complete the next course of antibiotics, then come back to see him and "we can discuss progress."

Naturally, the antibiotics that were ordered this morning are not ready at the pharmacy, so I may not be able to start taking them until tomorrow. The pharmacy is "behind." Yes, well. This is Kaiser, and anyone who uses them has their own horror stories. Not having a prescription ready is hardly the worst that can happen or has happened there.

Overall, truth to tell, I'm pretty pleased with outpatient care of my condition. It's a bit chaotic to be sure but manageable nonetheless.

For the time being, the IIED suit that I was preparing to take to my favorite plaintiff's attorney is on hold.... heh heh heh.

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Note: While I may seem to be cavalier about all this, in fact I know it's nothing to make light of. Even if my healthcare coverage is through Kaiser Permanente, and it may not be the best, at least I have health care coverage, and if I choose to use an alternative urgent care or med clinic, I can afford to do so. That's not the case for many tens of millions of Americans. So I'm lucky compared to many. While I may not be happy at the way I was treated -- and not treated -- at the Kaiser ER a couple of weeks ago, I have seen with my own eyes ERs that do much worse, that cannot handle the crush of patients at all and that seem to thrive on neglecting patients rather than treating them.

There is something deeply wrong with the practice of heath care in America. It goes back many decades, and nothing that's been proposed to date is capable of really reaching, let alone dealing with, the underlying problem. Our heath care system is not set up to deal with patients as people/individuals. It's set up primarily to serve the interests of industry. Hospitals, doctors, administrators, nurses all are served first and foremost. Patients are, for the most part, an afterthought if that. Our health care system, in other words, is upside down, and it has been that way for decades. It's a sad thing to witness and experience, but it's really all we've got -- if we're lucky enough to have access to it apart from whatever happens in the ER.

I resist hospital care because I've seen again and again, and I've personally experienced, how truly appalling it can be for the patient. I know too much of what goes on, how neglect is built in to the hospital care system, and how recovery is essentially impossible in a hospital setting. I don't mind outpatient and clinic care because I have seen and personally experienced how it can be -- but isn't always -- better for the patient to obtain necessary healthcare as an outpatient. Mistakes can be and are made no matter what, but outpatient care is more oriented toward the patient -- even if treatment takes longer and is more complicated to obtain.

But the crying shame is that so many people don't have access to anything but the ER. And they will be lucky to get through that alive and not immediately bankrupted.

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.

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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.