Who’s the Boss?

Thanks to all of you who presented me with nice responses full of good wishes to yesterday’s blog post about my health scare. In addition to words of encouragement, I also got several stories of experiences that paralleled mine. Apparently navigating the health care system – never a glorious experience – has gotten considerably more difficult in the past decade or so. Maybe Baby Boomers are ruining it for everyone!

I promised in yesterday’s post that I would give some thoughts on what I wish I had done differently and what I will do next time. (Perhaps the first change I should make is with positive thinking and instead of saying will do next time, I should say would do next time in the unlikely event that an ER visit is required!)

Interestingly, all three times that I have had small bowel obstructions, I have been in AZ. I find this quite astonishing because we live here for less time than we live in Denver. What are the chances? I don’t know if this is purely circumstantial, but it is interesting nonetheless. Anyhoo, I have gone to the same hospital each time. The first time I admitted to that hospital, it was because the Urgent Care I visited sent me there for a CT scan. When the scan indicated an obstruction, I was immediately admitted to that hospital. Subsequent admissions have all been simply because it seemed to make sense given they have my history.

Next time, I would choose a different hospital. Why? In part, because it is a Level 3 trauma center, and therefore it has a busier ER than a regular hospital. I have mixed feelings about saying that, because if a bowel obstruction isn’t traumatic, I don’t know what is. The truth is, however, that my trauma definition didn’t seem to be the same as the medical staff at the hospital ER. And who’s to say who is right? Perhaps the competition for the lone doctor’s attention was people who had been in car accidents and were bleeding to death. My takeaway, however, is that I am going to do some research right now on what hospital in this vicinity has a good reputation and is part of my insurance network.

If at all possible, I wouldn’t wait until 2 o’clock in the morning to head to the hospital. While I realize I only have limited control over the time I head to ER, it makes sense that 2 o’clock in the afternoon might be a bit quieter than the late night/early morning hours. Not only that, but as a result of waiting this time, I lost an entire night of sleep. My tiredness certainly didn’t help matters when it came to thinking clearly or healing.

I’m lucky that Bill is with me when I head to the ER. Even so, he wasn’t with me the entire time. For a number of very legitimate reasons, it turned out that Bill was out of the room or out of the hospital for every important conversation I had with a doctor or nurse except for two. He was there when the ER doctor finally examined me. He was also there when the surgeon came back to tell me that the obstruction had resolved and surgery was no longer necessary. But he wasn’t there when I learned that the CT scan showed an obstruction; he wasn’t there when the surgeon told me about the need for an NG tube for the contrast after I had been admitted. At that same visit, the surgeon told the nurse that he should put me on his surgery schedule for the next day without even giving me a second glance. He was out of the room when the ER nurse told me that I was in control of my medical care and I shouldn’t let myself be bullied into an NG tube without a lot of thought. My takeaway? I always have my cell phone in my hot little hand both in the ER and in the hospital. Whether or not Bill is there, I would turn on the recording device on my phone and record the conversation. After all, I am scared. I am sick. And I am under the influence of narcotics. Not a good combination for getting every detail right.

I would no longer assume that the left hand knows what the right hand is doing. The night after the doctor had deemed surgery unnecessary, the head nurse came in and informed me that I would be given no food or water after midnight because of surgery the next day. I, of course, panicked. “I’m having surgery? I was told it was no longer going to happen!” He checked and learned that I was right and he was wrong.

But perhaps the most important thing that I would keep in mind is exactly what the ER nurse told me: I am in control of my medical care. To me, that means not assuming I have to do exactly what a doctor tells me. As my grandkids would say: They aren’t the boss of me. They are, however, folks who are a lot more knowledgeable about medical stuff than I. I certainly am not saying I would ignore them. But instead of rolling over and allowing another attempt at the insertion of an NG tube, I elected to drink the contrast despite the surgeon’s warnings of its nasty taste and the possibility of vomiting and asphyxiation. The stuff did, in fact, taste incredibly nasty but I didn’t toss my cookies. So there.

One of my blog followers – a woman approximately my age – commented on yesterday’s post. I have had medical challenges the past 9 months. More than I have ever had in my life (including challenges with giving birth). I don’t know if it is my age or what but I have had to learn to stand up for myself with the medical staff. “No, I don’t want to do that. What do you mean by that or what does that term mean? Yes, I would be willing to do that.” I am not a super bold person so it hasn’t been easy – but necessary. And, I have tried to learn to listen closely to what they are saying and ask questions. I have also had some wonderful nurses taking care of me, a few PA’s and doctors as well. Some just so so, you have to just roll with it I think.

Good advice.

I have only one more story to tell you and then I promise I will not write another word about my hospital visit. At one point I was still in the ER awaiting a room assignment and Bill had gone home to get a bit more sleep. By that time I had finally been given morphine. I was alone, scared, and high on pain meds. My curtains parted, and a very cheerful person pushing a computer on a stand walked in. Despite my condition, I knew immediately that Accounts Payable was making its first appearance. After confirming that I was who I was, she happily informs me that after insurance pays its share, “you owe us $5,827.62, payable immediately.

Blink. Blink. Blink. (That’s me, not she.)

I glance down at my hospital gown, and inform her, “Well, I don’t actually have that much on me right this minute.”

Blink. Blink. Blink. (That’s her, not me.)

It’s Really a Pain

There are a number of things that are bad about bowel obstructions, nasal gastric tubes and the danger of death being the most obvious. Less obvious, but nevertheless quite odious, is the fact that they come on unexpectedly and inexplicably.

Bill, who – God bless him – trudges sadly along beside me as I enter the hospital emergency room in great pain, unfailingly asks me, “Why do you think this happened?” Despite knowing that he asks that question because he loves me, my answer is always, “If I knew, I wouldn’t do whatever it is that causes it.” And that’s the truth.

This past Wednesday, immediately upon finishing dinner, my stomach began to hurt. While stomach pain isn’t an everyday occurence for me, it does happen more than I would wish. It has since I had a colon resection in 2011. Most of the time, the pain goes away after a short bout. Two times in the past couple of years, the pain took me to an emergency room, where it then promptly went away. CT scans showed no bowel obstructions in those cases.

This time, the pain was persistent. Finally, at 2 o’clock this past Thursday morning, after I was comfortable that he had gotten a few hours of sleep, I awoke Bill and told him I needed to go to the ER. While he woke up and got dressed, I packed my bag for what I suspected was going to be a hospital stay. This time I was correct. I hate being right.

There is no good reason to be out at 2:15 in the morning. And there is CERTAINLY no good reason to enter an ER at that time of day. It was us, and many, many others who were perhaps in worse shape than I. Or – dare I say it? – on the lookout for pain meds.

If you don’t know that opioid addiction is a national crisis, then you are living in a bubble. But this is the first time my hospital visit placed me face-to-face with the challenges faced by the hospital staff, by non-opioid-addicted patients, and I guess even by those who are addicted. In the past, when I told the front desk that I had stomach pain and a history of bowel obstruction, I was addressed in short order. This time, rather than quickly getting me in front of a doctor or PA and some much-needed pain medication as well as a diagnosis, I was basically told to get in line. They assume everyone coming in complaining of pain is looking for drugs.

I finally was taken to an ER room where they inserted an IV tube (but no IV) and collected blood, but it was nearly two hours before I saw any type of medical personnel. The woman who took my blood told me the name of my nurse, and added that he was at lunch. I naively pictured him standing in the break room shoving some noodles from a cup into his mouth so that he could get to the woman with the bowel that could potentially explode at any moment. Instead, it was an interminable period before he stuck his head through the curtain, introduced himself, and told me he would be back in a bit.

At this point, I took matters into my own hands . “Whoa there, buddy,” I said, as he turned to go. “Does it matter to anybody on this staff that I probably have a bowel obstruction?”

He seemed quite taken aback, as apparently that information hadn’t been relayed to him – or to perhaps anyone past the front desk. He scurried off, promising to see about an x-ray.

He came back rather quickly and told me I was going to be taken down for a CT scan.

“Is there any way I could get something for the pain?” I asked. The answer, I’m afraid, was no. Hello opioid crisis. Meet Kris.

I was informed that no pain medication could be given until I met with a doctor. I understand the reasoning, I really do. Unfortunately, I was three down in line to see the man who apparently was the only doctor on staff at 4 in the morning at a Level 3 trauma hospital in a metro area. Perhaps someone should reconsider the staffing allocation. A PA would have done the trick. Or perhaps the doctor could have made a quick visit just to ascertain that I really was sick. My distended tummy was a dead giveaway.

I had the CT scan, and after I returned, I waited a bit more before I finally saw the doctor. He asked me what part of my stomach hurt, and I told him everywhere. His examination confirmed this. At one point, however, I was rubbing the left side of my stomach out of habit. When I have stomach pain,that is usually where it rears its ugly head. The doctor snapped at me, “You told me it hurt over here,” pointing elsewhere. It did. See above. It hurt everywhere.

I reminded myself that on a daily basis, the doctor meets people faking pain for Percocet. The nurse who inserted my IV tube told me hours earlier that there had been a recent patient who had broken his own leg to get pain meds. But heaven help those of us who really need the medication.

I won’t bore you with much more of my whining. I will tell you, however, that I did, indeed, have a bowel obstruction. I will add that though the lunch-eating nurse (who ended up being the kindest and most understanding medical person I met the entire time I was at that hospital) attempted to insert the NG tube, he was unsuccessful.

“Your nasal passage is too small,” he told me. “You tell them I said that when you get upstairs and they say you need to have a tube. You are in control of your care.” God bless him. I think the tears rolling down my face helped convince him.

Tomorrow I want to tell you what I learned from this visit and what I would do differently. I’m no expert, but medical care is changing daily, and we can learn from each other.

And here’s the man on whom I always lean and who is always at my side when times get difficult. He deserved a day at the NASCAR track yesterday…..