Catharsis, continued

I thought that hospitalists were internal medicine doctors, widely and deeply trained to deal with most every medical issue under the fluorescent lights of the hospital sky...

But I ended up being cared for by four hospitalists -- two were internal medicine doctors, one was an "intensivist," and the fourth specialized in "pulmonology." In addition, there was a cardiologist, a neurologist, my superb orthopedic surgeon's wondrous PA (Dr. ShoulderMan himself flew off to South America right after surgery), the pain management service (excellent folks), and the ID guru.

So explain to me how I ended up having to call my MDVIP (pseudo-concierge) go-to-guy from the ICU in order to get the folks listed above to actually *do* something that made sense?

Explain how my sore throat, which pre-dated the admission, was ignored -- how a simple order like lidocaine spray had to be made and remade three times, and the spray never arrived? Sounds like nothing, but it turns out it was a major deal. The ID's PA immediately added a Z-pack to the i.v. vancomycin yesterday -- and hooray, my fears of not-breathing are mostly allayed. I have to say that the PAs involved in my care hit homeruns -- they listened, they heard. She was the first to *hear* when it started, that it was not related to the intubation, that it was getting worse -- and to discover that the pre-op chest film already showed lower lobe pneumonia.

Ah hell. I need to get this stuff off my congested chest.

Interesting how medicos introduce themselves to patients, how they address the lazy bastards lolling around in those oh-so-comfy beds... A Bette-Midler look-alike was one of the internal medicine hospitalists. We first met while I was on the ventilator -- strangely lucid and trying to answer everyone's questions with paper and pencil. She had a lovely habit of not letting me finish writing -- trying to guess the next word, even grabbing the clipboard out of my hands and holding it up like we were doing a first grade show-and-tell. There was a complicated issue involving the interpretation of my echocardiogram, done a week prior to admission -- it had been misread (as a normal trileaflet aortic valve when, in actuality, it was a congenital bicuspid valve that was quite thickened and leaking, etc) and explaining this while intubated and hurting beaucoup was hard -- Bette Midler kept butting in. It took the cardiologist to save the day, as he muttered, "Let's just get another one..."

Bette never introduced herself. At all. The nurses, complete with eye rolls, did that for her. Two days later, back up on the ortho floor, she came charging into the room, threw back the covers, and began an unprecedented exam of my abdomen -- always top priority after shoulder surgeries. She looked vaguely familiar but I had trouble placing her -- she scared me to death. I kept saying "Who are you?" and she kept up her dedicated search of my belly. She was panicked, apparently, by the fact that my blood sugar had dropped into the 40s subsequent to an insulin injection. I was asymptomatic, drank some juice, and was given an i.v. dose of dextrose -- the blood sugar was up to 105.

She continued to ignore me, and began yelling at the nurse. I finally pretty much screamed, "Who are you?" The nurse placated her... I explained, upon her eventual introduction, that I was not "technically" diabetic, but that my blood sugar went up when infection reigned (as then) and when receiving stress-dose steroids (as I was then). I objected to the insulin, asking instead that she restart my oral meds, and allow me to finesse my hospital diet (have you ever looked at an ADA clear liquid diet??? It was all sugar!). She went ballistic and I began to regard her as an excellent cartoon.

I refused all insulin from that point on -- I mean, gee, an hour or so after getting the last injection, I had tanked -- duh! I had another medico reorder my normal meds, and never (well, only once) had another abnormal reading afterward.

Did she address the issue of me not breathing? The exacerbation-unto-hellishness of CRPS/RSD? The Fredster is convinced that CRPS/RSD is behind every symptom that presents... Did she take the time to go over the meds that actually were messed up? Do common sensical things like order the foley removed or discontinue the oxygen -- anything to expedite me getting the hell out of there and home. No, her last visit, announced by a tumbleweed whirlwind, consisted of her standing at the foot of the bed, both hands on my exposed, swollen, purple, ice cold, 10/10 pain-leveled ankles, saying something about the god-damned blood sugars and her objection to my use of oral meds.

She started a pain cycle that hasn't stopped yet. I was speechless from the pain, then in tears. I get that she thinks Amaryl will cause another "hypoglycemic" episode -- though pointing out the conspicuous role of insulin was futile.

She then gave me the results of several tests I did not have (MRIs -- impossible due to my bionic nature, and a TEE). I was also released with someone else's paperwork.

The other internal medicine hospitalist decided to go with the theory that the three episodes of respiratory arrest were due to seizure activity. He couldn't be budged from this opinion, despite the neurologist's own eye-rolling. I still have the damned goo in my hair from the EEG. I *have* a seizure disorder -- myoclonic -- but it is extremely well controlled and it's been years since it reared its ugly head -- I did not lose consciousness, or twitch, or nuttin' -- during the first two "episodes."

The pulmonologist was interested only in my lungs -- fair enough -- though he missed the preexisting pneumonia and decided to ignore the low O2 readings (and related alarm beeping beeping beeping beeping) during the last 24 hours there. He repeatedly asked me if I was sure I wasn't on oxygen at home. I repeatedly said something like "Hmmm, let me think. Ummm, no!" Still, he did his job, stayed within the lines of his "scope."

The intensivist? Crass as hell, rude, probably never heard a word I said -- and was the best of The Hospital-Acquired White-Coated Creatures. He made soliloquies, overweight, shakespearian as all get out. The one that allowed me to somewhat trust him? "You are in the worst possible place for your CRPS. There is nothing but stimulation down here..."

Geez. So many cooks, none really giving a damn about quality control (and very bad about passing on information one to another, failing to order schtuff because of the assumption that this was someone else's domain), never taking a history, even.

I woke in the wee hours of Tuesday morning, reached for a pen to write Fred a note, and was unable to grip it. I've had radial nerve palsy in that hand before -- but now it was the whole hand that wouldn't work. I found this alarming. Not one nurse, not one doctor took it seriously. I know that time is the cure -- but given everything that had gone on, I needed to hear that. My left arm was twice normal size following the surgery, so it mattered -- being handless. With a week's time, it has greatly improved, and now has an ulnar nerve distribution. As it happens, I see my neurologist on Friday, so at least it will get evaluated. What should a hospitalist do in this case?

I get the distinct impression that no one gives a royal shit if someone who was already pretty ill and disabled suffers worse illness and new disability -- I am a throw-away. Surely I am accustomed to things being bad, getting worse.

We would have been so much better served by remaining under the care of the orthopedic surgeon -- someone needed to orchestrate... even if the musical score sucks.

Whew. That's better. It wasn't my intent to relate so many pointless details -- but I was shocked.

The other shock was at the level of basic patient care. My sheets were never changed, except for a new top sheet whenever I managed to pour coffee everywhere. Smile. Fred gave me my one bath. The ICU nurse answered my request to "wash up" with: "Oh, they love to do that kind of thing on the floor. Let's wait..."

Thanks for listening -- whether you actually have or not. If not for the GD Sentinel Event back in 2002, would any of this be traumatic? I am trying to turn off the memory banks, trying to not fear you people... And the good definitely outnumber the bad. I think with great comfort and confidence of the respiratory therapists who saved the day, nurse Gwen who saved my life and gave all the glory to God (amazing, the number of nurses who want to PRAY with the patients! Oy!), Dana who kept me company during the last two beeping beeping nights, and who did some great nursing by violating orders and inventing a few protocols... And I am enormously thankful for the intensivist hospitalist and his direct approach, and for getting me breathing again.

Great food service, friendly housekeeping, stupid pain scores!