too many words

in my previous post, i was unduly cavalier about my odd relatives.  my first electronic act upon getting home from the hospital friday evening was to jot down [or laboriously peck out on my lilliputian keyboard] an email to the best brother-unit a sister could wish to have. that's right, i found myself unleashing a week's worth of pent up emotion all over sweet Grader Boob -- the self-imposed and preferred nickname of my english professor sibling, forever wading his way through a swampy, gassy pool of purported essays and research papers.


he's been in the game a good 30 years, has Grader Boob, and still spends 45 careful minutes on 2-3 page bits of underclass erudition.  he provides the most helpful and attentive commentary these youthful writers are likely to ever receive. i'm not saying that 'cause he's my brother-unit;  i'm also saying that because his standards are not simply maintained over Lo, These Many Years, they are, if anything, more stringent.  it's a sign of hope for those of us who aren't as convinced of a cheery future based on what we witness in the classroom. 


you know, stuff like having your hip broken by a student because you were the only physical barrier to his escape from the police officer hot on his heels. and having your students steal your walker when you make it back to work after the hip replacement!  stuff like that.


yeah, i dunno why, but that large "instance" keeps coming back to haunt me and will always inform my assessment of today's yutes.


of course, that was my experience at the level of high school instruction.  there weren't, thank goodness, any corresponding moments of physical violence in my 19 years of university teaching.  


no, those years had other offerings designed to maintain a steady state of depression. 


you know, stuff like having college freshmen and sophomores assert that the crusades date from the early 1900s -- before the american civil war of the 1950s -- and after world war II, that awful conflict of the mid-nineteenth century.  this academic high point occurred during my oh-so-brief stint as a latin teacher.  decades of research in determining pedagogical best practices have shown that the intermingling of disciplines, in this case ancient history and classics*, leads to student confusion and decades of lower back pain.

* in case you were wondering just what sort of radical latin class i was conducting by my unreasonable expectation that tomorrow's leaders might see parallels between humanity's tedious insistence on holocausts in various guises across time... it was a freaking warm up exercise designed to seamlessly review a few expressions with bellum and to introduce a short essay assignment.  instead, my brain exploded.  for those of you interested, these chestnuts were to be the inspiration for those 2-3 sentence-long masterworks:

bella horrida bella  (Virgil)

bella detesta matribus (Horace)

bellum omnium in omnes

bellum domesticum 

Ibis redibis nunquam per bella peribis (Oracles of Dodona) [a teacher's favorite, this one]

honestly, i've no clue why my mind went on this bender but, as you know, the guiding philosophy here at elle est belle la seine la seine elle est belle is "whose blog is it, anyway?"


i blame everything on the nefarious influences of Grader Boob.  


has he made any suggestions to moi-même, as to how my writing might be improved?  yes.  one suggestion, repeatedly -- making me worry over the possibility of early onset dementia.


hmmm?  what?  oh... right!  "too many words."  

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hi boob,

i spent the week in the hospital and am in a foul mood.  

you have been warned.

it was awful but could have been much worse.  i had the headache from hell, nausea and vomiting, topped off with more of a fever than "normal." called my MDVIP go-to-guy doc last saturday, taking care not to phone until he'd had time to get home after temple.  even though he encourages patients to call whenever there's a real need, i hate messing with anyone's sabbath.  god might get pissed.  so go-to-guy answered on the second ring and informed me he had just arrived in barcelona, to which i replied, "but you can still call in a prescription, right?"  


[i came close to demanding why he had not been available six hours earlier, that being the time differential between tête de hergé and spain, but managed to hold my tongue.]


so that's why his partner, dr. k, was on call when i decided i couldn't take this particular constellation of symptoms any longer.. then dr. k's aunt up and died and he flew off  to new york, making the time differences for my doctors simply untenable -- fred put one watch on each wrist but that only made things worse. 


i booked passage on the queen mary, anxious to keep up with the jet-setters in a manner befitting my socio-economic realities. but due to partner-man's in-flight telephonic insistence, we ended up at st. jo's emergency room instead.


why, yes!  that *is* the very same hospital what gifted me with crps to begin with, by a well orchestrated Sentinel Event back in 2002. had i lost my mind, returning to the scene of their crime?  well, yes, i suppose i had lost my mind... to a mother of a headache (imagine me, whimpering while rocking back and forth, to and fro...) and several days of high fever and nausea.  he tricked me, that wily partner, into expecting just a bag or two of fluids and some cortef.  


they wouldn't release me, of course, and as i was being wisked around the corridors and back alleys of that infernal place,  i decided to keep an open mind and a closed mouth... 


...until i couldn't any longer.  i managed four whole days without a single smart-assed comment, without any hint of the fear for my life that emerges whenever i'm within a nautical mile of that place.  did the fact that i was under a gag order by their risk management department legal eagles assist me in holding my tongue?  nope.  forgot completely about it.  fred's eyes bugged out.


how am i to remember that the murderous staff there cannot be held in any way accountable for their crimes against humanity? let's review, darling boob:  pounding head, empty and spasming stomach, high heat, extreme pain -- much of that pain from the pre-existing crap for which they are largely responsible -- adrenal (and renal!) insufficiency, lupus, avascular necrosis, osteomyelitis, and a partridge in a pear tree.  i think four days was admirable.


i strongly suggested discharge home to the hospitalist who rounded this morning. the bottom line?  despite kidney and sinus infections that were piddly and refusing to grow in cultures (that's my leitmotif), the ID docs decided it was my left shoulder at fault and ordered a CT scan of the whole area -- head, left shoulder, kidneys, hips, the squatters in my estomac, etc.  they even seemed to have clear ideas of why the pus in my shoulder wouldn't grow in the lab -- blaming the phenom on one of two sort of ordinary bacteria that have become resistant to antibiotics. since i am immunosuppressed, these average-joe sorts of bugs can be a problem. not the zebras doctors have been chasing for the past three years, but good old pedestrian plow horses.   


so we were all anxious to get the CT results.  i actually entertained thoughts of getting cured of these accursed bone infections! drum roll, please... because radiology, despite discussing the areas to be scanned with me, despite the written orders, despite doing preliminary imaging to make sure all was fine... radiology reported that they failed to scan the left shoulder.  


remember the port i had put in some time in march, before the ketamine infusions?  well, it has never been accessible for blood draws.  fine for infusions, but not available for anything else.  [grrr.]  the nurses, in attempting to explain to ID why some labs were not done, blamed the confusion on a member of the "iv team" who was supposed to draw the blood from my port...  i may have, kind of, sort of, sat there like a silent lump while the lying liars lied.  


yes, scientific method remains at its finest at st.jo's;  the brainiacs are still at the wheel.  


the thing that sent me over the edge, however, was the damned rsd/crps.  


fred and i have tried every trick we can think of, from making cute little signs for the bed, distributing informational fliers, having doctors write entries in the chart,  putting notes on the door, even suggesting it as a great topic for an in-service, etc. 


all we are asking is that folks not touch my legs and ask before touching my hands.  we have never had a positive response.  tell a nurse (or doctor or phlebotomist or tech) not to touch and you engender, apparently, that very urge in them.  the unfailing pattern:

me:  please don't touch my legs.  thanks!

health care professional:  of course not! [pokes at feet in order to feel pedal pulses, grabs calves for some unknown reason]

me [from the ceiling]:  DON'T TOUCH MY FREAKING LEGS!

health care professional:  you don't have to get nasty.  all you have to do is tell me nicely, profderien. [hates me for the remainder of my stay]

common variations involve "oh, i didn't think you meant me" and "i can't help it if the stethoscope around my neck swings down and hits your feet."

very, very, very disturbing?  since the declaration by the state that their screwup in 2002 was a Sentinel Event?  i kind of thought they would know by now what CRPS *was*.  it was disheartening in the extreme to find only two doctors (the ER doc and an ID doc) and ONE nurse who knew that it is a central nervous system disorder involving severe pain, allodynia, movement disorders, etc. -- just, in general, what it is about.

everyone else said yes when i asked if they knew what crps/rsd was (i unpacked the acronyms for them as well).  these folks all proceeded to then do you know what, leaving me on the ceiling again...  i cried, not from the pain, but from pure sadness and frustration.  the doctor who was in charge kept telling me it was a combination connective tissue disorder and cellulitis.  she apparently wrote that in the chart and the nurses all thought it a great quote.

my favorite moment?  two nurses leaning over, their elbows propped on the the footboard of the bed, staring at my feet.  one of them has a big smile on her face, and keeps advancing her index finger toward my swollen, dark-purple and decaying right foot, saying, "i can't touch this, hmm?  what would happen? i seen this before, ms. profderien.  this here is cellulitis.  you got to keep it clean. what would happen if i touched it, hmmm? we need to scrub this foot." she actually winked at the nurse next to her.  yep, she's gonna wash off discoloration from lack of blood supply and i shall be cured by soap and water.  i confess:  i didn't bother with please or thank you, or if you don't mind... and went directly to cursing at her.

okay, i feel better now.  
i guess i let things build up a bit too much.
okay, so maybe tears are still running down my moon face.

the ID docs want me to see dr. d (ShoulderMan!) asap.  it just so happens that i had already made an appt for next week, because the shoulder was getting pretty awful.  the best advice, though, was "go where they know you, know crps, and until you get there here are some antibiotics, stay in bed, but come back to the ER for a fever of 100.5 or higher." 


at that moment, the tech came in to check my temp, and it was 100.7!  we all had a good chuckle and then i went straight home where i promptly threw my thermometer away.  really.  i did.

i wouldn't mind one bit being something of an ambassador for crps, because it is very odd and despite not being all that rare, is something rarely encountered by your average medico. i am, for instance, my MDVIP go-to-guy doctor's only crps patient in 30 years of practice.  so i had to become an expert -- a dread occupation -- in order to get any kind of decent care. now, of course, go-to-guy is a crps pro.  


but to discover that the hospital that compounded error upon error such that crps was the end result has not even taught the staff to recognize it during the nine years since the sentinel event... leaves me tired, depressed, destitute -- and angry.

so much so that my dear brother has to field another rabid communication in a litany of rabid communications.

fred has had it,  is very tired -- of me, of everything.  i don't blame him at all.  just wish i could just wish it all away.

let me know more about classes and your writers... are you enjoying the reprieve from freshmen? i wish you knew how good a teacher you are. 

love,

your sister-unit, the gimp

SENTINEL EVENT: “An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.  Serious injury specifically includes loss of limb or function.  The phrase, 'or the risk thereof' includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.  Such events are called 'sentinel' because they signal the need for immediate investigation and response.”

The Checklist: Pause and Reflection... FAIL!

As part of the eternal quest to identify the nasty pathogen causing infection and inflammation in my left shoulder (and hip), I underwent an aspiration of that shoulder joint last Monday.  The hospital radiologist used dye and a fluoroscope to guide the insertion of the needle.  A nurse and a radiology tech were there to assist him, as there were beaucoup bottles and slides that needed to be prepared once he managed to get a sample.

So there we were, the four of us.

Before getting started, we participated in a strange and wonderful ritual -- a Procedure Pause and Verification of Site Ceremony.  For short:  The Checklist, an adventure in Pause and Reflection.

Essentially, the head medico calls out for everyone's attention, then tediously goes over who the patient is and what procedure is to be performed and on what body part.  The site is marked and signed by the doc, and everyone is in accord about whether it is the north leg or the south toenail of the eastern ankle that is to be poked, cut, or otherwise handled and abused.

In my case, despite a desperate attempt on my part to shave a decade off of my date of birth, we all concurred that we were there to stick a large-bore needle into my left shoulder in an attempt to draw off some nasty fluid from which we hoped to farm some identifiable nasty bugs.  The radiologist signed my shoulder with a flourish, and we were off!

Having experienced the impact of medical errors, I did not find the Pause or the List or the Purposeful Redundancy to be any kind of imposition.  Quite the contrary -- I was impressed.  I even told a few people about it... Folks who know the extent to which I have suffered due to medical errors, and the attempt to cover up those errors.

Of course, I spoke with  Brother-Unit Grader Boob -- at some point in the 1990s, he supplemented his teaching salary by working at a hospital near his university -- a hospital most known for its surgical errors, by which I mean the amputation of THE WRONG LEG.  In the lingo:  wrong-side surgery.

What a horrible thing to happen!  And how upsetting when it happened again!  Yes, that was the reigning attitude -- the mistakes just somehow "happened." In my sad experience, I learned much about verbs in the passive, about hospital-acquired booboos.  [In one of the more sinister conversations Fred and I enjoyed during a riotous stay at Saint Joseph's Hospital of Atlanta back in 2002, the retort to our query regarding what, if anything, the orthopods planned to do about my "hospital-acquired" tibia fracture was:  "Oh.  So you know about that?" {with a beautifully arched eyebrow} It just made us mildly curious as to what we might NOT know, you know?  Beyond the initial medication owie, concussion, internal bleeding, and fractured ankle -- with CRPS onset within hours -- had we missed anything besides this tibial oopsie?]

As a Gimp, the attitude in play in these instances horrifies and pisses me off no end:  Well, this person already knows pain and disability, so it is no big deal that a little more pain and disability might be added to their lot.  They probably won't even notice!  Of that 1995 BooBoo, a NYTimes article noted:

"Some doctors who appeared as witnesses said that the leg Dr. Sanchez removed was in such poor shape that it would probably have been amputated in the future." 

What a pompous, convoluted, ass-saving and totally deflective (better than Teflon!) attitude! 

Okay, so I may have given some considerable prior thought to the impact such attitudes can have.

Back to our story!

Yes, it was an impressive display, last Monday, inside a tiny radiology suite.  So simple a thing as a pause and basic review of identities and of left or of right -- what a marvelous idea! 

So there I was this afternoon, getting an incredible amount of Face Time with a noted Infectious Disease Specialist, and we were reviewing the goings-on of the last few years.  Given the back-and-forth rhythm of the orthopedic surgeries I underwent, it was difficult to stay on top of which shoulder did what, when -- even in a fairly ordered conversation.  The ID Dood and I chuckled over the note sent by my Go-To-Guy, which clearly stated that the present culprit, in terms of pain and diminishing range o' motion... was my RIGHT arm. 

Chuckle, chuckle.

Good-natured guffaw!

He said, "Well, with so many shoulder surgeries, it is easy to get confused."  Spurfle!

Then ID Dood called the lab to check on culture growth from last week's aspiration.  So he's on the phone, all Chatty-Kathy, with some minion when his eyes go into Serious Squint.  He had asked for the results of my "left shoulder aspirate," identifying me by name and date of birth.  Lab Minion, however, informed him that there was no left shoulder aspirate being cultured.  There was, however, a sample from...

{YOU GUESSED IT!}

...a RIGHT shoulder aspiration!

So congratulations on the Careful Checklist, the Procedure Pause,the Reflection and the Verification of Site and all -- but if you are going to then mislabel your biopsy or culture samples, you are still chopping yourself off at the knees.

So to speak.

I was  making light of it as Fred and I climbed into Ruby, the Honda CRV, and loaded the power chair on Bruno's Lift, when he said:  "Yeah, but imagine...  you are brought into the ED unconscious and all they get is your name.  They plug that in and see that you have had a shitload of tests done on your RIGHT shoulder.  They can tell you have a raging infection somewhere... and that must be it -- your RIGHT freaking shoulder.  So they amputate..." Okay, so his scenario kind of fell apart at that point, but you get his drift.

The possibilities running through my mind were less extreme but equally catastrophic.  What if such an error had occurred before, but without such an obliging lab technician on the other end of the telephone?  What if, say, following one of the five surgeries on my right shoulder, SuperShoulderMan rang up to inquire about intraoperative cultures from said shoulder, only to be told something slippery like "no report of growth," when in actuality there was growth, but in a specimen mislabeled as left?  Hmm?  Before you get all pissy and dismissive, ask yourself if it could happen...

I still feel they are to be congratulated for these steps to stop medical error.  They just need to tweak a few straggling details -- like somehow including a review of labels on lab forms on the checklist.  Or something.