Dr. Hackenbush! Calling Dr. Hackenbush!

Originally published back in the holiday season of 2008, shortly after our summer discovery that my prosthetic shoulders were harboring pathogens, this piece returns as a 2014 holiday tribute to the medical nitwits currently in my life. Among the nitwits this go-'round? Auxiliary personnel in the billing department of the same hospital depicted below. Also, the various board-certified neurologists who are gleefully passing the buck to their neurosurgical colleagues. Again, this is a repost, Dear Reader, as the Surgical Shoulder Wars are now ended, the bacteria having defeated even the inimitable and marvelous Doctor ShoulderMan.  But the hilarious conversations with medical professionals continue, even if the laughter has become markedly insincere.

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Fred drove through driving rain and piles of slick wet leaves late yesterday (early for us!), so as to get me to the pre-admission registration process at the hospital -- before they stopped taking patients for the day.

No problem. Ruby the Honda CR-V putt-putted happily, veering down the hilly streets, passing the elegant homes on the tree-lined way.

We even managed to snag the premier gimp parking space, and this at a parking deck notorious for being full -- and gimp spaces usually taken by remarkably spry looking folk, and cars without placard or "disabled" license plate. Okay, okay, the correct line is supposed to be something like: "You can't tell by looking!" (Shit, you sure can... It takes a gimp to know a gimp.)

So, Dear Reader, what am I supposed to do when, despite my best efforts... Okay, okay, jeez, you are a tough one, Dear Reader. What am I supposed to do when, after a few lame attempts to keep things on the straight and narrow, the nurse in charge of registering me for Monday's major surgery makes mistake after mistake?

Here is a sample of our stellar communication, verbatim:

The Nurse: When did you last have an EKG?
Me: In August, the last time I was here.
The Nurse: And when was that?
Me: In August.
The Nurse: And where can we get a record of that?
Me: Ummm, here? In my medical records? (See? She managed to get to me -- my "intonation ascendante" is a dead give-away. Ar! I used to get hit on the head with a ruler whenever my "intonation ascendante" gave way. What was that dear old teacher's name? I can't remember, in large part due to his pedagogical concussing, but I loved him.)

[Choo choo! Train of thought! Choo... Back to the scene of the crime... ]

Me: Ummm, here? In my medical records?
The Nurse: Hmmm. Maybe in your medical records.

Then we tried to exchange the information about my last echocardiogram. Should be simple enough. Doctor's name, address, phone and fax numbers, date of the test.

And I have to say that it sort of mattered a lot to me for this information to be correctly received, given that they discovered an aortic arch aneurysm via that test. I had even had a serious bout of chest pain the night before, during which I was unable to banish the thought that, well, "this could be it." I made it from the bed to the wheelchair and then out to Fred's office, and he got me the under-the-tongue stuff. Three of those, five minutes later, I was fine. Still. I cannot banish that fear, not entirely. And so, I faced The Nurse full of conviction in the wonderful potential of our communication skills.

The Nurse: Where was the echocardiogram performed?
Me: In Dr. Rosenstein's office, as an outpatient. He's in the Doctors' Building over at St. Mellifluous. Anyway, it was August 22. 9:30 AM. It showed my usual aortic insufficiency due to a congenital bicuspid aortic valve. Oh, and they found a... dilation... of the aorta, where the aortic arch attaches... so, yeah, that's Dr. Rosenstein, over at St. Mellifluous. His phone is 555-555-5555 and, surprisingly, that doubles as his fax.
The Nurse: Well, I don't know what to do.
Me: Pardon? Can't he just fax the report to you? That's 555-555-5555...
The Nurse: I hate to be the one to break it to you...
Me: What? Break what to me? Does this mean I can't have the surgery Monday? They went ahead back in August, just 3 days later, on the 25th... Why is it different this time, why? [Blither and blather, generalized anxiety bursts loose and flies around the room, backward.]
The Nurse: Dr. Schrödinger passed away last week.
Me: Who is Dr. Schrödinger? He did?
The Nurse: It was very sudden, a massive heart attack. I am sure all of his patients must be terribly upset.
Me: I'm sorry for your loss? [And there it is again -- she's screwing with my intonation encore une fois, de nouveau.]
The Nurse: So I don't know what has gone on over at his office -- hmm, maybe the staff can dig up your records. I'll give Judy a call.
Me: Judy? No, no, I think we have a misunderstanding. My cardiologist is Dr. Rosenstein. And his nurse is Linda...
The Nurse: Well then, why did you bring up Dr. Schrödinger?

It was a rough afternoon. I will say this for her -- she got my blood on the first stick, for which I remain grateful. A few things worry me -- for instance, she didn't give me the red arm band I usually get -- it has something to do with blood, the blood bank?

Wow, even away from her, she screws up my intonation, long distance.

Also, I did as instructed by Dr. Boutiqueur, and emphasized my need for stress-dose steroids (adrenal insufficiency) pre-op -- intra-op -- and post-op! I don't think it was even received by any of her grey cells. "That's okay," thought I, "I will just bring it up again when I speak with anesthesia."

Except -- I did not get to speak to anesthesia, despite the fact that my intubations have been difficult
-- to the extent that, at this same facility, back in 2005, they broke three of my front teeth trying to get the damned tube in. Yes, that's right. I have had a slight attitude about their anesthesia department ever since. They paid for the dental surgery, and for the very creative partial that had to be created. But I forgot to make any arrangement for the FOUR other partials that have had to be made. Some major, and ill-afforded, pocket change has been thrown at what looks to be a never ending problem.

Also, the good anesthesia rep is supposed to tell me which of my many meds I can take come Monday morning. The Nurse asked me to take whatever I "thought was right." Okie-dokie. So I am going to dig up the green folder from my orthopedic surgeon's office for the last go around, in hopes that I have the notes from the anesthesiologist about meds.

Because I've a sneaking suspicion that what "I think is right" is probably wrong.

I wonder who it was who cleaned out all sorts of unnecessary paperwork from my office a few months back? Ar! Must have been the same idiot who thought ShoulderMan victorious in the Shoulder Wars.

In summation [Oh, sit down and stop clapping.]: Major confusion about the tests done back in August, and from where the results can be obtained -- and whether the ordering physicians are even alive; no blood being readied for surgery, despite the fact that, back in August, I had a hemoglobin of SIX after surgery; no interview with anesthesia about stress-dose steroids and historic difficulty with intubation.

She jumped all over the MRSA in the nares issue, though. Thank goodness. Whew. What a load off...

Good grief! I got MRSA at the hospital to begin with, and the Fredster absolutely refuses to don the yellow dress and blue gloves -- not only do they offend his fashion sensitivities, but he overheats. There is also a tendency on my part to NOT ask for nursing assistance when I really do need it -- I hate to make someone get all that isolation gear on for what can seem awfully minor (bedpans, pain meds, help turning -- hey, you try it without using your shoulders/arms!).

So this weekend, my ID doctor has prescribed some antibacterial ointment that I am to stick up my nose. Excuse me, up my nares.

My question? If this antibacterial ointment kills the MRSA... why is it considered resistant to antibiotics -- or even at all virulent?

I forgot to mention that The Nurse's understanding of CRPS/RSD, which initially seemed quite promising, ended with her asking about the acronym: "How do you get 'RSD' out of rheumatoid arthritis? I usually say 'RA.'"

Me, too, when I am talking about rheumatoid arthritis!
Sigh.

Calling Dr. Hackenbush, calling Dr. Hackenbush!
(Below, please find the lyrics to Dr. Hackenbush, a musical number that was dropped from A Day at the Races due to concerns about the film's length.)


CHORUS:
So this is Dr. Hackenbush, the famous medico,
You're welcome, Dr. Hackenbush...

HACKENBUSH:
If that's the case, I'll go

CHORUS:
Oh, no, you mustn't go...

HACKENBUSH
Who said I mustn't go?
The only reason that I came is so that I can go.

I'm Dr. Hackenbush,
My medical standing's very high,
Well, anyways, ladies and gentlemen, I
am Dr. Hackenbush

CHORUS
He's Dr. Hackenbush...

HACKENBUSH:
I'm Dr. Hackenbush,
As a matter of fact, to be exact,
I'm Dr. Hackenbush!

FEMALE SINGER (Judy?)
I'm sure that they'd all like to hear,
Some facts about your great career

HACKENBUSH
Although my horn I hate to blow,
There's one thing that you ought to know:

I'm Dr. Hackenbush
Which all my friends will verify
Well, anyways ladies and gentlemen, I
am Dr. Hackenbush

CHORUS:
He's Dr. Hackenbush

HACKENBUSH
I'm Dr. Hackenbush,
You never would guess, but nevertheless
I'm Dr. Hackenbush!

For ailments abdominal, my charges are nominal
Though I'm great for I've a rate for tonsillectomy,
Sick and healthy, poor and wealthy, come direct to me
"Oh, God bless you!" they yell
When I send them home well,
But they never, no they never, send a check to me.

I've won acclaim for curing ills, both in the north and south,
You'll find my name just like my pills in everybody's mouth;
I've never lost a case...

CHORUS:
He's never lost a case...

HACKENBUSH:
I've lost a lot of patients, but I've never lost a case!

My diagnosis never fails, I know just what to do,
Whenever anybody ails, I'm sympathetic too,
My heart within me melts...

CHORUS:
His heart within him melts...

HACKENBUSH:
No matter what I treat 'em for, they die from something else.

When your nerves start to rock, put your faith in your doc,
When you're sick he will stick to the end,
With the possible exception of your mother,
A doctor's a man's best friend!

CHORUS:
Yes, a doctor's a man's best friend!

HACKENBUSH:
A doctor's a man's best friend, whoa-oh,
A doctor's a man's best friend,

HACKENBUSH & CHORUS:
A doctor is a man's best friend!

HACKENBUSH:
Right or wrong, wrong or right,
Night and day, day and night,
On his call you can always depend;
With the possible exception of your mother and your father
And your uncles and your brothers and your nephews and your nieces
And your sisters and your cousins, whom you number by the dozens...

HACKENBUSH & CHORUS:
A doctor's a man's best friend!

I Stole This From Ruthie Rader

I want to once again recommend Ruthie Rader's blog to you, this time because she has royally ticked me off, but that seems to be more of a personal foible lately than other peoples' actual fault.
Call it "projection," call it "denial," call it a fever of 102, just get me some frozen strawberries sprinkled with cancer-causing fake sugar and cover it to the precisely right level with nonfat milk. And get me a soup spoon.  You know the one I like -- from two patterns ago.

It makes me feel better.  Cold things.  Even the thought of cold things.

When I was in the hearsepital this last time?  I swear it felt like the alternate universe of hospitals (in my experience).  Caring doctors, responsive and smart nurses, all who redefined the expression "going the extra mile." Critical thinkers, too, from the aforementioned smarty-panted medicos to the food service employees who could reconfigure an overcrowded bedside tray in the blink of an eye, all while making sure you were who you were supposed to be.  (As if I knew...)

Anyway, there was one nurse who listened carefully to my terse declarations about CRPS, repeated so often and almost always ignored, and who asked if ice or something cool made any difference to the pain in my legs.

I guess the answer was pretty easy to discern... "Ohhh!  Ahhhhh!" I managed.

There were days, before I was diagnosed with avascular necrosis, then lupus, then CRPS, then osteomyelitis... that Fred would pack me in ice.  It was the only thing that worked.  Ice packs from head-to-toe.  "Ohhh!  Ahhhhh!" I used to exult.

Anyway, we weren't stupid about it.  He'd let me drift off to sleep and then dare to take the cooling comfort away, pack by pack, kind of like playing a dangerous form of Pick Up Stix.

With the CRPS diagnosis came precious few certainties, but the one everyone seemed to know was "never, never use ice or cooling devices."

"We're serious.  Never.  Ever."

We heard it from the CRPS Impressively Diplomated.  We heard it from the online sufferers, who had heard it from everyone.  We heard it from every physical therapist.  We heard it from the snake oil salesmen.

And not one could tell us the reasoning behind the prohibition.

So, anyway, this wunnerful nurse was wunnerfully made, and said, "Look, it helps, right?  And it looks to me like nothing much else is helping.  I mean, I gave you a boatload of morphine and you asked me, five minutes later, when I was going to give you the morphine!  So while I research this 'no ice' thing, why don't I bring in a couple of ice packs?" Ohhh... Sorry, I'll stop it with the OHs and AHHs, already.

Anyway, I left before she got back to me, so I am back under the thumb of that stupid fear.  But... now that my stomach is leaking blood like a sieve, and my fevers are sucky, I've discovered the brief and icy peace of frozen fruit sprinkled with carcinogens and topped off with milk.

And then... there are Ruthie's photos.  I have stolen one, but I hope YOU understand that this photo was taken by Ms. Ruthie Rader, belongs to Ms. Ruthie Rader, and was purloined from her wondrous blog Ruthie in the Sky, which documents her journey.  And what a journey it is.

When I lack the energy, will, and character to drag my sorry self to the freezer, I can still manage to ogle beautiful pictures of... cold.  Ohhhh....

Photo stolen from Ruthie Rader's blog: Ruthie in the Sky

Grosses Bises/Re-posting as an Object Lesson

Wow.  It's amazing how some things do not change.


I was browsing old entries, looking for something that dated from the summer of 2008.  I have never been a good tagger or key-worder of posts, and many from that time period were left essentially undescribed.  The one that I am republishing now, for instance, bears this label:  "a partridge in a pear tree." Cute, maybe.  Helpful?  Not in the least.


Reading it should have made me laugh, but given how it highlights that inefficiency has been alive and well chez MDVIP Go-To-Guy's office for quite some time, I am not even cracking a small smile.  It's even less amusing since it marks the actual beginning of the Shoulder Infection Saga.  At this point in the ridiculous tale, I had two prosthetic shoulders that had both begun to hurt, accompanied by infamous malaise and fevers.


I may have to give this conspiracy angle more thought, because it looks more and more like things were screwy from the very get-go.


This post is in the form of an email to a then dear friend, who is, remarkably, still a dear friend.  Like everyone at a physical remove, she echos frequent consternation and disbelief at my tales of labs gone missing, labs ruined, doctors out of the country, and health professionals behaving as boors.  I'm sure she thinks this is all an elaborate invention...  Especially after she gets today's email explaining why the wildly anticipated culture results from last week's sampling will not come to anything resembling fruition.


So it is [*poof*] July of 2008 and apparently, I've begun to make serious noise about the state of my shoulders.  After a frustrating few days, I vent to my friend, thusly:








Hullo --

Don't worry, it's not you -- I need some slow-speaking here on my end, too. The quality of the deliberate. Or... I need an analyst's couch.

I can't remember what I wrote to you! The blood work showed an elevated white blood cell count, a very high platelet count, high liver function tests/enzymes -- That's all she told me -- And I didn't want to hear any more. It is, I believe, all very vague. My white counts are usually very stable and hover at the 11,000 mark -- mostly because of my "normal" inflammatory state. (Touche pas à ma phrase...) When I saw him last, I had already started having the fevers and general misery (quelle malaise, cette falaise...) and that white blood cell count was elevated, too, but only to 13,000, I think. It's now 17,000 sumpin' sumpin'.

I need to vent -- which will hardly interfere with the innate logic of my presentation. You know this from innumerable past attempts to plumb the depths of the chaos of my language. My languages.

Where is La Belle Bianca? you ask, voice a-quiver. She is firmly ELSEWHERE today. En vacances, disons. Resting her voice.

So -- Today being Wednesday, we naturally begin from the début of the work week: Monday.(Please recall that Monday marks six days from the blood draw, and six days from the steep clamber up Prednisone Mountain.) I call dear Dr. Go-to-Guy's office and leave a message at about 2 pm. I am feeling like warmed over, tepid crap.

No, of course that is not the essence of my message! What do you take me for, and for whom, too? Also! The message was that I remained febrile, that the stress-dose of steroids had helped with much of the bone and joint pain, but that there was an intensifying, well-localized pain in my right shoulder -- which, by the way, was basically unusable. I did not share la malaise de ma falaise, because who wants to encourage these medical types, these diagnostiqeurs, in their disgust of people with generalized pain and an excess of adjectives? Dear Dr. Go-to-Guy is not your average bear, of course, but I still don't wish to open myself to ridicule, now that the medico blogging world has dared to air its fatigue and discontent. (There has been an adroit movement to shift the blame for the cynicism squarely onto the shoulders of the barrister. Ooooo, smooth-and-wholly-unanticipated!)

There is no call back.

Monday night becomes emotionally bad as well as physically bad because I am just so tired of hanging on. The violins begin to play. Yes, the world's smallest! Bianca warbles in an effort to cheer me up; Dobby plays leapfrog on the very shoulder in question; Marmy offers an exquisite hair ball; Sammy makes goo-goo eyes; and Fred? Well, Fred goes shopping. He is very kind and I try not to overwhelm him with ridiculousness. Good man, that Fred. Well, except for his recent executive decision to use chicken feed as cat litter. Very absorbent, but the house smells like a barn.

Yesterday, Tuesday, I called as soon as they opened, ticked off by then, thinking that my message might have purposely been derailed, thanks to all the bad blood going on between the doctors, nurses, and staff that are leaving to form the new practice, and the ones that are staying behind. Worked myself into a lather, lots of suds! While not normally a conspiracy theorist, I will run with one when tired and dehydrated.

When Darling Nurse does finally call, she does so in order to tell me that she got Monday's message and that she was (profusely) sorry. She lost my chart Monday, and can't do a thing without it and blah blah blah and could she call me back because she needed to consult with dear Dr. Go-to-Guy about a few things? In the inimitable language of Marmy: Ack! Ack! At least, all things are back to normal, and Lee Harvey Oswald did, indeed, act alone.

Darling Nurse's second call: She is kind of scaring me, although I suspect it is more an effort to impress me with references to quick, decisive action -- all brought about by her dedication to my health, and by, of course, the recovery of my chart. Doc is on the phone right now with your orthopedic surgeon (henceforth to be known as ShoulderMan) and he wants an x-ray stat, and probably a bone scan, and so on and so on. Inside, I am a tad bit pissed by all the stat-ness, after having been so desperate for help.

Also, I know that a bone scan would be a massive waste of time, money, and resources.

Third call: We figured out where I could go for the x-ray (to a hospital about 40 minutes from us, but we also would be in bad traffic, very bad traffic) and then she said I needed to call her right before I left the house because she would have "additional instructions" from dear Dr. Go-to-Guy.

Time came for us to leave, at least I think so -- Le Fred is dragging his feet, suddenly has to make a trip to Walmart, suddenly there is an online auction he simply must witness, but overall? He is being a total studmuffin! What no one takes into consideration is that *his* day is being ruined because he has to chauffeur me everywhere. Like I said, a studmuffin.

Anyway, per instructions, I called the office and asked for my good nurse.

-- "Your nurse is on another line, would you like to leave a voice mail?"
-- "No, she told me to speak directly to her."
-- [major put-upon sigh] "Well, i will have to put you on hold."
-- "Okie-dokie!"
-- DISCONNECTED.
-- Repeat performance, the only difference? "Your nurse has taken a patient into a room and won't be available for a while."
-- [major put-upon sigh from MY end!]
-- "Okie-dokie, there, then! We will call her from the hospital's outpatient radiology department. We're leaving. please let her know we are on our way. Thanks!"

I was very proud of my telephone skills, as I am usually nearly phobic. I don't like telephones. Part of the supreme irony of all this? The hospital we were going to is -- literally -- a straight shot across the street from Go-toGuy's office. Why couldn't this all have been: swing by the office on the way to radiology and make sure you have everything you might need?

Shut up, you! Yes, I realize that such a common sensical move was also mine to simply make. One somehow gets caught up in a frenzy of following orders. And yes, of course, if we would just join the rest of the human race and snag some cell phones, some of this ridiculousness might be alleviated.

Anyway, we get there -- We're an hour late but still in the windowof opportunity she outlined for me. I smile a toothy smile at the receptionist because I remember and like her. I give her my full and complete name, get out my picture ID and insurance card, and while she is frowning at her computer monitor and leafing through piles of paper, I make smart chit-chat with The Fredster. (I keep wanting to call him "studmuffin" now, but if he found out, he would be pissed, like he was about the whole "Cabana Boy" snafu! Now *that* was a fine misunderstanding, I must say!)

You're probably ahead of the curve of this story: Right! NO ORDERS. NO PAPERWORK. No outstretched hands to take my proffered proofs of coverage and identity.

Unbelievably, I have a conversation with dear Dr. Go-to-Guy's office staff that is eerily reminiscent of the last one before we left the house, in that 'My nurse isn't available, would I like to... '

"No," I erupted. "I would not like to... What I *need* are some x-ray orders..."

The nice X-ray lady gives me the fax number and I relay it. Then Go-to-Guy's office lady says, "And what is the number if we just want to talk to them some more?"

This is a huge, major hospital that is right across the street from where her little pin head sits. Of course they have the phone numbers.

Still, in the interests of world peace, I ask the nice X-ray lady, who promptly furrows her considerable brow and shakes her head "No. No. No." They just need a number, I beg... and RELUCTANTLY, she gives me a number for their back office. What is the issue about giving out a sacré phone number? Incredible...

In about 10 minutes -- a STAT order is faxed over for a plain x-ray series of the shoulder. Surely this is abuse of the word? All the other stuff, the bone scan and whatever, is not ordered. Fine by me, I have a headache and i think (no, I *know*) we are all bozos on this bus...



So we finish. Hooray! The x-ray tech says, when sufficiently wheedled, that she thinks everything looked fine, but that my doctor will call me at home -- that night, last night, Tuesday night -- as in "shortly."

We crawl home through rush-hour NPR traffic, I feed everyone, am all wound up, very feverish, etcetera, ad museum, et ainsi de suite, and so on and so on, amen. I keep the dread phone at hand.

No phone call. I seem to recollect some involuntary weeping mixed with inchoate laughter.

No sleep -- well, some -- but I don't know how much, because I wake up with the computer on my lap and no memory of what I was doing. I have started a ridiculous little blog and it just gets weirder by the day because of insomnia and pain, plus my undeniable native weirdness -- and I see that I have made an entry into said blog -- again with no memory of it. What the heck, eh? An entry is an entry -- except that I like blogging and want a good calibre of thought and writing -- that is definitely NOT happening now.

We arrive at today, enfin. I get an early morning phone call! Hooray! It is, forgive me, from ShoulderMan's nurse, whom Fred and I call, forgive us, SuperDyke. She is extraordinarily gay, even in this city of the très gay, extremely masculine, and she acts like a drill sergeant. We have been mildly frightened of her in the past, though she is also very, very organized and straightforward, two key characteristics that have been woefully absent this past week.

SuperDyke tells me, first, that they are angry with me because back in 2005, I failed to turn up for my post-op visit with ShoulderMan. I congratulate her on her elephant-like memory and explain that I had multiple problems post-op and that her office told me that none of them were their concern, and that subsequently, I caught pneumonia, was on a ventilator in ICU, and then had to deal with fractures to my sternum from where they did CPR, etc. Screw world peace.

She sniffed.

Then, she shifts into high gear and lays out the arrangements for me to have an aspiration (guided by fluoroscope?) from the shoulder this Friday afternoon -- at yet another hospital, this one totally unaffiliated with my dear Dr. Go-to-Guy. They will culture it and see if it grows any bacteria. That will take time, apparently, and so I won't be scheduled to see ShoulderMan until next Wednesday. Yes, Wednesday, when I am simultaneously scheduled with Magic Eye Doctor to see if my pressures are responding to the glaucoma treatment... Well, cancel that! Magic Eye Doctor already thinks I am avoiding him. (Maybe I will drop off a copy of the Warren Commission Report.)

So now it is "pre-cert" time and la-di-da dealing with BCBS time... and, I figure, dear Dr.
Go-to-Guy will finally call me this afternoon. Yeah! That's the ticket! That's what will happen!

RING RING. It is Go-to-Guy's good nurse, who advises me that she is not normally this bad, it is just that she is kicking her Diet Coke habit. Uh-huh, I say. What happened yesterday with the orders and all, I dare to ask. Oh... I sent them to the wrong hospital...

She is calling to tell me that:

DR. GO-TO-GUY IS OUT OF TOWN UNTIL JULY 24, that I need to "be strong and go on auto-pilot, alternate percocets with ibuprofen around the clock..." oh -- and that SHE JUST GOT IN A TELEPHONE FIGHT WITH DR. SHOULDERMAN, himself.

Well, I know that ShoulderMan and his staff will do the right thing, and shrug it off.

Because I know that they won't take it out on me, the patient!

So that's the whole sad story, in ridiculous detail, my dear Ms. D, and clear as mud, too!

I am munching on sweet, crunchy, bad-for-me cereal, sipping strong cold coffee, burning up with fever and pain, trying to find the high road, so that I can get on it!

Hanging by the proverbial thread,

All my love,
Prof

[it was a tough call, though... which post to repost. "Calling Dr. Hackenbush" was just nosed-out at the finish line...]

Calling Nurse K! Code Blog, Code Blog...

I'm taking a fucking hiatus.
Love ya,
Nurse K


That was the love note that Nurse K left to the more ancillary arm of her website devotees, and that was way back on 9 September.

I want to put her officially on notice that I am going into withdrawal. I check the vital signs of Crass Pollination: An ER Blog three times a day, without fail. Pressure is a little low, heart rate a little fast, but resps are a normal 16-20.

And I want Nurse K to know, in a more serious vein, that her readers are hoping that all is well, or getting there, in Nurse K Land. If there's anything we can do to help... [Yes, I am imagining her snarking me: "As if. As if you could help. You have no friggin' clue."]

Maybe she'll return to us reformed. A progressive Democrat. Dare I utter the S-word?

I challenge *anyone* to write a blog post calling for the Perpetual Approval and Even Expansion of the Emergency Medical Treatment and Active Labor Act -- very commonly known among bleeding-heart liberals as PAEE/EMTALA.

If that doesn't smoke her out, I dunno what will.

Dr. Bloody Gloves shall not prevail. Happy the Hospitalist shall spontaneously combust. And SumDood will just have to wait his turn. I believe, I believe, I believe.

O Lord, Hear My Prayer

I find it difficult right now to write anything. Putting cogent thoughts together, or even messy ones, distresses.

Just plain exhaustion and an increasingly pervasive depression.

Today, infectious disease appointments -- to draw a vancomycin "trough" level, get PICC dressing changed, etc.

Tuesday, The Boutiqueur and the infectious disease infusion center.

Wednesday, the orthopods -- stitches out? Some sort of plan?

Thursday -- sleep.

Friday, Hawaiian-Shirted Neuro-Man, a supremely important appointment.

We are infusing every morning at 11 am, though we'd like to edge that more toward noon.

It's babyish, but my throat bothers me more than anything -- it represents air and life, I guess. On the way to the hospital last week, Fred and I pooh-poohed said sore throat. Then, after being tubed, both for surgery and for intensivists' amusement, it was horrible. I sound like a croaking toad. Fred checked it and saw white patches on the side that hurts -- the ID Guy, when I finally whined enough that he actually looked, said it was "an ulcer." Fred rechecked it, saw no ulcer, still saw white stuff. The Bette-Midler-Lookalike Hearsepitalist -- oh, did we clash -- flashed a light on the right side of my throat and chirped that she didn't see anything. I'm sure she didn't.

I asked for throat lozenges beginning on Tuesday evening. They were reordered twice. Never showed up. When The Fredster settled me in bed here in my beloved Marlinspike Hall, deep, deep in the Tête de Hergé, he ran by the grocery and picked up four flavors, all sugar-free. Some lowfat plain yogurt. Feline supplies.

The dead zone in my right lung is back, in spades. ["in spades"?] Technically, I have pneumonia. Thick yellow crap. You are welcome!

The Boutiqueur, from a distance of safety, opined over the phone that maybe what happened was an assault by mucus plug. All I know is that I have reexperienced the breathless terror twice at home when the I-cannot-swallow thing happened. He always tells me it is anxiety.

I don't think so. It doesn't happen when I am anxious, for one. For two, I am fairly insightful about my emotional life, cognizant of schtuff like anxiety.

Back away, back away from the volatile.

Would you believe that the only "washing up" that happened in the hospital happened with Fred's help on Wednesday night? That the bed sheets were never changed -- only a new top sheet whenever I managed to spill coffee on it. Cough. Patient care? What patient care? It was all meds, meds, meds. If Fred hadn't been there, my teeth would have grown brown fuzz.

Hey, maybe that was the idea. My brown-fuzzed teeth were at the center of a grand immunological experiment. I'm just saying.

I made an ICU nurse cry. And not from hurt, oh no. She wanted to KILL me. I kid you not. Is it my fault that she was the person who finally pushed me over the edge? She decided to invent information rather than say "don't know but will find out..." That happened a lot. I consider it lying and, at least, unhelpful to my recovery to be given misinformation. She lied about the echo results, about the monitored bed, about the phone, about my meds, about the palsy in my hand -- but above all? She ignored, and was pissed off by, my frequent frequent frequent requests that she stop-the-fuck touching my legs.

I don't do the 20 out of 10 pain scale crap. For the first time ever, in hospital, at least, I went to 10/10. It felt like every nerve fiber, muscle fiber, was twitching nonstop. My legs burned like dry old wood in a fresh flame. Yes, very Joan of Arc -- nod to Leonard Cohen (and Jennifer Warnes). No, I don't see my battle as kin to her fiery epic; Yes, I find the transcripts of her interrogations and trials fascinating reading.

So, anyway, it hurt like hell. My right foot and leg were caught up in horrible contractures. Every time someone decided to pat my knees, pass a cord or tube over my body, brush me with their humongous booby, it was like an electrical jolt that served to amplify the pain that had already been keeping me company.

I would say to This Weepy Nursey, "Please don't touch me..." This Weepy Nursey would snarl, "I know, I know, you don't like to be touched." Like to be touched? Hell, I LOVE being touched. Ah, but don't go down that road. Let her think I am just some effed-up eccentric.

They all had their ID cards hanging by lanyards around their tiny little easily-snapped necks. Bend over a patient's bed and these laminated thangs, they land on the patient. "But I didn't touch you. Gaawwwddd!" complained This Bitch of a Weepy Nurse. Leaving me to explain about ID cards, cords, tubes, boobies -- sounding like an insane person. Leaving This Bitch of a Weepy Nurse to roll her eyes, and do it again.

"But I BARELY touched you!"

So I had a meltdown. So I called her some sort of idiot in front of a colleague. So I maligned her knowledge base. She had it coming. "You don't have to talk to me like I am an idiot. Just explain it to me," said This Bitch of a Weepy [sobsob] Nurse. "Apparently, I do," was my response.

She actually brought me my standard dose of methadone as a response to the pain arc. When I told her something more immediate and short-acting was called for, she practically threw it at me and I could see "Effing Drug Addict" play across the marquee of her mind. I spared her a recitation of the half-life of methadone.

I take 15 mg of percocet for bad breakthrough pain. Two 7.5/325 tablets. And that's what the pain management service ordered for me in hospital. This Bitch of a Weepy [sobsob] Nurse, however, decided that since they only carried 5 mg tablets, that two 5 mg percocets was the equivalent order. Hellloooo? I tried pointing out that if we tried three 5 mg tablets, we'd be doin' good. But that's too much Tylenol, she countered. Damned if it doesn't come in immediate release form without ANY apap, and at the 15 mg dose, too...

Once out of ICU, there was no quibbling back-and-forth about it. People also had to be told "please don't touch; please ask/tell before touching" only twice or so, and then were kind enough to spread the word. The problem on the floor? Inexplicable! Big old white bandage on left shoulder... But still, fairly hefty "pats" on the shoulder. I never said anything, but felt my pupils explode and the smile on my face freeze into a death mask grimace... That hurt a heck of a lot less than the slightest touch to my arms or legs.

I've got to stop.

In case you don't see it, or get it, or feel it? I think there is PTSD lurking in me whenever stuff goes even slightly wrong in the hospital -- when things go majorly wrong? As Mr. T might opine: "I pity the fool."

It goes back to May 22, 2002.

The final thing that wants to leak out of my fingertips this morning, before trying to clean up this bloated corpse and set off to see the ID folk, is an accounting of how frustrating it is to explain to the student nurse in ICU that the ventilator had been turned off for a trial prior to extubation. "It's breathing for you, sweety!" she kept chirping. I wanted to scratch her face off. Finally, I put my hand on my chest, so that she could see its rise and fall versus the non-activity of the machine. "oh!" she said, and ran out of the room, ostensibly "to tell somebody." Thank God for Respiratory Therapists... I had been started on my "trial" a good 45 minutes earlier, unbeknownst to my caretakers.

See? That kind of thing doesn't matter. Best to forget it. Don't dwell on the negative. Make like a duck and let it roll off your back. Don't sweat the small stuff.

Have you ever had pneumonia, lousy O2 sats, and tried to breathe through a straw, all the while trying to positively impress the People in White with your... vivacity?

All right, next time? I will continue to exorcise my demons, particularly The Bette-Midler-Lookalike Hearsepitalist who tried to kill me with insulin.

I am so grateful for this space.

And I am sorry for making the nurse cry, for enraging her, for putting her down. I am sorry I told her that the ICU needed to do an inservice on CRPS/RSD. I was basically alone, and afraid, and in pain. And stuck back in 2002, when forces -- in the guise of Doctors and Nurses -- conspired to devastate me.

Someone, Anyone -- give me a week, and then kick me in the butt. Okay?

(O Lord, Hear my prayer! Let something treatable have grown in the lab, one of Your smaller creations that wants a more hospitable home.)