Wednesday, January 19, 2011

Third World Surrealism

I’ve just come home from what surely must have been a couple of days in a third world hospital that Doctors Without Borders hasn’t yet discovered.
Let me back step a couple of paces.
I’m a two-time stroke survivor.  They were the same type, and in the same location.  The difference is that while the first one slowed me down, the second one, 33 months later to the day, knocked me flat on my back, and left me with almost zero upper epidermal sensory feedback on my left side.  If you tap my left shoulder, for example, unless it’s hard enough for me to feel deep muscle pressure, I can’t feel it.  My entire left side is that way in varying degrees.  I have some sense of feeling in my toes and fingers on that side, but not really, you know?  Mostly what I have on the left side is deep muscle feeling, a kind of aftershock to some contact, and strangely extreme sensitivity to hot and cold on that side.
I am mostly ambulatory, although the fine muscle coordination in my hand and fingers is lacking, and when I leave the house, I take a cane.
That’s background.  Robin Cook would have enough to make a pretty nifty medical thriller out of just that much.
Monday after lunch I was sitting at the computer editing the previous day’s morning service from our former church back in Pittsburgh, and my entire left arm from just below the deltoid to my fingertips went numb – like when you lie on it funny and it falls asleep.  I called my doctor, whose office is literally half a block from my home.  He advised me that, considering my history, I should go get it checked out at the ER,  which I did.
Here the surreal nightmarish journey to a third world country begins.
By the time I arrived at the ER, which I won’t name for purely obvious reasons – you know – like potential lawsuits for libel and the such, I had come to the conclusion that since this was a single symptom event, it was not another stroke.  The admitting ER nurse agreed.  So did the attending physician.  However, after satisfying the nutritional needs of the entire cast of Twilight, they decided to admit me and do more testing in the morning.  I arrived at the ER around 4:00 PM.  They took a chest x-ray, wheeled me in for a cat scan past the hospital Subway Shop, and returned me to the ER.  I was rolled into my room just before 9:00.
A thoroughly delightful nurse whose name has a heroic, if fictional history, did a thorough work up, med information, what did I need?  I told her I really needed my night time meds and something for my congested sinuses.  She pointed out what tests were to be done, made a note in my chart that I am claustrophobic and prone to anxiety attacks since the second stroke, and would need something to help me relax for the 90 minute MRI scheduled for first thing in the morning.  Still nothing for my congestion.
That was the way of the night.  I didn’t see another doctor all night/morning, and wasn’t given anything for the congestion, so as a consequence of this, I read two Alex Cross novels instead of sleeping.  Around 3:00 am the nurse showed up with Saline Spray for the nose.  My sinuses are congested, not dried out.
When ‘morning’ arrived, the consulting physician showed up, reviewed my chart,  and explained the tests – well, three of the four – to me.  MRI, brain and neck because he also felt this was not a stroke issue, but could very well be a pinched nerve, ultra sound of both carotid arteries to make sure there were no arterial blockage issues, and nerve conduction test done out -patient since they don’t do them in the hospital.  He didn’t tell me about the EEG, and they never did take a second set of blood, which I’d been told the previous night would be done.
Still begging for something for my congestion.  At this point I have been awake almost 24 hours. My BP is 151/98.  My strokes were both bleed-out brain hemorrhages resulting from high blood pressure, so this is a real concern to me.  No, they didn’t do anything to lower the BP.
It’s 10:00 when I’m finally wheeled downstairs past the subway shop for my first test – the EEG no one told me about.  Next, across the hall for the Ultra Sound, and then on to the MRI.
“OOPs!  - We’re sorry, Mr. Roth, but your physician hasn’t called up either the meds or the dye for your MRI, so we need to send you back to your room until the nurse can administer the meds.  We can do the dye here, but the doc still needs to order it up.”
No worries – I can’t breathe anyway.
The nose stuff showed up at 3:00 PM – eighteen hours after I requested it.  After three calls, the nurse finally got the call back from the requesting physician to order up the meds (2 mg Valium IV) and the dye.
I was wheeled back into the MRI at around 4:00.  Not exactly ‘first thing in the morning’ but at least I could breathe now.  About 90 minutes later, I returned to my room with a pounding headache from the jack-hammer operation they call an MRI.  When the machine shut down, my personal jackhammers kept working.  I asked for something for the headache at 5:30.
At 7:30, I asked for discharge papers.  I was not going to spend another uncomfortable night in an uncomfortable hospital bed simply because a doctor couldn’t be bothered to respond to my requests for information or treatment.  I never did get anything for my headache.
This hospital, like most, has a pharmacy.  It is closed from 9:00 PM until 7:00 AM.  Any meds not in a cabinet at the nurse’s station are ordered from an offsite pharmacy during that time, excluding OTC meds – like, oh, say, AFRIN spray for a severely congested nose that’s keeping a patient in agony all night.
If the nurse can’t find your doctor to approve and order up a med, there is nothing in place to allow the nurse to find another doctor who can review the chart and make a decision.  Hence, things like the guy in the bed next to me went from 11:00 PM, when he was admitted until 6:00 AM to get something for his chest pain.  (I’m no lawyer, but THAT smells like a lawsuit just waiting to be filed).
They weren’t happy about me checking myself out.  The self discharge papers I signed stated that I was doing so “against the medical advice of the attending physician”.  I circled that statement and wrote beneath it: “I have not seen an attending physician since I was admitted to this room yesterday”.  Then I signed it.  My departure was somewhat unceremonial and lackluster.  I didn’t even get a copy of the discharge papers.
I was home, asleep by 10:30  PM.  I didn’t get up until about an hour ago.
I still have to finish my audio editing, but I can breathe now.
My follow up with my PCP is Tuesday morning.  He’ll hear this story at that time, at which I will ask where else he has privileges, because it’s not likely that given the choice I’ll return to this hospital.  What a difference in patient care from Pittsburgh’s Mercy where I was treated for my strokes, to this place. 
Oh, I said third world only because I didn’t see a single physician, mine or otherwise, who wasn’t Pakistani, Indian, or some other eastern third world native.
And they all acted as though they only had limited visiting privileges, and Tuesday wasn’t their day.
And thus endeth the rant.
Did I mention I can breathe now?

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