Sunday, 1 March 2015
Another hospital visit
Another year, another visit to the hospital... this time a tiny piece of glass stuck in my wife's left foot caused persistent pain for weeks until we got her to check it out on Xray and ultrasound (nothing there, not even a small pearl) and to see the plastic surgeon, who excavated a big hole in her foot but came up empty-handed. Sure enough a day later as she started screaming in pain we observed a large red area develop on the dorsum of the foot that kept getting visibly larger and larger by the minute Saturday night as her mother massaged it utterly in vain, and then we realized, coupled with the increasing fever, she had developed a serious infection. I had some leftover antibiotics called suprax in the house which I urged her to take in order to avoid an unpleasant and stressful trip to the ER and the next day it improved somewhat but thereafter each day it seemed to get angrier and worse, with the fevers never relenting. The original plastic surgeon prescribed a similar antibiotic but after two days she was tired of waiting, rightfully so, and went to the local emergency dept.-- now you would expect we would think twice about such an act knowing as we do what health care is like here. And we did, we thought a hundred times about it. But there really was no choice.
As usual in the ER there was a lineup for triage, about an hour's wait. Luckily this time the government had installed an internet website to track these times similar to what you see in border crossings so you could look up the community hospital and see, for ex, there's a two-hour wait for triage for here, there's a two-hour wait to enter the sliding doors from outside at the central hospital, etc., a ten-hour wait at the inner city hospital to see the MD, a twenty-hour wait at the rural hospital to get a drink of water at the fountain, etc., etc. Eventually she did see the ER doc, who was utterly puzzled by her case, repeating incessantly how surprised he was by her non-response, by her allergy to next-best drug clindamycin, which were the correct ones according to the book; every hour, as he ordered tests including bloodwork and a swab of the open wound in her foot, he repeated how puzzled he was. So much so that he called the infectious diseases consultant for advice and a visit. Of course they never did show up that night, presumably having something more important to do, somehow that wasn't a surprise. Then, some 6 hours later, he told her how puzzled he was by what abc to administer, took off his white coat, put on his thick fur-hooded winter coat, almost picked up her black purse by mistake thinking it was his big house-call bag and walked out the front door. "Uh, is he going for a smoke?" asked my wife to the triage nurse. "Oh no, his shift is over. He's gone. Outta here!!!" she said, laughing at the sheer hilarity of the situation as she wandered off to tell others, no doubt, about the wonderfully funny story.
And of course, predictably, another emergency doctor then came onboard and repeated all the tests the previous one had done. "You know, I've already had a swab done" said my wife. "Really?" said the new guy, as he swabbed her foot. 'Uh, yes." "You did?" he said. "Yup. I would know!" She said. But of course, it was too late. They started her on intravenous toradol (a strong antiinflammatory (NSAID) similar to naproxen) which had proven effective for her pain relief as an outpatient. And the new doctor, inevitably, told her he was puzzled by her lack of response. But he had the heart to admit her to the hospital rather than have her sit on a stretcher in the middle of the ER in a blue gown, open at the back, where anyone could, if they wanted, see her underwear if she adjusted her position or moved at all. So instead she was transferred to the middle of the hall of the west wing of the fourth floor, a very busy hall in fact where there was constant traffic. (Of course we knew that already: that hospital is just another word for humiliation.)
The next morning the attending doctor came by to say hello. And that's almost all he said, other than "You're not going anywhere now" when she mentioned she had two very young children who needed her at home and a job she could barely afford to miss for financial reasons. "Oh no, you're staying here. NO WAY you're leaving here. I just wish you were on the right floor. You're not on my floor. You're on the WRONG floor!" he said, almost yelling, apparently not realizing he was standing in the middle of a busy hallway just outside the nurse's station. Then he interrogated her about the original suprax prescription. "Where did that come from? How did you get it? It's not available anywhere!" he said looking at her suspiciously. "I've already explained this twice in the ER, I took it, I had it at home, I wanted to avoid a hospital visit on a Saturday night. Is that hard to understand?" "Yes it is" he said, "you don't like hospitals? Why??" and without letting her answer, he left.
She was also puzzled that morning she hadn't received her daily thyroid medication as she had again twice already mentioned she took a daily dose, for years. Luckily just then a bright young pharmacist came up to say hello, cheery and pleasant. "Hi, I'm your pharmacist liaison. My job is to provide YOU with something called, continuity of care! It means all the health professionals on the big team here involved in your care as a client of our hospital are on the same boat!" She spoke as if lecturing a first-grader and inanely made a large boat with her index fingers. "Oh that's good," said my wife, "then can I get my daily thyroid pill, and the pain medication, toradol, I'm in a lot of pain again." "What!!!?!? I don't have any record of those!" she said, frantically searching the paperwork... how quickly a smile can be wiped off a face sometimes...
"Yeah. I need those. I haven't had any yet. I'm in pain. And tired, I haven't slept. I mean, I have to sleep in a noisy hallway, right? Look at me here!"
She stared at the chart. "We don't have any toradol, what are you talking about?" said the pharmacist.
"I've just received toradol for the last twelve hours. IV, two or three doses already."
"No you haven't, we don't have toradol."
"I just got two doses!" said my wife.
"Uh-- I'll go check on that," and she walked out.
"It doesn't make sense-- I'm trying to fight off this nasty infection, and these people keep stressing me!' she exclaimed. It was all cleared up some hours later-- it turns out the doctor had made a mistake in prescribing my wife toradol, the hospital didn't really have it, they gave it to her wrongly, by iv, or perhaps ordered it incorrectly, as both IV and PO, which was absurd, of course-- something like that. So the pharmacist clarified that issue right up nicely but returned with more for the interrogation.
"So what about that suprax, how did you get it? It has been back-ordered for years... no one has any anywhere. Where did you get it from????" she asked.
"I've answered this question so many times already... I had some at home."
"You had some at home... hmmm... really..." she said, looking furtively, as if about to call the police. "Are you sure?"
"Yup. I'm pretty sure that's what happened."
"Now, as regards the pain meds, we don't have toradol, AS I SAID TO YOU BEFORE." She paused and looked straight at my wife.
"You have a choice between morphine and naproxen. OK?"
"Isn't morphine much too strong for me?"
"I don't know how much pain you're in. So you want the naproxen?"
"I don't think I can take morphine. I don't want to be nauseated and knocked out."
"OK naproxen then??" she was becoming visibly impatient.
"Is that really all you have?" My wife implored.
"YES! You have a choice! morphine or naproxen! WHAT DO YOU WANT FOR DINNER? I mean, what do you want, for your pain med?"
"Is that all this pharmacy carries?"
"Why does my local drugstore have more options?"
"Hahahaha!!!! This is a HOSPITAL!!"
"OK, then there's no choice then, it has to be naproxen."
"Wow. OK. Finally. Thanks!!! Phew! wow!"
'"Isn't naproxen the same as aleve, which I can buy off the shelf anywhere, even the grocery store?" But she had walked off before hearing out the last question-- luckily.
Sometime later that day her attending came back for all of ten seconds, and, without looking at her open wound, asked if she was better. Then without waiting for a response he said, "I really wish you were on my floor. I have to walk all the way here to 4W for you! Just for you! I don't have any other patients here, just you! Well, you're not going anywhere, anyways. No way. You are stuck here! Uh anyways your bone scan is tomorrow" and he started to rush out the door.
"Can I ask you something?" my wife asked, hoping to engage him in some kind of human contact, to see if maybe, somehow, he considered this attractive young mother clothed, absurdly, in underwear and an open blue gown to be a human being rather than an object to be fixed. He turned without speaking-- but then, as so often happens to us in these circumstances, she had an absurd sort of brainfreeze: "Um--.... what time is the bone scan?"
He laughed at her as if she was an idiot: "That's what you want to know?? Whenever! I don't know!" He shrugged his arms up and he walked out.
The nurse was very sympathetic. "Too bad you're not on his floor. He does complain about you a lot. I mean that you're on the wrong floor. Poor Doctor E-- I feel bad for him. You're just on the wrong floor....."
"You mean I'd get better treatment if I was on his floor?" my wife asked.
"You never know, maybe..."
"Ouch, that hurts!" my wife said as the nurse injected fragmin into her abdomen.
"Yes poor Dr. E--..." repeated the nurse to my wife's grimaces of pain. But then the nurse screamed. She had dropped the nightly dose of naproxen on the floor. "Oh no... Oh no no no..." shaking her head. "What!!??" my wife said, worried something serious was amiss.
"I dropped your naproxen on the floor! Oh no. I'll try to get you another dose. But it might take a while. Would you do me a favor and tell them you knocked it over yourself, carelessly? As you were eating dinner?"
They both looked at the bedside table full of trays of untouched food.
"Uh-- make that knocked over your water bottle there. Oh god. Pharmacy is NOT going to be happy about this!" and she ran out.
And indeed it took a while. So she suffered in pain again for a half day: because of the dropped dose the pharmacy was not able to provide another pill until some twelve hours later. Apparently this substitution was completely against protocol usually patients are not permitted to make up for a spilled pill in that hospital but are taught, like small children, to suffer without for their error, as it is good for character-building. Thank god for small mercies: although she again vainly offered her morphine instead, at least the pharmacist didn't come up to interrogate her about the case of the missing dose. For we surely would have told her it was missing with the toradol she had received the night before just to infuriate her further.
Thus it goes without saying the thyroid medication, which the pharmacy liaison had made sure she was on, never arrived. It would have been more of a surprise, in fact, if it had arrived without any expenditure of work and complaint. When this person arrived later and explained the many reasons why toradol didn't exist at that hospital, again, my wife asked about the thyroid pill. "You're on thyroid pills?" she said, checking her notes.
"Uh, yeah, you checked that yesterday. You checked it with me. You even called up my two pharmacies I used and they verified it. Remember? You told me I got percocet on Sunday at an area pharmacy from the original plastic surgeon and asked me if I was a narcotics abuser, remember? then you mentioned the thyroid as well which was on their records for years-- unlike the percocet, which was the first time I got it, Sunday" my wife said. "Oh. Right. Obviously the porter made a mistake bringing it to another floor. You know you're on the wrong floor, right? Maybe that's what happened" and she quickly walked away, to never reappear again (perhaps swallowed up by an unfortunate discontinuity of care). So my wife took a break from all this and went to the starbucks in the lobby because she was dying for a coffee. There, by chance, she noticed the pharmacy was located across, walked in, and bought 20 pills of naproxen-- at the same dose they so carefully rationed to her upstairs-- for a few dollars to bring up with her. And in that way the pain relief situation was resolved to the satisfaction of everyone concerned.
This talk about wrong floor and such was making us both increasingly agitated, particularly since there was no information forthcoming on when she would leave which was our primary concern (I leave out the parts about the children crying at night and in the morning asking where their mommy was and if she would be OK) so finally I called up her attending doctor one morning after he had ordered an ultrasound on the large open wound on her foot, a procedure she refused to do for good reason, on the grounds that no one could put gel and push a probe on such a painful lesion without ill effects. But the worst was he had never even warned her that he had ordered it. Though, to be honest, he had never even looked at the hole in her foot, after 5 days in the hospital on the wrong floor, so it's unlikely he even knew about it.
"Yes who is this?" he said. "I'm the husband of M--- who is your patient, and I wanted to tell you she is very upset." "Look" he said "I'm doing a procedure right now. I'm very busy. What do you want?" "Why does she need an ultrasound?" "Well uh we need to know if there's fluid there. There could be a lot of fluid there. Then it needs to be taken out, you know. A LOT of fluid!"
"Have you looked at her wound?"
"You know, I don't know why she's my patient. She shouldn't be. She's on the WRONG FLOOR! Look, I don't like talking when I'm doing procedures. Bye." And that was it. End of story. I guess I was on the wrong floor with that phone call too.
Needless to say my wife is still in there, begging for her thyroid medication from anyone who would listen, terrified of knocking over her pill in that little styrofoam container and being accused of stealing a naproxen, even as I have to buy over the counter aleve to provide her with pain relief (at the same community drugstore where I was able to verify that they were all wrong: it turned out suprax is no longer back-ordered and now, for the last month, is easily available again) as the pharmacists are too busy checking her past history going back many years, to verify she gets her medication delivered to her room today (it's called 'continuity of care') and the attending is too upset about her presence on the wrong floor to see her...