This holiday week, I thought I would take a page from television and post reruns. The three essays this week are reworked pieces that I posted previously on my other blog. This essay was originally published on March 2, 2011 and involves a personal experience with healthcare. I did some light edits, but left the overall tone, which is even more casual than my usual conversational tone.
So, on Monday, I noticed a change in my body. In the interest of keeping this as conversational as possible, I won’t tell you what change I noticed. Feel free to google “upper gi bleeding ulcers symptoms” if you want to know what the warning signs are, but be forewarned. At first I thought these changes were simply the artifact of diet, travel, stress or an imbalance in the bodily humors that Hippocrates warned us about in 400BC. (Seriously, we can put a man on the moon, but we cannot figure out what combination of witch hazel and leeches will keep my phlegmatic humor in balance with my choleric humor?)
By Wednesday, when the situation was unchanged, I called my doctor to see if he had an appointment slot for me. The nurse said that she could get me in on Thursday at 3pm and I accepted that appointment. When she asked what it was regarding and I described what was going on, she said, “Yes, in situations like that, we recommend you go immediately to the Emergency Room.” I notice something is wrong, when I tell the nurse at my physician’s office, she tells me to immediately head for the ER and still—silly me—I really thought that I would go, get a script and I would be at work by noon. Instead, at the emergency department, I was quickly told that I was going to need an upper GI endoscopy and that I would be spending the night. So, from “Hey, I’ll just see my doctor tomorrow,” to “We need to admit you right now” in the span of about 30 minutes. Of course, the severity of this did not really sink in until the nurse at the desk stopped me from taking a sip from my giant coffee mug, saying “don’t drink that.” Whoa, shit just got serious…
As you may know, life in the ED is a lot of “hurry-up and wait.” They got me in very quickly at UNMC.1 They had gone to an EMR2 system there, which meant that I did not have to sit down and fill out a ton of paperwork before anyone would see me. The downside was that I had to give the nurse at the desk all my personal information, including social security number, with about 6-10 other people milling about, only one of whom was in handcuffs.
Once I was taken back, we started the parade of people telling me how pale I looked. It became the customary greeting, “Hello, Joe, I’ll be… wow, you look pale.” I mentioned that, before they say that, they should perhaps factor in the fact that I am a white guy, living in Omaha, NE and it’s the middle of freaking winter. It is amazing that, once everyone starts telling you that you look like crap, how quickly you start feeling like crap.
All the nurses were great, but—and I know that this will make me seem like a cranky old man—when my doctor came in, he looked like Doogie Howser’s younger brother.3 I immediately referred to him as “the fetus” to my parents. I know that UNMC is a teaching hospital, but still. Perhaps, if he wasn’t sporting Harry Potter glasses I would have been more forgiving. A bit later, another doctor came in and introduced himself to me as the fetus’s supervisor. I felt a bit better, except that he was dressed completely in black scrubs. So my life was nestled safely in the hands of the angel of death and a guy whose hands looked like they have held nothing more precious than a set of Dungeons & Dragons dice.
When I asked if there was any chance that I would not have to spend the night, the fetus said that the only way I would not spend the night is if I refused care. Apparently, there are a few secret code words and phrases that, if you utter, cause these people to run a set of dialogue sub-routines. Idly questioning the general parameters of care is one of those secret phrases. So, I was not even sure what was wrong with me, but I had to affirm that I did not want to be transferred, nor was I asking to leave against medical advice. I was simply asking for information.
Soon, I had consultations with a couple FP doctors, a GI doctor and someone from food service. Part of the problem was that my doctor did not have admitting privileges at UNMC. They offered to ship me off to some other hospital of my choosing or they could troll the hallways to find me a doctor here who could admit me. Never have had I felt like a piece of property, as they tried to reach my primary care physician to determine whose “hospital bitch” I would be. Apparently, the hospitalist that came in an hour later had come up with the requisite cartons of Kool cigarettes. He prodded my belly, listened to my heart and five minutes later had me admitted.
I will spare you the details of all the great tests they run when they think you have a bleeding ulcer (google “nasogastric tube” for starters, though its name may give you some indication of how it is used), but I did have one of those moments where I had one person on each arm, another at my feet asking me questions and a fourth person waiting to take some of my blood to the lab. Easily 50% of them introduced themselves to me. As time went on, what I do for a living must have made its way around those providing me care, because I saw a bit more of the AIDET principles (again, google, if you want), but it still was pretty confusing trying to follow exactly what was going on, what with all the different people who came into my room. I understand the team-oriented care process better than many and I was still wondering if everyone was on the same page.
Once they ascertained that I had no active bleeding, the big number they were tracking in me was my hemoglobin count. A healthy male should have a hemoglobin count in the 14-18 range. When I got there, my hemoglobin count was 10.8; as they started me on saline, it dropped to 9.5. They said that this was normal; as they replenished my missing blood with fluids, the number would drop. Seeing as when it drops to 8, they would have to start blood transfusions to prevent damage to various internal organs, I suggested that they simply stop giving me additional fluids. What’s a little desiccation when compared to rolling the dice on a blood transfusion? Oddly, they failed to see the clarity of my logic and continued to fluid me up. I watched the number drop, then, to 8.7 and finally to 8.4 the next morning. I was told that if I had been older or had any other health risks, they likely would have started me on blood then, but since they said I was young and healthy (two phrases I have not heard attached to me in a while), they were going to hold off until I hit the magic 8-ball.
About six hours after I was first taken back into the ED, I was taken up to a room. I am not sure what they had for accommodations, but I got a semi-private room right by the nurses’ station. I asked if I could use any of my Marriott points to upgrade, but, again, no one found this humorous. I was on the eighth floor and got the bed by the window, so at least I had a great view. Em came and brought me some sweatpants, slippers and my phone charger. I can honestly say that I have never been happier for those three items in my life.
The PA for the GI team came and asked me the same set of questions everyone else had asked me over the course of the day. The GI doc came in later, asked me what sort of research I did. He perked up at “health care,” but upon hearing it was patient, employee and physician opinion research, he immediately said, “Oh” in that tone that suggests that, while he was impressed that I was able to put on my own pants, upon further review, I had still put them on backwards. I was finally cleared, though, for clear foods through midnight. So, a mere twenty-two hours after I last ate, I was able to feast upon a cup of beef broth, a glass of apple juice and a cherry ice. It was like it was a Renaissance faire and I was the king.
My bunkmate was an older guy named Mark, who had odd tastes in TV. He liked Matlock and Saved by the Bell but got really wound up about regular season NBA basketball. It was like Greg Brown had a twin. He did not feel the need to talk to me, which was great. He did, though, tend to keep the TV loud and talked to himself in a rather odd strident mumble. At times I could hear him talking to the anchorwoman on the news, other times he would read the weather map as if he thought I was interested in the weekend temperatures in Memphis. The funniest thing about Mark was that the next morning, he was telling me that I should have met the guy who was in my bed the night before; that guy spent all night loudly talking to himself and watching TV. I said that I could hardly imagine what that could have been like.
When he turned off the TV at 10pm and went to sleep, though, I figured that, all things considered, it could have been worse. That is, until he turned the TV back on at 2:30 and rode it until morning. Between that, the two blood draws during the evening and the nurse’s aide running my vitals every couple hours, I got all of about seventeen minutes of sleep.
At 6am, I finally dozed off just in time for the nurse’s aide to come in and ask if I wanted to take a shower. I said, “No, I don’t feel like I need a shower so much as I need some extra sleep.” She left and then returned five minutes later and said that apparently her question wasn’t really a question. So, I got up and scrubbed up. Em and my father showed up a couple hours later. Finally, almost a day into this process, I met someone who had my father for chemistry at Creighton. My morning nurse, Lauren, had my father for general chemistry her first semester at Creighton and got a C+. Luckily, she did not take this out on me. Perhaps it was wishful thinking (or the Stockholm Syndrome) but Lauren was my third nurse and my favorite one. I choose to think that this was, in part, the fact that she survived the sweat lodge that is my father’s general chemistry class.
I went down to endoscopy on-time with Em and my dad. They went into the waiting room and I went into a room with two nurses, a lab tech and the doctor. When they asked me for the hundredth time if I had any allergies, I said that, so long as there were no cats wandering around the bay, I would be fine. I was surprised to discover that everyone in the room hated cats, with my doctor saying that, if one owned a pillowcase and a brick, there was no excuse for owning a cat. That was one of the last things I heard before the nurse gave me my twilight sleep.
I woke up later in dim room with sparkling lights on the ceiling. My first thought was that I was in the “chill down room” at a rave. Except that I could not hear any music. I never saw the doctor again but found out that I had two ulcers—one in the stomach and one in the upper intestines—which were no longer bleeding. Before I went in for the procedure, a hospitalist different from my admitting hospitalist, said that I would likely have to spend the night again, so they could track my hemoglobin numbers. But afterwards, the orders were that I could leave once I ate something. I ordered, ate, packed up my stuff and got out before they could change their minds. Em and I didn’t even wait for an orderly to escort me out of the building.
Now, a few days later, everything seems to be progressing well. Oh, and, just for those curious out there, NO, they did not say anything about my caffeine consumption.
1This would be University of Nebraska Medical Center. While a Creighton graduate, UNMC was the closest ED, which is how a lot of people make decisions, especially when you are surprised to realize that you are close to death.
2Wow, fourteen years and an EHR went from noteworthy to not worth mentioning.
3Referencing Doogie Houser does nothing to help the image of being an old man. Crabby is still a judgement call.
PX Matters with Joseph Snipp 
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