Thinking Man

October 2010

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Wrath

A big Fuck You to the medical profession

Last night I had a mildly upset stomach and went to bed hoping to wake up all good and well. Of course, we know my life and nothing ever goes easy or as we hope it will. I woke up with intense pain in the stomach. I got out of bed and took a pain killer, then got into the guest room bed so that my flopping and throbbing in pain would not wake Kate. I took the pain medicine at 6:40AM and the pain continued as if I took nothing.

Kate left for work very nervous about leaving me alone but I promised her that if the situation got worse I'd call my father and have him take me to the emergency room. The pain continued causing chills, shaking, and numerous other side effects. in 4 hours time I was able to take another pain pill. At roughly 11AM I took another pain pill and knew within 30 minutes it wasn't working. The pain was getting worse, not better. At this point I reached out to my father to get a ride to the ER. While I couldn't grab him, Kate was able to and he came to get me.

We arrived at the hospital slightly before noon and I checked in. Prior to leaving the house I had called my doctors office and found out they had two doctors at the hospital doing rounds. One would be there until 1:30PM and the other slightly after 2:00PM. Not an issue at all! Last time I went to the hospital I was signed in and hooked up to the IV with pain drip within 18 minutes. I expected no different this time around; but again as stated above "we know my life and nothing ever goes easy or as we hope it will".

At 1PM I was still in the waiting room waiting to even get into the ER. They had ONE trauma nurse on duty and she was slower than a Ford Tempo in the quarter mile. Not only that they took three people prior to me who actually came in after me. While I could understand taking the 84 year old woman with shortness of breath, there was no reason for them to take a man with a broken thumb or another man who tore open his stitches prior to me. I was buckled over in pain and practically rolling on the floor of the ER lobby.

Finally I get into the trauma area at around 1:15PM and explain the situation and severity of my pain. I am told they'll page my doctor who is in the hospital and then somebody will take me back to a bed. Now every time I've been to this hospital in the past they bring me to a private room; not this time. This time I got a bed in the hallway in a corner. I was told that I couldn't have any pain medication until the doctor sees me.

1:30PM ... 1:45PM and 2:00PM come and go. The nurse tells me she just saw my doctor and is sure he'll be back soon. At about 2:15PM I am told that both doctors from my practice have left and will not be returning. They even go as far as to tell me that the doctor they just said was in the hospital had actually left over an hour ago; which time were they full of shit?

I demand to see another doctor, any doctor, and a hospital administrator. I am told the ER doctor on call will be with me shortly and that so would a hospital administrator. Nobody came and we continued to ask what was going on. Finally at 3:00PM a doctor comes to the side of my bed. He asks me why I am there and I explain the situation to him, just as I had explained it to everybody else who had asked. He then asks me about the medications I am on.

I explain to him that I am currently not on any Crohn's medicine as my doctor and I had exhausted the oral prescriptions and had no remission with any of them. We had begone a treatment of Remicade however I had an allergic reaction to it. My doctor and I were exploring how we could overcome this; but due to their office holidays and my very hectic work schedule and lack of ability to get myself from point A to point B we had not been able to do so yet.

He responds with, "So you just stopped taking your medicine on your own?" I look at him and say, "No, that is not at all what I said. My doctor and I stopped the oral prescriptions in hope of using the Remicade. It failed to work for me and caused hospitalization and we have been unable to find an alternative at this time."

His response, "But why did you just stop taking the medicine the doctor gave you? You can't just self medicate!" This shows me two things. First and most importantly, this man is not capable of listening to a patient and that I can not tolerate. Secondly he knows NOTHING of my disease or the treatments for it as anybody with half a lick of knowledge knows Remicade is an IV treatment given in the hospital once every 2 - 6 weeks and is not something the patient takes on their own.

Again, and even more slowly, I explain the situation filling in this missing information. Again he tells me that I shouldn't have just stopped taking my medicine like that and that he should call my doctor to see what I should be taking. At this point I say, "Forget it, you're not listening to me and I've been here for 3+ hours without getting the one thing I needed; painkillers. I am out of here." and I began to get dressed. He tried to detain me by telling me that he can give me a pain killer now if I want as if that is going to make up for the three hours I flopped around in pain and the fact that he hasn't a clue of bedside manner or my disease. I tell him no thanks and I continue to get done.

I then storm out of the hospital, still not treated and still never seeing the hospital administrator I asked for. On the way home I swung into my doctors office and demanded to speak to a nurse or doctor. I pleaded my case and explained that I have an appointment on Monday to see the doctor but that I needed a way to make it through until then. I explained that the hospital was not a reasonable answer as I had already tried that. Finally I convinced the doctor to give me more pain medicine and I'll have to deal with the horrid pains I get on my own.

On Monday I shall see my doctor. I have a feeling this is the last time I will be seeing a doctor from this practice as scheduling appointments with them is a nightmare. The staff that manages the front office is less than competent and they all fail at effective communications. Had they explained to me the first, second or third time I called in early November that my usual doctor is on vacation for the rest of the YEAR, I'd have made an appointment with another. Instead they say, "He's on vacation currently." I say, "Ok, well I'll speak to my family to determine when I can get a ride next week and call back to try and schedule an appointment." They say, "Ok" and hang up. I get the scheduling information from my parents and Kate. I call them back and they tell me the office is closed for Thanksgiving for almost the entire week. Ok, again I go and get schedule information and then they tell me "Oh he's on vacation still." At this point I point blank ask when he is coming back and they say, "I think in January." I ask for an appointment with another of the doctors and they have nothing.

So now it will be December 18th, over a month since I was supposed to see the doctor. 5 weeks since my last treatment (which as we know didn't work). I've been in pain and agony almost every day since October and am at my wits end.

UPDATE:
Due to the amount of people who seem to think trolling me about my pain, or the fact that I expected service in an ER that promises quick service or that I even followed my doctors advice ... I am doing something I've never done before. I am no longer allowing comments by non-friends on this post.

If you don't agree with my choices, don't read my fucking page. This isn't a software review site; this is my life. If you do disagree and want to be civil about it fine. But get over your fucking selves being arrogant and rude to me when you don't even know the half of the situation.
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Comments

(Anonymous)

I have a close family member with IBD, so I have some sympathy for your situation, but as an ER doc, sadly, I have to say that your experience is typical, and future expectations should be tempered by the reality of our "wonderful" health system.

Several reasons:
1. ERs are terribly overcrowded. in 1992 there were 6000 ERs nationally seeing 80 million patients. In 2004 there were 4000 ERs seeing 110 million patients. Our ER has not been significatnly expanded in over a decade and we see nearly double the volume. So private rooms are a thing of the past, and hallway beds and long wait times are all too common.
2. Private MDs rarely ever see "their" patients in the ER. It has become the standard for the ER docs to primarily see every patient and only consult the specialists as needed.
3. "Chronic condition with painful exacerbation" is, sadly, not best treated in the ER. The docs don't know you, may not trust you (due to drug seekers), and pain perception is so variable that pain of 10/10 is not a priority for the ER staff. It's a grim joke for us that every patient rates their pain as a ten. Makes it hard to sort the wheat from the chaff. The fact that you were acting as if you were in pain doesn't mean much to us either, since we see so many hysterical people and fakers that all overt demonstrations of pain are taken with a grain of salt.
4. A better strategy for you is to have a plan with your GI doc of what to do at home when the pain spikes. Have a limited supply of some really strong pain meds which is to be used in case of emergency, and use it only very rarely. And honestly, IV pain medicine is no stronger than oral, so as long as you are not vomiting, oral medicines are preferred. Also, IV pain medicine can be more addictive and are best avoided for that reason.
5. When home management fails, if it's during working hours, it's better to coordinate with the clinic than brave the ER. Get a same-day appointment if possible. Coordinate a direct admission to the hospital, if it's probably going to be necessary. To be sure, some private pactices are resistent to this, but the ER (as you learned) should be the option of last resort.
6. Complaining, criticising, and threatening the staff (i.e. asking for an administrator) will not endear you to the staff at the ER or your doctor's office. The staff are human, and their reaction to perceived manipulative behavior will be to get defensive or passive-aggressive. The squeaky wheel does not get the grease. You will get labeled as a drug seeker or fired from the practice or undertreated or treated last. You *are* dependent on the good will of the staff (at both sites), and alienating them is not in your best interests. I do not defend bad behavior on the part of the medical folks, but you have to live in the real world.

Sorry you had a crappy day, and sorry the ER doc was a dud. Good luck to you in the future.

Shadowfax
Thank you for your well thought out and genuine comment. I agree with almost all that you wrote but would like to point out in relation to your numbered points:
1) This ER was just constructed in 2005 with the goal of having private beds for each ER patron, while I care not so much about the bed, they should have had those screens on wheels available for those in the hall to at least CHANGE into the gown.
2) This is very true; except that my practice tells patients when they have pain like mine to go to the ER, call them and one of their doctors will see me in the ER. So I was doing just as they asked me to :(
3) And I could understand and appreciate that, but had a NURSE come up to me I had a duffle bag with my COMPLETE records in them including the past four ER visits to that very hospital.
4) On this note I'll refer to your knowledge. I was getting dilaudid via the IV and orally. I think the IV was more potent because they could give me more than the 2mg pill? Again, I am not an expert so I wont pretend to be one.
5) Awesome idea and something I will investigate with the hospital and my doctors.
6) I didn't ask for the administrator until after I had been there for a while, and I asked politely. My reason wasn't to bitch, but to find out what was going on. This hospital is new, the ER is state of the art, and I have been there NUMEROUS times (not just for myself) and have NEVER seen it so under staffed or mismanaged.

Re: er

I would agree with you as in the point of an ER is to take in all the patients that are in a state of emergency first before the patients with lesser problems. However that is not to say that the rest of the patients do not deserve proper medical care. I wouldn't say that the ER is a problem, just this doctor who obviously doesn't know how to listen to his patients!