Wednesday, August 25, 2010

My Hawaiian Medical Adventure

First off, my ticker is fine.  I exercise it frequently throughout the day by depriving it of a percentage of the oxygen it is used to.  These 5-7 minutes of Aerobic exercise make sure it is kept fit and trim, and pumping wildly (however regularly) with glee.

I'll give a rundown of yesterday, just to let you know how much fun it was:

Background:  I have a pinched nerve in my thoracic vertebrae, part of the degenerative disk disease I apparently have (something to do with extreme trauma to the spine, like from landing on your head wearing 70 lbs of gear after sailing through the air.)  The nerve cluster in T4,5, and 6 is affected.  This nerve cluster sends pain signals that start at the spine just below the shoulder blades and radiate around the chest (the right side in my case) and terminate with a stabbing, sharp pain sensation in the chest cavity.  This has been going on for almost a year, and I was being treated for it when I left Fort Leavenworth.  Lately, it has been acting up, giving me mild to moderate pain; however when you know the source of the pain it makes it easier to ignore/deal with it.  The biggest effect it was having on me was inability to sleep, other than from 12 AM-3AM, plus adding to my usual irritability.

Here's how my Tuesday want:
0350:  Wake up--feel like there is a hot knife in my heart.  I try stretching, ice, heat, and massage to no effect. 
0415:  Wake up Carren, tell her I am going to the ER (she doesn't even have to ask why.)  She can't take me, because someone has to be home with the kids, so I self-recover to the Wahiawa ER.  (This hospital is pretty run down, like an underfunded county general hospital.  (Side note, at 0400, you can do 90 MPH on post and no one  notices.)
0420:  Arrive at ER.  Stumble in, mention chest pain (I didn't go into further detail, because the "Chest Pain" complaint will keep you out of the waiting room 99% of the time.)
0425:  Nurse tells me he thinks it may be kidney stones.  I roll my eyes, thank him for the diagnosis, and tell him to fetch a doctor and stand by the pain meds locker.  He has me pee in a cup. 
0428:  Doctor comes over, I explain the problem as best I understand.  I tell him I need a nerve block in my T4,5,6.  He gives me 2mg of dilaudid (hydromorphone, concentrated morphine) and asks if it helps.  Dilaudid makes me itch.  It takes the edge off, I still feel the pain, but am more relaxed about it.  They send me for a chest x-ray and CAT scan.  Then I get an EKG.  (At this point, times are irrelevant, as I lose concept of time (Thanks, dilaudid!)

  • They give me another 1 mg of dilaudid.  The nurse mentions that I shouldn't need this much dilaudud.  I mention that unless the Nurse has a medical degree, he can keep his opinions to himself, push the meds, and get me a bedpan.
  • Doctor thinks it may be gall bladder infection/gall stones.  Apparently I have some decent sized stones.  The fact that I have been treated for this exact pain, in this exact location, prior to today, with a diagnosis of pinched nerves in T4,5, and 6 has no bearing on his "diagnosis."
  • Doc pushes another 1mg of dilaudid.  Says I should be unconscious right now.  I tell him unless he gives me Fentanyl with a dilaudid back, in a drip, he'll likely never see my eyes close.  I itch.
  • Doc wants to wait for the radiologist to come in to work to read the x-rays/CAT scan to see if his guess about gall stones is correct.  He tells the nurse to push dilaudid every 30 minutes.
  • Radiologist finally arrives, shift changes in ER.  Radiologist reads films, says it's not likely gall bladder.  (No shit, Sherlock.)  New ER doc explains that this hospital can't keep me, because all they can to for me is push meds.  They don't have a neurologist or pain specialist there. 
  • Chuck is discharged from Wahiawa ER, Carren drives me to Tripler AMC with films, EKG, and record in hand.  (Pain is a 7 of 10)
  • Arrive Tripler ER.  Go to desk, hunched over from pain.  Give them ID and tell them I am having chest pains.  They take me into triage, take history and vitals, then HAVE ME GO SIT IN THE WAITING ROOM. 
  • Taken to bed, Medic (SPC Figeroa--Awesome guy) takes vitals, history  (2nd time I've given my history at the Tripler ER) and EKG.  Looks over Wahiawa records.  Tells us doctor is coming, will be able to give me something for Pain after DR sees me.
  • No doctor, pain increases.(Pain is a 8 of 10)
  • No doctor, Pain Increases.  SPC Figeroa is apologizing for the two doctors (one major, one colonel) not being there yet. (Pain is a 9 of 10)
  • Nurse (Kevin--another awesome guy) comes in ad takes my vitals and history. (3rd time I've given my history at the Tripler ER)
  • I am told  the doctor is going to give me a lumbar puncture and will be in to see me soon.
  • Am told the doctor is giving another patient a lumbar puncture, and will be in to see me after.
  • Med student comes in, takes history. (4th time I've given my history at the Tripler ER)
  • No doctor, pain still increasing.  Docs want x-rays (supposedly, they can't read the x-rays taken that morning for some reason)
  • Laying in hallway on gurney, completely overcome by pain (9 of 10) and feeling completely failed and  ignored by doctors.  All I want is some relief.  Start crying and cannot stop.  Am tremendously  embarrassed.  I don't weep gently, am uncontrollably sobbing.  The more I cry, the more embarrassed I become.
  • Go in to x-ray.  Cannot stop sobbing during x-rays.
  • Back to room.  Still crying.
  • Doctor finally arrives. (Carren tells me later it's been roughly 2 hours since I arrived in ER)
  • Doc starts asking questions about history, want's to know what the problem is.  (Because the other 4 times I gave my history were just for fun, he hasn't read or been told any of them.)  I lose my military bearing completely.  I sit up, put my face about two inches from his and scream through clenched teeth  "I am fucking in pain, that's my problem."
  • Doc finally gives order for dilaudid.  Kevin is standing by with it.
  • Much calmer, (Pain is a 8 of 10) and doc now starts making excuses:  "I am just an ER Doc.  I have to rule things out to get proper treatment.  We are really busy. blah blah blah."
  • They continue to push meds.  Much, much calmer now. (Pain is a 6 of 10)
  • about 2 PM, they get me an appointment with pain management for 2:10, and discharge me from ER.  Kevin gives me a shot "for the road" and SPC Figeroa takes me to pain clinic. 
  • Dr. McLean meets me at pain clinic.  Explains he's read through both my chart and through my medical records from Kansas city.  (Imagine that!  A pity the ER doc in the same hospital has no access to my records.)  He tells me that we are waiting on the treatment room to open up but he WILL take care of me.  Asks if there is any specific treatment I want.  I explain I've had success with radial nerve ablation in my lumbar spine, also would like a nerve block in my thoracic, if possible. 
  • He tells me that he will be able to do both, and definitely recommends both.  Doesn't understand why I wasn't sent to him hours ago. I tell him I don't understand why either, but am sure the ER doc can provide him all the excuses he may want.
  • Doc tells me about an implant device (upwards of $25K) that has been approved for use.  Will help dramatically with pain in extremities, gives me a DVD to watch about it for when I get home.  Thinking about this right now.
  • Doc takes me in to treatment room, puts needles in my T4, T5, and T6, sends current through them to make sure they are in the right place.  Then sends anesthetic to the nerves, then heats the needle, burning the nerves and limiting their ability to send pain signals for the next 6-12 months.  Then he injects steroids and more, a longer lasting anesthetic, so that the nerves won't hurt from the burn.
  • All the fluid buildup in the nerve cluster puts pressure on the nerves, making me feel like I've been kicked right between the shoulder blades by Jeff Reed of the Pittsburgh Steelers.  Comparatively, this is much better than the pain I have been in all day.  The stabbing chest pains are still there, but greatly reduced
  • By late afternoon, I am home.  Curl up on couch with icepack on my back, and go to sleep.  Wake up late in the evening, pain is lessened, but still there.  Change ice pack.  Wake up at 3 AM, take pain meds, back to sleep.  Wake up at 8 AM, chest is pain-free, back is still a little sore.
So that was my Tuesday.  I have a follow-up with Dr. McLean on the 2nd, where I will get more info on the implant and inform him that his new ranger name is Dr. McDreamy.  Spending 10 solid, miserable hours in abject pain, only to get relief in an hour at the end of the day.  Of all the hours spent in two ERs, NOTHING that the doctors tested for was the problem.  The problem was exactly what I told them it was at the outset.  I am going to find out what the best, most expensive hospital on the island is, and from now on will go there (and just tell them it was the closest one to where I was when I started hurting.)

Free healthcare.  The trick is finding a health professional who actually cares.  The ER doc at Tripler (another Major) certainly didn't expect his patient to come up out of bed screaming at him, or to proclaim his displeasure with him loudly enough so that everyone on the ward could hear.  I will be following up with a formal complaint through military channels--including the two-star just a few doors down from my office--in a few days.


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