Wednesday, January 23, 2008

Make me a Saturday-night drunk, please.

She would have been a Hospital Hobbyist were it not for her late husband having donated ten gazillion dollars to the research center at the hospital. Because he had, she got the white-glove treatment (or as near as we can manage) from the minute she set foot in the door.

Food service dug up some real metal silverware from somewhere, and she got that rather than the disposable stuff everybody else gets. She got a newspaper every morning. And she thought she'd get to direct her own care to a degree commensurate with her husband's donations.

Two out of three ain't bad.

See, I have this philosophy: Everybody, when it comes to actual medical care, is on the same level as the poor bastard on charity care. In other words, it doesn't matter if your Secret Service agents get touchy or your personal assistants don't like it; I'm going to assess you head-to-toe at least twice during the day. I'm going to do those neuro checks every two or four hours, and I'm going to draw your blood even if it means getting you to delay that call to your broker.

Because, quite frankly, you are sick enough (or think you're sick enough) to be in the hospital. You are, therefore, a patient. Not a donor, not a politician, not a celebrity. You are a body in a bed (reductio ad absurdum) which needs diagnosis and intervention, just like the guy next door who speaks only broken English and is here by the grace of God and the indigent referral service.

So. She comes in, she lies down and begins to moan, and I get ready to assess her and fill up the paperwork that comes with an admission.

She didn't want to answer questions. She didn't want to let me check out the incision that was giving her problems. She refused a blood draw twice until I walked in with a needle and a face like grim death. She didn't want to talk to the residents.

What she wanted, and thought she would get, was a narcotic pain pump and plenty of Phenergan for the narcotic-induced nausea. Just enough, you know, to take the edge off and fill time between her Thursday admission and her Saturday discharge (in time for the boots-n-bows charity ball, or some such). Again, two out of three...

There's been a lot of debate here locally about how rich folks get better medical care than poor folks. To an extent, that's true: if you have decent insurance and the money to make up the difference, you have a wider range of choices and much better preventative care than the schlub who works four part-time jobs to barely make rent. But when you get into the realm of the Really Fucking Rich, the people who have buildings and sports fields named after themselves, things start to break down.

See, the problem with being Really Fucking Rich is that the people to whom you have donated money tend to take you at your word. If you say you don't want to be disturbed, they'll not disturb you. If you refuse blood draws, the phlebotomist will be encouraged (usually by someone connected with Patient Relations) not to press the issue. Tests will be delayed until you feel it's convenient for you to go to radiology. Residents will be so cowed by meeting Mrs. MRI Suite that they'll be too shy to do a full assessment.

I read somewhere that an ED attending training residents told them this: "If my wife comes in after a car wreck, I want you to treat her just like you would the Saturday-night drunk in the next bed." In other words, no special dispensation for rank or privilege--you get the same careful attention as the next guy.

The official position of the folks in the carpeted areas is that, while rich donors might get special perks like free parking, their level of medical care is the same as everybody else's. 

That's not true. Their level of care is *poorer*, because Those In The Nice Chairs allow them to pull rank and act like they themselves know best. And mostly, they don't.

The upshot of my three-day run with Mrs. Potsofcash was that I got to have a pleasant chat with the Patient Relations people. Mrs. Potsofcash was upset that I disturbed her afternoon naps to do things like assess her or clear her PCA pump or administer medications. She was unhappy that she didn't get to refused timed blood draws (to check things like drug levels; they're called "timed" because, well, they're sort of time-sensitive). She was peeved that she had to wear a hospital-issue gown to MRI and remove her jewelry for same.

What can you say to that? Her complaint wasn't with my demeanor or my language or my personality; it was with the fact that I was providing care to her as is necessary in a hospital setting.

My response to the Patient Relations person was this: "Um...she's mad because I treated her like a patient in a hospital, is that it?"

God save me from special treatment. And from Patient Relations. And from donors.

Friday, January 11, 2008


Benefits of narcotics:

1. Freedom from pain.

2. Ability to hurple around house without cursing.

Drawbacks of narcotics:

1. Itch.

2. Weird sleeping patterns.

3. Inability to concentrate. Look! A chicken!

4. Itch.

5. Dizziness.

6. Apathy.

7. Short-term memory deficit.

8. Itch.

9. Strange dreams.

10. Inability to drive, do paperwork, file, or handle small objects without dropping them. Don't even think of cooking.

Analysis: Jo 0, Narcs 1. I'm going back to ibuprofen.

Thursday, January 10, 2008

Product Review: tramadol!

Ultram: the bomb of all bombs.

Twelve hours ago, I was lying curled up on Chef Boy's bed, leaking tears because my foot hurt so much I was afraid to actually cry, because that would joggle the foot and make it hurt more.

I just walked (after a fashion) from one end of the house to the other without pain.

Tramadol (Ultram, Ultram ER) is the shit, man.

It's an atypical narcotic, which means it won't make you stupid or nauseated and will make you only mildly itchy and dizzy. It's not considered a controlled substance, and in some countries (according to Wikipedia) it can be bought over the counter. (Yow.) We use it a lot in people with post-surgical pain, both IV and orally. I'd heard great things about it from my patients who'd had, say, neck or brain surgery that disturbed a lot of muscles, but I'd never tried it until yesterday.

Mister Happy, the doctor I see at the Doc-In-The-Box, gave me the choice between Ultram ER and Darvocet. Now, if you feed me hydrocodone in any form, I'm goofy and happy and then go off to a sweet, refreshing sleep for, like, sixteen hours. So I wasn't crazy about trying Darvocet, which has a lower side effect profile but approximately the same effect as hydrocodone. Ultram it was, then, and I took my first pill about an hour later. I currently have the maximum allowable dosage swimming around in my bloodstream. I wouldn't drive or climb ladders or dance feeling like this (dizzy, a bit off-center), but I'm functional.

And I can walk. Well, I can hurple along on the side of my right foot (the injured one) and the flat of my left foot, but it's better than hopping.

The Verdict: If you're suffering with post-surgical pain that simply doesn't respond to anything else, or if you've got, say, sesamoiditis that makes you want to cut your foot off, try tramadol. If all you have is a normal tension headache or a sore shoulder, you're better off with ibuprofen (tramadol takes a while to kick in).

PS: The results of the X-ray Mr. Happy took yesterday show that I have more sesamoid bones in my foot than is strictly considered normal. That in itself isn't cause for concern, since most folk walk around with a couple extra or missing bits, but it does explain why I was hurting so badly--more things got knocked out of place and inflamed. Thanks, Mom and Dad, for the creepy genetic combination that led to extra sesamoid bones and a strangely-placed, horizontal wisdom tooth under my right cheekbone. You guys rock.

Tuesday, January 08, 2008

La-dee-dee-dum-di-dum-dah...feelin' stabby!

I had meant to sit down tonight and write an amusing story about all the cool stuff I've seen over the last couple of weeks: Hypospadias repair! White matter degeneration! Traumatic amputations! Wife of prominent politician with major paranoid fugue episode! Person run over by truck! Talking to a dude in X-ray who got run over by truck!

But instead, I find myself musing on feeling stabby.

I feel stabby because, as I should've known, the curse of Shared DNA has hit yet again.

My Beloved Sister is seven years my senior. I've been able to watch and learn as she goes through various life stages. Up to now, the educational value of this exercise has been borne out in my choosing entirely new ways to humiliate myself, worry our parents, or annoy others. I never knew that I would be finding new ways to be clumsy as well.

See, MBS went through a clumsy stage. I believe it was when she was about my age that she either got poison ivy all over her body after wrenching her back, or when she fell off a stepladder and narrowly missed the window. Or maybe it was when she nearly shattered her cheekbone in the bathtub. (I can't recall; the stories are many and my brain cells are few.) Either way, I had plenty of warning that That Clumsy Stage would soon be happening to me.

I figured stepping on a needle was an accident that could happen to anybody. Right? Right.

Not so much stepping on a needle and then, two weeks later, getting sesamoiditis in the very same foot. The two are not connected. The sesamoiditis and my tipping over and bonking myself on the head in the shower, however, are. As is the attempt to recover from bonking myself on the head in the shower and thus allowing the handheld shower head to turn wrong-way-up, spraying the ceiling of the bathroom and all of the bathroom's fixtures and floor with hot water.

Chef Boy, in answer to my desperate pleas (because sesamoiditis really fucking hurts a lot, as in the worst pain I've ever had) brought beer over. He did not go into the bathroom. He'll read this later, so the jig will be up, but it'll be up after he's gone home and I've barred the door so that the concerned officers of the law he will send for a home check will not be able to get in.

Meanwhile, I'm going to limp to the kitchen and get an ice pack.

Moral of this story? Don't get sesamoiditis. And if you do, don't be clumsy into the bargain.