Map of life expectancy at birth from Global Education Project.

Tuesday, September 14, 2010

More of my whining

As you may recall, when we last left our hero, he was suffering from severe diarrhea, ileus, fever, and a mysterious lump at the site of his surgical wound.

So, the doctors kept pumping water into my veins, but never enough. They also gave me an antibiotic that might have a discouraging effect on a particularly vicious bacteria that was hanging out in area hospitals causing diarrhea, called Clostridium difficile. (This is still a big, and actually growing, nosocomial problem. It's an opportunistic infection that moves in when antibiotics have killed the normal bowel endosymbionts, and it kills a lot of old folks.) Leah seemed contemptuous of the bacteria theory, and I got the impression there was something the doctors weren't telling me. She also let it slip that Dr. Knozall had skipped a step by authorizing a full liquid diet on Saturday. Normally, patients start with clear liquids, a category which does not include fruit juice or the luncheon menu.

I figured out that they were actually afraid the anastomosis -- the reconnection of the cut ends of my intestines -- might be leaking. The doctors told me they were leaning toward the theory of an abscessed surgical wound. They would need to do a CT scan of my abdomen. I was panicked that they might have to open me up again, but they said that was unlikely. If they saw an abscess, they could drain it with a needle. That would cure me very quickly, and I could go home. Then, on Monday, Leah came in with some news: they couldn't schedule the scan before Friday.

What I also haven't told you is that the weather outside was abnormally warm, but the hospital was on winter HVAC. There was no air conditioning and the atmosphere was insufferable. They were actually starting to drill evacuation. If there had been a fan working anywhere in Beth Israel hospital at that moment, the shit really would have hit it. People who know me well will tell you that I'm usually tolerant and reasonably discreet, but there is a threshold where I go through a phase change. Was I going to sit in that hospital, in unrelieved agony, paying $730 a day, for all of Tuesday, Wednesday, and Thursday, before they would get around to doing something that might very well enable them to cure me on the spot? No, I was not.

Now it might be said that I only got upset because, like the rest of us spoiled post-industrial brats, I had come to claim technological miracles as an inalienable right that I wasn't even willing to wait three days for. Remember, those folks over in Iraq were still getting their asses blown off, and they weren't getting any CAT Scans. There is some truth to that.

On the other hand, in the old days, the doctors wouldn't have had to wait for a CAT Scan, for four days or four hours. They just would have stuck a needle into that hard lump under my incision and seen if anything came out. Crude, I suppose, but just possibly effective. Nowadays, with malpractice and all that, they just can't do anything without "a diagnostic procedure being performed." Another point in my favor is the $730/day. That wasn't coming out of my pocket, but it represented social resources that were being squandered. I'll bet you anything you like that if I'd been on an HMO, they would have had me under that CAT Scanner before the vomit was dry on Dr. Huang's shirt.

A few minutes after I had expressed my feelings to Leah, the Chief Resident showed up. "I understand you're a bit unhappy about the scheduling of your CT scan," he offered. (By the way, doctors call it a "CeeTee scan"; "CAT" is evidently a vulgarism.) I explained my feelings on the subject in terms impossible to misinterpret. Less than an hour later, Leah came in to tell me my scan had been scheduled for the next day. So it pays to complain, at least if you can do it in English and sound like you mean business -- but that is prima facie evidence that most people don't do it.

It turns out there is bad news about CT scans. For a scan of the abdomen, you have to drink the most revolting, nauseating, foul, vile, filth... At about 6:00 that evening Nance came in with a little pint bottle of this stuff. It had a sprightly drawing of a pineapple and bananas. "BARO-CAT", it was labeled, "radiological contrast medium in a pleasant-tasting beverage." My first reaction was that drinking anything at all would be suicidal. Dr. Goldman stopped by and I told him, "I can't possibly drink that." He told me that I had all night to get it down if necessary, but I really needed to try my best. You can imagine how I felt about the prospect of another attack of cramps. But I was a good patient again. I started sipping.

As far as the gastronomic experience, I would compare it to a concrete slurry flavored with saccharine and petroleum distillates. But what the heck, my local Christy's probably sells 20 cases of worse stuff than that every day. The big problem was that a couple of hours after I started trying to shove that stuff down my gridlocked guts, I began to feel as though I were just about to vomit any second ... any second now ... it's just about to happen ... and I kept on feeling that way all night long. Advice: given a choice between that kind of nausea and severe pain, choose pain.

In the morning, when the torturers came on rounds, I asked if they couldn't give me something for nausea. Of course! they said, and in a moment a nurse arrived with a hypodermic containing something called reglan. Inside of ten minutes, I felt much better -- almost well enough not to throw anything when they told me I had to drink another bottle of that filth. But, why didn't they give me the reglan in the first place, instead of forcing me to beg for it after 12 hours of agony? Are they really that stupid, or careless, or sadistic?

Next: The CT Scan


robin andrea said...

The shocking saga continues. I am trying to remember how many days you were in the hospital and when this particular event occurred.

roger said...

"Are they really that stupid, or careless, or sadistic?"

at least one of those terms applies, maybe all. the kindest choice would be stupid and careless.

bonus much per day does that hospital room cost now?

Cervantes said...

That's an interesting question Roger, and I can't answer it because nowhere can I find their current prices posted publicly.

kathy a. said...

roger might have an answer to the per-day cost. but hospitals are like airlines: no two prices alike.

i don't understand why a needle biopsy [and/or drainage of the lump] should be ruled out. they could learn right away if it was a particular infection; and bonus for relieving that pressure. that procedure is obviously much less invasive than another big-ass surgery, lessening the chances of complications and/or other infections. and using a needle instead of a scalpel means there is much less chance of an infection spreading. at least as i understand things.

Cervantes said...

It indeed seems very odd that they preferred to wait three or four days and do nothing until they could get me a slot with the scanner, than to jab a needle in there and see what happened. I cannot explain it.

C. Corax said...

I'm under the impression that teaching hospitals prefer the costlier, more complicated options by way of teaching the young 'uns.

Well, no. That's my impression of teaching veterinary hospitals. However, at vet hospitals, they have mastered the art of treating those who don't speak English.

Seriously, though, is it possible they wanted to do the CT scan for teaching purposes? Patient be damned?

kathy a. said...

plenty of teaching can happen without making patients suffer extra. "first do no harm."

they still would have done the CT, is my guess.

kathy a. said...

waiting breathlessly for the next installment, but meanwhile -- if that hospital had inadequate machinery and/or staffing to do a timely CT, and they wanted the CT before anything else, wouldn't it make sense to see if another local hospital could do the CT pronto?

i know, more cost for transport and yadda, but don't hospitals have mutual aid agreements of sorts?

Cervantes said...

Kathy, they would rather drink muddy water and sleep in a hollow log than send an insured body to another hospital. They call it "leakage."

kathy a. said...

i'm not supposed to laugh, but "leakage" is priceless.