Saturday, February 27, 2010

Durham Regional ER 10 pm and the Stud Finder

Durham Regional ER 10 pm Thursday
Durham Regional is owned by Duke, but it is Durham's hospital and not America's hospital, as Duke would, for some good reasons, think it is. We walked through a metal detector on the way in and there wasn't hardwood finishing and extra glass everywhere, the kinds which pour out over Duke. They had the metal detector turned up higher than at a domestic airport, but they were friendly and didn't make me take off my belt. The waiting room seemed to have a lot of people using the ER because they didn't have access to primary care. I guess I should explore Duke's ER and see for sure that I'm not overextrapolating since our last visit. Rex Hospital's ER in Raleigh didn't have metal detectors.

But we want it the Regional way. The Duke ER experience involved lying on a cart while a resident got some practice drawing spinal fluid with a long needle. Some would consider spinal taps the definition of pain, maybe a category or two below giving birth and passing kidney stones. Four attempts later, we decided the risks of the disease were worse than the risks of diagnosis. We went home. She didn't die, so it worked out by some measurement.

It's not like residents are always "practicers." Some have more recent experience and better results with routine procedures than their mentors. But I suppose to really know, you'd have to ask the resident at each point of the visit, "How many times have you done this, successfully?" And there is, not always but certainly not never, the Duke attitude of "I am super doctor, and you are lowly patient. So I don't need to listen to you."

Durham Regional has residents, but it doesn't back right up to the Duke campus. This time it's much simpler, with less to wory about: a severe stomach flu, but it's hard to shake off that Duke experience. And Regional has free parking by the front. When you come out in the middle of the night, you don't have to remember which floor of the Duke garage contains your car.

Emptying your stomach out a lot is the subject of college and other lore, but if it goes on long enough, your body runs out of water. I can't imagine what it would be like to be in the third world without IV fluids or a even sewage system. It must be a painful, humiliating way to die. Not the best thing to focus on right now - I'm just thankful for what we have. I don't mention it to anyone there; I am learning a little bit of discretion.

We tried to do the right thing. The ER is supposed to be a resource heavy and expensive last resort (if you don't need the mandatory free care of the ER). We went to a Duke urgent care clinic first, mid afternoon. It was convenient, with wait times posted on the web site. But 3 hours later, the friendly and confident staff were perplexed. They did tell us it was good we had not waited later to come in. In this case, just half a day of sever stomach trouble puts your health at risk

So we drove to North Durham.
A long wait with screaming babies ensued.
After the waiting room wait:
Tonight, we have been shown that even an experienced nurse sometimes can't find a vein. It's busy so an hour and a half later after we were called back and blood was drawn, an IV inserted but no doctor yet. L has some bruises for the IV attempts that didn't work.

Hey,we didn't get to finish that episode of Psych earlier. The mind wanders. I brought a new book, which was shockingly expensive to me last night (my blood drags me to used books and libraries). Today it seems to be worth a thousand dollars. But I can only keep with it for so long. promises to stream movies from your PC to your phone over wifi, but there was a problem with our internet connection today, and it doesn't work for me.

Oh, the things to think of before rushing out of the house. My primary concern is for L's well-being of course, but I can't stare at her and make it better (Regardless of all those movies - "keep him talking! Don't let him slip away!" As if consciousness were the primary deterrent of death. Who knows? Going to sleep tonight might kill us all). And her situation doesn't make conversation pleasant for her. So we are both bored, and passing the time becomes a big focus. What a week for the laptop to be at the repair depot. Thank you for wifi on the old heavy phone! But after a few e-mails and some minutes on FB, I just end up making this blog post way too long. Boredom breeds blogging. A society of happy, fully engaged people would at least have less blogs. Less literature,too, I guess. Hemingway had many sad,probably boring opportunities. I don't plan on being saddened to his level of achievement. I'm B-list bored.

Hipaa signs and signatures and brouchures abound, but I still know everybody's business. The thin curtain matters more than the thick paperwork. The lady next to us also has bad luck with her IV. Her husband asks, "They make a machine to find the bones. Why can't they make a machine like the stud finder? Y'a know, you rub it along the wall and it beeps and you find the stud. Why can't they make one for veins?

"Oh that's good," L says. "Write that one down."
I reply, "Terminate him with extreme prejudice. No one needs to hear it from him. I want that for my own million dollar idea."

"I got to ask Jesus." A little later, "You got to stop it. You got to stop it."
"Who is she (the nurse) talking to?" I whisper.
L responds, "She's talking to the IV."

I am going to eat better, walk more, and just be more healthy in general. That wouldn't have prevented this sickness, but I still want to avoid the hospital. I can already anticipate the feeling wearing off. Indeed, if I hadn't eaten the big breakfast with hot cakes this morning, I wouldn't have survived the wait until 9 pm for dinner. Oatmeal don't bring it like you need it sometimes.

Okay. Healthy takes a holiday. I'm thirsty and hungry at 11:30 pm and the vending machines don't do healthy. I get a Pepsi. Now I only have fives and a twenty.
Why did I give all my ones to Jenny for the pizza on Sunday? I've almost killed her several times as I drove her across southern Europe (and I heard the screams to prove it). That's some sort of bond. The least of her worries would have been me shorting her 5 bucks. She didn't seem concerned. But I didn't ask.

Aha! The coffee machine takes fives. One hot chocolate later and I have 16 quarters. It took as long to dispense the change as it did to spray the hot chocolate. I got quarters from 6 different states, if you count the Texas one which looked as if it had almost been scratched blank. Someone forgot and messed with Texas.

I returned, just having missed the doctor. A nurse rolled in an EKG cart. "She already had an EKG," I explained. She started putting on electrodes. "It's in the envelope thingy we gave to the first nurse." L affirmed the envelope's existence. The nurse backed off and rolled the cart away. Now both Durham Regional and Brier Creek Urgent Care are in the Duke system, but something didn't get through. Not much at all got through. The same questions, the reciting of the list of medications just given a few hours ago, the same wait on data entry. Somewhere in there is some sort of healthcare cost control and quality lesson. I've had the experience of the same doctor not being able to access his notes on me in the Duke clinic because they were taken in the Duke hospital, which is physically connected to the clinic. Oh, we are too young to know this much about Duke.

A new nurse comes by and administers some narcotics. It doesn't help all of the symptoms; in fact, the headache gets worse at first. It does help her sleep. The nurse worked magic the next bed over,too - the IV resistant woman in severe pain
is quiet as is her husband. The whole place has quieted down. And after some peanut (oops hit the wrong number) M&M's, delectable hot chocolate, and some Pepsi, I'm doing okay, too.

1:30 am
The doctor comes by. L wakes up and feels better, with the migraine gone (that's a big accomplishment - migraines are persistent and med resistant for her). The tests look good and fluid levels are up. Things should improve overnight then she can transition into the BRAT diet, which so makes me crave bratwursts. It has been too long, and it's too late. With a lot of sauerkraut.

They let me push the wheelchair out of the hospital. At Duke, you have to wait up to an hour for a professional wheelchair technician to show up and cart you out, no matter how much you swear you can walk. You fall down on your own time.

Things go better the next day. Much better the second day.

Wednesday, February 24, 2010

Juror Duty Final Post: Juror #12

Grumbling follows. You can skip to the 14:50 section if you just want the story.

The Whole System

The afternoon is running on.

So why are we all here? 80-100 people stuffed into facilities much less spacious, functional,or even beautiful than Durham's new bus station. At this point, there's a good chance that all of us will be sent home. Durham isn't that big and we are in the center of the county at the judicial building. Everyone is within a half an hour drive. Most people are ten minutes away. We could be at home, acting as productive or at least comfortable citizens until we are called or texted.

So why? Because "they" can. Hearing of a day's wait to buy something at Lowes would send you to Home Depot. But there is no other "they." It can take a half day of waiting for a needy pregnant women to qualify for WIC benefits, a lot of which consists of presenting incredibly easy to forge documents (I'm not suggesting that WIC moms forge the documents, but the process does not prevent fraud and still takes a lot of time, so what's the use. It would be like changing the process at the airport to require a 4 hour wait so an attendant can verify a handwritten note from your mom that says you are a nice person who doesn't cause trouble on planes). But women who need WIC benefits don't have many other alternatives even if the government doesn't value their time. Call Medicare and wait on hold for 30 minutes and then you might be told even the supervisor could tell you she can't help with a simple problem. I was literally told "call your congressman" because they weren't authorized to write a simple letter.

I know there are variables like how many people will show up and how many cases will settle, but it seems that if someone really pushed, the system could be improved. If nothing else, maybe some of the sitting bored could be sent out to pick up trash or something. But in the end, our being ready quickly is more important than our time. At $12 a day, our time is not valued. That's what the econ guys call moral hazard - underpricing our time makes it easier for the court system to waste it.

This is what you write when you are stuck in an uncomfortable situation by the man and you don't feel like reading because you are tired. You have plenty of time to grumble and write it.

2:50 PM
At 14:50, while I was inwardly complaining about waiting, the call came. 20 or so last names were announced and we filed into a small courtroom. Experience convinced the clerk to spell names, even simple ones, because of the difficulty pronouncing the names of a random cross section of Durham. Near the end, my name was called, and I line end up to move to small court room around the corner.

Do I want to be picked or do I want to go home? The 6 hours of waiting was wasted either way, but I now desired a civic engagement. Remember the oath! Okay, I remember the idea of an oath! even if I have no idea what it was.

Some basic instructions were provided.

12 jurors were seated. Not me. After some basic questions including listing your encounters with the law (most people listed speeding tickets), 1 juror was dismissed because she was related to the defendant. The chances of that happening were unfortunately misapplied to this court case; otherwise with those chances she would have won the lottery. 1 more seated. Not me.

At this point, it became apparent that the public defense lawyer was outgunned. It was very natural for the assistant district attorney. He was Matlock. For her, it wasn't automatic. She struggled with questions and often hesitated. She was lawyer#5 on on episode of Law and Order. I respect public defenders and the hard job they have, but this was going to be difficult with less experience than the other side.

3 jurors were dismissed, and 3 more were seated. Not me. Except for the first lady, no reason was given. Just "jurors number 3,5, and 10 are dismissed."

Juror number 12 was dismissed. I was called. I clumsily gathered my stuff. I am juror #12. I have a name for what I do.

But a few questions and a nervous demeanor later, juror #12 was dismissed. However, the assistant district attorney was impressed about the speeding ticket in Spain.

So I missed out on a 2 day trial on an assault case.

As I gave the paperwork to the clerk, she assured us that it wasn't personal. But anytime you aren't picked, it's personal. From choosing kickball teams to a stranger who passes over your house to buy a different one, you have something invested in the decision.

Like my Dad says, you'd complain if you were hung with new rope. Better to have loitered 6 hours and lost, than to never have received a check for $12 in the mail in 2 to 4 weeks at all.

As I left the Judicial Building for my house, which does not require a metal detector to enter or have bathrooms that smelled like a back alley on a hot summer day, I started to get over the sting of rejection.

As it turns out, dismissal meant I was processed slightly earlier than the crowd who had never been picked. By the way, when you are at the Durham Judicial Building, just take the stairs. You'll see them full of people who know not to wait on the elevators.

Monday, February 22, 2010

Jury Duty, Morning to Lunch

I got one of the two working computers for a few minutes. It looked
like 15 year old technology, Netscape and Windows 95 (queue Start Me
Up, by the Stones. Maybe it was Linux emulating Win95). But, be
grateful, something is better than nothing. Well a little bit. Web
sites have advanced a lot in the past few years, and they don't
display correctly if at all, in old browsers. I couldn't see anything
in Facebook after I logged in. I had to reboot it at one point.

Now me being me, I am tempted to bring an old wireless router and plug
it in to one of the computer outlets to provide everyone wireless.
But they have put the actual terminals 10 ft off the ground. And this
is a building with lots of authority figures, many with guns. So civil
resistance is not advised. That oath we swore or affirmed may have
implied not messing with the technology. There are bibles scattered
around the room to act like the one you'd normally put your hand on.
We just metaphorically touched them and metaphorically said the oath
with an "I do." I can't remember the oath, and it's not posted
anywhere, but it seemed reasonable enough at the time. Instead I
focused on more tangible details like how to validate my parking. The
main thing the clerk got across was to not leave before authorized
because bad things will happen, such as a warrant for your arrest and
forfeiting the $12 for the day.

We got a 25 minute break, so I went outside and discovered a cold
driving rain. You really need to look at the weather more closely
than seeing a high around 60 and thinking yeah! The little clouds on
the screen matter too.

I am counting down the minutes until lunch. It reminds me of college
Physics class, where I would anticipate the tick made by the
mechanical clock and then duly recorded it each minute. It's not like
this room is any less exciting than my normal day. It's the feeling
being trapped, of having less options.

I saw a news station truck, so I started to get nervous. The older
ladies I was sitting with assured me that it was a murder trial where
a women had killed another women who was her man's lover. I told them
that my wife had promised to kill me in that situation instead of the
other woman. They liked that.

After lunch:
I was tired enough that I misremembered the lunch times and show up a
half hour early instead of just on time. I make mistakes like that all
the time, but when you're on the fifth floor of a building with metal
detectors at the entrances, it's not as convenient to go for a walk.

Durham Jury Duty: The Beginning

Jury Duty Hour 1
Filed and started the expected cattle call lines and waiting.
"For network security," no wifi is available in the jury room, and the
computer stations are mostly used as normal seats. McDonald's knows
how to buy a system that keeps its credit card system separate from
wifi users reading their e-mail. The guys with guns can't figure it
out. Maybe they have other priorities, but what about my needs? :)
It was Sam Waterson presentation, but we got some useful information
from a video and from the clerk in person. A merciful break let me
find a fines collection office to get change for a Coke.

3 court rooms of 14 people needed, so with a room of around 100
jurors, we have a decent chance.

Friday, February 5, 2010

Somewhere mid South Carolina

Rainy but warmer. We're going to the beach! (North Florida)