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.


Katie said...

Daniel, only you can transform waiting in a hospital into intriguing prose:)

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