The P.I.A.

I could get into the details, but the short version is that a shoulder that has been sore for months suddenly exploded into nauseating pain radiating from my shoulder to my elbow. Anything that is “radiating” on the body doesn’t sound like a good thing, so after work I dutifully stopped in at the Urgent Care place, got a check up, an x-ray and an arm sling, told I had calcium deposits and a bone spur in my shoulder, told to make an appointment with an orthopedic doc and was sent home to rest up with steroids and some pain meds.  A calcium deposit?  I am picturing images of vast salt mines.

So I am hanging out all weekend in bed mostly, using ice packs and taking pain killers that were disappointingly useless.  Eventually I got up to take a shower, reached up to rinse out my hair and   ZAP * POW * YIKES * it was like getting hit by lightning in the upraised shoulder and I actually passed out, just like that.  This happened two more times that day so I finally figured maybe a trip to the ER was a good idea, you know, just in case the doc in urgent care was wrong…….

And so the saga of Power Struggles and Being In The System begins.   It’s been a few years since I have been in an emergency room for myself, and this particular hospital is one I had never stepped into before, but I think the scenario is probably the same everywhere.   Because the pain was in the left arm and that is the heart-attack arm,  I got fast-tracked.  Wait time from entry to admission was three hours, which I guess in the scheme of things might actually be reasonable?  I don’t know.

First order is to put in the IV and here was the beginning of Not Being Listened To.  It just so happens that some of us have very tiny, difficult veins that are almost impossible to hit and cause great consternation among nurses, phlebotomists and vampires alike.  After all these years of being tortured every time I need a blood test, I know exactly where to tell them where to insert that needle, which avoids needless abuse on my body and  saves them time and possible embarrassment on their part.  So I suggested to the nurse which vein is the easiest one to tap.  She turned to me with Major Attitude and said “I’m a nurse, I do this all the time, I know exactly what I am doing, let me do my job”.   Then she proceeded to agonizingly miss and blow out every single vein she attempted to try (except the one I suggested), leaving me bleeding and covered in gauze and tape.  Without making eye contact, she then slunk away (hopefully mortified, you bitch), and sent in someone a bit more adept, who was willing to listen to me, although it’s now after the fact.  So she hits me where I tell her and bingo, they get the IV in.

Power struggle #2 – they want to give me morphine. I know those in pain crave the morphine bliss, but morphine makes me violently sick for a prolonged period of time, regardless of concurrent use of anti-nausea meds.  I tell them this.  But the ER doc tells me not to worry, he will give me some anti-nausea meds with the morphine.  I ask him to please find an alternative.  He looks at me like I am a child and tells me I won’t get sick.  I tell him from multiple experiences that I will and it’s something I do not want to experience again. Ever. I get so sick from morphine that it is actually in my advanced directives that this is a hell ride I do not want to go into the Valley of Death on.   I tell him this, Very Emphatically.  So he finally concedes,  gets me a different drug and adds some anti-nausea to that one too, just in case.  I have a feeling that someone will now be writing “P.I.A.” in my chart (ever see that Seinfeld episode with Elaine? It stands for Pain In the Ass).

I am finally admitted and upstairs in a room, and from that point on it’s a question of watching the clock to see when it’s time for the next dose of pain-killer. They give it every six hours but it only lasts for four and a half.   It never totally takes the pain away but it makes it manageable, if I have ice and don’t move don’t move don’t move and try breathing slowly and steadily….. it’s like having labor pains in your arm. I was really good at natural labor, “Good Peasant Stock” as the OB had jokingly put it back then.  But with this, none of my good peasant stock is helping.  I end up just crying during that last hour when the pain gets away from me.  They tell me they can’t get the machine to unlock and dispense my meds any closer than every six hours without doctors orders.  But the doctor is not available.

“What happens with the original meds the Urgent Care doc put me on?  Do I stop them? What about my regular prescriptions?”.  These are the things I asked, but nobody has an answer.  They say that I cannot take my own daily medication that I brought and they will get back to me on that.  Hours go by, and then a day, and so I miss all the doses of everything. I figure it’s no big deal since nobody seems too worried about it.

When I am not watching the clock, I am staring at the dry erase board across from my bed.  It has the date, the name of your current nurse, the name of your current tech, and then something that says “status”.  Under status, someone has drawn a Smiley Face.  I am assuming that was the last patient’s status, or maybe it is wishful thinking on their part for me.  I stare at that Smiley Face mocking me and wish I had a dry erase marker, because if I did I would haul myself out of bed and draw a screaming Mr. Bill Face with its hair standing up and flames coming out.   Who are they trying to kid?

Power struggle #3 – they have attached this Octopus to me.  They have slapped all these sticky leads on and all these wires leading to this clunky monitor that you carry along with you when you get up to use the bathroom and try not to lie on when you move.  I am assuming Someone out there in that central space of bustling personnel is watching to see little blips that say the patient in 207A is alive.  Sometime during the day I finally do see a very nice doctor for all of three point two minutes and he tells me my heart is absolutely fine, it’s definitely the shoulder.  The next time the nurse comes in, I ask if I can take off the clunky monitor, since it’s not my heart.  The nurse can’t do this without the doctor’s orders and the doctor is gone.  I am sure they are busy tending to other people.  This isn’t “House” – throngs of handsome professionals are not lurking outside to deal with every need…or maybe they were thronging around someone else’s bed……. 

Finally an orthopedic PA did arrive and did shoot some steroids directly into the shoulder.  I would have thought this would have provided some instant relief, but it did not, and I found myself having to spend yet Another Night there while they waited for Tests to come back and the pain to subside.

Somehow, throughout the day, two of the leads from the Octopus have become disengaged and fallen off the contacts.  I wasn’t sure which one got plugged in where on my body to put them back on, so I left them hanging unattached. I figured someone out there on the floor watching our blips might notice that 207A is sending weird signals and investigate.  But nobody comes in to check.  By the end of the day it appeared nobody was watching or cared, so the next time I got up to use the bathroom, I unhooked the rest of the leads and left the Octopus lying on the chair.  It was a couple of hours after doing that when someone came rushing in my room to see if 207A was dead, as there was a flat reading on their screen.  I was scolded, and they hooked it up again, despite my protests that the doctor said my heart is fine and I don’t need these things, and that it had only been half hooked up for hours before, and that,  you know, theoretically the patient in 207A had died anyway…..

After an eternity and hell through fire, that magic timer box must have opened and it’s time for pain meds, and with that, I finally get to sleep –  about an hour or two into badly needed sleep actually – when someone WAKES ME UP at night to give me some of my own prescriptions meds that I had asked about the previous day and already missed two doses of anyway.

“What is this?” I asked.  “It’s  L  and  G ” the nurse tells me.  “But I’m not on L, ” I say, “I am on S”.     “L is the same as S” they tell me.  But, I happen to know they are NOT the same drug.   S is not the generic for L, S is the generic for P.    So I said I am not going to take it.

They probably have outlined that P.I.A. in bright red in my chart now.   To get even I suspect, two hours later they walked in,  turned the bright overhead lights on and woke me up yet again to take my Vitals.

It’s 3:00 a.m. following my second night there.  Somehow, the Octopus they reattached gets tangled up in my IV and rips the IV needle out of my hand and there is blood all over the place.   This is the route that my next dose of pain medication will be going through shortly, and now we have to start all over again.  So the P.I.A. in 207A clicks the little call light on.  Nurse Bill, a lovely, calm man, tries to find a vein and notices that every single one of them now has a blooming hematoma, courtesy of ” Ms. I’m A Nurse I Know What I’m Doing” from the ER downstairs.  He decides not to pursue this himself and goes to find a phlebotomist who is good at this kind of thing.  She gets that sucker back in, using a vein I suggested.  I refuse the reattachment of the Octopus.  Bill the Nurse says that’s OK, we can’t force you.   Thanks Bill….

And so, I did finally bust out of there right before lunchtime.  It took a few hours for the doctor to come and give me his Blessing,  to get The Paperwork completed, and then the final Removal of The IV.  I refused to wait even longer for the wheelchair.  I did apologize to every nurse or tech I saw on the way out for any cranky behavior on my part.  It is amazing what pain vs. absence of pain will do to a person.

I did learn a few new things regarding hospital survival.  For instance, the first meal they brought was REALLY BAD.  I almost laughed, it was so classically awful, it substantiated every cliché about hospital food.  But my roomie, bless her,  a young woman suffering from a week-long massive migraine, hooked up to drugs much more effective than mine and donning sunglasses, peeked her face through the curtain and handed me something called the Alternative Menu, which is actually a step up the ladder from the regularly offered fare.  If she hadn’t cued me in, I never would have known.

I learned that if you do not Question Authority, that you will become part of the machine and that you can be forgotten because the staff are busy, and possibly short-handed, and mistakes do get made, and also you are dealing with personalities. Like anywhere else, some of these people are great and some really have an attitude.  I know that decisions can be made that are not necessarily in your best interests, or beliefs, for the sake of saving time, or because “that’s how we do it”, and while going through the medical system people can be treated like sheep.   While you will not be popular for questioning, it is imperative to advocate for yourself, or anyone else you care about who may be undergoing medical treatment, or admitted.

Tomorrow I finally get to see an orthopedic MD, which I still haven’t done, because they were “all in surgery” at the time.   And that is what I have been doing for the past week.

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6 Responses to The P.I.A.

  1. Judy says:

    Most important lesson: avoid the hospital at all costs. They never let you rest, and they never communicate with each other. Works only for life-saving purposes and/or if you already have your own doctor.

    • daeja's view says:

      Yes, that is the #1 lesson for sure. The thought went through my mind quite a few times that “You could get killed in a place like this”.
      Unfortunately, sometimes when things are happening to you very quickly or could be dangerous it’s not always an option.

  2. rachelle says:

    i am shocked to hear what you’ve been going through. it’s scary to think that this is what lifesaving is about.

  3. I am so sorry you are going through all of this. I can relate. I fell on black ice last winter a broke a bone in my shoulder – major pain!! The “medical system” reminds me of the old movie/book “Catch-22.” My greatest fear is not being together enough to be able to function as my own advocate! Hope you are feeling better…

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