Scared to Health

A Matter of Trust

Kim — Fri, 27 Oct 2006 18:31:19 +0000

Hmmmm….

The adult looks rather tense.

The kid’s getting ready and it’s not even his turn yet!

He’s even comforting dad by holding is hand.

Is it just me, or does the doctor looks slightly like a mad scientist?

I swear I’ve seen that face in a “B” horror movie.

******************************

John decided not to fire his endocrinologist after all.

Remember the mess with the medications that had me so fired up?

John went to his next appointment with Dr. Endocrinologist.

Seems there was a bit of confusion.

Dr. “Endo” got the impression that we had moved to New York and were trying to have him renew perscriptions from our new location. According to him, the pharmacists were not clear in explaining the reason behind the “loss” of five months of renewals.

Okay….

That explains why he would not order renewals.

But…

Why didn’t Dr. “Endo” bother to pick up the phone and respond to either the professional-sounding phone call from John or the “you-got-some-’splanin’-to-do!” challenge from me?

One phone call. Two minutes.

That’s all that would have been needed to (1) resolve the confusion and (2) keep the goodwill in the physician/patient relationship.

Well, the goodwill is still there.

John didn’t fire him.

He likes Dr. “Endo”.

For some reason, I don’t trust that doctor.

And I can’t put my finger on exactly why.

****************************

What exactly does contribute to trust in a physician/patient relationship?

The subjective feeling that the doctor actually cares about the patient as a person as well as a constellation of diagnoses. To the doctor, you aren’t just a number or just another patient.

Communication: knowing that the doctor is willing to answer questions as they come up. Knowing the physician will call you back when you have a question or a problem.

The trusted doctor encourages patients to educate themselves on health issues and is not afraid to address an article or an internet reference.

Knowing when it is time to call in a consultation or refer to a specialist. The doctor you can trust knows when they don’t know.

So the onus is all on the physician?

Not at all.

The patient keeps appointments as scheduled or gives adequate notice if unable to do so. Doctors are busy and they run tight schedules. The appointment you don’t keep is an appointment someone else could have used.

The patient exercises patience if the doctor is running late with their appointments, knowing that medicine is anything but orderly and urgent matters arise. The patient understands that the doctor does believe the patient’s time is valuable and tries to adhere as closely to schedule as possible.

The patient is compliant with the medications and plan of care developed with the doctor. If they cannot be comply, they are honest with the physician in describing the issue(s) that interfere with compliance.

If the patient disagrees with the way a doctor deals with a medical problem, the patient is honest about their feelings and discusses the issue with the doctor. The first inkling that there is a problem should not be the request for their records to be transferred to a new office.

If these factors are present, trust in the physician/patient relationship can flourish.

*****

So, the patient needs to agree with everything the doctor does.

Absolutely not!

Examples:

Our pediatrician of 27 years would never give anything to stop vomiting. Nada. No Phenergan suppositories no matter how many times I phrased the question.

I could have easily obtained anything I wanted from any ER doctor I worked with, but I did not. Why? Because I knew I could trust my pediatrician and while I had a different opinion on the use of medications in vomiting, it didn’t mean he was wrong.

The outcome? Three adults who survived every bout of pediatric gastroenteritis intact. And hydrated.

Same pediatrician: my son had his first febrile seizure at the age of about 2 years.

A prolonged post-ictal phase ended with Son running up and down the ER saying hi to everyone about 8 hours later.

Negative spinal tap. I was a wreck.

The ER doctor could not get my pediatrician to admit my son for overnight observation.

Dr. Pedi said it was not a necessary admit, that because I was an ICU nurse, I was able to provide adequate observation at home. The ER doc was ticked. I was ticked (and told Dr. Pedi at the follow-up visit).

The outcome? An EEG later that week (this was pre CT era) and a totally uneventful course for the rest of the illness. And an unnecessary hospitalization prevented.

Did I want my son admitted? Yes, so I would not have to deal with the fear that witnessing another seizure would surely ignite. Did I change pediatricians? No. The hospitalization would have been for my benefit, not my son’s. Dr. Pedi had his eye on his patient.

One final example.

My bout of chest tightness was diagnosed as esophageal reflux/spasm. Home from the ER I go armed with a prescription for Protonix.

I did not believe it was reflux for one minute.

I had heart problems. I knew it.

So I express this concern to my new internist and he runs an additional EKG, listens to my concerns about being written off because I’m a woman, and wants a run-down in detail of exactly how the chest pressure began and progressed.

Diagnosis confirmed. Reflux with esophageal spasm.

So do I drop my internist because I don’t agree with the diagnosis?

No. And why?

Because he listened to me. He cared that I felt brushed-off in the ER. He did his own evaluation.

And for the record: he was right.

It wasn’t cardiac at all.

*****

So John feels he can trust his endocrinologist.

He’s comfortable with the man’s style and was satisfied by the explanation of communication break down.

I can live with that.

He loves his new family practitioner, also. Even if she did use the dreaded “c” word.

You know the one.

Colonoscopy.

In the end, he has two doctors he feels he can trust and whose opinions he values.

Who says you can’t have it all?

Immersion

Kim — Thu, 14 Sep 2006 20:47:38 +0000

How cute is this?

Of course it doesn’t specify which “cheek” they are talking about, but we get the general idea!

I’ve gotten hugs from my patients but never a kiss.

My husband doesn’t count. Well, that’s not true.

He counts, but he isn’t my patient!

The only patients that seem to like my “cheek” are little old ladies!

******************************

Hubby never had any problem taking control of his diabetes once he came to grips with the diagnosis.

He takes his blood sugar more frequently than he has to with Type 2 diabetes and has seen the cause-and-effect of dietary mis-steps, adjusting his intake and choices accordingly.

He exercises and has now lost 20 pounds and wears a 32 inch waist.

He hasn’t been this thin since we married 27 years ago!

I didn’t realize he didn’t know anything about his medications.

******************************

Up until John’s visit to New York last month, I had been filling his weekly pill containers.

One for the morning and one for the evening.

He knew the nature of the medications he took. A pill for lowering his blood sugar, one for his triglycerides, aspirin and a med for his cholesterol.

I’d discuss the meds with him, often using the generic and the brand names interchangably.

*****

What John didn’t know was which name went with what med.

Although he took his medication bottles with him, when he needed a refill on two of them, he was lost on how to go about getting them 3000 miles from home.

When we did arrange for them to be filled, John was taken aback by the fact that the medications given to him there didn’t look like the same medications from home.

What was Gemfibrozil?

I had referred to it as Lopid even though we bought the generic version.

But the shape is different!

Different company.

He was anxious that he would mess up his med schedule and perhaps take too much metformin.

I was surprised at how unsure of himself he was after three months on the same medication.

*****

Then it hit me.

I had been handling the bottles. I had been filling the weekly medicine cassettes. I had been talking to the pharmacy about refills.

John had been taking his medications passively.

Up until the age of 51, he had never even been on medication. It made sense that while he could grasp the mechanics of blood sugar readings and tweaking his diet to make those readings fit parameters, the weak link in the chain would be his understanding of medications.

I wasn’t helping matters by handing them to him in cassettes marked only with the day of the week.

*****

To learn, John needed to actively immerse himself in the administration of his medications.

It wasn’t enough to have the medication names written on the bottom of the cassettes.

He needed to hold the bottles and read the labels every day. Become familiar with the generic and brand names. See the dosages so that they became etched in his memory and take control of getting his medications refilled.

Just as he needed to learn how to navigate the health care system when he had never even seen a doctor, he needed to learn his way around the world of pharmaceuticals.

*****

And so my part in this diabetic partnership has become one of support.

I shop, so I make sure portion controlled, healthy snacks are always available. Our house has had more fruits and veges in the last four months than in the previous two decades.

And honestly, that is really my only “responsibility” when it comes to helping John with his diabetes these days.

He’s conquered the diet, exercise, glucose testing and now the medication aspect of his illness.

Today he received the results of his first A1C since his diagnosis. He dropped from 8.7 to 5.7.

5.7 is in the reference range for non-diabetics.

I’d say he’s done a pretty good job.

A Doctor is Jettisoned, A Family Practitioner Is Found

Kim — Fri, 08 Sep 2006 18:46:26 +0000

Dang!

Doncha wish you lived in the ’50s when this breakfast was considered good for you?

My grandmother used to make this sort of breakfast for my grandfather every day at 0400 before he went off to work.

My grandfather is now 90.

My grandmother lived to be 78.

Maybe cooking it is bad for your health, not eating it.

Of course, today we have other options.

Egg Beaters, turkey sausage.

But nothin’ beats real bacon. Crispy, mouth-watering bacon.

Accept no substitute!

******************************

Thanks to all who commented that a Family Practitioner might be a good choice for my husband.

He has his first appointment with his new doctor in two weeks. Young doc, in his late 30s who is in a Family Practice with his wife! It’s a family practice in more ways than one.

Very happy to take on new patients and was recommended by the marketing manager of the hospital he is affiliated with.

I’m sticking with my internist, who I absolutely love, but should he retire, I’ll join my husband at the new place.

He will not be seeing the endocrinologist who has taken care of his diabetes for the last four months.

******************************

I had a bad feeling when my husband was told at his last appointment that his endocrinologist, Dr. H, only wanted to deal with his diabetes.

Now how does one just deal with diabetes without dealing with lipids, cholesterol, blood pressure - basically the whole patient?

That was a red flag to me.

And then there was the prescription refill issue.

I will describe it. You tell me if I’m crazy.

John travels for ten days to New York. We packed his daily med containers. He brings extra pills in their original bottles.

Eight days into the trip, John realizes he won’t have enough Lopid or Metformin to last until he gets home.

No problem, our Safeway calls the Rite Aid in New York. The prescriptions are transferred. When we need the next refill, they will get the scrips transfered back.

Problem. Rite Aid only accept one refill, even though John had 3 additional refills on both meds. The prescriptions were removed from their system. Neither pharmacy can refill the prescriptions.

Safeway calls Dr. H. He declines the refill request. He has strict refill policies, regarding when you can get refills and when you can call, etc. However in this case, John was stranded through no fault of his own.

John is frantic he won’t get his medication. He calls Dr. H. and leaves a message, explaining the problem and noting that Dr. H probably did not understand the background. John is a lawyer, his call is calm and succinct.

I am pissed. Not knowing that John has already called Dr. H., I call too, and leave a very, shall we say, adamant message that

(1) not allowing my diabetic husband access to his medication is tantamount to holding him hostage to inflexible refill rules and

(2) as far as I am concerned, is damn close to patient abandonment.

Being a nurse, I have very little tolerance for what I perceive as physician arrogance.

Dr. H never calls either one of us back.

When I am at Safeway pharmacy for my meds two days later, the pharm tech notes that Dr. H called in just enough pills to get John to his next appointment. Not one more, not one less.

Think there is a control issue here?

Dr. H, in the words of the inimitable Donald Trump, on September 14, 2006 you will be fired by your patient.

An endocrinologist who is not willing to care for the whole patient is not an endocrinologist he needs to see. Having to fight for metformin is inexcusable. All those pamphlets you threw at us during the first visit, while extremely informative do not pass for medical care.

John will see, instead, a Family Practice physician who can take care of all his medical needs in one office and see him as a whole person, not just as his latest A1C.

Should an endocrinologist be needed in the future, we will obtain a referral from his new doctor.

And by the way, your reputation is well known, and while you may be a very good doctor, your inflexibility is inexcusable.

We won’t be adding any sparkling anecdotes to your legacy.

Ovary There!

Kim — Sat, 02 Sep 2006 04:19:31 +0000

I know just what her stomach feels lke!

Except I’m the one with the complaints!

Not about me!

I’m doing fine and am 32 pounds down in 36 weeks, physical therapy pretty much cured my back pain….until I undid four weeks of therapy at the Journey/Def Leppard concert.

Since when does three hours of foot stompin’ rock-and-roll mess with one’s back?

And don’t tell me I’m older…

If Mick Jagger can strut around a stage at the age of 64, I can certainly dance in place without fear of anatomical damage!

Can’t I?

******************************

No, my complaints are about “Inferior Medical Center”.

Get a load of this story.

See if you can spot the no-nos…..

******************************

The year: 1990

I’m five months post-partum with my youngest daughter, who is entertaining herself with Big Bird on a blanket on the floor.

I’m chatting with my sister on the telephone when I am consumed by a sudden, sharp lower abdominal pain that doubles me over.

Literally.

I hang up the phone because with the ungodly pelvic floor pressure I was then experiencing, I figure one of two things is going to happen next:

I’m going to need a bathroom very quickly or

I’m going to give birth to a cantelope

Since cantelopes don’t run in my family, I decide to prepare for the first option.

But I couldn’t bear down.

And I couldn’t stand up straight.

I was bloating like a balloon. And it didn’t feel like helium.

I couldn’t pick up the baby. I couldn’t even sit down.

Something was horribly wrong.

I called my husband and he came home to rescue the baby from the floor and to take me to the hospital.

******************************

This was all occuring at noon and I knew my OB/GYN was at lunch until 1400, so even though I didn’t think I needed an ER, it was what was available.

The triage nurse informed me (as I sat there at a 45 degree angle and wondering if the cantelope would resemble my spouse) that it would be at least a two-hour wait.

I unfolded myself to a 60 degree angle and said that if that was the case I’d just wait and go to see my own doctor because she would be back by then. I wasn’t angry or anything, I was just being practical.

I’m not sure what made her change her mind. Maybe I resembled the Hunchback of Notre Dame. Within 90 seconds I was in a room.

******************************

While the discomfort was constant, the pain varied in intensity. While I was waiting to be seen, a nurse walked by and saw me grabbing the sides of the (pelvic) gurney and panting.

Did I need pain medicine?

Uh…yes, please.

Two Vicodin. PO.

BA = before assessment.

Don’t get me wrong, I appreciated it. But in light of what was happening…..

******************************

It wasn’t even a gurney. It was a table.

Heather, and that is her real name, was the Physican’s Assistant on duty that day. She took one look at me, listened to my history, did an exam and pronounced her diagnosis.

“Ovarian Torsion”.

Damn, she’s good!

Let’s get an ultrasound!

Okay!

***

Two hours and two liters of water BY MOUTH later…..I’m in ultrasound and three people come around to look at the screen.

(Yes, they let a woman with acute abdominal pain drink enough to fill her bladder.)

The sonogram tech began his interrogation.

When did you last see your doctor?

Five weeks ago.

Everything was FINE?

Uh…yeah…why?

I can’t discuss the results with you.

Uh oh….

***

The bloody urine specimen I gave them on arrival was sent to the lab to rule out a urinary tract infection.

Or a kidney stone the size of a cantelope.

I told them it was contaminated and would be of no use.

When I got back from ultrasound, they told me my urine was contaminated with blood and of no use.

Hellloooooo straight cath! Let’s add burning uretheral spasms to the mix!

I also discovered that pelvics are not transferrable. One person cannot verbally tell another person what they felt.

Oh great…

I had to have a second pelvic from the off-going ER doc. Apparently it was very productive because I then got one from the ONCOMING ER doc! Hell, let’s just sell tickets and let everybody have a look, eh guys?

The concensus? A ruptured, and hemorrhaging, ovarian cyst that measured 7.5 centimeters causing intermittent ovarian torsion.

I told you that PA was good!

I would have to be seen by the on-call OB/GYN.

It was now 1600 hours.

I would need surgery.

***

Four hours later Dr. OB Wan shows up.

I’ve been in the ER for eight hours now.

Hemorrhaging, supposedly, but still with no IV access.

Still in pain, but somewhat muted by the earlier Vicodin.

And guess what?

Another freakin’ pelvic.

I told him to go ask the other guys.

***

Now I get my IV because I am going to surgery.

But I get something else, too!

An NG tube because they let me drink so much water before my ultrasound, that I was not considered to be NPO!

I refused.

He insisted. I knew the risks of aspiration, he said.

***

The nurse brought the NG into the room packed in ice.

Ice? I’m getting an iced tube in my nose?

Profuse epistaxis from right nares?

Check.

Go left, old nurse.

Profuse epistaxis from left nares?

Check.

Get away from me NOW.

The OR wouldn’t be ready until 2300. I went in at 2345, almost twelve hours to the minute that I had arrived, now bleeding from both ends.

***

The anesthesiologist gave me Neo-synephrine to snort bilaterally and then after I was out placed an NG without difficulty. I had 400 ccs of fluid in my stomach.

Per the OR nurse, who gave me a full report later:

They did multiple attempts at a laparoscopic removal but because of scar tissue due to three C-sections, Dr. OB Wan couldn’t see.

And as he was palpating all over my abdomen to get the offending organ into view, he pushed a little too hard and the entire cyst burst.

Good thing no one faints at the sight of blood in the OR because when they opened me up it was everywhere. She said they had a hell of a time cleaning it all out.

It pays to have surgery where you work (I worked Psych there at the time) if you want the real scoop.

I survived and Dr. OB Wan saved the ovary.

***

Recovery was uneventful except for two things:

The insurance company considered my surgery day my first post-op day even though I didn’t even get into surgery until 2345 and wasn’t finished for hours into the next day! So I was discharged home less than 36 hours later, with a five-month old to care for and after my second abdominal surgery in five months.I was charged for a hospital room at the same time I was in the ER.

At my six week recheck, Dr.OB Wan said that if I wanted any more kids I had better have them within two years and then have my tubes tied! Why? Because if I took the birth control pill after the age of 35, I would die! And he had the graphs to prove it!

I hightailed it out of that office so fast you would have thought I was an Olympic sprinter.

Dr. OB Wan still practices. Ran into him a few times at another hospital when I was working ER. He didn’t know me and I didn’t tell him he was one scary guy.

***

You see, that is the thing with Inferior Medical Center. The actual experience there is exasperating, frustrating and sometimes just plain unpleasant.

But everything always turns out alright in the end.

I mean, Dr. OB Wan did know how to save an ovary.

He just didn’t know what the hell he was doing when it came to reproductive advice or the latest statistics on birth control pills.

And isn’t that what you want from an OB/GYN?

Never been to a male OB/GYN since. I get my care at a Women’s Clinic staffed by female doctors and Nurse Practitioners who know what they are doing when it comes to caring for women.

Guys, you can be really good at what you do as OB/GYN doctors and nurses, and I would have accepted a male nurse in L&D without a flinch.

But it takes a woman to know what you are going through. And I hate to admit that.

But it really does.

I’m Just A Bill

Kim — Thu, 17 Aug 2006 00:13:47 +0000

UPDATE: “I’m Just A Bill” has won the bronze medal post award at this week’s Patient Consumer Parade at Six Until Me!

Yes, I actually downloaded “Schoolhouse Rock” from iTunes!

Maybe I should have titled this, “I’m Just A Dork!”

I wasn’t even little when Schoolhouse Rock came out, but to this day I can sing “Conjunction Junction”!

If you think that’s bad, I know all the state capitols from listening to Wakko sing them on “Animaniacs”!

******************************

Well, it’s been three months since John’s gangrenous gallbladder was removed and his diabetes discovered.

He exercises twice as much as ever, runs blood sugars from 103-124 while on 1000mg of Metformin and I dropped about 7-10 more pounds since I stopped buying sugar.

John still is able to drink his wine and he is very good about keeping it at 5 ounces a day. I however, drink Diet Pepsi like it is never going to be produced again.

Hey, no one is perfect!

But now it comes in two new flavors!

What other addictive substance can boast of that?

******************************

For the last three weeks I have been flooded with “EOB”s. For the initiated, it means “Explanation of Benefits”.

In other words, I have found out what we were charged for John’s hospital stay, his doctors, his labs, radiology, etc., and exactly what our insurance will pay.

I nearly fainted, but for reasons you may not suspect.

******************************

For almost two hours, the life of my husband was in the hands of two doctors: his surgeon and his anethesiologist.

For this responsibility, the surgeon charged only $1500 - including all pre-op and post-op visits. Remember, this was a complicated laparoscopic surgery requiring a three day hospital stay, with a Jackson-Pratt drain a foot-and-a-half long into his abdomen for two of those.

For his services and responsibility, the anesthesiologist charged only $1520.

I nearly fainted for two reasons:

I can’t believe how low these charges were. I honestly expected three times as much as that. And it would have been worth every penny.

Our insurance paid them 100%. ONE HUNDRED PERCENT! I didn’t think any insurance companies paid doctors what they asked for. Then again, these were specialists. My regular doctor doesn’t get 100% of what each visit is billed for. Even with my co-pay.

But then came the piece de resistance: The Hospital Bill

Inferior Medical Facility charged John FIFTY THOUSAND, FIVE HUNDRED AND FIFTY-FIVE DOLLARS AND NINETY-SIX CENTS.

$50,525.96

I did faint.

Oh, but wait! Inferior Medical Facility is in our “plan” so we got a discount!

$41,816.96

Of which a little less than 80% was paid by our insurance. Which means that in the blink of an eye, in the time it took a gallbladder to go bad, in just 72 hours, we became nearly $9,000 in debt.

It would take me longer to spend that much in Vegas.

Thank god we have insurance. What happens to those who don’t? What if you are poorer than dirt and your gallbladder goes out? How do you pay?

Fifty thousand dollars for a med/surg room.

A room that for at least 24 hours, he shared with three other patients.

With approximately every four hour appearances of an RN.

With 60-90 minute waits for pain medication.

With blatant JACHO violations.

Whose motto in the ER is “HIPAA Go To Hell”, but on the floors lab results were guarded like Guantanamo Bay.

For a man who was totally self care, alert, oriented and ambulatory.

A man who had to ambulate to the nurse’s station to ask for pain meds because no one was answering his light.

******************************

I’m waiting for the itemized hosptial bill to arrive, just to make sure he wasn’t accidentally charged for giving birth to twins.

Here’s how I figure it:

Assume his nurses make an average of $55.00 per hour (not unusual in CA). That would mean his nursing care would have been approximately $3960.

Figure his housekeepers made $25.00/hr. Not likely, but for the sake of argument. That is $1800.

The room, using a moderately priced hotel figure, electricity, water…oh, $125 per day. (Remember, nursing and housekeeping are separate). That is $375.

Figure fifteen dollars per meal (that would factor in the dietary workers and allow for the fact that some of the meals were clear liquid), even though he was NPO for a couple of them. That would be $120.00

I’m up to $6375.

Let’s be generous and give the Diabetic Educator $250 for her one and only visit to the bedside that lasted 30 minutes.

$6625.00

Let’s really go out on a limb and say $50.00 per fingerstick, four times a day. $600.00

$7225.00

Let’s give $10,000 to the OR team (sans doctors).

$17,225.00

And oh, about $3000 for his forty-five minute use of the recovery room and the fact that the nurse was on call.

$20,225.00

And IV fluids….along with the antibiotic he got twice a day. $25.00 per IV bag…he used maybe six liters. $150. Antibiotics twice a day - let’s give ‘em a BIG price, like $500 per dose, six doses, $3000.

$23, 375.00

Let’s allow $2000 for oxygen.

$25,375.00.

Can somebody tell me where the other $25,125.96 went?

He didn’t use that much pain medicine…..

I can tell you where it didn’t go.

To the doctors.

******************************

By the way, the fourteen hours that John was in the ER cost $4725.

It was in addition to the regular hospital bill charges.

Our co-pay was only $50.00.

And it wasn’t waived when he was admitted.

******************************

When the itemized bill does arrive, I’ll let you know how close I was to my estimates.

I suspect I will be waaaaaaay off…….

******************************

Next: How Many Pelvics Does It Take to Diagnose a Hemorrhaging Ovarian Cyst, Anyway?

Takin’ Care of Business

Kim — Tue, 01 Aug 2006 01:59:25 +0000

This is the face of diabetes.

No, actually it’s the face of my husband who has diabetes.

This was taken in Ireland; he’s in an old house/castle.

I assume it wasn’t occupied.

I wasn’t with him because I was in Killarney in an internet cafe.

Hey, internet access points are few and far between in the southwest of Ireland and I had to take advantage of the opportunity provided to me at the time.

Okay, I’m not ashamed, I’ll admit it.

I’m addicted to blogging.

Is that so wrong….

******************************

How can I put this delicately?

There was a period of time after hospital discharge where John needed assistance with meds and blood sugars and each meal was an inservice in what was okay and why.

Frankly, he was waited on hand and foot during recovery.

And he kinda liked it.

I was afraid we were developing a case of PDS: Prima Donna Syndrome.

I nipped it in the bud before it had a chance to sprout.

Actually, John took over responsibility for his diabetes care by the time I had gone back to work. He is doing well and is motivated to the extreme.

******************************

I was stunned when the hospital questionaire came and John didn’t want to fill it out.

I reminded him of the four-bed ward, the waiting an hour (or more) for pain medication. The interminable waits for his bell to be answered, the diet screw-up that postponed his surgery for hours, the HIPPA violations, the JACHO violations - everything I saw and witnessed during the four days he was in the hospital…..

He said he was happy with his care and didn’t want to fill out the form.

Excuse my language, but WTF?

He certainly complained to me during the hospitalization.

They must have given him an amnesiac before discharge.

He said he had some nice nurses, and only a few of them were airheads.

Oh…well that makes up for everything.

Men……..

******************************

With any new change, there is a learning curve and John had a few experiences with learning how diet directly affects blood sugar.

I had gone shopping and bought two types of cereal. Whole grain cereal for John and frosted mini-wheats for the family. But John thought the frosted mini wheats were okay and decided to have a bowl.

Blood sugar a bit later: 195

Okay, as his doctor says, the reason to take a blood sugar is to be able to ask yourself “Why?” if it is out of whack, and then make the appropriate changes.

John thought, because I had bought them, they were okay for him to have.

That led to a discussion on complex vs. simple sugars and why the sugared cereal had that effect on his blood sugar.

Lesson learned and changes made.

Great!

Now, the doctor had said that a good time to check his blood sugar was two hours after dinner. So that’s what John did. It was 209!

What he didn’t realize is that the bowl of cereal (John loves his cereal) 90 minutes after dinner was going to affect the reading! It’s two hours after you eat, not two hour after dinner per se.

Speaking as a nurse, I’m learning a lot about patient education. You can be highly intelligent and still not quite grasp the basics of your illness at first. We’re both learning as we go along.

******************************

I didn’t accompany John to his second doctor’s appointment. He felt comfortable going alone. It was too early for a repeat A1C.

The Lopid had dropped his triglycerides from 288 to 77. I was amazed.

Longer living through chemistry!

John’s cholesterol was under 200, but the ratios were all wrong. The “bad” cholesterol predominated. So….another med, Vytorin was added to the mix.

And then the shocker.

It has always been my impression that when a physician gives you a card that says both “Internal Medicine” and “Endocrinology”, he is an internal medicine doctor who has a specialty in endocrinology.

He acts as an internal medicine doctor who has a special interest/ability for endocrinology patients. My doctor is an internal medicine physician who specializes in pulmonary dysfunction. Now my lungs are perfect, but he acts as my internal medicine doctor.

So at the last visit, Dr Hsu tells John that he has to find an Internal Medicine doctor.

He only does endocrinology.

Pardon my language again, but WTF?

********************************

So we are now in the same position my son was in a month ago.

My doctor no longer takes Blue Cross, although when I was in the last time none of the office staff was aware of that - in fact they were stunned. Couldn’t figure out who told me that.

Every other doctor recommended had an impacted practice and was not open to new patients.

The only doctor in our area who is taking new patients is an absolute jerk of the first magnitude.

I know. I worked with him. He isn’t even a good doctor.

So…I will try my doctor again to verify the Blue Cross problem because he is now taking new patients. I love the guy. But if he is not, we are going to have to go across the bay to find my husband an internist.

Failing that, we’ll start at the top of the yellow pages and work our way through.

It shouldn’t be so hard.

For anybody.

Next up: I’m Just A Bill…..

The Doctor Is In and A Nurse Learns to Watch Her Back

Kim — Mon, 24 Jul 2006 03:40:18 +0000

Ummm…..yeah!

Because those “healthy” men who don’t think they need to see a doctor are probably harboring triglyerides so high the fat in their blood rises to the top of the tube (yes, I just saw it yesterday) or their cholesterol is 6,589 or…..

….they have diabetes.

Afraid of needles?

Grow up.

Afraid of the prostate exam?

Dying of prostate cancer is worse than the rectal exam.

Got the “It can’t happen to me, machismo attitude?”

Get your head out of the pile of sand you buried it it in.

You are not immune from life, aging or disease.

Get a grip. Use that macho man attitude to overcome your fear.

Ask around. Get some referrals.

Make some calls.

See a doctor.

You owe it to your wife, your kids, and your grandkids.

Any Questions?

******************************

John’s first doctor’s appointment was interesting.

Dr. Hsu is quite a character. An internal medicine doctor specializing in metabolic disorders (aka: endocrinologist), he has a great sense of humor.

The first thing he did at the appointment was hand both John and I a pamphlet on Type 2 diabetes and tell us we had ten minutes to read it. When he came back, he’d test us and as a nurse, he expected 100% correct from me!

Instead of lecturing he asks questions.

Here’s a paraphrasing of the first visit.

Dr: Why do you take your blood sugar four times a day?

John: Because the hospitalist said to do it that often.

Dr: But why do you take it?

John: To see how well I’m doing?

Dr: You take your blood sugar to see if you need to make changes in your lifestyle. In your diet. For you, twice a day at random times should be enough. You only take your blood sugar to see if you need to make changes.

I told the doctor that I had gotten all the bad food out of the house and had bought Glucerna shakes and bars and sugar free everything.

Dr: That’s no fun. I’m not a fan of these diabetic products. You eat normal food in controlled portions. I prefer that “real food” be eaten.

Whoa! I thought the whole world would be changing and all we really had to do was eat healthier, exercise and tweak how we were doing by the blood sugar readings.

He set a goal of 110-140 fasting and a two-hour after eating goal of 160.

He increased the metformin to 1000mg and divided the dose into twice a day.

(I know to those who have diabetes, these numbers seem wonderful. John’s A1c was 8.7 so he had been dealing with the diabetes for awhile. He responded well to the metformin, thank goodness.)

He stopped the atenolol. John’s BP was only elevated in the hospital. We were to check his BP twice a day and he gave a prescription for atenolol if we wound up needing it.

Dr. Hsu put much of the decision making on his patients I noticed. Perhaps because I was a nurse. But it seemed to empower his patients. The doctor could advise, the patient could choose to take the advice. John was still a bit confused about it all, but we left with three gazillion pamphlets on diet, cholesterol, eating out, weight loss….

You name it, we had a reference for it.

That day we went home and I signed John up as a member of the American Diabetic Association.

Did you know ETOH increases triglycerides?

I did not know that.

******************************

John picked up on his own care and blood sugars pretty quickly. He’d call me at work to ask questions and get an opinion on how he should handle his blood sugar reading and what would be okay to eat.

I felt comfortable returning to work as John was essentially healed from the gallbladder surgery and was really getting comfortable with the diet.

******************************

How can I put this delicately?

The ER has eyes and ears everywhere and it you say something about someone, it will get back to them.

It got back to me.

******************************

I was informed by a very reliable source when that unflattering things had been said about me while I was gone by co-workers on certain shifts. And that I needed to watch my back because, essentially, these people were not my friends.

Indeed, I had a few people independently tell me the same thing.

And I was told what was said and who said what. So I know who they are.

No, these people are not my friends, they are my co-workers.

I was devastated.

******************************

I did not quit.

I’m a nurse to take care of patients so that is what I decided to focus on.

I work in the best ER on the planet in terms of patient care and in one of the best hospitals I’ve ever known.

The problem is my job went from being a place where I invested every part of me to just a place where I go to work and do my job, do it well, and come home.

Everything seems good on the surface. We joke, laugh, help each other and talk about the same things we always have.

But I know.

I watch my back.

And those stab wounds hurt.

Meanwhile, Back At the Ranch

Kim — Thu, 20 Jul 2006 06:36:47 +0000

Back at a different Starbucks this time as I continue my boycott of Borders

Let me tell you what relaxation is: it’s a wireless connection at Starbucks at dusk with Sam Cooke on the satellite radio.

Sam Cooke absolutely ROCKS. Steve Perry is so like him, vocally.

Now do I sing along or not?

Nah, I’d curl Simon Cowell’s hair with this voice.

(Okay, I’ll admit to a few verses of “Bring It On Home”…)

******************************

When we last left hubby, John, he had just come home from the hospital and we were beginning the life of diabetic and wife.

I was stunned at the learning curve for the Accucheck monitor we bought. It took me an hour to read the directions, lock and load the device and do three practice runs on my own fingers before I was ready to attempt a blood sugar on John.

Then we had to find the right depth of the lancet for John, as you can vary it to get the most blood with the shallowest stick. That took a good three times. We varied from “where’s the hole?” to “I think I’m hemmorhaging!”.

Finally we found that 3.5 was good for him.

I use a machine five times larger and much more complicated at work and it took me less time to learn it.

But the home one doesn’t require every 24 hour “quality assurance” checks and I don’t have to follow JACHO rules! Ha!

******************************

John came home on a Monday night and I knew with my exhaustion and his need for monitoring (he was less than 48 hours post-op), so I called in a day ahead to let work know I would be not coming in Tuesday.

I figure this is important. I’ve missed two twelve-hour shifts already so I figure it is time to apprise my manager of what is going on at home.

Whereupon I was barraged with a vivid description of how stressed everyone was and how burnt out and how badly I was needed and could I at least do four hours.

I was floored. But, teeth grinding, I agreed to four hours.

And then the seething began.

In retrospect, I can’t blame my manager. Our local county hospital nurses had decided to go on strike for a few days so most of the ambulance traffic was coming to us. She had her own stresses she was dealing with. Being a manager can suck sometimes.

But I wasn’t thinking that at the time.

All I could think of was how I had filled in during every emergent, elective and cosmetic surgery my colleagues had over the last 2.5 years, every tendon trauma, every death in a family, and I picked up more than my share of sick calls.

Including calls from co-workers who had, shall we say, exhausted all other ways to get a day off.

But I was expected to suck it up and come in when I needed the support.

Poor, poor pitiful me(<---channeling Warren Zevon here.) Oh yes, I can throw pity parties that make the Oscars look like pre-school picnics!

Luckily, I decided to email my manager and tell her how hurt I was by the attitude. If you let feelings build up, they just fester, in my experience.

My manager got right back to me, said that I had sounded more upbeat on the phone than I felt and not to worry, she had things covered.

Most excellent!

******************************

I’ve always been an American Idol fan, but I never thought it would be a sanity saver!

We watched the show that Tuesday night and I felt like I was transported emotionally. Every care, every worry just lifted into a cloud of endorphin-induced euphoria induced by amateur rock and roll and Simon’s biceps.

And Taylor Hicks!

Oooo baybee, I needed that!

Except….. John normally leaves the house and watches “Idol” at the neighbor’s house because I get, um…..rather vocal during the show.

And if you tell anyone, I’ll deny it, but I cry every week. Especially on Wednesday elimination nights, but I can work up a good one on Tuesdays, too.

So my poor post-op husband was a prisoner in his own bed as I “did my thang” during that week’s American Idol.

My sanity was restored.

I think John needed counseling for a month.

******************************

Two days later, we board a plane to go back to Indiana to see my son graduate from Notre Dame.

It’s a walking campus. You need a major reason to put your car anywhere except the periphery of the university.

John gets the idea that being 4 days post-op is a good reason to get a “handicapped” placard for the rental car.

We still walked a lot, but it was a lot easier on John to walk a bit less so soon after surgery.

(And guess what? We got to see Dave Brubeck get an honorary doctorate…THE Dave Brubeck….the “Take Five” Dave Brubeck. Tres cool!)

******************************

By the time I was ready to go back to work, John was doing his own blood sugars four times a day and we were eating healthier than any time in our marriage.

Even I was losing weight even though I was now eating three meals a day AND snacks.

John now has a body like Mark Spitz (for you young ‘uns: seven Olympic Gold Medals in swimming back in the ’70s).

I still resemble Roseanne.

Hey, I’m workin’ on it!

******************************

Next: Walls Have Ears and Meeting Dr. Hsu, Endocrinologist

“Why, You Don’t LOOK 49!” or Baby, This is What 49 Looks Like!

Kim — Fri, 14 Jul 2006 20:23:28 +0000

I thought I’d take a break from our story to give myself and the rest of my female cohorts a big “high-five”.

You see, today is my birthday - the big 49, and I’m proud of every line, sag, stretch mark and gray hair!

(Okay, I cover the gray hair…I can’t help it, it goes all “twangy” on me if I let it go!)

I was about ten years old when my maternal grandmother was my age and I thought she was as old as Methusela.

It must have been awful to be that old. Back then, all I wanted was to be a teenager.

They had all the fun!

How little I knew.

****************************

I had the good fortune to know both my paternal great-grandmothers. As my Grandma lay in her nursing home, she told my mother that:

“It’s hard, because although my body is so old, in my mind I’m still seventeen.”

I may have been all of five at the time, but I’ve never forgotten that statement.

******************************

So how does it feel to be 49?

Well, I have low-grade back pain about 80% of the time, probably from almost 30 years of being a nurse. And I don’t seem to have the stamina to work 12-hour shifts anymore.

But I still have a passion for rock-and-roll and back pain or not I’ll be screaming and dancing at the Journey and American Idol concerts at the end of August. My iPod is full and I am a huge fan of Matchbox 20, Gwen Stefani, Bo Bice and Kelly Clarkson. In my world the Bee Gees rock and they always will. I am not ashamed of crying when George Harrison and Maurice Gibb died. I’m glad Paul McCartney is available. Unfortunately I am not.

***

I take medication for high blood pressure, high cholesterol, depression, acid reflux and the occasional ibuprofen and muscle relaxer for the back.

But I’ve lost 25 pounds since November 29th, and my blood pressure medication will soon be weaned off. I eat healthier now than I have ever eaten in my life.

***

I lost my father to a heart attack/pulmonary embolism when he was 62 and I was 42.

But I have a wonderful husband (married 27 years) and three great kids of whom I am very proud and two of them will be married next summer.

***

I don’t I have the energy to raise a young child anymore.

But I love kids and look forward to a ton of grandkids to spoil within an inch of their lives. It’s the perogative of a grandparent! I’ve saved all my kids’ toys for when I have grandkids! You are never too old for Candyland and Chutes and Ladders. Who knows, maybe a book I give to one of them will inspire their career as my great-grandmother did for me when she gave me “Cherry Ames, Student Nurse” exactly forty years ago today!

***

I speak my mind and I no longer care who gives a damn!

But I feel like myself for the first time in my life. My opinions matter. What I want matters. I deserve everything life can give me. I am so freakin’ worth it. I no longer need to submerge my needs and wants for those of my family. And conversely, I’ve become more compassionate as I’ve experienced life and loss and helped many people through difficult periods in their lives. Most of them were strangers; every one of them has a place carved in my heart.

***

I believe that MENOPAUSE IS NOT A DIRTY WORD!

Actually, I may want to revisit that within the next few years, but why has a normal phase of life turned into an illness that has to be treated? I’ll embrace it! Why would I not, because it means I’m old and will turned into a dried up old prune? Not this woman.

***

I no longer have any urge to get a Bachelor’s degree and the thought of sitting in a classroom makes me claustrophobic.

But I’ve become a Civil War buff, embraced any and all new technology that Apple can throw at me, read voraciously and finally found an outlet for writiing that I have wanted to do all my life. I have a house full of history books on the US and the middle east (son majored in Arabic and Political Science), religion and politics and Classics that I have yet to peruse and I’m more excited about my daughter’s Advanced Placement US History class than she is! She gets to read “Founding Brothers” - that rocks!

***

I’m a Republican. And conservative.

But I’ve learned that I learn more by listening to those who disagree with me than by trying to make my point to them. I’m interested in concepts that differ from my own. I’ve learned we all want what is best for America, we just have differing ideas on how to accomplish them. One must be flexible. I’ve lived through the JFK assassination, LBJ and Vietnam, Nixon and Vietnam and Watergate, Jimmy Carter’s malaise and Iranian hostages, Reaganomics, Clinton’s extra-marital/presidential activities, 2001 and the War on Terror. I’m sure there are more eras, some better and some worse that we will face. We will make it through. We always do.

***

I don’t dress to impress.

But I also don’t dress in old-lady or baggy clothes and while I have a great midriff (it’s the only part of me that seems to have escaped the ravages of the sun), I can’t bring myself to show it off, as it doesn’t seem appropriate at my age. I may change my mind when I’m fifty, however. My body is mine and I’m proud of every single 65.5 inch of it.

***

And so ladies, from my perspective,that is how it feels to be 49.

And while there are decades of maturity behind me, I still look at the world as though I am seventeen.

Like Great-grandmother, like great-grandaughter.

Hitting the Wall

Kim — Thu, 29 Jun 2006 23:24:56 +0000

Ever feel like this?

The baby can represent anything.

Your family.

Your job.

Your life.

All of the above.

I re-discovered something I had noticed long before.

Life doesn’t stop because you need to stop.

Kids still need driving.

Clothes need washing.

Houses need cleaning and

Suitcases need packing because you are leaving in less than 48 hours and your husband is only two days post op and he can’t lift anything or drive because he’s on Vicodin and arrangements need to be made for your daughter who is running you at 100 mph because she is 16 and that is her slow speed……

I am woman, watch me faint….

******************************

John was discharged that morning but not until we had made the acquaintance of nicest, gregarious women I’ve ever met.

She happened to be John’s hospitalist for discharge.

In the room she was calm, easy-going and encouraged questions, especially from the “secretary” ensconced in the corner with her computer (me).

Outside the room she was running. You would never have guessed that she was so busy.

Bedside manner extraordinaire.

She gave me a couple of duties:

Find out if my doctor would take John as a patient.
Let her know so she could talk to him.

Well, my doctor, having absorbed over 100 patients from my retired doctor’s practice was not taking on new patients. So (light bulb going on over my head), I ask for a referral to an internist/endocrinologist and receive a name.

Great!

I call Dr. Endo’s office and they will accept John if his A1c level meets their criteria. In other words….ya gotta be a REAL diabetic to make his list! John made the list and an appointment was scheduled before the hospitalist left the floor.

Then Dr. God-the-Spitfire Surgeon came in to remove the Jackson-Pratt drain from John’s abdomen. I made the mistake of asking just how far in the tubing went. Remember, it was exiting below the belly-button.

“Well….(you pain in the ass peon in the corner), it was where the gallbladder was.”

Uh…oh, sorry, I should have known that. Please allow me to kiss your shoe coverings as a penance for my ignorance.

Actually, you saved my husband’s life so you can insult me all you want.

About twelve inches.

John blanched.

She pulled.

John yelled.

And this man was a former Marine, so he does NOT complain of pain unless he really feels it.

Said he’d rather go through boot camp again.

That ’bout sums that up!

******************************

We had good news that morning.

First of all, no insulin! John would be managed with Metformin as it seemed he was making insulin but was not able to use it (insulin resistance). He would see his new doctor in three weeks but in the meantime he would check his blood sugar four times a day to get a pattern established.

We could do this!

Not only that, but Elvira (that was really her name) was John’s nurse that morning/afternoon of discharge and she was everything a nurse should be.

Available, efficient, did not rush the discharge but made John stay for his lunch because she had medicated him with insulin and didn’t want to take a chance he would have a reaction at home, even though the MD said he could leave. And she put one more IV antibiotic through the IV before he left because it was up from the pharmacy and he needed it!

There was no arguing with Elvira! You could just feel she was there for her patients, not just going through the motions.

Oh thank the lord, there is hope for my profession yet!

I took the time to grab the Accucheck, the prescriptions and run to the pharmacy for both.

And then I picked up John from the hospital with a wonderful set of discharge instructions from God-the-Spitfire Surgeon.

Impressive.

(Next: The Learning Curve, American Idol and Support from my job…..NOT!)