Curbside Consult with Dr. Jayne 3/6/17

Jayne Goes to the Hospital

You may have surmised if you follow my Twitter postings that I recently spent some time in the hospital, but not in a patient care capacity. It was one of those unplanned, middle-of-the-night type of events that no one ever wants to happen to them.

Of course, the chain of events might be different when you’re a physician. You sit at home wondering if you are over-reacting and generally second-guessing yourself. At one point, I found myself in severe pain, wondering if I could hang in there until my urgent care opened at  6 a.m. rather than risking the emergency department during flu season. When those thoughts start to cross your mind, it’s definitely time to go.

Based on my symptoms (including the fact that the pain was so bad I couldn’t bend over to put my own socks on), I had a sneaking suspicion that I was going to end up with surgery, so I grabbed my travel necessity bag and threw it in the back seat of the car. That’s the advantage of being a frequent traveler, but you never want to be that patient who rolls into the triage area with an overnight bag, so I left it in the parking lot, perhaps as wishful thinking.

My worries about being in the ED during flu season were unfounded and I wound up being the only person in the waiting room. Registration was a snap since I had my insurance card and photo ID at the ready, wanting no barriers between myself and some serious pain medication. I had to endure five minutes of bad late-night TV (some dating show involving “baggage” that was truly, truly horrid) and was called back.

There are times when you are sick, especially when you are a healthcare provider, when you wonder if you’re over-reacting to what you fear might be going on. I knew when my blood pressure was in the 160s/100s range with an elevated heart rate that whether or not my brain was over-reacting, my body most certainly had an issue with what was going on.

The ED physician ended up being the spouse of one of my urgent care colleagues, who fully appreciated what it means when a physician rolls into the ED in the middle of the night when they’re supposed to be working that morning.

Tests were ordered and an IV was started. After receiving some pain medication, I very quickly understood why people abuse it. The phrase “magic carpet ride” doesn’t begin to describe what it feels like when you see the privacy curtain flowing to the left and the door jamb scintillating off to the right side of the room.

I was pleased that my pain immediately went from 10 to 2, but even more grateful that my blood pressure and heart rate started moving more towards normal as I rolled off to get my CT scan. Once those results were back, the physician returned to complete a more thorough history and physical to prepare my admission documentation.

This time he had a scribe, or at least who I thought might be a scribe since we weren’t properly introduced. Normally I’d make a point of saying something, but I was still surfing on my cloud of Dilaudid and just wanted to know what the plan was and call my COO so he could find someone to cover my shift that was supposed to start in four hours. I was totally ruminating on that detail because I didn’t want to be “that doctor” who just doesn’t show up.

There was a parade of different nurses through the room. I received some antibiotics and some different pain medication. Then it was off to the inpatient unit to wait for the surgeon to meet me before I was whisked off to the operating room.

I received a room assignment on a brand new wing (confirmed by the new paint smell) and arrived right before shift change. Both the outgoing and incoming nurses were wonderful, explaining everything that was going on and letting me know when my next doses of antibiotics and pain medication were due. The outgoing nurse got a chuckle out of administering my intake questionnaire since I knew the answers to all the race, ethnicity, blood product acceptance, and cultural pain practices questions before she was even done asking them.

I was trussed up with DVT-preventing sequential compression leggings so I didn’t get a blood clot. Thankfully, she showed me how to disconnect myself so I could get to the restroom without having to call for help. I guess there are some benefits to being a physician.

The surgeon came by promptly and said he wanted additional confirmation of the diagnosis in the form of an ultrasound, which was performed immediately at the bedside. You know when you’re in trouble when the ultrasound tech takes a bunch of extra pictures even if you can’t see the screen.

Not more than 20 minutes after the test was done, the nurse came in to announce that they would be coming to take me to the operating room sooner than later. She was followed by a patient care tech bearing a couple of packets of pre-op scrub wipes, who dropped them off with instructions on what to do.

By this time, I had non-medical family at the bedside. They were shocked that the staff would expect the patient to do their own pre-operative prep. I’m no expert on pre-surgical care, but I’m hoping if the patient wasn’t a relatively healthy and mobile person that they would assist a bit.

I went quickly to the operating room after that, rolling out the door while reminding my family where to find the healthcare power of attorney and living will if something went wrong. I didn’t have time to get a copy before then, but you can bet that it’s in my Dropbox now. I had my noon dose of antibiotics in my lap since it would be due while I was downstairs and my nurse didn’t want them to be late.

The weekend operating room staff was excellent. I woke up feeling like no time had passed and with all my teeth still where they belonged. I’ve always been afraid of general anesthesia and having my teeth messed up during the intubation, so it was the first thing I thought of. In hindsight it’s pretty weird, but healthcare people think of all kinds of weird things based on what we’ve seen. I had a happy little pillow from the hospital auxiliary tucked under my blanket to brace myself with in case I had to cough and was back in my room in a flash.

The next shift change signaled a change in the level of care I received. As the nurses rounded together, the incoming nurse commented about me deciding to “self-discontinue” the DVT-prevention leggings. Since I had just come up from the operating room and hadn’t left the bed yet, I had no idea what she was talking about. I still had the leggings on, but it turns out someone removed the controller and inflation tubing from my bed when they took me to the operating area. It didn’t occur to me in my post-anesthesia haze that they weren’t connected to anything. Blaming the patient for a process issue isn’t a good way to start a patient care relationship.

From there, things trended downhill. What I did have was a lovely private room with a (no kidding) 60-inch flat screen television and dietary staffer who personally went through the menu options with me for dinner and breakfast. What I did not have was timely antibiotics and pain medication or consistently visible handwashing or foaming. I also did not have a functional IV access site and had to argue to have it moved when it was oozing enough blood that it was leaking out of the dressing and onto my hospital gown.

It turns out that due to staffing and census issues, my nurse was split between two hallways. What that translated to was feeling like I wasn’t getting good care and that I was last on the list. I know hospitals are busy places and there probably were patients sicker than me, but when I’m on scheduled medications, I’m not giving you more than 15 minutes grace before I ring the call button. I was close enough to the nursing station that I could hear the call signal sounding at the desk when I rang it. I could also hear when it went into “alert mode” because it hadn’t been answered by the first-tier response time. Eventually a patient care tech answered and said she would contact my nurse, who didn’t come in.

This cycle repeated every 15 minutes until my antibiotics finally arrived. The nursing staff was equipped with Vocera two-way communications lavalieres, so there was really no excuse for lack of communications while I waited for my antibiotics to arrive over an hour and 15 minutes late.

Although she was apologetic and said she’d return in 30 minutes as soon as the infusion was over, she did not. That led to another 30 minutes of call light and alarming IV pump nonsense until someone came to the rescue.

By now it was 11 p.m. I was due for scheduled pain medication at midnight, but I was honestly afraid to go to sleep because I knew I couldn’t count on getting medications when they were due without being a call-light stalker. By this point, I wasn’t taking any narcotic pain medications, just scheduled NSAIDs, and I wanted to keep it that way. It’s a terrible thing for a patient to be afraid to sleep for fear they won’t get their meds.

As predicted, they didn’t arrive on time, leading to another 30 minutes of call-light tag before they arrived. She was happy to offer narcotics for breakthrough pain, but if a patient is doing well on scheduled meds and gets them on time, there shouldn’t be any need for breakthrough treatment. Needless to say, we had a few words about the timing of the medications.

I was finally able to sleep for about four hours, although it was restless sleep with the anti-DVT leggings pumping up every 30 seconds despite the fact that I had also received heparin shots for clot prevention and was ambulatory. The phlebotomy started at 5 a.m. I dozed a bit until vitals at 5:30. Surprise, after the last “conversation” with my nurse, my medications arrived promptly at 6 a.m.

I knew there was a good chance I’d be discharged that day, so I decided to wash up, throw on some mascara to look less pathetic, and make arrangements for a getaway car. Many surgeons round early and I was crossing my fingers for that kind of schedule. I was feeling really good, and after my Garmin registered 500 steps in the room and the administration of a second heparin shot, I decided the annoying DVT leggings really could come off.

Back when I was still delivering inpatient care at this hospital, we made a big deal about the discharge day and discharge planning and making sure the patient understood the planned schedule and would be ready to depart at the appropriate time. The primary care physicians were scolded if we rounded after 9 a.m. because that interfered with the 11 a.m. discharges.

Things must have changed because the discharge plan was significantly fluid despite my wishful thinking, lovely eyelashes, and fully dressed status. The dietary team came up to go over the lunch menu around 11 a.m. and I waved them off, saying I didn’t plan to be there for lunch. I was finally released from captivity a little after noon. I went home and immediately went to sleep, waking only when my alarm told me it was time for pain medication.

I’ve been recovering nicely with a steady diet of ibuprofen, Tylenol, and Pepcid. I’d kill for the martini that isn’t on the list of prohibited dietary items, but I’d rather wait until I can really enjoy it. Everything tastes strange, even a week out, and despite the lovely covered dishes that have showed up on my doorstep.

Urgent surgery is a heck of a way to get out of working your scheduled urgent care shift, so I wouldn’t recommend it to anyone. I’m just glad this little adventure in healthcare didn’t happen at HIMSS or on any one of my frequent trips across the country. I’m happy to be doing a little more activity every day, even though the score still stands at Gallbladder 1, Jayne 0.

I’ve mentioned my experience to friends who work in the process excellence realm at the hospital in question, so hopefully some change may come of it. I had to chuckle, though, on Wednesday, when I received a thank you card from the hospital: “It was our pleasure to provide your care throughout your stay with us. Our goal is to always provide you with quality care and excellent service.” Of all the people I interacted with, it was signed by the overnight staff who gave me the most concern about quality.

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