Friday, June 1, 2012

Be-pazzled

Day Two of "consultation" with Dr. Paz went differently from Day One. That is to say, it went worse.
I will take some responsibility for being in a peevish mood to start. It was convenient for Doctor Paz to do his rounds at breakfast.
The hospital stay with arbitrarily restricted movements made me understand the boredom of house cats, how every part of the day is an event. The doctor visit should have been separate from a meal, particularly breakfast, which didn’t have much chance of still being warm from the trip from the kitchen to begin with. Instead, Paz arrived right after the food and wanted full attention. Getting medical attention–even the bandage changed–had been difficult enough that it did not seem prudent to ask him to come back later. I have no doubt that being considered more important than food feeds his ego.
The man himself immediately overwhelmed any irritation I had about his timing. I started with a reasonable question that should have been answerable after two days: what type of infection did I have?
He answered, "Well, usually infections like this are..." and he used a $12.00 medical jargon word that meant "multiple sources of bacteria."
I made it clear that I did not care what these things usually are and wanted to know what I had. His response was to ask if I "even" knew what his big word meant.
The arrogant display of God Complex pissed me off. I defined his word for him, pointed out that he had not answered my question, and that my only interpretation was that he did not know.
He said that not all tests had been returned but that the blood culture showed that I did not have a widespread blood infection. His answer to "Why couldn’t you just say that?" was to stare blankly.
He also could not adequately answer my questions about the change in my basic insulin regimen from reliance on time release insulin to total use of only instant-acting regular insulin. He started with generalities about the instant only theories of treatment, but had no answer to the question of why he would make such a change in a patient he had never known. I can and would have readily accepted changes in the amount of insulin, but not a switch in basic regimens.
He basically resorted to manipulation by informing me that if I was not happy with him as my doctor, I could request a change. I told him that I was a proactive and involved patient and that if he could not deal with that, he could assign me to someone else.
I made sure he knew that I expected bandage changes on the infected toe. I had been admitted Friday night and this conversation on Sunday morning had no bandage change in between, I made it clear that the nurses adamantly maintained that they could not do a bandage change without specific orders from a doctor and wanted to know how such a basic thing that was the reasdon for my being in the hospital had been overlooked while less important things like my insulin had been changed.
He resorted back to my options if unhappy with his care.
I was out of patience with the manipulation and the God Complex by then. Fully and completely out of patience. I told him that I had not seen any real care from him and that if his godhood could not deal with patients who asked questions, that he needed to transfer me to someone else and explain the shift to his hospital supervisors, but that I knew he couldn’t do that because "you are not a very honest man."
He walked away from me after that. I know from asking nursing-type staff that he was still officially my doctor but I saw or heard nothing from him for the final 24+ hours of my stay at Sturdy.
My fellow inmate complimented my ability to stand up to a doctor who he agreed had been being cagey in answering questions and wished he could be more like that.
I reminded him that there’s always a cost to being like me.

Wednesday, May 30, 2012

Imprisonment

I must confess that I am not the best patient in general, but that the events at Sturdy specifically made things worse.
Sturdy Hospital seems to have a great reputation among the people I know, although I never asked anyone I know who is more from the Attleboro than Providence area. Sturdy’s good reputation earned specific regard for the emergency room and trauma care.
I had one surge of frustration in the ER Friday night. When I needed to urinate, that simple objective was blocked due to footwear. They didn’t want me moving without the skid-pad socks or something so didn’t want me using a bathroom. I remember having a flare of temper about that simple bodily function becoming a "project." My fever was at a height and I accept full blame for the flare up. Both from my emergency care that night and from the retina reattachment surgery of last January, I have no complaint or criticism of Sturdy Hospital or its employees.
I’ll admit it; sometimes I can be difficult. Throughout the weekend, , I had been poked and bled out continuously. That will sour anyone’s temperament.
Intravenously, I was fed various antibiotic cocktails. It seems the IV monitor sensed emptiness continuously, and the machine made rude, awakening noises.
I was restricted to the bed by the hospital’s fear of a trip-and-fall lawsuit rather than by my disabilities.
So I may very well have been testy by imprisonment and restriction and sleep deprivation. Unfortunately. Justifiable complaints flooded me fast and furiously after those first nudges.
It took an entire day to stop the "nurses" from putting an unwashed urinal bottle on my food table.
By machines, staff or another patient, I was being woken constantly and always either too hot or frigidly cold.
The Charcot foot was back to maximum swelling and pain; this was the probable cause for the toe infection.
I could get answers to no question.
My insulin regiment had been changed, then changed back and the on-duty person clearly did not understand how insulin worked.
Even after constant explanations and instructions at every dose all weekend, the staff could not get the eye drops required post-retina reattachment right; this increased the prednisone that gave me so many other problems.
My blood sugar was being lowered by number management rather than how I felt. This always results , in depression and irritability on biochemical levels.
The final slice to my frayed nerves was the guy down the hall, the one who insisted on drama queen screaming every time the nurses did whatever it was they were doing, any time day or night. His screams were fake, like those of a four year old who screams out for the attention of being potentially hurt rather than because he was hurt.
Maybe my harsh judgment of this other patient was unfair, considering I am both insensitive and have an extremely high pain threshold. But when I called out "Shut up and take it like a man, you wuss!" all the fake cries of "Ouch! Oooh! God damn it, lady!" ceased instantly.
So by the time Dr. Paz interrupted my already cold breakfast on Sunday morning, I was alert to problems because I had seen problems, and of no mind to tolerate further ones....

Monday, May 28, 2012

Feeling an Unseen Presence

Dr. Paz disappeared from my hospital room at Sturdy Hospital that Saturday morning while the prednisone dropped in my eye was making me puke. His inability to find a bedpan for me had proven him pretty useless at the scene anyway.
I did not see him again until Sunday morning, not because of my blindness but because he never came back to finish the conversation or to ask about the sudden and more violent illness. The unsaid implication that astute regular readers may have picked up on is true: NO doctor looked at the infected toe on Saturday.
The toe remained in the same bandage from Friday night to Sunday morning. This seems standard at Sturdy; one of the nurse-type people yelled at my roommate for having changed his own bandage on his wound. He did so because the nurses" had not, and they said they cannot change bandages without a doctor’s specific instructions.
Yis excuse dominated my stay at Sturdy and came off as an excuse for laziness by the staff. I don’t want to call them nurses because I am not sure which were actually nurses, which might be "certified nursing assistants" and which might be volunteer candy stripers. These days there are no differences in uniforms and I would be too blind to probably see the difference anyway.
I was allowed to neither shower nor bathe because they had no doctor orders allowing me too.
My long term insulin regimen of mostly time release insulin bolstered by smaller doses of regular had been completely changed without consultation with me or my GP. This did inexplicably change Saturday night, to further confusion by the "nurses."
I requested whole milk instead of a 1% or 2% because the lower fa milks raise my blood sugar more than whole milk does. That needed doctor’s approval for "cholesterol concerns."
The doctor, presumably, had also disallowed further blankets because of my fever. I could shiver violently and be denied further comfort. On Saturday, while I was afflicted with one of my violent fits of shivers, they told me that they would have to wrap me in a chilling blanket that would have a temperature sensor up my rectum if the fever did not break. I told them to dole out more (and real) aspirin for the fever because the cold blanket thing was not going to happen. When they said the blanket was "doctor’s orders" I told them clearly and sincerely that if such a thing were tried, more than the temperature sensor would end up deep inside someone’s rectum, and it would not be mine.

Saturday, May 26, 2012

Paz-manian Devil

The duty nurse who brought me from emergency to my third floor room at Sturdy Hospital gave me the first warning that I might not hit it off well with Dr. Paz. I had stated clearly that I wanted no resuscitation or mechanical means of being kept alive. The nurse was clear that Paz did not approve of those decisions with people as young as myself. I made it clear that no one else should be making quality of life decisions for me.
Let’s be real here: if I were a blind dog with a lame leg, many compassionate owners would put me down.
Doctor Paz avoided the issue when I brought it up directly to him the next morning. I repeated my wishes clearly. The conversation did not last long for a completely different reason. The prednisone prescribed still for recovery from the retina reattachment surgery gave me one of those sudden, empty-stomach surges of stomach acid. Paz stood by in a useless frozen panic as I asked for a bedpan, He disappeared during the ensuing confusion and I did not see him until the next morning.
I did, however, feel his presence and influence. I hade listed all medications upon arrival, and despite my insulin regimen of 25 units of N and 5 of R, Paz decided to prescribe a course of treatment that completely eliminated the time release insulin in favor of reliance only on the "instant" R at mealtimes. I went more than 24 hours without any time release insulin, and the nurses did not seem to fully understand how the different insulins works or that it is a dangerous to willy nilly change the entire philosophy nod treatment of a diabetic, particularly one whose sugar will be off due the an infection. I asked for time release insulin with each shot they gave at meals.
I got a shot of only time release around 8 PM that Saturday, with a snack of graham crackers and pudding (which doesn’t sound diabetic-recommended to me either) but with NO R Insulin. An hour later, the nurse took my blood sugar yet again and was in an uproar that it was now higher.
They has given me food without any instant insulin when my body contained no residual time release insulin. Of course the snack hit the blood sugar long before the time release insulin had effect. I had to explain this more than three times to a nurse. My hospital roommate understood it long before the nurse did.
For the life of them, the staff was also not able to get my course of eye drops correct over the entire weekend. I was being pumped with various antibiotics and heparin. I had been bed-bound even to the exclusion of a shower or bath even though I was mobile, just slow and blind. I was being poked and bled out in various ways several times per day in different ways. No one could tell me what type of infection I had contracted. It had taken me all day to break the staff of their habit of putting the never-rinsed portable urinal on my food table. The doctor had not returned since that morning, when he had stood by uselessly unable to find a bedpan.
Day Two under his care at Sturdy would be different, but no better.

Thursday, May 24, 2012

Reaching for Godhood

I think it is almost inevitable that most doctors will eventually develop some element of a god complex. Their jobs lends them authority over their patients. Most patients grant the authority automatically, and the unearned power over other people develops automatic assumption of power over other people. The phenomenon also readily overtakes people in other professions where power and authority is granted without the need to be perpetually earned, including judges, police, teachers and parents.
I expect little agreement with this thought, but I think authority figures need to continuously earn and prove the worthiness of their power. When they don’t, you end up with burned out teachers, abusive cops, corrupt judges and Morgan Stanley CEOs who collect multi-million dollar bonuses after losing billions of dollars.
I don’t have much patience for teachers who patronize adults like children I more often want to slap control freak parents in department stores than the children they ride and deride. I do not deal well with doctors who think it is enough to issue orders without thoroughly discussing all aspects of the instructions or prescriptions with their patients. I’ve stayed with a GP who has this problem, though he and I have long since wondered why the other bothers at all. In my mind, it’s a place other than an emergency room to go with a minor emergency. In his mind, I am sure that I have not been a deadbeat even as a self pay patient factors in. I have always been able to manage my GP’s personal level of God complex, in part because he does show some appreciation for my blunt honesty. That honesty has usually manifested as incredulous sneering laughs or open refusals when I have completely disagreed or knew I would be unable to follow through with specific aspects of prescribed treatment.
While in for a massive and sudden toe infection at Sturdy Hospital over the first weekend this May, Dr. Paz realized pretty quickly that he had not acquired a new worshiper.
I had seen problems at Sturdy despite my blindness, so maybe I was looking for other problems. I’ll accept some responsibility for the difficulties without getting into specifics of Doctor Paz’s upset that while he was the most educated, he was not the smartest person in the room that weekend. By the time the problems at the hospital had mounted, I was certainly more than a little cranky.
Why I don’t think I was wrong in the situation: I was arguing on grounds of treatment of care; Dr. Paz was reinforcing his God Complex to someone who wasn’t ever going to be drinking the Kool-Aid.

Tuesday, May 22, 2012

The Smaht Guy

I have to make a statement that I don’t like making. It sounds arrogant, and I do not believe myself better than anyone else when each individual’s strengths and weaknesses are tallied.
I am often–but far from always–the smartest guy in the room.
Intelligence has not gotten me all that far; I have a permanent disconnection to other people in general and this can make it hard to utilize specifically. I have intellectual friends, and friends whose company I greatly love without ever really noticing that they are not what the "smart crowds" call my type." I have low standards: if I enjoy the company and get a few laughs out of time together and the other person is of good character, I make friends without worrying too much about common interests.
I try not to use big words, although guess at times I underestimate how big some might be. Particularly in my time as a property manager, I developed a "Schneider the Super" persona in large part to keep people in my solidly working class neighborhood comfortable in our interactions.
My intelligence is not just empty book smart leaning towards "greater" philosophical leanings. I seldom find people like that top be very practical. The intelligence I have, however, is intuitive, creative and analytical. Those applications lend themselves much more broadly than sheer intellectualism.
This can be a problem for people sometimes. People who think they’re smarter than they are often develop problems with my casual from-the-hip attitude. Those who need to derive a personal sense of superiority from their intelligence often develop problems with me. I’m no better than anyone else, but I am no worse either. I have never had much patience in inflating anyone’s ego, power trip, or God complex.
Usually try to just let the world tun as it may until something I perceive as a problem crosses my personal lines in the sand. I’m not quiet or submissive after that happens.
During my stay at Sturdy Hospital, I was the smartest person in the room for the entire imprisonment. Worse, my movements were restricted because I got labeled as a trip and fall (thus lawsuit) hazard. Add to this that a blind guy, as I have learned, is often considered with the same regard as a piece of furniture in the room.
Blindness is confused with stupidity. When I complained that the portable urinal had not been rinsed out over the entire weekend, the nurse questioned how a blind guy could know that. I heard the pour into the toilet, the flush, and the steps back to my bedside, but never heard any water running or bottle filling or being re-empties. That is not rocket science.
The piss bottle became the foundation of a difficult hospital stay. I definitely got the impression that "my problems were twofold I was smart enough to know what was going on around me, and uncouth enough o question it.
I maintain that I was simply paying attention and taking an active role in my treatment. It turns out–yet again–that doctors don’t like that.

Monday, May 21, 2012

Sturdy as it Goes

I’m planning in shorter posts that deal with the many elements of my sta at Sturdy Hospital. This seems unfair in a way, but the stresses of the increased Charcot foot problems and the infection have stressed me enough that my eyesight has seemed further diminished. It’s easier on me this way.
I ended up at Sturdy because the retina reattachment was done there. The hospital has a good reputation for trauma care and I saw nothing that contradicts that in the OR or the ER.
The actual hospital care, however, warrants public warnings. Maybe that II was there over a weekend left me with exposure to poorer conditions than would be normal during the regular workweek.
My combination of blindness and foot problems got me labeled as a trip and fall hazard, so I was restricted for the duration. I was allowed away from the bed only with assistance and only when I had to take a dump.
I had to pee in a "portable urinal," the hospital’s name for a wide mouth bottle.
I do not see well enough to know if the roommate in the hospital room kept the curtain between our beds drawn, He had a lot of company an they always sounded nearby and unbuffered. Luckily for me, I’m not the type to worry about such niceties.
I had two issues with the urinal, and both set me in a negative light to the entire stay.
First, only one nurse or assistant rinsed the bottle over the entire 3 ½ day stay, and that was only on one occasion. I asked about this and the nurse asked how I know that if I was blind. I had to point out that I could still hear them empty out, flush, and not rinse..
Even worse, the nurses kept returning the unwashed bottle to the tray table I was expected to eat off of. They did this for the last time on the third morning there, which had also been my last day there. I yelled to the nurse about what she had done with the admonishment appropriate to any moronic three-year-old, "WHAT IS WRONG WITH YOU?"