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....

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.

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.

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.

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.

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?"

Charcot Relapse

The prednisone prescribed following the retina reattachment surgery had many bad side effects and a major unknown good one that it reduced about 85% of the Charcot foot swelling. Unfortunately, when I had discontinued the prednisone in hopes of feeling better, the main Charcot symptoms of horrific swelling, elevated foot temperature and old feet odor resurged.
Contrary to statistics on Charcot, I have considerable pain associated with it. Tendon and nerve damage keep things burning and throbbing. Theoretically, Charcot patients are supposed to be some 30 years older than me and have such bad neuropathy that they don’t feel much of anything going on in their feet.
Basically, when the foot swells, circulation that is poor in diabetics to begin with is further reduced. This happened to me despite my attempts to keep the afflicted foot moderately exercised. I have had two disastrous side effects of the swelling.
The first is undeniable bone loss in the ankle. My right leg is visibly shorter than my left and there’s not much expectation that I will ever walk right again. The central bone in my ankle softened, split and rotated; the tibia no longer seats correctly. The heel bone also suffered loss of mass and integrity, mostly in its central area. While the leg is so massively swelled, nutrients cannot reach the center anywhere near as well as they should.
The second result is a constant risk to diabetics but also massively increased risk while the entire leg below the knee was swelled to more than twice its normal size: infection. In a matter of two days, a cut big toe went from being a little red to massively infected with dry gangrene.
I could neither see noir feel the opriblem as it developed, so consider myself very fortunate to have a roommate who has been attentive. The fast moving infection was caught early enough that the infection did not reach the bone. If it had, amputation of the two would have become necessary.
Things are healing well; the stay at Sturdy hospital ended almost two weeks ago, and not without giving me fodder for a few blog posts about what was an almost exclusively unpleasant experience.

Practice Dummies

After writing the post that listed the doctors who have seen for the eye/s, it occurred to me that the three I most recommend–Magdalena G. Krzystolik, Heinrich Krosschell and to a lesser extent Harold Woodcomb –share something that all the other doctors lacked.
The three who did best by me each essentially owned the practice. Krzystolik and Woodcomb are listed first among their associates on their letterhead and in their advertising. Krosschell is his practice.
Now that I have noticed this, I will probably never see a new doctor, for eyes or anything else, who is not the principal doctor within the practice.
When choosing a doctor, I want the head honcho who can make the decisions. I want the one who had ambition enough to branch out on hir own.
What I do NOT want is people like Koch’s Michael O’Brien or the Smiley clown who briefly worked for Woodcomb. They are associates, and thus employees. Any employee in a business needs to be able to rationalize hir salary, and the subordinate doctors in any practice can be under any level of real or imagined pressure to increase their billings. Their financial contribution to the practice may often take precedence over patient care. This is America: healthcare is a business.
This newly realized pattern among the doctors I have seen applies equally well to Paul Arrigg and Deborah K. Schlossman at the Joslin Eye Clinic. The latter demonstrated the worst of paid employees: she tried to leave a paper trail of work that she had not actually fully preformed and was rushing out the door to leave on a Friday. Arrigg strung me along with separately and steeply billed follow-up visits and tests and in-house referrals that generated separate bills, all in preparation for procedures he had no intention of performing.
The near year of treatment with Arrigg allowed my vision to worsen, which all but guaranteed less success with the eventual retina reattachment not performed at Joslin.)  My association with Arrigg ended when I persisted in my interest for the procedures he had outlined.  He then told me I would be better off seeking treatment more local to me in Rhode Island.
I doubt the retina reattachment would have been necessary if O’Brien had not scared me into the PRP laser. I’m sure to have been forgotten in a flow of new paying patients since then, but they took in fees and "earned" their salaries back then. Their mothers ought to be proud.
The employees will always worry about their job first, even above what is best care for the patient. Only the primary owner has the motivation to keep the long term reputation of the practice as a priority.

The Round-up

A major intent of this blog from, the beginning was to share information in the hopes of helping other people avoid some of my mishaps.
The key piece of information that cannot bear repeating enough is that boner pills such as Levitra, Viagra, and Cialis can cause permanent blindness.
The way this blog has been searched and found indicates that my experiences over the last few years almost places an obligation on me to give a less detailed but more thorough review of retina specialists in Rhode Island and New England and eye doctors who practice retina specialties.
My last post hailed Magdalena G. Krzystolik and I can recommend no one above her. Reasons include technical ability, integrity, honest communication with the patient and the fact that she demonstrated more interest in me as a patient than in patient payment. While educated here in the U.S., she was born in Europe and seems to lack American capitalist priority.
The other absolute positive referral should also be listed fist: Heinrich Krosschell. He is not a specialist but a general eye doctor. He himself knows this limit. He can give you general views by his experience but will not hesitate to tell you when a problem is beyond his scope. This honesty over both ego and profiteering earns him a lot of my esteem.
I saw two doctors with Koch Eye Associates. I recommend neither, nor the practice. Michael Negrey gained some points for looking into what could have been a thyroid problem, which others might criticize as unnecessary testing. He loses all regard however, because he has such a God Complex over his patients that he failed to communicate to me about most aspects of the cataract surgery. If I had been given the option of a lense that would have allowed close up vision, I would have a higher quality of life these days. Negrey made those decisions for me without consultation. He also utterly failed to inform me that the cataract procedure posed risk of triggering retinapathy. He failed to inform me of this despite knowing that one of his associates, Dr Michael O’Brien, was performing PRP laser treatments on me in the same time frame. Dr. O’Brien also did not inform me of the serious risk factors of the procedure he performed, including the fact that the procedure is almost guaranteed to cause at least some level of what it is supposed to prevent. O’Brien’s bedside manner was wonderful, but evoked the warnings of smiling at crocodiles. He scared me into the PRP due to the Cialis induced vitreous hemorrhage, despite being told that other retina specialists had willingly forestalled any such treatment after havin done multiple examinations of my eye. He seemed to care only about being a productive employee to Koch’s billing department.
Dr. Harold Woodcomb was one of the retina specialists who thought is safe to wait rather than rushing me into PRP laser. I saw him for a period of years and defected only when disillusioned by his failure to even consider the (documented) possibility that Cialis caused the vitreous hemorrhage. In hindsight, I probably should have stayed under his care rather than roving to people and practices that did more harm than good.
I had been seen once by a Dr. Smiley in Woodcomb’s Providence office. He attempted scare tactics to roll me into immediate PRP surgery. I can find little direct information about him as he seems to have disappeared. He no longer seems affiliated with Woodcomb’s practice and may be the Dr. Smiley working in California, but I am not sure of that.
I submitted to treatment a the Joslin Eye Center in Boston. They charge a lot of money, but no aspect of the care itself seemed to warrant their reputation as "best in the world." Dr. Deborah K. Schlossman barely examined me but added notes to my file that claimed to have informed me about things she never mentioned. Dr. Paul Arrigg seemed much better, but he strung me along for months with plans for procedures that it turned out he had no realistic intention of ever doing. In those months, the retinapathy worsened. If I had the reattachment done sooner, the outcome probably would have been better.
Prior to the hemorrhage, I had trusted my routine specialist care to John Loewenstein at Massachusetts Eye and Ear Infirmary. I sought treatment there also under gullibility of world class reputation and ceased treatment after learning that I had other developing conditions in the eye that Dr. Lowenstein could not have been bothered to indicate to even the slightest degree.
I saw Dr. Arthur Geltzer in Providence in 1998. He was one of many doctors who used the "I do this surgery now or you will be blind in six months" scare tactics to get my money. With the experience of the past few years, I believe more than ever that if I had done the surgery then, I would have been blind in six months and then been told that I waited too long to have the surgery.
Patients need to run from any doctor who uses scare tactics, particularly the six month line.
A search through the blog will lead to more details about my experiences with most of the docs and quacks on the list.