I know myself and how I can be, and how other people see me as difficult. Primarily, I am brutally honest, which contrary to your mother’s lies, is not the best policy. I do not indulge other people’s egos for the sole sake of their egos, and see my life, even as it is now, as something other than clay for shaping by control freaks. My refusal to blend in with the flock of sheep or take that plunge with the other lemmings leaves me vulnerable to other predators.
I respect other people’s opinions and beliefs, but have found that others get upset in various ways when it becomes clear that respecting other opinions and embracing them as my own are two different things. I do alter my thinking and change my mind, but there has to be logical reasons that change the why of my thinking, not the what that is makes up the thoughts.
Those ways that my odd brain works really sums up a great portion of my almost-automatic disagreement with doctors. I can narrow it down to the differences in attitudes with my GP: he looks to maintain a quantity of life, and I would greatly prefer to have a quality of life. This same thing would cover the from-the-gate difficulty with Dr. Paz at Sturdy Hospital. He was opposed to a Do-Not-Resuscitate" order from someone so young. Put ego in the mix where others thinks their beliefs should automatically apply to everybody, and some level of conflict is as inevitable as neuropathy in diabetics.
I think of these quirks in relation to my last day at Sturdy because a "diabetes educator" came to visit me. I visualize some regular readers or people that know me going pale at the thought of the explosive conflict that must have resulted from such a meeting. No conflict occurred.
There is one major aspect to my personal diabetes care in which I am probably (almost certainly) dead wrong about but have and will stubbornly continue my way. The diabetes educator and I discussed this point with disagreement, but we each maintained enough respect for the reasons for each other’s opinions that no conflict arose out of a difference of opinion.
The diabetes educator did not draw out my more stubborn aspects because she at least listened to the me and the reasoning that developed over near 40 years of living with diabetes.
The diabetes educator was much younger than I. She freely admitted that I taught her a few things about how diabetes was handled long before she got into the field, and some things she quietly acknowledged but "they" were not "supposed" to acknowledge to patients. She dispensed advice, not dictates.
She got called away and was one of the few Sturdy staffers to leave my bedside without fuming from the ears. I was looking forward to speaking with her again, but when allowance for discharge came in that Monday afternoon, I did not wait around for tearful goodbyes. I figured Dr. Paz and the staff had a party to begin as soon as I had left the building.
The lack of conflict seems logical: the diabetes educator understood what I consider a basic fact: you cannot tell someone that the sum of their life experiences is wrong.
Wednesday, June 13, 2012
Tuesday, June 12, 2012
Mercy Me!
My co-habitant for my weekend in Sturdy Hospital was imprisoned for an infection of his throat. He worked at a waste water treatment plant, so the staff, as it turned out, had specific concerns about the nature and source of his infection. His doctor–who was not the self-worshiped deity named Paz–was concerned that he might have MRSA. The nurse who told him this in clear hearing of me said she didn’t think that was the case, but that if the doctor was right, they would transfer him to his own room to prevent widespread contagion.
I butted in to ask what that was going to do for me–the guy with a chronic and temperamental illness and an open infection on my big toe who had been trapped in the room with the MRSA for an entire weekend.
The nurse was completely unconcerned about the potential of me catching MRSA from the roommate or its potential to worsen whatever fast-moving, as-yet-unidentified infection that had afflicted me. She told me I had no risk of catching it, but could give no non-contradictory reason why he would have to be segregated to a separate room if he did turn out to have MRSA.
MRSA "mersah" stand for Methicillin-resistant Staphylococcus aureus. It’s a staph infection resistant to the usual antibiotics. Staph bacteria grows on the human body without harm but can go bad if trapped under the skin such as in a boil or ingrown hair or when the body is feeling overloaded with other problems.
Most people "catch" MRSA in hospitals or nursing homes. My concerns were by no means paranoia and I do not understand why my roommate was not sequestered on the doctor’s first suspicion. MRSA is that superbug you leave the hospital with when going in for something more routine. In a setting where the nurse-types are too lazy to rinse urinal bottle, should I believe they are meticulous in sanitizing themselves between patients?
The reverse possibility should have also been considered. At the time of my discharge, the exact nature of my infection had not been determined. How wise was it for the staff to place the roommate in with the surly guy with the unknown and extremely fast-forming toe infection that had gone from being red to gangrenous in two days?
The contagion concern may be the real reason neither of us had our bandages changed in more than a day. It’s certainly easier for the staff to neglect the patients than to thoroughly sanitize every time sanitizing would be called for.
The roommate was also discharged that Monday, and was told specifically that he did not have MRSA. I left without having heard what had afflicted my toe. Only because I was diligent in learning the truth did I finally get results, and not until June 6, a full 30 days after discharge. It was, as was "usually" the case, a combination infection of basic staph and strep. Yes, you can get strep in other areas outside the throat, and even on your toe without having cause to stick your foot in your mouth.
I butted in to ask what that was going to do for me–the guy with a chronic and temperamental illness and an open infection on my big toe who had been trapped in the room with the MRSA for an entire weekend.
The nurse was completely unconcerned about the potential of me catching MRSA from the roommate or its potential to worsen whatever fast-moving, as-yet-unidentified infection that had afflicted me. She told me I had no risk of catching it, but could give no non-contradictory reason why he would have to be segregated to a separate room if he did turn out to have MRSA.
MRSA "mersah" stand for Methicillin-resistant Staphylococcus aureus. It’s a staph infection resistant to the usual antibiotics. Staph bacteria grows on the human body without harm but can go bad if trapped under the skin such as in a boil or ingrown hair or when the body is feeling overloaded with other problems.
Most people "catch" MRSA in hospitals or nursing homes. My concerns were by no means paranoia and I do not understand why my roommate was not sequestered on the doctor’s first suspicion. MRSA is that superbug you leave the hospital with when going in for something more routine. In a setting where the nurse-types are too lazy to rinse urinal bottle, should I believe they are meticulous in sanitizing themselves between patients?
The reverse possibility should have also been considered. At the time of my discharge, the exact nature of my infection had not been determined. How wise was it for the staff to place the roommate in with the surly guy with the unknown and extremely fast-forming toe infection that had gone from being red to gangrenous in two days?
The contagion concern may be the real reason neither of us had our bandages changed in more than a day. It’s certainly easier for the staff to neglect the patients than to thoroughly sanitize every time sanitizing would be called for.
The roommate was also discharged that Monday, and was told specifically that he did not have MRSA. I left without having heard what had afflicted my toe. Only because I was diligent in learning the truth did I finally get results, and not until June 6, a full 30 days after discharge. It was, as was "usually" the case, a combination infection of basic staph and strep. Yes, you can get strep in other areas outside the throat, and even on your toe without having cause to stick your foot in your mouth.
Monday, June 11, 2012
Monday Monday, can't trust that day,
Monday Monday, sometimes it just turns out that way
I will admit to the possibility that I was in difficult mode by then. I try to come across as easy going, but that’s an act I cannot usually maintain for long. This blind guy tends to look for problems once he has seen problems. Sturdy’s staff had provided many to be seen.
First problem: the 4 AM wake up to be poked and prodded. Neither my roommate nor I could get back to sleep that morning. The man-baby was screaming again in his drama queen way, a voice of protest that carried not a hint of actual pain. My routine of calling out belittle commands to "man up, you wimp!" shut him up to the amusement of the nurses and my roommate.
The 4-in-the-f’n-morning wake up demanded of sick, recuperating and in need of rest people became more of an issue when one of the nurse types let it slip that we were woken so the staff could take the end of shift patient vitals. The shift ends at seven.
When questioned about "end of sift," the worker said they don’t have time to do it in the last hour. I asked by what stretch of the imagination could something be considered at the "end" if it did not even fall in the last 25%. She held on to her time constraint excuse and I went into calmly sarcastic conjecture of ill patients prescribed enforced bed rest then woken up at four AM for something by her own admission should be being done at six; that I could hear the staff hanging around the desk idly talking for the last half hour of each shift; and that if she got bedridden with illness I sincerely hoped she would see more consideration at whatever facility she ended up.
I am not a morning person.
In between the wake up and the conversation about shift ending, one of the nurse types emptied the portable urinal from the window sill, again did not rinse it and replaced it to the tray table. My reaction was immediate: "What is wrong with you?!" She did not see the problem, because she had put it where you can find it." I resisted telling her exactly where she could put it in favor of pointing out that if I left it on the window sill I could find the window sill, she did not rinse the bottle, and that I eat off of that table. She began to withdraw, but I loudly insisted that the table be thoroughly cleaned. I suppose that helped make me a difficult patient.
I was not inclined to get better when I heard the big reveal to my roommate: his doctor–who was not the self-worshiped deity named Paz–suspected the nature of his throat infection....
I will admit to the possibility that I was in difficult mode by then. I try to come across as easy going, but that’s an act I cannot usually maintain for long. This blind guy tends to look for problems once he has seen problems. Sturdy’s staff had provided many to be seen.
First problem: the 4 AM wake up to be poked and prodded. Neither my roommate nor I could get back to sleep that morning. The man-baby was screaming again in his drama queen way, a voice of protest that carried not a hint of actual pain. My routine of calling out belittle commands to "man up, you wimp!" shut him up to the amusement of the nurses and my roommate.
The 4-in-the-f’n-morning wake up demanded of sick, recuperating and in need of rest people became more of an issue when one of the nurse types let it slip that we were woken so the staff could take the end of shift patient vitals. The shift ends at seven.
When questioned about "end of sift," the worker said they don’t have time to do it in the last hour. I asked by what stretch of the imagination could something be considered at the "end" if it did not even fall in the last 25%. She held on to her time constraint excuse and I went into calmly sarcastic conjecture of ill patients prescribed enforced bed rest then woken up at four AM for something by her own admission should be being done at six; that I could hear the staff hanging around the desk idly talking for the last half hour of each shift; and that if she got bedridden with illness I sincerely hoped she would see more consideration at whatever facility she ended up.
I am not a morning person.
In between the wake up and the conversation about shift ending, one of the nurse types emptied the portable urinal from the window sill, again did not rinse it and replaced it to the tray table. My reaction was immediate: "What is wrong with you?!" She did not see the problem, because she had put it where you can find it." I resisted telling her exactly where she could put it in favor of pointing out that if I left it on the window sill I could find the window sill, she did not rinse the bottle, and that I eat off of that table. She began to withdraw, but I loudly insisted that the table be thoroughly cleaned. I suppose that helped make me a difficult patient.
I was not inclined to get better when I heard the big reveal to my roommate: his doctor–who was not the self-worshiped deity named Paz–suspected the nature of his throat infection....
Sunday, June 10, 2012
Heparin
Because the staff at Sturdy Memorial Hospital deemed the lame blind guy as a trip and fall hazard to be restricted to the bed, they injected heparin several times a day. This is a sulfur drug intended to prevent blood clots in people kept prone too long, and or have an IV in too long as clots can form at the TV catheter.
One of the nurse types started a conversation on Saturday by remarking that I was not bruising from the heparin at all, even at the stomach injection sites. She explained the heparin in that conversation. I asked if a medication meant to prevent blood clotting could have produced the positive side effect of lower than normal blood pressure. She said it very well could have.
On Sunday, when the bandage from the open and infected foot was finally opened, the previously dry toe abrasion had bled freely for the first time, through a diabetic’s reduced circulation and through the constrictive Charcot foot swelling. I figured the heparin was helping in a number of ways and had no complaints about the side effects.
Side effects of this drug can include fever and chills, which made the whole "cold blanket" debate with the nurses seem pretty sinister on their part, as if they gave a drug with those potential effects to a feverish patient then threatened temperature and anal sensor probing torture for kicks.
The potential side effects of lightheadedness, loss of balance or coordination, sudden weakness and leg numbness seems to make this either the most perfect or absolute worst thing to give someone deemed as a trip and fall hazard.
I am sure that before long, at least some of Sturdy’s staff had been wishing that the side effects of confusion and difficulty speaking or understanding would afflict me. Instead, I stayed sharp minded throughout my imprisonment.
I had no bleeding problems as can be common, including skin discolorations or foreign matter in other bodily fluids. I’m sure some of the staffers were wishing me to bleed due to my constant questions and concerns, which I had no shyness in voicing.
The problem came on the Monday morning when the nursing staff declared they had to draw a lot of blood, not just for the usual rounds of tests but because they had to type me in the event I needed a transfusion. Apparently, my hemoglobin counts and blood volume had fallen. I asked if this was due to the heparin. I thought it was a reasonable question in and of itself, especially considering what the other nurse-type had said two days before. This nurse type became defensive and told me flat out that heparin had no side effects.
I don’t respond well to people who lie to my face. As the next post will relate, that last day at Sturdy started badly and the lying woman just added fuel to the fire of my soul. I not only let her know that I knew she was lying, but questioned if all the blood they had leeched out of me that weekend would have reduced my blood volume, and pointed out that taking "even more than normal" amounts of blood because the blood volume was down is an absolute absurdity.
I was more than she could deal with and she retreated.
Really, in response to my question of the potential heparin connection to the blood volume, she could have said "maybe" or "I’m not sure" and I would have resigned myself to the situation without a confrontation.
Why is it that people who choose to lie react so badly to being called out?
One of the nurse types started a conversation on Saturday by remarking that I was not bruising from the heparin at all, even at the stomach injection sites. She explained the heparin in that conversation. I asked if a medication meant to prevent blood clotting could have produced the positive side effect of lower than normal blood pressure. She said it very well could have.
On Sunday, when the bandage from the open and infected foot was finally opened, the previously dry toe abrasion had bled freely for the first time, through a diabetic’s reduced circulation and through the constrictive Charcot foot swelling. I figured the heparin was helping in a number of ways and had no complaints about the side effects.
Side effects of this drug can include fever and chills, which made the whole "cold blanket" debate with the nurses seem pretty sinister on their part, as if they gave a drug with those potential effects to a feverish patient then threatened temperature and anal sensor probing torture for kicks.
The potential side effects of lightheadedness, loss of balance or coordination, sudden weakness and leg numbness seems to make this either the most perfect or absolute worst thing to give someone deemed as a trip and fall hazard.
I am sure that before long, at least some of Sturdy’s staff had been wishing that the side effects of confusion and difficulty speaking or understanding would afflict me. Instead, I stayed sharp minded throughout my imprisonment.
I had no bleeding problems as can be common, including skin discolorations or foreign matter in other bodily fluids. I’m sure some of the staffers were wishing me to bleed due to my constant questions and concerns, which I had no shyness in voicing.
The problem came on the Monday morning when the nursing staff declared they had to draw a lot of blood, not just for the usual rounds of tests but because they had to type me in the event I needed a transfusion. Apparently, my hemoglobin counts and blood volume had fallen. I asked if this was due to the heparin. I thought it was a reasonable question in and of itself, especially considering what the other nurse-type had said two days before. This nurse type became defensive and told me flat out that heparin had no side effects.
I don’t respond well to people who lie to my face. As the next post will relate, that last day at Sturdy started badly and the lying woman just added fuel to the fire of my soul. I not only let her know that I knew she was lying, but questioned if all the blood they had leeched out of me that weekend would have reduced my blood volume, and pointed out that taking "even more than normal" amounts of blood because the blood volume was down is an absolute absurdity.
I was more than she could deal with and she retreated.
Really, in response to my question of the potential heparin connection to the blood volume, she could have said "maybe" or "I’m not sure" and I would have resigned myself to the situation without a confrontation.
Why is it that people who choose to lie react so badly to being called out?
Wednesday, June 6, 2012
As Heard on TV
I say "heard" and not "seen" because I can no longer really see the TV in any detail. I can’t see it because of the very thing by the very people that was being advertised: PRP laser surgery by Koch Eye Associates.
PRP can cause the very problems it is supposed to prevent. My left eye blindness started with a vitreous hemorrhage triggered by a dose of Cialis. It became permanent blindness in what my current eye doctor called "the most complicated eyes" she had ever seen because Koch Associate Michael O’Brien had scared me into the procedure with the haunting question, "But what if it wasn’t the Cialis?" The hemorrhage happened about 16 hours after I took the Cialis. I don’t believe in coincidence, but got scared of the possibility that I could be wrong.
Peripheral loss was almost immediate. I had my first flashers after the third of six PRP sessions. .Light sensitivity increased and night vision decreased. Over time, the peripheral closed in and floaters–another form of hemorrhage became regular occurrences. Two yeas after the period of PRP sessions, retina reattachment surgery performed by the excellent Dr. Krzystolik of Southeastern New England Retina failed to improve my vision.
I had a vitreous hemorrhage, not a retina problem related to the diabetes. My retina and eye condition were stable. The PRP made it unstable. I would have fully healed from the vitreous hemorrhage and would be able to see if I had not done the PRP laser treatment.
No less than three other doctors over the preceding decades had tried scaring me into PRP with the warning "You will be blind in six months if we do not do this surgery." I think that beyond being the scare tactic that nets patient money, this is the catch all of liabilities for the quacks. If you start to lose your vision to advancing retinapathy after PRP sessions, the doctor can shrug, say sorry, and tell you "You waited too long, so we were too late to prevent it." And from experience, Koch Eye Associates will check on the status of your bill and outstanding payments before you leave.
I find the TV commercial upsetting because it was directly advertising PRP. It was not advertising the importance for diabetics to have regular eye exams. It did not give information about the warning signs of active retinapathy. The ad herds people right for an expensive and profitable procedure that can cause precisely what it is supposed to prevent.
No one at Koch warned me about the risks I had cataract surgery also with Koch in between PRP sessions and no one warned me that the cataract procedure can also trigger retinapathy. Since my last appointment two-plus years ago, no one has ever called to see how I was doing.
One scholarly site had this to say about good ol’ PRP: "Scatter laser photocoagulation has been shown to reduce the risk of severe visual loss from proliferative DR. However, scatter treatment is associated with some decline in visual function. These effects should be studied more extensively and should be considered when comparing pharmacologic treatments for proliferative DR." I don’t think there are many doctors eager to prove the negative effects any further. That could only result in decreasing the profitable business of PRP treatments.
Don’t just take my word for it. Here’s some of the sites I referenced.
http://www.medfusion.net/templates/groups/5500/9575/ericmann-prpfordrp.pdf
http://www.ncbi.nlm.nih.gov/pubmed/17891003
http://www.omicsonline.org/2155-9570/2155-9570-2-149.pdf
This diabetes forum site has mixed reviews and opinions.
http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=19&t=24243
I have no doubt that PRP can be a crucial procedure for some patients, but emphasize that it can be crippling to others. The key strikes me as how stable the patient’s eye is. The best way to determine this is for exams with photographs by the same doctor three to six months apart. If the doctor cannot show you active areas of bleeding in comparing the photographs. You are better off resisting the doctor’s urge to profiteer on your pain and suffering.
The Koch commercial was not pitching exams to diabetics, but the procedure itself. There’s reason for wariness in that.
PRP can cause the very problems it is supposed to prevent. My left eye blindness started with a vitreous hemorrhage triggered by a dose of Cialis. It became permanent blindness in what my current eye doctor called "the most complicated eyes" she had ever seen because Koch Associate Michael O’Brien had scared me into the procedure with the haunting question, "But what if it wasn’t the Cialis?" The hemorrhage happened about 16 hours after I took the Cialis. I don’t believe in coincidence, but got scared of the possibility that I could be wrong.
Peripheral loss was almost immediate. I had my first flashers after the third of six PRP sessions. .Light sensitivity increased and night vision decreased. Over time, the peripheral closed in and floaters–another form of hemorrhage became regular occurrences. Two yeas after the period of PRP sessions, retina reattachment surgery performed by the excellent Dr. Krzystolik of Southeastern New England Retina failed to improve my vision.
I had a vitreous hemorrhage, not a retina problem related to the diabetes. My retina and eye condition were stable. The PRP made it unstable. I would have fully healed from the vitreous hemorrhage and would be able to see if I had not done the PRP laser treatment.
No less than three other doctors over the preceding decades had tried scaring me into PRP with the warning "You will be blind in six months if we do not do this surgery." I think that beyond being the scare tactic that nets patient money, this is the catch all of liabilities for the quacks. If you start to lose your vision to advancing retinapathy after PRP sessions, the doctor can shrug, say sorry, and tell you "You waited too long, so we were too late to prevent it." And from experience, Koch Eye Associates will check on the status of your bill and outstanding payments before you leave.
I find the TV commercial upsetting because it was directly advertising PRP. It was not advertising the importance for diabetics to have regular eye exams. It did not give information about the warning signs of active retinapathy. The ad herds people right for an expensive and profitable procedure that can cause precisely what it is supposed to prevent.
No one at Koch warned me about the risks I had cataract surgery also with Koch in between PRP sessions and no one warned me that the cataract procedure can also trigger retinapathy. Since my last appointment two-plus years ago, no one has ever called to see how I was doing.
One scholarly site had this to say about good ol’ PRP: "Scatter laser photocoagulation has been shown to reduce the risk of severe visual loss from proliferative DR. However, scatter treatment is associated with some decline in visual function. These effects should be studied more extensively and should be considered when comparing pharmacologic treatments for proliferative DR." I don’t think there are many doctors eager to prove the negative effects any further. That could only result in decreasing the profitable business of PRP treatments.
Don’t just take my word for it. Here’s some of the sites I referenced.
http://www.medfusion.net/templates/groups/5500/9575/ericmann-prpfordrp.pdf
http://www.ncbi.nlm.nih.gov/pubmed/17891003
http://www.omicsonline.org/2155-9570/2155-9570-2-149.pdf
This diabetes forum site has mixed reviews and opinions.
http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=19&t=24243
I have no doubt that PRP can be a crucial procedure for some patients, but emphasize that it can be crippling to others. The key strikes me as how stable the patient’s eye is. The best way to determine this is for exams with photographs by the same doctor three to six months apart. If the doctor cannot show you active areas of bleeding in comparing the photographs. You are better off resisting the doctor’s urge to profiteer on your pain and suffering.
The Koch commercial was not pitching exams to diabetics, but the procedure itself. There’s reason for wariness in that.
Monday, June 4, 2012
Toeing the Line
After slinking away from my harsh refusal to indulge his god complex, Dr. Paz did call in a surgeon to look at the infected toe.
The toe had brought me to Sturdy Memorial Hospital, but after the Friday Night ER admission, it seemed to be ignored in deference to my being diabetic, and I am sure that the toe’s condition instigated some finger wagging of "bad diabetic."
As a diabetic, my circulation does not equal a healthy person’s. I know that, and also know that the side effect is pretty inevitable. I apologize if you’re reading about the inevitability for the first time here; your doctor may not have told you for fear that you would surrender to the inevitable and not take care of yourself. If you’re diabetic, know this now: doctors lie.
My diabetes was never as bad as my numbers–A1C peaking at 16–say it should be. But I had developed Charcot Foot, which passed in and out of Phase One twice. The relapse of the massive swelling further reduced my circulation and the infection, in most likelihood, would not have developed without the Charcot.
Dr. Paz had obviously warned the surgeon about what a hole I am, without tempering the situational truth with how Dr. Paz himself had drawn forth my rougher aspects. The surgeon approached me with an attitude, even while I regarded his arrival with relief. Unfortunately, the surgeon, whose name I don’t remember in part because he ended up doing nothing, harbored his own god complex.
The surgeon looked over the toe, which necessitated the first bandage change in a day and a half. He looked over the Charcot foot. In his godly wisdom, he decided he would take the infected skin off the oe, and would probe the massive swelling that was the tendon that runs on the inside of my foot. I readily agreed to the former but refused the latter.
"We have to know if it’s infected," he insisted.
Told him that the non-toe swelling had been previously diagnosed as Charcot foot. His willingness to stick something into the Charcot swelling told me that he did not know much or anything about that. "No offense, I said, "but the Charcot is known for getting infected by well meaning doctors who either culture it or try to mechanically reduce the swelling. If you do that, two months from now, you’ll have forgotten all about me and I will be having my foot amputated. The toe needs care, but you are not going to stick anything into the foot."
He must have been thinking "Paz was right. What a hole." Because he could not do everything he wanted to do, the surgeon left me without doing anything, including replacing the bandage.
A nurse asked me about the incident a short time later. I asked he if she had ever heard of Charcot foot. She said she had "heard of it." I emphasized to her that most medical people, like her, had only heard of it and that the highest incidence of foot loss directly from it was when well meaning doctors broke the skin at the swelling. I had researched it and would minimize those risks myself.
I had been told that Sturdy had no podiatrist on duty that weekend. After the incident with the surgeon, one appeared, Martin Harris of Plainville, Massachusetts.
Dr. Harris cut away infected skin, determined that the infection had not reached the bone, and removed the toenail, which had pretty much detached itself anyway. He rebandaged the foot.
He also told me that I had been 100% right in stopping the surgeon from probing the tendon with the clear prediction, "It probably would have been a lot sooner than two months before they’d have to amputate."
The toe had brought me to Sturdy Memorial Hospital, but after the Friday Night ER admission, it seemed to be ignored in deference to my being diabetic, and I am sure that the toe’s condition instigated some finger wagging of "bad diabetic."
As a diabetic, my circulation does not equal a healthy person’s. I know that, and also know that the side effect is pretty inevitable. I apologize if you’re reading about the inevitability for the first time here; your doctor may not have told you for fear that you would surrender to the inevitable and not take care of yourself. If you’re diabetic, know this now: doctors lie.
My diabetes was never as bad as my numbers–A1C peaking at 16–say it should be. But I had developed Charcot Foot, which passed in and out of Phase One twice. The relapse of the massive swelling further reduced my circulation and the infection, in most likelihood, would not have developed without the Charcot.
Dr. Paz had obviously warned the surgeon about what a hole I am, without tempering the situational truth with how Dr. Paz himself had drawn forth my rougher aspects. The surgeon approached me with an attitude, even while I regarded his arrival with relief. Unfortunately, the surgeon, whose name I don’t remember in part because he ended up doing nothing, harbored his own god complex.
The surgeon looked over the toe, which necessitated the first bandage change in a day and a half. He looked over the Charcot foot. In his godly wisdom, he decided he would take the infected skin off the oe, and would probe the massive swelling that was the tendon that runs on the inside of my foot. I readily agreed to the former but refused the latter.
"We have to know if it’s infected," he insisted.
Told him that the non-toe swelling had been previously diagnosed as Charcot foot. His willingness to stick something into the Charcot swelling told me that he did not know much or anything about that. "No offense, I said, "but the Charcot is known for getting infected by well meaning doctors who either culture it or try to mechanically reduce the swelling. If you do that, two months from now, you’ll have forgotten all about me and I will be having my foot amputated. The toe needs care, but you are not going to stick anything into the foot."
He must have been thinking "Paz was right. What a hole." Because he could not do everything he wanted to do, the surgeon left me without doing anything, including replacing the bandage.
A nurse asked me about the incident a short time later. I asked he if she had ever heard of Charcot foot. She said she had "heard of it." I emphasized to her that most medical people, like her, had only heard of it and that the highest incidence of foot loss directly from it was when well meaning doctors broke the skin at the swelling. I had researched it and would minimize those risks myself.
I had been told that Sturdy had no podiatrist on duty that weekend. After the incident with the surgeon, one appeared, Martin Harris of Plainville, Massachusetts.
Dr. Harris cut away infected skin, determined that the infection had not reached the bone, and removed the toenail, which had pretty much detached itself anyway. He rebandaged the foot.
He also told me that I had been 100% right in stopping the surgeon from probing the tendon with the clear prediction, "It probably would have been a lot sooner than two months before they’d have to amputate."
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.
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.
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