Tag Archive for ER

ER Trip #3: Part 2

Part 2: The Respiratory Therapist

**After initially writing this, Liz told me some of the timeline was off during my attack.  I’ve modified the times to reflect what Liz wrote down as things were happening.

After I was settled into a room upstairs my nurse was smart enough to ask how long it had been since my last meal.  I had been feeling a little hungry, looked at the clock and realized 14 hours had passed since that slice of left-over pizza.  They offered me graham crackers and a TV dinner, but Liz needed to go pick up my CPAP from home and hit up Taco Bell drive through for me because she’s awesome.

My first respiratory therapist was great.  It turned out he’s REALLY into sci-fi television and movies and there happened to be a Farscape marathon playing.  He took the time to get to know me a bit, got a sense of my asthma history, suggested a few things, etc.  I have a huge list of medications and of course the admitting doctor didn’t order all of them.  They even substituted Advair 250/50 for Dulera 200/10, but I knew the dosage was way too small.  Mr awesome RT just went ahead and fixed that for me in the computer.  When I asked about other medications I’m supposed to be taking I was told all medications legally have to be ordered by the attending physician, brought up from the pharmacy and administered by a nurse.  This is about the time RT #1 closed my curtain and said he’d be back in 10 minutes (wink wink).  Upon returning he also noticed a 3rd ABG had been ordered which would be my third in less than 12 hours.  He wasn’t interested in putting a 3rd hole in my wrist and I wasn’t interested in receiving one so that was also fixed.

My second respiratory therapist hated using the computer system and wasn’t interested in a Stargate vs Battlestar Galactica discussion, but she was had been treating lungers like myself for thirty years so I couldn’t really hold that against her.  She knows how to take care of her patients.  Lorraine talked to us too about all kinds of stuff and made sure I had everything I needed.  Even though I was prescribed treatments every four hours, she was checking up on me every two hours which is when I actually needed them.  Towards the end of her shift I was definitely feeling the need for another boost around 5pm.  I thought they were coming back at 6:00pm, was having some asthma-brain, but they actually weren’t scheduled until 7:00pm.  Asthma-brain is this weird thing where you get a little fuzzy due to the lack of air.  Liz kept telling me to call the nurses and eventually by 5:30pm we had called and were told they could be there by 6:00pm if that was ok.  I agreed, I didn’t think things were that bad, but knew I really needed it by 6:00pm

In the meantime my hospitalist, the physician assigned to you while you’re in the hospital, came by to check on me.  He could easily tell I wasn’t in good shape and wondered where that breathing treatment was.  We told him it was on the way, he put in an order for some salumedrol and then doubled checked my prednisone dosage.

Six o’clock came and went.  By 6:05pm I was starting to enter the serious-respiratory-distress-zone.  Liz inquired again where my medicine was.  The message was “soon,” but respiratory therapist number three, Josh, didn’t show up until around 6:15pm.  At this point in time I was starting the same type of coughing fit which sent me to the ER in the first place.  My airways were constricted allowing no more than 30% capacity in whenever I breathed and that dull/searing pain was surging through my chest like an Etch a Sketch drawing my lung structure.  In my 22 years of officially having asthma, and regularly scaring people with my attacks, this is what I would call a time for action.  Josh walked into the room looking like he was hung over, and proceeded to spend the next five minutes standing in front of the computer while everyone in the hallway could once again hear me breathing.

Liz: “Could you please get him started on that breathing treatment?  He really needs it.”

Josh: “I just got here ten minutes ago…”

Josh continued to meander across the room at a glacial pace, eventually giving me that treatment around 6:30pm.  All this really did was open my airways enough so I could start wheezing which made me cough more, made my lungs hurt more and as a result made my airways constrict more.  If you’ve ever been in ER/hospital situations they ask you about pain levels on a scale of 0 or 1 to 10.  Low end is obviously nothing or very little and 10 would be someone stealing a kidney without first slipping a rufi in your drink.  I was around the 7/10 level, coughing horribly, wheezing in between ragged breaths, as red as a tomato, crying and thrashing about in the bed.  This is when Josh decided his job was done and started slowing walking out the door announcing he’d be back in four hours.  As absurd as this sounded neither of us did anything as he sauntered out.  Liz quickly found my main nurse, Jeff, appraised him of the situation and asked to get Josh back for a follow-up treatment.  Jeff and Jen, the nurses were changing shifts, got him on the phone and were told…

Josh: I’m not allowed to give him anymore medicine.  I can try to ask my supervisor about it I guess.”

…and refused to come back to my room.  Now I know I can’t expect everyone to adhere to the Marine Corp’s motto of not leaving a man behind, but in two decades of receiving treatment in hospitals, emergency rooms, training rooms and doctor’s offices –  I’ve never seen, experienced nor heard of a respiratory therapist walking out of the room while their patient is going into a full-blown asthma attack.  Jeff and Jen were under strict orders to defer any pulmonary issue to the respiratory therapist on duty and at first weren’t sure to do.  So Liz and I basically took over and “suggested” a plan of action.

  1. Liz got my asthma bag, which Jeff and Jen thought was awesome, out of the corner so I could use my own rescue medications.  At this point I didn’t care about the rule and Jeff also said to feel free and take any of my own meds since it was clear Josh couldn’t do his job.
  2. Liz had Jen check on the salumedrol ordered by my hospitalist.
  3. I asked for some tussionex or cough syrup to control this outrageous coughing which doesn’t stop until it’s suppressed.

Six puffs later on my inhaler got my airways to quit closing and traded the thrashing for shaking.  In the meantime Jeff got me back onto 2L of oxygen, you know – one of those things a respiratory therapist might think to do, and talked with my hospitalist about what to do next.  Someone found Josh, made him come give me another breathing treatment, and I eventually got the salumedrol and tussionex.

Jeff and Jen came back in around 6:45pm to check on me and see what was going on.  I could almost sort of talk, and Liz and I proceeded to inform the nurses about Josh’s performance, what happened, what could have happened if I had not used my own meds, and that we didn’t want Josh back in my room.  Neither Jeff nor Jen did anything to defend the guy and were extremely apologetic.  Jeff’s shift was long over and he had to take off so Jen finished up and went out the door to the main desk in the ward where she immediately began ranting to a co-worker about Josh.  I wasn’t the first person to complain about this guy.

Even though I didn’t want to see this slacker’s face again, Josh was the only person available so I still had to receive my breathing treatments from him through 4am.  Every time he came into the room I eyeballed him.  Instead of acting like a sullen teenager he now called me, “sir,” and bookend-ed everything with a please and thank you.  There were times when I did need extra meds in between the scheduled treatments, but I just puffed on my inhaler because I had zero confidence in Josh doing anything correctly.  The guy didn’t know how to properly get a reading from a pulse oximeter and most of the times he tried listening to my lungs his stethoscope was sitting on top of the heart monitor patches.  To be fair Josh was probably nervous and or scared about what had happened, but there’s no reason my well being should be put in that kind of danger while in a hospital.  It was as if he was following an imaginary checklist of what to do and I was presenting a scenario not covered on his how-to-administer-a-breathing-treatment cheat sheet.  Jen kept coming back to check on me and apologized several times for everything that had happened even though none of it was her fault.  I’m just glad I didn’t end up worse than I was after all was said and done.

ER Trip #3: Part 1

Part 1: I asked to go to the hospital

This past weekend was a bit of a bad one for me.  I was asked, “Do you need to go to the hospital” more than usual and for good reasons.  I wasn’t feeling very good at all Sunday morning, and this was even after sleeping for almost 9 hours.  We had planned to go see a movie and I was determined to do it no matter what.  I did a neb treatment, packed up my EDC bag and we headed out the door.  Elysium (2013) was great and I highly recommend seeing it.  Neil Blomkamp really knows how to address social issues.  During the film I opted for some rescue inhaler puffs instead of busting out my nebuilzer and I did another treatment during the credits before leaving.  We went home and I immediately started another treatment.  I know some people’s guts don’t always steer them well, but I tend to know what’s going to happen when my asthma flares up.  This time I knew I was going to end up in the hospital.

As I continued to feel worse I decided to tell my friend, Andy the paramedic, what was going on because he always has a funny way of telling me what to do.  About the same time I was filing Liz in on the situation and told her I probably need to head into the hospital.  I usually avoid going at all costs, but Andy reminded me the longer I wait to go, the longer I end up staying.  Liz got some work stuff together, I packed up all my meds and documentation, and we headed out the door.  I don’t know if it’s all in my head, but whenever I finally decide to get help, it’s like I finally let my body act and react like I’m in respiratory distress.  That 15 minute drive to the hospital always seems to take longer than usually driving to that part of town, and of course the shortness of breath and coughing continued to worsen.

I often hear people complaining about going to the ER or the Emergency Department.  They tell stories about waiting in line to check in at the front desk, sitting in the waiting room for hours to be seen and never quite satisfied with the speed of service or attention to detail.  I’ve never experienced that before, well…maybe once.  As usual I wasn’t even halfway to the desk and someone was rushing to get me a wheelchair.  Liz got them some basic information to get things going and I was immediately wheeled back to a room where four, maybe five, people got to work.  Two people were trying to get an IVs started on my arms and were successful on the fourth attempt with an 18 gauge.  Seems like whenever I’m bad the veins like to hide.  A third person was talking about “bagging me” while getting some neb meds going but fortunately they didn’t end up putting me on a respirator.  They pumped me up with salumedrol and ativan to get things calmed down and gave me cough syrup to try and suppress that horrible dry cough of mine.  As soon as things got slightly better I received my first ABG and then we waited to see what happened.  Once things got under control they ordered a 2nd ABG to compare numbers.  Arterial blood gas tests are when they take blood out of an artery instead of a vein meaning they stick a needle into your wrist and try to not gouge too many nerves.  At least this respiratory therapist knew what she was doing and was quite patient about waiting until she was certain what has happening.

The doctor overseeing me was the same one from our last visit there and she recognized us right away.  I’ve obviously been back in the area long enough because ER staff recognize me again.  She was aware of and remembered my issues – I’m pretty sure that helped get things under control more quickly.  Bloodwork, X-rays, CT scan, etc were ordered.  Around this time a couple of the nurses popped their heads in and said, “Hey – I can’t hear you breathing any more!”  That’s usually a good sign.  The test results all came back as expected.  The X-rays showed no fluid or ambiguous masses and the CT came back with evidence of air trapping and small airway disease.  While I wasn’t nearly quite as bad as when I arrived, things weren’t quite good enough to let me loose after 7 hours and they decided to admit me for observation.

Another ER visit

This summer is truly turning into record breaking asthma for me.  As of today:

  • I have 22 days of prednisone under my belt with another 27 on the way
  • Two courses of anti-biotics
  • Two ER visits
  • Four PCP visits
  • Three Pulmonology visits
  • One Allergist visit
  • About 120 nebulizer treatments

Wednesday was brutal outside.  The temperature hit at least 90F with humidity to add to the heat index.  I know the heat index isn’t “real” but it sure does affect people like myself with pulmonary conditions.  I’ve been trying to figure out a better parking solution at work because the closest lot with my level of parking access is 880 walking yards away.  When I’m feeling ok, that mile of walking every day is great, but I’m not ok right now.  Ironically my doctor wrote a letter asking for a parking accommodation and later that day I ended up in the ER due to an exacerbation from walking around campus.

Trips to the emergency room or emergency department are never enjoyed or wanted.  I fancy myself as “tough,” never think I’m that bad and in the moment usually suffer from “asthma brain” fueled by a lack of oxygen.  It’s good to have someone around to make the decision for you or easily identifiable metrics defined to know when to go.  Walking around outside that day was causing my lungs to ache with every breathe which eventually led to dull, then sharp pain.  Around 6:30pm I’d rank my inhalation pain around 7/10, was shaking uncontrollably and had tears streaming down my face.  And that’s ok cause strong men also cry…right?

Whenever I recount stories like this, they sound ridiculous and of course I would try to force someone else to seek medical attention if they were in my situation.  What I had going through my head that night were things like:

  • There’s no way it can last that much longer
  • I’ve been worse before (it’s true)
  • I’d rather wait to incur more medical costs until after 7/1 when I have more FSA funds to pay for it
  • I’ll be ok

My wife started threatening to call an ambulance, and while I do respect all my paramedic friends, I hate taking ambulance rides.  Eventually I agreed to go if she would drive me, and she did.  I had already done four nebulizer treatments at home that day and by the time I finally went to the ER, my pain had dropped from 7/10 to about 4/10.  With the heat, humidity and thunderstorms, the ER was packed, however, since I’m a bit of a frequent flyer they recognized me when we walked in the door and let me cut in line.  As they were wheeling me to a room I began to notice all the people standing/sitting in the hallways being treated so I was grateful for a bed.  They got started on me right away with the standard tests.  The “asthma” wasn’t bad, I just wanted to punch a wall every time I breathed.

The respiratory tech was a good one that night.  Instead of answering a bunch of questions, I handed over my notebook which is when they start taking me seriously.  I’m basically on high doses of every type of maintenance and rescue medication in addition to the anti-biotics and prednisone I’ve been taking.  The attending physician ordered blood work, a chest xray and the dreaded ABG.  This was the first time a respiratory tech performed a blood gas test on me, usually they bring in a phlebotomist and it goes horribly.  This dude got it right away and I can actually move my wrist – major bonus.

Unsurprisingly they didn’t find anything out of the ordinary, well that is from what’s already known, they got me patched up and sent me home.  They did pump me full of morphine though which really made it easier to breathe.  I’m sure Rick James would tell us it’s one hell of a drug, but that’s a bit rhetorical.  At this point my body is just too tired, stressed and worn out from 6 weeks of asthma and not sleeping.  I need to start seriously looking out for myself the rest of the summer to avoid any more complications.  I sometimes joke about people dying from asthma, but it’s true.  I’m fortunate enough to have a special lady friend looking out for me, a good team of doctors and a boss who is accommodating.  I don’t know how I became so lucky some days.

No one likes a braggart

So I had been slightly over-impressed with myself for making it through this March without any major pulmonary incident.  The Ides of March slipped past with no hemoptysis, and I seemed to be well on my way into the summer of “the worst allergy season ever” without many of the symptoms I keep reading about on Facebook.  I saw my pulmonologist at the beginning of May and things seemed ok.  My lung function was slightly down from last time, but I seemed to be holding my own…and then it started.  The flare up that that required me to inhale 61 nebulizer treatments last month, and take two unsuccessful rounds of prednisone.

I think Rick James says it best – Prednisone is a hell of a drug.

My first course of steroids was five days at 50mg.  That kind of quick punch can usually get me back on track if I’m not too bad.  I started feeling better, but went downhill immediately after.  Round two started as a 15 day taper which got me feeling better on day two only to start getting worse on day three.  Day four ended with a coughing fit on the floor after unsuccessfully attempting to get up off the couch and walk 20 feet after Game of Thrones.

My ever-awesome wife got me over to the preferred hospital in town post haste.  They saw me coming and greeted me with a wheelchair at the check-in counter to immediately get an IV started for salumedrol.  I have to laugh sometimes when I hear people complaining about emergency room visits and waiting hours for treatment.  Whenever I show up, I get the platinum club treatment.  Liz says they had people hovering over me like the time I had pneumonia, the big difference being my oxygen saturation stabilized without too much effort.  I was able to leave after not too many hours, avoided a hospital stay and celebrated with Taco Bell.  My prednisone taper was replaced with a much stronger dose and started some anti-biotics.

Yesterday I started feeling much worse again after all those IV steroids wore off, but was able to keep things under control with the nebulizer.  This morning I followed up with my PCP and the nurse told me I look like shit.  That was followed with, “will you slide your shorts down please,” and a shot of Kenalog into my posterior.  That empowered me to get a lot of work done at home today, but I’m sure I still come off as a crazy person who hasn’t slept for days.

My pulmonologist is out of town, but I have an appointment with his NP later this week.  A buddy of mine asked if I’ve ever thought about getting totally checked out at one of the big pulmonology centers in the country and that’s actually not a bad idea.  Fortunately I really like my lung doc here, he was totally in my corner before we moved and still is now that we’ve moved back.  It often seems like there’s still something not yet diagnosed with all the problems I have.  It’s been a couple years since I really pushed for some answers, I think there are still more out there.

Candy for big kids

Remember way back in the day when you’d go to the doctor and get a sticker, sucker or what have you?  Well about about us big kids?  What do we get?  Tonight I found out what it takes to earn a Taco Bell Beefy Melt Burrito $5 Box.

  • 10 or so puffs on a rescue inhaler
  • 7 nebulizer treatments
  • 1 Z-pack
  • 85mg prednisone
  • a couple muscle relaxers
  • anti-anxiety medicine
  • codeine cough syrup
  • a 4hr coughing fit
  • continually turning purple
  • and my 3rd trip to the ER this year

Is it worth it?