Tag Archive for hospitals

Hospital Recovery

So once you’ve gotten bad enough and have given into the Dark Side, admitted defeat, or were just plain taken to the hospital against your own will..what happens afterward?  Getting back to normal can be just as hard as the exacerbation which got you there.  In some ways you have to not be stupid and in other ways you just need to be a little smart.  Here are some things I’ve figured out the easy way and hard way.

Stay on top of your meds.  Even though you most likely feel craptastic after getting out of the slammer (aka the hospital) you’re most likely feeling somewhat better because of all those intravenous steroids they pumped into you.  This past Monday I had 350mg of steroids along with an IV magnesium sulfate drip and was hobbling on sunshine for about 12hrs.  They instructed me to nebulize duoneb no fewer than 4x/day and take extra albuterol if needed.  I thought I was doing alright, I even nebbed some albuterol in the lobby while waiting for a ride home to get a jumpstart on things.  Twelve hours later though I was gasping for air, sitting on my bed, and attempting to get some medicine into my airways with Liz threatening to call 911.  Don’t worry, it all ended well, you just gotta stay on top of things.

Use the buddy system.  I just mentioned Liz threatening to call 911.  In a way, it’s her two-edged sword of seeing just how bad I am while also being prepared to get me some help.  I have a major aversion to ambulance rides so this kind of threat will perk up my responsiveness especially if her cell phone is in hand.  Seriously though, make sure someone is checking up on you and that you can readily get a hold of someone if you need to.  If you’re breathing is bad enough, you might not be able to tell a 911 operator what you need and cell phones don’t always easily tell emergency medical services where to find you.

Keep yourself busy.  This may sound easier than it really is, and mental health is a must.  Sometimes I’m awake for days with no end in sight, or just by myself for hours and hours at a time.  Find a hobby, write a blog, watch movies, read books, knit scarves, build models, repair a toaster, or add HBO to your TV line-up and watch all their original series.  Whatever it is that interests you, make sure you have something to do.

Stay active.  Take this one with a grain of salt, but my point is to not become too lethargic and lose what cardiovascular fitness you had before all this started.  I’ve had weeks where I’ve only gotten out of bed for bathroom breaks and showers before.  I understand when you’re pretty limited in your activity.  No matter how bad I am though, I try to make sure I push myself a little every day.  Sometimes that means walking to the mailbox to send those Netflix DVDs back or just sitting on the couch instead of lying in bed.  Sometimes that means cooking a meal and doing my laundry, and some days all I can really accomplish is going to the doctor and then back home.  Just be sure to not lie around all day every day, and have some attainable goals in mind for getting back to the usual stuff.

Find a community.  With any chronic illness, it can be hard to relate to your healthy friends, and it can be hard for your friends to relate to you.  You need to find some friends to complain to, commiserate with, attain advice from, and share your experiences with.  You might check with your doctor’s office, local hospital, or American Lung Association for any support groups.  You might find a group on your social media of choice, or you might even have a group of friends already with whom you can talk.

Don’t be afraid to call your doctor.  I hate going to the hospital and being in the hospital, but it’s even worse if I have to go back.  Similarly to staying on top of your meds, keep an eye on my peakflow numbers, oxygen saturation, when and what medication you’re taking, your general symptoms, and your gut feeling.  Worst case scenario is you’ll call your doctor’s office or the answering service and be told it sounds like you’re ok for now.  The real worst case is you not doing anything and ending up back in the hospital, or lying on the ground in your house trying to crawl to wherever you left one of the 5 inhalers and 3 nebulizers.

What tips do you have?  What has worked for you?  I’m always looking for more tips and tricks to getting back to normal as quickly as possible.

Fall 2013: ER Vist #7

I should note this isn’t my 7th visit for this part of the year, but my seventh 2013 visit.  Things were going ok, until I ran into some snags with environmental triggers and needed to up my prednisone dose temporarily.  That was working pretty well until I dropped from 40mg to 20mg.  I was having increased night time symptoms and my oxygen levels haven’t been in the normal range like they usually are.  Last week I passed out a couple times at home.  I’m just glad it didn’t happen while out and about anywhere.  My weekend was a little rough as usual with most of my time just spent in bed or on the couch.  One of those things I’m almost always asked at work on Monday is how my weekend went, what did I do, what did I accomplish?  I usually give some non-committal answer because who wants to know that I only slept about 10hrs total, laid on the couch for 24hrs and watched 32hrs of television?

Monday was a little rough for me at work.  Liz was thinking maybe I should stay home but I needed to teach that afternoon.  I made it through the class ok but was constantly having to stop and breathe as I wasn’t able to get enough air out while talking.  It’s one of those things that can be hard to explain without having experienced it before.  I guess you could imagine trying to have a conversation while jogging/running too quickly.

Monday night was worse and Tuesday morning even more so.  Once again Liz was questioning my need to go to work and asking if I needed to go to the hospital.  That’s always a sign the inevitable is becoming obvious.  That morning I woke up with peakflows around 50% and my oxygen saturation under 90%.  Getting my morning meds and some albuterol in me usually perks me up, but by the time I was at my desk an hour later I was right back where I had started with my O2 bouncing between 87-92%.  I got another neb going and informed Liz what was happening.  I didn’t improve much at all so within an hour Liz had picked me up and gotten me over to my “Cheers,” aka the local hospital, where everyone knows my name on the night shift.  Even though this was early/mid morning, my nurse was someone I’ve seen several times before and the ER doctor on duty was one who had treated me earlier this summer as well.

I really enjoy working with medical professionals who take the time to listen and read.  This doctor knew I had been in there before and instead of doing the standard gamut of tests and imaging scans wanted to know what I thought would help.  We briefly discussed a few things and minutes later they started an IV with 125mg of salumedrol along with some ativan to try and relax things inside my chest.  On room air I was able to get back up to 95-96% for a while and then it started dipping back down to 90-93%, but it was better than when I arrived.  They eventually let me bounce around lunch time and I was able to spend the rest of the day resting at home.

The original taper for the day, plus the IV drugs and the modified prednisone I took later in the day got me up to about 200mg which isn’t exactly for lightweights.  I really hate the side effects of the drug, but it at least offers significant benefits for me.  Today I’m able to somewhat talk and walk around the house a bit.  I’m not constantly panting or looking for something to grab onto or hold.  Yesterday at work I went to fill a water bottle at the sink and had to find a chair to sit down while the bottle filled.  I don’t feel fine by any means, but I’m at least able to be up and moving around a bit.  Hopefully I can go back to work tomorrow and get a day in before I head back out to PA to follow up with my non-local pulmonologist.

Summer 2013: ER Trip #5

Deciding To Go

This whole past week hasn’t been good with night time PF readings constantly dipping into the 300s.  My daily breathing treatment count slowly climbed to 10 by Thursday and I was once again being seriously asked if I needed to go to the hospital.  Of course I probably should have, but I really didn’t want to and had a case of the asthma-brain influencing my decisions.  I figured I’d go the cheap route and call my doctor yesterday morning to bump up my prednisone taper or something.  An email, I love that some doctor offices let you email them, to my primary care physician resulted in a quick reply that my doctor was not in today and suggested I contact my lung doctor.  While some might think I was blown off, the response was actually quite reasonable.  I still haven’t followed up with my lung doctor since I was hospitalized and they’re the ones that finally got me back on track in July before the drywall dust debacle at work last month.  So I left a message at my pulmonologist’s office, you can never actually get a person on the phone it seems, and waited.  I waited all day long and then ended up back in the ER.

It’s hard to describe, but unless I encounter a severe, unplanned trigger or circumstance – I can tell when I’m going to have a day bad enough to result in an hospital trip.  I kind of had that feeling Thursday and I definitely had that feeling Friday morning.  It’s that whole gut reaction thing.  I hadn’t slept for several days, but did get a couple hours sleep in mid-morning.  The sleep helps, but when you miss a scheduled breathing treatment, I’m not always sure which is worse.  Chuck and Liz got home just after 5 and Chuck really wanted me to play with her.  That’s about the time when the meds stopped keeping the symptoms at bay.  A good friend of ours brought over some amazing chili and corn bread for dinner.  We ate, Liz told me to go take more medicine, we hung out and watched some of The IT Crowd.  I was back into the cycle of PF at 400 or below, neb, get back up to 500ish and then slowly drop back down.  During this time I was noticing my O2 getting to 93, which isn’t bad, but also isn’t good, and when I’d start panting for no good reason I knew I had to keep an eye on things.

Around 11:00PM, PF values were at 350 and below.  I went ahead and told Liz and decided to re-evaluate myself at midnight.  An hour came and went.  I did everything I was supposed to and took all my meds, but my numbers were still the same.  It was time for ER trip #5.

I feel bad for Liz.  Yeah I have all the breathing problems, yeah I go for days without sleeping, yeah I’m on tons of drugs and am always getting stuck with needles – but I do all this while often getting to forget about normal day-to-day life.  Liz still has to go to work and teach, she ends up taking care of Chuck 90% of the time and that’s on top of everything else normal people do and take care of in their daily lives.  So while I’m feeling awful and need a ride to the Emergency Room, Liz, who is already tired, knows she’ll be up until at least 4am, will most likely be wrangling our daughter tomorrow AND has work obligations in the morning.  I think the Coen Brothers’ Nihilists say it best, “it’s not fair!”

Getting Treatment

Another quick PF check clocked me at 320, Liz’s mom came over to watch Chuck and I sloth’d my way to the car with asthma gear in hand.  Thunder had just started on our way out and I wondered how many other asthmatics we’d encounter.  With the high heat, insane ragweed/pollen counts and now a thunderstorm rolling in – I knew us lungers would be out in force.  The trip there was pretty easy since traffic dies way down after midnight.  When we pulled up to the ER entrance there was a less-than-smart citizen smoking a cigarette immediately next to the entrance.  While I would have loved to share my thoughts on all the no-smoking signs staring at the guy, I shuffled as quickly as I could into the building without breathing in the poison.  Before I knew it our friend from registration was telling a guy who I was cause she knows I can’t talk right when coming in.  I scribbled my name on a piece of paper, tried to answer a couple of questions to someone else, and they wheeled me back to a room.  Haley even came back later and got Liz some Subway.  All I have to say is it pays to know people.

Usually I get stalked back to the room by several people but today was the exception.  I lumbered off the wheelchair and onto the bed, was given a gown and the triage person left.  Remember me wondering how many other respiratory patients would be in there today?  Well there were a lot.  Ten minutes go by and someone from radiology showed up with a portable x-ray machine to perform a chest scan.  Liz told her it wasn’t really worth getting an x-ray right now because respiratory hadn’t even started meds yet.  I’ve had this happen before and when my airways are so tight, I can’t really breathe in enough for them to get a good image.  Five or ten minutes later you would have thought I’d just finished a marathon by the amount of sweat rolling off me because breathing can be hard work.  Another PF check showed me now at 260 so I decided to just start a breathing treatment of my own.  It really does pay to carry your own medicine with you.  Half way through my own meds, the room nurse came by assuming respiratory had started their thing from the noise of my nebulizer compressor.  She immediately put in another call to see where they were, got an IV started on the first try (last two trips took 4 pokes each), and set me up with 2L of oxygen.

The respiratory therapists, two this time, came by and were surprised to see me medicating myself.  They hooked me up with a couple duoneb treatments, listened to my lungs several times and relied on Liz for information.  Apparently I was really making their day because the main one announced they should go buy lotto tickets.

  • I knew my baseline, historical and current Peakflow information
  • I brought all my meds as well as had them listed on paper
  • I use a spacer
  • I’m compliant with my medications
  • I write down all meds taken and any circumstances surrounding my breathing
  • I had a fairly good idea of why today required me to come see them

They even asked if I had considered running a seminar on how to be a good asthma patient.  As usual one of the first comments was, “well I’m not really hearing any wheezing,” but they were surprised at how little air I was moving.  Liz quickly informed them of my general symptoms cause she’s awesome.  X-rays came back again to get that chest scan and Liz heard the therapists out in the hallway talking about how I don’t really “seem asthmatic” at first glance but I’m obviously a severe.  The respiratory therapists came back in to give me a 3rd treatment, but wanted my opinion on it since I had done nine in the previous 24 hrs and three more in the past hour.

RT: Here’s the deal, I think you could use another one, but I’m kind of concerned with your heart rate and the side effects.  What do you think?

Me: Let’s hold off for a bit and see what happens.  I’m already moving a lot more air.

After seeing my PF has gotten up to 450, they decide to go ahead and let me hold off for a while.

RT: We’ll check in with your doctor and see what he thinks.  I’d give you more medicine, but they only let me neb you 3x before a doctor gets involved…cause I’m just a lowly respiratory therapist.

Me: Yeah, and I’m just a lowly patient.

The Doctor

My doctor rolled in and right away I could tell there was something different.  On a rare occasion I encounter medical professionals too cool for school who want you to know they have it together.  They’ll say lots of big words, not really let you answer questions and walk out leaving you with more questions than before they arrived.  Dr C was not this kind of doctor, he was actually kind of awesome.  He had obviously looked through all my info.  He knew I had been there 4x prior, he knew I was on all the medications you would normally prescribe, and he knew I wasn’t your average asthmatic.  After discussing my medication, treatment and brief history the conversation quickly turned to something more interesting.

Doctor C: Have you guys by chance heard of RadioLab?

We then discussed that guy who gave himself tapeworms to cure his horrendous allergies and asthma.  While all three of us thought it was great the dude cured himself, Dr C wasn’t exactly endorsing the act of purchasing worms someone has harvested from their own feces.  After we had a good, well as much as I could muster, chuckle about infecting oneself parasites, the topic of conversation quickly switched to my Maxpedition Jumbo Versipack, aka the Asthma Bag.  I don’t know why all the medical people who see it thinks it’s so awesome.  Kind of makes me feel cool just to have it.  Doctor C picked it up and examined it thoroughly.  He really dug my setup.

So what to do…Doctor C was concerned with my O2 levels.  He also asked about other non-standard treatments they sometimes administer to avoid intubating.  My oxygen saturation usually registers pretty high in the 97-98% range.  After I had another breathing treatment and things settled down a bit, Doctor C took me off the nasal cannula to see who everything looked.  I did dip into the 80s briefly, but mostly stayed at or just above 92%, which was the defined line.  I was glad to not get admitted again.  I would guess we probably spent 20 minutes or more talking candidly with the doctor.  At no time was he acting like he needed to be somewhere else or one of his other patients in the ER that night was more important than me.  Interestingly I later popped his name into Facebook and discovered we not only graduated from the same university, we have cool Facebook friends in common.  Small world.

The Aftermath

One great observation the doctor made was when someone like myself is on prednisone, the taper really shouldn’t end until several days AFTER I’m doing well.  I did finally achieve that back in July but then had another setback with the construction dust flare-up.  So my taper’s back up to a “big boy” dose and I’m fairly confident I’ll be ok through the weekend until I can follow-up with my regular doctors.  The salumedrol is probably the most effective medicine I get at the hospital which I cannot give myself at home.  It’s a corticosteroid, similar to prednisone, administered through an IV.  I’ll be good for a couple days on that alone, and the extra oral prednisone should boost me the rest of the way.

This further cements in my mind the need to participate in an asthma research study.  I’m looking forward to beginning SARP III next month.  I’ve also been wondering if I should be nebulizing any other medications.  I’m already taking Spiriva, but maybe something like scheduled DuoNeb treatments supplemented with Albuterol treatments would be more effective?  Definitely something to talk about with the various doctors I’ll be seeing in the next few weeks.

Lastly I must mention the traditional drive through Taco Bell.  The hours of labored breathing can really work up an appetite.  I finally tried one of the new Fiery Doritos Locos Tacos.  The Nacho Cheese variety is pretty decent, but I was really disappointed with the Cool Ranch.  There just isn’t a strong taste to wow me into believing I’m eating an amazing Doritos-Taco Bell food combination.  To be fair Cool Ranch Doritos don’t exactly have an over-powering taste on their own, but I feel it should be stronger when combined with a taco.  The Fiery version takes the cake for me.  It has a big, bold flavor that improves upon the standard Nacho Cheese.

doritos_locos_tacos

Summer 2013: ER Trip #4

Tonight I have a success story because I wasn’t too much of an idiot.

Today was like most days for the past few weeks.  I went to bed early in the morning with a neb to take the edge off only to wake up a few hours later desperately needing more albuterol.  I then spent the rest of my day watching Netflix, taking care of some work stuff and doing more treatments every three hours or less.  Right around 4pm the treatment’s effectiveness seemed drastically reduced and I started dreading the idea of having to go back to the hospital AGAIN being I was just released on Tuesday.

I just wrote that long post on Asthma Acting and decided I better heed some of my own advice for a change.  It was time to get some data and seriously consider the best plan of action.  My oxygen saturation kept dipping down to low 90s and my PF numbers were consistently in the low 400s to mid 300s.  This meant it was time to go.  Granted I was no where near as bad as Sunday, but I could tell I was on the cusp of a hardcore attack if I didn’t nip it in the bud.

Liz asked her mom to come over and hang out while Chuck was sleeping, I packed up my gear and then we headed over to the hospital.  When we pulled up Liz noticed one of her friends was working registration who immediately helped me into a wheelchair and told someone else at the desk my name and info.  That in itself is a HUGE help cause it’s pretty hard to talk when your lungs are only pushing 30% capacity.

They wheeled me back and a nurse got me started on 2L oxygen, hooked me up to a pulse ox and heart monitor, and then attempted to start an IV and take some blood.  Little did I remember she was the one trying to start lines on my right arm just a few days ago.

Nurse: Hey, weren’t you here just a few days ago?

Me: Yeah…

Nurse: Man, you were really freaking us out!

Which actually reminded me of a short conversation with Jeff the nurse when he returned Tuesday morning after the “Josh Incident.”

Jeff: Dude, you were making me really nervous last night.

Me: Dude, I was making MYSELF nervous last night.

It’s true, I’ve seemed to have that effect on people throughout my whole asthma career because I usually wait too long to do something.  This night was totally different.  Instead of five people hovering over me for 2hrs and trying to figure out how to make it stop, we had a much calmer situation with fewer people scurrying around.  Unfortunately it took four tries to get an IV started again because when I can’t breathe my veins like to dive deep like the Red October avoiding depth charges.  I’m just glad they didn’t order any ABGs.

Soon the respiratory tech arrived and I’m sure you can imagine my relief it was not Josh, aka worst medical professional of the decade.  She listened to my lungs, had me create a PF baseline, asked what my personal best is, listened to my lungs, got me started on a double albuterol neb and then got some information out of my little black notebook with follow-up questions to Liz.  This woman was good.  As soon as she saw all my documentation and found out this was my fourth time this summer, immediately after a hospitalization, she knew I was on top of things.  She knew my airways were just hella tight.  She could tell what my cough was doing to everything and when one of the nurses said, “I don’t hear any wheezing,” the respiratory tech responded with, “his airways are too clamped down to even let him wheeze.”

YES!  SOMEONE KNOWS WHAT THEY’RE TALKING ABOUT!

After the double albuterol ended, we followed that up with some pulmicort and solumedrol.  Slowly, ever so slowly things started to open up.  Should I have stayed home?  No.  Was it the right thing to come in? Yes.  Did I avoid a possible re-admittance into the hospital?  Most likely.

So a few hours later we got to leave and I followed tradition by getting some Taco Bell on the way home.  This is also the most healthy I’ve ever been after leaving a hospital.  Even though I’m all jacked up on drugs right now and will be awake for a while, I’m no where near feeling as awful as I usually do.  Take it from me, the guy who freaks out the hospital staff – know your limits and go to the hospital when you’re supposed to.  The only real damage would be the bruises all over my arms from this week.

8 IV lines 2 ABGs 5 Blood draws

8 IV lines
2 ABGs
5 Blood draws

ER Trip #3: Part 3

Part 3: House Arrest

After that harrowing experience last night I luckily bounced back mostly ok due to the salumedrol, regularly scheduled treatments and all my inhaler puffing.  My hospitalist came by again in the morning, with news from my pulmonologist, giving me the option to stay or go home.  As much as I love lying in a high-tech bed having meals and drugs brought to me on a constant basis, I decided to leave.  Their one condition was I’m under “house arrest” and to do as little as possible.

As soon as Jeff, same guy from previous day working another shift, was informed of my discharge he asked for some basic information in case the “customer satisfaction” people needed to contact me about my stay.  I gave him my phone number and Jeff went to find a wheelchair ride for me.  Just as we were about to go one of those customer liaison folks showed up asking me how my stay had been.  Liz and I briefly described the “Josh situation” and praised every other employee we encountered.

So here I am, at home, feeling awful, but awful in my own house.  I didn’t realize how much I wasn’t doing until I came home.  I just need to get up to grab a snack, refill my water, put a DVD into the player or retrieve something in the house.  They weren’t kidding about pretending like I’m still in the hospital.  This is my 5th round of anti-biotics for the summer and who knows how many prednisone tapers.  I’d really like to just kick the sickness for a month and take a break.  In order to do that I’m really going to have to pretend like I’m still lying in that fancy bed.

The good news is that my lungs performed in the hospital the exact same as when I’m at home managing my chronic lung disease on my own.  I was still needing 7-9 breathing treatments a day, my peakflow numbers were still low, my oxygen saturation behaved similarly and this was all under the care of professionals and being given supplemental oxygen.  As usual I get the feeling no one really knows what is going on other than my asthma is really bad again.  I have some follow up visits scheduled with the doctors and I hope I actually show some progress between now and then.  I also found out people are testing positive for Mono at work and others have had colds lingering on for weeks.  There’s no way I’m going back to work to just get sick again – especially if I’m not well.  I went ahead and emailed one of the SARP sites for more information with the hopes of applying.  I think something like this could be awesome for me and very interesting as well as informative.  For now I need to just stop moving around so much and try to get better.

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.

Hospital charge masters

If you’ve ever spent time in an Emergency Room, Emergency Department or have been admitted into a hospital – you’ve probably heard of something called a charge master.  Every time I hear charge masters mentioned, I think of that South Park episodes where they made fun of Mormon history.  There is neither rhyme nor reason as to what hospitals charge.  I think they have several of those 32-sided dice which they roll and then multiply by a magic number.  It’s ludicrous.

If you didn’t notice last week, the federal Centers for Medicare and Medicaid released the amounts hospitals across the nation charge for the 100 most common treatments and procedures.  I’m not sure which is more shocking – the disparity between prices charged by hospitals or the almost impossible task of actually figuring out what those charges are.  This is one of several major issues with the American health care system that is more concerned with making money than treating and healing the sick or promoting wellness.  If only medical emergencies were such that you could decide what is wrong with you, find the most cost effective hospital and then seek treatment.  Many Americans shudder at the thought of everyone moving to Medicare/Medicaid, but at least then everyone would be charged the same, regulated price.