Adventures in Healthcare

I feel very fortunate that I’ve never had any serious healthcare needs in my adult life. That said I also have no idea about how that world works, and what the expectations are for everyone involved. Recently I learned a great deal the hard way.

After Memorial Day, I woke up with some swollen glands in my throat and an inability to swallow food comfortably. This was a new one on me. It wasn’t strep, it wasn’t a cold (no congestion), and I didn’t think it was tonsillitis. At first I thought it was just allergies and it may have started as such, but it refused to go away. After staying home a couple of days, I figured I should see a doctor.

Lesson #1. When you need to see a doctor, the lead time for an appointment is about 7 days in New York City. So plan ahead. Make an appointment as soon as you get sick; if you get better, you can always cancel. Also, if you’re totally falling apart at the seams, then tell the receptionist and she can try to move you up. Also, there’s apparently something called “urgent care” that I wasn’t able to investigate.

Anyway, I did not want to wait several days to see a doctor, but the receptionist said they would be taking walk-ins on Thursday. So Thursday morning I walked in. I was told I’d need an appointment, and that maybe I could be squeezed in during the afternoon. This befuddled me to no end. By this point, swallowing food for me was like being punched in the face. I couldn’t swallow without recoiling and stamping my feet. I had been subsisting on soup and tea for days. Not wanting to wait until the afternoon, I went straight to the ER.

Lesson #2. In the ER, nobody trusts you. If you say you’re in pain, and they can’t see it, then you are not taken seriously. The ER physician looked at my mouth and diagnosed me with a common viral infection sore throat and prescribed me 600mg of Ibuprofen every 6 hours. I made the mistake of describing the pain as 6 on a 10 scale when I should have said 9. I was being too objective. The pain itself was bad, but it was the fact that it prevented me from eating or sleeping well that was the real problem. I actually broke down and cried in front of her because I hadn’t been able to sleep or eat well for days because swallowing was so painful. She asked if I had a history of depression.

On Friday, the Ibuprofen wasn’t helping at all. I decided to try steam treatments. I boiled some water, and sat over it with a towel over my head. It felt great. But then so did my roommate’s ice pack. At this point, anything on my face felt great because the entire lower right portion of my face, from neck to ear, was feeling the bulging pressure of my inflamed gland. The left side had managed to heal itself, though. Nevertheless, on Friday night I was sleeping with a pan under my face to catch the drool because to swallow it meant sharp pain that would prevent me from ever sleeping. I slept in hour-long spurts through the night.

Saturday morning I woke up with a mouth that looked like Eddie Murphy in The Nutty Professor, turned inside out. Everything was huge and misshapen. Back to the ER.

Ah, nothing like walking to the ER on a sunny Saturday when your friends are having a fun birthday party and you have tickets to a show that night and you ain’t making it. And a Saturday afternoon ER is not a Thursday morning ER. Saturdays in the ER mean two hours of screaming kids and people even sadder than you.

Lesson #3. If you’re going to the ER, bring a book or two, an iPod, and a change of underwear and shirt, because you never know. Fortunately for me I had all but the last two.

My new ER doc took one look at my mouth and rolled her eyes at Thursday’s diagnosis. She gave me antibiotic shots on the spot. I suspect she was about to send me on my way until I started throwing up into the small cup I had taken for more convenient drooling. I’d started gagging on my own enormous uvula. This accelerated me to the trauma unit.

Lesson #4. If you’ve ever wondered what your uvula is for, it’s for times like this. For most of your life it doesn’t do much, but one day, it steps up to the plate and knocks one out of the park for you. Had it not intervened, I’m sure I’d have had several more days of swollen-face sleeplessness and soup.

A lovely ENT consult was called in and she performed a peritonsillar abscess drainage procedure. It combines the joys of oral surgery with the props from a David Cronenberg film. She needled me some local anesthesia, and sliced open the back of my mouth. She even let me hold the vacuum cleaner to suction it all out! I have the strangest urge to subscribe to Fangoria now.

So I sat in the trauma unit, in post surgical bliss, mouth full of gauze, bin full of you don’t want to know what, for a couple of hours until I asked someone what my status was. Someone asked someone who asked if I could swallow yet. I said no. It was decided that I should stay overnight for observation. About 3-4 people came by to tell me this before someone actually got me a wheelchair and a room assignment. Oh but first I needed to get X-rayed by the guy with the mobile X-ray robot. Oh and I needed an EKG.

By 11 p.m. or so I had a room. My roommate, Mr. Valentin, was watching Beowulf (the cheesy live action one) and snoring like Grendel. I asked the nurse to turn off his TV, which she did. This naturally awakened the sleeping Grendel who demanded his TV be on “because he’s paying for it.” We requested that the volume on the TV be reduced and he grumbled incoherently. Mr. Valentin then asked for a blanket and received one a half hour later, prompting more complaints and accusations that I’ve received special treatment. The nurse offered to move me to another room, and I offered her my undying love.

My new roommate was Anthony. He was much cooler. I slept fairly well. Swallowing was no longer painful, but did require effort.

Waking up the next day, I dutifully ate my breakfast, and the attending physician and my ENT (as well as another ENT, just for extra fun I guess) confirmed that I should be discharged, since I could now swallow my own meds, and no longer require them to be administered intravenously. So I figured someone would come along to unhook my IV, give me a prescription and send me home.

Lunch arrived, no one discharged me. I asked 3-4 people to check on my status. No one got back to me.

Dinner arrived, no one discharged me. By this time the night crew had come on and I unfortunately had to get in their faces because I didn’t sufficiently get in the faces of the day crew. I had stayed awake all day, in yesterday’s underwear mind you (I had managed to take something resembling a shower, and despite being given mouthwash and toothpaste, I was refused a toothbrush), figuring I’d be leaving within the hour. I did not want to have to pay for another night in the hospital when the hospital’s error kept me there.

Curiously, several people came by throughout the day inquiring as to my roommate, Anthony, whose whereabouts were unknown, as he was apparently smart enough to just sneak out of the hospital.

Lesson #5. Only your doctor can discharge you. You will see your doctor only once in a given day, so make it count. Make sure someone writes down the fact that you’re to be discharged and that someone notifies the nurse’s station. Get an estimated time of discharge.

The poor night crew only gets a doctor when there’s an emergency. And nurses and staff aren’t allowed to make decisions, only to follow orders. I eventually realized I had to “refuse treatment” to prevent getting hooked up to another IV bag at 10 p.m.

Fortunately for me that night, there were others in need whose cases I could piggyback on in order to get a doctor’s attention. She wasn’t my doctor, but she told me I could sign an AMA (“against medical advice,” not to be confused with “American Medical Association”) form to discharge myself and she gave me my antibiotics script.

By 1 a.m. I was home safely. I slept like a rock for 12 hours. I dreamt that I was in purgatory with Donald Fagen from Steely Dan. He said all the best jazz musicians were there because they were too hot for heaven but too cool for hell.

Epilogue

Lesson #6. Nurses and hospital staff are the saints and angels of this world. They have to put up with unappreciative patients and doctors, and they have to do it nicely. Our society has reduced them and the healthcare business in general to two fundamental directives:

1. Prevent death.
2. Prevent lawsuits.

The order or importance will vary by person and circumstances. Also, there is apparently no centralized project management in a hospital. I’ve been told that everyone needs to go to the hospital with their own advocate, a friend or relative who can fight for them. This seems whacked. There is no one looking at all the cases and asking questions about status. There are only doctors who have authority and are seldom present, and nurses who are omnipresent but have no authority.

I don’t want to sound overly critical, because doctors and nurses have to constantly adapt to the constant chaos that is human suffering, and they generally do the best job possible. They’re not superheroes and I think a lot of people expect that. A lot of people also expect customer service in a hospital, too, but that’s just not how a hospital works.

And for me this isn’t over. I’ve yet to find out just how much this adventure will cost me and what inevitable complications will arise with my insurance provider. Anybody want to take a bid on this particular showcase?

UPDATE: Jay and Reece asked for the official diagnosis: peritonsillar abscess. According to Wikipedia, it’s also known as “quinsy” and notable people suspected to have died from it include George Washington and Pope Adrian IV.