Adventures in defensive medicine
Nearly two weeks ago my right shin began to hurt. I manned up, decided it was only a shin splint, and toughed it out. I chose poorly, for several reasons.
Last Saturday I slipped just a bit on the back stairs and came down hard on my right leg, which objected loudly. After spending the rest of the day on ice and ibuprofen, and not sleeping much at all, I dropped on my PCP Sunday morning.
It was the duty physician--no slouch, one of the founders of the practice--who suggested compartment syndrome. He had me doing more ice, more elevation, and as much Ibuprofen as I could tolerate. If, said he, the leg is still uncomfortable in two days, go directly to the ER.
It was and (reluctantly) I did, not without wondering why we didn't instead try an orthopedist. Emergency Departments always have an element of black comedy about them. In my view they are places to avoid unless one is actually bleeding out, has about six fractures, or both. People with mystery issues should stay away, House notwithstanding.
The sole bit of good luck this visit was that it wasn't very busy when I got there. Dr. S's hint of compartment syndrome was enough to get me through registration and triage fairly quickly. But EDs, like the military, operate on the "hurry up and wait" principle. Having hurried through the first two steps, I waited. I had brief visits with an RN, a PA (who dosed me with Vicodin), and a very young physician, and waited some more. The cubicle TV was set to Dr. Phil, and he was the only doctor over 25 within ten feet of me all day.
The upshot of all this was to send me for ultrasound. Dr. S had already ruled out fracture by palpation, and by the fact that while I could only put weight on the limb with pain, I could put weight on it. I'm not endorsing this Dx, just reporting it. The limb only swelled when I tried to use it. I had been in cold storage for nearly an hour when Doogie Howser saw me, so the swelling was reduced. With all this my position on the triage scale was degrading, and it was some time before the transport person arrived to schlep me to Radiology.
I'm not remarkably tall, but my feet hung over the end of the gurney (cost cutting?). If you've ever made a gurney trip in a hospital, you know that transporters usually open doors by ramming them with the gurney. The prospect didn't appeal, and I tucked my legs up after the first near miss. We did make it to radiology without incident, where I--wait for it--waited some more. I figured by this time that my triage status was worse than that of a dog with a cold nose.
When the rad tech did show up, he was friendly and cooperative, indulging my professional curiosity by angling the ultrasound screen enough for me to watch. We looked, as it happened, he looked in detail everywhere but where the pain centred. Techs aren't supposed to diagnose, but this one said he saw neither clots nor vascular compression. Again, I'm just reporting here. He finished, we shook hands, and he wheeled me to the corridor...to wait for the return trip.
Through much of this, everybody I encountered was worried that I was cold. Actually, the temperature was very pleasant. What I was was bored...and hungry. Wanting to be ready for anything, I hadn't had breakfast. It was midday by this time, and we had arrived at the ED before 9. This got to be a preoccupation, because medical staff with lunch were strolling past the gurney.
The transporter eventually showed up. I hauled in my feet and he wheeled me back to my cubicle: only to find it wasn't mine anymore. There was a moment of confusion, whereupon the nurse said, "take him to 7 1/2."
Room 7 1/2 is, in that ED, a stretch of corridor wall between Room 7 and the john. I took this as a measure of how far my triage status had fallen. Eventually the RN dropped by to say that I was awaiting the radiologist's interpretation. Note the word "wait."
In a perhaps misguided bit of humanity, the staff went out and fetched my wife. "Room 7 1/2" had no chair. She had had breakfast but not lunch, and so was beginning to share my preoccupation.
Located just inside the trauma entry to the ED, "Room 71/2" made up for its lack of amenities with a considerable amount of traffic. One reader has commented elsewhere about the one thing that modern hospitals lack: peace and quiet. He was in a room: try it in a hallway. Actually, I thought it fairly peaceful as hospitals go. Had I not been obliged to carry on domestic conversation, I would have dozed off.
Eventually, the RN showed up with the radiologist's interpretation. I know a little bit about the nuances of medspeak. I observed that the interpretation carefully avoided anything resembling a declarative statement. After six hours in the toils of emergency medicine, the closest thing we had to a diagnosis was my own. Thank you, Einstein. But I was free to go, clutching my Vicodin scrip.
On my health plan, the co-pay for all this theatre is $50. The Vicodin does what Vicodin does best: blunts pain, rather than relieving it, and adds its side effects to the amusements.
We'll figure it out eventually, right? House always does, after four or five false starts. Heh.
Last Saturday I slipped just a bit on the back stairs and came down hard on my right leg, which objected loudly. After spending the rest of the day on ice and ibuprofen, and not sleeping much at all, I dropped on my PCP Sunday morning.
It was the duty physician--no slouch, one of the founders of the practice--who suggested compartment syndrome. He had me doing more ice, more elevation, and as much Ibuprofen as I could tolerate. If, said he, the leg is still uncomfortable in two days, go directly to the ER.
It was and (reluctantly) I did, not without wondering why we didn't instead try an orthopedist. Emergency Departments always have an element of black comedy about them. In my view they are places to avoid unless one is actually bleeding out, has about six fractures, or both. People with mystery issues should stay away, House notwithstanding.
The sole bit of good luck this visit was that it wasn't very busy when I got there. Dr. S's hint of compartment syndrome was enough to get me through registration and triage fairly quickly. But EDs, like the military, operate on the "hurry up and wait" principle. Having hurried through the first two steps, I waited. I had brief visits with an RN, a PA (who dosed me with Vicodin), and a very young physician, and waited some more. The cubicle TV was set to Dr. Phil, and he was the only doctor over 25 within ten feet of me all day.
The upshot of all this was to send me for ultrasound. Dr. S had already ruled out fracture by palpation, and by the fact that while I could only put weight on the limb with pain, I could put weight on it. I'm not endorsing this Dx, just reporting it. The limb only swelled when I tried to use it. I had been in cold storage for nearly an hour when Doogie Howser saw me, so the swelling was reduced. With all this my position on the triage scale was degrading, and it was some time before the transport person arrived to schlep me to Radiology.
I'm not remarkably tall, but my feet hung over the end of the gurney (cost cutting?). If you've ever made a gurney trip in a hospital, you know that transporters usually open doors by ramming them with the gurney. The prospect didn't appeal, and I tucked my legs up after the first near miss. We did make it to radiology without incident, where I--wait for it--waited some more. I figured by this time that my triage status was worse than that of a dog with a cold nose.
When the rad tech did show up, he was friendly and cooperative, indulging my professional curiosity by angling the ultrasound screen enough for me to watch. We looked, as it happened, he looked in detail everywhere but where the pain centred. Techs aren't supposed to diagnose, but this one said he saw neither clots nor vascular compression. Again, I'm just reporting here. He finished, we shook hands, and he wheeled me to the corridor...to wait for the return trip.
Through much of this, everybody I encountered was worried that I was cold. Actually, the temperature was very pleasant. What I was was bored...and hungry. Wanting to be ready for anything, I hadn't had breakfast. It was midday by this time, and we had arrived at the ED before 9. This got to be a preoccupation, because medical staff with lunch were strolling past the gurney.
The transporter eventually showed up. I hauled in my feet and he wheeled me back to my cubicle: only to find it wasn't mine anymore. There was a moment of confusion, whereupon the nurse said, "take him to 7 1/2."
Room 7 1/2 is, in that ED, a stretch of corridor wall between Room 7 and the john. I took this as a measure of how far my triage status had fallen. Eventually the RN dropped by to say that I was awaiting the radiologist's interpretation. Note the word "wait."
In a perhaps misguided bit of humanity, the staff went out and fetched my wife. "Room 7 1/2" had no chair. She had had breakfast but not lunch, and so was beginning to share my preoccupation.
Located just inside the trauma entry to the ED, "Room 71/2" made up for its lack of amenities with a considerable amount of traffic. One reader has commented elsewhere about the one thing that modern hospitals lack: peace and quiet. He was in a room: try it in a hallway. Actually, I thought it fairly peaceful as hospitals go. Had I not been obliged to carry on domestic conversation, I would have dozed off.
Eventually, the RN showed up with the radiologist's interpretation. I know a little bit about the nuances of medspeak. I observed that the interpretation carefully avoided anything resembling a declarative statement. After six hours in the toils of emergency medicine, the closest thing we had to a diagnosis was my own. Thank you, Einstein. But I was free to go, clutching my Vicodin scrip.
On my health plan, the co-pay for all this theatre is $50. The Vicodin does what Vicodin does best: blunts pain, rather than relieving it, and adds its side effects to the amusements.
We'll figure it out eventually, right? House always does, after four or five false starts. Heh.
Labels: emergency room, health care reform, healthcare
posted by Uncle | 13:27
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