So, as promised, here is how all my medical melodrama began. I warn in advance this will be long and in several parts, but I do think it makes for interesting reading. I’ve tried to really highlight the whole “medical-person-as-patient” experience because while I’ve had this or that done or tested since starting medical school, this was definitely the first “real” full-on patient experience I’ve had, and I was surprised how different (at times surreal) the whole thing could be sometimes. Anyway, here’s how it went down…

I was sitting on the floor in a bedroom at my father-in-law’s, organizing items from a whirlwind of internal spring-cleaning and moving, fresh from having orchestrated our stuff here from Mexico. It had been decided that “home base” for Claudia and daughter would be my FIL’s, and we were doing the necessary work to get that done. I had gotten up and took a few steps when I found the ground slowly giving way, my rib cage and left shoulder becoming one with a chest of drawers (believe me, the furniture got the raw end of the deal) — I felt no pain, just blackness…

…until I heard Claudia yelling my name over and over. I had no idea how long I was out, but it probably wasn’t more than a minute or three. Funnily enough, Claudia didn’t even hear a thud; she just happened to walk in and freaked out (naturally) seeing me on the floor. In spite of the grogginess not having worn completely off, I was strangely confident that I knew what happened and why.

Syncope is not something to treat lightly because it is not uncommonly an indicator of grave problems. In the case of the heart, an arrhythmia or some other cardiac problem means not enough blood gets to the brain (excuse me while I kiss the floor). Neurologically, any number of seizure types can be at play here, as well as other neuro stuff I’d never pretend to understand, but it’s not a good thing, and thank God that’s not I was dealing with. No, it just so happens that a week earlier, I had some bloodwork done and found that my hemoglobin was at an all-time low of 7.6. For the first time, my MCV (cell size) had dropped into the 50s. For the medical types, this clearly indicates a chronic anemia, but what was alarming was how fast the Hgb/Hct had dropped. I had an EGD in Mexico just 4 months prior and my Hgb was 10.2 — what gives? Because of these results, I had some more tests ordered, but they were still out; I also had an appointment to see a hematologist because of several oddities I’ve made mention of here before, but that appointment was 3 weeks away.

I did wind up in the ER that evening and was admitted that same night (good thing it wasn’t the weekend or a Monday!) My presenting Hgb was 7.4 and my ferritin, ran later, was 4. Yes, FOUR. Over the next 24 hours, I had 3 units of packed RBCs put in and another EGD, just to be sure. Of course, the EGD came back negative as before, which means that even it’s time for the other scope. Yes. That one.

But before we go there, here are some random fluffs from the first 36 hours or so:

• Because this was clearly a bleed from somewhere (other hematologic oddities aside), it was determined that I needed a digital rectal test to see if I was bleeding down there. I reiterated that guiac, etc. tests have always been negative and that I had no other lower GI signs, but I wasn’t getting out of this one. I had a great ER nurse, and she said that it was just par for the course. But was it the nurse who did this? Oh no, it was Bruiser Brody, bald-headed, goateed cage match wrestler. To add insult to injury, as he put on gloves, I saw he had tats on his potato fingers. “You’ll feel some pressure,” he said…yeah, at about T11-T12. Jesus Mary and Joseph…I could have predicted the outcome of that exam right then and there. I told my nurse, the one with lithe fingers and small hands, that he didn’t even take me out to dinner first. Fully expecting that to be the 100th time they’ve heard it, I found out later it was the laugh of the night for them. Who knew?
• When blood arrives, apparently everyone goes into military drill mode. I don’t know if it was blood bank person or the charge nurse, but there was this exchange of patient, blood type, serial number, and other relevant data exchanged to my nurse like a challenge-response nuclear drill. “Serial X73413, do you concur?” “Yes, I concur.” I was waiting for them to load the IV pump and turn the keys at the same time to start the drip.
• By the time I made it on the floor it was midnight. I was NPO from the time I was taken back from the ER waiting room, and I was dying for something to drink, perhaps even a sandwich or something light. “NPO for your EGD tomorrow.” Dammit! “Look I just got here and I know it’s just after midnight, but come on–can’t I get sandwich or some soup/crackers–something!?” After checking with the doctor, I was allowed to have clear liquids until 1:00am. Bastards. Then he walks his happy ass in there and takes what Jello I did have away because it was red. WTF? This is an EGD for Christ’s sake, do you expect Jello to still be there 8 hours from now?!?! I was pissed.
• I reported the anesthesiologist who did my EGD because he was upset over some scheduling problems and kept slamming things around. I asked what he’d be using for sedation out of curiosity, and he looks at me over his glasses with this scornful look of, “I could make up a word and you wouldn’t know any better,” but he wound up saying simply, “Propofol.” “Oh, OK, thanks,” I replied, to which he just chuckled, fully expecting me to have no idea what he said. But when the cursing and slamming of things started, that’s when I got pissed and said, “Do we have a problem? Because I’m not comfortable with your managing my case if you can’t even manage whatever it is that’s wrong here.” Completely flabbergasted, he just said, “No, that’s fine,” (mind you, no admission here, just telling me it’s fine) and proceeded to explain how the nurses royally screwed things up, like that was going to make it OK with me. I don’t give a rat’s ass who pissed in his Cheerios or how–his behavior was out of line and was making everyone in the room–including me–uncomfortable. There’s more to this story, but it’s not worth going into any more. I had three more visits to the GI lab, but thankfully that was the last time I saw him. (the sedation went fine, thankfully)
• The GI lab was FREEZING. There’s no need for this. Radiology has six-figure CT scanners, million+ dollar MRI machines, and whatever environment those babies need, they get. They’re pampered, lubed, polished, the GE or Siemens guys coming by to do maintenance just because. Some laptop cart with a fiberoptic snake on it doesn’t need a near-zero environment. You have my asshole GI doc (more on that later) who wants it cold, and the tech whose hand is practically shaking as she’s putting leads on me.
• There is a DEFINITE difference between the day nursing staff and night staff. It’s the A team and the C team. When 7pm rolled around, I dreaded what wicked this way would come. Why a night nurse can’t answer the fucking call button at whatever hour at night when nothing’s going on (and I mean this happened many times, so it wasn’t like that one time another patient was nose-diving) and the day nursing staff was on it almost without exception within a minute? I’d walk a ways down the hall and almost every one of the staff were either gossiping or surfing. One of them was nice and predictably would be surfing on a terminal just outside my door, but he wasn’t my nurse. He always got me whatever little thing I wanted, so I appreciated that and made good with what I had. Whatever works.
• Neurology came by for a consult the morning of my EGD. Neuro doc said he was there because heme doc asked. (my mind can see, “R/O neuro origin” in chart…) Fine. I ask his questions, recognize the mini mental status exam as it was being asked, then he asked me to put my hands in front of me and close my eyes. He did a Romberg with me lying down, how lame is that?! He said he didn’t feel it was neuro in origin, hope things go well for me. Deed done, I think, he got to wet his beak at my trough, happy travels. But no–later that day, someone shows up to take me to do an EEG. Huh?! I asked who ordered it, and it was neuro guy..after saying to me point blank he didn’t think it was neuro in origin. It was a disgusting example of milking it, and I refused unconditionally. For all Happy Hospitalist and others go on ad nauseam about consumers wanting everything for free, providers do their nice bit of raping and pillaging themselves. Dr. Supine Romberg had the audacity to come by the next day and asked why I refused the EEG. That bastard I’m sure billed a patient encounter to come to my room to ask why I challenged his judgment, because he didn’t offer anything else. But it STILL doesn’t end there–two days later, a dietician came by because Neuro Guy ordered it, feeling I needed “weight counseling.” While already on the GI service. What an ass.

Tune in for the next installment in a day or two!