Hospitalia: Bowel Run

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So at long last, this series continues. We left off with a negative EGD and an extremely low Hgb/HCT that was dropping even within these 48 hours. Well, what’s an eager GI doc to do if an EGD is negative? Of course: the colonoscopy. Aside from the unpleasant idea of having a metal snake going against traffic, I was pretty calm, knowing enough from recent experiences that I wouldn’t know any better.

Even though I’ve never had one, I know a few who have, and I knew that a “bowel prep” was involved. This is a nice term that means being forced to take some substance(s) that make you go to the bathroom so much that nothing is left. Literally. As long as you haven’t eaten recently, the upper GI is empty after a few hours unless you have a problem (eg, stricture), so this prep is unique to the lower GI where visualization would obviously be a problem without it.

I already spoke of the less-than-optimal bedside manner of my GI doc, but he outdid himself this day. The sadistic asshole ordered–and I shit thee not:

• 4 doculace (Colace): This is a mild laxative/stool softener. Harmless enough, but why 4?
• 1 bottle (~10oz) magnesium citrate: This is some nasty stuff. It’s fizzy salt water with a metallic-limestone aftertaste. Alone, this would make most people regret they drank it. Cramps and disomfort are par for the course here.
• 10mg x 3 lactulose: OK, here’s where Dr. Fecophilia has just jumped the shark. This order alone would have at least resulted in some violent events. The problem with lactulose is that gas/cramping is massive. Oh, and I was supposed to have already had mag citrate above. When my dad was in end-stage liver failure before his transplant they’d use this stuff for hepatic encephalopathy; it’s a different mechanism for why but the end result GI-wise is the same. I saw what ONE would do to him; I don’t want to imagine 3. Ah, but the best is yet to come…
• 1 gallon Golytely: Perhaps the most ridiculously inappopriately-named product in medicine, one does not “go lightly” at all. No, one does not go gentle–one rages, rages against the power of the ‘lyte. This stuff also has a relative called “NuLitely,” probably because one says, “Nooo! Nooo!” after knowing what it is. It’s not enough you are drinking a laxative in the first place; you are essentially chasing it with a gallon of water. Oh, and you can’t nurse this stuff over hours since the water would be gradually absorbed in the small intestine, enter circulation, and would eventually be peed out instead. No, this stuff has to be imbibed as if one were a pledge at a frat party, slamming one small glass after the other without mercy. This is often used all by itself for surgical bowel preps. What I did to this sadistic bastard to make him use this in concert with the others in his terrible arse-anal is beyond me.

To make this long story short, I refused the Doculace and the lactulose. I had been on a combination of clear liquids and NPO for over 48 hours; this was overkill on a normal day, much less when lime Jell-O was the closest thing to solid food I’d had. The next morning in the GI lab, the doctor came by and asked why I “refused his orders.” I said I thought it was overkill and that I promised I was adequately prepped on what I took. He then lectured me patronizingly on the need to follow directions but stopped short of cancelling the study (as if I’d let that happen w/o a fight).

The actual in-room experience was even more pleasant this time than the EGD: no foul throat spray, no mouthpiece/bridle (to keep from biting the scope) being fitted, just lying on my side when all of a sudden I was sleepy, then I was in the recovery area. That propofol is some dreamy stuff.

[Un]fortunately, the colonoscopy was negative, no signs of bleeding, polyps, erosions, or anything suspicious. Now what?!

Well, that’s for the next post.

Like last time, here are some more tidbits to share:

• I wanted to know all the values of my bloodwork, so I asked to see my chart rather than nickel-and-diming the nurses for individual values (which is all they’d be willing to do). I had to sign a release form authorizing myself to view my chart. My signature had to be witnessed that it was indeed me signing it. For me. And I had to fill in exactly what I would “allow” myself to access (labs only, h/p, etc.) Does this not strike anyone as the height of the absurd? I’d understand if I had to sign something putting a request in writing to appease the hypermeticulous records people, but an authorization?
• Said chart review had to take place with a chaperone. I can understand this–not everyone has a “big picture” view of this document’s importance, and some malcontent nutzoid could have bad intentions. I had 30 minutes with which I could view what I wanted (or what I “allowed” myself earlier, heh), and while I knew someone from cubicle-land would be there, I didn’t expect the Eye of Mordor watching me, just standing there, making sure I didn’t harm The Precious. Never a word, always watching. I would have liked to have browsed more at leisure, but I think it was the whole point was to be made to feel like a voyeur to your own data.
• Nurse: “So they tell me you’re studying to be a doctor.” Me: “Yes, that’s true.” Nurse: “So what’s your major?”
• What’s with medical staff of all varieties barging into the room while knocking?! If you’re going to invade my room space, as is the right of you to do since this is a hospital and not a hotel, don’t make it seem like you’re “respecting” my privacy when you’re fully in the room, door wide open to the hall on the second knock as I’m walking from the bathroom with my gown open. Knock, wait a second or so (at least don’t open the door fully to the hallway), or don’t bother.
• If techs want to wear white coats and stethoscopes (which, as in respiratory techs can be totally part of the job), receptionists want to wear scrubs when they see no patients, and doctors can wear whatever they want, please don’t blame the poor patient not knowing who is who. I made the mistake of thinking my new, un-introduced nurse was a radiology tech and you think I called her mother a slut. (“Did you hear what he said?!”) Hospitals need to impose some basic standards to avoid confusion, and common sense dictates that unless you work in a peds clinic, My Little Pony scrubs will not foster respect or that one is in good hands by any adult patient still conscious.

Next installment: the even longer metal snakes these GI docs have waiting in black suitcases, [un]informed consent, and the past that comes back to haunt you.

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  By Vijay, June 13, 2008 @ 2:05 pm

  Though I know most of the big picture details, your writing fills in the missing bits. And it opens an otherwise closed window into the patient’s view of the US healthcare system for me.
  Great post.
  Eagerly waiting for the next episode.
• 

  By Karl, July 3, 2008 @ 12:57 am

  You forgot the Jevity.

  Really really sucks being a patient.

  My money was on their dicovering some-
  thing with the Colonoscopy…now, this
  is starting to get interesting.

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