June 16, 2009

Already sleeping, with your Audrey Hepburn updo intact,
pearls clotting at the well of your throat-
I take off my tie but ignore my shoes.
In the morning you tell me we are like
trees who don't lose their leaves.

Yesterday was one of those 'medical suck' days.

WARNING: Personal events diary daylog. Skip now if that bothers you please.

I am dealing with ongoing medical problems, most if not all of which stem from my being overweight. Sleep apnea, GERD, general malaise, joint pain, crappiness. Yeah, like that. Anyway, I was put on some drug a few weeks ago. In the 3.5 weeks since going on that drug, I have gained 22 pounds (compared to gaining 14 pounds over the prior year). I can't prove it's causal, but I haven't changed my eating or activity habits, so, um, yeah. Anyway, this has made the sleep apnea noticeably worse - ironic, since the drug was meant to treat the GERD, a prime cause of the apnea. But in the past couple of weeks, I've been feeling really, really crappy. To the point where my nearly-40-year-old ass has started actually noticing left-side chest pain and shortness of breath.

My primary care doc and the ENT doc dealing with the GERD both told me: In the event you get chest pain or any other thing like that that's worrying, do not pass go, get thee to an ER and let them make sure you're not in trouble, then call us and set up appointments.

So last weekend I couldn't sleep much at all. My breathing was so fucked that if I lay back and tried to sleep, I'd last maybe 5-10 minutes (awake) before sitting up and ripping off the CPAP mask with air panics. So I only slept by being awake long enough that I *couldn't* stay awake, even through breathing discomfort, and then I'd fall asleep for maybe 2-3 hours and wake up with my left chest and shoulder feeling like somebody had danced a rhumba on them, in a cold sweat.

Monday morning, I fell asleep at 6am and woke at 8am after having issues the night before, some of which I bitched about in the catbox, with my left chest feeling *really bad*. So I figured 'fuck it' and walked the six blocks to the nearest emergency room at one of the Columbia Presbyterian pavilions here in Manhattan.

I entered the ER at approximately 11:30am (I dithered a while first, yeah). Signed in. Waited 40 minutes. Got called back. Filled out more paperwork. Waiting 30 minutes. Got called into triage, had my blood pressure and blood-ox and pulse and temp taken. BP was 137/74, blood oxygen was 99%. That was reassuring; seemed unlikely I was having imminent heart problems.

They seemed to think so too. Waited another 30 mins, then was sent into the ER to sit in another chair for 2 hours. Then I got an EKG. This is something like 4 hours after arriving. Medtech takes the EKG, directs me back to the chair in the ER. Still haven't seen a doctor (or even a nurse, which would've been fine with me). Wait another hour. Get my BP/pulse/temp taken again. BP is 141/71. Blood Ox still 99%. Temp is 98.9. Get directed...you guessed it...back to the chair.

At around 6pm, I gave up and asked the staff what the process was for checking myself off that particular merry-go-round. They said that because I hadn't yet seen a doctor, I could just walk out, no billing or checkout process needed.

So I did. I was feeling better (probably because I'd been sitting in one place quietly and because the pain was mostly from muscles and hypoxia incidents during the night, whereas I'd been breathing OK while awake). Also, I knew that they would probably look at the data from the BP and EKG and say 'you're not having a heart attack. Make an appointment with your doctor. NEXT!'

I can't say I'm really upset - given that they apparently decided I was not in any immediate trouble, I *expect* to have been triaged low. What pisses me off is that that's all I wanted to know - i.e. 'am I having a heart attack or angina pains now, or can this wait a couple days until a cardiologist can see me.' At no point was I even told who I was waiting for, or what my status was. It wasn't until I went to talk to the staff at 6pm did they say 'Well, you're next to see the doctor...' If they had even said "This is a bad day, so there is an expected wait of 6 hours because you've been triaged as very low risk" I would have been perfectly satisfied with that answer - and been able to decide to leave, having gotten the information I wanted.

So instead, I wasted an entire day to return home feeling still crappy, knowing only that I'd probably make it the few days until my cardiologist can see me without undue risk.

This is one of the myriad reasons I hate the American medical 'system.' I hate calling it a system, because a system implies something that follows internally consistent rules and is interrelated. Maybe American medical quagmire is better. It's not the docs fault, or the nurses' fault - there were two doctors on duty in that ER, and as the staff told me, everyone in our relatively aged local population who has a complaint over the weekend tends to show up in that ER on Monday morning to see a doctor.

But still, I can't help feeling that it would have been better for all concerned for a nurse to take the 5 minutes it would have taken to look at the data gathered by the 'techs and tell me 'we don't think you're having a heart attack. You can wait xxx hours to talk to the doctor about your ongoing medical problem, but if you have a primary care doc, you should make an urgent appointment with them and then avoid sitting around here.'

Sigh.

The jittery horror of 
  stepping into a room 
    to meet new people 
      dropped away.
        as I saw their faces,           quiet intensity,  
          and understood:               a matching caution
                                        at the expensive challenge
                                        of social exchange for a too receptive mind
These people are family.                
Their minds are like mine. They speak my story, 
my quandaries and strengths from unfamiliar mouths. 
I feel the strangeness of belonging, of being in-step. 
I can read these faces, anticipate their concerns and feelings, 
the aching points of contention. 

The strange particolour duality; confidence in intellectual clarity, 
fearless advocacy for ideas and ethics, and a softer self, stepping away 
from battles of self defence, as if they were all unwinnable.

Socialised to resolve contention in favour of our context, 
The mind then makes this choice every time. 
So hard to stand up for the rights of the self. 
They seem to be so tenuous and compromised, 
perhaps a problem of conceptual focal length. 

Not worth making a fuss, avoiding conflict 
until the pressure reaches some critical intensity 
and some kind of fissure, explosion, or escape 
changes the landscape irrevocably.

I watch her self-doubt and professional efficacy 
flash and tumble. 
We stay an hour longer finding commonalities, small ones, 
parallel paths, recognition and smiles. 

I walk to the car better armed to care 
for my own perspective
now that I can see it corroborated 
in the lives of others.