Sunday, June 29, 2014

Columbia Memorial Hospital Experience

So my friend Lisa posts on her Facebook page Saturday night that she has been really sick and hasn't been out of the house in five days. I know she's on deadline to finish her book (the History of Hudson) so I call her to see what's up? She didn't want to trouble her friends, she says,  but tells me she'd really like to go the emergency room. I'm house sitting for another friend so I say, "I can be there in ten minutes."

Now mind you, I hate the emergency room just as much as the next guy, but I'm foregoing personal preferences for a friend in need. I pick her up at her house just outside downtown Hudson. It's early Saturday night and lots of people are hanging out getting some night air. Lisa looks rather dreadful, her face is swollen, her eyes are puffy, but she doesn't need to hear that. I load her in the car, and she tells me she thinks she has Lyme disease.

Columbia Memorial is a fairly big place. As a matter if fact I was once treated for Lyme here. When we arrive we are greeted by a nurse, I think, with a cart who takes Lisa's info. She's polite, like a hotel concierge and asks "what brings you here?" to my friend who again reports headache, fever, body aches. The nurse nods and offers us a seat. So far the waiting room has very few people. There's a small girl with her Dad inquiring about her mother. There's a young blond girl with her foot in a cast sitting in a wheelchair watching television. Several people, some bandaged, others not, are exiting a locked glassed-in area in front of us. I think maybe it's clearing out. Our timing is good.

The nurse/concierge asks if we've been seen. In unison we say "no." She apologizes and tells us to follow her in through locked double doors. Once past the entry gates, we're moved to another waiting area and informed that Lisa will have blood drawn. "We are waiting for a bed," says the attendants, a young girl who is wearing a baby doll top making is seem like she might have just rolled out of bed. The bed on which we are waiting, apparently needs to be disinfected. Lisa is slightly slumped in the chair next to me. I'm worried that she's been sick for a long time, she's in severe pain and we're still waiting. Finally the bed is ready. I deposit Lisa there with a nurse who takes her temperature, and blood pressure and I'm satisfied momentarily that my friend is finally resting.

The temperature is high at 100.8 but no one seems worred. I sit around for a while getting anxious that still, no one has taken Lisa's blood. It's past 8pm and I make one of many continual trips to the desk to ask for a "progress report." I am assured that the Phlebotomist has been summoned. I find a diet pepsi in lieu of real food because it's after 7pm and the cafeteria is closed. The nice concierge shows me the vending machines. She's trying very hard to continue to be helpful. I know I shouldn't, but I find this surprising. The service here, so far, is pretty good. It is far better than I've had at some local restaurants.

When I go back to Lisa's bedside, the Phlebotomist is there searching for an elusive vein in Lisa's limp arm. They poke her hard to try to draw blood. Lisa is taking the multiple stab wounds quite well. I grab her hand and guide her through some breathing like maybe she's in labor. I've learned a lot about breath. My yoga teachers are masters and at this moment, I am grateful I was taught how to take one breath per minute. I relay this technique to Lisa. We start to do visualization together, but instead of going with me to our happy place, Lisa starts on some tangent about how if you make room in your closet, metaphorically that is, then the right man will show up. This launches me, Lisa and the woman taking her blood into a strange conversation as to whether, in truth, any woman ever really wants to live with a man. Since the three of us apparently aren't living with men at the present, we agree that it's a bad idea if it means giving up your closet.

Lisa's arm won't submit and give blood, so they poke her again in the back of the hand and this works. She gives up nearly ten vials of blood for every imaginable tick related disease out there and possibly a few more.

After the blood there's a lull, and I watch Lisa's discomfort grow. She's complaining of pain. They gage her pain by asking "on a scale of one to ten how's bad is it?" Lisa reports a solid "9" yet they administer no method of relief.  I make another trip to the desk to ask, "Do you think there's something you can give her? I say this rather sheephishly. In truth, I'm not sheepish, but I can see that battling it out with nurses in the ER can only result in a collision of power. I go the humble route. And after all, they're trying very hard. "Yes," is the reply I receive, and soon the nurse shows up. She's a 50 something lady with a bob hair cut that's laced with pretty grey streaks. Slim, athletic, she's in some cool running shoes and deep grey colored scrubs which I think fit her quite nicely. I suggest something to get the fever down. An ice pack arrives. "Can you give her tylenol?" I ask. The nurse agrees Tylenol is a good idea and asks Lisa if she's taken any today. Lisa says yes. They compare notes and finally the nurse leaves to get some.

Before the meds, they take another reading of Lisa's temperature and it is alarming. Her fever has suddenly spiked to 104 degrees and this adds some speed to the women attending her. So far, we've not seen an real MD which at this point seems really questionable. Though this concerns both Lisa and I, we figure that he/she will come later. Now, with a fever on the rise there's talk of Lyme disease.

I've had acute Lyme disease. It also landed me in the ER just like this in the late 1990s when they knew less and cared less about Lyme disease in Columbia County. It didn't help that I was in a Massachusetts hospital (not recommended). It took a lot of yelling and screaming on my part for me to see an infectious disease doc, (that's after a spinal tap) who finally diagnosed me correctly, but not before I was losing the ability to use my left arm. This for another time.

I think that Lisa has Lyme and probably half of the world might have guessed this as well. She reports to the staff having been bitten by a tick back in May. The pit crew working on her want to see the bite mark, but there are no remains of the attack when we all examine Lisa's lower back. But the brief investigation reveals something very alarming. There's a hideous raspberry colored rash growing like wild fire around Lisa's lower half. It's disgusting, quite frankly, and I don't want her to see it in case it scares her. The nurse practically jumps back when it is uncovered. It looks like someone wrapped a nasty, abrasive rope around her middle and yanked on it tight consecutive times or dragged her around the block a few times with it.
Suddenly they start IV fluids and there's talk that once the fever comes down they'll add antibiotics to the feed that's wired to the back of her other hand.

Lisa is also getting a dose of morphine. When they pump this in I know they were taking her condition seriously and answering the call to the question, "on a scale of one to ten, how's your pain."

She rests. I hang with her chatting until I recognize that the morphine is kicking in. She's giggling a bit to herself, and I take that as a good sign and leave the half curtained cubby for a while so she can sleep.

Lisa is in the dimly lit space half asleep with tubes in her hand, and a steadily beating monitor pounds out an mechanical alien beat. The nurse asks for a urine specimen which means we're going on the road. I help Lisa get out of bed holding the IV bag above her head and steadying her body while trying to keep her gown closed in the back so she doesn't flash the entire unit. The method somehow works as I guide her into the toilet across the hall. She pees in the cup while I stand outside with the door half closed to offer the illusion of privacy. It's past 9pm. Several thousand people have been in this bathroom and the odor confirms this. It's gross, but I'm rather sensitive to smells. Lisa emerges with the yellow cocktail cup, capped and ready for transport. She slides back into bed. I'm hoping that the blood work and urine reveal enough to get her on the antibiotics.

At 10pm I tiptoe toward the Physician's Assistant desk. She is a no nonsense woman who smiles at me though I know she's seething at the notion that I'm questioning her work. I hope not to be threatening, but hey, I'm the patient advocate now. This is my work for Lisa. The PA assures me that giving Lisa antibiotics is on her "agenda." I find that a strange use of terms, but this is no time for semantics.

Back at base camp Lisa is looking less red. When the fever spiked she was about as bright as a beet. She seems more tired. We both are. There's a rumor circulating that she might be admitted. I think that it's a strong possibility she might spend the night, and she's in favor of that decision if it should fall that way.

I close her curtain because it's nearing the witching hour in the ER. You know, that time when crimes happen, parties end badly, fights occur. Hudson is a small city, but a city all the same. The history of its sordid past still lingers. There are still lots of drugs, stabbings and stealing left on the streets. It starts like a parade of  zombies through the halls outside Lisa's cubby. There's a kid with a blood splattered t-shirt, and a woman with him in a pink top who has a nasty bruise on her forehead.  I conclude that this is probably a car accident. There's a guy in a neck brace with gauze wrapped around the back of head, the front of his head, the side of his head. He is bleeding from all three bound areas. I watch him as he gingerly enters the disgusting bathroom. I make a mental note not to pee for the rest of the night. It's a miracle, but later I watch a quiet attendant with a pail and brushes rework the bathroom into a more inviting place. That cleaning lady deserves a medal. She exemplifies the meaning of selfless service.

Another hour passes. I'm exhausted. I had spent the earlier part of the day doing three hours of yoga, a sun salutation series to be exact 108, ringing in the summer solstace. The spirit of yoga is a wonderful thing right now.

It's nearing midnight. Lisa is asleep. The second round of morphine put her out this time and gratefully, the flow into her veins now includes a megadose of antibiotics. We have settled in until further notice. I sit on a plastic chair at the foot of her bed. I rest my head against the wall and pass out for a half hour. The second string nurse, helper comes in to check Lisa's temperature which has mercifully plummeted to 99.9 degrees. We're out of the woods. And then the PA comes back to issue the conclusion to our episode. They feel ok about letter her go home. Next steps are to unplug her and get the discharge papers in order. This ultimately takes an hour an a half.

The shift has changed. We greet a new nurse in bright green scrubs named Chester. He's the first person who's taken time to introduce himself. I think he likes us. The professionals agree, said Chester, that Lisa has Lyme disease. And though I feel that's rather obvious, I'm delighted to hear the news. Chester is in charge. He seems fixated on Lisa and despite Lisa's medical extravaganza, she seems to notice.

We leave with a cotton hospital blanket under my arm. I tell her it's our souvenir along with a script for doxycycline. It's 2am. I speed through the 24 Hour Price Chopper to grab a tooth brush and some water.

I sleep on Lisa's couch after tucking her in. I've been up for 23 hours. It's been a long night. Before I doze off, I think about it.  Columbia Memorial did a great job of managing Lisa's medical crisis by being calm, attentive, human, sensitive, empathic, and professional. I think that helping urgently sick and injured people night after night, day after day is a crazy thing to want to do, but in reality, those people are amazing. Lisa is safe. I am happy and grateful.