Wordless Wednesday: The Impatient Outpatient

Asthma sucks

Sorry for the recent lack of blog posts, I’m busy being a professional patient. Air quality is bad, and my lungs are totally out of whack. And I’m sick of being sick.

The First ER visit of my 30s

First off, I had an awesome birthday. And an awesome time Saturday at the #SLCTweetup. Sunday was a tough day.

The morning started out in a wheezing coughing fit. I went to urgent care as soon as they opened. After a quick exam, a listen to my lungs, chest x-ray, and review of my health history, the doctor diagnosed me with “bronchitis with reactive airway inflammation.” He gave me some narcotic cough syrup for the cough, and Advair to restart my maintenance asthma regimen. I spent the day in bed, coughing and wheezing. It felt like my chest was on fire.In the early evening, Taylor and I were laying down and talking. To ease my shortness of breath, I took another puff of Albuterol, which set me off in a coughing fit. After coughing so hard that I couldn’t control bodily functions, my breathing was sporadic enough that Taylor hauled me off to the ER. 15 minutes later, I stumbled into the Mountain View Hospital ER waiting room, with feet numb from lack of oxygen. The ER staff pulled themselves from the Super Bowl, plopped me into a wheelchair, bypassed triage, and took me to bed. They helped me peel off my clothes, dressed me in a gown, and started my examination. My pulse-ox was at 91 and I had a fever of 102.5*. Within 45 minutes, chest x-rays and nasal cultures were done, breathing treatments and steroids administered, and I was finally feeling some relief. They confirmed that my illness was not caused by influenza or H1N1, and concurred with the earlier diagnosis of bronchitis. They gave me a prescription for Z-pak, and told me to get lots of rest. I was in and out in 2 hours. That’s the way an ER visit should be.

Sounds dramatic? To be honest, I’m used to all the lung drama. I’ve mentioned my “organ recital” of medical history in a previous post. I’ve talked about how I got pneumonia after an accidental spray paint inhalation. I’ve talked about how I was “poisoned” at work from inhaling an industrial strength aerosol chemical. If something you can breathe in exists that can make you sick, I’m susceptible to it. This nasty Utah inversion air? Makes me sick. When I say I’m dealing with “SOB,” I mean shortness of breath.
I’ve had asthma since I was 11. I have sleep apnea. I’ve seen pulmonologists in 4 states. I have tried most of the inhalers on the following chart:
But as I went through my old posts, I realized that I never blogged about my biggest lung condition of all, Acute Respiratory Distress Syndrome. ARDS is a life-threatening lung condition that prevents enough oxygen from getting into the blood, typically resulting from trauma or sepsis. I survived it after three weeks on a ventilator. Would anyone like to hear my story?

Healthcare Rant: When Quality Care Goes Wrong

As I’ve been dealing with many difficult health issues this past year, the U.S. healthcare reform debate has fallen below the Nicole radar. It surprises me that I’ve avoided it, as my career is in healthcare administration. I know it’s an important time in my field, but seven months of unemployment have kept me out of the trenches. Despite a very concerted effort, I have not been able to find work in my field. Although I have skills that would be portable to many other fields, I don’t want to give up what I love. I believe that quality care should be available to all people, regardless of their ability to pay. While it’s true that many healthcare organizations offer charitable care to the needy, it seems like many people in need fall through the cracks.

I am currently insured through my husband’s employer on a plan with Cigna. The plan provides excellent benefits at a low cost for in-network providers. I am extremely lucky to have $5-10 copays, and very reasonable coinsurance. Unfortunately, the Cigna network has been fairly limited in both the Atlanta and Wasatch Front areas. In Atlanta, I couldn’t use Emory facilities in network (while working for Emory, and promoting their Campaign Emory fundraising). In Utah, 90% of Intermountain Healthcare facilities are out-of-network for Cigna. This is frustrating to me, as I’m a previous 4.5-year employee of Intermountain. I believe in their Mission, Vision, and Values, and want to support them with my healthcare dollar.

My previous positions with Intermountain were as an assistant to a medical director at LDS Hospital, and as a Patient Service Rep in Accounts Receivable Management. I have also worked for City of Hope Cancer Center, Prime Healthcare Services, and University of Michigan Medical Center. I have experience in customer service, billing, coding, transcription, Joint Commission an AOA accreditation, physician credentialing, training, research, and have processed countless financial assistance applications. I have participated in executive-level hospital management meetings. Although I am not an expert by any means, I can confidently say that I am qualified to have an educated opinion on what works in healthcare, and when healthcare goes wrong.

Case in point: My daughter Rosie has been sick for a few weeks with kidney problems. My otherwise lively child has been mopey and lethargic, and complains of pain daily. On Christmas night, Rosie was very sick and begged me to take her to the hospital. We left our family holiday party an drove to the IHC Provo Instacare (which is in-network with Cigna). I advised the Instacare registrar that I had submitted a financial assistance application to the Lake Park and Creek Plaza billing offices a few weeks prior, and was unable to pay a copay. The Instacare flat out refused to see her without a copay…so I ran out to the car, grabbed a Christmas card, and paid her copay with the Christmas cash I got from my grandma. And what happened then? They took her blood, scanned over the results, and told us to go across the parking lot to the Utah Valley Regional Center Emergency Room immediately (which we later found out was out-of-network).

The ER registrar was a little nicer, especially when I brought along the copy of my recently-completed financial assistance application. We sat in the ER waiting room for over an hour, and spent a few more hours in the ER room 9 (which had a broken recliner, and no other chair available). After 4 hours, they said her urinalysis showed that she had inflammatory cystitis. If the Instacare would have taken 5 extra minutes to take her urine, she could have gotten on antibiotics and saved us a 4-hour ER visit and copay.

When we arrived at Instacare, it was a few minutes before they were closing at 9 pm. They happily took us back to the room, but pushed us back out the door in 5 minutes.My question is: “If they were going to send her to the ER, why did they take my gift money to pay a copay for a “visit” that didn’t really end up being a VISIT?” Luckily these visits happened before the end of the year, because we’d already met our deductible. Had this happened a week later, we would have been slammed with deductible fees.

A few days later, Rosie had another ER visit. Her symptoms had worsened, she had a high fever, and I drove her back to the UVRMC ER (still not knowing it was out-of-network). The doctor wasn’t sure why she was in so much pain and guessed that she had kidney stones or appendicitis. He ordered an abdominal CT scan to see if the problem was GI or urinary. After 3 more hours of sitting on room 9’s broken recliner, we found out that her scan was fine. Rosie got a pain pill, some “orange pee” pills, and a stronger antibiotic. Since then, we’ve been following up with a non-IHC pediatric urologist and she’s doing much better.

I was going to just sweep this experience under the carpet, but then earlier this week I received several IHC financial assistance rejection letters. Besides the recent hospital visits, I had some outstanding bills from all of my sleep apnea visits. Apparently we are slightly over the National Income Poverty Guidelines (remember my husband is a struggling regional airline pilot?) Despite our unmanageable debt from student loans and my 7 months of unemployment, we do not qualify. When I called the billing offices to get more information, I was told that our income was slightly too high, and our balances were not high enough for them to make an exception. Gee thanks.

I know I’m not the only person to have an experience like this. After going through it personally, it has really lit my fire to get back into a position where I can help avoid situations like this. I’m going to keep working on my medical coding certification, which I’ve been working on from home to keep myself busy while looking for work. It’s time to make my voice heard. I’ve been in both hospital management, and also at the receiving end of a “charity” denial. I hereby recommit my effort to apply for all the positions I am qualified for. I need to be a part of my field again.

Sleep Study Number Five

I’m just finishing up packing for my overnight sleep study over at Piedmont Hospital Sleep Lab. This will be my fourth overnight sleep study since 2004, and fifth if you include my daytime multiple sleep latency nap test. I’m deciding on what comfortable, yet accessible pajamas I can wear so the sleep lab tech doesn’t see too much (yes, there are cameras in the room and someone watches you sleep all night. Almost voyeuristic). It’s time to figure out how to fix my sleep apnea and daytime hypersomnia. Is anyone interested in a silly photo narrative of what it’s like to be the patient in a sleep lab?

Inhalation Hazard

It was inevitable. Every hospital I’ve ever worked at, I’ve been a patient at. I thought I’d be getting off easy with a freebie at U of M Hospital, but I proved my precedent correct yesterday.

I was feeling a bit exhausted from Sunday’s roadtrip, but otherwise with no illness symptoms. Right after lunch, I went into the tiny closet restroom across from my office, and was floored with a terrible smell. I really needed to relieve myself, so I thought I’d quickly finish and leave. Upon the throne, my eyes, throat, skin, and lungs started burning. My skin started to blotch up. I looked up in the air, and saw little particulates dancing around. I became lightheaded and dizzily fell off. Someone had used the industrial strength disinfectant spray (for cleaning bathroom surfaces) as an AIR FRESHENER, and sprayed it all through the air.

This chemical spray, which should only be used in a WELL VENTILATED AREA…not a little closet bathroom whose fan turns off with the light. And it wasn’t like a little shot of potpourri spray, it was full-on 80’s AquaNet-like sprayage. It was as potent as oven cleaner. There’s a demon sprayer in my department (I still haven’t figured out who) and I’ve left notes before to please be considerate when using this CLEANER to “freshen”. I’m pretty sure I hit the brunt for a very recent spray. For some reason, the environmental services team leaves this aerosol in the department at all time, just because it’s kinda far-flung from the rest of the public restrooms in the building. I started using those far-flung multi-stall public restrooms, but I didn’t yesterday. I learned my lesson.

I immediately sent an email to Safety Management services, who advised me to go immediately to Employee Health. They said they’d send out an “environmental industrial hygienist” to check out the ventilation in the room. My favorite coworker walked me to the Med Inn and waited for me to be evaluated. Employee health checked my vitals, gave me a puff of Ventolin, and had me rest in the lobby for 15 minutes. Still felt shortness of breath, chest tightness, and eye stinging. They suggested that I be evaluated in the ER. So they wheeled me down, I waited an hour to be triaged, another 45 minutes for chest xrays, and finally 3 hours after the exposure got the breathing treatment.

The morning after, I still feel yucky. My eyes still sting, my breathing is slightly labored, and I really don’t feel like working. However, I’ve got a dentist appointment this morning that I have to get out of bed for. They’ll be checking the tooth abscess from the root canal and see if it’s healed enough to do the crown prep. Haven’t I been through enough already?!?

A Brighter Outlook

This morning, David was in surgery for just under 3 hours for a revision of his amputation. They assessed the remaining tissue and removed the damage, adjusted the bone, and sealed up the stump. Dr Goodman said that it went as well as could be expected. He’s now back in his room on the 11th floor, raving about the “most beautiful view than you can ever imagine in this neck of the region.” He’s still having some hallucinations from the meds and the anesthesia, but he’s making some coherent speech. Monday he will have the knee reconstruction on his right leg, but until then, his “job” is to get better. He would like a few visitors for short visits, so feel free to contact me or Barbara and we’ll let you know if it’s a good time.

D-A-D in S-L-C in I-C-U

This week in Michigan I felt that the Bullock family was settling in quite nicely. Rosie started school at Allen Elementary, and her teacher is wonderful (and also the wife of regional pilot, with whom I can commiserate) Taylor was off Sunday night-Thursday morning…and I finally had some wholesome, consistent alone-time with him. We went on a day-date (On the Border and “Juno”), did some furniture shopping, went for drives around the area to get acquainted with greater Canton/Plymouth/Westland/ Northville/Livonia area. We set up bank accounts, auto and renters insurance policies, and other necessities after a move. We’ve been reeling in generosity of the Pearce family and their lovely home. I started my Quantitative Reasoning, Statistics, and Critical Thinking classes. I felt like things were settling down…as much as they could for not actually moving into our apartment yet. Until Friday night.

I received a call from my mom. My dad, David, had been in a pretty serious rollover accident near Fillmore on the way back from a work trip to St. George. He’s an audio/visual engineer with the LDS Church, coming back from equipment upgrades on the Temple and Visitors Center. He was with two other coworkers, Bruce and Nathan, in the back seat of a van (we still aren’t sure if it was a minivan or large 15-passenger van), with lots of heavy A/V equipment that was being transported back to Church Headquarters. I haven’t gotten the full story, but here’s what I’ve pieced together.

Around 1:30 PM, Friday January 11, Bruce dozed off while driving, pretty close to the Meadow/Kanosh exit on I-15. He was startled awake by the sound of the caution grooves on the freeway, and overcorrected right when my dad yelled out his name. There was a slight hill down which the van flew over and tumbled a few times, and landed on the other side of the frontage road. Matt, a passing motorist from CA on his way to Provo for his daughter’s wedding, saw the accident and was the second person on the scene. I’ve talked with Matt a few times, and this is what he explained to me:

The van was very well crushed and totaled. It had flipped and flown three or four times. Matt saw David’s rear end was hanging out the side window of the crushed, upside-down van. It looked like he was crawling in with his left leg squashed under his body. Matt saw that the seatbelt was still attached, so he found a knife and cut him out of the seatbelt to relieve the pressure. Matt and some of the other motorists who stopped to help, set out some blankets, clothes, and other items so David could be laid out on the ground without getting cold and snowy. He was fully conscious through the whole ordeal. They administered consecrated oil and gave him a priesthood blessing.

The paramedics arrived and started triaging and treating David. Nathan was freed from the car fairly easily, and walked away with some minor cuts and abrasions on his forearm and elbow. Bruce was crumpled, not crushed, in the debris of the van and required the Jaws ‘o Life to free him. He sustained some lacerations and contusions to the face, and was patched up within a few hours at Fillmore Hospital. My dad was taken by ambulance to Fillmore Hospital, where they diagnosed a pelvic fracture and a completely dislocated knee that had stopped adequate bloodflow to his leg (below the knee). Two hours post-impact, they decided that his condition was way too serious and he’d need to be LifeFlight’ed to Intermountain Medical Center in Murray.

For those who read this blog, and don’t know David….he’s no lightweight! My guess is that he’s somewhere around 6’2″ and 320 pounds. Due to weather conditions and the weight and balance on the helicopter, they were unable to chopper him to Murray. They loaded him on a fixed-wing LifeFlight plane, and flew him to Salt Lake International Airport. Then they took him (via helicopter) to IMC. Within an hour of arrival, my dad was taken in for an 8 hour surgery with a vascular surgeon, orthopedic surgeon, and general surgeon.

The pelvic fracture was on the wing of the pelvis, which is a non-essential area for bodily movement, and did not require surgical intervention. He had a pretty massive open wound over the pelvic fracture from the seatbelt, which they cleaned up and took care of. The main concern was his knee and lower leg. In addition to the dislocation/fracture of the knee, he had a significant crush injury to the leg. A saphenous vein graft from his right leg was required to restore bloodflow to his left leg. An external fixator was installed on my dad’s lower leg, which elevates the open-wounded leg for drainage. After just over 8 hours in the OR, he was moved to the Thoracic ICU.

By the time I got the call, Taylor was into the 2nd day of his 4-day trip, so I decided to take Rosie out to SLC on the first flight of the morning. After 4 hours of sleep, we woke up at 4:00 am and drove to the airport. The layover in Minneapolis and flight to SLC was pretty uneventful. I knew that Rosie wouldn’t be able to go into the ICU, so I arranged for her to stay with the Lewis’ family while I stood vigil at the hospital. My mom and Jacob had stayed overnight through the whole surgery until 6 am, and were sleeping, so my job was to be on call for questions and support at the hospital. After taking about 6 condition-calls at my parents’ house, I drove over to IMC. The IMC Campus is huge, and I was a little confused because I’d been told he was going to be transferred to Shock-Trauma ICU. After about 15 minutes of going from nurse station to nurse station with no luck (his trauma alias was ZZZIM, ZITI for some reason) I found a doctor who has been briefed on his condition and he showed me where to go.

When I walked into S204, I couldn’t believe how swollen and bruised up he was. His neck had swelled so much that it was bigger than his head, but even his ears, eyes, nose, and tongue were swollen. He was sedated on Versed and intubaed. The most gruesome sight was his leg, itself. It was covered in bandages and elevated, but was soaked in blood and fluids from the open wound (to help reduce swelling and edema). Thana, his ICU nurse, was absolutely wonderful. I spent 5 hours with her, as she kept tabs on his vitals, dopplered his feet to verify adequate bloodflow, infused more units of blood, checked labs, glycerine-swabbed his mouth to keep it moist, and other nursing functions. She and I got along really well, and she designated me as the family spokesperson to give updates to anyone who called the ICU with the privacy code. Throughout the afternoon, Mary, Grant, Julie (his sister), Grandpa Jack, Mom, and Bishop France visited him. He was given another priesthood blessing by Jack and Patriarch Sheffield, and was guaranteed a full recovery.

I spoke to all three surgeons over the course of the day. The vascular surgeon said that this was one of the most difficult surgeries he’s ever done because my dad’s calf was so large. We joke about our “Watson Cankles”…our giant calves and ankles that have no end. The swelling made his calf about the size of a volleyball, and he had to use his deepest instruments. The maneuverability within the leg was darn-near impossible to operate quickly, and the surgery lasted over 8 hours. Unfortunately, from the time of impact to bloodflow restoration was just over 9 hours…and normal function of the leg is only guaranteed within 6-8 hours of blood deficit The orthopedic surgeon said the health of his muscles and nerves will take a few weeks to determine, and he will likely have permanent nerve damage. He could have partial or full muscle loss, which could require amputation. The general surgeon said she’ll be rounding once or twice daily to make sure that his other vital systems are functioning normal (i.e. respiratory, urinary, cardiovascular, etc)

For a while, the respiratory therapist tried to wean him from the ventilator to see if he would breathe on his own, but he coughed and gagged irregularly, and it was clear that he would still need to be intubated for a while. We were told that due to the pain medication and sedation, it was necessary to keep him on the vent while his body healed, because he wouldn’t be able to adequately breathe on his own (due to trauma and existing asthma and sleep apnea). His Versed dose was weaned from 10 to 2 while I was there, and for part of the early evening he was responding to stimuli. The first response made me laugh…I asked him if he knew that 3 of his 4 favorite girls were next to him, and he smirked and shrugged his shoulders. A few times he tried to open his eyes, but his eyelids were swollen shut and purple, and his eyeballs were completely red. He loved it when I scratched his head, and would lean into it a little. He grabbed my hand a few times, but didn’t have much grip (from a bandaged hand with a chunk of flesh missing).

I stayed at the hospital from about 1:30 PM to 6:00 (at shift change) and went back from 8:15 to 10:30 MT. I had been up for 21 hours, after only 4 the night before, so I headed back to Chez Watson and slept on the couch. I will probably go back again this morning around 8, stay till 10:45, go to sacrament meeting at 11, then come back to his bedside. I’d originally planned to fly back to Detroit this afternoon, but in my priesthood blessing from Grant, I felt that the family needs me here for a few more days. I’ll have to play it by ear.

Any prayers or positive vibes through the universe would be muchly appreciated. I’ll try to keep updates on my blog everytime I’m back home by my computer. You can call my cell for updates also.