Monday, March 15, 2010

Pain in the Postpartum Ward (not for the squeamish)

Once the ER decided to admit me to the hospital it was determined I'd be going into "overflow." I was wheeled into the "Postpartum Ward" and down the hall, far, far away from the nurses station.  I later learned the four elderly patients in the Postpartum ward were there so we could have private rooms.  I didn't ask for a private room, nor did I care whether or not I had one.  There were two things I did care about;  I needed to stay on my bipolar drugs and I needed the nurses to stay ahead of the pain.  And here might be the clues to some of the very bad care I got there.

I'm allergic to narcotics.  In order for me to be able to take a narcotic, it's introduction into my system must be preceded by a good anti-nausea drug.  If not given an anti-nausea drug, I vomit until the narcotic is out of my system.  That's just the way I roll. This in itself should alert the nurses administering my pain medication that if I'm screaming in pain, I'm not faking it so I can get more narcotics. I am not fond of narcotics.

Once taken out of the ER and into the Postpartum Ward nurses would give me a pill for anti-nausea and within seconds of my swallowing the pill they would inject the Dilaudid directly into the IV port.  So the narcotic would hit my system immediately while the anti-nausea drug had to be digested.  In my opinion this is a very bad policy since it cause unnecessary vomiting.  In the ER they injected the anti-nausea drug into my IV port prior to injecting the Dilaudid.  So when I was wheeled onto the Postpartum Ward I wasn't in pain.  This gave me a moment's lucidity to notice my surroundings.  I had a private room.  I hadn't asked for a private room, so I asked about that.  Why a private room?  I was told that the hospital was making an effort to turn every room into a private room.  Nice, fine, but now I have questions about billing.  Will I be charged for a private room I didn't request?  Is that a cockroach crawling across the dirty squares of the acoustical tile ceiling above my bed?  I checked the drawers in the bedside chest.  In the old days, there would have been a little stainless steel kidney shaped pan to vomit in.  There would also be a cheap tooth brush, a small tube of toothpaste, and a low-rent comb.  All three drawers were empty.  I asked for something to vomit into and was given a big pink plastic tub (much like the tub I use at home to scrub floors with).  There was no washcloth, no towel in the bathroom.  Since I'd come into the ER dehydrated as well as having an abscess in my colon there was a little container in the toilet to capture urine so my "output" could be measured and charted.  Several times the nurses neglected to measure my "output" resulting in the shocking experience of sitting on the toilet and finding myself actually sitting in my own urine. I just dumped the "output" into the toilet water and then replaced the empty container so I could pee.  Best medical care in the world, my ass.

There were times during my two night / two day stay when I was in such excruciating pain I was delirious and screaming for help.  I pushed the call button, waited a few minutes, pushed the call button again and eventually had a nurse answer the call with something like mild annoyance, saying "What do you need?"  "I'm in terrible pain."  " You aren't due for another shot for an hour."  "Somethings very wrong.  If you gave me the right dose of  painkiller I would be able to make it through to the next shot."  "Sorry.  Just try and relax."  And then speaker would click off.

A word about the Postpartum Ward: Changes in the insurance industry have probably made the Postpartum Ward obsolete.  These days you might as well have your baby in a turnip patch, because once that baby is out of your womb the hospital will be under pressure to get you home as fast as possible.  If you have postpartum problems they are more than likely going to be considered "a pre-existing condition," and you'll be given a pill to get you through it.  Hopefully you won't kill hubby and the five children you already have.  But since there is no postpartum care these days that requires an entire ward, the hospital has a ward it isn't using.  So, lucky me; I was "overflow" and sent to the Postpartum Ward, where the rooms at the far end of the ward were private rooms, probably reserved for the lucky wives of wealthy men who could afford a private room to keep their batty wives in until the "baby blues" were over.

My second night I had a pain crisis at shift change.  I don't know if the day nurse had given me a dose of dilaudid before she left, but the poor night nurse had to face a screaming, sobbing me, hanging doubled over on the medical device from which my IV bags were hanging, to show up in front of the nurses station.  The aid was reading a book with his feet propped up on a chair.  I was upset that I was in so much pain, but I was also worried that they weren't giving me my bipolar medications in accurate doses or on time. To the night nurses credit, she did not snap back at me.  She remained calm as I screamed at her, tears of pain and frustration running down my face.  I had a major melt down that I believe was entirely unnecessary, avoidable, and detrimental to my health.  Had they controlled my pain, none of that would have happened.  But I think that went in my medical record in a way that allowed then to consider my cries of pain as the ravings of a drug seeking lunatic.

I survived the night; the next morning I was feeling better.  The antibiotics and flagyl were working and the night nurse had kept my pain under control.  But with the arrival of my clear liquid diet (more on that in another piece) came the new Day Nurse.  Let's call her Bambie.  First time I noticed her in my room was when she came in to take my vitals.  I had MSNBC on the tube.  Nancy Pelosi was being interviewed.  Bambie wrinkled her lovely nose and said, "Who is she?"  I said, "That's Nancy Pelosi."  She asked, "What does she do?"  I said, "She's the Speaker of the House."  She asked, "What's that?"
While I was pondering whether or not to attempt to educate Bambie on the workings of the United States Congress, a tall, thin, redheaded, freckled faced man walked into my room.  He said, "Hi, I'm Chris Rock from Risk Assessment.  How are we treating you?"  I burst out laughing and asked for his businness card.  While I was glancing at his card I saw Bambie take my medical history and covertly, but not very expertly, draw Chris Rock's attention to the malady listed top of the page.  She pointed to it with one hand as she held it with the other.  They both raised their eyebrows at the same times as if they were saying, "Well, that explains a lot."  I said, "Bambie, what is that paper in your hand and why are you showing it to him?"
"It's just your medical record."
"Is bipolar listed at the top of that page?"
Chris Rock says, "Why would that matter?"
"It might make you think, 'No need to take her seriously, she's just crazy.'  If you want to know why I'm in the hospital, ask me!  If you want permission to take a peek at my medical records ask me; you're in my room (My volume is rising). And you, Bambie, you have just broken the law. You have shown someone my medical records without my permission,  That, you stupid bitch, is against the law.  Get the fuck out of my room."  They both stand in stunned silence.

I stand up.  Once again I say, "Get the fuck out of my room!"  This time I add, "Both of you!"  Neither of them moves, but they do look at each other and then back at me.  "If you don't leave my room instantly I'm ripping this god damn IV port out of my arm and calling a cab."  I start peeling the tape off my arm.  Chris Rock says, "That will really hurt."  I say, "I don't give a shit."  Get out of my way.  By now Bambie is backing out of my room.  But Chris Rock is holding steady.  I advance on him, and the last thing he says before he backs out of my room is, "Insurance won't pay if you leave before you're discharged."  That was the only helpful thing he said.  I shouted "Where is my doctor?  Call him now."

I called the hospital operator and ask for the hospital Ombudsman.  She asks "what's that?"  But then puts me through to a number.  The phone rings about five times and then a mans voice answers.  I say "Is this the Ombudsman?"  He says, "What's that?"  I ask, "Is this Chris Rock?"  

I grab my the thingy my IV bags are hanging from and start stomping down the hall to go outside and have a smoke.  Up ahead of me I see Bambie coming out of a room and I call out, "Run Bambie. Run!"