previous post next post  

A window into government-run health care

Mind you, this is a single story, and I have no problem imagining similar problems in a for-profit hospital, especially one that is swamped with patients.

But I can relate to Chuck's experience - you know what the problem is, but they don't want to listen to you.  It's a double-edged sword, especially if you happen to be wrong this time, and the docs need to cast a wider net.

But it's frustrating as hell when you are in severe pain and have to sit through the litany, again.  And again.  And again.  I had a similar (though more slow-motion) experience with a gout attack that took two weeks to resolve, because the medical community wanted to run with their templates, and not adjust to the reality in front of them.

Here's the backstory - Chuck Z has a chronic episodic pain issue due to spinal damage incurred when he was wounded in Iraq.  This is a chronicle of this most recent brush with it.  Reprinted here with his permission.
I'll give a rundown of yesterday, just to let you know how much fun it was:

Background: I have a pinched nerve in my thoracic vertabrae, part of the degenerative disk disease I apparently have (something to do with extreme trauma to the spine, like from landing on your head wearing 70 lbs of gear after sailing through the air.) The nerve cluster in T4,5, and 6 are affected. This nerve cluster sends pain signals that start at the spine just below the shoulder blades and radiates around the chest (the right side in my case) and terminates with a stabbing, sharp pain sensation in the chest cavity. This has been going on for almost a year, and I was being treated for it when I left Leavenworth. Lately, it has been acting up, giving me mild to moderate pain; however when you know the source of the pain it makes it easier to ignore/deal with it. The biggest effect it was having on me was inability to sleep, other than from 12 AM-3AM, plus adding to my usual irritability.

Here's how my day want:
0350: Wake up--feel like there is a hot knife in my heart. I try stretching, ice, heat, and massage to no effect.

0415: Wake up Carren, tell he I am going to the ER (she doesn't even have to ask why.) She can't take me, because someone has to be home with the kids, so I self-recover to the Wahiawa ER. (This hospital is pretty run down, like an underfunded county general hospital. (Side not, at 0400, you can do 90 MPH on post and no one so much as notices.)

0420: Arrive at ER. Stumble in, mention chest pain (I didn't go into further detail, because the "Chest Pain" complaint will keep you out of the waiting room 99% of the time.

0425: Nurse tells me he thinks it may be kidney stones. I roll my eyes, thank him for the diagnosis, and tell him to fetch a doctor and stand by the pain meds locker. He has me pee in a cup.

0428: Doctor comes over, I explain the problem as best I understand. He gives me 2mg of dilaudid (hydromorphone, concentrated morphine) and asks if it helps. Dilaudid makes me itch. It takes the edge off, I still fell the pain, but am more relaxed about it. They send me for a chest xray and CAT scan. Then I get an EKG. (At this point, times are irrelevant, as I lose concept of time (Thanks, dilaudid!)

They give me another 1 mg of dilaudid. The nurse mentions that I shouldn't need this much. I mention that unless the Nurse has a medical degree, he can keep his opinions to himself, push the meds, and get me a bedpan.

Doctor thinks it may be gall bladder infection/gall stones. Apparently I have some decent sized stones.

Doc pushes another 1mg of dilaudid. Says I should be unconscious right now. I tell him unless he gives me fentanyl with a dilaudid back, in a drip, he'll likely never see my eyes close. I itch.

Doc wants to wait for the radiologist to come in to work to read the xrays/cat scan to see if his guess about gall stones is correct. He tells the nurse to push dilaudid every 30 minutes.

Radiologist finally arrives, shift changes in ER. Radiologist reads films, says it's not likely gall bladder. (No shit, sherlock.) New ER doc explains that this hospital can't keep me, because all they can to for me is push meds. They don't have a neurologist or pain specialist there.

DOC INFORMS ME THAT HE CAN'T TRANSFER ME TO TRIPLER ARMY MEDICAL CENTER, BECAUSE THEY DON'T HAVE ANY OPEN BEDS IN ER., AND ARE REFUSING TRANSFER.

Chuck is discharged from Wahiawa ER, Carren drives me to Tripler AMC with films, EKG, and record in hand.

Arrive Tripler ER. Go to desk, hunched over from pain. Give them ID and tell them I am having chest pains. They take me into triage, take history and vitals, then HAVE ME GO SIT IN THE WAITING ROOM.

Taken to bed, Medic (SPC Figeroa--Awesome guy) takes vitals, history and EKG. Looks over Wahiawa records. Tells us doctor is coming, will be able to give me something for Pain after DR sees me.

No doctor, pain increases.

No Doctor, Pain Increases. SPC Figeroa is apologizing for the two doctors (one major, one colonel) not being there yet.

Nurse (Kevin--another awesome guy) comes in ad takes my vitals and history.

I am told doc is going to give me a lumbar puncture and will be in to see me soon.
Am told DR is giving another patient a lmbar puncture, and will be in to see me after.

Med student comes in, takes history.

No doctor, pain still increasing. Docs want x-rays (supposedly, they can't read the xrays taken that morning for some reason)

Laying in hallway on gurney, completely overcome by pain and feeling ignored by doctors. All I want is some relief. Start crying. cannot stop. Am completely embarrassed. I don't weep gently, am uncontrollably sobbing. The more I cry, the more embarrassed I become.

Go in to xray. Cannot stop crying during xrays.

Back to room. Still crying.

Doctor finally arrives (Carren tells me later it's been roughly 2 hours since I arrived in ER)

Doc starts asking questions about history, want's to know what the problem is. I lose my bearing completely. I sit up, put my face about two inches from his and scream through clenched teeth "I am f*cking in pain, that's my problem."

Doc finally gives order for dilaudid. Kevin is standing by with it.

Much calmer, doc starts making excuses: "I am an ER doc. I have to rule things out to get proper treatment. We are really busy. blah blah blah.

They continue to push meds. Much calmer now.

About 2 PM, they get me an appointment with pain management for 2:10, and discharge me from ER. Kevin gives me a shot "for the road" and SPC Figeroa takes me to pain clinic.

Dr. McLean meets me at pain clinic. Explains he's read through both my chart and through my medical records from Kansas city. (Imagine that!) He tells me that we are waiting on the treatment room to open up but he WILL take care of me. Asks if there is any specific treatment I want. I explain I've had success with radial nerve ablation in my lumbar spine, also would like a nerve block in my thoracic, if possible.

He tells me that he will be able to do both, and definitely recommends both. Doesn't understand why I wasn't sent to him hours ago. I tell him I don't understand why either, but am sure the ER doc can provide him all the excuses he may want.

Doc tells me about an implant device (upwards of $25K) that has been approved for use. Will help dramatically with pain in extremities, gives me a DVD to watch about it for when I get home. Thinking about this right now.

Doc takes me in to treatment room, puts needles in my T4, T5, and T6, sends current through them to make sure they are in the right place. Then sends anesthetic to the nerves, then heats the needle, burning the nerves and limiting their ability to send pain signals for the next 6-12 months. Then he injects steroids and more, ;longer lasting anesthetic, so that the nerves won't hurt from the burn.

All the fluid buildup in the nerve cluster puts pressure on the nerves, making me feel like I've been kicked right between the shoulder blades by Jeff Reed of the Pittsburgh Steelers. Comparatively, this is much better than the pain I have been in all day. The stabbing chest pains are still there, but greatly reduced.

By late afternoon, I am home. Curl up on couch with icepack on my back, and go to sleep. Wake up lte in the evening, pain is lessened, but still there. Change ice pack. Wake up at 3 AM, take pain meds, back to sleep. Wake up at 8 AM, chest is pain-free, back is still a little sore.

So that was my Tuesday. I have a follow-up with Dr. McLean on the 2nd, where I will get more info on the implant and inform him that his new ranger name is Dr. McDreamy.

Spending 10 solid, miserable hours in abject pain, only to get relief in an hour at the end of the day. Of all the hours spent in two ERs, NOTHING that the doctors tested for was the problem. The problem was exactly what I told them it was at the outset.

Finally, I called my NCO to give him an update, and told him I wasn't going to be at work today. He said 'No problem sir, I'll tell them you got quarters for another day. If you don't feel up to it, I'll cover for you the rest of the week."

Have I mentioned how awesome he is yet?

Free healthcare. The trick is finding a health professional who actually cares. The ER doc at Tripler (another Major) certainly didn't expect his patient to come up out of bed screaming at him, or to proclaim his displeasure with him loudly enough so that everyone on the ward could hear. I will be following up with a formal complaint through military channels--including the two-star just a few doors down from my office--in a few days.

Feel free to post this experience, use names, whatever. I honestly don't remember the Docs names other than Dr. McLean, because I tend to not give a rat's a$$ about remembering the names of incompetent imbeciles.

--Chuck
Incompetent imbeciles may be a bit harsh, but, while I've not had Chuck's level of pain, I've been in severe pain while the medical community seemingly took it's sweet time about things, too.  It tends to make one uncharitable.

19 Comments

I'm only going to say, "Hang in there, Chuck -- it ain't over yet, by a long shot."
 
We, as a grateful nation, or at least those of us who are truly grateful, owe Chuck and all our other troops in similar circumstances much better treatment than that.

He earned it, the hard way, defending us and our freedom.

Now, dammit, he better get it.  IMMEDIATELY!

And fire any sorry SOB who stands in the way!

For every guy like Chuck who can and will make a fuss, there are probably a lot of enlisted guys lacking the forum to make their shabby treatment known, or to force solutions.  I really worry about them, and their treatment.

Obamacare for everyone will make a day like this seem like "the good old days" when at least some people eventually got something that worked.  

And, all retirees better pay attention, DOD sure could save a bundle if they just dumped Tricare/Tricare for Life, and put everyone on medicare/medicaid.    We already know their promise of "free healthcare for life" was a lie, or at least has been repudiated.  How can we believe any promised the government has made to veterans?

 
For every guy like Chuck who can and will make a fuss, there are probably a lot of enlisted guys lacking the forum to make their shabby treatment known, or to force solutions.

I agree strongly with this. No point in kicking dead horses so I'll let it go but I have always felt this was an area that sorely needs improvement on.

 
This is one of those stories which contains a wealth of information. First, I'm fully aware of Sherlock's constipation issue. The real trick is to find the person who actually cares. Most of the time, when you go into the Military/Veteran Healthcare System, the first person you talk with is the dang "Gate Keeper".  Their job was to keep you from talking to the nurses, nurse practitioners and ultimately, the Docs.

The most important bit of counsel Chuck offers is in his next to last paragraph. Whether you're dealing with Military or Veterans, develop a power base or network.

I love it, when the Doc what is your pain level on a scale of 1 - 10? Your answer is 40. I had an central nervous system infection, which the Military thought was a head cold. I wrote a request for a doctor to lance my eardrums, but it never got past the "Gate Keeper". When they finally blew, one took 50% of my hearing on that side the other took 100% of the eardrum, the two small bones and 100% of my hearing. Unless they must deal with the pain personally, they just don't get it.
 
Wow.    Just wow.  But then again, I had a self-righteous Nurse Wretched (yes, the gentle Cricket said that and will say it again) tell me that there was no way I had a spinal headache after a screwed up epidural for an emergency C-sec.  I have the nervous system of a pig, with a high tolerance for pain.  I was walking around with a spinal headache, and Nurse Wretched informed me that I could not move, let alone waggle my little finger lying down, with a spinal headache.

24 hours later, I had to have a blood patch done.  Diagnosis?  Spinal headache due to failed  epidural. 

Nyah. 

It is my prayer for Captain Chuck to stay in the game, and to have what he needs to alleviate his discomfort.
 
Unless they must deal with the pain personally, they just don't get it.

A doctor once looked at the X-rays of my left foot, which clearly showed bone chips where bones should have been, then looked at my green and purple, swollen-to-twice normal size foot.

He grasped it and twisted it axially, and asked, "Does that hurt?"

After he picked himself up from the floor, I asked, "Did that hurt?"

 

Doctors always did make the worst patients.  I asked one doctor we had in Germany where he would go *in the system* of either military socialized medicine or the German.  He hemmed, and hawed and then gave me this crapweasel answer:  "If my wife and children do what they are supposed to do and not get sick, it isn't an issue."  I pressed him with this:  "But you will be here for two years.  What IF?  How do you feel about being subject to the system with regard to health issues?"  Denial, thy name is Doctor (redacted). 

He had the grace to look at the floor and not answer me.  I refused to see him after that.  I liked the Yugoslavian doc much better anyway.  He was kindly, older and very knowledgeable. 
 

 
 @ Cricket, Chuck is in all of our prayers, he's got some *unfinished business!*

@ BillT, from the wisdom of your writings, it appears that you are a personal "young man."

BillT,  it also appears your are *really up front and very personal*. Sorry, to hear about the leg spasms.

Just one question, BillT, Isn't it true male humans are supposed to have just one "Adam's Apple", not three?
 
Bill, you win five Internets for that one,  and my personal thanks (I, too, have had some Dumb Doc experiences). 

That is the greatest feat of, not arms, but fists I have heard that was performed by an American fighting man since Major Unger knocked the Time Magazine reporter off of the bar stool in Saigon, back in 1963.
 
Medical screw-ups happen on the civilian side too.  

My last surgery was on my right shoulder, so they used my left inner elbow to insert the IV.  The IV hurt like HELL.  The nurses told me "IV's don't hurt once they're inserted.  It's all in your head."  They finally believed me the next morning when I showed them the lovely red streaks that went from wrist to elbow. After the nurse picked her jaw up off of the floor... she removed the IV and called the doctor.

When Kevin was circumcised, the doctor cut too deeply and couldn't stop the bleeding.  They used a chemical cauterization which usually works for bleeders... but ended up having to stitch him also.  He's 10 and still gets little bumps like infected ingrown hairs at the stitch sites.  The urologist "thinks" it will be ok, just "inconvenient".

My Mom's doctor blew off her claims that there was a new bump behind her knee a few years ago, telling her it was just arthritis.  It wasn't.  It was a tumor that resulted in a full knee replacement and removal of a good portion of bone that had to be rebuilt artificially a year later.

No medical system is perfect, nor is there a doctor who will always get it right.  You just have to hope that you have the right doctor, at the right time.. every time.
 
While no medical system is perfect, the doctors and health care professionals who deliver care tend to not listen to their patients or are lousy diagnosticians.  That is what makes the system lousy in the first place, and in the second, the system is designed to manage care, not cure illness or heal injuries.  I have had three surgeries on my left arm to prove it.  The closest hospital I could be airlifted to with a trauma center was a medical school.  I am whacked out on morphine, and barely remember the doctor telling me that the pin was 'experimental.'  I told them we didn't live in that state, and follow-up would be impossible.  They did the surgery anyway.

I really hated being the gift that kept on giving.  THAT is what torques me about insurance.  You are supposed to be restored to a state comparable to what you were before the injury.  I am lucky that I have full use of my left arm; I was a non-union compound fracture for nearly four years.

When my nephew broke his arm, he was in Canada.  He actually fared better than I did simply because his break wasn't as serious as mine (his was in alignment and not a compound fracture), and he got a doc in their medical system who knew how to set broken bones.  He hated being tied up, but he healed completely without surgery and is doing fine.  The irony of it all is what kills me...


BillT, didja get a pic of the doc's face? 
 
Cricket, I would love to see that pic, if it exists, and was taken a day or so later, to allow the bruise to come into full bloom!
 
Gee, seems like lots of us here, both Military and Civil, have had Bad Doctor Experiences.

I shudder to think, and to say, this,  but I betcha it's gonna get worse for all of us.
 
100% agreement with John (Not The Armorer)'s comment at #2, above.  Total disgrace that injured servicemen and veterans are treated this way. 

Stories like these are why I've had a pathological hatred of doctors and doctors' offices for most of my life.  No, I've never had anything like that happen to me, but even the chance that it might keeps me away from doctors.  Well, that and the fact I currently have no job, no insurance, and no money to spend on nonessentials. 

It was different when medicine was a calling that only the truly dedicated went into.  But the need for doctors has led to an explosion in job openings and hiring, which always dilutes the talent pool.  Some of these schmucks shouldn't be treating animals, much less people. 
 
You've all pretty much terrified me. I'm half convinced now that if I ever get sick or injured, the docs will finish the job. Oh well. Gotta pray for continued disgustingly good health. And I'm still gonna start taking judo. :)
 
I feel your pain. Pun intended.

It took the Army ten friggin' years to fix my back after a Bradley accident, or two. Half my career I spent in pain off and on again. Meds out the wazoo and a couple surgeries later, I finally got relief.
Still have pain, but it is much better after the second surgery to fuze the L5/S1.

Pathetic.


 
1idvet,
I, too have a crushed disc at L5-S1. I blew it out so badly, blood-vessels & nerves grew into it while the damaged tissue around it was trying to heal. Now, every second of every minute that I'm awake, I'm in serious pain. My pain-doc knows that, my GP knows that.
My GP is a great guy that actually listens and trys to get you to the specialist that "can" help you. The problem seems to be getting the specialist to actually remove the disc and fuse L5-S1. I've been beating this drum for 17 years, and they have not got "A Round Tuit", yet... I'm still trying, but getting tired. None of the pain meds help unless I take enough to be 'Non-Func'. Not gonna go there.

 
@1idvet and @ChrisP, *Very Well Stated!* Be Glad that you have an option of surgery. For some of us, that's just not an option.  As 1idvet puts it, "Meds out the wazoo...", yes, ChrisP, it leaves me 'Non-Funct'.  Grumpy, what do you mean by 'Non-Funct'? I may go to bed on Mon at 9PM and maybe, wakeup Wednesday or Thursday *night*, if I'm lucky. The weird thing about meds is the very thing that helps control them can cause them. I've got a good Neurologist, he said, "When that happens, just sleep it off. But whatever you do, don't worry about it. This is where your body stores up some of the meds."
 
John (NTA) and all the others, 110 percent agreement. I'm having some issues (getting older isn't for sissies) with my right hip. For two years I would go to the specialist my doctor referred me to and at every appointment would say my hip hurts. "We're not sure if it's your hip or your back, we need more tests," was the usual reply. I had X-rays of hip and back, an MRI and a trip to a chiropractor that convinced me Torquemada must have been one. No relief anywhere. Went to a private orthopedic center to see about having back surgery. Doctor said he wouldn't do the surgery until I lost weight, I asked if there was someone else I could see and he referred me to another back surgeon who said "Hey, it might be your hip, let's get an X-ray, the ones you had are two years old." It was a digital machine and I was still pressed up against the sensor when he said, "Yes, it's your hip, let's get you to a joint replacement specialist." I went from the first doctor to the second in about 45 minutes and from the second to the third in about 10 minutes. I still have to lose another 45 pounds before this one will do the surgery but at least I'm confident he's competent and I believe he knows what he's talking about, I've lost all respect for the guy my GP sent me to first.

Side note, the GP I went to before was fired from the clinic I go to because he was playing slap-and-tickle with his nurse at work. His wife came in and there was a three way slug-fest (mostly the wife's fists.) I know someone who was in the waiting room when it happened and I guess the police had to come and escort the three off the premises. Doctors are like the ads on TV: Your results may vary.

All that said with my job I get to interact with a lot of doctors. One of the best, most caring and knowledgeable surgeons I've met is semi-retired but still works in the wound clinic here. He's like a lot of doctors, he wants to do a good job and wants what's best for his patients but he has to work within a system that he isn't totally happy with.