On the Mend

As you can see from Deborah's post I had a little health scare last weekend, which has kept me off the intertubes for several days.  Fortunately it turned out not to be a huge deal and I should be returning to work on Monday.  I did get quite a tour of high tech medicine in the process, which was of some interest to me.

I have been going rather hard at work for some time as my union pension plan clients grapple with what the market debacle has done to their funding.  I had 15 hours of meeting on Thursday, followed by a lengthy one on Friday that began at 7:00 AM.  So naturally on Saturday I decided to go to the gym for an hour and a half in the morning and then play tennis (first time in a couple of years) for two hours in the late afternoon.  Without bringing water, because, I am a moron.

When I got home my chest began to hurt and my heart beat seemed a bit rapid.  So I did what any man would do (and I do use "man" specifically) and decided to move a carpet out of a room where we were going to keep a new dog, then walked up the street for Chinese take out, bought a book, drank a beer -- all of the text book things they tell you to do when you're  49, a bit overweight, and suffering from chest pains.  

Finally, about 10:30 I tried to go to sleep and the pain intensified to the point of rather substantial discomfort (the kind of bloodless phrase my wife complains keeps me from getting prompt medical attention anywhere).  I woke my wife and said now seems like a good time to go to the ER.  We debated the merits of Georgetown University Hospital -- a more genteel ER on a Saturday night -- versus Washington Hospital Center, the proper place for cardiac care here in our nation's capital, but set in a much more gritty place, with an ER to match.  Convinced that this couldn't really be anything serious I voted for Georgetown in the hope that the sweet, sweet painkillers I needed would be administered that much quicker

The ER call seemed quite prescient as there was only one person ahead of me and bulky men with chest pains seem to be taken rather seriously.  In no time I was getting multiple IVs, an EKG,and blood work.  The EKG was normal and I assumed it was just some sort of muscle pull or spasm, but then the blood work showed higher than normal levels of troponin, an enzyme associated with heart attacks.  Well, they all seemed to take this rather seriously at GUH.  The next thing I knew they were discussing medivacing me to Washington Hospital Center.  "A helicopter?" I said.  "Isn't that a little over the top?" -- if you'll pardon the expression.  I was assured it was not.  Go figure.  

I met the helicopter medics and we discussed the fact that we might be competing for airspace with the Obamas' return on Marine I from date night in New York.  Just tell them who I am I suggested.  The morphine was kicking in well at this point, making the helicopter ride seem an interesting novelty,  (I slept for most of the very short ride.)

At WHC, there is an ER directly adjoining the helicopter pad, so I was seen immediately.  The medical fellow attending there looked (and sounded) strikingly like Steffi Graf.  I wondered if I was having some tennis induced delirium.  She did another EKG and then a sonogram of my heart and quickly figured out that I wasn't dying and quite likely had not had a heart attack despite the diagnosis of "myocardial infarction" on the papers from Georgetown.  Soon some poor woman who had been stabbed multiple times was flown in and I was appropriately put on the back burner for a couple of hours.

Once admitted, I felt like I was on an episode of House, where you know the first several diagnoses are never right.  A second medical fellow dropped by and indicated that he thought I had a pulmonary embolism, i.e. blood clot in the lung and wanted me to have a chest x-ray and a CT scan, a vaguely HAL like machine that tells you when to breathe.  It was too early in the episode for this to be correct and the scan showed no clots (which made me happy -- killer blood clots seem disturbing to me).  That was how I spent my Sunday.  The chest pains returned on Sunday night, along with a low grade fever, which made me a little uneasy.  On the plus side, I felt fully free to describe my pain as a 7 on that ludicrous 1 to 10 scale they use and get some more morphine, my bestest friend ever. 

Monday was the main event, a cardiac catheterization to see if there was any problem with my coronary arteries.  The team that did the procedure had the unusual distinction of being both highly professional and personable.  It is important in all hospitalizations to have that moment when all dignity is lost and this was it.  The Calvin Klein briefs were removed and stored in a "bio-hazard" bag -- I am not making that up -- and the nurse I dubbed the Bushwhacker began shaving my pubic hair with an electric razor.  She was very please with her handiwork too, joking that she had gotten me all ready for the beach season.  I had been expecting to be sedated through this process, but when the doctor approached to make an incision in my groin and thread a guide wire up to my heart I noticed I wasn't just awake, I was seven shots of espresso, wide-eyed fucking awake.  "You're going to feel a little pressure," he said.  No I thought, I am going to feel you stab my groin and shove something up my arteries.  Not wanting to seem like a baby, I merely clenched every muscle.  It wasn't really all that painful, but it was definitely disconcerting.

Afterward one of the nurses said to me , "are you a bit of a drinker?"  Why do you ask, I said innocently.  Because, honey, that valium didn't phase you a bit.  I was pretty sure that there had been no valium.  Or maybe it was light valium  -- valium 64. 

Of course they found no blockages of any kind the arteries.  But I do have a sleek new hairdo for summer.  The new diagnosis -- myocarditis, an inflammation of the heart muscle. 

After a cardiac catheterization, you are supposed to stay more or less flat on your back for the next six hours.  To help kill the time, I got to have an MRI and another sonogram (for a phantom bleeding kidney cyst thought to have been spied on the CT scan) and a stint with the machine that goes ping to confirm the myocarditis, which, of course, I did not have. 

In the end, all tests proved negative, leaving me with a diagnosis of idiopathic pericarditis, an inflammation of the sac around the heart.  Pericarditis was described to me as something diagnosed by omission, but when I read the description of the symptoms, what I had fit them perfectly. 

I was pretty pleased with most of the care I got, even if it was a sometimes frustrating experience.  (I'll make a policy point so this doesn't seem endlessly self-indulgent.) It occurred to me though that notions of consumer driven health care are even more a crock of shit than I thought.  I am a fairly well educated and informed person regarding health matters -- I would never, however, have considered suggesting that any of the tests or medications that I received were unnecessary.  In the end you have to trust the medical professionals with whom you are dealing and follow their advice.  The idea that consumers can be a meaningful check on health care expenditures in this kind of context is sheer nonsense.  

Glad to be back on my feet.  Thank you all for your kind wishes and especially to Deborah for her lovely post.    .     .   

Comments

[oddjob]

The idea that consumers can be a meaningful check on health care expenditures in this kind of context is sheer nonsense.

Agreed. Six and a half years ago when I had appendicitis I drove myself to the local ER (in Lynn, a comment Sir C. will appreciate). (FWIW, I'm not medically trained, but I knew the likely symptom pattern for appendicitis and so was aware of what was happening sufficiently early on that driving myself was not a dumb idea.)

My suspicions were confirmed by the blood work, although the doctor on duty at first doubted I had appendicitis.

When I was operated upon I got the traditional 6" incision (and "the scar"). After the fact, when I first went to the surgeon's office afterwards so he could check my progress I asked about why he had used that approach instead of the laparoscopic one now available. (In that approach they just make two or three tiny abdominal incisions insert a laparoscope, snip the appendix and easily remove it. You're up and about in a week or two instead of six weeks.)

He replied that he had been concerned about the possibility of rupture.

The ER doctor had already told me that my appendix was only in the very early stages of inflamation.

I'm still skeptical about the surgeon's answer, but in that situation who are you to stop and specify what procedure the surgeon will use on you???

[oddjob]

(Oh, excuse for not saying I'm also glad you're back on your feet!)

[ballgame]

On the plus side, Sir C, we Cogbloggers get to enjoy a very entertaining change-of-pace post!

;)

Glad the tests all turned out to be (in retrospect) unnecessary and that you'll be back to normal soon.

As to the whole 'consumer driven health market' thing, it always struck me as ludicrous BS to begin with — I mean, you just had a car accident, are you going to send out RFP's to ambulance companies and then make a decision about which one you want to go with? But, one time I needed to get a specific procedure done — something relatively minor and not urgent — so I thought, OK, prudent consumer and all (even though I had insurance) … I called up a doctor I had seen before and asked, "How much do you charge for ____?"

They don't give out prices.

So … free market health care … yeah. Right.

[Sir Charles]

oddjob,

Surgery in Lynn -- I don't know, I might be inclined to drive the few extra miles to Boston. Unless it was a gunshot wound. I am guessing that's something that they handle with aplomb in Lynn.

Thanks for the kind wishes.

ballgame,

Yeah, I've always shared your view too, but it was really driven home to me in spades with this encounter. About the only thing we consumers can do is do our homework in terms of the facilities that are likely to have the most expertise in a given situation. That said, in the even of an emrgency we are often at the mercy of the fates.

I'm glad you were entertained -- all experiences are partially redeemed if one emerges with a story.

[Mary]

That was one hell of an episode, but I'm glad to hear you're recovering. On the bright side, you can now say you have some things in common with both Bob Dylan and porn stars.

[Calvin Jones and the 13th Apostle]

Sir Charles:
Glad you are safe and well. You are right about health care. It's 20 years ago now, but I had an episode that required the ER. Anyway, again this was 20 years ago, the insurance company wouldn't pay the full claim because they said the doctor was too expensive. I had no choice on the doctor. It was basically that doctor, right then(Sunday night .. between 8 and 10pm), or die. Health Insurance is so messed up in this country is all I'll say.

[ari]

Good to have you back, C. Did you get to keep the helicopter?

[Voice O' Reason]

Sir C of DC,

So glad you're on the mend, dear. I type this from the 6th floor of Cedars Sinai in L.A., where I'm staying overnight -- not for me, but to keep a dear friend from repeatedly trying to get out of bed in the middle of the night. He's in end-stage liver failure, and things aren't looking rosy for him...more extremely jaundice-yellow, actually. He's pretty clear during the days, but at night he's disoriented and hallucinates. So far, he's asked me to help him find the lady with the horse and get her off of him, to get the dog off his legs, and to help him get out of bed so he can find the "mystery gadget" he needs for "the competition." When I looked perplexed, he said, "I'll just wait for the guy. He'll be here soon. He knows what I mean." He slept quite a bit tonight between 8 p.m. and now (5 a.m.-ish?), but there are a few more hours of vigilance required before the next shift of caring friends reports for duty.

Meanwhile, my dad's in a nursing home on the East Coast, incapacitated after two strokes and a heart attack caused him to age about twenty years in the last three or four. He's not too enthusiastic about life, with no positive prognosis for an improvement in either attitude or condition.

So I guess what I'm saying here is, stay healthy. And take care of your liver. And don't hop in a time machine back to the '50s, smoke too much, drink too much, and essentially live the kind of life that would put you where my dad is right now. I require your continued vital, vibrant presence on the planet.

[litbrit]

So I guess what I'm saying here is, stay healthy. And take care of your liver. And don't hop in a time machine back to the '50s, smoke too much, drink too much, and essentially live the kind of life that would put you where my dad is right now. I require your continued vital, vibrant presence on the planet.

Hear, hear.

You gave us a scare, C. I can only imagine how freaked-out Mrs. Sir C must have been--I can do Calm-in-the-ER facade up to a point, but once there are CT scans and hospital admissions and MRI's and, heaven help me, helicopters? I reserve the right to freak out as completely, loudly, and broadly as need be.

So dude, don't you dare go back to the office Monday unless you are 100% recovered and have no pain, no fever, no cough, no prohibitions, and no qualms.

*phew*, it's good to have you back.

[Sir Charles]

Mary,

I also now have track marks worthy of Johnny Thunders from all of the IVs. I am trying to decide if my new haircut makes me look, um, taller.

Calvin,

My wife had a terrible experience along these lines. She went to an ER of a participating hospital and had to be admitted. What no one bothered to tell us was that all of the doctors were independent contractors and not not necessarily Blue Cross participants. So we got balance billed by two of them. For once being a lawyer seemed very, very practical and I told them both to fuck off and sue us. They went away.

ari,

The helicopter was the thing that made me most nervous in the whole endeavor. We've had a couple of really bad medivac accidents around here recently. Of course the only other time I have been in a helicopter was as a freebie inducement to listen to a time share pitch in Hawaii -- this was only marginally more painful than that.

VOR,

Sorry to hear about your friend and father -- the irony here is that I got to verify that the old pipes around the heart are actually in very good shape. Not really the way you want to find that out.

D.,

I can't believe I left out the best part of the story. Mrs. Sir C. had to travel by car while I was being whisked away on the helicopter. She had to travel about 30 minutes across town and got caught up in a drunk driving roadblock in DC's Adams Morgan area. She evidently yelled at the cop "I'm 50, I'm sober, and my husband is having a heart attack!" They let her through very quickly. She was pretty freaked out by the whole thing -- and vexed by my tendency to give low numbers on the pain scale.

[Percy Percy]

Great post, Sir C. Reminded me how much I've missed you. I hope to see you exploring the bloggy possibilities of the theme "my life is going so much better now."

[Voice O' Reason]

Chuck,

I would not want to mess with Mrs. Sir C, uniform, weapon(s) or no.

Made it through the morning here. He got restless at 6 a.m. (Partially because the guy in the next room keeps shouting, "Mommy, it hurts! Mommy, it hurts!" Poor thing.) So my pal asked me to play the ukulele for him, which may have wound up being more painful for him than his whole medical situation, but I gave it the old college try. It's remarkable how much I don't know, however.

Looking forward to arrival of next shift so I can go get my roots done and then go home and nap.

Sir C, continue your restful, healing ways.

[Sir Charles]

Percy X2,

Thanks. I have at least a few posts in mind, but it really has been so crazy that I haven't had the time or the strength. I feel ever so much better right now, so I am hoping to get back on track.

VOR,

Ukulele therapy -- who knew?

[Prup (aka Jim Benton)]

Welcome back, Sir Charles. As I said, your lubricated lucidty would have been much missed, and it is a shame we can't throw an on-line party for you. Somebody here could bake a cake, I could throw together a good meal of Pakistani food -- or e-mail you a slice of DiFara's pizza -- once you are allowed such things. And if there's a small closet, I might even give you a sample of something I've been trying to get legalized.

Know about those pain scales too, and hate them. Since I've never had cancer, heart attacks, or tic doleraux how can I compare. Now if they'd only compile a 'political pain scale' ("Would you compare your pain to listening to a speech by Sarah Palin, Karl Rove, or just Evan Bayh.")...

[kathy a.]

what an adventure! so glad you are doing better, but echoing litbrit: do NOT drag your butt into work until you are 100% sure, and mrs. sir C signs off on it.

good points about "consumer-driven health care" in emergency type situations. chest pain such that morphine is your friend is definitely such a situation. sure, it was a lot of tests -- that is how they figure out what is happening, by testing and ruling out hypotheses, since you don't have a window in the chest area and dont' come equipped with diagnostic alert buttons like modern autos.

there is a down side to "consumer-driven health care," too. i'm incredibly troubled by direct-to-consumer ads about meds and appliances [what, is my transit station part of the medical team now?], as well as oprah-style testimonials about medical approaches. [hormone makeover, anyone? full-body scan "just to be sure"?]

[Sir Charles]

Prup,

Pakastani food sounds delightful. I had Thai for lunch today and after several days of hospital food it tasted magnificent.

It is my great hope that many of us will attend Netroots Nation this year. I would love for the chance to meet members of our little community.

kathy,

I promise I will not push it -- but Friday I did a fair amount of work from home and via email and didn't mind. My office is only a mile from my house, so I don't have a tough commute -- and I can pretty much call it a day whenever I wish absent a meeting.

The full body scan phenomenon and weekend retreats at high end resorts devoted to these kinds of medical explorations are really dubious. They tend to create unnecessary medical intervention and subject people to radiation for no good ends.

I was pleased with the care I got and don't think any of the tests were unnecessary. Pericarditis really is one of those things they diagnose by elimination.

[Lisa Simeone]

Sir C, you must head on over to Crispin Sartwell's blog and check out the latest song he has posted. It's right up your alley:

http://eyeofthestorm.blogs.com/

[Sir Charles]

Lisa,

Wow -- that was so trippy. Kenny Rogers in psychedelic hippy mode. I don't think I've ever seen a lead singer basically lounge on the ground while delivering his song.

It's a long way from "You Picked a Fine time to Leave Me Lucille."

[Prup (aka Jim Benton)]

Sir C:
Since I can't figure out how to get it intop the modem, I can't ship you anything but ideas. Here's an easy favorite of mine, if you like a HOT snack. You or Lady C go to a Pakistani grocery --should be easy to find in Washington -- and buy a pakage of Pakora Mix. (National over Shan if you can find it, Shan is better for most things, but National does this right.) The instructions will suggest you mix in some things, but I have a few different ones. Try pignolias, white corn, some celery and/or water chestnuts chopped fine. Only the instructions tell you to deep fry it. Instead, make it like a pancake, on a griddle or, beter, in a skillet. Cool, snack, and have as much cooling liquid to go along with it.

[Sir Charles]

Prup,

Sounds good -- especially the pignolias of which I am very fond.

[has_te]

The quest must yet be stilled.
For lifestyles, predisposing factors, personal physical issues
which predispose to this relatively unsatisfying Dx.
"Why did this particular thing happen,
what might it mean for me;
How can I keep it from any sort of return
or more critically
how to keep it's bigger more serious [?] brother at bay."
I'm sure your very best Physician is not at all reassured by this
benignity and will persist after the diagnostic grail..

BUT you made it..pretty ok...we're all glad. Take care.

[nimh]

Oh my, oh my, Sir Charles. That was quite the scare you went through. Even if you delivered the narrative with admirably British relativation - James Bond has nothing on you - that must have been frightening. And at times (very) painful - brr. I'm sure I would have just broken down sobbing sometime halfway through.

Very glad to hear that you did not, in fact, turn out to have any of the alarming things you were initially diagnosed with. And that you seem to have gotten quality care throughout, in spite of misdiagnoses.

Take it easy, eh? Maybe no 16-hour working days for a while?

[nimh]

Oh, and I don't even know how I'd react if I'd been in Lady Charles' shoes ... that drive across town must have been a nightmare of frenzy. Life bless the both of you.

[Sir Charles]

nimh,

Thanks. I am back in the office finally, but will keep it to about a nine hour day today. After a full week of being idle for the most part it actually feels good to be back. I won't push it though.

My wife definitely had the worst of it. And yes, I felt like the care I got was very professional.