31 October 2008

Attack of the Crohn's

For about a week, I've felt incrementally more miserable to the point that Tuesday night (28 October), I realized that I felt comparable to how I felt back in April.  [For the unintiated, I was hospitalized for five days with a bowel obstruction in the middle of that month.]  My wife, upon hearing this, insisted that I be checked out; I eventually did.  I said I knew what the problem was, and that the solution was to get back on Prednisone.  I happen to have a supply of it remaining from this summer that is still good to take.

The next day, after she and her employers (she works at an urgent care center) insisted that I needed to be checked out, I relented and let her take me to be examined.  We paid out of pocket (with a check to be cashed later, 'cause, you know, we're broke) and had a series of X-rays taken of my abdomen.  The doctors for whom she works took a look and determined immediately that I had some bowel loops formed and the beginnings of another obstruction.  So far, so good--I had pretty well determined based on how I felt that that was the case.  Then I was admitted back to Norton Suburban, and stood little more than 15 feet from my wife's boss as he spoke with the physician through whom they admit patients.  He described exactly what was going on with me, and my need for steroids and antibiotics; we left and expected to arrive to a planned course of treatment consistent with what I just described.

We were in the room by 5:30 PM, and no physician saw me until 9:00 that night.  This was not the admitting physician, but rather a second shift lackey who took one look at the X-rays we brought with us (then less than six hours old) and said they looked "perfect" to him; that just because I have Crohn's did not mean my current woes were related to my condition and that it may be gastroenteritis since that had been going around.  Did he test me for this theory?  Well, he ordered some lab work done on my blood, but the only real way to know what's going on in the guts is with imaging.  He wrote orders for X-rays, and depending on the outcome of those, a CT scan.  My X-rays were still current and as an out-of-pocket patient, I had no desire to pad their radiologist's pockets, or to expose myself to unnecessary radiation.  A woman arrived to take me to radiology; I explained that it was superfluous and that I would not go for X-rays I didn't need.  At this point, the lackey doctor canceled the CT  (the only useful test I could have taken) and deferred my case to someone in the GI department the following morning.

7:00 AM brought me a visitor--not someone from GI, but a surgeon who--surprise!--thinks I need to let him cut on me.  Leave it to a surgeon to look at a traffic jam and decide to fix it by rebuilding the road.  He specifically said that the admitting physician called him in on my case.  That's funny, because her only information on me was either what my wife's boss told her on the phone--which everyone denied she ever relayed to anyone else--or what her lackey told her.  If she was acting on the former information, then I want to know why a lackey had the authority to dismiss everyone else's understanding of my situation and withhold any further testing--to say nothing of treatment.  If she was acting on the lackey's perspective, then I want to know why she would call in a surgeon if her man on the ground says I'm fine.  The truth is, she likely called in the surgeon when she was originally called and planned to get him in on the action regardless of whether I needed surgery.  In any event, when I explained that I know enough about my condition and surgery's role relating thereto that I know surgery begets more surgery and would only consent to it if absolutely mandatory, he left, disappointed.  I suppose his portfolio hasn't gone well lately and he was hoping to generate some income by cutting on the Crohnie.

By 9:30, a GI doc finally arrived.  She heard my story to that point, took one look at my X-rays (you know, the ones the lackey said looked "perfect") and her eyes bugged out.  I was drinking contrast for a CT scan within a half hour; by 1:00 she had ordered the steroids I said I needed all along.  I had two bowel movements before I even had the CT.  I had my first shot of steroids at 4:00 and a second at midnight, by which time I'd had a third bowel movement.  Sometime that night, the lackey returned and attempted to cover his tracks by explaining why he did not want to test me without knowing if I could handle being tested (referring to the effect of ingesting the contrast).  This is lame, because the bloodwork he ordered was to determine that I could handle it; certainly there were no red flags in those labs because that's all the GI doc had to go on the next morning when she ordered the CT.  He agreed this time with me, though, that everything appeared fine and that I should be able to graduate from a clear liquid diet to a low residue diet and plan on leaving the next day.  Great.

The nurse came in shortly thereafter to explain that the GI had overruled the lackey's ideas and I was restricted to a clear liquid diet until morning.  By now, I've had more than enough of doctors ignoring what I have to say about my own condition and deferring to one another.  It's like asking your mom about something and she says to ask your dad; you do, and he says to ask her.  At some point you get fed up and shout, "I can't give myself permission, so would one of you grow a spine and exercise your authority?"  Finally, this afternoon (Halloween), the GI returned.  She insists that no one contacted her about increasing my dietary intake, and that it would have been her on-call doctor who elected, as had others the previous night, to take no action and leave me in the hands of someone else to deal with later.  She gave in, though, and conceeded that I seemed to be fine, wrote me a prescription for Prednisone and discharged me--pending the approval of the medical doctor (chiefly represented by the lackey).

My wife pointed out that the lackey had said the night before that he was content to defer entirely to the GI; the GI insisted she was "just a specialist advisor" and that he--or at least someone in his group--had the final say.  Again, we're back to doctors yielding authority to other doctors.  Eventually, though, the whole thing was resolved and I was allowed to leave.  It's funny, because I started Tuesday saying I needed Prednisone and by Friday I had a prescription for...Prednisone.

The entire debacle was a microcosm of the American health system.  Doctors say they want patients to be involved in their health care, but the truth is that doctors like people who don't question them.  After all, they spent a lot of time and money to wear that white coat, and it means they're above reproach.  "Maybe you're the one living with this chronic disorder, but you don't get to tell us what's going on."  Doctors do, however, look out for one another.  That's why surgeons are called in by doctors who have no compelling medical reason to call them, and that's why on-call doctors are the equivalent of tech support.  You don't even have to know about computers to work tech support; you just have to know how to read the pre-written cue sheet, and I think it's even less demanding to be an on-call doctor because you never have to actually get involved at all.  Instead, you simply say that you're unwilling to alter the course of treatment or order tests, regardless of whether or not the course of treatment even exists or is effective, or whether tests are clearly necessary to treat the patient.

During my stay, I watched Barack Obama's half-hour long infomercial.  I had been working on finishing Plato's The Republic, which had cast some doubt on his candidacy for me.  Then I watched and listened as Senator Obama reminded me that he feels the American health system does not do enough to take care of patients, and I was vicariously reminded that John McCain--whom I, at one time, sincerely trusted would oppose a lot of the things I have described in my own recent experience--has taken the opposite tack on health care.

Will Obama improve our health care?  I don't know that he can or will, but I do know that he says he wants to try.  So, too, does Senator McCain, but his proposed way of improving the health care system is to emphasize the heartless, money-grubbing side of it.  Will a vote for Barack Obama mean not having to fend off a surgeon peddling a procedure that does not guarantee an improvement in one's health?  I can't say that it will, any more than I can say that having 10 cm of my intestines cut out will make me feel better.  What I can say, though, is that I do believe that we have to let Obama try to improve things.  We often content ourselves, saying that America is the greatest land on Earth.  While this may be true, I think we continue to sell ourselves short by not striving to always make it better.