been a long time

Hello everyone,
sorry I have not been here in a while. My son, the day he was supposed to move to college ended up in the emergency room twice. He is a completely healthy 18 year old who developed severe abdominal pain over about a 24 hour period. I took him to one ER here in the South Sacramento Area. The lobby felt like a cold dirty war zone. People yelling, others just hanging out speaking loudly abuot various personal issues. and meanwhile my son was writhing in pain. The walls were a bland color, the chairs were cold, hard and dirty. We waitied about one hour in that room. Then we were taken back and triaged by a nurse who insisted on giving Eli a lecture on over use and abuse of alcohol in teens. Mind you, Eli had not been drinking and all he could think about was pain relief. Finally we are put in an exam room. Then we waited and waited and waited.. I kept peeking my head out of the curtain and when I did everyne would either look down for turn away, No one would look at me or acknowledge me. Finaly a young MD came in and told us how busy he was and how many patients he had seen since the start of his shift. He then looked at Eli, did not touch Eli, ordered some labs and an ultrasound of his upper gut. Did not really discuss annything with me. And he left the room. We then waited and waited for about another 30 minutes before Eli was given pain medication. He was writhing, pulling at his hair and saying that the pain wass killing him.
For those of you that have children, you know there is nothing worse than seeing your child ill and in pain and you are helpless. I am his mom not his health care provider. I was, just like him, at the mercy of the ER and the MD.

Finally, he was given morphine and was able to calm down and relax. Eli had not slept for two days at this point.
We were sent for an ultrasound of the upper abdomen becasue that is were Eli's pain was manifesting. The ultrasound was negative. There were no gallstones.. (let me tell you that it is very unlikely that a thin, 18 year old male would have gallstone in the first place). They also said he did not have a kidney stone.. I am not sure why they looked for that and oh yeah, the urine sample that he gave which you would want to look at if he had a kidney stone was still sitting on the counter of our exam room. No one ever looked at it for blood or any other abnormalities.
Oh yeah, Elis' white blood cell count was elevated..16 thousand. (normal is below 10 thousand). The MD came back and said that the tests were normal and that he wass sending us home. We asked what we were to do when the morphine wore off. He just looked at us and proceeded to leave the room. The nurse came back to go over discharge and I asked if the MD was going to give Eli anthing for the pain. She said she would ask.. She came back about 10 minutes later and said the MD would like to know what drug I would like him to prescribe.. What the hell! Why is he not in here having this discussion and why is he asking me??

Oh yeah, another thing happened.. Some time during our five hour visit there, One of the nurses said to me that the MDs like working there bcause most of the clients are ignorant and they don't ask questions and therefore the MDs dont have to explain anything.. This hospital cares for many of the poor folks in the south Sacramento area, many form foreign countries. Isn't that a nice attitude?

We went home and sure enough the meds wore off and we were right back where we started from. Eli suffering and getting worse.. We called our family MD who ordered and upper GI. This is where you swallow some barium and you get xrayed while it is moving througn your gut. this is a test for ulcers and stomach irritation. While this was happening ELi was getting worse. Wewere now in downtown Sacramento. So off to another ER.. We went to Mercy General. A hospital with a good reputation and in our insurance plan. Gotta go where your insurance has a contract.
We waiting in the ER which was filled with people coughing, moaning and suffering.. and some where there for minor issues but they had no private health care provider so they needed to use the ER for non emergency care. Afterabout two hours in the waiting room we were taken back and triaged by an ER MD. She was so overwhelmed by the day and the hospital was implementing their new electronic medicall record system so everything takes about twice as long. No fault, just the way it is.. I remember that from our own transistion.
This MD was really concenred about this healthy 18 year old male with abdomincal pain. She wanted some tests and to give him pain medication. The policy is you can not give pain medication unless a patient has a bed. We we were in the hall in a chair. No bed.. no pain medication.. Again Eli was getting worse. Now he had a fever 101.2. In order for Eli to get blood drawn I had to take a wheechair and transport him myself to the lab. Then I had to transport him to the xray to see if the barium was still prevelant in his gut because if it was he could not get a CT scan which is what we should have gotten in the first place. Well , too much barium.. the reason the barium swallow was ordered is becasue it is cheaper and it was easier to get his unxurance to apporve that rather than a STAT Ct scan.
Well that really blew everything.
Finally the ER MD requested a surgical eval.. Eli's pain was now generalized belly pain and he was lookinig really sick. The surgeon came down and took a history and felt his belly and did not think he was a surgical patient but he was going to admit him to observe. Thank god we were not being sent out again.
The surgeon was really upset at the events that had taken place up to that point. Me too.
This was friday at 2pm and Eli was admitted to the hospital.

His white blood cell count wass climbing and his belly pain was worsening. He was requiring morphine every two hours. I was getting very frustrated. Eli was sgetting worse and there were still no answers. Admitted and left alone for the night.

The surgeon returned at about 8:30 on Saturday AM. He touched Eli's belly and said he still did not think it was surgical. Drew more blood and said he would be back the next day. The next day?????
As the day progresed Eli was getting sicker, confused, increaseing pain. I was beside myself. My husband was there too and we were both feeling powerless.
I asked the nurse to call the surgeon. I wanted to know why if he thought Eli wass not a surgical case then why did we not get an internist on the case?
The surgeon did not return the pages.. this went on for several hours. Finally I decided that I wantd to get another MD. I felt abandoned by this MD and watching my son getting sicker was no longer an option.
My husband found out the name of the person that could help facilitate the change of MD and she contacted his vice chief if surgery. Once this hapened and I got on the phone to tell the original surgeon that I wanted another MD that I was very unhappy with his care.. he then stated that he would like to contiinue the case and the he would be more available and speak with me directly instead of getting report from the nursing staff. Appearantly the RN was not giving the information in a way that clearly indicated the change of Eli's status.. Whatever the reason, it is too bad that I had to threaten to fire this guy before he would really step up to the plate.
That night, Saturday, he visited several times and still was not convinced that it was surgical. and another xray still showed barium so a CT was still not an option.
Finally Sunday morning when Eli had a temp of 103.8 and aWBC count of 20 thousand the surgeon thougt it was time too do an exploratory laparotomy. Do you think??? Three days of worseing abdominal pain, fevers and and elevated white count.. what more do you need??

The surgeon went in and in the middle of the surgery he came out to tell us that Eli had a ruptured appendices and that it had probably ruptured three days ago.
No apology, no nothing.. He stated that he needed to go back in and complete the surgery, which he did in about two more hours.
ELi came out of the OR with a catheter, a nasogastric tuble and a drain from his belly.

What a way to start your freshman year.

We spent the next fours day in the hospital and now we are home .Eli is recovering.

I know this has nothing to do with HIV but it has to do with our health care system.

A CT scan is expensive.. but look how much money was spent because the CT was not ordered initially. I am sure the we spent many thousands of dollars trying to figure things out because the CT wass not done . Trying to "save" often costs more in the end.. Just like my disscussion in an earilier post about spending on prevention for HIV rather than treating the actual disease itself.
This does not seem very complicated to me but the policy makers don't seem to see things clearly.

This other part of this story that strikes me is that you have to threaten to fire in order to get proper care. Most people are not as "aggressive" as I am. Most people, once they are in the hospital become passive patients and passive family members. If you are passive bad things can happen. I believe that in a situation like this we are the consumer, the costumer.. where is the costumer service. Why do people in the hospital treat the patients like they are a burden..
We as consumers must stand up and demand excellent care. We have a voice and should not be afraid to advocate for yourseslf or your loved ones.
I do not mean to imply that all hospital workes are like this, we had some terrific nurses. But I should not have to tell people that I am a nurse practitioner in order for us to get respect and information.