had to watch the eagles game on a small hospital tv today as i've been cooped up since late last week with no clear picture of when i'll get out.
-begin rant-
this has been and incredibly frustrating experience and continues to reinforce for me that too many doctors are self-important script followers lacking the ability or courage to think critically. most of them could be replaced more effectively by expert systems at least for initial diagnoses.
i've been here since friday pm and they still have no idea what i have.
thursday - i go to my primary doctor because on wednesday night i noticed a painful little bump on my elbow around midnight. by 2 AM and have a high fever with chills and the bump is growing. by thursday morning, it's the size of a golf ball and a black dot has appeared on the center of the bump. my primary doctor, nice guy who i like thinks i have bursitis and asks if i've been resting on my elbows. i ask if bursitis usually causes fever and chills. hmm, he says, it must be an infection, maybe MRSA. i say i'd guess a bug bite, possibly a spider bite? he goes on and on to explain how what everyone believes are spider bites are in fact never spider bites (no spiders in the northeast are venomous enough to hurt people) and that usually it was really MRSA. he says it's probably an infection and asks me if there has been anything leaking out. yes i say, but it's been clear. he thinks he needs to drain fluid to see if it's bursitis. i point out that something black is embedded in my elbow, but he ignores it and tries to drain fluid, getting nothing. he prescribes me some oral antibiotics.
friday - the antibiotics have helped my fever but the swelling continues to increase and is spreading up my arm toward my torso. i call my doctor because he made me promise to call him to follow up. i call at 9 AM as soon as the office opens. no return call. at 12:30 i call to follow up to learn they have closed for the week. what?!? i call his answering service and ask them to page him because he asked me to call him today. at 2 pm i get a call and tell him what is going on. i ask him if i should go to the hospital, he says yes i should go. crap, i'm supposed to be going to the inspection of the house we're trying to buy at 3 pm. i go to the emergency room and wait for 2 hours before getting into the exam room to tell them what happened. i show them the black thing and they ignore it. they think it's probably an infection and treat me with clindasomething. they don't take a culture of the fluid seeping out of my arm. i wait. they decide i have to stay overnight so they take me upstairs to admit me. they tell me they're going to put me on vancosomething instead to cover more types of infections. both doctors i meet in the ER think nothing of the black spot in my arm. the nurse tells me i'm supposed to get it every 12 hours so my next dose is due at 10 am, around the time the infectious disease specialist will be around to check me out. my fever goes down and the swelling subsides a little.
saturday - i wake up and ask the new nurse (shift change) where my vancosomething is. she says i'm only supposed to get it every 24 hours. i say the overnight nurse told me every 12 hours. she says "no, the label says every 24 hours". i say i'm sure i was told every 12 hours to no avail. i wait. the infectious disease specialist i was told would come at 10 am doesn't show until 4 pm. by then, swelling has increased, area is hot, and my fever has spiked again. he comes in, basically shrugs his shoulders, yeah, it looks like an infection. i won't be able to tell you what kind until i see the results of the culture. i say they didn't take a culture, he's surprised. i tell him that i was too, but they took blood. he says it would only show up in the blood if it had infected the blood, but then i'd have a bigger problem. he turns to leave. before he gets to the door, i finally ask someone directly "aren't you going to take this black thing out of my elbow?!?!" he tells me he thinks it's a scab. i note that it has skin covering it, and ask him if skin grows over scabs. he comes over to take a closer look. he starts poking at it and then it pops and fluid starts leaking out. he takes a culture and pries out a little oblong black object and (i'm not kidding) turns to my wife and me and asks us if we can see what it is because he doesn't have his contact lenses in. i say i have no idea what it is, it looks like a little oblong black thing. he tells me he's going to send it to pathology and decides that he's going to prescribe me doxysomething in case it was a tick. i ask him why the vancosomething was set up for every 24 hours when it seemed to be working to decrease the swelling. he says it should be every 12 hours and says he'll change the orders. my fever is spiking so i ask for motrin. 2 hours later the motrin, doxysomething, and vancosomething arrive.
sunday - the infectious disease guy comes in to tell me nothing grew from the culture. i ask if they'd typically expect something to grow from the culture since i'd already been on antibiotic? shouldn't someone have taken a culture when i first got here? he says that he's going to send in the orthopedic surgeon to drain fluid from my elbow as that should promote healing. i'm thinking healing from what? you guys have no idea what i have. the orthopedic surgeon comes checks me out and immediately says "looks like a tick bite". he's not sure there's any fluid in there, that it looks like it just might me tissue swelling, but sticks a needle in my arm anyway because that's what the infectious disease guy asked for. he roots around for a while and gets nothing. finally at the last second before he's about to give up, he finds some pus. he thinks they may be able to get a culture of this. now my arm is swollen, red, itchy, hot, and hurts like heck. and they still have no idea what i have. and i had to prompt them to do something about the thing that led directly to 50% of my treatment right now. idiots.
NOTE: i fully recognize how hard their jobs are and the amount of training they've had to go through or the various pressures they face and how they're held to such a high standard (though a lot of that they bring upon themselves by doing self important things like insisting that everyone refer to them as "doctor" so and so instead of "mister" so and so). there are plenty of doctors who i respect and i think are smart, but the fact that these guys have taken a completely empirical approach to treating me and have shown little, if any, interest in actually figuring out what is causing it illustrates a fundamental problem with western medicine -- it's designed to treat symptoms and not cure diseases. not a bad business model i guess. if they actually cured people, they'd lose most of their recurring customers.
-end rant-
at least the eagles won. wasn't elegant, but it was exciting at the end.
Labels: doctors, football, miscellaneous
