Thursday, April 23, 2009

Solving the Medical Crisis, One hypochondriac at a time

I woke up at 4 am this morning with the worst abdominal pain I can remember. I'd been in Ruby's bed since 3 am when I'd walked her back to her room, a nightly event. I have a weak spot for the kid who wants to bed down with someone rather than alone; I was her long ago. Anyways, I wiggled out and wandered back to my plusher bed and hoped the pain would subside.

No luck. I never slept again and eventually got up again at 5:30, pain worse than ever. I gave the ole porcelain god a shot, and then dropped down a few laxatives left over from my postpartum days and called my mom. The truth is, though I idly hoped that the laxatives would force out some internal evil spirit, I was sure I had my first kidney stone. My mom and sister have both passed about three of stones each, and since it is often a genetically linked malady, I've been waiting for years for the day to arrive. I phoned my mom at 8:30 her time, and asked her to recall her symptoms. She was vague and insisted they would be different for everyone, not very comforting.

Less comforting than that was the fact that outside of my mother, sister, and one close friend, I have known one other person who frequently had stones (of course, most people probably don't advertise). Jim, a former neighbor, friend, and church member when I was kid, had so many kidney stones in his life that he became complacent about medical care, figured he had passed them before, he'd pass them again. His final stone took his life. After waiting two days, through excruciating pain, for the stone to pass, he finally went to the doctor, but it was too late. Uric poisoning had entered his bloodstream and he passed away about 36 hours after making the trip.

The way I was feeling, I just wasn't going to let it go; visions of motherless children were haunting me. After I hung up, I turned to Web MD. After a symptom check, I had a new forerunner: appendicitis. And wouldn't you know it, if it was my appendix, taking laxatives is strictly forbidden, it will cause a rupture. Perfect.

I went back to bed and slept on my side in doubled over position, holding my abdomen and beginning Lamaze breathing when Jason woke up to ask if I was OK. No, I told him, I don't think so. I proceeded to outline my symptoms and corresponding suspicions and suggested I might need to see a doctor. He agreed, but waited for me to make the final call. I delayed another 30 minutes, but after nearly 3 hours with no let up on the pain, which radiated from my belly up to my breastbone, down to my hips, and through to my back, I was ready.

Jason sprung into action. He dressed the kids, loaded us all in the car, picked up an egg mcmuff for Ruby and Trey to share and dropped them off at daycare. Then, we headed for urgent care at Gateway, and before I knew it, I was in the doctor's office.

Why is it that as soon as you reach the doctor's office things start to taper off? While I was still in pain, each time I was left in the room: to check on the urine, to wait for the doctor, to order the blood count, to analyze the blood draw... I wondered, am I getting used to it or am I subtly feeling better? The doctor's final decision was to order a CAT scan to rule out the appendix. It seemed a reasonable plan as I still had severe cramping, albeit oh-so-subtly less intense. If it was appendicitis I wanted to know now.

The order had me at the hospital in one hour, so we came back to the house and I slept for 45 minutes. I awoke feeling better, a lot better, who knows what really happened, maybe I had let the evil demon out as I passed gas in blissful oblivion. But, given the drama act I'd put in all morning, and the fact that Jason had taken his whole morning off, we decided to stay the course. If I simply let him head off to work, blew off the scan, then who knows, I could feel worse in 15 minutes and change my mind again. Since neither of us have ever had scans, and we have good health insurance, it seemed a worthwhile venture to rule out something as serious as an inflamed appendix.

So, off we went to the hospital, where I was surrounded by many, many patients much sicker than I. I waited in a lobby with other walk-ins and watched countless hospital beds pushed in and out of the X-ray Imaging department. What we all had in common were our 32 oz. Big Gulps: iodine and water mixtures for tinting your insides for the photo shoot.

I was supposed to wait an hour, but that grew to 1.5, during which I made steady improvement and my pain had all but disappeared. I spent some time checking with my insurance and pricing the scan, and after learning I would be making a significant investment, started to have real doubts about this whole thing. I told the receptionist I was feeling better and had decided to cancel, but Jason encouraged me to follow through. When a lab tech came out to tell me it would be another 30-40 minutes, I drove Jason to pick up our other car and run off to work, and I returned by myself to the hospital.

Things sped up at that point. I was given a saline IV, through which some new dyes were injected, and my abdomen was photographed and read. It was invasive enough that I'll spare you most of the details on that. Another 20 minutes brought me word from the radiologist that the appendix looked fine. All for naught.

So, as I sit here tonight with a flu-induced headache and general malaise, I'm pondering the thoughts I had throughout the day. How did I end up getting a CAT scan that I really shouldn't have? Do we blame the doc for overprescribing tests? Do we blame the insurance companies for offering to pay for them? Obviously, we can't go that direction, what if my outcome had been different? The rupturing of the appendix can kill you pretty quickly and I would not have footed the whole bill - NO WAY.

HMO's tried to cut costs by rationing doctors on the number of referrals, diagnostic tests, and hospital stays they could recommend. And bonuses were added for those who came under their allowances. Clearly, that will never work either, as it totally clouds the clinical and ethical principles the doctor follows in his/her decision-making.

What about WebMD, and the internet in general? If you are prone to worry about your body enough to research, aren't there a lot of scary illnesses to be found out there?

So, why did I get the scan? The easy answer is that I'm a hypochondriac in the care of responsive, and cautious doctors. And maybe that's it, the whole thing ended up pretty embarrassing (though admittedly the outcome would be what you would HOPE for) but it was ultimately my decision all along the way and there were multiple opportunities to back out. On some level, finding something would have been vindicating (though the nurse did admit there might still be a kidney stone, they used the wrong contrast color to see that), but of course in the long run, not in my best interest. And in some measure, I am relieved, and too exhausted (and still a little sick) to really care.

Will I make a different decision in the future? Well, I doubt it. Whatever is the real matter, I was a sick woman this morning, and I just can't promise that when I encounter totally foreign symptoms I will be able to just ride it out. So, I guess that the only solution is to isolate the worriers, the hypochondriacs like me, and rediscover a protocol for their aches and pains that can rescue the medical community and the insured from this overpriced economic disaster.

For now, I'm just grateful I have good insurance.

1 comment:

  1. Holy crap girlfriend. Good for you though. We can go back there together and tell them how it is. They thought I was a junkie and turned me away when I came in with that nasty respiratory infection that lasted a month and I coughed so hard I broke cartilage. I'm with ya!