Monday, June 7, 2010

To sedate or not to sedate?? Yeah, I totally have the meanest doctor EVER!

May 27, 2010

As I was beginning to drift off into a much deserved sleep following yesterdays whirlwind first day of clinic visits my cell phone began to ring.  I had almost, without much thinking, moved to hit the "ignore" call button on my Crackberry but saw that it was a (504) number and that made me think it may be the clinic.  I was awaiting the results of my counts because my doctor didn't have them when I had finally made it through the marathon wait to see her.

I suspected it had something to do with the fact that the time between when the blood was drawn and when I made it into a room to actually see my doctor, in my mind, was not enough time to run the lab work and get the results.  But who am I to say that their whole system was broken?

I'm just the lowly cancer patient who spent the better part of the day being bounced from room to room and went home with no clue as to what was to happen next in regards to my treatment.  All I was armed with was an appointment to have my PICC line flushed and dressing changed two days later, as well as a follow up appointment to see the oncologist on June 16th.

I had gone from being checked, poked, medicated and monitored 24/7 for 28 days and now all I had were two appointments in the next couple weeks.  It was a little unnerving.  If I was looking for a " you're in remission ma'am" type of experience I was going to be very let down.  I was quickly learning that patience was a virtue that I really needed to master in order to make it through all of this.

I picked up the phone and was greeted by the familiar and broken English of my doctor.  Great, not only did I have to get the doctor that feels sleeping medication is a sure sign that your gonna off yourself, I was also blessed with one that I had to have repeat things and at times spell the word in question.

Thankfully I got the first part of the news in almost perfect dialect therefore allowing me to learn that my counts looked great.  The problem came with the following part.

It was almost like a verbal word game.

She would say the phrase and then I would try to interpret what it was that she was saying.  This may not have been so frustrating if she wasn't talking about...oh, I don't life!  The few words that I could pick up were "biopsy", "urgent", "don't be late" and "tomorrow".

Everything else like "where", "when", "who would be performing the procedure" were much, much, MUCH harder to understand.  It took an additional 10 minutes to learn that she wanted me to come for a bone marrow biopsy on the 27th.

Tomorrow.  Got it.

I would need to be there by 12p.  Got it.

The doctor that would be performing the test was a colleague of  hers and would be doing it before going out of town for the Memorial Day weekend. Took a few tries...but got it.

It was imperative to have the test done now so we could see if my marrow has rebounded in order to start the next phase of treatment. A bit more difficult and admittedly not sure what all the rush was about for this doctor to do the test before he left on vacation especially when my counts were good...but she's the doctor and I'm the patient, it.

The last part proved to be the hardest which was what part of the hospital I needed to report to for the procedure.

Me:  Where do I need to report for the test?

Doctor:  Fuhst flo

Me:  Ok..on the first floor?

Doctor:  Uh..yes.

Me:  What is the name of the department?  Is it oncology?

Doctor:  No.  You go to fuhst flo...(and this is where the game begins because at first listen I swore she said the following) and BDT.

Me:  Ok.  First floor...and was that BDT, like B for boy, D for dog and T for Tom?

Doctor:  Ugh no.  You go to fuhst flo...

Me:  (slightly peeved that she is insistent on repeating the one part of the equation that I already understand, but trying to remain calm thinking that surely since I spelled it out with words that represented the letters in question that she would follow my lead and becoming increasingly aware of the fact that she sort of sounded like the Chinese woman saying "and then" on Dude Where's My Car..this may not end well)

Doctor: Uh...fuhst flo..DDT.

Me:  Ok...let me just make sure it's D for dog, D for dog and T for Tom??

Doctor:  Fuhst flo...

Oh DEAR GOD female Jackie Chan...I got that part....what I need to know now is the last part.  The actual department that I report to.

Doctor:  Its D as David, T as tea and D as David. 

Ding, ding, ding...we have a winner!! 

I thanked her for calling me and getting me in for the biopsy so quickly.  I then asked if there was anything I needed to do in order to prepare for the procedure since the last two biopsies I had while inpatient at Tulane, I didn't know if there was a different set of rules for an outpatient procedure.  She assured me that I would be in an out in a few hours and didn't give me any other instructions.

We arrived at University Hospital about an hour before the procedure in order to register.  I was more nervous about being late for the actual biopsy appointment than I was having the procedure itself done because my doctor had been so adamant that this colleague would be leaving to go out of town.  It almost seemed like I was playing beat the clock because the waiting system that had plagued us at the clinic was in full glory just across the street at the hospital.

My mom kept reassuring me that things would be fine and soon we were called to register.  Once again we came face to face with the reminder that I needed to find out my Medicaid status or unearth a money tree because...tick, tock, tick, tock...we were now at 9 days and counting before we would start getting hit with my clinic and now University Hospitals bills for treatment.  Way to suck the wind out of my sails people.

We finished registering.  I got my orders and made my way to where I would be having the biopsy.

The room was freezing, but the nurses were so nice.  I undressed and slipped on the hospital gown as instructed and attempted to wrap my now shivering legs in the thread bare sheet that was provided.  I heard the nurse call my name from the other side of the curtain and then ask if I was changed.  I advised her that I was and then she asked if I would like a blanket.  I had to stop my teeth from chattering long enough to say yes.

As she pulled back the curtain and covered me with a blanket she asked me if I had this procedure done before.  I advised her that this would be my third biopsy.  Her next question was one that struck me as odd.

Nurse:  Are you having sedation for your procedure?

Me:  Ummm.  Yes.  I mean...ummm, I had sedation for the last two, so I would assume I am.

Nurse:  Oh.  Hmmm.  Okay.  Well the doctor should be with you shortly.  (and with that she pulls the curtain closed)

I sit on the other side pondering what the hesitation in her voice meant but don't have to wait long because I hear the nurse talking to another nurse about how "this patient thinks she is having sedation for her biopsy but there are no orders written".  They kept talking about it as if they had shut the door on a cinder block room where I was inside and unable to hear a word of what they were discussing.  When in fact I could hear every word, every sigh and every squeak of their shoes as they walked away.

I wanted to yell out...I can hear you!  But figured that agitating anyone that will be sticking a needle anywhere close to my body was probably not the best idea. 

The next time the curtain opened I half expected to see the whispering nurse but instead met the face of the two doctors that would be doing the procedure.  While I was trying not to allow myself to be anxious over the fact that the nurse was under the impression that I had no sedation orders for this test I became increasingly nervous over the fact that the only thing these doctors had to go on in regards to my care was a sheet of paper with the order to do the biopsy and the type of leukemia I had been diagnosed with.

Thankfully, for me and my health, I am a good listener and note taker because every question with the exception of what type of chemotherapy I had while at Tulane was able to be answered by either memory or my calendar that I carry with me.  Being led through a question and answer session before being stuck in the hip with something resembling a hollow icepick may unnerve some people and I was....honestly very much in that some people category.

The doctor could read my hesitation and anxiety like a bold faced book with pictures and quickly dug into his scrub pocket to find his cell phone so that he could call my oncologist.  After his second attempt he got her on the phone.  His approach was so matter of fact that part of me wanted him to put her on speaker phone so I could hear her response to each of his questions.  Especially when he fired off questions and phrases like "I'm gonna need a little more history other than what is on this piece of paper" and my favorite "you expect me to drive a needle into YOUR patients hip while she is fully conscious and had nothing more than lidocaine to dull the pain".

He then asked me if I would prefer to have the procedure with or without sedation?  I told him that I'd prefer to have the sedation.

He asked me if I understood that I would still be conscious and awake, just like the previous two?  I told him that I did.

He then asked me if I would mind waiting until Tuesday, June 1st to have it done because my doctor, in ALL of her infinite oncological (totally my made up word) wisdom, had failed to A) write sedation orders and B) while she could authorize it over the phone, which sounded like a brilliant plan to me, she hadn't told me to not eat or drink anything after midnight so that I wouldn't possibly choke and die while mildly sedated. 

So lets options are to do the biopsy now, white knuckling it with a doctor that doesn't want to do it without sedation therefore increasing my own anxiety at the fact that he is now possibly nervous while driving a needle and other instrument into my hip bone -OR- I can wait a few extra days and have the test done while I'm relaxed from medication and the doctor is relaxed due to the fact that I am relaxed?'s a no brainer!  What time you want me here on Tuesday?

I thanked the doctor for his time and of course apologized because I felt bad over the fact that I felt as though he wasted his time with all this calling of my doctor crap.  I mean seriously...what kind of doctor sends someone to have this type of procedure without thinking about their comfort??  Ugh....

The doctors left and closed the curtain behind them.  I scrambled to get dressed and waited for the nurse that would come and discharge me.  Another few minutes and I was making my way out to find my mom.  She seemed surprised to see me so soon and when I told her why I was done so quickly her surprise turned to the same disbelief that I had.

I contemplated just jabbing my doctor randomly the next time I see her and then later asking her if she would have preferred to be sedated.  I was pretty sure the humor would be lost on her and that i may possibly delay my treatment and result in criminal charges, so I quickly filed that thought under "not right now but maybe in the near future".

I tried not to let it bother me too much.  Being frustrated takes too much of my energy and that is something that is a precious commodity nowadays.  I decided instead to be grateful for the fact that at least our entire day hadn't been consumed by this appointment and that the conclusion would find me home resting with my family.

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