Posted by musil on August 8, 2005, at 20:40:38
Musil is my screen name and I have posted on the med boards a number of times and have tried to direct a number of people I know to psychobabble for support. But I must submit a personal tale, perhaps there is an MD, nurse or attorney reading who will comment on what next to do.
In my current state I will stick with hyphens to delineate factual events in a chronological order. I'm too scattered to use numbers.
- Since 7/20/05 I have been very nauseated and crampy in the middle abdomen, with very little action in the large intestine.
- I have been on 16-24mg Suboxone daily for pain maintenance for 20 months (T-6 costovertebral grinding/dislocation). I find in normal times that the suboxone is a no brainer throughout the day and works well for me.
- I am on 10mg Lexapro/day
- I am on 20mg diazepam (10am/10pm) per day for maintenance PTSD anxiety control.
- For sleep I alternate these sleepers: night #1 no meds, #2 Ambien 10mg, #3 no meds, #4 .5-.75mg triazolam and start again at night #1 in the cycle. The goal is to take holidays and to alternate sleeper benzos to avoid acclimation.______________________________
The events:
On July 27th I entered the ER of our small local hospital for feculent vomiting. An xray was ordered by the tired PA, my large intestine and colon were empty, and my small intestine was crammed full of stuff I'd eaten. I heard the radiologist advice the PA not to use the word "obstruction" but to send me home with a DX of constipation, which is what happened. Despite mag. citrate, Milk of Magnesia, and a diet consisting mainly of prunes, dried apricots, 10 litres of filteres water per day, I found that I was still bloated above my beltline but pants that used to be too small were now fitting me as my abdoment swelled with food and water. I was dehydrated because I could feel my tongue swelling in spite of 5 litres of filtered water ingested.
- I generally deal with the constipating effects of my medication with fibre and exercise, managing to pull off a sucessful bathroom event every 3-4 days. It's not easy, but it's my life, and it could be worse, as I soon learned.- Day 1+? (6) I vomit feculently and in a projectile fashion, picking stool chunks off the back of my teeth. Too stunned to gather the vomit, I call my MD office whose nurse tells me to go directly to the ER again, this time a different local hospital, supposedly better. Again, an xray of my abdomen. This time a barium CT scan shows no obstruction (thanks, I believe I just eliminated the obstruction though my oral passage -- here, smell my breath -- whooooophew!) and I am discharged again and told to contact my MD.
- Day of the point of this story. 4AM. Just barely make it to the bathroom, and I begin to sh*t through my mouth, literally, violently, and alone. Almost lost consciousness due to aspiration and inability to catch my breath in the feculent atmosphere, despite repeated flushes. The attack lasts 60 minutes, after which I find that my tummy bulge has decreased to normal. I am sweating bullets at that point, since I was certain that the proper assimilation of my meds like diazepam and lexapro has not happened because the pills clacked against the back of my front teeth and dropped into the toilet in front of my eyes. I call my MD, who sends me to the same ER as before.
I drive in after assuring my wife and kids that I'll be OK (thinking and hugging them as if this was it, Dad isn't coming home again). Why she doesn't accompany me with a 6 and an 8 year old child just awakended at 7AM on Saturday you'll understand.
I throw all my meds in my favorite polarfleece bag, grab my wife's powerbooks and a bunch of Family Guy DVDs for company in case I get admitted. I present to the ER, again. 4 hour wait to see an MD. He is short, wears lifts and has a pompadour, a hairstyle that never bodes well for the patient. I explain my symptoms, he hold up pretty well in consideration of my recent other vists to the ER, and orders a thoracic xray and another barium CT oral scan. He finds nothin, bustles in, says I'm stable for the next 24-36 hours and to follow up with my MD. I laugh (partially at his hair) and state "when I contact my MD they send me here. To save another trip, would you please call whoever's on pager since it's a silly circle and I'm sure you don't want me back here again..."
Now here PAY ATTENTION. I've just suggested an alternative to the ER doc's orders by asking him to call whomsoever is on call for my MD on a Sat night, rather forcefully, since this is my 3rd time expensively that I've been sent to an ER for feculent projectile vomiting. I was ready to go and packed, but this 3rd time I changed the routine so that instead of leaving I made a request of the ER doc to call my MD's office, not an unreasonable request. He glares at me, I immediately feel uncomfortable, and he leaves and closes the door to my room. I immediately get up and crack the door to listen, because I want to hear what he's saying as I don't trust him. I hear him say to someone "He won't leave my ER. There's nothing wrong that I can find...."(then silence) then a slam of the phone as he hung up.
Next, my nice ER nurse comes in and says that I'm being admitted under the care of a Dr. Avery with a surgical consult, and that I should expect to see this Dr. Avery as soon as I get up to the "floor". And so I enter into the process of admission, and soon my arm hair starts to tingle as the nurse asks me to show her my meds. I take them out one by one from my polarfleece sack and begin to read them to her. She without asking grabs the bottle from me and looks at it and begins writing, finally saying after an awkward silence that she needs to hold the meds. She finishes with the first bottle (Suboxone) and puts it down. I hand her the next and pick up the Suboxone to return it to my bag and then it comes crashing down upon me: in order to be admitted I must give up my meds to the nurses. After a moments hesitation I give in, when I really should have run at that point. I hand the nurse my medications, and I ask her if I will be permitted access to them so I can take them as prescribed. She is silent but then nods yes, and says the floor nurse will dispense according to the orders.I am to be given NPO, nothing by mouth. I ask if fluid and nutrition and food will be given via IV which has been inserted by a delightful fey individual, and I ask again about the meds via IV since the NPO status. The nurse nods her head in agreement, not answering my question.
OK so far, I'm a little suspicious (and I am not by nature, always wanting to trust people and stay well informed). She slips away. I admit to one thing: I did my damndest to slip as many pills into my dirty underwear into my backpack before she returned. I failed and got only Lexapro, the pills I cared least about. Take my meds from me, will you? I began to think, especially since I had signed NOTHING, no informed consent, no HIPPA agreement, no admissions form, nothing.
Next, I'm in my johhny in a wheelchair, and I enter a room stiflingly hot and stinky with another person in the far bed. My IV machine is started and I ask what I am being fed and she says "saline" and I ask when the nutrition will be added and she says that only saline has been ordered and I am not to receive any of my medications until the MD can talk to me, which should be within the hour. I ask to see my orders, my chart, and she says that is not permitted.
I stay only because I need to figure out if I have an obstruction that a smart doctor can find, not an idiot doctor like the ER doc.
I sit back, slightly pissed. I should have asked to look at the order. 4 hours go by. I miss a scheduled diazepam dose and a lexapro dose. It is time for night. I take a lexapro from my dirty underwear.
ultimately, some 32 hours after entering the hospital grounds, I discover the following:
- I had been admitted for "Observation and Malingering" NOT under the care of any MD but under the orders of the ER doc, who ordered that I not be given any of my medications, that I be deprived of nutrition and information for 24 hours, that I be observed for my reported symptoms (I was fine: no food = no vomit. No nutrition however leads to very low blood sugar, and no medication leads to the start of several discontinuance syndromes). At hour 30, exactly 24 hours after being admitted, this mysterious MD on the floor, who has never checked in on me before, opens my door and turns the overhead flourescent lights in a darkened room, causing me to immediately squint. I have permanent contact lense implants behind my cornea (search for Artisan IOL) and this makes my irises contract into vertical slits, rather like a cat's eyes.
She says to me "Why are you looking at me with such anger in your eyes?" and before I can answer her pager goes off. She makes to leave and I say "I certainly hope that I haven't waited 30 hours for this to be our entire conversation" and she says to me "There is no point in conversing. You refused to leave the ER, you were admitted for observation for 24 hours, I'm arranging your discharge...as she walked out the door. Stunned, bloated from a hyper IV pump, hungry as hell and blood sugar low, in full withdrawal from suboxone and benzodiazepenes, the "surgical referral" enters my room, the same guy that took out my gall bladder. He asks me what's up. I take down my clip board, begin to explain the history, and he interrupts me and says "hay, do you know so and so in town...you might know him" or "and you still see so and so for treatment, right?" when that MD has been out of the system for 2 years. Ultimately, this young surgeon looks at me and says "I don't know what's wrong with you, I look at the films and the barium is making it down into your colon...I notice you're taking very constipating medication..."and I say "I manage the motility with a high fibre high health diet with fruits vegetables and grains and generally am able to move things alone well enough -- I am concerned because of the sudden onset of the vomiting of fecal matter". Surgeon shrugs.
bottom line: I am discharged. Wheeled out into the bright hot sun and left in the wheelchair to either get up or rot, I guess, without so much as an offer for toast and juice or how I'm getting home. The kicker is that the guy next to me when I was on the floor was complaining about wanting a cigarette and gets a nice syringe full of Ativan for his nicotine fits while I have full scripts for benzos but no order on the floor to give them to me, no explanation, no nothing.
I stayed simply to get to the surgeon and the MD, who were promised to me in the next hour over 30 times over 30 hours, ultimately until the 24 hour observational admission had passed.
I managed to walk to my truck, took some meds as appropriately as I could, headed to a store and bought fruit and a yoghurt (I was bloated with saline) and spent today entirely trying to get back on track with my meds and psychologically after being abused to such an extent.
I had patient rights, the right of implied consent, and HIPPA, and I was denied all of those rights and lies to every hour. I was denied my prescribed medication at the order of a pissed off ER doc for no good reason and I was in full withdrawal several times the following day as I tried to reach steady state with my meds.
1) What would cause me to vomit feculently like that 3 times in one week? I haven't had a BM in 10 days and it still feels like food isn't passing my ileocecal valve. Bowel sounds were normal.
2) Isn't the behavior of the hospital in the least suspect and isn't someone liable for the unreported pain and suffering that I endured? I cried, I sweated, I worried, I waited, I waited, I waited, 30 times I waited and asked for the Dr. and she was waiting for a 24 hour mark to pass on the floor before not speaking to me but discharging me. I asked why my meds were being withheld and was told nothing. I asked especially urgently as discontinance syndrome began to impact my faculties.
I am still awaiting to hear about a referral to a GI specialist, if not tomorrow then I will contact one myself and drive up ASAP for testing. Is it possible that the meds I am taking have so affected bowel motility that /THEY/ are the cause of the backup? I just don't see that happening: it happened too fast, a BM one night then feculent vomiting and abdominal swelling the next day, and again, and again.
Any comments about my behavior or treatment provided or inflicted would be appreciated. I remain ill, still needing care, just now getting my meds in order in my brain in terms of half-life and staying-power, and I still don't have a solution. I'm eating a very bland diet, am waiting in fear for another vomiting event, and I have to find a GI specialist in Maine ASAP on my own. OK by me, but I'm a little jaded at this point.
I have the number to the GI team at Brigham and Women's in Boston, instead of what's availabe in midcoast Maine.
poster:musil
thread:539367
URL: http://www.dr-bob.org/babble/wdrawl/20050712/msgs/539367.html