Things don't always go as planned; thoughts on an emergency room

I am on a work team of about 30 people. A few of us are in different parts of the country, but most are in Birmingham, Alabama, our company's HQ, which is drive of a little less than three hours from here, south of Nashville, where I live. From 2015-2020, I drove to Birmingham most weeks and stayed one to three days. 

Since March 2020, I have worked 100 percent remotely, and I consider myself fortunate. If I were younger, I would want to be in an office setting more, but being in the sunset of my career, this arrangement works beautifully. It's not like I'm climbing a corporate ladder, trying to advance and/or need face time. The computer is fine for any face-to-face I want to have. 

Infrequently, however, I will drive to Birmingham for a meeting. It is less often now, and until this week, I had only been down once this year. 

This past Wednesday, there was a team outing. The group I am part of was going to lunch together and to a minor league baseball game. I thought this would be a good time to go, and I was looking forward to seeing my Birmingham teammates in the flesh, including the three people who report to me.

A bigger draw to Birmingham than my job are my younger son, daughter-in-law and one-year-old grandson who live there. My plan had been to drive down late Tuesday, spend the night with them, work a couple of hours from their house Wednesday morning, then go meet my group for the day's activities. 

Well, things don't always go as planned. I woke early Wednesday morning with significant pain in my lower left side. left lower back and groin area. As I got up and moved around, it only worsened. 

Somewhere around 15-20 years ago, I had kidney stones. I remember the pain as near unbearable, and over (about) a five-year period I had a couple of different procedures to get rid of them when I was unable to pass them on my own. 

I figured that was what this had to be. I hated to be a burden to my son and daughter-in-law who were getting ready for work, but I also knew I was going to have to have some help. I informed my son about 7:15. He got his wife and son off to work and daycare and whisked me off to an emergency room. 

It was a free-standing emergency facility, not inside a hospital, but affiliated with one. 

I walked right in and the only people I saw were the employees behind a window. No hurrying and bustling around like the emergency rooms, or emergency departments, we see on the TV medical shows. 

A guy behind the window had me fill out a form. Within five minutes he took me back to a room and had a nurse take vitals. 

About ten minutes later, as the pain was worsening, the doc came in, a fellow of about 40 or younger. Two young women (I presume who were students) came in with him and they took notes. He did not introduce them. 

He introduced himself as Dr. So-and-so as he shook hands with my son. He then offered his hand to me, which was awkward because I had a blood-oxygen meter on my right forefinger. 

I told him what was going on. I told him I had had kidney stones a long time ago and the pain was reminiscent of that. He asked if I had seen blood in my urine or sensed burning during urination (sorry for the detail), to which I answered no. (I remembered this had happened once with a previous kidney stone but not another one). 

He said, as he was turning to leave, "we'll do a CT scan and get you something for pain." I asked if the "something for pain" could come quickly and I think he said, "mm-hmm" but I could not swear to it as his back was to me by then. 

The pain worsened as I waited. My son went out in the hall and asked the doc if they could get the pain medication going. He said the doc did not look at him and just said, "we will get in there soon."

I became nauseated and pulled a trash can over because I thought I was going to be sick. At this point the tech who would do the CT walked in and said, "this is not good." He must have distracted me enough that the nausea passed, but he got a "barf bag" for me just in case. He was kind and compassionate and got the CT done in about ten minutes. 

Shortly after getting back to the room, a nurse came and drew blood and started an IV with pain medication. It was heavenly and the pain soon subsided. 

About 15 minutes later, Dr. Personality reappeared and said, "you don't have a kidney stone," to which I replied, "Huh."

To which he kind of raised his eyebrows and shrugged. 

He asked me a couple more questions about location of the pain. I told him about my wife's experience with shingles a few years ago and he said, yeah, it could be possibly shingles and if it is, you'll break out in a rash. 

I told him I had had the shingles vaccine, and he said, well, then shingles is less likely. 

I then told him about my knees and my upcoming surgery which would be on my right knee. This pain was above my left leg, but I told him both knees were troublesome. To this he said it could possibly be "referred pain" from my knee.

"So should I talk to my orthopedic?" I asked him. 

"Yeah, probably," he replied. 

He then said, "give me 20 minutes." 

"Uh, to do what?" I asked. 

"To get you out of here," he replied. He would discharge me with a pain prescription. 

Before discharge someone from the business office came and collected my insurance information and my co-pay. She was perhaps the most engaging person I met that day other than the CT guy. 

The same nurse who had taken blood and installed my IV came in and gave me some papers which she told me nothing about. She disconnected me and told me I was free to go. (I later looked at the papers, which described my visit, with instructions to return under certain conditions such as running a high fever. None of this was communicated to me orally.) 

I went back to my son's house and went to bed. The IV pain medication was still in effect, and I went right to sleep. Within a couple of hours my son had had the prescription filled, and I took one of the pills and slept off and on throughout the afternoon. 

One of the times I was awake, I called my ortho's office here and received instructions to come in the next morning and see the physician's assistant. I left Birmingham early the next morning and met my wife at the doctor's office. They did an x-ray of my hip and back. 

The P.A., who is great and who I have been seeing periodically over the past 18 months as I have done physical therapy, received injections and moved toward this surgery, said all looked good with my hip but there was definitely some advanced arthritis in my back, and I had probably done something to irritate that, which was causing the acute pain. 

She said, eventually, I would probably want to have an MRI, but that would be in the future and my main focus should continue to be on the surgery I will have June 19th. She had a nurse give me a steroid shot, sent me home with a steroid prescription and said to call her this Monday if I was not considerably better. 

I am already considerably better and have some peace of mind knowing this flare-up was caused by the overall skeletal problems I have been having that have led me to this upcoming surgery. I am glad I have not had a recurrence of kidney stones. 

Going back to the emergency room experience, as I was walking out with my son, out of the corner of my eye I saw the doc sitting at a computer at a desk maybe ten feet away from me. To give him one last chance to demonstrate that he might have cared in the least, I yelled over at him and said, "Thanks, Doc."

Without looking up from the screen, looking at me or changing his facial expression, he said (or mumbled), "You're welcome."

Let me say this. At my age, I see a fair number of physicians, physician assistants, nurse practitioners and nurses. I have written about this in the past. They are almost all great -- caring, compassionate, patient people who take time with me and answer all my questions. I am pro-healthcare and owe a great debt of gratitude to the folks who take care of me. 

Which is why, when I come across a guy like the doc in this emergency room, I am taken aback. If you read back over my narrative, you can see I largely had to ask him questions to find out any course of action that would be taken. 

I understand he is a "hospitalist" who is not going to have expertise in urology or orthopedics, but one would think, working in that setting, he would know enough to talk about my options without my having to drag it out of him and, for god's sake, would have the slightest hint of a bedside manner. 

I am concerned about my health, but I am not a hypochondriac. Believe me, I consider every option possible before I visit a hospital emergency room. But when it is a true emergency, as this was, isn't that what it is there for? 

Oh well, lesson learned. 

The good news is I am OK, and although I am not looking forward to it, today all systems are go for June 19th and knee replacement. Hoping for no intervening setbacks. 

Getting ready

My knee replacement surgery is scheduled for June 19th, three weeks from today as I write this. 

I started going to physical therapy more than a year ago, and I have continued to do the exercises. I am also riding a stationary bike several mornings a week and going to our local recreation center and using a resistance machine. All of this, according to my surgeon, should help with my recovery. 

I am following closely my blogger friend Debby who, from where I sit, seems to be making a remarkable recovery, already walking unassisted, if I am reading correctly, at two weeks. 

The last time I saw my doc, he told me he would schedule a CT scan to get a better view of my knee. I did not question him, as I figured he knows best. Anything that will help him be more precise, I am in favor of.

My insurance company, not so much. Per a recent letter from them: "Based on the information we have, this CT scan is not medically necessary." According to them, it is medically needed "when there are certain x-ray findings . . . and you have hardware in your knee from a previous surgery."

With neither of these being true, they are nixing coverage of the CT. 

My doctor was copied on the letter. I emailed his office yesterday, reporting my receipt of this letter and asking what I should do. While I have not received a response, a little while ago I noticed on the patient portal that the appointment for the CT, which was to be 9 a.m. Monday, June 2nd, is no longer there. I have other appointments Monday -- a meeting with the Physician Assistant, a "Total Joint/Spine class" which I assume will fill me in on what to expect, and blood work.  I guess we will discuss the CT scan and whether we will appeal this decision. 

I am pretty anxious about the surgery. I contemplated out loud to Wife yesterday as to whether I am doing the right thing. I am walking better, I told her, and if I were to lose some weight and periodically get the injections, I could be OK, I suppose. 

As she has learned to do after 40-plus years with me, she listened and was careful with her response. She pointed out how long I have been dealing with this, and that it's not like I made some rash decision. 

And she is right, of course. 

So that is where I am. I suppose I am ready to face it. The surgery will be on a Thursday morning and if all goes well, I will be home that afternoon.  My first PT appointment is already scheduled for the following Monday. 

All thoughts and prayers are greatly appreciated. 

*********************

My son-in-law's cancer journey continues. He is three months out from surgery, and all things considered, he is doing pretty well. He is back at work, and he can sit for lengthier periods of time. I won't go into all the complications he has experienced but suffice it to say it has not been easy. But over the past few weeks, he has shown much improvement. 

There is good news and not-so-good-news from recent scans and blood tests. His scans (CT, MRI, full body PET) show "no visible evidence of disease." The blood tests, however, indicate the very likely presence of microscopic cancer cells in his body. It was one of these particular blood tests that detected the presence of cancer in his colon again last fall, which resulted in his surgery in February. 

For now, he goes on with life and continues to heal. And he waits. We all wait. There will be more tests and scans in late June. For a few weeks, however, he and his family can enjoy each other and the relaxed pace of summer. They are thankful for that. 

I am reminded of the verse Kelly has at the top of her blog page: "For we walk by faith, not by sight."

Oh hail no!

Have you ever witnessed a hailstorm? They are fascinating forces of nature, and I have seen about three in my life.

In the south Arkansas town where I grew up, my dad was an independent insurance adjuster, meaning he worked under contract with different property and casualty insurance companies to work and settle claims made by their policyholders. Car wrecks and fires were his "bread and butter" so to speak, but the occasional storm was a big boon to his business. He carried a ladder with him to climb up on roofs, with roofing damage being some of the main claims to come from storms. 

Not long after he had bought out a partner and gone completely on his own, a hailstorm hit our town. I am guessing I was 14 years old at the time. It was late afternoon and only my mother and I were at home, and it sounded as if someone was throwing rocks at our house. 

The hail was golf ball and baseball sized, and it was remarkable. When the storm was done, I went out in the yard and picked up a few of the hailstones to put in the freezer so I could show my dad when he got home. 

He had been in a nearby town during the storm and knew nothing about it until I showed him the hailstones. 

His phone started ringing that night, and he and my mother (who worked with him) worked almost around the clock for the next six months settling storm claims. 

Yesterday afternoon about 3 p.m. I was at home alone, working in my upstairs office, and I heard sounds reminiscent of those I heard more than 50 years ago. Rocks hitting the house, pelting the windows. 

While it was not as intense as the one from my youth (there were golf ball sized stones, but most were the size of a large marble) this was a strong storm. I opened the back door and watched and listened. 

I had parked my truck in the street because of a visitor in the driveway earlier in the day, and my car that I need to sell was also out. There is no damage I can see, surprisingly. 

I have not been on my roof and will not be climbing up there, but plan to call my insurance agent to ask him to send an adjuster early next week to inspect for damage.

Here is a sample of what happened here yesterday: