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Monday, November 26, 2012

HAVE YOU EVER BEEN A PATIENT IN AN EMERGENCY ROOM?

For the first time, I went through the ER process.  Having just survived the sudden deaths of two close friends, a hospital is about that last place I wanted to be.  If you're squeamish, you might want to stop reading now and return tomorrow for my posting on "Painkillers and Death."  At least the graphics won't be so awful.  Part 5 of Pearl's Ashes will probably be provided on Wednesday.

I slightly jammed my right thumb on Thanksgiving, and it began to hurt.  On Friday, the pain was severe, but the thumb looked almost normal.  I applied some triple antibiotic ointment and hoped the pain would go away.  

The problem is that I am right handed and my left hand is almost useless.  I might be able to throw a football ten feet.  I can button my shirt with my left hand only with great difficulty.  I just about need my right thumb to do everything, from putting on socks to using my computer to washing dishes.  The result is that I kept hitting this thumb, resulting in a jolting pain each time.  Saturday morning my thumb looked like this:



Not too bad, but I couldn't sleep much the night before.  You would think that sleep should be an escape from pain, but my body apparently doesn't work that way.  This is when the pain got so intolerable, that I would have given anything to take a painkiller.  The only pill in my cabinet was Alleve, so I took it, and my knee pain eased, but my thumb was kept throbbing.  Saturday morning came and  I called my doctor (let me refer to him as Dr. M), for it would have been insane to drive to Ala Moana Shopping Center that day.  This was still a black shopping day.  Plus, bothering him just for a slightly bumped thumb was already embarrassing.  He told me to wash the thumb with soapy water, apply bacitracin and use a warm towel to speed the repair process.  Sunday morning, after another fitful sleep, my thumb worsened:


Still not all that bad, but the continuing problem was that I kept hitting this right thumb and each time suffered excruciating pain.  Monday morning:



It looked so ugly that I arranged with Dr. M's staff to be snuck in at 2:10 PM.  I had to somehow cover the thumb to join a friend for lunch.  I had no gauze or anything that was medically worthy, so used Kleenex held together by a bandage:



Yeah, enough is enough, but, one more time.  The staff of Dr. M was horrified when they saw my thumb.  This is what it looked like just before I saw him:




This photo was important because I later showed it to at least half a dozen medical specialists.  Dr. M lanced it, but felt I should see a hand specialist as soon as possible.  There apparently are only two of them in Honolulu, and the best way for me to do this today was to go the Queen's Emergency Room where one was on call duty.  Now this was an  experience!


First you need to be screened through like at an airport.  Then there is a relatively short wait to go through something called triage.  If you're dying you are immediately seen.  If you are bleeding but not close to death, you get second priority.  If you have a sore thumb you are at the bottom of the list, and, worse, as people keep entering, they can jump ahead of you, so with my condition, who knows, perhaps I might have to wait all night.  

Using my eloquent best, I tried to make a case for having to see this special hand doctor who my Dr. M had called, and even showed the back of his business card with a note indicating that a Dr. Gary Blum be contacted ASAP!  This did not impress the nurse much.  She opened my bandaged thumb to help her determine my triage ranking.  Unfortunately, she was also coughing, which worried me some.  I  then played my wild card and presented the above photo of my thumb on my iPhone before the pus was released.  She revealed sufficient alarm and called in a superior, and they both appeared to be influenced, quietly mumbling something that sounded like fast track.  However, I was warned that some of the potential patients in the waiting room had been there for five hours and they were extremely busy today.  It was 3:30 PM.  

In the waiting room no one was obviously bleeding or moaning.  Several staff kept telling me that they were extra busy today, so sorry, but this will be a long wait.  They all seemed under controlled stress.  I showed to as many of them as possible a photo of my thumb and was my charming best.  Any one of them, in my mind, could have had decision-making powers.  

However, I did have a Scientific American to read, which approximately takes forever to finish.  In fact one article was about the danger in hospitals.  Interestingly enough, your hands are the most important factor.  Watch what you touch and use those anti-bacterial lotions as regularly as possible.  However, this quote from that article was downright frightening: 

Medicine, published online in April, demonstrated the potential infection risk posed by the privacy curtains around hospital beds. In an initial survey, 95 percent of curtains in 30 rooms harbored VRE or MRSA. When the curtains were replaced, 92 percent became recontaminated within a week.
There was thus a lot more than germy hands at play.  And many of those in the waiting room had bad coughs.
The waiting room was very, very cold. Several people somehow had found sheets and blankets.  Many were in wheelchairs  There were around 35 people waiting.  I innocently asked if there was a major situation like a sudden plague, for I don't remember so many awaiting emergency care.   I thought it was remarkable that I was the only oriental person.  I later learned that Queen's and any emergency room have this problem.  Many Pacific Islanders have no other option but to use this service.
On the plus side, there was an aquarium, the lighting was good enough for reading, there were two television sets and names kept getting called.  However, triage meant that as long as more serious ailments arrived, I might never be seen. After two hours, it looked like the number in the room had increased. I also wondered what parking would cost. I'm now on page 34 with 62 pages to go.
Then at 5:35 PM, a wait of a tolerable two hours, I was shown into a kind of operating room, which was not cold and had on Monday Night Football.  I retold the story for the sixth time to someone who looked important.  Then Dr, Blum, the hand guy, came in for the seventh telling.  The story got better each time.   Apparently my thumb condition was a lot worse than I thought, and I was fast tracked, for Dr. B wanted to keep me in the hospital overnight for observation and to intravenously feed antibiotics.  The worry was that this infection could spread to other parts of my body.   I,  however, explained to him that three years ago my wife had been told by Dr. M to go to the Kuakini Hospital Emergency Room to check her oxygen level.  For some reason they intravenously gave her an antibiotic, to which she was allergic, and was kept overnight as a precaution.  She died five weeks later.
So, he instead used Plan B by operating, taking off at least a square inch of skin.  I could show you what my thumb looked like, but will spare you this grossness.  A nurse taught me how to cleans the thumb in anti-biotic soap and apply a series of gauzes held in place by some tape.  That's it!  No ointments.  Not sure if they said to do this several times a day or only once daily.  They must have given me a piece of paper with instructions.  I was provided the prescription for two antibiotics and also had to purchase an assortment of gauzes, tapes and antiseptic liquid soap.   Oh, parking was free.
On the way home I stopped at Long's/CVC where one problem was that the line to pick-up your meds was at least 20 people long, with a line that hardly moved.  At least in ER I could sit and wait.  After an hour, I got home with everything.  However, I wonder if I should call someone, for they had me take those two pills in the ER to start the process, and, while the large white one looked the same, the dark and light green capsule was red at the hospital.  Life can be complicated.  

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