Tuesday, April 3, 2012

Maybe it Would Help

Well there he was again. Another ER trip, another ER doctor. He did not know if he could take on another battle right now. He was tired. He was tired of fighting. So he picked up the phone.

And he called.

It was like a Snoopy cartoon, with the annotation above the head: "*$@)#*&%(_!!!!", and then ")@^%$@_%&*("..."#@(*%&^$&" ...and now when he knew the end of the rope was in hand, he just stopped. There was nothing left to do.

So he thought of doing something new, something different. And he called some one who he thought would care. He called me.

Not certain how I could help, I listened. And then when he sent me a phone number, I was not sure where the line could connect. I was not sure where the line was drawn. It was a number and then there would be a dial tone and then some one would pick up the phone. There were no rules for this. It was outside of "Protocol". But it wasn't really outside of Protocol because it happens more and more every day. Dr. Patty Verdugo does it, this group does it, and I have been formally asked to join. I declined. But this night was different, this time was different.

I introduced myself. I just started with basic information and then I was switched to the ER doctor. The ER doctor, rightly so I may add, was caught off guard. Actually, so was I but then there are no rules in this life. If the intention is to help, then I need to try.

So that conversation was ended and several additional conversations ensued.

Finally, the ER doctor went back to the patient.

Perhaps there was some more "@_(*%&@#_%*!_(@*$%" ... "@#(%)!#&%*^_!" ... At any rate, my phone rang again. Perhaps the ER doctor chided the patient for making an outside call. For distracting attention away from the other ER patients.

Happens every day. And it doesn't happen every day. Jumbles of confusion, "protocol" and "rules" and the Patient and the Doctor and the Miss and the heart rate and the this and the that. And the other thing. So a possible resolution?

Just let the Nurse know that you are scared, I suppose that is okay. Just ask the Nurse to be in the room if the Doctor wants to speak again. Don't worry about how that will affect your medical care, they will not be mad. Sure. They have lots to do and this will be another thing. But it will be okay.

So maybe they don't realize that patients with dysautonomia know about the autonomic nervous system. Maybe they don't realize that a heart rate of 70 is low for some one who may have a hyperadrenergic type of Postural Orthostatic Tachycardia Syndrome. A relative tachycardia that is persistent...maybe they don't know how much the patient knows about this syndrome. Maybe they don't know that the patient has a bp cuff at home and she knows when she is hypovolemic. Maybe the doctors are taught to give resuscitation fluid for ER trauma, for dehydration, for oh! But if there is cardiac failure, the ER doctors are taught that fluid is actually CONTRAindicated; we don't want fluid backup into the lungs and congestive heart failure, too.

The Big Question: fluid or lasix; fluid or lasix.
The Big Answer Here: The nurse is awesome, tidying up all the beds and all the relationships.

Patient and Physician are restored, Nurse is fulfilled, and the Art and the Science of Medicine live on for another night. Waiting until 0700, when the change of beeper shift comes once again.

What would happen if the Nurse was there for all future conversations? Maybe it would help. Maybe it would help.

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