Tuesday, April 3, 2012

The Week Thus Far, Part Two: Negligence is Gross

Part Two: What Drove Me Apeshit This Week:

My gynecologist/surgeon has a VERY limited knowledge of my body, which is to be expected, since she's only in charge of the girl parts. That's why, when you have major surgery like a hysterectomy, with someone who only knows what's going on from your va-jay-jay up to your uterus, you need surgical clearance from your OTHER doctors, who know your body in a far grander scheme.

The gyno did the LEEP on my ill-fated cervix when that demon had to be struck down, and it was really no big deal in the end, though it was scary. She got my first screening mammogram back abnormal, and sent me for a follow-up diagnostic mammogram, which ended up being just fine.

I went to her with my abnormal bleeding pattern and she did a D&C to roto-root me but found a cavalcade of nastiness in my uterus in the pathology that indicated that the uterus had to come out, hence the hysterectomy.

Yesterday, we had my one-week post-op visit. My 6 wounds are healing just fine, though they're still sore and I still have some abdominal swelling, bruising and scabs from the dressings, not to mention rashes from the adhesive on the EKG leads, to which I'm allergic but put up with all the time. I have very little energy, and it's an effort to take my "daily walk," which is to the alley to the garbage dumpster to empty out my ashtray. I'm worn out after taking a shower. Catching the upper respiratory infection 2 days post-op was NOT helpful. I'm up and around a lot during the day, up and down the stairs a lot, and will make it to church on Good Friday and Easter Sunday, so physically, I'm healing as well as can be expected.

Anyway, the gyno walked into my exam room all sun-shiny, like she always is, beaming, asking me how I'm feeling, shaking my hand.

"Well, I'm alive," I told her snidely.

"What's the matter?" she asked.

Now, keep in mind, my baseline blood pressure runs, on average 80/50 or 90/60 on a decent day, or if I'm doing really well, I break 100 on the systolic, and function just fine. But you had to know I was pissed off, anxious and incensed when my BP is taken and it's 130/84, which is high for the AVERAGE person, much less someone with chronic hypotension and tachycardia.

"You never should've released me the day after the surgery. I ended up back in the ER Tuesday night," I told her. She was unaware of this, as neither the ER doctors or Stosh confabbed with her about it. I told her my potassium, magnesium, electrolytes and blood sugar were all dangerously low, that I was so badly dehydrated I was demented and ended up taking 2 or 3 (I don't even remember) Dilaudid in a 4 hour period, without realizing what I was doing, and had taken the rest of my night meds, and that my mom had found me unresponsive on my bedroom floor. Breathing, but otherwise completely unconscious, having fallen out of my office chair. I told her that I spent the next day and a half being pumped with IV fluids, and in the meantime, when she asked how my mom was feeling with HER cold, I came down with the URI and was discharged reluctantly with a 101.3 fever.

I told her I had no memory of Tuesday at all after my sponsor/friend had taken me home from the hospital, and was disorientated in the ER when asked what day or time it was, though I knew my mom and Pastor were both there. I had no memory of the evening, of having taken the Dilaudid, of anything until I was shot up with Narcan to counteract the narcotics and had such a jolt to my system, I thought my heart was literally going to fly out of my body. I told her how the nurse was getting frustrated with me because I was shaking so badly, and so dry as a bone, she couldn't get an IV line into me and I have, literally, almost a dozen needle marks in my hands and arms to prove that I was poked repeatedly and am consequently all bruised on my left hand and arm. The nurse went so far as to attempt to get a vein in between my thumb and index finger on my left hand, she was that desperate.

My gyno took no responsibility for what happened to me, blaming it on Stosh and loosely on Tatus for not informing her that I was back in the hospital the same day she released me, calling both of them "irresponsible." But I'm relatively certain they both were aware, especially Tatus, that I needed extra IV fluids. If it's anyone's fault, it's the ER's, who should've told her I was back. But it's ultimately her own damn fault she turned off my IV prematurely. I simply can't keep up with the fluids well enough on my own to compensate for the loss of them after a major operation with my system the way it is. It is my impression that she was negligent and clearly didn't listen to me when her resident (not even herself) came in and checked on me Tuesday morning. Technically, they're supposed to keep you after an operation until you can defecate on your own. My urine output was scant in the catheter bag after surgery and scant in the measuring bowl in the toilet on Tuesday. Even drinking lots of water, I only peed once or twice on Tuesday, and hadn't had a bowel movement yet.

I was discharged from the hysterectomy with stool softeners (when I have chronic diarrhea in the first place and don't need them) and an Rx for Norco, which my mom threw out after Stosh said I'd have to tough the recovery out without narcotics, because I couldn't be trusted with them, rightfully so, after the dehydration dementia near-OD. (And I *have* toughed out the pain with Advil. Because I *am* tough. Tiny but mighty. But I've also had diarrhea ever since I got home, which weakens me further.)

As I said in previous blogs, I had clearance appointments with both Stosh, my internist and Tatus, my cardiologist. The most Stosh was concerned with was the bowel-cleansing prep before the surgery and knew it'd be rough on my GI tract, with as delicate and malfunctioning it is, which is why he wants to do a colonoscopy but isn't sure I'd survive the prep necessary to do the test. I told him how the "bowel cleansing" mostly consisted of me constantly running to the toilet to emit burning, ridiculous amounts of bile out of my ass, since that was all that was left in my system, and while I tried to keep up with fluids, I went into surgery already dehydrated.

Tatus, knowing my Postural Orthostatic Tachycardia Syndrome is aggravated badly by dehydration, always urges, in his clearance dictations, to make SURE I'm well-hydrated before, during and AFTER the procedure or operation, because I'm little and I dehydrate really easily. It's a very simple concept and request. Tatus said, as he put the pediatric blood pressure cuff around my arm, "It's not like you weigh 138 pounds,...." when I told him that in pre-admission testing, I weighed in at 118 (which I've lost 3 lbs since) and I agreed with him. My system is unique, unusual, complicated and delicate. I'm not the "average" patient. What applies to 99% of the gyno's other patients probably doesn't apply to me and my system.

Which is why it was utter insanity that my gyno took me off my IV in the hospital last Tuesday morning, less than 24 hours after the operation. My bag ran out early Tuesday morning, so I told the nurse, and when I expected another bag (or 2) to be administered, I was told the IV was being discontinued, much to my surprise. The bowel cleansing had left me so dehydrated, as had the surgery, but the gyno felt that I could, by myself, pump enough fluids over the next several hours to compensate for the loss of fluids. Not true.

Neither Stosh nor Tatus thought I would or should be discharged the day after the surgery. But the gyno, who assumed I was like the average patient (and worse yet, a Public Aid case), told me to go home early Tuesday evening, because I was "capable" of eating and drinking on my own. Tatus, who hadn't seen me yet on Tuesday but was planning to stop by before he went home, got a text from me at around 5pm, I think, saying that there was a change of plans and that I was being released, so I wouldn't get to see him before I left. When we talked later, I think he was surprised that I had been.

I kept emphasizing to the gyno that she should've left me in the hospital at least one more day, and while Stosh thought that was the best course of action as well, she was in charge of my case and it's HER fault I was discharged, yet she said, "But MOST of my patients do fine 24 hours after surgery..." and "most of my patients don't need narcotics after the operation...." Again, I'm anything but MOST of her patients.

She fought me tooth and nail and played the blame game, which, if she has a problem with one or more of my other doctors, she should take it up with them, not me. I'm just the helpless patient. Yes, my mom told the ER that the gyno (and she gave them her name) operated on me the day before, and my mom did her part explaining everything that was going on to the ER people, so it's not like it's our fault that there was what the gyno called a miss-communication or lack thereof.

It's no wonder OB/GYN malpractice insurance is so expensive, it's driving all the doctors of that specialty out of Illinois and into cheaper states. Because some OB/GYN's fuck things up.

I'm still pumping Gatorade at home and lots of juice and tea to stay hydrated and taking an antibiotic for my other sickness. I've honestly had enough of knock-knock-knockin' on Heaven's door lately, folks, and I mean that sincerely. Luke gave me back my Keith Richards "Too Tough to Die" t-shirt, which is my good luck charm, and I feel like I've got 9 lives but I've used about 6 or 7 of them already. It's going to take a lot more than dehydration to stop this Offbeat Drummer.

Back in black
I hit the sack
I've been too long I'm glad to be back
Yes, I'm let loose
From the noose
That's kept me hanging about
I've been looking at the sky
'Cause it's gettin' me high
Forget the hearse 'cause I never die
I got nine lives
Cat's eyes
Abusin' every one of them and running wild...

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