News from back home

I was awake early today, which usually happens when I know I have a morning flight. Because we were ready early, I called my mom, which, on Eastern Daylight Time, makes her six hours later than on Hawai’i Standard Time. (Given its latitude, Hawai’i has no use for shifting its daylight hours later.)

That morning, my mother had heard back on some tests that she had had done. It turns out that she has giant cell arteritis, a condition that often occurs with polymalgia rheumatica, for which she has been receiving treatment with steroids for about a year. This link has further information on both conditions.

A few days before we left for Hawai’i, I had been thinking how lucky we were that my dad, who has had a number of medical issues in the part year, was doing well. That same day, my mom had an appointment with her family practice doctor, who was concerned that her sed rate wasn’t staying down. She had had a couple of instances with difficulty chewing crunchy foods and he was concerned that she had developed giant cell arteritis. He wanted her to see a rheumatologist, have more blood work, and see a surgeon for a temporal artery biopsy. She wanted to wait to do the biopsy after we returned, but it turned out that it was arranged for more quickly, so she had it taken last Friday, with the results coming today, Wednesday. It was a bit of a shock to us when the biopsy came back positive, because the only symptom she had had was the very occasional jaw pain. No visual problems, no headaches, no sensitive temples or scalp. Given that it was caught early, there is little chance of any lasting damage.

Mom’s doctor is about to retire. We were joking that he wanted to go out with a bang, diagnosing a serious condition early on minimal symptoms. It shows the value of having a good family doctor looking out for all aspects of your health. Even though he is retiring, my mom will be in good hands, with care provided by her new rheumatologist and one of the younger doctors from the family practice who has been her back-up provider in recent months as her long-time doctor has been cutting back his hours to ease into retirement.

Now, nothing else is allowed to happen on the medical front, at least until we get home from our second week, now in Honolulu…

 

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Hours in the ER

On a Monday in January, I accompanied a family member to a walk-in clinic, which resulted in our being sent to the ER of a local hospital to look into some EKG issues. They did do a prompt EKG, and, satisfied that no heart attack was occurring, sent us to wait in the filled-to-overflowing waiting room.

We spent over five hours waiting there.

This is not complaining about our situation. While the wait was long, we knew there was no immediate danger and there was no ongoing pain to deal with. What was so difficult was watching others who were in pain and in poor condition waiting so long.

Like the 90+ year old woman who had been sent by her primary care office because she was struggling to recover from an illness. She felt that she was in the way and inconveniencing everyone else. Her heart was breaking from watching other people in need. We told her that she had spent many years helping and caring for others and that now it was time to let others return the favor and care for her.

There was a woman who came in by ambulance after an accident who had back and leg injuries and who was standing on one leg and supporting her weight with her arms on her wheelchair because she could not sit. The ambulance needed to take their gurney back and the hospital didn’t have any spare gurneys or beds.

The most wrenching example of that lack of a place for patients to lie down while waiting to be seen was a man with advanced Parkinson’s who had been brought in by an ambulance crew after a fall in his home. ┬áIt had taken four people to carry him in a blanket-sling down the stairs to the ambulance. He was brought in on a gurney with a suspected pelvic fracture, but that did not stop them from moving his partially-dressed, blanket-wrapped body into a wheelchair. His sister, who was herself elderly and mobility-impaired, arrived along with a friend. As the hours went on, the man began to slump further and further down in the wheelchair. The friend went to fetch a staff member to help before he fell onto the waiting room floor. The staff member succeeded in shifting him into a somewhat more stable position, but it was clear that the stiffness from the Parkinson’s was making it difficult. The friend asked if there was somewhere he could lie down but was told there were no beds in the ER and no beds in the hospital available. A bit later, he was again in a precarious position and the friend again summoned staff. Even with three people and some extra pillows, they had difficulty re-positioning him and he nearly landed on the floor. All of us in the waiting room – staff included – felt helpless and worried.

Eventually, the 90+ year old woman was called back, which led to a round of applause from the waiting room. Shortly after that, my family member was called. They each spent the next three hours on beds in the ER hallway, about five minutes of which were spent with a doctor. The man with Parkinson’s went back a few minutes after my family member, fortunately to a room with a bed.

As we were preparing to leave the ER after 10 PM, the two women who were accompanying the man with Parkinson’s were pleading with the ER staff to keep him overnight, because there was no way the two of them could get him back into his home. Remember it had taken four able-bodied people to carry him out and they were two older women, one of whom used a walker.

We don’t know what happened.

We – our community, our society, our country – have to do better.