One a.m. ER advice

Monday night, last week, at one a.m. my mother took my grandmother to the Emergency Room.  I am a 5 hour drive and 4 hour airplane ride away from them, however I must confess, had I been there, I am not welcome at doctor visits with my grandmother.  My career path has given me insight, perspective and opinion into western medical ideology.  My grandmother however has white coat syndrome, she worships them and whatever they say goes and no one is to question them or her translation of what they say if she is unsupervised. My grandmother came from what is considered the ‘white picket fence’ model home.  My grandfather was an electrician and she raised three girls, lost a fourth in infancy and another to breast cancer as an adult.  Her husband died of colon cancer and her caretaker, my mother, has had two episodes with cancer, the other daughter has remained healthy.  I give you this information to allow for the foundation that anyone in her company is rendered incapable of making informed decisions about health care situations involving her.  I am sure many of you out there care for someone who is this way, completely trusting doctors in a god like fashion who will not tolerate any input or questioning about medical decisions. “They know best.”

Cheating is applied in this situation through technology.  My mother cheats, she texts me, to tell me what is going on and for prompts.  I feed my mother questions for the doctors.  My 84 year old grandmother is a former smoker, diagnosed COPD’er and has high blood pressure (in the presence of doctors).  She is 100lbs soaking wet and probably around 5’4”.  Recently she has had a positive and negative chest x-ray for pneumonia all in the same week. Which one is wrong, your guess is as good as mine as I have not see them or listen to my grandmother chest with a stethoscope.  Needless to say she has been put on a chorus line of inhalers and steroids topped off by antibiotics and anything else she can complain about and get a free sample for. She loves free pharmacology samples. She actually plans her office visits to optimize her ability to procure these samples, she has the system figured out.

You’re waiting for the advice? Well here it is: Advice #1:  Go to the ER at one a.m.  Although this may seem like a bad idea sometimes it is an optimal idea, especially on a Monday night.  The night staff is not as involved in the hospital politics, they are there to do their jobs and go home only to rinse and repeat.  You may find a lull in the ER, a bit of boredom that allows for the full attention of  the doctor and emergency room staff, the tech may give the doctor insight – don’t disregard them they have been around the block too.

Advice #2: always have the full list of medications with you.  Write down the prescription name and if it is a generic, what it is the generic for.  Ask the doctor to exam the list for any possible drug interactions that may be pyramidal.  Pyramidal means that the effects of the drug solo are what is desired, but if there are pyramidal effects the desired effects are essentially on steroids, literally, and the side effects are amplified in ways that are not predictable.  This is what happened to my grandmother.  Oh, I forgot to tell you, she called my mother with a swollen tongue and numb face.  Her breathing was fine, but she could hardly talk or control the monstrosity of that swollen tongue in her mouth.  She was put on an ace-inhibitor that reacted to another one of her drugs and well, have you seen Star Wars III when Jar Jar Binks gets his tongue in Anakin’s pod racers beam, like that. Now you giggle, don’t feel bad so did I.

Advice #3: treat the doctor with respect, but don’t put him or her on a pedestal, he/she is not a god and he/she does not know everything.  I didn’t even meet the man that took care of my grandmother and I love him.  He sat down with my mother and showed her his physician’s drug book, admitted that there is absolutely no way he can keep up with what Big Pharma throws at him and logistically went through the list and all the ins and outs of my grandmother’s hospital visits of the last 6 months. I asked my mother if she thought he had a son, like him of course, that I could stalk when I get back home!

Advice #4: take advantage of the spare time/boredom.  You will be surprised, doctors really want to do no harm.  They have a tough position these days and their enemy is time. They have to get to the next patient. The ER has to flow or it will become a living hell, believe me: been there and participated in that. But a quiet night in the ER when a patient presents a problem that has not been fully addressed is like getting a fun game of scrabble, we want to use all the letters to get everything to fit together beautifully for the highest score possible, grandma’s visit was over 350.

Time is the culprit that can turn a good doctor into a bad one, things get missed, people get hurt and hell breaks loose.  Doctors want to help you, they just don’t have the time, sometimes you get lucky and get one that has more time, use it.  And if you don’t get the extra time my grandmother was blessed with last night make sure your prepared and have questions like: “If this was your mother (sister, daughter, son, brother….you get the idea) what would you do?” This slows time down and reminds them why they spent all those sleepless nights learning and becoming a doctor, to help you.  Slow down the time for them and for you. You, or a loved you are responsible for sitting next to you, will be a lot healthier in the end! My grandmother got lucky, I wish the same for you.

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