Thursday, July 11, 2013

More Thoughts on Bad Medicine

If you can't tell, medicine is where my heart has always been, so this is a subject near and dear to my heart.  Seeing people receiving less than outstanding medical care hurts my heart.

I had another thought about my last post, and rather than make a comment which could be missed since I feel it's an important thought, I thought I'd better post another entry.  Something that is so important is knowing that you the patient are taken seriously.  It is the responsibility of every health care professional to help make that happen.  I, like everyone, indicated in my last post have had to "turn patients away" but never did I ever disregard them.  I did NOT want to run the risk of them feeling like their illness or symptoms were stupid or unimportant.  I TOLD them they were important and it was definitely important for them to be seen so they could be healthy and things would not progress to an even worse state.  I may not have been able to see them whenever I was in an emergent/urgent area if they had a problem that was not acute, urgent etc. but I could definitely help them find the care that they did need, AND ensure that they were validated as a person.

That having been said, I was having other thoughts that I left unsaid.  It is SO important to be honest with your patients.  Honesty, while in this day and age seems to be more rare, is precious.  If you don't know what's wrong with them, rather than take the attitude that it's all THEIR fault that something is wrong and they have wacky symptoms that don't seem to go together, tell them.  I am so sorry, your symptoms are manifesting in a way that this seems a rather mysterious illness, and I don't know what it could be........BUT, we definitely need to work at helping you on your way to recovery and a healthier you, so we will EXPLORE what that illness may be, we will find out what it is, so that we can treat the underlying cause.  Let's do some tests, I'll talk to my colleagues or if all else fails you.........don't forget there's always the internet people!  Let them know, I don't know right now, we will test, we will find out and we will get you healthy again.........NEVER FORGET THAT IT SUCKS TO BE SICK, IT SUCKS TO BE IN PAIN AND ANYONE WITH THE OPTION WOULD NOT BE IN THAT STATE!  I thought I should highlight that for you since so many seem to take that attitude that coming to see you is on the top of everyone's to do list for the week.

When I was having so many odd symptoms, it was a brand spankin new doctor just out of the box that diagnosed me.  She had no idea, but had heard of my odd symptoms and sought ME out.  I didn't know her from adam, she worked in a different area than I did.  She did tons of tests, she talked to me, looked at me, even had me bring in photos of myself and family.  She explored EVERYTHING at her disposal.  She didn't know what was wrong with me, but sought the answer for me.  I thank God for her every day, because I could still be wondering while getting worse were it not for her.  She had an intuition for what MIGHT be, and she followed up on that.  She then educated me about what was known about my illness, and I took it further.  I looked up anything and everything I could get my hands on, I wanted to know what was going to happen to me.  My symptoms are NOT typical of my disease.  I have some typical, but I have some atypical also.  But then again, if you treat symptoms and not the problem, you have a whole list of syndromes, illnesses or medical problems.  So, it very well may be that people with my disorder have joint pain, migraines, arthritis, bone deterioration etc etc.  We may never know until someone takes all the files of all the people with my illness and does a comparative study.

I know when I was diagnosed, I basically became the leading authority on my disease.  I then successfully diagnosed and encouraged treatment of several other women I recognized with the beginning symptoms that began first manifesting with me.  I was diagnosed in the 90th percentile, which is very far along in any disease/syndrome.  I'm hopeful we were able to avert some of the worse ones for the young ladies I came into contact with after finding out about, and studying my disease.  If you break me down piece meal then I have chronic migraines, arthritis, PCOD etc etc.  But if you look at the entire picture, perhaps there is a treatment for my disease which would treat them all by treating at the source.  I don't want to be the lil old lady with 50 million pill bottles, I don't like taking medicine and have enough trouble taking what I already have to.  Because my disease affects also my digestive system, I take medicine for high cholesterol, which I've had since a little before diagnosis, acid reflux a little after diagnosis, and the metformin for the actual disease itself.  To me, it's evident that one affects the other.  Disease affects digestive system......digestive system decides wheeeee this is fun let's do other weird stuff now!  That's one reason I think it's SO important we look at the person as a whole.  Do ALL the symptoms stem from the same source.....if so, is there a way to treat the source and alleviate ALL the symptoms?  Wouldn't that be awesome?

No matter what, if you know, if you don't know and let your patients know that, that's what matters in the long run.  Letting them know they are important and their health is important to YOU, is important.  When you finally find out, especially in cases like mine, and the link I posted in the previous entry, after years of mistreatment, nontreatment, told you're crazy etc.  Diagnosis is like a banner.  It's like SEE I KNEW SOMETHING WAS WRONG AND YOU PEOPLE TOLD ME AND TREATED ME LIKE I WAS STUPID>>>>>>>>IN YOUR FACE!  LOL

Yeah, there are hypochondriacs in the world, but it's .0000000000000000000001% of the population so you can't go around treating everyone like a loon just because YOU'RE lazy and don't want to look for the answers!

Bad Medicine (Part 2)

Well, I did warn you I had a lot to say on this subject :P

Before I begin, however, I want to lay the groundwork for who and what Corpsmen in the Navy truly are.  I've spent time as a patient in other service's facilities, and I must say, I don't see the same capacity in them.  I'm not sure if this still holds true today, but prior to my leaving in 1997, it was.  The closest I could describe a corpsman would be a P.A. without a license.  This did not hold true for ALL corpsmen as there were those with all ability levels, differing devotion and desires to practice medicine.  I will say that if you were serious minded, and showed an ability and competency and desire to learn, the avenues for you to explore medicine were opened to you.

I have personally worked on surgical wards, with heart patients, the infirm, long term illnesses, acute illnesses, in out patient areas, in a "welfare" or "sociologist" capacity, in ER's, primary care, with the old, young and every age in between.  I've stood in on surgeries, births, and even performed minor surgical procedures.  I've worked as first responder, and the person who holds your hand, or brushes your hair before a family visit.  I remember all the patients I've ever had, and they are all very dear to me.  The lady that called me songbird when I worked nights and used to sing quietly to myself when I would be cleaning IV poles while the ward "slept" and would call me in to keep her company and sing to her between my rounds since she couldn't sleep.  The ones who would tell me family was coming and so I did my best to make sure they looked nice so they could feel better about receiving that company.  Every size, shape, and color have passed my way, and even a few colors you'd never expect to see a human be.......indicating something was definitely wrong.....although one co worker managed a very lovely shade of lavender I've never seen again (yes, they were fine after I'd asked them to sit down, take a break and let me check them over).

I learned more about some diseases and their processes from observing or talking to my patients than you could ever find in a book.  This is why I taught my strikers to look at, and listen to your patients.  This brings up what I wanted to talk to you about today.  A striker in the military, is someone that wishes to take a new path into another profession.  One that either didn't have the original test scores, or a job wasn't open to them when they first joined the military.  It was my job to train them, observe them, and evaluate their performance with either recommendations to our profession or a recommendation to pass if they proved unsuitable.  On one occasion I had about 5 strikers I was teaching while running Military Sick Call.  This was meant for those that fell suddenly ill with flu, colds, minor injuries that didn't need emergency attention to come and be seen.  We corpsmen were responsible for seeing the majority of the patients as #1 we outnumbered the Doctors, and #2 most were your typical illnesses one might see on any given day, this kept the doctors open to see the more serious cases.  We practiced directly under a doctor's medical license, so their license was our umbrella.  That is one reason that not every corpsman operated under the same capacity, since some truly did show no medical expertise and thus were placed in other capacities, either in supply, admin etc.

On one occasion, a young lady I was mentoring approached me reference one of our patients that had presented to our clinic after having been turned away from Tripler Army Medical Center.  We were suited for outpatients and limited Primary Care for more urgent matters as well as Family medicine at our location, and so the army hospital was our outlet for emergencies.  He had atypical symptoms, but my striker was concerned because as she was instructed, she observed her patient.  She told me the symptoms he'd presented with, and what his appearance was, and I said well, this was a wonderful opportunity for us to teach her how to do her first EKG.  I then found out from a co worker that our EKG machine was on loan to family medicine for one of their patients.  I went to also observe the patient she was concerned about, and was struck by his general appearance, although he did not complain about "textbook" symptoms.

Directly after my observance, I asked her to please get me a wheelchair since I would be taking him to Primary care to use that EKG unit and I did not want this patient ambulatory at that time.  My strikers were also taught discretion since our goal is not to alarm a patient that is more serious, thus pushing them over certain thresh holds and so she quietly did as I'd asked.  At that time, a corpsman from Primary Care happened to walk into my clinic to get something, I can't recall what, but I took the opportunity to tell him about our current patient and my feelings on his diagnosis.  I told him he had atypical symptoms but his coloring indicated that it was possibly a heart attack.

This corpsman gave me a wonderful example of what bad medicine and arrogance is.  Sight unseen, he asked the symptoms, which I told him, and added, that the patient's overall coloring was grey.  I've been around enough sick people to know, red, blue, grey, extreme pallor, yellow and other various colors are indicators that there are serious issues.  Petty Officer Gibson either did not hear my physical description of this patient, or he chose to ignore it.  He then poked at the heart chart, indicating that NONE of the typical symptoms were present and therefore he personally was refusing the patient.  I said that was fine, I'd take responsibility for the care of the patient in that case and would take him to Primary Care myself, since our EKG machine was currently on loan.

I walked the patient down to the other end of our facility, hooked him up, and lo and behold what did I see......Myocardial Infarction.  For those of you that don't know about medicine, that's the big one, the one you DON'T want to have.  As it happened, one of MY doctors was on call in Primary Care that day, so I made sure my patient was calm, told him that I'd be right back, and just to relax a moment.  I let myself out of the room where I'd performed the EKG, approached my doctor, and told him both of the interaction I'd had with the Primac staff, the fact that Tripler nurses had turned my patient away, and presented him with my findings.  Ambulance (which I was on duty for 24 hours that day) was arranged, and I had asked that my doctor please have a discussion with petty officer Gibson about his flippant attitude towards medicine and to please educate him about atypical symptoms as well as the world having patients that simply refused to have "textbook" symptoms for illnesses.  This was why it was so important to observe as well as listen to your patients, and why I taught in the way I did.  I took the patient to the medical center, and asked to speak with the doctor on call.  I had some pull there, as I'd worked for a few years in the capacity of liason for Navy patients, and had some rapport in their command as well.  After having had the patient settled in, and making sure his family was contacted so they could come and see him at the hospital, I informed the lead physician of what had occurred prior to "normal working hours" and asked that he follow up with the staff on the importance of not turning away patients simply due to them not presenting with a certain list of symptoms.

God saw fit to let that man survive a horrible ordeal.  One that never should have taken place.  Were it not for my striker's quick thinking and intelligent response to come to me immediately, he may have been placed in "holding" in the waiting room for one of us or a doctor to see him.  I taught them, every time they went to call a new patient/number, to always look at every person in the waiting room.  Anyone can take a turn for the worse and go from "normal" to immediate at any given time.  There were times when we did need to bring someone back sooner, and I'm very happy to say that from that batch of strikers, every single one of them had glowing reviews from me, some with higher marks than others, and the one that brought that patient to my attention, as well as another young man showed exceptional intuition in medicine.  The young man came to me, prior to leaving the military to let me know he loved medicine so much and learned so much from me that he'd decided to go on to medical school.  I was so very proud of him, and of my other strikers, especially when I saw a life saved, God helped him hold on, but make no mistake about it, that young lady was a hero that day.

This was a shining example of both the best and the worst that medicine can do, the man ridiculed for showing up at an ER and told to leave and attend sick call was passed off as crazy, lazy or otherwise, but in my experience, most people don't want to go to the ER, or even to see a doctor.  Why people assume that they do is beyond me.  It's not like it's fun to wait for hours, or that we had games.  We didn't.  People came to us because they were not well and needed our help and care.  That time in the morning should have been the first strong indicator that something was not right.  Who the heck wants to miss out on hours of sleep just to go to the hospital?  That would have been the first clue I looked at, and everything else would have fallen in line right behind it.  When you hold someone's life or health in your hands, it's precious.  We can never look at it any other way.  We can't afford to be arrogant, lackadaisical or indifferent.  It is those very things that kill people every single day.

I will say, medicine is not an exact science.  It can be part knowledge, part intuition, part curiosity, and part a care of others.  You must love puzzles and solving them.  Every illness deserves attention and care, even the most mundane.  Becoming jaded is a strong indicator that you should not be where you are, you will cost lives, or psychological damage to others simply by your attitude towards them.  if you don't know what's wrong, don't assume that it's nothing.  Just because YOU don't know doesn't mean someone else doesn't either.  Even patients I've had to turn away from emergency care, I've taken the time to sit down and explain, this is for immediate care, and I can't see you here, simply because if someone comes in, things can get very ugly very quickly and I may need the room for emergencies, HOWEVER, you are absolutely right, your illness does definitely need to be seen, and it just so happens I have access to the scheduling system in such and such clinic, and if you'd wait one moment I will look and see what kind of opening I can find for, we're in luck, there's a doctor that can see you this evening, please take your medical records with you and tell so and so on duty over there that I've sent you and set you up with an appointment and they should be able to check you in right away.

Sometimes no doesn't have to be NO, it can be I can't but someone can.  An explanation and exploring the options goes a long way.  And NO ONE should ever be made to feel as if their concerns are not valid.  Just because they're not emergent today, doesn't mean that if we turn them away, they can't take a turn for the worst tomorrow.  After all, I had a disease for years that no one ever knew about, and it's changed my life in so many ways, I can't even count them.  I had it even before I had symptoms for it, and long after they came, I had a name for it.  I knew something was wrong, sought help, was passed over, told I was crazy or making too much of this or that, but you see, I wasn't.  Never would I or did I ever treat one of my patients the way I'd been treated by some.  I hope that the ones I taught, have a big impact on medicine where ever they are, because people deserve to be cared for.  It's called Health CARE for a reason.  Get over yourselves!  Just because you know a lot of BIG names for things doesn't make you better or smarter than someone else.  You don't walk in their shoes, you have NO idea how they feel.  They came to you for help........SO HELP THEM, BE A HERO.

It only takes a second to reassure someone that their welfare is important to you.  It only takes a touch, a look, a word, don't be so stingy, if you're there because you have the talent for it, take the time to care, it will mean the world to your patients and it will give you a sense of fulfillment and joy in a job well done that you can never fathom you could ever have had.

I'm going to try this......

I'm not sure how to do this truly, but I am going to try and post a link on one of the blogs I follow regularly.

I don't always post comments, but hopefully the blog writers I do follow know I do care about what they have to say, even when I'm silent.

I felt compelled to post this since I have a lot to say on the subject and his current experience in delving into a very frustrating and serious medical issue.  Most of my readers don't know me from personal experience, but they do know me from what I've written here.  Any that do know me from personal experience can perhaps understand what I'm about to write about.

I was in the military for nearly 10 years.  I worked in the medical portion as a Hospital Corpsman.  I have to state my appreciation for that profession as the Navy, from my personal experience with other branches, has the best trained enlisted personnel in their medical ranks.  I've also had the pleasure to work with some fantastic doctors, and the misfortune to work with a few, who's abilities I would rank as less than dubious at best.

In my experience while working in the military, I've trained other medical personnel, as well as running clinics, training and evaluating others who wished to branch into medicine etc.  I always tried to encourage those I trained to look at our patients first as people, know them, even as far as knowing what shift they worked when possible.  In that way, you could best serve to cater to special medical needs.  I was very well acquainted with my patients, and tried to always be mindful of looking at histories as well as their current illnesses.  Whenever faced with something new that I'd never dealt with before, I always did extensive research to know what it is my patient was likely to be facing.  I took nothing at face value, and even when working on a busy ward, I found the time to go to the medical library and read up on whatever it was I wanted/needed to know.

I can not say the same for some of the doctors I worked with.  As I previously stated, I worked with some doctors who were just amazing.  Always caring and always looking to better the care they gave to our patients, and I am eternally grateful for all that I was able to share and learn from them.  After all, no matter how much training/education/experience you have you can never know everything there is to know about medicine or patient care.  There are new diseases that are discovered every single day, and the ones that have been around for what seems an eternity are so many, there's no way to know them all.  The doctors who left something to be desired were the ones I worked with who's attitude seemed to be that of arrogance.  They thought because they could tag an M.D. after their name, that gave them license to dismiss others as ignorant, liars etc.  In short, they thought they "knew it all", and quite frankly I could dance circles around them since they simply had an air of not caring about them.

These are the kind of doctors that, when you do have an odd, special or out of the ordinary problem give you that look.  You all know what I'm talking about.  I'm sure you've run into it at some point in your lives, and I hope you took the opportunity to leave and find a doctor who did care.  It's that look that says, you're full of crap, you have no idea what you're talking about, you're crazy and you're lying to me.  It's that look that says, you just wanna "milk" some medical issue to try and get some time off, or something along those lines.

I have heard some of these same doctors literally speak the following words to their peers "You can't listen to what a patient says because they'll just lie to you."  Quite frankly, when I heard this uttered from the lips of one of the doctors I worked with, I was highly offended.  It was not aimed at me, but I took the opportunity to tell that doctor that his bedside manner sucked, he was a horrible doctor, and that if he had such a low regard for medicine and the patients we treated, I was certain that he could find a job where he would never have to be around another living person.  I can't be certain since I turned on my heel and walked away directly after, and stormed off to cool down, but I could swear the other doctor smirked and snickered at that........hopefully in agreement with what I'd said.  I took my role in helping people become and stay healthy very seriously, and it was an atrocity to me to think that a doctor I worked with could actually work against my personal goals of having healthy, satisfied, well cared for patients.

This was just months prior to my beginning to have serious medical issues myself, and after years of attending "fertility clinic" to try and find out what was wrong with me, so that I could look forward to having a child of my own.  The doctors I worked with there, viewed me as a "normal healthy woman" that simply had issues with getting and staying pregnant.  I won't say that they disregarded the underlying issues, since they were very caring, and listened to me.  It wasn't until later, when I did begin having issues that the underlying causes were actually searched for, and that was also years in coming to light.

During that time, I began to gain weight for no apparent reason.  I was very active, swam every day, ran, lifted weights etc, and this was a noticeable weight gain.  I began having very serious migraines, abdominal pains that literally brought me to my knees.  I began to have issues with pressures in the atmosphere, with pain and discomfort in my hands and feet, hips that would crack and "get stuck" at times, and just general aches and pains in joints.  I was also becoming depressed because of being treated like a second class citizen with some of the very same doctors I'd worked with for extended periods of time.  I had one doctor tell me, "There is no way that you can be eating what you say you're eating and still weigh what you do."  This after I'd gone to one of them in desperation for help since I was fighting this mysterious weight gain so fiercely that I'd begun to eat 2 cups of rice a day and once a week adding a can of campbells's soup to it to add some much needed nutrition.

Anyone who has never been in the military can not fully understand what it means to be gaining weight, or over weight while in the military.  You are regarded as a slacker, useless, stupid, or somehow less than competent at your job.  Since I was in charge of the area that I worked in, this was not a concept that held weight, regardless of how common it was, and was found to be inaccurate after I was in for surgery and out of the clinic for 30 days to heal.  I had written extensive instructions for every single thing we did every day, and was still consulted at my home during my healing process, and even had to come in to straighten things out while on medical leave.  Yet, all of a sudden, I was "stupid".  It's not something someone says to you, it's how they treat you.

Once diagnosed, I ended up losing 30 pounds in a month, which was a terrifying loss, and all of a sudden I was "smart" again.  A doctor I'd worked with for years overheard an interaction between me and some patients one day, and approached me to say, "I've never realized what a great Corpsman you really are."  I knew I was good at my job, LOL so it wasn't news to me.  It was just further evidence that ignorance prevails when people overlook someone simply due to outside factors.  My peers and subordinates knew my worth, and so did I, so quite frankly, I didn't need the outside confirmation.

During that time I was treated as if I were crazy, that one symptom and another just simply made no sense.  My vision was completely blacking out due to sudden onsets of my migraines, I was shrinking, and a spinal xray showed that my scoliosis was advancing.....which according to doctors I worked with was impossible in adulthood.  Then I tried to encourage the doctors to look at my diagnosis as a big picture, that one thing had very much to do with another.  The onset of it all was too closely related and manifesting in such a matter of time to be anything but one whole rather than a bunch of tiny pieces.  I was told then that they could not say that PCOD was the reason for my weight gain, migraines etc.  Yet 20 years later, they now know that it is a system wide endocrine disorder, and that I need metformin/glucophage to properly process food or it goes straight to the fat cells because though I produce insulin, the receptors are malformed.

They still know relatively little about my disease/syndrome for my liking, and I'd be more than happy to be an example of a learning patient for them, however, there are still far too many doctors out there that "know it all" to listen or learn from medical disorders or to listen.  The ones that have looked at my overall symptoms and illness, I'm sure, are the very same ones that helped to further understanding about it, though there is obviously still much to learn.

I feel for anyone who has ever had the misfortune to be treated as stupid or crazy due to a doctor that simply refuses to listen.  I know all too well the desperation of crying for help to get better, when there seems to be no one listening, or worse yet, regarding every word you say as some crazy person's imagination.

Typically, we see a LOT of that with "women's" issues in medicine.  Since they manifest so differently sometimes, and women can have some very mysterious symptoms.  Also, our society seems to be so "sexist" still in regards to viewing women as ignorant, crazy, or hysterical with little or no reason to be so "dramatic", which is definitely more apparent in medicine.  But that tendency is NOT solely unique to women's's just more common.  Evident in the following blog, who's link I hope posts correctly here for you now.  This person has been so brave, and I know things have been difficult, confusing, frustrating, and just plain ridiculous at times evident from his recent post, regarding a fellow church member basically telling him maybe his illness was due to his being a "hypochondriac".  It's all too easy and all too prevalent for people to be disregarded, passed over, passed by, disbelieved, mistreated, misunderstood or simply even ridiculed rather than for people to be loving, supportive, and kind to others when they're going through hard times.  I'd rather see people understand how very much it sucks to go through life knowing something is horribly wrong with you, and knowing how many times a doctor has looked at you with "closed eyes" or a "closed mind", thus denying you even the peace of mind of having some kind of diagnosis.  These are not people to be disregarded, they are the ones we should be most mindful of, add to our prayers, and add the doctors they interact with to be prayed for as well.  Let God touch their hearts and minds so that they can once again view their patients as people with real problems and pains so that they can treat them, the whole person, not just a symptom.

I hope everyone who reads this can add others like this or any you know to your own prayers.  We need a movement in our world, so that we won't overlook others who are very much in need of our attention and prayers.  People like this brave soul who has recently been passed off as untreatable to finally find out he has a diagnosis.  Keep him, his doctors and all those who have yet to be diagnosed or treated in your prayers.

I hope that no one out there has had the opportunity to be treated like I and others have, and depending on the doctor still am, but if you have, my prayers are also with you.

Monday, July 8, 2013


Under the weight I feel beginning at the top of my head.

There are just some days you feel the weight of the world so heavily on you that it literally feels like you're being compressed under the weight of it.  I'm not quite sure how or why it is, all I know is that it IS.  I'm not even sure that clear thinking is able to be done at these times, because I feel as if it's relatively difficult to form a complete or logical sentence.

I've recently had a bout of nostalgia and have been trying to look up people that I remember from days gone by to see how they fare.  Hopefully they fare better than I, since my life leaves a lot to be desired.  Rather a lackluster affair right now LOL.  But I'm happy to say, the ones who's names I could remember seem to be faring fairly well thus far, and for that I'm eternally thankful.  I'm not sure why it's important that others are doing well when you're in a state of fluctuation, instability, or upheaval, but for some odd reason it is.

Perhaps it's because it reestablishes hope or peace to know that sometimes things can work out for others, even if not for yourself.  It soothes me to know that I'm not completely lacking in my ability to determine goodness in others.  Perhaps it wasn't me choosing poorly that resulted in the current pains of the day, but perhaps it was poor people choosing me which led to it.  I am gullible, and do tend to believe in others, giving the benefit of the doubt until it's proven I shouldn't have put faith in them.

It's just nice to know that my impressions of who/what some people were still holds true today, where others closer to me have failed.