A.M.A.

Until recently, I thought A.M.A. just stood for the [American Medical Association].  At approximately 6:45 p.m. on September 7^th of this year, I found out that A.M.A. also stands for Against Medical Advice.  For this is when I refused to stay another night in the hospital, and I was given a clearer understanding about why I was having to endure what I had been.

You see, I was created with a very big mouth (so to speak) and a great reluctance to remain silent when I can clearly see wrongs that need to be righted.  Quite naturally, this is especially true when I am the one being wronged, but since our Heavenly Father is working on me to take everything personally (in one way or another) my scope has expended greatly.  Out of respect to the wishes of my readers here, who would rather not be exposed to anything of a more spiritual nature, I will address that side of the issue more completely in [On My Own] over on The Trib.

To better understand what led up to my decision to A.M.A. at the hospital that Monday evening, I would like to take you back to the beginning of the incident.  I do not remember just exactly when it actually started, but I started feeling seriously nauseous Tuesday (Sept. 1) night.  That feeling became progressively more pronounced until I threw-up for the first time Wednesday evening.  I could not ingest anything—even a sip of water (cold or otherwise) had to come right back up, which involved a lot of dry-heaving.

By Thursday evening, I could not stand the dry-heaving any longer, and I had a thought about the cause just might be my heart.  I had heard or read something about one of the symptoms of a so-called silent heart attack being an upset stomach.  So, I asked Arlynda to call for an ambulance.

The ambulance arrived around 9 p.m., which I think was about five minutes after she called.  After getting in the ambulance and before leaving in front of the house, they checked my blood pressure to see which emergency room I should be taken to.  If they determined that I may have heart issues, I would be taken to one better equipped to handle it, and when they kept getting 254 (+/-) on the high side and not being able to get a number on the low side, to the bigger facility I went.  Oh yeah, I was still feeling like I constantly needed to throw-up, and I begged for something to alleviate the feeling.  They gave me a shot of something, but the feeling persisted.  Thankfully, I did not have to actually throw-up in the ambulance, but in less than an hour after arriving at the emergency room, I was dry-heaving again.

I was not rushed into a trauma room upon arrival, but by general emergency room standards these days, I was attended to fairly quickly.  Hey, I only had to stay out in the lobby in a wheel chair for less than an hour after I was taken off of the ambulance stretcher!

All of my focus was upon keeping from dry-heaving again, and I begged them to fix that when I was finally taken to the emergency room examination area.  They did give some more of what they gave me in the ambulance, but it did not seem to help.  I lost track of how many times I failed to keep from dry-heaving while I was still in the emergency room examination area.

I also lost all sense of time, but I am fairly sure it was sometime Friday afternoon before I was moved from the emergency room into intensive care.  They said that the reason why it had taken so long was because they needed a special bed and room for me.  I threw-up twice more on the trip up to intensive care, but at least I had accumulated some stomach acid (of something) to actually throw-up by then.  So, those last two were better than dry-heaving.  My little bucket had a little over a quart(?) of black stuff in it when they nurse emptied it in my intensive care room.

The special bed they put me in was wonderful at first.  I even asked what kind of mattress it had, and they told me that it was an inflatable one.  My special room had overhead lifts, but my bed did not offer much in the way of hand-holds to help with me being able to move by myself.

Since I was in daze, I was not interested in much more than being able to actually sleep, which was not granted to me.  For I have never been able to naturally go to sleep on my back since I can remember.  Now, I can pass-out from exhaustion, which is all I experienced during my stay in the hospital, and even then, an hour or two of semi-unconsciousness at a time was all I was allowed.

Have you ever sat in a [bean bag chair]?  If you have, you know that they are wonderful.  That is, at least until you want to move around, and then you find out just hard it is to even just shift positions—let along get out of the thing.  That is what I discovered about my special bed, and when I asked if I could be placed in another kind, my attending [RN] told me that that doctor’s orders had me staying in that bed until further notice.

All in all, 90% of the RNs, techs and aides I had some dealing with were wonderful.  For they were always quick to bring me another blanket or whatever else like that I asked for, but doctor’s orders prevented them from doing much.

I can remember being seen by an actual doctor three times for a grand total of around 30 minutes.  Two RNs told me that they did not know why I was still in intensive care the last day or so since my blood pressure was consistently down to around 135/80 and I no longer had an irregular heartbeat, but there I would be until a doctor had me moved to a regular room.  Oh yeah, an early blood test showed that I had some sort of staph infection, but when I asked an RN about it, she said that my white blood cell count was now normal.

At around 2 a.m. on Monday morning (Sept. 7) a herd of RNs, techs and aides piled into my intensive care room and announced that the orders had to come in for me to be moved into a regular room.  Since I had been given assurances by several RNs that they saw no reason why I could not go home at any time, I figured that the hospital needed to put me in a regular before releasing me to fulfill some sort of required Medicaid procedure.

I was told that the reason why it had taken so long to move me to a regular room was because one had to be found to accommodate the size of my bed.  When I was asked by an RN I do not remember seeing before how much I weighed, I told her that my bed said that I weighed 108 kilos.  She smiled and shook her head, and then told me that my chart had me down as weighing over 900 pounds.  Hence, the reason for the special bed and intensive care room.  No, I had not bloated up to 900 pounds when I entered the emergency room, and no one with the authority to change what was on my chart had done anything to check what I really weighed.

When my assigned doctor in the hospital came to my regular room at 11 a.m. that Monday morning, I pressed her on letting me go home.  She said that all of the heart issues were now under control, but she still wanted to wait on the results of one last blood test to make sure of me no longer having an infection, which would not happen before the next morning.

No, I did not want to stay in that torturous bed one second longer than I had to.  So, I reasoned with her that if the infection showed up again, she could just call-in a prescription for something to take at home, and that I would be willing to give more blood as soon as she wanted.  She relented and told me that she would quickly put in the paperwork to have me released, along with writing prescriptions for enough medicine to keep my high blood pressure and diabetes in check until I could see my regular doctor.

Needless to say, I was very happy, and I called Arlynda to tell her the good news.  Then the hours dragged on.  Arlynda was also in contact with my daytime attending RN at the time, who told her that she did not know why it was taking so long.

At 6:30 p.m., my daytime attending RN came into my room to tell me that Medicaid had declined to pay for one of my prescriptions and that it would not be straightened out until the next morning.  She also said that my paperwork had not been put in until 30 minutes beforehand.

I suppose it is a grossly overused expression, but I really am old-school in my thinking that a patient is at the mercy of doctors when it comes to being released from a hospital.  Subsequently, the fact of a patient having the right to refuse medical service is a strange one to me, but I insisted upon going home from the hospital that evening.  My daytime attending RN asked me if I wanted to A,M.A., and after she explained to me what that stood for, she went to get a form for me to sign.

I quickly learned what AMAing really meant at that hospital.  For they pretty much completely washed their hands of me—even refusing to wheel me down to where Arlynda could pick me up.  So, there I sat on the side of my special bed on the fourth floor of that huge facility, but I still had access to the phone in the room and the call button for a nurse.

My daytime attending RN (who was off-work by 7 p.m.) had asked me if we had a wheelchair at home, but I thought that was for me getting around after I made it out of the hospital.  Arlynda told me a little later that the RN had told her that she would need to come up and get me in my room.  Oh, did I neglect to tell you that when I was putting on my regular clothes, I discovered that I only had the strength to stand (even while holding onto something) no longer than 10 seconds without collapsing in a heap?

When I found out that they were expecting Arlynda to come up to the fourth floor to get me, which she was incapable of doing because of her very poor health, I hit the nurse call button and begged her to wheel me out to the curb.  She said that she would see what she could do.  A few minutes later, she came back to tell me that an exception was made because of Arlynda being in such poor health herself and someone from transport would soon be up to take me down.  The nurse returned with three prescriptions she had found for me (in the trash?) and around 45 minutes later, I was in the car and headed home.

Arlynda was very worried about what other complications might arise from me AMAing, but she was as much in shock over them leaving me to fend for myself as I was.  She calmed down considerably when I told her that what I had been subjected to was meant to give me more to write about.

No, I have not been given the go-ahead to name names yet.  I can tell you that I was at one of the two major hospitals in this town, with both of them supposedly being in the top 100 hospitals in the country.  I met several truly awesome caregivers there, but the general policies and procedures of the healthcare system has become utterly corrupt.  For it is only interested in what is in their best interest—certainly not the patient’s.

I finally made it into our own bed around midnight, and around six hours later, I decided to get out of bed to make sure of being able to function a little better than I had when I made it home.  Making it into the house from the car had been an obvious miracle the evening before, and I wanted to see how hard it was going to be to make it to my Tuesday afternoon appointment to receive the Avastine shot in my left eye.

Our bed sits very low, with the box springs under the mattress being directly on the floor.  The reason for this was having some short-legged puppies that couldn’t get in bed with us at a normal height, but being so low sure makes it hard for me to get out of bed at times.  I have been using how much effort I have to expend getting out of bed to help gauge how well I will be able to get around the house.  When it is a struggle, I know that I had better not become too ambitious with taking trash outside and stuff.  When I discovered that I could not get out of bed after three tries that Tuesday morning, I was fairly sure that I would not be going outside at all—let alone making my afternoon appointment with the eye doctor.

Arlynda and her mother were still asleep, but I would not have asked for them to help, anyway.  For there was not much that either one could have done.  However, I was given the idea (from you know who) to build up the height of where I was sitting on the bed to lessen the pivot angle.  So, I grabbed clothes and whatever else I could find to put under me by rolling onto one side of my rear and then the other until I was sitting about a foot and a half higher.  A waist-high set of drawers was within reach, and I planned on trying to reach for the back top side to pull myself up.  On my first try, I missed getting a hold on the back, but when I went to ease back down, I realized that I was actually able to stand up by just pushing off of the top of the chest.

Now what?  It was 20 feet and turns through two rooms to my chair in the living room.  Arlynda’s sister gave her a folding walker a few years back, but there is not enough room in our house to make using one less trouble than not.  I was still able to use the walker as a cane when I did not have a wall or a piece of furniture to hold onto, and I did indeed make it to my chair without going down.

I called to cancel my eye doctor appointment soon after 8 a.m., and Arlynda went to fill the prescriptions I had from the hospital.  There wasn’t any for either my high blood pressure or diabetes, but the plan was to start going back to my regular doctor for such as soon as possible.  It turned out that was the 17^th of this month (last Thursday) and I would be seeing a nurse practitioner instead of my regular doctor.  A new appointment to receive the Avastine shot in my left eye was also secured for the same day.

During the time between getting out of the hospital and the 17^th, I was trying to build up some muscle in my legs.  The times I have tried to exercise since becoming so sick with my chronic fatigue syndrome 21 years ago had always proven to do nothing more than tire me out too much to function, but I was at a point of desperation.  So, not being able to do anything else but be conscious seemed like a good trade-off if I could get to where I could walk more than a few steps at a time. 

I did get to where I could be on my feet for around five minutes once or twice, but my usual limit was two minutes and 30 feet in total travel distance.  It was going to have to do, and I was able to make it back out to the car with the help of being in our wheelchair on the morning of the 17^th.  The wheelchair was loaded into the back hatch of the car, and Arlynda went into to the eye clinic to get me one of their chairs when we arrived.  I had a work-in appointment for 9 a.m., and it was all done by 9:02 after checking in at the front desk at around 8:45.  When I asked them if they were a part of the same healthcare system I have been having so much trouble with lately, they told me that they were just affiliated with it while really being on their own.  This explains why they are still as good as they are.

We then had five hours to kill before my 2 p.m. appointment with the nurse practitioner, which was great for Arlynda’s mom.  For she can spend days at a time in a Wal-Mart.  Wal-Mart was avoided, but the three other places appeased her great desire to roam free down shopping isles enough for us to make it to my next appointment with time to spare.

Alas, I had been assured of making my appointments without trouble, but I had not been assured of making it back home without trouble.  When the nurse’s aide went to take my blood pressure, she could not get a clear reading.  She went to call in a more experienced nurse’s aide, who came up with 220/150.  I was thrilled.  For the readings I had been taking at home with an automated blood pressure cuff were 50 points or so higher.  The nurse practitioner freaked and refused to write me a prescription for high blood pressure medicine.  He cited that he was obligated to send me to the emergency room for them to write the prescription (at best).

I had been clued in by a physical therapist during my hospital stay that high blood pressure and an irregular heartbeat contributes to overall weakness.  So, I was actually quite eager to start taking medicine for it again (6-7 years ago was the last time) but the nurse practitioner would not prescribe anything other than something for my diabetes.  Back to the same emergency room as before I was heading.

On the way out of the clinic, we found out that I did indeed have a primary care doctor.  He had been assigned to me when I went for a follow-up after having to go to the other emergency room in town with this system for the severe pain I was experiencing in my right thigh two years ago.  I only say him the one time and swore that I would not see him as a doctor again for a number of reasons.  None of that mattered a bit to this healthcare system, and I was informed that I could not see another doctor of any kind within their system outside of the emergency room/hospital without his express permission.  There will be more to this story to come on another day, I am quite sure.

The nurse practitioner did call the emergency room, and they were looking for my arrival.  Arlynda and her mother were exhausted, and I told them to go home while thinking that it would probably be midnight or so before I could go home, if I could avoid being admitted into the hospital again.  An aide wheeled me up to the front desk, and a few minutes after officially checking in, I was wheeled into a small examination room next to the waiting room.  After telling four different nurses just why I was there, my blood pressure was checked and I was wired for an [EKG].  My blood pressure registered at 226/138, and the EKG showed that my irregular heartbeat was back.  I was then wheeled back out into the waiting room.

During the two hours or so I was in the waiting room, I overheard a lady on a cellphone tell someone that their doctor was pretty sure of her husband having a blood clot in his neck, which was actually visible.  Since he was sitting next to her at the time, my concern over a blood clot in his neck either heading to the brain or the heart after breaking loose was surely unfounded.

I asked a man sitting across from me if he knew the time, and he said that it was 5:01 p.m. before asking me how long I had been waiting.  After I told him 2-3 hours, he muttered that he was not going to wait that long and left.  Oh how I wanted to go with him.

Thankfully, someone came out to get me a few minutes later, and I was placed in one of their regular examination rooms (like I had spent over 12 hours in the time before).  Hey, at least I was not dry-heaving this time.

A few minutes later, a truly awesome person came into the room to hook me to the monitors and look with great credulity at the reason why I was there.  A few minutes later, an equally awesome doctor came in to inform me that since I was not experiencing any pain or other problems, he would write me a prescription for my high blood pressure medicine and send me home.

It was 6:01 p.m. when I left a message on our phone for Arlynda to come get me.  It had taken less than 30 minutes to be properly handled after it was my turn to be examined by someone with the authority to take care of me.  If you are keeping score at home, the trip to the emergency took at least two hours longer for me to start taking medicine for my high blood pressure than it would have if the nurse practitioner had of wrote me a prescription—even with the time it would have taken to drive to our pharmacy to pick it up.

Please understand that my ire is not directed at the people who work for this healthcare system.  Well, certainly not all of them.  For they have their share of awful people in the lower ranks, and more than their share in management.  Nonetheless, the really good ones really stand out.

Have you been keeping count?  I do not know if the 10-12 hours I was kept in the examination area of the emergency room while waiting for a special room in intensive care to become available added more to the total cost for my care, but I am quite sure that the 36(?) unnecessary hours I spent in that special intensive care room (along with the 74 hours I spent in that special bed designed to handle enormous weight) greatly added to the total.  There is also not being prescribed high blood pressure medicine to take until I could see a regular doctor directly contributing to my second trip to the emergency room when the nurse practitioner decided to take the legally-safe route.

Who do you think will be paying the bill for all of this?  The tax-payers of Missouri—that’s who.  For I am on [Medicaid].

Is it incompetence or corruption on the part of the healthcare system in question?  For with the state of Missouri undoubtedly not being nearly on top of costs as a HMO, unscrupulous healthcare systems could receive payment for a lot of unnecessary services that may or may not have been actually rendered.

Nonetheless, what about the [Hippocratic Oath]?  For not being concerned about me not sleeping while I was in the hospital, along with failing to provide me with at least a prescription for enough high blood medicine to get me by until I could see a regular doctor was doing me harm—was it not?  Ah, but I am sure that the healthcare system in question did everything it was legally-obligated to do.

Alas, during the years I was always disgustingly healthy, I was not the least bit concerned about the true condition of healthcare in this country.  I hope you do not have to find out just how poor it is like I have.

P.S.: Despite the vision in my left eye already being greatly improved, other factors prevent me from diving back into the regular swing of things online until later.  Hey, it has taken me around eight hours to write this mess, but I will make every effort to get going again as soon as possible.

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