My most recent visit to the local hospital was very eye opening. So we are in the middle of this “high contagious”, “deadly” pandemic and you wouldn’t know that at the local hospital. So when you come into the ER, the security guard stops you and asks you the standard COVID questions, and then sends you to the correct location in the ER. In my case I have no COVID symptoms and I haven’t been exposed that I know of, I was just having chest pains. Now let me explain the chest pains part so you have a better understanding of what is going on.
As I have alluded to before in other posts, I have Rheumatoid Arthritis and Fibromyalgia which are both autoimmune diseases and I take an weekly injection for the RA that suppresses my immune system, so first I like to avoid places like the ER cesspool of COVID and second, RA can attack the organs in your body, which is what is happening in my case. For the past two months or so, I have been having elevated resting heart rate (like 120) and high BP, plus heart palpitations and chest pressure. I have seen my family practice docs and been referred to a cardiologist, but I’m playing the game of waiting for them to get around to calling me to set up an appointment. In our area, most of the specialists are not seeing new patients.
So here I am at the local ER (we have two hospitals in town). I got past security and I’m now at the little computer to enter in my information. The very first screen states that if you are having chest pains or other heart attack signs, skip the registration and see the nurse. I do just that, only to be told to please continue filling out my information. I do and I’m assuming they will take me back right away, but I’m just standing there waiting. I wait for 4-5 minutes and then they call me back to the triage area. There they check my vitals and then take me back to the fast track to draw some blood and other labs.
The young nurse had a difficult time tapping me for an IV and was just digging around looking for the vein (which I now have a rather gnarly bruise from). She then switches arms and puts it on the underside of my forearm for some reason. Now, I have to have quarterly blood tests for my RA medication so I don’t normally have issues with someone finding a vein, but we move on. I now have the IV on the bottom of my right forearm and I’m off to X-ray. I wait in the X-ray waiting room and then they take the chest X-ray and then kick me back out to the main waiting room.
I just don’t understand their logic and flow here. So let me see if I understand this. Let’s give you an IV and take your vitals and then put you in the “general population” again. It is a little misleading if you are trying to judge wait times, which by the way, are claiming to be 10-15 minutes. So I’m sitting out in the main waiting room with my spouse. We are just waiting, we waited some 3 hours (good thing I wasn’t having a heart attack).
As we are hanging out, I scan the room and I notice that a fair amount of patients have the wrist band and IVs, so they have been triaged, we must be waiting for the main ER. A guy comes out of the restroom, which is right around the corner from us, he is coughing his lungs out and all I could think was, please don’t have COVID, please don’t have COVID. He walks within 4 feet of me and my spouse. I mean he was wearing his mask and we were wearing ours, so I’m sure we are protected from COVID and a nuclear attack at the same time. He goes to the vending machine, which is 15 feet in front of us, still coughing and grabs a Coke and then coughs and talks to the older lady sitting next to the vending machine. He is bitching about the other hospital in town.
He then goes and sits in the general population of those that don’t have COVID. He then starts to very loudly talk to a lady a few chairs away who is bitching about the wait times. She claims she has been waiting some 5 hours now. He then very loudly exclaims to the entire waiting room that we should not go to the other hospital as they wouldn’t see him. He said that he is COVID positive and they refused him, he nearly passed out so he got into his car and drove to this hospital and proceeded to lie about his COVID status and made it to the main waiting room. Ugh, so here he is spreading his germs around, thank you for being that asshole.
The one thing that I noticed is that I’m not seeing any COVID protocols being followed. There is no one cleaning anything, the three plus hours we sat there, I never saw one person from house keeping, not one thing wiped down, hell the dust and trash under the chairs is from weeks, maybe months of not being cleaned. But at work, we have someone cleaning door handles and common flat surfaces every few hours. Go figure.
They finally call me back and take me to a cardiac room and then it is like I’m about to die, they get the Nitro going, they get the aspirin going, all that stuff that they didn’t care about for the past three hours. They took my temperature for the first time as well as they skipped that when I entered the ER for the first time. They had problems getting an accurate temperature, which they blamed on the old temp probes. But often patients with RA run a lower body temperature, my normal is about 95.6 instead of 98.6.
I saw the ED doctor, who wanted to make sure that I knew he was smarter than I am and didn’t want to hear me talk, he just wanted to impart his knowledge. Which BTW, was not anything new to me, I have studied this before, but he is a PHd, so I must be smart. Explaining to me that I’m not having a heart attack and so on. Now, let me state that I didn’t go in stating I was having a heart attack. The button said chest pains and I’m having chest pains. The button said rapid heart rate and I’m laying in the bed and have been for an hour and my HR is 117. The button said uncontrolled high blood pressure, and I was, it was 157/117 while again resting for the past hour plus. But by all means, please explain to me what I’m not feeling.
He was so arrogant that it started to piss me off. He’d ask a question and then when I got to answer it, he would cut me off and start speaking again. I’m sorry that is not a very good bedside manner doc, but whatever. BTW, if you want to challenge me to a quiz off, about a wide variety of topics, I’d be happy to educate you on the real world. But I move on as that is not the topic here.
So I’m then told that they want to admit me and I’m fine with that, I was already prepared for that actually. I’m really dreading this entire visit of hurrying up and waiting Olympics.
So they admitted me for the night for observation and then tests in the morning. I was very shocked at how nice the rest of the staff is at the hospital. Now I totally understand all the BS the ED staff has to put up with, but you can’t treat everyone the same, that is just not fair to them and to you as the provider.
I got to the observation wing and they got me settled very quickly. My nurse for the night was a total train wreck, but she was very sweet and friendly. By train wreck, I mean that everything she tried to do failed and she needed assistance. But I didn’t get upset, I just figured she must have been new to this game (later I found out that wasn’t the case, she is just a train wreck).
I was too late to order dinner and of course the hospital never thinks about that, they just don’t care. But when I asked, I was told that they can get me some sandwiches and juice, and that worked perfectly well. I was told nothing after midnight, so that wasn’t a problem either.
That night was fairly sleepless with constant interruptions for vitals and blood drawls to check my Troponin levels. I’m talking 11:22, 12:38, 1:09, then 4:44 and 7:10, so not terrible, but rather annoying. But I’m not one to complain, they are just doing their job. At the 7:10 “wake-up” I met my nurse for that shift, and he was really cool and down to earth. I like that in a nurse, he is straight up, period.
At 8:20 I was given my first injection of Cardiolite or Technetium (99mTc) sestamibi which is the tracer agent they use for nuclear medicine imaging (Nuclear stress test).
By 10:00, I’m in the nuclear lab, laying on the table as the Nuclear SPECT (single-photon emission computerized tomography) camera travels across my chest to obtain the images of my heart at rest. After that, I’m taken to the stress test lab for my stress test. You can learn more about a nuclear stress test here (https://my.clevelandclinic.org/health/diagnostics/17364-pharmacological-nuclear-stress-test)
Since I had surgery in my knee in 2020 and it was not 100% successful, and has been very painful lately, I made the mistake of opting for the Lexiscan injection instead of the treadmill stress test. While I’m waiting for this test to be administered, I’m having a nice chat with the nurse who is connecting up the monitors and telling me what to expect. I find out that she was once married to a Marine, who sadly (but not shockingly) screwed her over and cheated on her. I let her know that not all of us Marines are the same, many of us are good guys. It was refreshing to have a chat with someone as most everyone I had run into at the hospital was quick to do their job and move on. She took the time to talk with me, while she was doing her setup.
For this type of stress test, you are on a bed connected to monitors (Blood pressure, EKG, PulseOx, and I’m injected with the Lexiscan® (regadenoson) injection. This injection will basically simulate the heart as if it was being exercised. I was told that I might feel warm, flush and have difficult breathing and that I need to communicate what I’m feeling. The test will last four minutes and half way through they will inject another round of Cardiolite into my IV for scans later. The PA told me that the reversal is caffeine and that once I drink the Coke (I got to choose my caffeine source of choice) the effects would reverse in 10 seconds. Yeah right, but ok, I’ll play.
I’m kind of dreading this, but let’s pull the trigger and get the show on the road. I get the injection of Lexiscan® and I immediately feel my chest getting very warm, in fact it gets rather hot. I then start to feel flush and I’m having to breathe deeper as well. They then inject the second round of Cardiolite and I immediately feel so much worse, hotter, very faint like I’m about to pass out. The sounds in the room are getting muffled and I thought for sure I was going to pass out. I’m then told the test is over and I’m sat up and given the Coke. I take a sip and bingo, I start to slowly feel better. I finished the baby 7.5 ounce can and I feel like I did prior to the test.
I’m disconnected and wheeled back to my room. I’m told I can order lunch and eat and then I will be taken to the Nuclear lab again for the last set of scans. I got back to my room and sure enough, I was able to order food. I found the food to be ok, but very much lacking. I don’t mean lacking in taste, that was ok, I mean in portions. I ordered pancakes (two of them), scrambled eggs, a blueberry muffin, 2% milk and Cheerios. What I got was everything but the pancakes. But when the food arrived it was time to go for round number two. I had enough time to call and request that my pancakes please be sent up. They assured me that they were on the tray. So I guess I’m blind now too.
Off to the lab for the next set of scans and the tech had major problems with my monitor leads. She had to stop the test about eight minutes into the nine minute test to fix the leads. According to the monitor my heart was either beating 75, 44, 29 or 0 beats per minute. I even joked with the tech, saying “great you killed me”. This is not the first time that they had problems with the leads, in fact, the ER put a set on, and then they put another set on. When I go to the observation ward, they put another set on (leaving the previous two sets on). They had problems throughout the night so they put one or two on here and there, right next to the other set. Back in the nuclear lab and she put on two more leads and we reran the test.
Back in my room and I see another tray of food, sweet my pancakes have arrived. Open the lid and well, scratch that my mini pancake has arrived. Are they serious, this is a pancake, for a two-year old?
Alright I finally start to eat and my doctor comes in, this is the first doctor I have seen since I left the ER. This is my cardiologist that I have been trying to schedule an appointment with. He is so apologetic about this and told me that he has had a talk with the new patient coordinator about this. This just happens to be the cardiologist that I saw in 2017 when I was in the other hospital when I thought I was having a heart attack and so did the ER. I clicked with him so I’m glad to see him as my doctor. He spends 25 minutes in my room talking to me, sharing and he is very knowledgeable about RA and Fibro and how it interacts with the heart. I was very impressed and even confirmed the scarring on my lungs and said he can see it on the x-ray and hear it as well.
He tells me that the palpations I’m feeling are PVCs, where the lower chamber beats before the upper and there is no treatment, but can be related to those with RA, Fibro and other autoimmune diseases. The tests all look good and he thinks that the high HR and BP are POTS (Postural orthostatic tachycardia syndrome), which is again related to autoimmune diseases and he prescribed me something that should help. He couldn’t apologize enough for them not getting me in soon, and has an appointment for me this week. He apologized about the guy in the waiting room and talked with the hospital admin about it and recommended that my spouse and I get tested later this week (we already scheduled PCR tests).
I’m relieved to know that I’m not having a heart attack and though serious, when treated POTS is not life threatening. So I need to get my prescription filled ASAP. I also have an appointment to see him in his office later this week.
The rest of the visit was fairly uneventful. They gave me a dose of the medication that the doctor prescribed for me and it seemed to be working, it kept my vitals at 120/81 and 72 bps, so it seemed to be working and I’m happy about that. We will see what happens next.
One of my other observations was that though everyone was wearing a mask, I wasn’t required to be in my room and I only noticed the cleaning staff cleans the restroom once a day, which again, I found odd during a pandemic.
I got released just after dinner, which was an interesting experience. I was told that I was on a cardiac diet, which meant that I could only have items with the red heart after them. Much of the menu actually had the red hearts after each item, but when I called, I wasn’t allowed much of what was on the menu. No milk, no salad dressing, no soda, no pudding, I was shocked and a little upset as I had done the right thing and planned out my meal before I called, only to be told that each item I wanted wasn’t available to me, even though it has the red heart after it. Oh well, no big deal, I got a small grilled chicken sandwich, corn and mashed potatoes (even though I order a different type of potatoes), the only dessert that I could order was red Jell-O and the only drink was lemonade.
I got released shortly after I ate and I found it odd that once they handed me my discharge papers, I was allowed to walk out of the hospital, that must be a COVID policy, as I have never heard of that before.
Getting changed to leave the hospital, we removed 15 of the monitor stickies, several were stuck to my gown as well.
I’m happy to be home!