There’s some backstory here that needs ‘splaining. First of all, let’s get the planned itinerary out of the way. I left on Mar 28th and arrived on Mar 29th. On Mar 25th, I got notice from my insurance (Tricare Prime) that I needed to find a new primary care doctor by April 1. The letter was dated several weeks earlier. 

This pissed me off because on March 22, I’d seen my primary care doc and got a bunch of blood tests done pertaining to a chronic problem. Had I known I was about to be “dumped” from treatment at the MTF (which I’d been coerced into 4 years before) I would not have bothered.

Anyway… with little more than five days notice, I have to find another primary care physician. First, I contact the physician my husband has used for years. That’s a no go. Then I find the largest group practicing near my home and affiliated with the hospital nearest my home. I contact them and am told that each physician decides whether to accept new patients and their insurance. After a few denials from specific physicians in that group, I’m finally informed that none of the 13 will take me on.

By this time, I’m in Arizona. So, I search again and this time find a physician who will take me. I fill out the paperwork and am informed by Tricare that if the paperwork is received before the 2oth of April, the assignment to the new PCP will be valid on May 1.

That’s wonderful and I make an appointment with the new doc for May 6. I plan to be home on April 28th… exactly a month after I left. Except for the perhaps wasteful blood tests, everything is good.

Except… on April 25th, I am running a fever and have stomach pain. Monday, April 26th, the pain is worse, the fever a bit higher. Since I don’t think I have a primary care physician to call for a referral to an urgent care clinic, I call Tricare directly. I am informed that since April 17th when I submitted my request (that I was told would be effective May 1) I do have a PCP and that I must get any referrals from her.

Unfortunately, she hasn’t seen me before and ethically can’t make any referrals. (This is another topic…) and therefore I can’t get a referral from anyone. I am advised that since this is the case I should go to the ER since that doesn’t require a referral. However, it’s been pounded into me that using the ER for routine care is a bad, bad, wasteful thing and that Tricare might not cover it. Since I don’t think my problem is an emergency, I’m not that thrilled with that advice. But I’m also worried that I won’t feel like driving 1200 miles unless I get feeling better.

So I go to the nearest ER which is less than a mile from my daughter’s house. Why I should have chosen an ER much further away may be the subject of another post. Let’s just say that the close hospital didn’t have a great reputation. But… I was only going to probably get a prescription for an antibiotic and a suggestion I follow up with my PCP when I get home, right?

Um… no. Now I knew that the hernia I’d had surgery for a year ago had herniated again. It was high on the list of things I planned to address with my new PCP. But it wasn’t causing me any problems… or so I thought. I was wrong. When the ER doc and the surgeon pressed (rather lightly) on that part of my stomach that was already hurting, the pain made me want to jump off the bed. A CT scan confirms that there were “issues” with the hernia.

So… I’m to be admitted and surgery is scheduled for 7 the next morning. I wouldn’t be happy except they’ve given me this wondrous drug through a barely working IV and I feel no pain whatsoever anywhere in my body. (I’m kicking myself for not getting the name of this drug, but it was described as an IV form of ibuprofen and not often given because of its bad effects on the kidneys.)

I realize that one reason I’m being admitted is that I’m running a fever. The first thing done after I’m taken to the strangest* room I’ve ever been in is to give me an IV antibiotic. Except remember how I said that IV port was barely working? So, I get a new IV inserted and get the antibiotic. Finally. What should have dripped into my vein in 30 minutes took close to 2 hours because of a finicky or malfunctioning IV machine.

And then there was a shift change. When the antibiotic bag finally emptied, the IV machine appropriately started its beeping. I finally found the nurse call button… and was told someone would be there momentarily. Or soon. Or something that pacified me for a while.

For an hour in fact. Somehow I managed to ignore the beeping and watched two sitcoms. Then I called again. Same answer. I watched another show. Then, I managed to sit up enough to reach the IV machine. Since all the rails on my bed had been raised, this wasn’t an easy thing to do. All the mechanisms for lowering them are on the outside. Anyway… I managed to turn the IV machine off. (All it took was reading the instructions.)  I’d had all the beeping I could take.

At this point, I managed to catch the eye of a nurse’s assistant (or whatever they are called in AZ) and motioned for her to come help me. She looked me in the eye and walked away. I cannot tell you how angry this made me. At her and at myself for allowing myself to be trapped in this bed.

Anyway, a few contortions here and there and I managed to lower the rails, the controls are all on the outside and obviously intended to be unreachable by the patient. Finally… I’m FREE!!! And I carry myself and my IV pump down to the nurses station. Where I’m ignored in the same way my previous calls to the same station had been.

Oh heck… let’s not be coy. The reason I should have gone to an ER miles away from this one is that my daughter, when she got pregnant, had been told to avoid this very convenient hospital because of the employees’ attitudes. But… I told myself that applied only to the OB/GYN and NICU parts of this hospital. Surely the whole place wasn’t bad…

Wrong. A bad employee attitude infects thoroughly and, IMHO, it’s because it drips down from management. I knew this, but chose to ignore it because I thought my exposure would be very brief.

I’ve never seen a place where “it’s not my job” would have been a more appropriate slogan for employee name tags.

When faced with this type situation, sometimes a hissy-fit is called for. And I can do hissy-fits. Let’s just say that one of the employees thereafter answered my needs.

Now, I’m not a particularly needy patient as long as it is made possible that I can care for myself. This means that I’m not strapped down and that the rails on the bed not be positioned where I can’t get out of bed myself.

I’m not accusing any of the staff of this hospital of deliberately “imprisoning” me, but a lack of thoughtfulness combined with a desire for everything to be ” neatly in line” can make that happen.

A patient who has just had abdominal surgery cannot lower the bed rails around her feet or remove the wraps intended to prevent blood clots herself. Even though she may have been given “permission” to get up and go to the bathroom by herself, when she’s restrained in this way, she needs help.

And… she can’t get this help when some helpful person has come in while she’s asleep and moved the call button out of her reach. Oh yes, it may look neater placed over there, but I can’t reach it!

Finally, I have convinced the nursing and non-nursing staff to leave things where I can reach them and to NOT fence me in, and… to give me the rest of the antibiotic drips outside the IV pump.

Oh yeah… I had another IV inserted (three days, three IVs… that par for the course, right?) but none of them are good enough for the IV pumps. So, to keep me quiet (much more necessary than keeping an IV quiet) the nurses have decided to unhook me from the IV except when the antibiotic is dripped.

But someone forgets to close off the big bag ‘o saline and nearly all of it drips on the floor under my bed. This is first noticed about 7 am and the nurse puts towels on the floor and calls for maintenance to come clean up the mess. Except the nurse doesn’t check the IV and it continues to drip on the floor.

When my lunch (liquids still) is brought I notice that the IV is still dripping onto the floor and close it off myself. I never knew how sticky this IV fluid could be until I stepped in it.

Anyway… because this is an “it’s not my job” sort of place, no one — including the janitorial staff — is able to clean this mess up. When I was discharged 12 hours later, it was still a sticky mess with several towels strewn around the floor.

Speaking of beeping IVs and other beeping alarm medical monitors, I think that hospital staffs in general have learned to tune them out. And I don’t blame them. For some reason, even though I should have been sleepy from the narcotic pain meds I was on, I was instead wide awake. There was a big clock with a second hand in my room and I found myself timing the beeping IVs from other patient rooms.

(I refused to allow the door to my room to be closed because I was terrified that the call button and phones would be outside my reach and no one would hear me calling for help. Yeah, I admit it, I’ve got a problem with being confined.)

IVs seem to beep at intervals just shy of two seconds if the clock in my room was accurate. To make matters worse, this interval starts whenever the machine senses a malfunction. And while all the beeps were close to each other as to what tone on the scale they played, it was if they’d been tuned by tone-deaf piano tuner. The result when three or more IVs are vainly begging for attention is very unpleasant.

The very least a hospital could do for patient comfort would be to tune and synchronize their IVs! Well… not really. I suspect that would make it even easier for the staff to unconsciously assign them to mere background noise. 

But enough about IVs, let’s talk about pain. This was my third abdominal surgery. The hernia is an incisional one from bariatric surgery I had about 15 years ago. (I am a bariatric surgery survivor even though I am still obese.) This was also the most painful recovery of the three. I really didn’t expect it to be so bad because it was laparoscopic. I thought the “minimally invasive” aspect would make this surgery less painful.

Nope. While the incision from my first hernia repair was almost 7″ long, for this surgery I had 8 cuts. Six of them were about 1/2″ each, one was a bit over 1″ and one was 2″. That’s six inches. But the painful part (at least according to what I was told by the nurses and doctor) was due to the air pumped into my abdomen for visibility or access or something during the procedure.

Maybe the pain was made worse by the fact that I was on a clear liquid diet for 2 days and the IV antibiotics. I could not eat anything without fairly severe nausea for four days after I was released. I took more pain medication more often for a longer period of time after this surgery than for any surgery I’ve ever had. It was a week after being released that I could sleep in a bed or stand up straight. Thank goodness my daughter has a very comfortable recliner.

But now let’s talk about the discharge. Remember I can’t stand up straight and my abdomen hurts like hell. (In my worst scenario fantasy, the surgeon took 8 chopsticks and stirred and tossed my insides before fixing the hernia.) The surgeon and the hospital intern both recommend some very minimal home health care — a walker, a toilet riser, and one visit by a home health nurse. It should note here that my daughter could not physically help me in any way that required lifting or straining because she was recovering from a c-section.

So we are now back to the fact that I don’t really have a PCP. For home health care to be covered by my insurance, a referral from my PCP is required. As explained above, I did not have a “functional” PCP at the time. Even if I had, my insurance would have covered only the walker and the nurse’s visit. Yet, the really useful, necessary thing was the toilet riser. None of these things were very expensive and paying for them out of pocket didn’t kill me, but it did make me think about how little thought has actually gone into what insurance covers or doesn’t cover and the hoops the insured and the doctors have to go through.

OK, I’m through bitching about this. For now.

*Oh wait… I’m not quite through! I mentioned that my hospital room was strange.  That’s because it was designed (halfway, at least) for bariatric patients. Except for the bed, which was “normal” sized, most of the room was outsized. The door to the room was about 5 feet wide, the toilet seat was so large and high it was uncomfortable. Yet the door from the room to the bathroom was “normal” sized. On my walks around the floor, I saw at least 5 rooms with the large doors. From this, I conclude that the hospital hoped to cash in on the current obesity surgery fad.

I want to make it clear that any of the following which might seem derogatory toward military health care is derogatory only toward SYSTEMS. The people involved are wonderful and trying their very best to be the best medical providers. What I criticize are the rules/regulations/etc.,  and the hoops they and their patients must jump through.

This guy is good for me. He’s emotionally and professionallly honest with me. He calls me on my bullshit, but doesn’t make me feel like a moron. This is probably personality more than medical training — but we are able to communicate with each other.

This ability is priceless. MasterCard, Universal Health Care, Electronic Medical Records and all the other technological advances in medical care cannot replace the physician/patient relationship.

My MTF assigned PCP has this ability too, but she’s restricted in her ability to follow-up and follow-through with her patients. It’s just too damned hard to get an appointment with her and she has as little input into the availability of appointments as I do. This is a system failure, not a physician failure.

I got lucky. Through conversations with the non-MTF appointment person and billing agent, I learned which hoops I needed to jump through within the MTF referral process. Oh yeah, the MTF appointment clerk I worked with after learning the right words — ie, words she could “respond to” without repercussions led to EIGHT (that’s right, 8!) referral numbers, each with four authorized follow-ups. Folks, that translates to almost unlimited access to this non-MTF physician.

This freedom of medical treatment comes at a price. I must pay $12 bucks each time I see my new favorite PCP. (Please don’t tell Congress or the DOD that I consider that one fantastic deal.)

I’ve not mentioned “fibromyalgia” to any other doctor since the one who didn’t “believe” in it because I don’t want to be classified as a nut case or drug seeker. Also, I do not believe that fibromyalgia is the cause of all my pain. I think I also have a pinched nerve or something that causes sudden, extreme, but thankfully short-lasting pain in my legs.

My main problem – as mentioned in “I am my own PCM” is the lack of opportunity to discuss multiple aches, pains, symptoms, etc., with my doctor in one single visit. Appointments are generally limited to “what, specifically, is bothering you today?” That really doesn’t lend itself well to “well… several things and could they possibly be related?”

I do have a verified diagnosis of arthritis and I wonder which pain is caused by that. I classify my wrist, shoulder, knee, and ankle pain to it… but shin pain? I dunno… and apparently neither do most doctors. Why does the shoulder and knee pain differ when somebody squeezes either body part (a typical occurrence at Southern family reunions) from the more ordinary “oh god, I’ve overused this joint today” pain?

Bottom Line: I don’t know what the hell’s wrong with me, but articles like “Drug Approved. Is Disease Real?” don’t help answer the question. Note that the addition of Straterra to my normal drug regimin has almost eliminated the need for Tylenol and Naproxen. The only drawback is the tendency of Straterra to cause dizziness. Unlike most folks, I have a benign brain tumor that (though dead through radiation) may cause dizziness.

hmmm…. what side effects of what up with do I put?

No. I have to take responsibility for myself and my health.

As I’ve experienced a few dizzy spells the last few weeks, I’ve decided to take a good look at my medications. There are 8 (eight!!) prescription drugs I take daily. Could it be possible that while there are no “serious” interactions among these drugs, that some combination is causing me to feel dizzy?

My Tricare Prime PCM relies on the computerized comparison of these drugs to determine “compatibility” and, I suppose the MTF pharmacy does also. Yet, my body is unique and may react differently than normally expected.

I’ve decided to do my own research into each drug I’ve been prescribed and then I will go over those results with my PCM, whoever he or she may be at the time I finish.

I have a tendency to bash military health care at times, but I have to report two good recent experiences. First, a visit to the Urgent Care Clinic at Moncrief Army Community Hospital, where I was seen quickly, given some relief immediately and sent away with medicine – no extra trip to a pharmacy.

Unfortunately, the medicine didn’t work well enough, or the strain of the 850 mile drive home simply made me worse. So, the day after Christmas I call Barksdale and my description of symptoms (and the fact that they could electronically access the visit to Moncrief) got me an appointment yesterday morning.

I’ve learned that you don’t simply call and ask the appointment person for an appointment. They rarely have any, but they will always get you a call back from a nurse who has much greater appointing powers.

This makes twice, yes that’s TWICE in a row that I’ve seen my assigned PCM! Maybe things are settling down there and she will be around for a while.