Saturday, February 28, 2015

Chest Pain Radiating to the Shoulders & Neck - A False Alarm (part 2)

Presbyterian Intercommunity Hospital-Whittier
The first part of this post is here:

It took barely half an hour to arrive in Presbyterian Intercommunity Hospital – Whittier (PIH), and I calculated that if the ambulance travelled at 60 MPH, then the distance must have been approximately 30 miles. In the ambulance with me were two paramedics and a registered nurse. According to one of the EMT's, normally an RN is not included but since I was considered critical transport, the RN was a requirement for this particular ambulance company. When I was unloaded at PIH, it took a while to find the unit I was being sent to due to the huge size of the hospital. All we knew was that I was going to room 3001 which meant it was on the third floor. But the third floor of which building was the question since the hospital had two buildings. Eventually we found it and I was offloaded from the gurney to the hospital bed. Lucky for the ambulance staff, they didn’t have to lift me and even if they had to, it would have been too easy for them since I’m only about 120 pounds soaking wet.
Hospital Care Kit

My private room and bathroom was spotless and a care kit sat on the bedside table. The usual items in an admission care kit like a basin, pitcher, tumbler, toothbrush, toothpaste, body wash/shampoo, lotion, mouthwash, and a full size box (!) of Kleenex  were already at my tray table when I arrived at the hospital. What was an unexpected surprise were a few additional personal touches to enhance a patient's comfort like an eye mask, ear plugs, and lip balm. Nice job PIH! The only thing I had trouble finding was the remote control for the TV and the wall lights. The next time the CNA came, she showed it to me - it was stowed in a receptacle under the bed. The visitor’s bench on one side of the room also happened to be a pull out bed in case a relative or friend wanted to sleep over.
My hospital bed
The nurse came and introduced himself (Rafael), hooked me up to a Holter monitor, checked my heart and lungs, did a stroke assessment, then asked me about my medical history. He said a hospitalist (doctor) was coming to see me shortly. Rafael come back later to swab my nose for an MRSA (methicillin resistant staphylococcus aureus) test. He said they had to do it whenever a patient was transferred from another hospital. He reported later that the test was negative. Meanwhile, I fired up my computer and connected to the hospital wi-fi hotspot. I hope I did the sequence correctly: call 911, stabilize in the ER, get admitted to the hospital, then post to Facebook, instead of the last one being done first. Well, I couldn’t connect to the wi-fi in the ER so…

The hospitalist came, listened to my heart and lungs, asked questions, did another stroke assessment, then went to the nurse’s station to write his orders but first I asked him if the nurse could give me a snack or if I was supposed to be NPO for the anticipated tests in the morning. Thankfully the CNA came back with a turkey sandwich and milk. It was my first meal since noontime the previous day and it was already 3:30 a.m. While I was eating, my brother apparently read my post on Facebook and tried contacting me via Skype video chat, but I had turned my computer off while the doctor was talking with me. When I turned it back on, I saw the missed call but before I could call back I had to update Skype first. When we finally connected, my brother Larry and his better half Ninette said they had just gotten back from out of town when they saw my post. We chatted briefly and updated them on my condition, then I tried to get some sleep by about 4:15 a.m. Alas, my body reverted to night shift mode and only slept for about an hour. The nurse came to ask me if I wanted the alternating pressure device attached to my legs to prevent stasis and blood clots. I declined and told him it wasn’t necessary since I expected myself to be moving around anyway.

The phlebotomist came next and I asked her about the blood test and since it included blood sugar and cholesterol levels, I informed her that I had eaten only two hours prior. She said she was going to note on the computer that it was a non-fasting result. Soon shift change came and I met the day shift nurse, Emily. To my surprise, Rafael, the night nurse gave report about me in my presence. I have never experienced that before. I told Emily that I was an uncooperative patient because I refused to wear the alternating pressure device.

So this is how Monday morning went: breakfast was served and as I was about to start eating the orderly or transport aide from the radiology department came by to pick me up for my head MRI. He was nice enough to give me a few minutes to eat. I was supposed to be on a cardiac diet (low fat, low cholesterol, low sodium) so it was surprising to see eggs and sausages on my plate. I haven’t eaten those things in years!

Then I was transported downstairs on a wheelchair down long hallways until we reached the MRI room. They were finishing up with another patient, then it was my turn. They checked me for metal objects so they put aside my partial denture and I let them know that I had a metal plate on my left ankle which has been there since 1972 when I broke it in a motorcycle accident. The technician said it was okay. I was pre-warned of the noise of the machine and given earplugs and an ear cover. Pretty soon, the machine started thumping and I started to get anxious. My pulse rate went up and I tried to slow my breathing down. Then suddenly I realized, it wasn’t so much that my heart was beating so fast and hard but it was the thumping of the MRI machine, so I just concentrated on relaxing. Pretty soon 14 minutes in the claustrophobia causing machine was over, and I was wheeled back to my room. It took so much concentration to keep me from jumping out of the machine in the first couple of minutes.

When I got back to my room, I asked Emily if I could walk up and down the hallway for at least half an hour so I don’t miss my daily workout and so that what is reflected on the Holter monitor would mimic what I would normally do at home. She okayed it but told me that if I started having chest pain or dizziness, to alert the closest nurse. With that, I started my walk. I encountered a therapy dog on my first lap and let it smell the back of my hand, then I continued my walk. Alas, it only lasted for 6 minutes. Did I have chest pain or dizziness? Well, no. I saw someone enter my room with a machine so I followed her. The cute girl told me I was going to have a Lexiscan. I asked, who is Lexi and why is she going to scan me? Two other technicians showed up while I was being hooked up to an EKG machine and something which I found out later was the Lexiscan was injected in my vein. While the 3 techs monitored me, my attending physician showed up and I gave him a fist bump instead of shaking his hand because it's better for infection control. He asked me a few questions and told me that my MRI was normal. There was no sign of a stroke that the other hospital may or may not have seen on the CT scan. That was another good news in addition to my normal troponin levels. I was to be taken downstairs again later for a stress test which did not involve a treadmill. The Lexiscan nuclear dye would take care of detecting any abnormalities in my heart and circulation. If you want to learn more about Lexiscan like I did, just look it up on the internet. Shortly after, another phlebotomist came to draw blood for CK-MB test.

I went back out to the hallway still wearing a hospital gown, reset my stopwatch to zero and started my walk again. This time there would be no more interruptions other than dodging nurses, doctors, housekeepers, and visitors in the hallway. Fortunately I wasn’t accused of indecent exposure since I wasn’t wearing anything underneath the gown. I should have asked for a diaper to provide more coverage rather than go commando. I completed 35 minutes and decided that was enough. A nurse's aide came to my room to bring me gray hospital socks so I can wear them instead of the red ones which came in my care kit. She said red socks were for patients who were at risk for falling and after seeing me power walking in the hallways, she didn’t think I was one. I jokingly told her I could fall for her so the red socks would be justified. She said I better not. When I saw her again a few minutes later, I changed the tone of my voice and told her – I could fall for her (as in love). Jokingly, of course J
COW-Computer On Wheels

While walking up and down the hallways of the telemetry unit, I noticed there was a COW (computer on wheels) in every room running e-MD, an electronic medical records system. I’m used to the Cerner and Epic systems. Aside from e-MD, the staff used Vocera to communicate with each other, it was attached to their lapel or scrubs near the neck area then they would mention the name of another staffmember and the system automatically connects to the other person and they can talk to each other. I won’t be surprised if the Vocera is also connected to the patient’s call light.

Lunch-Barbecued chicken breast, mixed veggies, mashed potatoes, oatmeal raisin cookie

Lunch came soon and I checked with Emily if it was ok to eat. She said yes and that the only thing I can’t have is caffeine because it affects the Lexiscan test. Trying my best at being a model patient, I even took my tray back to the dietary department cart out in the hallway and let my nurse know that I ate 100%. While I waited to be picked up for the test after lunch, a social worker stopped by to ask me if I had an advance medical directive. I said I didn’t but had a POLST (physician’s orders for life sustaining treatment) in my doctor’s office. She said that if I was interested in filling out an advance directive she could bring the forms for me, help me with it and have it notarized for free in the hospital. So I asked her to bring me one. Since she was a social worker, I also asked if they assisted patients with transportation if nobody was able to pick me up to take me home. She said they did and I requested the service. She came back with the blank advance directive which I proceeded to fill out. By the way, an advance directive is a legal paper filled out by a patient on what his wishes are if he becomes incapacitated and cannot make medical decisions for himself. The patient also assigns another person to make sure that his wishes are carried out.

Then an echocardiogram technician showed up and she did the ultrasound test while I lay on my left side. A few minutes after she left, I was finally wheeled along even longer hallways to the nuclear medicine department. The myoview/lexiscan test was done while I was lying supine first, then in the prone position. I was sent back to my room to await the results and if everything was clear, I was to be discharged.

I saw the social worker again and asked if the notary public was still available to witness my now completed advance directive. Unfortunately he was gone for the day so my advance directive is still unofficial until witnessed by a notary or two other uninterested parties.

Emily came back to see me at about 4 p.m. and told me my myoview/lexiscan stress test was negative for abnormalities and she would be preparing my discharge papers as well as arranging for transportation. I tidied up my hospital room before getting discharged and took home the care kit because when I asked the CNA if they wanted to return items I didn’t use to the supply room, she said they were going to automatically throw them away.

At 5 p.m. came and unhooked my Holter monitor, removed my IV access, then walked me downstairs to the lobby where the taxi driver was already waiting for me. I thought it was a hospital van that was taking me home and was surprised it was a taxi. I jokingly asked Emily if they used Uber to transport patients. I thanked her for taking care of me and bid her goodbye. Then I boarded the taxi, chatted with David, the driver as he entered the 710 freeway towards Long Beach. Because it was President’s Day, traffic was light and we arrived at my home in about 25 minutes. Thus ended my latest bout with chest pain false alarm.

It was reassuring to know that after all the necessary tests have been done, the chest pain, burning sensation in the neck and shoulders, and dizziness had nothing to do with my heart and brain.

However the cause of all the pains I've been experiencing remains a mystery as it is still happening two weeks after my trip to the ER and one day of hospitalization.  It could be that my body is suddenly reacting differently to exercise now and the soreness is not what I used to experience.

Random notes and observations: Just realized that I had this problem on National Heart Month.

If anything happened to me while I was by myself at home, I might not be found until weeks, months, or even years later, which has happened to other people and became news items.

With two IV sites and four blood draws, my arms look like a heroin addicts’.

As much as possible, I try to minimize my impact towards the world and my relatives and friends because as much as I dislike inconvenience, I do not want to inconvenience anyone either.

This is about the 4th time I've had a false alarm in the last 15 years or so but I've never really told anybody about it, not even my immediate family. Of course there was no Facebook when the first two happened.

I was surprised that neither the ER nurse nor the Telemetry nurse asked me if I was out of the country recently as required by the ebola screening process. Maybe because I didn't have a fever.

I think the reason why I couldn’t be accommodated in any hospitals near my home was because while I was at the emergency room, there was a drive by shooting in Long Beach where 5 people were shot and in another incident, a man in a wheelchair run over by a car.

When I was having those frequent pains, it made me more grateful when I was able to wake up in the morning still alive.

Tuesday, February 24, 2015

Chest Pain Radiating to the Shoulders & Neck - A False Alarm (part 1)

In the past month or so, I had been experiencing some tightness in my chest, burning sensation in my shoulder and neck muscles, along with dizziness which I can describe as similar to turbulence while flying in an airplane. I’ve always rode it out rationalizing that it was just muscular pain and my inner ear problem which happens from time to time but always suddenly disappears for months at a time. I couldn’t account for the burning sensation though. I finally made a doctor’s appointment and told him about my symptoms. Blood was drawn and the doctor’s office was going to get a preauthorization for a treadmill stress test. My lab tests turned out to be normal except for a slightly elevated creatine kinase (CK), and bilirubin. When I asked the doctor about this, he said those numbers were nothing to be concerned about. In the meantime, they were still waiting for the insurance company to respond to the preauthorization request.

On Sunday morning, February 15th, I felt the symptoms worsen in the morning, then thinking I might be hypoglycemic, I ate 3 pieces of toast and lay down on the couch for a few minutes, which seemed to help, before I started my workout. Because of the way I felt, I only did a low intensity workout on the recumbent stationary bike and kept it to my minimum of 30 minutes. I had lunch afterwards then watched a video. At about 2 p.m., I started feeling the symptoms again and it worried me. Perhaps it was time to call 911 before anything worst happened. I picked up my phone (Majicjack) and there was no dial tone, so I disconnected the USB cord then reattached it. I dialed 911 and was transferred to the paramedics line. After a few rings, I got cut off! I dialed again and this time the paramedic dispatcher answered and verified my address and was told the paramedics were on the way.

Initially, 3 medics came, then at least 7 more showed up. I said, darn, how many units rolled? One of them said “The city of Long Beach considers you a very important person”, which made me chuckle. They said they were going to take me to a hospital. On the way out of my apartment on the second floor, the paramedics asked me if I was able to walk down the stairs towards the gurney. I said yes. I was already attached to an EKG machine with the wires on my chest. The paramedic holding the EKG machine led the way and I said to him, "this must be how a dog feels on a leash". He laughed and said, "oh, still cracking jokes huh?"

As I was being loaded into the fire department ambulance, the medic mentioned that I was going to be taken to Pacific Hospital of Long Beach (now College Medical Center). I asked if I can be taken to Memorial Hospital of Long Beach instead or Community Hospital of Long Beach where I work. He said that the only emergency department that was would be able to take me is PHLB because the others were busy. So off to PHLB we went, the same hospital that laid me off a year and a half ago, with an ER that I did not exactly trust based on my observations when I used to work there. The medic gave me three sprays of nitroglycerin 5 minutes apart and had me chew and swallow 2 baby aspirins. Time of arrival in PHLB: 3:15 p.m.

The thing with chest pain is that you get seen by the nurse or doctor right away, or so you would think, but since I was still conscious, did not appear to be in distress, with a heart that was still beating, I wasn’t seen as quickly as I had been in my previous hospital visits. I was transferred from the paramedic gurney to another gurney right next to the holding room where the psych patients were waiting to be medically cleared before being transferred to the psych unit. I was hooked up to an EKG/blood pressure/pulse oximeter machine which emitted beeps every few minutes signaling something amiss with my heart. Either that or the machine was not detecting accurately. Blood was drawn, a chest x-ray was done, then a CT scan of the head. I had sent a text message to my cousin Maryann informing her that I listed her as my emergency contact. Shortly, she and her husband Mike showed up at the emergency department and I updated them on what was going on. They were surprised to observe what appeared to be homeless people in the waiting room and the behaviors of the psych patients a few feet away from my bed. Believe me, I experience that every day I’m at work because that’s the population we mostly treat.
Before Mike and Maryann showed up, I heard a policeman mention a 5150 to any designated LPS facility and asked one of the nurses what LPS meant. The nurse didn't know, so being the show off that I am, I proceeded to explain that LPS stood for the Lanterman-Petris-Short Act which basically says that no one can be involuntarily committed to a psych hospital indefinitely unlike before. For more detail, you can read about it here: . 
In the meantime, the admissions staff was trying to get authorization from the insurance company to admit me for observation or transfer me to another hospital within their network which have prearranged contracts with the insurance company. That took hours probably because it was a Sunday and the following day was a federal holiday (President’s Day). I was offered morphine for the chest pain which I declined because I felt it was too strong a medication for me, so I was given a couple of baby aspirin. I was told that my troponin level was normal but the CT scan showed a possible mini stroke very recently, however it was inconclusive.

When the insurance company finally gave authorization to transfer me, I thought I would be sent to Memorial Hospital which was only about a mile away and because it was part of their network. Instead I was being sent to Presbyterian Intercommunity Hospital, and I was thinking the one in Downey, but then I was mistaken again and was told it was the one in Whittier which was much farther away from home. Maryann and Mike stayed until 10:30 and when I learned of my transfer, I sent them a text message update. Thank you so much Mike and Maryann for staying with me for a few hours. The ambulance arrived at midnight and shortly after, I was being whisked from Long Beach to Whittier. I learned later why none of the other Long Beach hospitals couldn’t take me.

To be continued in Part 2, as this entry is quite long already.