I'm very tired (hospital capers)

Miscellaneous and Personal Stuff I Must Share
1

First off - props to the ED staff at the Lyell McEwin hospital in Adelaide. It can’t be easy running one of the only EDs in the Northern Suburbs, and you’ve treated us really well each time we’ve been in there.

This is also not a request for medical advice. I am simply venting about a situation that’s been running me ragged for the last few weeks.

But I’m so friggin’ tired.

Hubby’s been complaining of abdo pain for several weeks now, on and off. It started off at a frequency of once every few weeks, now we’re up to about once to twice a week, with three episodes in the last two months so serious I’ve hauled him off to the ED. The most recent was last night.

He’s also complaining of just not being hungry. Not nauseous, just not hungry. He’s losing weight, I can see it. And I think he’s afraid of eating just in case it triggers the cramps. It doesn’t tend to, but he’s expressed that fear before.

On the first instance, we presented at the ED on a Sunday night with him complaining of cramps in his lower abdomen and back ranging on the pain scale up to about 8. This is for a man who rarely marks anything above a four.

So they admit him, check his vitals, do an xray, check his bloods and urine and give him some buscopan and some painkillers. About four or five hours after we get there, the pain seems to have gone and they discharge him.

The second episode was the week before Christmas. At about four thirty on a thursday morning he wakes me, complaining of the same pain up around an 8 or a 9 again. So again we present at the hospital, this time they give him morphine and around seven am admit him (he doesn’t get to the ward until the early afternoon, but that’s something else). A gastro sees him, does an ultrasound and the bloods again, says they’ll need to do a follow up. They send a card in the mail a few days later for an appt at the end of the month, so they’ve obviously not found anything. But they release him at about 2pm on the Friday afternoon when the pain’s gone and he’s been able to eat and keep the food down.

Yesterday was the worst, and where I find myself getting the most frustrated. He’s been complaining of the pain all day, since about four am. He’s thrown up once early in the morning but not since then. He won’t let me get him to the hospital until about 7pm, when he’s once again complaining of the pain being up around 9.

We get him to the hospital, we get him into the ED, they give him some codeine and some buscopan and leave him. The pain passes, so they note it down and leave again. About forty minutes later he wakes from his dozing and says it’s increasing. By the time the nurse gets back to the cube about fifteen minutes after that, it’s up around 8-9 again.

The attending can’t tell me if they’ll admit him or release him. Which is fair enough. But I have a new job to start in the morning, so I can’t be at the hospital all night on the off chance, and I have to go home.

The nurses come back with morphine and dose him up. He says the pain gets back down to about a 4, but spikes every so often. About 2230 I have to leave, I have to get home and get ready for work the next day. As mum and I leave, we notice the waiting area is getting full.

About one thirty, hubby calls me. They’ve released him. The pain is not even gone, it’s just down to the point where he’s not screaming in agony. But they’re saying because they can’t find a specific cause, they can’t do anything for him. Apparently the waiting room is about full by the time he gets off the ward.

Last time it wasn’t so busy, this time it got mad busy. My theory is that it got so busy they needed to free up some beds, and because no specialists are on at midnight on a Sunday, and he wasn’t in any danger of dying and they’d got his pain down (even if not fully controlled), then they released him. And I don’t blame them. Again, they’re one of the only EDs in the Northern Suburbs. They were mad busy when I left, and even busier again when they discharged him.

But I’m so frustrated. My husband is now on our bed, crying in pain. I can’t do anything to get him to the hospital. I need to get to work, this is the first day of a new job and I have to be there. I may be able to leave early, but I’ve got to be there or not get the job. And I don’t have a car to be able to drop him off. Plus I don’t want to take him in too early, so that again there’s no specialists in. So I’ve pleaded with him to see if he can hold on for another hour, hour and a half, then to call my mother and get her to take him down there.

I know unspecified abdo pain is a righteous arse to diagnose and treat, but I’m just so tired, so scared and so upset right now. I just hope if we get him back there today, the gastro can finally nut down what may be causing this, so we can get a handle on it.

2

Take him back (or get somebody to take him if you can’t, upon rereading), and don’t let them kick him out like that again. If you have to make a scene, do it. If he has to make a scene, tell him to go for it. He stays until they have some idea what’s going on, and nothing else will be acceptable. This has been going on for too long already, it’s time for them to get off their asses and do something about it.

At least that’s what I’d do if it were my husband. If I had one.

3

IANAD and all that, but it sounds to me like he needs to go to his primary care physician, relate this history to him and insist on a full work up. No CT of the abd? What about lab work? How about a decent physical assessment (rebound pain etc)and history?

It sounds to me like this ED is only treating symptoms and then pushing him out the door. Obviously, this is not working longterm. I think having your mother there is a good idea. Sorry about the new job, but most employers would understand about something like this.

4

IANAD, but: I’d ask them which specific potential diagnoses they have ruled out, and how.

If it were my family I’d ask about appendicitis and gall bladder stones. Also kidney infection. This is based only on my observation of friends and family, where those ailments have presented similar on/off symptoms. Irritable bowel syndrome? Colitis? Intestinal obstruction? Newly-developed celiac disease? Friend of mine with this last disorder reports symptoms similar to what you describe. Has he been seen by a specialist, a gastoenterologist?

Have you tried to correlate the occurrence of symtoms with any particular foods? For example, a person with celiac disease may respond in this way to ingestion of any wheat product or other gluten-containing foods. It would be annoying to try out a gluten-free diet, but it would not be harmful to try it while you’re waiting for the doctors to get their act together.

From what real doctors have told me, abdominal pain can be extraordinarily difficult to diagnose. The internal organs don’t always transmit pain accurately; one can have pain in a completely different place from the one that’s actually got the problem. And many things can cause intermittent symptoms. (I could tell you a number of anecdotes to back that up, but that would be rather pointless.)

I’m sure there are tons of other possible causes, but IMHO filling a person up with painkillers and sending him home is not a good response to what you’ve described.

5

If it’s diverticulitis, that’s not going to go away on it’s own, and many severe cases require surgery. IANAD and all that, but I am a wife, and I understand completely the alarm bells in your head that are requiring you to fulfill your obligations to a new employer. There’s one thing I’ve learned in this life, and that’s that you can always get another job. Your loyalty to a person/department/company will never be met with same. You are a commodity to them, and when the mood strikes them, you will be gone with not so much as a handshake. Your husband is forever, so focus on him. Get him well and then worry about a job.

6

Agreed, he has to get seen by a doctor who isn’t in triage mode. This is something that should be pursued via his primary care physician. I understand that intense pain is unspeakably awful (between a history of frequent migraines and a recent wrist break that was a whole world of new pain for a short time, trust me, I do), but this should be looked after outside of ER visits.

7

This sounds a lot like what my aunt went through last year - about 2 weeks of on-and-off pain in the abdomen and lower back, becoming worse and worse over time and finally beginning to throw up when she ate, until she finally agreed to go to the hospital (the whole situation was being complicated by a depressive episode due to an unpleasant breakup, and changes in her meds which were giving her various side effects).

The ER ran tests and finally admitted her when a GI doc decided they had to do an exploratory surgery to see what was going on, because none of the tests/labs were pointing to anything definitive.

They do the surgery, and when she’s in recovery, the doc comes out to speak to my mom. He had removed a “mass” of indeterminant type (holding his hands apart in a size similar to a football!) and they had to remove a section of her colon as well. They would have to send the “mass” to pathology to figure out what the hell it was. There was no real concerns that my aunt wouldn’t recover completely from this surgery (and in fact, she’s fine now).

After more than a week (did I mention the surgery was on boxing day, and pathology was on minimum staff through to the New Year?), they got the results back.

A burst appendix.

The doctors estimated that, considering the extent of tissue damage and infection, her appendix had probably burst about a week to ten days prior to her being brought to the ER. They were shocked that she had still been walking around, helping cook Christmas dinner, etc. It’s amazing that she withstood the pain, and since a burst appendix can lead to death… well, she was a teaching case for the hospital’s med students!!

A year later, she’s 100% recovered (with a very neat belly scar!), and her mood is considerably better as well!

Ask for an exploratory for your husband - it might be something that just isn’t presenting as expected, but would be found really quickly if they actually looked at it!

8

OK, one more “it was appendicitis” anecdote. A friend had been having intermittend abdominal pain for practically ages. Months. It would generally go away, and the docs attributed it to “nothing” or just and intermittent gastric upset, nothing to worry about. Finally, one time, somebody took a blood sample. By the time she got home, they were calling her to come back, right away, as there was a hugely abnormal amount of white blood cells, indicating some sort of infection. Yep. Appendicitis it was, fortunately not ruptured. It was removed ant the problem never came back.

So I’d ask what tests they have done to rule this out, if any. And if it were me or my family, I’d ask for a test for infection to be repeated.

ETA, when my kid had appendicitis, her doctor openly said that they were not at all sure that was the correct diagnosis. She was outside the usual age range, and the pain was not in exactly the right place. However, he added, the outcome of operating and finding it was not appendicitis was far better than the outcome of not operating and finding out too late that it had been. It was, and she recovered in a matter of a few days after the surgery.

9

When my appendix burst, I was running a fever. I had chills, so much so I had the heat cranked up in my apartment. In Florida. In August.

My appendix had burst and sealed itself off, so I had a bunch of little pockets of pus they were able to siphon out with a big needle (they called it Band-Aid surgery, since I didn’t need to go to the OR.) Oh, and this was 10 days after my son was born!

Your husband needs to be seen by someone who can figure out what is going on, not shove pain pills in him until the pain subsides a bit and then kick him out the door. That’s not getting to the bottom of the problem. You need to insist he go, and insist he stay there until someone figures out what’s wrong.

He’s sick, he’s hurting, and he needs you to have his back. Go be a Mama Bear and figure out what is wrong with your husband!

10

mnemosyne, exploratory surgery is not a good plan for somebody with undiagnosed abdominal pain if there are no signs to suggest severe pathology other than pain.

MLS and eleanorigby, the gentleman has been investigated.
Xray should have outruled a ruptured or obstructed bowel, ruptured appendix, kidney stones or perforated gastric or duodenal ulcer.
Ultrasound should have outruled appendicitis, gallstones and kidney stones.
Blood tests will outrule acute bleeding from an ulcer, ruptured aneurysm or diverticulum as well as infection, pancreatitis, acute hepatitis and biliary obstruction.
Urinalysis will outrule kidney infection and to some extent, kidney stones.
Vital signs include temperature, BP and heart rate, and would be deranged in the event of infection or ruptured viscera.

Just because it is the ED, doesn’t mean that an examination won’t have been done. Someone will have felt his abdomen and loins and listened for bowel sounds. Since the first thing an ED doctor thinks when confronted with abdo pain is “Is this an acute abdomen?” he will have been poked and prodded fully. No one with rebound pain should have gotten away without a surgical review.

One would assume all of the tests were normal, or he would not have been discharged.

Ideally, your husband needs an OGD, colonoscopy and CT abdomen. All of which could turn out to be normal.

Does your GP have direct admission rights? If they do, get them to phone the hospital and have him admitted, without going through A&E. Admission for investigation and pain management is perfectly legitimate.

11

Yes, very logical. The operative word here is “should.” I don’t know what, if anything, the medical personnel told the OP about the results of the tests. It’s easy for an ER to say “we did blood work.” If it were me or my family, I’d want to know specifically what tests they did, what the results were, and what that means.

What particularly bugs me is the last couple of visits (bolding added):

Excuse me? I am definitely not a doctor or a lawyer, nor am I one to litigate easily, but this is a lawsuit waiting to happen. I’m not suggesting that the OP should sue now, but the hospital should be very wary of having sent away a person in obviously severe pain without knowing why. Nobody gets pain that bad for no reason. IMHO the hospital should keep him there until they CAN find a specific cause (or causes).

12

Thanks for all the anecdotes and suggestions and such guys, I’m currently in zombie-land and I needed to get all that off my chest.

He’s got a surgical consult with a gastro later in the month, I think in about a fortnight or so.

The second time he was in hospital, when he was kept overnight for obs he had a visit from a gastro, who is the one who booked the consult later in the month. Unfortunately I haven’t been able to be there when the doctors were seeing him - he’s a temp, and it’s well within his employer’s rights to fire him if he ends up taking too much time off work, even if it is due to illness. Whilst they haven’t made noises in that direction, it’s still something I’ve been having to keep in mind when I’m making the decision about whether to go to work or not.

But yeah, all of the information I have about this is second hand through my husband. He’s relaying what the docs have been telling him, and I don’t know how much is getting lost in translation. So when I say they’ve done bloods, I know they’ve taken blood to test each time, but I’ve not gotten an answer about what they’re testing for. The other problem is that apart from the first time (when we didn’t know how serious it was) they keep discharging him when I’m not there. So I don’t know if he’s keeping anything they’re telling him from me, because he doesn’t want me to worry.

I’m thinking the gastro has booked the consult because they don’t know what’s going on, and they want to do more exploration of the problem. Which is fair enough. And I get that he should go to his GP and see if they can do any investigation in the interim, but the problem with all of that is that I can’t make him get to a doctor unless he’s just about passed out on the floor. I’ll suggest, cajole, discuss, threaten, debate and try everything short of dragging him out the door, but he won’t seek medical help until he’s in acute pain. And then that’s when we end up at the ER again because it invariably happens to be late on a Sunday night or some time before dawn.

I’m trying to be a Mama Bear, which is how I get him to the hospital in the first place. But right now I’m running on about empty. I’m just hoping the gastro consult will show something up, anything, so we can start on a course of treating this and hopefully get it under control.

13

Sierra Indigo- I’m sorry, this must be a terrible time for you.

If it is any help, most hospitals have a standard admission profile.

Usually:
FBC (for anaemia and infection)
Urea and electrolytes (kidney function and dehydration)
LFTS (liver and gallbladder function)
Bone profile (for problems with kidneys and bones)
Random glucose to check for undiagnosed diabetes
Inflammatory markers
Amylase (to check for pancreatitis)
A urine test will check for blood, white cells, nitrites and ketones.
A chest X-ray
An ECG

You can ask your own doctor to repeat all the above blood tests easily and if anything is abnormal you’ll have more information than you have now.

There is no easy way around the fact that hospitals work 9-5 Mon-Fri just like the rest of the world. Out of hours you’ll get an emergency service only, and at this point a day off work to attend A&E or the GP looks like a better option.

Anyway, abdominal pain radiating to the back would normally suggest pancreatitis, aortic aneurysm leakage (unlikely in this case), kidney stones or a bad kidney infection, as well as musculoskeletal back pain.

14

Heh. I was thinking about you last night, Sierra, and hoping things were going to go better today. The mama bear remarks made me think of a time when I was hanging out at the hospital with my husband. (One of the many, many, times…he has some interesting things happen to him.) If you can stand an anecdote from a wife with hospital waiting experience, it culminates in a couple of nurses restraining me from choking the life out of a dick that deserved it.

Some years ago, Erik was having some pain in the groin region of his left leg. Over the course of a couple of days, the pain spiked, he got a nasty fever, and a baseball sized lump appeared from the painful spot at the top of his leg. I got him to the E.R. and I recall from that first visit that they gave him some antibiotics, some pain killers and sent him home with instructions to say something if it didn’t go away in a few days. Well, it didn’t, so back to the E.R. we went.

The E.R. Doc decided that he needed to be admitted for them to find out what was wrong with him, so he got a bed and some Nubain and one week later he wasn’t any better. They had been pumping him fuckall full of Rocephin and some other hardcore antibiotics and it wasn’t touching the problem.

The baseball thing was his lymph node. I was out of my mind thinking that he had cancer or something, and the doctors couldn’t tell me that that wasn’t what it was. They had no clue. The one doctor in particular, Doctor Tan was kind of a dick about it, but I come from a point of view that doctors are the ones who spend time in school learning how to diagnose, so for a few days, I’m pretty laid back with him figuring that getting shitty won’t do any good while he and the nurses are trying to do their thing.

One day, a week or so into this, I tell him that I can’t figure out why they won’t even biopsy the lump to find out what the hell is in there, and why are they continuing to do something that obviously isn’t working? “Do something else!” I say.

This jackass looks at me dead in the face and says, “It doesn’t matter if it doesn’t work. We’re going to do the cheapest thing.”

:eek: :mad:

I came about three feet off the floor a’la Crouching Tiger Hidden Dragon style and began to fly over my husbands bed reaching for his neck. Lucky for him, two alert nurses were on my side of the bed and grabbed me just before I made it. I was going to send this bastard to an E.R. bed of his own, or to meet his maker. Didn’t care anymore. He walked out of that room sneering at me and never returned. The biopsy happened the next day and the next attending doctor told me later with a laugh that that wasn’t the first time Dr. Tan had engendered that sort of reaction from people. He had been fired and sent back to Singapore after that.

Apparently, the hospital staff kind of half wanted me to make it over that bed.

Anyhow, the lump wasn’t cancer. It was cat scratch fever that had settled in that lymph node. They removed it quickly and my husband has a nice scar to show for it at the top of his leg.

No real point to telling that story, I suppose. Except to say that I sympathize. Having a partner in inexplicable pain with no real answers is terrifying and maddening. Be strong baby!

15

This guy has NOT been investigated well or fully, IMO. I think he needs more than a quick poke, some painkillers and a pat on the back. He needs a gastroscopy, a colonoscopy, and perhaps an abd CT. How about a full history to start things off?
It’s true we are getting this about 4th or 5th hand, but I’ve had too much experience with ERs in my time to not be :dubious: about how much attention he has actually received. If I weren’t a nurse, for just one example, and an ICU nurse at that, my husband would have been sent home AGAIN with a reprimand for drinking too much caffeine and his WPW would not have been found and treated. Even when I insisted, they still messed up and dumped a crash cart into him before they got it figured out. I’m not anti-ER, but they are most definitely flawed and do overlook stuff–especially when it’s “crazy busy”. This guy has now presented to the same ER with the same symptoms and signs 4 times. It is past time for him to be worked up.
His abd pain could be anything. Nothing should really be ruled out at this point–or more accurately, the OP has not been told just what has been ruled out. Since nothing has been stated, nothing is officially ruled out (and even then it could be something presenting atypically). We don’t even know if a decent history has been taken. On his second visit to ER, the one where he was admitted–that’s when the full work up should have been done. It wasn’t, and so the symptoms (and not just symptoms, he has signs as well) persist.

I hope they figure it out soon. 8/10 pain is no joke.

16

I remember seeing something on TV (I think it was “Mystery Diagnosis”) about a girl who had abdominal pain, throwing up, all sorts of things. They kept finding nothing, thinking it was gallbladder stones, etc etc…even after removing it she still got sick. And she was vomiting up a storm constantly. They removed her appendix and her gallbladder, but it kept coming back. Eventually it was found out to be a Sphincter of Oddi Dysfunction.
Although he’s not vomiting all the time, you could try looking into that as well, it seemed like it was very, very hard to diagnose.

Here’s a link to the episode summary as well. It’s the bottom half of the entry.

Good luck and prayers to you, I hope everything turns out all right, and that it doesn’t turn out to be something so obscure…

17

Oh, sweetie, you take care of yourself…get a good night’s sleep. It won’t do your husband any good if you get sick too!

18

I recommend calling the specialists office and seeing if you can get a sooner appointment, especially because it seems to be getting worse. What if he doesn’t have a fortnight before whatever is wrong REALLY goes wrong? The worst that can happen is that they will say no, and sometimes they will offer to call if there is a cancelation, even if they can’t squeeze him in sooner.

19

If you can get him to the GP, Lyell Mac uses IMVS for pathology. You could ask the doctor to have IMVS fax copies of the blood results to him/her.

Any chance you have private cover? You could get an urgent referral from your GP to a private gastro guy/girl.

20

I have a friend who two years ago almost to the day was really suffering from stomach pain, loss of appetite, etc. The pain kept returning, he was losing weight, they did all the GI work… they found it was non-Hodgkins’ lymphoma. (He’s doing fine now, in full remission.)