Friday, March 29, 2013

Romy's Appendix Ruptures: Day Seven

What a day full of drama. I guess it never ends here at Alta Bates hospital in Berkeley. If you were in disbelief of what happened over the past few days, you will flip out over the last day at the hospital.

We were hoping that the insurance would get its act together so we could leave today. They did actually get everything ready on their part, however, before Romy could be discharged, the way he would get his antibiotics had to be arranged. We were told yesterday that Romy could go into an outpatient infusion center and get his antibiotics injected each day he needed them. However, because it being around Easter and stuff, the infusion center was closed, and the outpatient idea wasn't going to work. The only option we had was to get the PICC line in. We were really avoiding this because Romy didn't want a catheter shoved up his arm and to his heart, especially if he only needed it for a few weeks. But, I guess this was our only option, unless we wanted to stay in the hospital even longer. . . .

The nurse ordered the PICC line team to come by Romy's bed whenever they were available. Apparently, the PICC line team is in high demand and isn't available without prior arrangement. We were told we were "very lucky." Whatever.

Romy Hospital
This is the breakfast meal that finally came. Rice Crunchins!

It was still morning, but Romy's food was a bit late to arrive, as it normally was late because of the gluten-free allergy. When it did eventually come, Romy was napping, and I was bored, so I started looking at the breakfast. It was some General Mills Rice Crunchins cereal and milk, with a banana and juice. I flipped the cereal over to look at the list of ingredients. I was absolutely horrified when I read down the list. The cereal contained barley malt extract, which contains gluten! I notified the nurses right away, who contacted the dieticians. We informed them that barley malt extract contains gluten. They were very puzzled and seemed genuinely unaware of this fact. The dietician told us that they thought it was the only breakfast cereal that was gluten-free. The packaging does not indicate that it is gluten-free. Rice Crunchins is not gluten-free!

Romy Hospital
Rice Crunchins has barley malt extract, which contains gluten!

Romy doesn't have Celiac's disease, he is only gluten-intolerant. But, can you image that this stupid hospital has been feeding Rice Crunchins as the gluten free meal to the whole hospital!? This is not only an oversight on the part of the dieticians and the hospital staff, but it is EXTREMELY DANGEROUS to those who come to Alta Bates with Celiac's disease. We notified the nurses, who by this point were probably very used to us calling them, and they sent the message to the dieticians. After a few hours, the head dietician and a trainee came by to Romy's bed and were all crazy nervous and extremely apologetic. They seemed unaware that barley malt extract contained gluten. They told us that when they got our message, they had to go on the internet to check if it was true or not, and then realized that it DOES contain gluten. WTF!? Why didn't they do that before they decided on serving it? We then made a formal complaint, but who knows how far that will go. The dieticians said that they will initialize a large scale check on all the gluten free meals to check if they were indeed gluten free, and train all of their staff 'again.' Who knows if they are even competent enough to do that.

Romy is clearly grossed out by the PICC line.

This is a cartoon of how the PICC line goes in.

After all of this food drama, the PICC team finally came by. They asked me if I wanted to watch or not. I did want to watch after all of the previous experiences we've had here. It seems like somebody always has to watch to make sure things go right. However, I quickly got the feeling that the PICC team was very competent and good at what they did. The team consisted of a guy and woman, and a cart full of supplies and an ultrasound machine. They informed me that they needed to make a sterile area around his arm, so I had to step back as far as I could and wear a face mask too. First they hooked him up with all the EKG probes, to measure his heart beat, and then they got the ultrasound ready and something to do with a magnetic pickup which would see where the tip of the catheter was going inside his veins.

The team then put out a bunch of blue cloth blankets on top of Romy, which were the "sterile field." The blankets were sterile and then they rubbed the sterilizing stuff all over their arms and skin that was exposed beyond the blankets. The woman then monitored Romy's heart, and the guy began to inject the tip of the catheter into the side of Romy's bicep, and then into his vein. The team was so hysterical. The woman kept commenting about Romy's beautiful EKG, and if it was a fancy art piece in a museum. She was so serious when she said it. Then we watched the magnetic pick-up weave its way up Romy's arm as the guy was shoving the catheter into a tiny hole he punched through Romy's bicep. I was worried I would get a little sick, but it was like watching a funny movie. At one point Romy moved his hand onto the blue blankets so he could get a better look at the monitor, and the woman yelled out, "Don't touch the sterile field! The sterile field!!!!!" Romy was soooo confused and then she told him to put his hand back under the blanket. Without skipping a beat, she was back to complimenting and admiring Romy's beautiful and strong EKG signals. The guy got into it to, and then all of a sudden the catheter was in place, and it was all over. The guy counted 13 cm of line sticking out of Romy's arm, and then snipped it off, and attached an end to it that could be used to inject the antibiotics. He tested it out with saline fluid, which Romy said he could feel as a cold sensation. Then they removed the sterile field away, and gave him a few instructions, and left.

The really nice Japanese man gave me the flowers his family sent to his room, because he said, "At least I can truly enjoy them." We are finally home!

After the PICC line was in, Romy felt weirded out by it, but we were quickly distracted by the discharge operations. Once the hospital and insurance were notified that we were all set to go, it was amazing how quickly they rushed us out of there! Literally within a few hours, I was getting the car from where I parked it, and waiting for Romy who was wheel chaired out of the hell hole, and into the Subaru. But before we got out of there, the funny Japanese man next to Romy's bed insisted that we rob the room of hospital supplies. He told us to take it all, because the hospital has already charged us for everything we see in the room. Then he pressed the nurse call button and told her he needed a brand new package of latex gloves. The nurse looked confused but went to get them for him. When she came back with the gloves, the Japanese man handed them over to Romy, and said, "Here you go, you can use these." Hahahha! Then he told me to take the flowers that his family gave him the night before, because he thought I would enjoy them more outside of the hospital. He said it was too dark in the room for flowers anyways. What a nice man!

We then drove the 15 minutes home, and that was it. For the next few weeks, I will need to give Romy an IV of antibiotics, and he will have to come in a few times to get checked out to see how his appendix is healing. At some point, the surgeon will remove his appendix. Tomorrow, a nurse will come by and teach me how to inject Romy with antibiotics.

Thursday, March 28, 2013

Romy's Appendix Ruptures: Day Six

This morning a meal arrived for Romy but it was a gluten meal (cream of wheat and french toast). We were never notified that he could eat again, so it was surprising. Apparently, late last night the doctor responded to the nurses calls, but the nurses never told us Romy could eat or drink (with the most important part being that he could drink!) I kindly told the man who delivered the food to take back the plate because Romy needed a gluten free plate (as he was getting previously) but they did not return. We figured since he got a meal (even though it was the wrong one), that meant he could eat or drink again, even though we were never notified officially by any nurse or doctor. After an hour later when no replacement meal came, we asked for it again by way of a nurse. One hour passed after this, and he still did not have a meal. Every time a nurse came in to check on him we notified them that there was no food yet. Two of Romy's doctors came in and we told them also that he didn't get food yet, and they told a nurse. It was literally like this for so long. We would tell somebody, they would tell somebody, and supposedly a food order was placed. However, it does not take 3 hours to whip up breakfast. Finally a nurse said she would put in an order for yogurt and fruit separate from the breakfast order. That never came either. Finally at 12:30pm I got so fed up, I went to Whole Foods to buy Romy something and notified the nurses at the front desk that he still did not get food and I was going to buy him something. I was so mad at this point! I yelled at the nurses and they kept apologizing, but didn't actually do anything. I figured that if he still didn't have food by the time I got back from Whole Foods, then I would talk to the charge nurse. 20 min later, I was back, and Romy still didn't have food!!!! I requested the charge nurse, and spoke to her regarding yesterday and today and asked for a manager. I kept asking her who is responsible and who is held accountable, because it didn't seem like anybody gave a damn. Finally around 1:30pm he received a gluten-free lunch (but never got breakfast).

Romy Walking the Halls
Romy is well and walking the halls.

I finally got to speak to the manager around 2:00pm. She was very nice and identified that there were multiple areas and incidents where mistakes and oversights were made by the nurses and the doctors. I told her that I was concerned mostly about yesterday when we kept asking the nurses if Romy could eat or drink anything, and they never allowed him to have anything, but also didn't give him the IV we asked for either. She said that although the nurses were not allowed to give IV without an order, they are supposed to advocate to the doctor and they were supposed to relay our request for an IV yesterday when he was not allowed to drink anything. No request was made by the nurses. When we asked Dr. Westeguard personally if he could eat or drink, and she deferred to Dr. Fowler, she did have the power to recommend IV fluids since he couldn't drink, but she did not! On top of all this, when he didn't get food this morning, it just made things worse. He didn't eat anything at all yesterday, and now today, for no apparent reason, he didn't get food until lunch! What a dysfunctional hospital!!! ALTA BATES SUCKS! Why is it so hard for them to relay simple information? What's scary is that supposedly this is one of the better hospitals in the bay area!

After everything calmed down, and the nurses changed shifts, things were back to normal. The doctors came back with Romy's blood cell count, and his white blood cell count was going down and it was now within the normal range (below 10 units). Amidst all of the drama earlier today, the doctors decided that Romy could go home today with IV antibiotics taken at home. This required that Romy get a PICC-line in, because they didn't allow patients to keep an IV thing in their arm after they leave the hospital. Romy kept asking if there were other options, like coming in everyday to get the antibiotics instead. Nobody knew of any other options until the infectious disease doctor mentioned an outpatient diffusion center just a few blocks away. He said that they should be able to give him the IV antibiotics everyday, as long as Romy didn't mind getting poked with a needle everyday and sitting there for an hour. Romy thought this was preferable to the PICC-line, and at least if he goes to the diffusion center, a nurse will be able to check on him everyday and if he needs blood work done, they can take his blood there too. The infectious disease doctor thought this was preferable too.

Relaxing - Last Night!?
Romy passes the time talking to friends and relaxing.

So things were arranged to get everything worked out with our insurance plan. But the insurance was sooooo slow authorizing the diffusion center care, so we couldn't leave the hospital until they worked it all out. It was already close to 4pm by the time everything was decided. The case counselor woman told us that it typically takes 24 hours to get insurance authorization on something like outpatient care at a diffusion center. So guess what. . . we had to spend one more night at the hospital! How exciting!

The Polish guy with the broken leg next to Romy left this afternoon. He does body work on the head and back, and invited us for a free practice session (he is learning so he practices on patients for free). We exchanged information. Almost immediately after he was wheel out the door, the cleaning people came in and changed all of the sheets and wiped everything down. They were so fast. The bed was left empty for maybe one hour before the hospital wheeled in another old Japanese man. He just had surgery to remove a quarter of his colon! He was kind of funny and alert. I never saw somebody so persistent in calling the nurses. He made some funny jokes too.

There was a lot of down town, sitting around and waiting today, so I graded homework and lab reports, and I tried to do some work on my paper. It was in general a slow day with lots of frustrations, but hopefully we get the hell out of here already. I am afraid to look at the bill when we finally do get out!

Wednesday, March 27, 2013

Romy's Appendix Ruptures: Day Five

Early this morning, when the nurse came to give Romy's morning dose of antibiotics, she decided that his IV was getting old. It was a little sore and painful for the last day, so this morning they finally changed it out, and poked a new hole a few inches away. It was near his wrist, a stupid spot since it has very thin skin and its close to a joint where there is a lot of motion. Romy complained about it later, and said that if he was fully awake, he would of stopped the nurse from putting it there.

We learned at breakfast that the CT scan was going to be scheduled for 11am. Instead of a breakfast plate, Romy got two liters of contrast fluid. It was berry flavored, but it looked like white liquidy chalk. Romy said it was gross and made him gag, but he downed the two liters over the next two hours. He couldn't eat anything before the CT scan. I scheduled an appointment to call one of the scientists at DRI who might be my potential boss if I get hired, so I stepped out of the room for about an hour and a half to talk to him. When I came back in, I barely had time to tell Romy what I learned over the phone call before he was wheeled away to the CT scan! I waved goodbye as he was wheeled down the hall. I had a bunch of laundry to do now at this point, so I decided to go home and wash some cloths, and download a few programs on my computer while he was in the scanner.

Romy at Work
Romy is feeling better and he is out of bed internetting on a chair! We have a nice view of the Berkeley hills out the window.

Romy told me that when he went in for the CT scan, the contrast agent was injected at a high rate. Romy mentioned his vein swelled up. By afternoon, when he was getting his antibiotics, it swelled up again but apparently Romy was able to tolerate it. Soon it will have to be replaced. Nicole and Marcel came by to visit again. It wasn't very nice out, kind of cloudy and rainy, so we staying in the hospital room. I ate lunch and N&M were munching on stuff. The guy in the bed next to Romy's got his lunch plate, but nothing came for Romy. We were wondering since his scan was over, if he could get some food and drink now. When the nurses went to go check, they said the doctor ordered him to have nothing by mouth until they could decide what to do after analyzing the CT scan results. So we waited until we heard back.

Soon Dr. Fowler came by to tell us what we did not want to hear! He said that there were still many small abscess sacks but nothing that coalesced into something drainable. He said that there would not be any procedure done today to drain the abscess. Also, it looked like the appendix was still very inflamed and messed up. Even though Romy was feeling better (he did not have any pain medication at all today) his appendix was not very much better. So the doctor ordered that he stay on antibiotics for longer. He wanted Romy to stay one more night so that he could monitor his progress and see if his white blood cell count would go down to normal. Then tomorrow he would arrange for him to go home and continue the antibiotics at home. At least he could go home soon!

Walking Around Today
Happy to be spending our last night in the hospital!

We were so excited and also bummed by the news. Soon after Fowler, a nurse came in and we asked if Romy could eat now that there was no procedure that was going to be done that day. She said she didn't know but she would check with Fowler, because the order for 'nothing by mouth' was still on the charts. That meant he couldn't even drink water either! So Romy waited to hear anything back. Every time a nurse came in that afternoon, we asked if Romy could eat or drink anything. When the dinner plate came for the guy in the next bed, we asked again if Romy could eat or drink anything. Every time we asked, we got no answer. Every time they called the doctor, they could not get through to him, and just assumed that he was in surgery. Romy was starting to get really thirsty. We asked that if he could not drink, then could he get an IV at least? The nurses kept saying that they could not get through to his doctor and they did not have the power to give him an IV. Even the second doctor, Dr Westeguard, kept deferring to the one that was not available, instead of making an order herself for him to drink! It was getting very frustrating!!!

By 8pm, we got so annoyed that Romy just drank water and ate a few strawberries anyway. This was starting to get upsetting. It seemed like they didn't care if Romy was gonna go thirsty or hungry. Unbeknownst to us, Dr Fowler did call back by 9pm but it was never communicated to us. We were already going to sleep by then. In general, the end of the day turned sour. Dr Fowler should've changed his diet orders as soon as he determined no procedure would be done that day. Also, it should be automatic of you have a 'nothing by mouth' diet order, that you should be able to get an IV for fluids without any doctor's order!!!! WTF!?

Tuesday, March 26, 2013

Romy's Appendix Ruptures: Day Four

Romy is continuing to get better today. Early this morning, they took his blood again so that they can continue to monitor his white blood cell count. Today we think he may get his CT scan to see how well he is healing. But we won't know until we hear about his blood cell count. Romy finally got the energy to take a shower this morning and he is looking better than ever! Nicole and Marcel came to visit today. It was such a nice and warm day, we decided to see if we could find a wheel chair for Romy and go outside. The 6th floor didn't have any available, but Romy thought he might be able to walk. He hobbled out of his hospital bed and we took him to the elevator.

On The Roof
We went to check out the roof. It was really bright and sunny.

I think it must have been pretty unusual to see Romy walking around, holding a coat over his arm. The nurses looked very alarmed and tried to stop him. They thought we were stealing him from the hospital and he was escaping! Once they realized we were just going for a walk, everything was ok. We got down to the first floor, the lobby, and then walked over to another set of elevators. We passed by a whole rack of wheel chairs so we asked the people at the security desk if we could borrow one. They gave us a really nice wheel chair, and we wheeled Romy to the elevators. They took us up to the 3rd floor roof over the south side of the building.

On The Roof
Romy's hair is all clean after his shower this morning.

The roof was really nice. There was a garden and a fountain. We also found a sun dial. We stayed up there for a while, but Romy started to feel a lot of pain after a while. So we decided to go back to his room so he could get more pain medication and relax again. The pain medication that Romy was getting was pretty strong (dilaudid, 7 times stronger than morphine), and Romy didn't want to keep taking it since the pain wasn't as horrible anymore. The nurse offered him Tylenol as the other option. She went to go investigate how much he could get, and when she came back, she was able to get something more intermediate. It was a pill that was somewhere in the middle between something really strong, and something you can buy over the counter. I think it was called Norco. Romy liked it much better. He was much happier for the rest of the day.

When we got back from the roof, we heard from the blood people that Romy's white blood cell count was still too high (11.8 units, down from 13 yesterday). The goal was to try and get it below 10 units before the CT scan would take place. They figured since the trend was going down, they would schedule the CT scan for tomorrow morning. That was exciting news! If the appendix shows a drainable abscess tomorrow, he only has one more day in the hospital!

Real Soft Food!
Romy is very happy to have real food now, even if its kind of bland.

Other good news too. When lunch came around, we discovered that the doctor upgraded Romy's diet again today. Now he can eat "soft foods," which apparently is anything soft, like cooked veges. It seems it has nothing to do with fiber though. Not sure how soft foods are any different from normal foods, as once it gets into your gut, the food should be already mushed up and soft. It was the first time Romy got a nice plate of food (although it looked better than it tasted). Mashed potatoes, cooked carrots, and some beef roast. Nothing fresh though, all cooked and mushy.

Nothing very eventful happened later in the evening. We just relaxed and watched a movie on the TV screen above the bed before we fell asleep. We did learn one thing from Romy's nurse today about the weekend staff. She told us that the nurses are learning how to use a computerized system for all of the patient files. Currently, they carry around clipboards and binders with all the paper records of what happened to each patient and when. Substitute nurses are being hired for only a few days at a time while the real staff nurses are getting trained somewhere on the new computerized system. So the nurses we had that sucked were all substitute nurses. That makes a lot of sense. Too bad Romy came in during this bad timing!

Monday, March 25, 2013

Romy's Appendix Ruptures: Day Three



Day Three



Day Three



Day Three



Day Three



Sunday, March 24, 2013

Romy's Appendix Ruptures: Day Two

Once Nicole and Marcel left last night, another patient was rolled in and took the other bed spot in the two-bed room. He was an old guy who had a ruptured hernia after it was supposedly fixed two years ago. Over night, the nurses kept coming in to check on Romy's antibiotics, IV, and his vital signs like temperature, and blood pressure. The pain medication wore off, it seemed before any of the nurses would come with more. I kept asking them when Romy would be scheduled for more pain killers, and they always reported a time. However, it seemed like we always had to buzz the nurse to actually get it. It was only until 6am or so this morning that one of the better nurses told us that the pain medication is by request only, and it is not given automatically like the IV or antibiotics. I wish somebody would have said that earlier! By morning, Romy was feeling a lot better, and his fever went away. However, Romy could not eat or drink anything, so no breakfast tray came for him.

A doctor that Romy nicknamed the "douche" came in (yet another different doctor) mid-morning (or yesterday? I can't remember) and asked Romy to recount his version of what happened. They do this to check if you are ok, I guess. So Romy said the whole story about how the first doctor ordered appendix removal surgery based on the wrong CAT scan, and then a second doctor changed the plan due to the misread CAT scan. This new doctor tried to cover for the other doctors saying that nobody misread anything. This just seems hard to believe. How do you decide to drain pus from a clear abscess, but then get another doctor to say that its totally too messed up to drain anything? At this point its very confusing. It seems like the doctors are going back on what they said, and trying to save their own ass because they totally didn't realize they were looking at the wrong CAT scan at first.

Romy in Hospital Room
Romy felt a lot better this morning after sleeping and getting drugged up on pain medication.

The day progressed kind of slow. Romy was just resting and sleeping. The nurses were monitoring his urine and it seemed to be very dark. The nurse kept saying, "Oh that's dark, let me check if you can drink anything." But then they never came back with an answer if Romy could drink anything. Another doctor came in and he was the infectious disease specialist. He just asked a bunch of questions to determine if Romy was at high risk of begin infected with something already prior to entering the hospital. He determined no, and then left. He also said he would check to see if Romy could drink fluids, but never came back. Then we asked the nurse aid if Romy could drink fluids because we felt he might be getting dehydrated. She was very helpful. She was one of the only nurses (even though she was "only an aid") that we felt did her job properly. She told us to be demanding and keep bothering the nurses if we felt something wasn't right. She said a lot of them are bad nurses and they don't care. She said if we felt we were being ignored, to call the charge nurse (the one in charge of all nurses). So that's what we did. We called the charge nurse and 45 minutes later he came in. We asked about the fluids and the dark pee and told him how we've been asking all morning multiple times and nobody gave us any answer. He said he would ask the doctor and get it taken care of. Almost immediately, (he must of yelled at Romy's nurse) the nurse came in and told us the doctor said that now he could drink clear fluids and eat things like jello only. The nurse bought in cranberry juice and water. Romy drank it and his pee wasn't as dark anymore. Things were starting to get better.

IV and Antibiotics Day2
The I.V. is constantly dripping, giving Romy fluids and antibiotics.

Also at some point today, the nurse brought in these inflatable pads that wrap around Romy's calves. They hook up to a machine that automatically inflates them in a pattern that massages his legs to keep blood flowing around in his veins. This is supposed to prevent blood clotting since he is laying in bed all day. I think they are good. I tried them today, and I liked them, but Romy thinks they are annoying.

Leg Balloons
The nurse brought Romy some air balloons that wrap around his calves and automatically inflate and massage his legs to prevent blood clots.

Also at some point, a PICC-line specialist came in, who was ordered by one of the doctors that wandered in today. He wanted to replace the IV in Romy's hand with a catheter that goes up Romy's bicep and up the arm, stopping right outside of the heart. This just seemed a bit unnecessary at this point. We said that we would rather not have that done, and the PICC-line specialist agreed, but said he was order by one of the doctors (we nick-named this doctor the douche doctor). So that was held off for now.

By the end of the afternoon, we gathered enough information about who Romy's doctors actually were (there were so many, it seemed, in the beginning). There were three in the end today (two in the ER, and a third that appeared today). There was the old guy (Dr. Fowler), who was the one to admit to us in the ER that the February CAT scan was mis-read, then the douche doctor, which might be the one who mis-read the CAT scan (the one who today denied any CAT scan was misread), and then the third woman doctor (Dr. Westergard) who wandered in after the PICC-line specialist. She also agreed that the PICC-line was unnecessary. She then told us that she was going to take over the douche doctor. So I guess now Romy has two doctors - the old dude and the woman doctor. We are okay with that so far. The PICC-line guy was held off, and there was also the infectious disease specialist who is analyzing Romy's blood samples everyday he will be here to monitor.

We found out that the old man in the other bed was a veterinarian doctor. He operates on dogs and cats. He was released later this afternoon and his semi annoying wife came to pick him up. Nobody was assigned to the other bed for the rest of the evening. Yay!

Saturday, March 23, 2013

Romy's Appendix Ruptures: Day One



Earlier This Week:


Day One (today):

Romy in Emergency Room




