Thursday, July 09, 2009

Tin God Syndrome: The Doomsday Doctor

It has been a long time indeed since I have run into another physician with the dreaded Tin God Syndrome. I attribute this extraordinary good luck to 2 things: the steady and reliable care of Dr. Fetus (my PCP), and the fact that the Methadone has all but kept me out of the ER for TN pain for almost 3 years. As I have learned all too well, nothing brings on the symptoms of Tin God Syndrome in a physician quite like the chronic pain patient. It's like a person with allergies: they are just fine until they get stung by a bee, and then things go horribly wrong.

However, in the last few months I have been in the ER twice, for 2 completely different reasons & ran into 2 completely different Tin Gods: the one you'll read about here now (the Doomsday Doctor), and the one you'll read about above tomorrow (The Hit-and-Run Doc).



Several months ago, I woke up to stabbing pain in my lower right quadrant. I sighed deeply: not another kidney stone or ovarian cyst! I called the clinic, but no one was available to see me. I was told to go to the ER. I chose to go the one closest to my home. I had never been to this particular hospital before, but I figured, how bad could it be? This was a pretty easy case. Even a second-year

med student could handle it.

I had no idea I was about to run into one of the most traumatic of all Tin Gods: the Doomsday Doctor.

The motives of Doomsdays are difficult to ascertain: what makes a doctor want to take his superior knowledge of every single possible disastrous thing that can happen to the human body and use it to absolutely scare the ever-loving crap out of his patients? Were they not hugged enough as a kid? Are they unhappy that there aren't more emergency-room horror flicks? Are they just one of those people who immediately go worse-case-scenario and like to have company when they do? Or did they get into medicine simply for the chance to be the doctor who gets to tell someone they have some extremely rare and possibly untreatable disease...and they are sorely disappointed that the chance has yet to present itself?

The world may never know.

You can imagine the chaos Doomsdays ensue when they listen to your symptoms, nod wisely, lean in closer...and begin to freakin' terrify you with his honest, earnest, learned opinion that your planter's warts are actually very rare tumors and you may lose a least three fingers, if not the hand! Have a headache? He will muse aloud about aneurysms and how sad it is that your age group is statistically more likely to die while having them repaired. Got a sore throat? He will start writing down the phone number of his golf buddy, the specialist in cancers of the larynx, before you even have the chance to pop a cough drop. Doomsdays are incapable of keeping their apocalyptic thoughts to themselves: they must share them with you. Damn it, they are pretty sure they are even ethically BOUND to share them with you! And share them they graphic detail. Whether you want them to or not.

I went into the ER expecting to have to take a urine test, get some blood work, have an ultrasound done, get a prescription and go home. I've been through it far more times than I'd ever care to count since I got MS. Most of the time, it's a pretty simple and straightforward matter, and rarely takes a whole lot of time. I know the drill, and know it well.

This was not going to be one of those simple, straightforward times.

I was sent back into a room fairly quickly, and the doctor came in almost right away (which in itself should have sent off warning signals). Like most Doomsdays, he seemed perfectly normal during this first interview. He nodded a lot, gave me a long and unnecessary speech about the common nature of urinary symptoms in multiple sclerosis (yeah, I noticed that about a decade or so ago, thanks) and told me he'd order some tests, then retrieved a cup from a cabinet for me to tinkle in. As I said, he seemed perfectly normal, lulling me into a false sense of security that this was, in fact, a doctor uninfected with any form of Tin God Syndrome. The only thing I noticed that was a bit off was that he not only didn't have my chart with him, he didn't have ANYTHING with him. No papers, no clipboard. I've never seen a doctor do that before, but hey, maybe he just has a really great memory?

He left, and I took the beforementioned urine test. Even my untrained eye could see the blood in the urine. The nurse also noticed it right away, and gave me a look of sympathy. She took it away, and about fifteen minutes later, came back and told me there was in fact blood, as well as signs of dehydration. It was time for the blood work, with the added bother of getting an IV put in for some fluids. Again, this is a drill I am quite familiar with. A half hour or so later, a woman came in with the ultrasound machine. So far, so good.

And then...I was completely ignored for over four hours. No nurse came to check on me. There was no sign of the doctor. Maybe my chart was lost (which would explain why the doc didn't have it), and now they've forgotten me? The bag of fluid was almost empty. I had been in a good amount of pain---not to mention a considerable amount of nausea---for a damn long time. I felt woozy, sick to my stomach and tired of feeling like I was urinating flames. And to make matters worse, I'd been put in a room with no television, and I'd left home without a book (which is a rookie mistake, and I should know better). Then to rub salt in the wound, I could just barely hear the TV in the room next to me...and they were watching a Washington pow wow! Unfair, unfair.

Another hour came and went. An orderly came in at one point, looking for someone, and I practically begged him to find my nurse. I had attempted to do so myself, but was unsuccessful. Every time I pushed the 'call nurse' button, a woman told me she'd 'find my nurse,' and apparently the search party was still out. I wasn't sure if it was a bad thing to be hooked up to a bone-dry IV, but it was pretty clear that if my nurse didn't make an appearance soon, I was gonna find out.
FINALLY, my nurse arrived, apologizing that they had been very busy and short-handed. She put yet another bag on the IV (how long did they plan to keep me here?) and also came with injectables: pain & nausea. I was shocked. I hadn't asked for anything for pain, only for the nausea. This was a first for me! I've never been given pain meds without asking for them; without begging for them 90% of the time. I wanted to be grateful...but something seemed wrong. The feeling was much stronger when I found out I was being given Morphine...and a pretty hefty amount of it to boot. I asked the nurse why; after all, I had not asked for pain meds. No one had asked me what level my pain was on either the 1-5 or 1-10 scale. So why was I being given so much Morphine? Why was I being given another bag of fluid? She told me the doctor would be in to see me soon, and rushed out.

I was, at this point, feeling very uneasy. This was all very weird. Very wrong.

I was then left alone for YET ANOTHER HOUR! I was no longer in pain, no longer felt like I was urinating fire and no longer wanted to leggo my Eggo. What I was, was scared. What was going on? Why would no one tell me?

I began to panic. I called my husband...who had begun to get pissed off. Why was a routine, MS-patient urinary problem taking almost seven hours to resolve? Why were my questions ignored? He was on his way.

While on the phone with him, the doctor came back. He had a grave look on his face. It was not unlike the look the Well-Accessoried Doctor gave me when she told me my MS had gone progressive. I felt a pit of fear in my stomach. And some curiosity, as once again...there was no chart, no papers, nada.

He asked me to sit down, and then he took a seat as well. He looked at the ground for a minute or two, sighed heavily, and then looked me in the eye. Here's how the conversation went:

DR.: "I'm afraid the tests didn't show anything."
ME: "What do you mean?"
DR.: "No kidney stones, gall stones, ovarian cysts or UTI."
ME: "I don't have a gall bladder."
(startled) "Excuse me?"
ME: "My gall bladder was removed in 1997."
DR.: "Well. That explains the lack of gall stones."

He said this with complete seriousness. I just stared at him.

ME: "Why did I have blood in my urine?"
DR.: "You didn't."
(confused) "I saw it. The nurse then TOLD me I had blood in my urine."
DR.: Well, I'm afraid the tests didn't show anything.
ME: "So what's wrong?"
DR.: "Well, I think you should go and see your doctor right away."
(startled) "Why?"
DR.: (sighing) "We don't have the ability to test for...certain things, here. Not at the moment. This is why I must STRONGLY URGE you to see your doctor right away."
ME: "How soon is right away?"
DR.: "I'm afraid you really need to be seen as soon as possible."
ME: "What do I tell Dr. Fetus? I need to tell him what to test for. I can't just go in there and tell him I needed to be seen right away for some unknown, random test."

DR.: (looks at the ground again for another minute or two) "I'm sorry, but there is some indication of the possibility of a large mass on your cervix."

I stared at him in some shock. It was one of those moments, when time seems to stop. I doubt the very large amount of Morphine in my bloodstream helped with that much.

ME: "A large mass?"
DR.: "It's important you understand, we do not have the ability to perform certain tests at this hospital, at the moment. You need to see Dr. Fetus."
ME: "Are you saying I might have cancer?"
DR.: "That's not what I'm saying at all. We would need more tests, and for that, you'll have to go to Dr. Fetus."
ME: "What tests do I have to have done?"
DR.: "That will be between you and Dr. Fetus."

Doomsday then stands up, dusts off some imaginary specks of dirt from his lab coat, looks at the ground for another few moments, and then looks back up at me.

DR.: "I wish you the best of luck, ma'am."

He said that with extraordinary gravity, the same way someone does when they let you know your dog has just been hit by a car. He then turns to walk away.

ME: "Wait a minute, wait a minute. You're scaring me. My mom died of breast cancer when she was just 44, and my grandmother died of uterine cancer at 46. Both of them fought cancer for years before they died. You need to tell me: is there a chance this mass is cancer?"
DR.: "I can't tell you that. Although I can say, with your particular family history, it is absolutely essential you see your regular doctor right away. Do you understand, Mrs. Zen? Do you understand?"
ME: "Yes, I understand. What I don't understand is this: if I don't have a UTI or kidney stone, or ovarian cyst, what is causing my symptoms? Why am I in so much pain and having so much nausea, and urinary symptoms? Could this mass cause all that?"
DR.: "Well, that's not likely but not impossible. However, with the blood in your urine, it is possible that you've got a UTI and you are in the early stages, and therefore, it isn't showing up in the tests just yet."
ME: "Wait a minute, I thought you said I didn't have blood in my urine?"
DR.: "The nurse found some blood, very small trace amounts, not enough to indicate a UTI or kidney stone. A very negligable amount."

He starts to walk to the door, thinks twice, and comes to sit down in front of me again and takes my hand.

DR.: "I need you to understand that you need to follow up with your regular doctor immediately, within the next three days at the very most. You are in need of more specialized testing and care than we are qualified to provide you in the ER. Do you understand, Mrs. Zen?"
(scared almost to the point of tears) "Yes, I understand."
DR.: "Excellent! I wish you the best of luck, Mrs. Zen. The nurse will be in in a few moments to remove the IV and give you your discharge instructions. Have a good day."

Doomsday then very abruptly leaves the room.

A few minutes later, my husband Jonathan arrives. As I tell him the story, I burst into tears and start shaking all over. Jonathan is wary. He doesn't trust this Dr. Doomsday. I don't know what to believe, and the Morphine for sure isn't helping there.

Twenty minutes go by, and my husband is now super-pissed. He tracks down my nurse and tells her that Doomsday told us to see our regular doctor right away, and we aren't going to be able to do that if we don't get out of that hospital NOW.

The fire he lit under her must have burned, burned, burned...because she showed up with a quickness. And with her: my discharge papers and yet ANOTHER shot of Morphine! She gives it to me, telling me that Doomsday ordered it, and telling me this in a tone of voice that conveys that this order was not an option, and if I'm smart...I'll take the drugs and be quiet about it. Jonathan is shocked at the amount: it is again another healthy dosage.

My IV out, and papers in hand (with the ominous-sounding diagnosis of "needs further investigation"), we leave the hospital. I have been there, at that point, for damn near eight hours.

We drive, at my husband's insistence, straight to Dr. Fetus' office. We go into the clinic, and I sit down (the Morphine has kicked in and I am feeling less than steady on my feet) and Jonathan goes to tell the receptionist what has occured. I see the look of surprise on her face, and in less than five minutes, we are shown back to a room.

Dr. Fetus is not in...I am seeing another of the clinic's doctors, Dr. Waitawhile; so named because he is quite firmly of the wait-and-see-maybe-it-will-resolve-itself school of thought.

We tell him what happened at the ER, and show him the papers. He looks at us in ever-increasing amounts of ill-concealed shock as the tale unfolds. He is especially confused as to what "tests" Doomsday thought the clinic could provide that the hospital could not, and why he wouldn't tell me what those tests were. I didn't know, because despite my repeatedly asking Doomsday, I never did get an answer.

Dr. Waitawhile went right into action. He ordered another urine test, and gave me a pelvic exam. He then went off to request the chart from Doomsday. I'm not even sure there IS one, as I never saw it the whole eight hours I was there.

We were waiting a good twenty minutes before Dr. Waitawhile returned, with a puzzled look on his face. "This is the weirdest case I think I have ever been involved in," he told me. Apparently, it was proving very difficult to get the records. Usually, it was just a matter of requesting them, then getting a fax. But he was being given the run-around, and he didn't understand why. When he finally DID get something, all he got was the results of the blood and urine tests. Nothing from the ultrasound, no doctor's notes, nothing. He then talked to both the nurse and Doomsday...and got completely different stories! The nurse said there was blood in my urine. The doctor said there wasn't. Doomsday also refused to either confirm or deny that he told me about any "mass."

I sat in utter shock. What on Earth was going on here?

On the plus side: the urine test came back with no blood. When I told Dr. Waitawhile that I had seen the blood in the original urine test with my own two eyes, he told me it was possible there had been small trace amounts of blood in the urine at that time, but that it wasn't detectable in the sample I had provided in the clinic. That suggests no UTI, but doesn't rule out stones (which could have made me have blood earlier but none now) or ovarian cysts. He then went to check on another patient, and we waited.

I was so nervous, it felt like hours before Dr. Waitawhile returned. The puzzled look was gone from his face. In its place, was irritation.

He told me that he had, after several calls and a great deal of aggrivation, received the full records. Or at least, he assumed they were the full records: there were very little nurse or doctor's notes, and it looked as if several pages were not transmitted to him. He called it "bizarre."

The verdict was in: there was no mass on my cervix. In fact, Dr. Waitawhile told me, with the sort of ultrasound that was ordered (and performed), it would be impossible to detect a mass on my cervix. For that, I would need the same exact test Dr. Waitawhile administered: a pelvic exam. Apparently, the cervix reacts in a certain way, when touched, if there is a mass. Mine didn't. He was also quite angry that I had been told that the ER could not perform "the kind of test" I needed to determine that: what ER couldn't give pelvic exams? No ER he had ever heard of. I was in agreeance on that; I've had pelvics in ERs before. I've never heard of an ER that couldn't or wouldn't perform that service. What kind of hospital was this that I had spent my day in?

And to top it all off, something other than a cervical mass DID appear on that ultrasound, despite Doomsday's insistence that the tests had shown "nothing": three ovarian cysts. These were probably the case of my pain and other symptoms. And the now-you-see-it-now-you-don't bloody urine indicated that there might be a kidney stone that wasn't showing up on the scan. I have a tilted uterus (TMI, huh?) that does often interfere with ultrasounds, a problem that was very bothersome during my pregnancies. Dr. Waitawhile gave me a prescription for nausea meds and pain relief, with the instruction (of course!) to "wait it out" and if I started having any more blood in my urine or more severe pain, to come back to see him, see Dr. Fetus...or go to any other ER in town.

In the end, it did turn out that I had a kidney stone as well as the three ovarian cysts. And those doctor's notes and other missing pages? They never did materialize.

I made a complaint with the hospital, and with the med board. This guy was the worst sort of cruel, comparable only to my experience with Caligula. No doctor should scare patients like this. I still don't understand exactly what happened, and I don't think I will ever get just why this guy chose to do what he did to me.

I do know, I won't ever forget it.

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At 12:45 PM, Anonymous Anonymous said...

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At 8:17 AM, Blogger Angel said...

HOW freakin' BIZARRE!!! And good for you for following up with the medical board.

I am so sorry you have to deal with such nutbags. But you make me a smarter patient when I'm faced with a similar nutbag.



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