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).



TIN GOD SYNDROME:

THE DOOMSDAY DOCTOR

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 will....in 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."
DR.: (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."
ME: (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."
ME: (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?"
ME: (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.

Update

I've been MIA the last week or so....but with good reason.

About a week and a half ago, I began experiencing this very weird pain. It was in two different places in my abdomen. I couldn't figure out what was wrong. Within a few days, I had completely lost my appetite and was dealing with increased nausea and severe fatigue. I made a doctor's appointment, but before I could go in, the pain became very severe and I ended up in the ER.

I am very happy to report absolutely NO problems with this ER visit! The nurse was incredible, checking on me at least every 10 minutes, the resident and the attending were both great doctors who treated me with the upmost care....not a Tin God in sight. I was given pain relief WITHOUT having to either ask or beg for it. My concerns were taken seriously and my questioned answered promptly. I was treated both with care and respect. I have written letters of complaint to the hospital in the past for poor treatment, and it was a great joy to write instead a letter of appreciation.

But, back to the issue at hand. At first, appendicitis was suspected, which frightened me. I am no big fan of surgery. After that was ruled out, the doctor was perplexed. It seemed like another case of kidney stones, but it also seemed like another case of ovarian cysts. After much testing it was determined to be BOTH.

I've had kidney stones, and I've had ovarian cysts. Never have I had them both at the same time. Trust me on this...it's not an experience I wish to repeat. Despite my extreme dislike of surgery, I am now very seriously considering my OB/GYN's suggestion that I have my ovaries removed. I am, quite frankly, tired of all these cysts, and knowing that my parternal grandmother died of ovarian cancer, I am forever worried that someday it might not be a cyst at fault. And to be frank, my periods have been very troublesome since I had my tubal ligation three years ago. I would not be sorry to bid them adieu.

In addition to the kidney stone/ovarian cyst problem, I am having yet again another Prescription Refill Disaster. This time it concerns not my pain meds, but my Tegretol, which I use to combat the trigeminal neuralgia. The very last thing I need right now is a bout of the neuralgia, so it's very important that I take my meds. Tegretol is also a drug which needs to build up a "level" in your bloodstream. I always call it in for a refill several days before I run out, so that I DON'T run out.

Well, it didn't work out that way this time. I kept calling my pharmacy to check on the refill, and they kept giving me the same answer: my doctor's office had not yet called back. I contacted the Prescription Coordinator, and got the ever-present voice mail. I was finally able to speak with him, and the first words out of his mouth were, "I don't even see that medication on your record." I've been taking it for over a year now. He then mumbled something about being "behind" and assured me it would be taken care of that very day.

That was four days ago. I still have no meds.

After playing voice mail tag for another two days, my husband finally called and insisted on speaking with the ever-elusive Prescription Coordinator, who promptly blamed it on my doctor not being in the office. The prescription was then given to the "general pool" so that one of the other doctors could sign it. That was yesterday. I finally got a call from the pharmacy today....it is filled and ready. Unfortunately, it was filled and ready three hours after my husband left for work, so I will not be able to actually get the prescription until tomorrow...which marks two weeks without it.

My face started to hurt today.

I am also incredibly shaky from what I assume is the level of Tegretol in my system going down. I can't stop shaking. I can't count the things I have dropped in the past week.

I see the doctor again on Monday. Because of the cyst/stone situation and now, my face acting up, I have little doubt that I will have to ask for more pain meds this month. I hate doing that, but I don't see where I have much choice. Maybe if my Tegretol had been filled on time, I could've swung it, but now? Not so much.

On the happier side, yesterday was my ninth wedding anniversary. My husband bought me some lovely silver nose rings, a beautiful chocolate-brown shawl and a box of Godiva chocolates. I think I'll keep him.

Anyway, that's what's been keeping me from the computer recently. Sitting up at the computer desk is extraordinarily painful. I'm beginning to think there's something to my husband's laptop idea. I have always been worried that I would break one in a Big Clumsy MS Moment, but I have really missed blogging and I've really missed my online support group and message boards this past week. Food for thought.

Pain Article: Pain Relief and Emergency Rooms

SAN ANTONIO, TX, United States (UPI) -- Patients who visit hospital emergency rooms for treatment of out-of-control pain frequently find that you can`t spell relief 'E-R', according to recent studies.

'The results of these studies show that persistent pain is common and substantial after emergency department discharge,' said Knox Todd, director of the Pain and Emergency Medicine Institute at Beth Israel Medical Center in New York.

'We, as emergency room doctors, do not do a good job at treating the patients who come in our doors,' Todd told United Press International as he presented a pair of studies that examined what happened to patients seeking help for their pain.

In one study, a survey taken online, only 36 percent of patients who appeared at the emergency room in severe pain were examined within one hour. About 47 percent of the people in the survey defined their visit to the ER as 'poor,' 'terrible' or 'the worst experience of my life.'

In the second study, clinicians at 20 hospitals in the United States and Canada interviewed 842 patients after their discharge from an emergency-room visit. They said that 40 percent of the people who arrived in pain left in pain because they were under-treated, untreated or ignored.

'I`m not surprised at all by these reports,' said Samuel McLean, assistant professor of emergency medicine at the University of Michigan in Ann Arbor. 'There is a lack of education and a lack of understanding among emergency room physicians about pain. You can`t look at someone and know what kind of pain they have.

'ER doctors are used to seeing broken bones and heart attacks and recognizing these people are hurting,' McLean told UPI. 'When they see someone with persistent chronic lower back pain who is a minority, not well dressed, without insurance, the doctors becomes suspicious and the first thought is not that the person is in agony, but that he or she is looking to abuse medication.' McLean did not participate in the studies but concurred with their findings.

In the papers presented Friday at the annual meeting of the American Pain Society in San Antonio, Todd and colleagues also reported:

-- About 21 percent of patients said they waited more than three hours in the emergency department for doctors to see them.

-- About 25 percent said the ER doctor believed them when they explained they had out-of-control pain, the reason 88 percent of the people with pain went to the hospital.

-- About 15 percent of ER experiences resulted in doctors taking immediate action. More than 30 percent of the time the patients said the ER doctors 'didn`t believe my pain.'

-- In the survey 47 of the patients went to the emergency room because they said their primary care physician would no longer treat them, mainly because the doctor was concerned that he was already giving the patient a high dose of opioids or that the doctor said 'he had done all he could do.'

-- About 44 percent of the patients said they felt they were treated with dignity.

Penny Cowan, founder and executive director of the American Chronic Pain Association, said she hopes the Internet-based study will help prompt more research into the area and result in education of both doctors and patients about chronic pain and the role both doctor and patient have in controlling it.

'This preliminary survey highlights the many challenges faced by those seeking relief from chronic pain,' she told UPI. 'There is a marked mismatch between patient expectations and the emergency department treatment of pain.'

Todd agreed. 'Further research is needed to assess if more aggressive analgesic treatment during the emergency department stay may provide better pain-related outcomes after discharge,' he said.

Checking In....

...to let everyone know I'm still here.

It's been a weird month or so for me. My mother-in-law and sister-in-law were here for ten days, and the house was pretty crowded. We're now looking into buying a home. Personally, for me, it's got to have a master bathroom. I'm sick of schlepping up and down the stairs five or six times a night.

I used a scooter for the first time while my in-laws were here, at Jonathan's insistance. We went to the Oregon Zoo, and usually when we do the Zoo, I am exhausted by the end and sick for a week. Well, I took the scooter...and it was surprisingly easy and effective. I am now seriously considering buying one for occassional use.

A few days ago, I met a friend from the message boards. We met at Powell's, and I had a great time. She has the lightest blue eyes...very striking. And her son was just adorable.

I'm getting a little worried about the upcoming summer, because I am already having trouble with the heat and it's only April. It may be time to invest in cooling paraphenalia. I don't want to be stuck in the house all summer long this year. I'm tired of living that way.

On the plus side, I've been able to stay out of the ER for some time now. On the negative side, the last time I went was probably the most frustrating visit ever.

I had terrible pain in my side and other symptoms that pointed to either a bad UTI or a kidney stone. I called the doctor on call, who told me to go in. Now unfortunately, this coincided with a bad bout of the facial pain. I was handling the neuralgia, but dealing with both pains was more than I could tolerate. I kept trying to explain this to the nurse and then the doctor, but they couldn't understand me. They thought I was there for pain meds again. I kept trying to explain that yes, my face hurt, but I was more concerned with the kidney issue. It finally got (sort of) straightened out, and I got some antibiotics: my reason for going in the first place. Then the doctor gives me this long, drawn-out lecture about not coming into the ER for pain meds. Excuse me? I hadn't gotten any, didn't want any. I tried to explain this, but once again, the facial pain made it difficult to talk and nearly impossible for the doctor to understand me. I tried to ask for paper and pen, but was pretty much ignored or misunderstood. I gave up trying to explain myself and resigned myself to listening to the lecture.

And then came the kicker...remember that last time I was in the ER, when the doctor on call supposedly told the ER to refuse treatment? This doctor told me that apparently this was a PERMANENT order. They weren't to treat me for pain again, ever. Period. I showed her my pain management contract, which does give me clearance to come to the ER so long as I call the doctor on call first. The ER doc told me that it didn't matter. "My" doctor (meaning the on-call doc) had ordered the ER to withhold pain treatment from me. I told the doctor that there had been a mix-up, that my regular doctor was aware of the problem and that the contract was the final word, not this on-call doctor's (or the PA, whichever the case may be). She flat-out did not believe me. TOLD me she didn't believe me. She then accused me of lying to her about the last time I'd been into the ER! At first, I had no idea what she was talking about. Then I remembered her asking me, earlier on, about the last time I'd had my pain treated there. I had told her it was back in January. Now this ER doctor was livid with me because she'd looked up the record and seen that visit to the ER when I had NOT been treated a few weeks ago. I tried to explain myself, that I thought she wanted to know when the last time I had been treated here was and that during the visit in question I had not been examined nor treated. The ER doctor continued to insist I had lied for some ulterior purpose, although what that is, I have no idea. I didn't want to argue, really couldn't argue with my face the way it was. I just sat, dumbfounded, and listened to her rant at me.

Again and again, she kept telling me that she "wasn't comfortable" giving me pain meds. I would try to tell her I didn't WANT any, but she would tell me to not interrupt her. She droned on and on about how "important" it was for me not to "use the ER to treat chronic pain." I'll admit, my patience was running thin at that point, as there seemed to be no end to her lecture. I finally said to her, "My doctor has given me a contract. I call in, and they tell me to come to the ER. What am I supposed to do, NOT follow my doctor's orders?" The doctor didn't understand me, and it took a few times before she finally got the jist of what I was saying. And her response? Basically, that I have to "learn to live with it" and that I have a bad doctor! "I'd look into finding another doctor, if I were you." WTH?

She was finally done with her nearly ceaseless ranting and left the room. I didn't know whether to laugh, cry or sigh. I sighed.

I'm still not sure WHAT is going on. I don't know if there is a permanent order, or if this particular ER is just sick of the sight of me, or what have you. But I do know this: I no longer feel comfortable getting care there. ESPECIALLY if there is this misconception that I am NEVER to be treated! And who, exactly, made THAT order, anyway? I still don't know who lied to me: the on-call doctor, or the PA. I'm starting to think the PA is the source of the trouble, and the hospital wants me gone.

You know, you hear about the shithole our nation's health system has become, but you don't really KNOW until you end up smashed in the cogwheels of the demon machine....

Yesterday's Doctor's Appointment

Yesterday, I finally had my appointment with the Well-Accesessoried Doctor (yesterday's accessory: a gorgeous silver bracelet, perhaps of Navajo design or influence). She took one look at me and knew what was going on. "The TN again? How do you feel?" I told her I had slipped into the seventh ring of hell. I was that despondent.

The whole appointment, I was struggling with the pain and trying desperately not to cry. If there is anything in this world I hate, it's crying in front of anyone. It took me years before I felt comfortable crying in front of my husband, and I still prefer to cry alone or in the shower if at all possible. The crying in the shower thing started when I was younger and had to share a bedroom with my sister. Only in the shower, did I have any privacy. It's a habit I've never really broken...if I am very upset, I take a shower.

Many people might think the crying thing is out of pride, or a matter of image. I think it's more about my father's attitude towards crying when I was growing up. He absolutely could not tolerate it, for any reason. "Stop that crying or I'll give you something to cry about!" was one of his favorite axioms. Even as a child, I remember thinking that this was a load of horseshit. Beating a kid because they cry is NOT going to get them to stop crying...it'll make them cry more, and make them feel as if no one cares about their feelings.

It's backfired on me before, though, this difficulty with crying. I have had people, when I was younger, not believe me when I would talk of difficult things I had been through (although that in itself was rare), because of the calm, almost detached way I'd speak of it. No tears. I recall one incident quite clearly: one night, when I lived with a bunch of friends in East Dayton, I was attacked in a parking garage. I narrowly escaped being raped. I went to the police, but never felt that they believed me. I later found out that my roommates didn't believe me, either...because I went straight to the shower and never cried. They didn't know me well enough to know that I went straight to the shower TO cry.

And in recent years, I've found that many doctors are unwilling to believe my level of pain is as bad as it is because I'm not weeping hysterically, like most other people would be in their estimation. They don't realize that I cry later, when I'm alone.

Back to yesterday's appointment. A few very good things came out it:


1) She agreed to look into the transdermal patch option, and photocopied the article I brought her from the Trigimenial Neuralgia Association newsletter. It may not be an option for me...but I had to at least try.

2) I told her what happened at the hospital with Dr. Otherwise. She took my letter and told me she would talk to Dr. Otherwise and definately look into this. She also re-affirmed that I am indeed supposed to call the on-call doctor before going into the ER during the weekend or off-hours, and that I am perfectly within my rights (and reasonable to boot) to ask the on-call doctor to call the ER and let them know I am coming and why.

3) I got a shot of Morphine & Phenergan....which STOPPED THE PAIN! HALLELUJAH! Within minutes I felt like a normal person again...just a very, very tired normal person. I got something to eat, and slept for hours.

4) She also gave me a prescription for 30 more Oxycodone. I just pray I can make it til the end of the month with those. I thank God she gave them to me.


So for now, I'm as stable with the pain as I can be. Thank God Almighty for the Well-Accessoried Doctor!

An Update

Still in pain, still getting little sleep, little food and little relief.

To top matters off, my doctor's office insists I can't be seen before Tuesday. I am beginning to feel like I'm getting the run-around here....


I've decided that a number of things need to be done:

1) I made a complaint with the hospital about the incident on Sunday. Maybe THEY can figure out just what happened and why I was not treated. I also need to make a complaint against Dr. Otherwise. SOMETHING happened Sunday, and I suffered needlessly as a result. This CAN'T be allowed to happen again....and with Dr. Otherwise telling me one story and the P.A. telling me another, making complaints might be the only way to sort out this mess.

2) I need to either get more medication per month or better medication. I've been looking into transdermal patches, after reading an article in a recent issue of the Trigeminal Association newsletter. If I had some of those, I wouldn't need to go to the ER as much or (hopefully) at all.

3) I need to have, in writing, exactly WHEN I am to go to the ER, WHAT I am supposed to do both prior to going and once there, and exactly WHAT the ER is directed to do for me in the event that I am examined and deemed in need of pain relief.

4) If my doctor is resistant to any or all of these (and I really hope
she's not, as I like her personally and I certainly don't hold Dr. Otherwise's attitude against her), I may have to shop around for a new doctor. A few people in my support group told me they have had better luck in pain management treatment from DO's than they have with MD's. I'm looking into this....


Thanks to everyone for the well-wishes. You'd think with a disease that literally drives people to kill themselves out of pain that doctors and hospitals would WANT to ease said pain....

Another update: the company I wrote the "STOP CALLING ME!" post about called again today. I spoke to a supervisor who again assured me that no more calls would be made to my telephone number. Yeah, right.

My Run-In with Another "Otherwise Busy Tin God"

I've spent the past two weeks going to doctor's offices and ERs, thanks to the trigeminal neuralgia, which has decided to ignore all my attempts to curb its hellish effects. Sunday night, I ended up in the ER once again.

But first, unbeknownst to me at the time....I ran into another Otherwise Busy Tin God.

I've written of Otherwise Busy Tin Gods before. They are a product of HMOs and their viewpoint of giving patients less time and doctors more patients. Quite frankly, I am surprised so few doctors contract this version of Tin God Syndrome in this day and age. Otherwise Busy Tin Gods are overworked, overstressed and always, always in a rush. They are also rude and never want to take the time to get to know a patient or their needs. Most doctors can handle the greater workload while still giving their patients quality care....but many short-circuit into Otherwise Busy Tin Gods.

In a nutshell: I have a pain management contract. It tells me to go to the ER only if the office is closed and I cannot bear the pain any longer. It also tells me to call the doctor on call first before going on. On Sunday, I couldn't take it anymore and of course, the office was closed. So I called the doctor on call....who turned out to be an Otherwise Busy Tin God. From there on in, I'm not really sure WHAT exactly happened.

Here's a copy of the letter I wrote to my primary care doctor. I've changed or X'd out all identifying information:



Dr. T:


Please put this letter in my chart/medical records. Thank you.

As you are well aware, I have MS-related trigeminal neuralgia. I had had this for nearly seven years. Until November of 2004, however, it was (for the most part) controlled by various medications with the infrequent need for urgent or emergency room care. Since November of 2004, however, the pain has gone from an occasional moderate-to-severe bout to almost daily, almost constant pain. It is excruciating, and it is debilitating. The impact on my life cannot be measured.

Saturday evening, my facial pain due to trigeminal neuralgia worsened considerably. I had hoped to “hang in there” until Monday morning and call the clinic. However, by Sunday evening, the pain was unbearable. I had not slept in three days and could not eat. I had no relief from pain medication. I could concentrate on nothing but the excruciating pain I was in, and my abject exhaustion.

I called the clinic’s answering service and asked to speak with the doctor on call. Dr. Otherwise called me back within minutes. I told her that the pain was unbearable, that I had a pain management contract and that I was going to the ER. I then asked if she could please contact the ER and let them know I was coming. She seemed confused, and asked why this would be helpful. I explained that it made the process easier and faster if a doctor called in advance and told them I was coming and why. Dr. Otherwise agreed to contact the ER, saying that she would make the call and tell them “only” what I had told her. I took this to mean that she would tell the ER that I had called, describing great pain from trigeminal neuralgia and the ineffectiveness of my current medications to treat it, resulting in a need to go to the hospital.

When my husband and I arrived at the ER, we spoke with a P.A. named Edgar X. He did not examine me nor did he assess me. He told me that he could not treat me, because my doctor had specifically instructed him not to. He showed us the phone message from Dr. Otherwise: “no treatment for chronic pain necessary.” Mr. X made it very clear that he would like to assess and treat me, but his “hands were tied.” He discussed non-narcotic possibilities, such as Norflex and Torradol, but the conclusion was that they would be of little to no help in my current situation.

I was confused, as Dr. Otherwise had made NO indication to me on the phone that treatment would be denied me (had she done so, I never would have braved the rather windy night and gone to the ER; wind on a face hurting from TN is torturous). I told this to Mr. X, who suggested I meet with Dr. T to “achieve a meeting of the minds” as he was getting “mixed signals” from Dr. Otherwise and myself. I told him that such a meeting of the minds had already taken place, in the form of a pain management contract between myself and Dr. T. Mr. X made it quite clear that despite my pain management contract, he could not treat me because Dr. Otherwise had instructed him not to do so. I asked that he call Dr. Otherwise, as perhaps Dr. Otherwise did not understand that I had a pain management contract in place or the extent of my pain and my condition (when my TN acts up, my speech is sometimes difficult to understand; my MS has also been causing my speech to slur lately). Mr. X refused to do so, claiming the ER was “too busy” to allow him to make such a telephone call. He suggested instead that I get discharged, return to the waiting room and call Dr. Otherwise myself. He also told me that coming to the ER was not the “best option.” I agreed, but explained that there was really no other option available to me at that time, and that this stipulation had been discussed at length between myself and Dr. T in the past, resulting in my current pain management contract. He responded by telling me that he, sadly, had no option as my doctor had specifically ordered that I was to have no treatment from the ER. He asked when I would be seeing a neurologist next. I told him that I had a referral in the works, but even then, all a neurologist could do was monitor my medications and send me to the ER if they failed to work (the only “cure“ is a surgery my insurance will not cover, and which does not, at this time, have a very high success rate in any event). Mr. X agreed that this was likely. He told me again that he wished there was something he could do, but unless Dr. Otherwise called the hospital and changed her order, his hands were tied. I needed to call the doctor on call, or go home. He urged me to contact Dr. Otherwise and see if “something could be worked out.”

I was discharged, and we went into the waiting room. By that time, my face hurt so badly I was unable to communicate much at all, so my husband contacted Dr. Otherwise for me. He told the doctor what had occurred, and the doctor denied having instructed the ER to withhold treatment. She repeatedly told my husband that she was “only supposed to answer the phone” and “could not assess or prescribe ‘additional’ medication over the phone on the weekend.” My husband told her that I did not ask for, nor did I expect her to prescribe, any medications; that, in fact, my Oxycodone had been refilled on 3/3 and I did not need more. It was simply not working. Dr. Otherwise continued to insist that she could not prescribe any “additional” medication. She also referred to my situation as “odd” and said she “could not understand” why we asked her to call the hospital before we went in. My husband explained that it was our understanding that we were supposed to contact the doctor on call before going in to the ER, and that it was simply easier on everyone involved (myself and the hospital) if the doctor on call informed the ER of my impending arrival. He agreed that our situation was not a usual one, owing to trigeminal neuralgia being such a rare condition. Dr. Otherwise responded by saying, “You’d be surprised how many people have it.” She seemed somewhat agitated, and was not prepared to listen to what my husband was saying. She continued to deny having told the hospital to withhold treatment. He told her we’d seen the note, but perhaps the hospital had misunderstood, or perhaps she had misunderstood my somewhat slurred speech on the phone earlier that evening. We asked that she call the hospital back to clarify the situation, and she did agree, but she continued to insist that she could not “prescribe medications,” that I would have to be seen and assessed. My husband told her that this is exactly what I wanted: to be seen and assessed. However, the PA could not even do this much, so long as Dr. Otherwise’s recommendation was in place. Dr. Otherwise then began to tell him that the hospital could “refuse to treat me” after assessing me if that was the doctor’s choice. He told her we understood that, but as it stood at that time, I had not even be examined. She finally agreed to call the hospital back, but told him that she would say “exactly the same thing” she had said before, making it unclear as to what she was going to accomplish, if anything. We did not know what to do; officially, I had been discharged. I was in more and more pain all the time, and had no pain medication with me. We decided to return home and simply attempt to suffer through it, until we could call the office in the morning, rather than spend an entire exhausting night in the ER to no avail.

I took two more Oxycodone upon arriving home; an hour later, I still did not “feel” them. I continued taking Oxycodone and Ibuprofen throughout the night in an attempt to control the pain. I was not able to sleep, for the fourth night in a row. Although it embarrasses me to admit this, I spent the night between an online support group for people with chronic pain and lying on the sofa, crying from the agony of the pain and the demeaning way I had been treated (or more accurately, not treated).

To say that this situation was humiliating is an understatement. To be in chronic pain to the point where medication is not helping, you cannot eat or sleep and you feel you cannot bear it anymore…and then to be denied help, is a special kind of pain that cannot be adequately described.

I do not over-use the ER. I have been in twice in the past few weeks; before that, I had not been into the ER for nearly six months. I use it only as a last resort, when medications are not working and the clinic is not open (I always prefer to come into the clinic, to be treated by doctors and nurses who know and understand me and my condition). Unfortunately, my TN often worsens at night, leaving me in a bad situation: suffer or go to the ER. I usually choose to simply suffer. I had to call my husband home from work in order to take me in, and pay a babysitter to watch my kids. I assure you, I do neither of those things on a whim; we are not rich people who can afford to miss work or pay babysitters on a whim. Not to mention the fact that going to the ER often means painful examinations and shots which leave me with site reactions for days afterwards. As I said before, I use the ER as a last resort only.

I am still confused by what happened, and I’m not sure who (if anyone) was in the wrong or where the “wires got crossed,” as Mr. X put it. I am also not sure as to what to do to prevent this sort of thing from happening in the future. I do know that the following needs to be cleared up as soon as possible:

1) My pain management contract needs to be re-written. As it stands, it is mostly handwritten and in places, illegible. I have had it refused at hospitals in the past, because they cannot read what is written and once because they suspected I wrote it myself. I ask that a typed version of the contract be made available to me, so that there is no confusion or suspicion involved. I apologize for this necessity.

2) I need to know whether or not I am expected or required to contact the doctor on call prior to going to the ER. It was my understanding that I am indeed supposed to do this; however, the last two times I have called have led me to question this directive (the time prior, the physician I spoke with was also confused as to why I called before going into the ER). Preferably, if I must call, I would like to have that directive added to my contract. If I am not to call, I apologize for my misunderstanding.

3) I need to know if it was rude or inappropriate of me to ask doctors on call to contact the ER prior to my visit to let them know I am going in and why. The hospital staff has led me to believe that this is very helpful to them, but if it is inappropriate, I will discontinue doing so with my apologies. I understand how very busy on-call doctors tend to be and it was never my intent make their lives more difficult.

I understand that this is not the ideal situation for anyone involved. Unfortunately, my present circumstances have left me with very little choice in the matter: my insurance will not cover surgery nor will it cover a pain management clinic. I can afford neither on my own. And though I am to see a neurologist again shortly, I do not hold much hope that very much, if anything, will change. I believe it is necessary to be realistic: I am in a situation with chronic pain which occasionally does not respond to oral medications. It is what I need to do when those eventualities occur that is at issue, and that issue is one I need to get resolved in writing and to the satisfaction of everyone involved. The chances that I will be spontaneously cured of this are nil, so I must prepare for those eventualities as well as I can.

The fact that my MS appears to be worsening considerably and may be morphing into secondary-progressive MS is no doubt contributing to the increase in pain levels I am currently experiencing. That is beyond my control, unfortunately. The dental work I am going through is also no doubt adding to the pain. That is an unavoidable aspect of the necessary dental work, and also, beyond my control.

Dr. T, you have always treated me and my pain in a compassionate and humane manner. I am certain we can come up with some workable solutions to this ongoing problem. I am still not sure what happened last night, but I do know that I wish to avoid a repeat of the situation in the future.

Thank you for your time.


Sincerely,

Zen Angel



In a perfect world, a person like me could get adequete pain relief without resorting to begging, pleading and demeaning ER trips that sometimes leave you in more pain than you were in before you walked in the door. I understand that there are people who fake chronic pain to get narcotics. I understand that sometimes people with chronic pain get addicted, or use it deceptively to gain narcotics. I am NEITHER. I am just a person with a legitimate chronic pain issue that is tearing my life apart. What about people like me? Should we have to suffer, just because some people are using the ERs to get high?

I am never out of pain anymore. In order to be out of pain, I would have to take enough pills to knock me out for hours or leave me a zombie. Not to mention the fact that I would quickly run through the amount of pills allotted to me in a month. And at this point, with the ER turning me away....well, that's going to happen, anyway. Which means more trips to the clinic and ER for shots...if they don't turn me away, that is.

They call trigeminal neuralgia "the suicide disease." They say it's called that, because it's so painful, so excrutiating, that people commit suicide just to get away from it. But I'm not so sure. I wonder how many lose hope, not from the pain but from a health system that refuses to adequetly treat it? How many cannot take the constant blows to one's pride that comes with the current pain management system in America? Or how we're treated, always, like drug addicts or potential drug addicts? The frequent urine tests to prove we're not junkies, or the begging and pleading that comes with any request for new medication or more medication? And how many people commit suicide because some asshole Otherwise Busy Tin God turned them away?

I will not be one of them, never fear. My firmly-held religious beliefs would never permit it, and I would never leave my kids without a mom and my husband alone. But I understand it. Oh, how I understand it.

Tin God Syndrome: Caligula, the Ongoing Saga

Well, I have yet to hear back from the patient representative regarding my complaints about Caligula. I'll give her one more day, and then I'm calling again.

But that doesn't mean I haven't heard from Caligula himself.

Yesterday, I went to my doctor's office to be seen after my recent trip to the ER and run-in with that bastard Caligula. Now, my regular doctor isn't a bad sort. She's kind of young, but she's compassionate and willing to listen to the patient. There's a lot to be said for that.

Anyhoo, she asks me about the ER visit and I tell her all about my two run-ins with Caligula, and how awful he was. When I told her about him shaking my head and tapping my face, she was appalled. She immediately went to look for the ER report.

I could tell right away that said report wasn't good news. She had that unfortunate look on her face that people get when they are deciding whether or not to let you know you have spinach in your teeth and it was there the whole time you were talking to your boss/mother-in-law/cute bartender.

First, she tells me that according to the records from the first ER visit, Caligula did an actual physical examination for twenty-two minutes. The recommended exam for trigeminal neuralgia takes about two minutes. Secondly, he DID indeed call other hospitals to see if I had been there recently for medication, forcing me to wait in pain while he did so. His notes also indicated that he believed I was drug-seeking.

At this time, I told my doctor that Caligula never once asked for a drug test; in accordance with my pain management contract, had he asked me, I would have given him one. Just like the other dozen or so I've taken over the last few years, it would have been clean.

I can see, however, that this is NOT the bad news she's so reluctant to share. That morsel was on the second ER report.

On THIS report, the majority of his comments had more to do with my haircut, tattoos and nose ring than with my physical condition. But worse, his notes indicated that as it was the second trip in a month, in his view I was in fact drug-seeking. To bolster this belief, he added for "proof" that my left hand appeared to be burned in a manner that was consistant with a crack pipe.

A CRACK PIPE.

It took me a moment to recover from the shock of this. As I was trying to gather my thoughts, my doctor let me know in no uncertain terms that she was writing a report of her own, to be attached to the ER report, stating unequivacably that she had treated the burn within 12 hours of its occurance and it was NOT consistant with a pipe burn, but was clearly and without doubt a liquid scalding. Also, her report would include the fact that I have had numerous drug tests, and not a single one has ever shown any illegal drug use. Not to mention the fact that I have never exceeded my alloted amount of medication, did not even seek stronger medication for the first six years of my condition, and have repeatedly refused narcotics in favor of non-narcotic medicines like Torradol.

To say that I am offended and horrified by Caligula's oral diarrhea is putting it mildly. This utter bull feces is on my medical record. I, a person with a well-documented and diagnosed chronic pain disorder, have been accused of being a crackhead. A clumsy crackhead.

I've called my lawyer for advice. I'm also in the process of drafting letters to the medical board and the hospital review board. This time, Caligula's gone way too far.

Tin God Syndrome: Caligula Strikes Again

Last night, I simply could not take any more pain. I had to sleep. I haven't sleep more than two or so hours at a time in weeks, and I was at the breaking point. I called the doctor on call, who sent me to the hospital. I took a notebook with me, which ended up being a good idea, as I was there long enough to need a legal change of address.

Anyhoo, here's what I observed during last night's trip to that hell known as the Emergency Room:


11:30 PM
I go the the check-in window. I'm standing behind two extremely obese women who are waiting to get visitor's passes to the maternity ward. One is wearing
what can only be described as "fishnet short-shorts." You can clearly see her thong through them. I'm doing my best to look elsewhere. The women chat with the check-in gal endlessly about the new addition to their family, completely oblivious to the fact that there is a woman in pain and walking with a cane standing behind them waiting to check in. Finally, they move on. I pull out my Cheat Sheet, show it to the check-in gal and the ER process begins.

11:50 PM
The waiting room is nearly empty, which I take as a good indicator that I might not be here too long before being seen. As far as I can tell, there are only two actual patients in the room with me:

Patient #1 is a white woman in a hospital wheelchair. She is accompanied by her boyfriend, and they are both wearing Dairy Queen uniforms. The woman has an Ace bandage around her arm, but seems to be in high spirits. They are both watching "Roseanne" on the tv and laughing loudly. I wish I could share their good mood, but it feels like my face is being electrocuted.

Patient #2 is a Hispanic male, maybe 18 or 19 years old. I don't know what's wrong with him, but it's clearly not a stomachache: he's eating a Big Mac meal and when he finishes that off, he goes to the vending machine and gets two bags of chips and a Dr. Pepper.

Also in the room is a 20-something, attractive African-American woman
ignoring the signs asking that cell phones be turned off. She receives call after call, and complains in a booming voice about how her boyfriend has food poisoning so now she's had to waste the night in an ER. I turn my hearing aid down when she begins to describe to one of the lucky callers the exact composition and frequency of the boyfriend's vomitting spells. Ewww.

There is a phone provided for the room's use...but that is being commandeered by an African-American woman in her late 50's. Just as the other woman ignored the "no cell phones" signs, this one ignores the "calls must be limited to five minutes" sign next to the phone. She was on the phone when I arrived, and didn't get off for an hour...at which point, she left the hospital. I am not sure if she came in with a patient, or just wanted to avoid using a pay phone. At least she was not discussing bodily fluids.

12:35 AM
The triage nurse calls my name. I show her my Cheat Sheet, and she signs me in. I notice that she doesn't ask me what my level my pain is on the pain scale...but I don't want to speak, anyway, so I don't press the issue. It occurs to me (again) that I really must take a sign language refresher course. It would make these trips so much easier and less painful.

12:50 AM
About a dozen young, very attractive white people come rushing into the room. The girls all look like they came straight from a shooting of America's Next
Top Model. The guys are all very The OC-ish.

They are all visibly distraught over their friend, "Mandy," who came there by ambulance. For the next hour or so, I hear bits and pieces of what happened to Mandy. Only one girl there apparently witnessed the entire thing, but she left maybe 15 minutes into the Yuppie Squadron's vigil. I hear the words "car," "horrible," "blood" and "shattered" repeatedly. I know I shouldn't be eavesdropping...but I'm in pain and bored stiff. I turn my hearing aid up.

1:25 AM
Two guys arrive. Patient #3 has a shaved head and bad, prison-type tattoos all over his legs. His buddy has very long, 80's-era-Metallica hair. They sit in a corner as far from the Yuppie Sqaudron as they can get.

Hot on their heels, Yuppie Mom has arrived. She is frantic to know what has happened to Mandy. There is one girl in the group (whom I am going to call "Social Climber") who has pretty much taken over since the Sqaudron
arrived--despite the fact that next to no one, including Yuppie Mom and Mandy's boyfriend--seems to know who she is.

It is from Social Climber that the Story of Mandy in its entirety is finally told.

I was not far off the mark when I described the girls: they are, in fact, models. They were putting on a Fall fashion show, and afterwards, went to a "wrap-up" party. They car-pooled in, and when they were getting ready to leave, it became clear that the girl who drove Social Climber and Mandy, someone named "Robin," had been drinking at the party and shouldn't drive. Robin and her friend "Becca" became angry when Mandy suggested that Social Climber drive instead
(a point she repeats several times; Social Climber is doing her best to make sure everyone knows she's MANDY'S FRIEND and a VERY IMPORTANT PERSON). Apparently, Robin and Becca were angry and jealous that Mandy had gotten "first run" on the catwalk, and were in no mood to hear lip from her about driving. They all got in the car, with Robin and Becca in the front seat and Mandy and Social Climber in the back. The other car of models was still loading up; that car contained the girl witness who left earlier in the night and had yet to load up, and because of that, she saw the entire event.

As I said, the four girls are in the car, when Robin gasps and announces that she has dropped the "folder," which contains their paperwork and without which they will not be paid. She gets out of the car, looks under the car, and then tells everyone the folder has fallen under the vehicle. Robin then gets back in the car and asks Mandy to retrieve it as she is the tallest and therefore has the longest reach. Mandy gets out of the car, crouches down and reaches her hand under the car to search for the folder.

Robin releases the emergency break (they were on an incline)and the car rolls over Mandy's arm.

At this point, Social Climber announces three or four times that it was, in fact, she who called 911 so soon after the incident. It was she who took the keys from Robin so she could not drive away (although just how and when she did this, she never mentioned). And it was she who "tipped off" the police about Robin's drinking (cause you know, cops can never tell when a driver is drunk or not @@). And it was she who called Yuppie Mom and Mandy's boyfriend to tell
them to come to the hospital. And not only was Social Climber at the hospital
for Mandy, by golly, she was gonna stay there for as long as she was needed, no matter what!

Only when Yuppie Mom thanks and praises her enough to appease her giant ego does Social Climber stop bragging about her part in the story. One of the males
in the Sqaudron is actually so bored with Social Climber that he goes across the room and changes the channel from Murphy Brown (which I was watching) to sports (which I wouldn't watch even for a pinch in the ass from James
Spader). He actually tells the room prior to making the switch, "I'm sorry for anyone watching this, but I gotta change the channel!" in the most condescending voice. I AM watching the show, but this guy doesn't care and I can't argue. To make matters worse, he stands and watches it for a few minutes and then wanders away. He's gone for upwards of a half an hour. I would have changed it back, but by that time Dairy Queen boyfriend has became noticebly interested in some football show. Sigh.

2:00 AM
The admitting clerk FINALLY calls my name. I go into the little office, sign the financial papers and wait for them to type every last detail of my life into the computer. By the time I get back to the waiting room, it has mostly cleared out. Yuppie Mom, Social Climber, one of Mandy's friends and I are all that is left.
As I am now the last patient in the waiting room, I thought, surely I'll be seen soon?

2:30 AM
The Hispanic Big Mac Attack guy has now been seen, examined and discharged. He is leaving the hospital with his discharge papers. I am STILL here, 3 hours later. The pain is getting worse and worse, and I am beginning to panic. I change the channel. Still Murphy Brown.

2:45
My name is finally called! Hallelujah! I follow the male nurse down the hall and to my room. I turn on the little tv. Murphy Brown.

3:20
The door opens, and if my face had not been so incredibly painful my jaw would have hit the floor. It's CALIGULA.

I immediately ask for another doctor. Caligula looks at me for a moment, and then recognition sets in. He then lets me know that the ER is extremely busy tonight, and if I wanted to see another doctor it would mean two more hours sitting in pain. I give in. I do, however, insist on having a nurse in there with us. He's irritated, but complies. He says nothing to me until the nurse, a sweet lady with a Jennifer Aniston-type hairdo, arrives.

Caligula: Weren't you in here last week?
Me: No, about three weeks ago.
Caligula. Uh huh. Why are you here today, same thing?
Me: Yes.
Caligula: Is it any better, worse?
Me: It's worse. I can't sleep. I'm exhausted.
Caligula: Well, what do you want me to do?
Me: (thinking, I don't know, be a doctor?) I spoke with my doctor. She told me to come in and per my pain management contract, get a shot.
Caligula: (sneering) Of what?
Me: (thinking, of Kahlua? What the fuck do you think?) Morphine and Phenergan.
Caligula: (rolls eyes) Those aren't for sleeping, you know.
Me: (thinking, what an idiot) I can't sleep because of the pain.
Caligula: Right. Did you get your haircut?
(I had my mowhak re-shaved the other day)
Me: Yes.
Caligula: (sneers) Let's get you examined. (reaches for gloves and the dreaded tongue depresser, his preferred instrument for torture).
Me: (showing him the note from the dentist) My dentist has said, no oral exams.
Caligula: (angry) Why?
Me: (beginning to wonder if Caligula CAN read, as he never seems to notice the plainly obvious on anything written I've ever given him) It will exacerbate my pain and the infection. I am on penicilin for it now.
Caligula: That's not true.
Me: What is not true?
Caligula: It won't exacerbate the infection.
Me: Well, that's what she ordered.
Caligula: Well, it's not true.
Me: It won't exacerbate the infection, you are absolutely positive?
Caligula: I'm positive.
Me: But it WILL exacerbate the pain.
Caligula: I HAVE to look in there. (Once again, Caligula doctors never think much of pain; it's a complete non-issue for them).
Me: How many years were you in dental school?
Caligula: (looks pissed) That's not the point. Open wide.
Me: I will open as wide as I can.
Caligula: OPEN WIDE.
Me: (in a very firm tone) That's as much as I will do.

Caligula begins his exam. The nurse comes and takes my hand. Caligula does not do a "full" version of his horror show act today, and I am positive it is only because of her presence. The exam takes only two or three minutes. He doesn't shake my head this time. I am relieved.

Caligula: Well, I'm ordering you a shot. ONE SHOT.
Me: (confused) I only need one shot. Look at my file. I have never asked for more.
Caligula: (looks at me in disbelief). Well, just ONE shot. Nurse?

They leave the room. The pain is unbelievably worse. I hate this guy.

4:00 AM
A nurse (not the nice one from the exam) comes in with my shot. She tells me she'll be back in fifteen minutes to see how I'm doing.

4:15 AM
No nurse. The shot is beginning to kick in, and I am nearly weeping with relief.

4:35 AM
The nurse finally arrives with discharge papers. She never asks me how I'm feeling. She rushes in, and tries to rush back out. I stop her, and ask if I can speak with the doctor before leaving. She tells me it's not likely, can she pass along a message.

"Sure. You can tell him that I'm not drug-seeking. I don't enjoy coming here. It's not how I wanted to spend my evening. It's dehumanizing to have to beg for pain relief. And his unnecessary exams just make both my pain and my humiliation more acute.
You can tell him that for me."

The nurse takes a moment to pick her jaw up off the floor, and asks me if I need a copy of the patient rights statement and the number for the hospital administrator. I say yes, please. She gives me them, and leaves.

On my way out, I notice several members of the Yuppie Squadron entering a room near the exit doors. I peer inside (yes, I'm nosy) and see a beautiful young girl with her shoulder and arm in a cast. She looks so very sad. This, clearly, is Mandy. Yuppie Mom is there, talking on her cell phone (does NO ONE notice

the "no cell phones" signs?). Social Climber is nowhere to be seen.

She sees me looking at her, and I smile and say, "So...you're Miss Popularity! You'd better get well soon, dear. There's a lot of people pulling for you." Mandy smiles.

5:30 AM
I finally make it home. I'm asleep for about two hours before the pain comes back.

Thank you, Doctor Numbnuts.


I've called the administrator, who gave me the number for the patient representative, who is supposed to call me back on Monday to discuss my two encounters with Caligula. I can tell you this---I'm through with him. I don't care how much longer I would have to wait to see another doctor---I will NEVER be "treated" by this asshole again.

Tin God Syndrome: The Caligula Tin God

Yes, dear ZPT fans...I've run into yet another Tin God: the Caligula Tin God.

Last night, I was in so much pain that I couldn't stand it anymore. I hadn't had more than an hour and a half's worth of sleep at a time in two weeks. I couldn't eat, could barely speak and had begun to panic. And I don't panic easily.

Enough was enough. Time for another ER visit: my first in almost six months.

So I went to the ER, waited for 2 1/2 hours to be seen...and in comes the Caligula Tin God.

Caligula Tin Gods are of the opinion that pain is a minor concern. I stronly suspect this is because Caligulas have never been IN any chronic, debilitating pain themselves. Caligulas are also the first to suspect you are "drug seeking," because once again: they don't think much of your, or anyone's, pain. They look at people coming into the ER for pain relief as bothersome, crybabies and potentially, drug addicts. In any case, a complete waste of their time. And whereas other

Tin Gods who think this way simply try to get you in and out of their ER room as quickly as possible so they can treat "real" patients...Caligula wants you to suffer for it. Caligulas are rare beasts, but when you do come in contact with one...they quickly turn your bad situation into something far worse.

The first thing Caligula says to me is that he's read my ER Cheat Sheet, and although I have requested not to speak...I am going to be required to speak so he can "rule out speech problems." He is also annoyed that the nurse didn't force me to wear a gown (pulling my shirt over my face at that moment was more than I was capable of). The interrogation (because that's what it is: Caligulas turn any exam room into a torture chamber) begins:


Caligula: You have a pain management contract?

Zen Angel: (speaking through a clenched, painful jaw) Yes.

Caligula: And what does it say?

Zen Angel: (wondering if he really DID read my Cheat Sheet, because it's written there in plain English) To come into the ER if my meds don't work.

Caligula: Your pain meds?

Zen Angel: Yes.

Caligula: Are you out of Oxycodone?

Zen Angel: No. They just aren't working.

Caligula: When did this bout begin?

Zen Angel: Two weeks ago, when I burnt my hand.

Caligula: Which hand?

Zen Angel: (wondering if this guy is a moron, as only one hand is wrapped

in gauze) My left one.

Caligula: How did that occur?

Zen Angel: My leg went out on me, and I spilled chicken soup on my hand. Second-degree burns.

Caligula: (in a condescending tone) Who told you that?

Zen Angel: My doctor, when she treated it.

Caligula: I see you've been to this ER before.

Zen Angel: Yes, but not for about six months.

Caligula: Where have you been going in the meantime?

Zen Angel: (confused) Nowhere.

Caligula: Which ER have you been going to in the last six months?

Zen Angel: NOWHERE. I haven't needed to. My meds were sufficient.

Caligula: I'll have to call around and check on that, you know.

Zen Angel: (flabbergasted) Go right ahead.

Caligula: Have you seen a neurologist?

Zen Angel: Yes, three.

Caligula: What are their names?

Zen Angel: I don't really remember right now.

Caligula: (condescending) And WHY is that?

Zen Angel: I'm in too much pain to think straight, Doctor.

Caligula: (rolls eyes) I'll have to examine you now.

Zen Angel: (thinking he meant the sort of exam I usually get: a few touches to the face to rule out trigeminal tumor or paralysis; painful but not unbearable) OK.

Caligula goes to a drawer and begins rummaging around. I am getting worried about what he intends to do.

Caligula: Lay back on the pillow.

Zen Angel: Why?

Caligula: (sighs) I have to examine you now. (pulls out a large tongue

depressor and a light)

Zen Angel: (horrified) I can't open my mouth wide.

Caligula: You have to.

Zen Angel: (begging) Please, don't do this. You have no idea how much it hurts.

I am already diagnosed.

Caligula: Well, that's what you get for coming in on a weekend.

Zen Angel: (thinking, what the fuck?) Please, don't.

Caligula: Open your mouth wide.

Zen Angel: I can't.

Caligula: OPEN YOUR MOUTH WIDE.

Zen Angel: (opening as wide as I can) This HURTS.

Caligula: (ignoring me) Say "ahhhh."

Zen Angel: (writhing in pain) AHHHHHHH!

Caligula begins taking the tongue depressor and painfully moving it all about my mouth, scraping my gums, tapping on my teeth and pulling my cheeks in many directions. I am in agony, and pull away from him.

Caligula: Have you even SEEN a dentist?

Zen Angel: (offended) Yes. I am in the middle of having all my teeth removed. It's on my Cheat Sheet.

Caligula looks at me blankly. I realize he hasn't really read it.

Zen Angel: I lost my teeth due to contaminated reservation drinking water.

Caligula looks at me in disbelief. I would elaborate, but the "examination" has left me curled up in a fetal position and crying my eyes out in pain.

Caligula ignores this.

Caligula: Sit up.

Zen Angel: (sitting up) Why?

Caligula grabs my head with both hands and begins SHAKING it back and forth, forward and back. He does this so hard, he makes my hearing aid feed back, which he ignores. He then begins tapping on my face, and only then proceeds to the usual facial exam that I am used to. By this time, I am beside myself with pain.

Caligula: I'll be back.

Caligula leaves the room. I am in worse pain that I have EVER been in from the neuralgia. I can't stop crying, and call my husband. He is pissed, and tells me he is on his way. I curl back up on the bed, staring in anger and horror at a little sign which reads: "Your comfort is of UPMOST importance to us! Please let us know if there is ANYTHING we can do to make you more comfortable!" I think to myself, yes, there are two things you could do: give me my damn shot, and then shoot Caligula.

Twenty minutes go by: twenty minutes of the worst pain I can recall ever being in. I am nearly hysterical. Finally, the door opens: it is not Caligula, thankfully, but the very sweet and understanding nurse who first spoke with me.

Hallelujah, she has my shot.

Nurse: The doctor spoke with your regular doctor, and ordered your shot. It's Morphine and Phenergan. Is that all right?

Zen Angel: YES!

The nurse then gives me my shot, and tells me she'll check on me in 20 minutes to see if it's working. She never does. I don't think this is necessarily a shortcoming on her behalf, as it was a shift change and the new nurse didn't seem as on the ball as she was.

My husband arrives. I am so relieved. The shot has just kicked in. The pain isn't gone, which is unusual as Morphine usually does the trick. I strongly believe that it would have, had not Caligula put me through his diabolical "examination," which might be against the Geneva Conventions. I'm not sure. The pain is, however, bearable...and I can finally get some much-needed sleep.

That is, if I can ever get out of the hospital.

The new nurse comes in twice over the next half-hour, to let me know that Caligula had STILL not typed up my release forms. My husband is getting more and more pissed off.

FINALLY, the new nurse comes in with the forms. A single sheet of paper, with several typos. I don't even have to sign the freaking thing.

We dash out of there and head home. I slept most of the day, thrilled to be able to do so. The pain came back around 7PM. I am unwilling to go back to the ER after my horrific experience, but I don't know how much longer I can hold out. Hopefully, until my doctor's office opens at 8AM.

Now I am left with a connundrum: I very much want to complain about Caligula's treatment of me, which is very much contrary to the hospital's policy on pain management and treatment. I was left feeling humiliated and violated by Caligula's behavior...and that's saying a lot, because I've run into a shitload of Tin Gods in my time, and haven't felt violated by one in this manner EVER. But this time, I do. I feel...attacked. He did everything in his power to make my condition WORSE, to worsen my pain and agony, for no fucking reason whatsoever. When the pain DID come back, it did with a vengeance I haven't ever had to deal with before, and I know beyond a shadow of a doubt that Caligula is to blame.

My problem is, I need this ER. Badly. There are times when I simply cannot wait for my doctor's office to open. I need relief NOW. And I'm afraid to rock the boat. I'm afraid that if I complain about Caligula, the next Tin God will simply refuse to treat me at all. And I hate, hate, hate that I have to feel that way. I hate that I have to worry about such a thing, that I can't simply expect to be treated humanely for a legitimate, chronic illness referred to by nearly every medical authority as one of the WORST pains known to mankind.

And I hate Tin Gods, for putting me in this position in the first fucking place.

I haven't yet decided what to do. I'm leaning towards making a complaint anyway, because although I worry about rocking the boat, I am MORE worried about running into Caligula the next time I need a shot.

And I'm worried about the next patient, who comes into the ER needing relief and finding only the inhumane hands of this bastard Tin God.