Trauma Observation #17/ Medical Records Monday, Feb 23 2009 

I don’t need a Kindle, I’ve  got computerized medical records to read. They’re some of the most interesting “books” I’ve ever read. They are a series of notes by individuals who practice different medical arts: medical social workers, nurses, PT/OT, doctors, surgeons, respiratory therapists, nutrition. We are all writing in the chart analyzing, assessing, planning, discussing, documenting, discharging  a persons medical life.

 There are different screens in the patients electronic medical record. There is one that simply lists in a descending row a short description/diagnosis of what the medical problem was that brought the person to the hospital. To me they are poems that tell a story and leave a trail. Below are the words I found in one patient’s electronic medical record.

med refill

blood in urine

defibrillator malfunction

sob (short of breath, not son of a bitch)

chest pains

rectal bleeding

dizziness

epistaxsis

left side numbness

rectal bleeding

testicular swelling

chest discomfort

sob

scrotal swelling

palpitations

med refill

swollen testicles

Trauma Observation #16 Death by Denying Dental Care/Necrotizing Fasciitis Friday, Feb 13 2009 

I got a call from ICU to help identify a patient. He was dying and the doctors needed to get in touch with the family ASAP. I was nervous as I rode the elevator up to the floor. The man was  hooked up to every machine invented. Big blue and white tubes going in and out of every orifice, veins impaled with IV’s galore, hyperventilating machines, heart monitors beeping and beating out time,  flashing screens full of green lines, zig zagging peaks and troughs, the surveillance of all bodily functions.  And I looked at his swollen and sweaty face and saw death.

The nurse told me to enter the room I’d have to gown up, wash my hands, and wear gloves. I didn’t like putting on all the gear, it felt creepy and there were killer germs everywhere and I needed to be on guard. Then the residents came over to talk to me. They explained what happened in voices that betrayed fear, awe, disgust, and disbelief. The patient had an abscessed tooth and they surmised that he hadn’t gone to see a dentist until the infection was out of control. The pain must have been excruciating. He saw a dentist and then went to a  hospital ER  and got a prescription for antibiotics filled.  But it was too late. The infection had spread: it was necrotizing fasciitis, the dreaded flesh eating bacteria.  Actually, that’s a misnomer. The bacteria doesn’t eat flesh, it pumps out mega amounts of toxins and exotoxins that destroy tissue and organs.  The doctors were gobsmacked and said this isn’t supposed to happen, this guy shouldn’t be in this room dying, he should have been diagnosed and treated immediately. They didn’t expect the patient to make it through the night because the bacteria had invaded major organs and one by one they were shutting down.  Domino effect.  The super, duper antibiotics – vanc, clinda – that were being pumped into him weren’t doing a damn thing.  The two of them just shook their heads. For a moment we all stood around the door to the patient’s room in  an awkward silence. And I thought: this guy is going to die tonight, alone, if I don’t hurry up and find someone and tell them to get here, STAT!

I had to go through his belongings, find the wallet, or even better, a cell phone with preprogramed numbers. I lifted the bulky plastic bag out of the closet. I gingerly  took a pair of pants out of the bag. They were filthy dirty, the kind of dirt that is so embedded in the fabric that it will never wash out. Pants that are worn over and over and over again, over years – poverty pants. I could see the outline of  a wallet bulging from the back pocket and slipped it out. It was a  beat up old piece of brown leather that had been well sat on.  There was no money, not even a penny. No credit cards. I fished out a few business cards. With my gloved hands, I reached back into the bag and and pulled out a shirt, socks, muddy boots, a black leather coat.  I saw the bottles of antibiotics. They were full of pills.  No cell phone. Drats!

And then I felt sick to my stomach and scared. I stood there and thought, what am I doing? I was violating the patient’s privacy, a nosy parker, touching his personal belongings, rifling through his things without his permission.

I started calling the numbers on my hospital issued cell phone. I left short, cryptic voice mails designed to create fear and panic and thus, quick call backs.  A few minutes later the phone rang. The caller didn’t know the patient. Another person rang and said he’d call someone who might be able to help. Phone rang again, the woman said the patient was an acquaintance but she knew his pastor and would have him to call me. Pastor called and said he was on his way. Whew, the patient wouldn’t die alone after all and who better to be with him than his pastor.

I found out the next day the patient “expired.” The health care system killed him. He was a poor man, no medical or dental insurance.  And because he had no access to a dentist, and dental care is expensive, and dentists don’t like to, and by law don’t have to see uninsured patients, he died. If he had been able to see a dentist and got diagnosed and treated  right away he might be alive. He’s not the first and and he won’t be the last to die this way. Deamonte Driver, a 12 year old boy from Baltimore, died because his tooth infection spread to his brain. The Washington Post ran a story with this headline: For Want of a Dentist. I have another headline, it’s more accurate: Death by Denying Dental Care.

I found out too, that the pastor never came. The patient died alone.

Trauma Observation #15 Transamerica/A Blessing Sunday, Feb 1 2009 

I had my first transgendered patient. He was a she, but he was doing she poorly. The patient looked like a man trying hard to be a woman, but in no way pulling it off. The voice, the facial stubble, the clothes said male. I suspect the patient couldn’t afford to take hormones and was poor. I ended up being right on both counts. The patient was elderly, tall and skinny with long, greasy, gray unkempt hair. She was new to Chicago having just recently arrived from California. California is a much better place to be transgendered. San Francisco practically invented transgender and hippie; she was a bit of both. Midwest, not so much. She had come to Chicago to live with a friend and start a Church for the transgendered. She called herself a Reverend. The plans fell through and she was asked to leave her friends apartment. Homeless and still wanting to open a church for the transgendered. She had both savvy and schizophrenia. My job was to find her another shelter. She had been at  Pacific Garden Mission but didn’t feel accepted or safe there. We talked for a few minutes about how difficult it was to be transgendered in America. She thanked me for not judging her and trying to help. I called a gay organization and was told to send her to a shelter on the North Side, stay on the North Side they cautioned me. I brought her to my office and she called a relative in California to let them know she was okay. I could tell from the conversation it was a person who really cared and understood her.

Later that evening I found a note the patient left for me on my computer keyboard. It was written in cursive and said, “Hello, I would like to offer you something, the only thing I have to give.  A blessing for you, a person who has helped me. Father above, I ask you to bless this woman. May she have all she needs in life; good health, wisdom, abundance and understanding. May she be blessed with her hearts innermost desires. Watch over her lord Jesus. We ask in your name. Reverend.”