As I mentioned last month I had a health issue that at first I thought wasn't dangerous, but worsened and illustrates an asinine preconception the right has about emergency rooms that is seriously wrong.
More below the fold, but you'll need a strong stomach.
April 3, 2010 around midnight, I was preparing for bed, when my nose
started bleeding from the right nostril. I could not get it to stop. After
fifteen minutes with it bleeding at about the consistency of a drip coffee maker, my wife and I called a friend and we went to the
emergency room at Elmhurst Hospital.
After waiting for more than one hour, I was finally called by the triage nurse and was subsequently sent to an area called "Fast Track." After nearly two hours waiting, during which time my nose started bleeding again briefly, I was called in to see a nurse practicioner, who blamed it on " the dry weather" occurring recently. When I pointed out that I had never had a nosebleed in my life, she seemed uninterested as did the doctor who examined me. Their recommendation was that I irrigate my nose regularly with a saline spray. They could not have been less interesested in my concerns
At about 2 a.m. on Monday, April 5, 2010, I was awakened by the sensation of my nose bleeding. I went to the bathroom where I could see my nose bleeding. After 20 minutes of pressure, it stopped. I went back to bed and about 4:30 a.m. it started bleeding again. After about thirty minutes, it stopped. I called my primary care physician and she agreed to see me that morning.
My primary care physician referred me to a otolaryngologist and drew blood to check my platelet level and clotting factor, both of which she advised me later were normal. I called and made an appointment with the otolaryngologist for the next day.
That afternoon, my nose started bleeding again. After approximately one hour of pressure, it continued to bleed. I could feel it going down my throat. I also nearly choked on a large clot about the size of a folded handkerchief that I coughed up after much gagging. At one point, I removed my hand from my nose for a second to see if it stopped. A spurt of blood reminiscent of a fountain flew out of my nose. This is what my bathroom sink looked like some three hours after the spurt flew out of my nose:
As you can imagine, that unnerved me. At that point I got a friend to
take me to the emergency room at New York Hospital in Flushing,
Queens. After a wait of about an hour, I recounted what had happened
to the doctor, who advised me that they could not see anything
bleeding at the moment and told me to continue to my appointment with
the otolaryngologist. About an hour after returning home I had
another nosebleed, which stopped after about half an hour of applying
pressure. Upon waking at 6:30 a.m. the next day, I had another
nosebleed, which stopped after about twenty minutes of pressure. During all this my stools were black, indicating the presence of blood.
I went to work and went to the appointment with the otolaryngologist that morning. My nose was not bleeding, despite her efforts to induce bleeding to better cauterize the bleeding vessels. She eventually cauterized an area that is commonly a problem, suggested that I spend a thirty to forty minutes walking in the neighborhood to see if I started bleeding again. As I didn't, I took the subway back downtown to work. Upon entering the elevator, my nose started bleeding heavily. I asked the receptionist to call the otolaryngologist's office for me and they advised me to come back in. A colleague helped me get a cab.
Upon returning to the otolaryngologist's office, the bleeding had stopped. She packed my nose with approximately six feet of sterile packing material, prescribed penicillin and vycodin for the excruciating pain caused by the packing and told me that she thought it best if it left it in until Friday, April 9, 2010.
I went home, filled the prescriptions and attempted to rest. I could feel and taste blood in my throat. My stools remained black and I felt weak and tired. I was unable to sleep the entire night due to the pain. On Wednesday, April 7, 2010, the otolaryngologist called me and told me that she actually felt it would be preferable to remove the packing that day. I went to her office, she removed the packing and my nose started bleeding again. After several attempts to locate the source, she advised me that it appeared to be coming from a position high in the nose (a sensation I had explained to both emergency room doctors). In her words, she had never seen a nose bleed come from a position that high in the nose. She said that it appeared to be an artery close to the skull base. She wanted to have a CT scan to rule out any other issue such as a tumor or some other growth. She called my insurer and received the approval.
I had the CT scan done and returned to her office. She was trying to get approval from my insurer for a procedure that would require her to admit me to the hospital and have the procedure to cauterize the vessel conducted under general anesthesia. She expressed concern that the vessel was close to the skull base and that possibly, due to the thinness of the skull at that location, she could possibly fracture the bone. She packed my nose again and I went home.
At the time I left her office, my insurer still had not granted approval for the procedure.
That night I was barely able to sleep. I woke at three a.m. with the metallic taste of blood in my throat and some seepage of blood through the packing in my nose. I woke my wife and we went to the emergency room at New York Presbyterian Hospital in Manhattan. After explaining the situation to the emergency room doctor with all the detail I could muster, a doctor from interventional neuroradiology explained that they felt the best situation, given the frequency, duration and volume of the bleeding was to perform an embolization of the artery. I consented, the procedure was performed and my nosebleeds have stopped. The otolaryngologist told me that she spoke to the doctor who performed the procedure and was advised that they found two "blushes" (you have to love the seemingly benign terms they use for something so serious) coming from arteries in the skull. She advised me that I was fortunate. I joked with her that there is some benefit to being a bit of a hypochondriac.
The emergency room doctors are clearly overworked. While I am angry that the doctor at Elmhurst Hospital seemed to have his mind made up and really paid scant attention to the fact that I had never had a nosebleed and didn't even suggest that I might want to sleep in an inclined position to avoid possible aspiration of blood, something I figured out on my own, I do appreciate the fact that it was a Saturday night and the ER was chaotic, to put it mildly.
I was clearly third time lucky, but I also have good insurance and notwithstanding that fact, I was essentially blown off twice in the emergency room. i could not imagine what would have happened if I had no insurance. Emergency rooms are clearly not the answer for health care for the uninsured. It's beyond intellectually dishonest to make that argument. It's inhumane.