Tuesday, April 29, 2008

It's MRSA.

Here's a little recap of my hunt for a hand surgeon last week. It started Thursday morning at the dermatologist's. I was there for a different thing, a biopsy. I showed him the hand. He cultured the draining fluid and referred me to a hand surgeon on an urgent basis, saying it needed evaluation and possible debridement. That's when they go in with tools and scrape it all out. Not pleasant. But most certainly better than the alternative.

Of the six hand surgeons on my insurance plan, three refused to operate on an infection. One told me it was because the surgical facility they use wouldn't allow it.

Another doc would have done the debridement, in an inpatient hospital setting; but after I faxed my medical history to his office, he changed his mind. This was a highly regarded surgeon, and the one my dermatologist specifically referred me to. After he changed his mind, I asked his staff member a certain question to pass on to the doc; there was something I wanted to know. Today I called for my answer. Would he see me for something else, a non-infection hand surgery? No.

Four refusals. Two docs were left on the plan. One seems new to the area; no one has any idea if he's any good or not. I'd prefer not to go to an unknown doc if I can help it. The other doc, a Dr. M., wouldn't see me until the next week.

So by Thursday afternoon, I could see this was a serious problem. At 3 PM I went to the ER at Holy Cross. Why? Because I'd learned, in my health adventures, that they'd refer me out to a hand surgeon that would have to treat me, and it wouldn't matter if that doc was on my insurance plan or not.

Good tactic, huh?

Except I didn't leave the ER until 5:24. The surgeon's office was closed. I didn't have him paged. Wrong decision.

I called early Friday morning, and he'd left for the airport only ten minutes before. He came in to do a couple urgent procedures before he left.

I called my old hand surgeon, Dr. G, who did the great job on my right hand - but isn't on my current insurance plan. He suggested some docs, said he'd make some calls if he could, but nothing helped. Same with my primary and my ID doc. They'd never heard of this *refusing treatment* business and were as outraged as I was.

But that great Dr. G? He would have refused it too. That makes five out of seven, folks.

I called Dr. M again. He was, at least, recommended by my primary. On Thursday, his staff member had told me - in a distracted, bored voice - that he didn't see people on a *walk-in* or urgent basis. She seemed a bit outraged that I'd even ask. Since it looks like he's closely affiliated with Broward General, which is our local Level 1 Trauma Center, this was a bit surprising.

Docs with dumb and/or attitudinal staff are to be avoided; and since he wouldn't see me urgently anyway, I turned my efforts elsewhere. I called again Friday. Same response.

By Monday morning, of course, I was out of options. I called Dr. M's office again. He can see me Wednesday. Tomorrow. My appointment's at 11 AM.

Only time will tell how this will play out. I don't know that this one-week delay in treatment is going to make any difference. But it certainly is a reasonable possibility. Debriding an infected wound before it closes is a very different procedure than doing so after it closes. Done afterwards, we may be talking about far more permanent damage to the nerves, tendons, tissues, blood vessels, and bone. We're also talking about a higher risk for amputation, septicemia and death. That's exactly how it went down with the huge MRSA abscess in my left foot in 2004. Why it's maimed.

The one-week delay, then, may well mean a worse outcome. In that case, aren't we looking at a violation of the Hippocratic Oath? The part that says, First, do no harm?

If nothing else, I must ask: Why are you a doctor in the first place? Why the hell are you refusing to treat someone because they're sick?

Say it all comes out fine. The infection clears, not much scarring or loss of function, we don't even need the debridement surgery, just antibiotics and time.

At the very least, this has become one of the more traumatic infection episodes I've had. The worst since the left leg got so bad in 2006. I HATE to be distressed over these things. I put a great deal of effort into staying calm, cool and collected. Peaceful. I do NOT like to be rattled by my health issues.

On Thursday, when the reality of the refusals hit me, my blood ran cold. The calm and reasonable fear this all caused has not stopped since then.

Now? Now I'm looking at the wave of the future. After trying so hard to get medical people to take MRSA seriously in the past, like at Holy Cross inpatient where they kept trying to put another patient in my room and wouldn't wash their hands after touching me, the pendulum seems to have swung the other way. I bet that recent study had something to do with it: the one that says MRSA kills at least 19,000 Americans each year. More than AIDS.

Logically? The patient they should fear the least is me. They know what I have and can take precautions. It's the unknown carriers that spread this, not people like me who know we're colonized and say so. But people are not always logical, not even the vaunted intelligent and educated members of the medical community.

The wave of the future? I'll continue to get more infections. One day I'll get a bad one. I'll be refused treatment again, over and over; and before I find someone who'll treat me, it will be too late. Septicemia will set in and I will die.

And yes - unfortunately, I was right. It's MRSA. The culture came back today.


Jean said...

oh, dear k...all the strength I can gather is heading your way.

Jan said...

k..this is so unfair!

The practice of Medicine has become nothing more than a business..to heck with the Hippocratic Oath, it seems.

I'm sure that words mean nothing to you right now, but please know that I am praying for you, and praying that somehow, someone will be willing to help you.

Pretty Lady said...

I'm thinking of you all the time.

You're at the doctor right now, as I write this, I see. You're on top of it. It's not too late; you know how to take care of yourself, you ARE taking care of yourself, you have the relationships with doctors in place, and you know how to communicate.

I'll check back soon.

k said...

Jean, I can feel that. It helps. Thank you.

And you too, Jan and Pretty Lady. Words DO matter. Why we blog, right? Words matter. They make a difference.

Jan, now I know how to handle this: start with my usual ID doctor and don't look back. If I'd just gone straight to her office last week, things would have come out differently.

But I think - I hope - no lasting harm has been done. The wound opened again to drain itself, like a miracle. Jeez. I'm crying. That one thing can made all the difference in the world. Just letting it drain on its own.

I think I'm so calm and then I'm in tears again...I'm so tired. For two days I couldn't get out of bed, fevers, bad.

I'm sorry you have to read all this because I always think of your mother and how it was for her at the very end. It makes me so angry I have to close my mind to it, still, even though I've known for a while now. And then I write all this MRSA stuff and YOU read about MINE...

My ID doc NEVER forgets why she's a doctor. NEVER.

Pretty Lady...see the comment in the post above, okay? I need to think on this as I garden.