Saturday, December 22, 2007

My night at the ER

16 December 2007 Day 69
Originally uploaded by lilituc.

I was doing so well, and then on Sunday afternoon, I started vomiting. Nothing had changed, so it was pretty odd. I didn't have ketones and my bg was fine. My husband called the doctor on call - again Dr. S. This time he made Dr. S listen to my entire medical chart and wouldn't let him talk over him. Dr. S said it was no big deal and he'd call in a suppository. He also said to stop taking all the medications I'd been prescribed. He said we could go to the ER if we wanted to, but made it sound like we were being overly paranoid and there was no point. I'm not going to tell you what we call Dr. S in private!

Normally I'd wait longer than two hours to go the ER, but it was already 5 pm and I hate waiting all night long and not being able to sleep, so I figured we might as well go right then. We got to the ER just after 6 and I didn't get triaged until 7:15. To be fair, they had their hands full. There was a woman in her early 30s with severe abdominal pain, a two-year-old who'd had explosive diarrhea for several days, and an elderly woman with a possible broken hip. Actually, I can say "probable" after observing her for 20 minutes. So they triaged me and then I didn't get seen until 9:30. I had to keep getting up to vomit while I was waiting.

By the time they saw me, I had moderate ketones and was pretty dehydrated. They didn't check until after they'd given me one bag, so they kind of went overboard and took a bag right out of the fridge. I warned them cold fluids would probably make me nauseated (because of another medical condition), but they were all, "you need fluids" and wouldn't hear it. The weird part was another nurse randomly came in, walked over to me, taped the line up and down my arm twice, then left. So I was a million times colder. In retrospect, I should have just pulled off the tape, but I was kind of confused at the time. Anyway, I got really nauseated.

That's when they went into overdrive! I thought it was odd they thought that was such an emergency. The doctor came running in and the nurse and then they gave me Phenergan and I was out. So I didn't get to ask the doctor the questions I had or get a copy of my labwork. I was discharged around midnight.

For those of you who work in the healthcare field...what do you think of this - it's the best ER in town, but they don't have private rooms. The patient on the other side of the curtain was a homeless veteran who called 911 because he wanted to commit suicide, and while I was getting my fluids we basically overheard everything. The poor guy.

I had a surreal moment the next morning when Dr. S's nurse called to find out what happened. I explained to her about what had happened, but she didn't seem to grasp that diabetic + ketones + dehydration = super bad. Also, when I told her the Phenergan knocked me out, she actually said, "No, honey, you're thinking of the painkiller. Phenergan isn't sedating. Does your tummy still hurt?" So glad I didn't get Dr. S as my surgeon!

They never figured out why I was vomiting. I've been okay since then in that I've been progressing normally.


Jonah said...

Man, your post makes me think I never want to move to Seattle!

My endo is available for me to talk to 24/7, except two weeks per year when he's on vacation.
When I was vomitting and my mother called him at two in the morning, he advised going to the hospital and then he gave us more advice on what to do if we decided not to go to the hospital.

And when I was diagnosed and the internist sent me home and then later found out I was in DKA, she called the hospital ahead of time so that I didn't have to wait at all.

Lili said...

Jonah - I'm not sure why you wouldn't want to come to Seattle. I didn't call my endo because I didn't need her advice. I knew the point at which I needed to go to the ER and decided to go early in this case due to the time. We contacted the oral surgeon's office because they needed to be notified. I thought they might have some further insight into why I was vomiting, but they didn't, which wasn't a surprise or anything. I just thought we'd at least check.

The ER might not have realized how quickly a Type 1 diabetic would develop ketones with vomiting, but that's pretty common so I wasn't surprised. The treatment I received was mostly appropriate. I certainly wouldn't expect to wait if I was in DKA!

Jenny said...

The Tigan suppositories doctors have prescribed for many years for vomiting were completely discredited this past year. They don't work. This was in all the newsletters for doctors. HERE'S and article discussing this.

You really need a better doctor!

Christine-Megan said...

It's not uncommon for big ER's to not have private rooms. They just can't keep up with how busy they get.

I go to a small "ambulatory center" if I can and they have private rooms, which is nice.

Jonah said...

Ah, I thought it was your endo's office you called, I didn't get that it was the oral surgeon's office.

Lili said...

Jenny - He's definitely not my doctor. The ER offered me the suppositories as well. I didn't get either of them because I wanted to know if they were as sedating as the other forms, and no one could tell me. Well, except Dr. S's nurse, who thinks Phenergan isn't sedating at all, heh.