Heart attacks and other silent killers

by Grace aka costofcollege

She thought it was only a 24-hour bug. What she really had almost killed her.

A 46-year old woman awoke suddenly before dawn feeling “kind of funny”, and then ran to the bathroom to throw up.  Her husband insisted on taking her to the emergency room because he thought she could be having a heart attack.  It turns out he saved her life.

Don’t think it can’t happen to you and don’t trust your instincts. 

I would tell you to trust your instincts — except in this case my instinct was to chalk up my symptoms to something else and to worry about whether the doctors and nurses would think I was crazy. So I’ll say don’t trust your instincts, if your instincts are to wait and see what happens. When you just don’t feel right, don’t ignore it. Fredi says that 9 out of 10 women with my symptoms would not have gone to the hospital. I wouldn’t have gone either, if it weren’t for Tim.

Many women have no chest pain, no tightness, no pain in the arm or jaw until it is much too late. Many women suffering a heart attack simply “don’t feel right,” just as I did. So if that happens, don’t ignore the feeling and don’t worry about someone thinking you’re crazy. Get yourself checked out. The worst thing that happens is they send you home and tell you you’re fine. You can live with that.

I’m sure I’m not the only one who has thought about similar scenarios, and hopes to make the right decision if a heart attack, stroke, or other calamity strikes.  I can relate to the woman in this article.  Once while on a tropical island vacation I woke up in the middle of the night with severe pain in one arm.  Although I considered that I might be having a heart attack, I ultimately decided not to go to the hospital.  It turned out to be the right choice, but I could have been deadly wrong.

Have you ever wavered in deciding whether to rush to the emergency room?  How did it turn out?  Do you feel confident about knowing how to react to the symptoms of heart disease, the “No. 1 killer of women in the United States”?  What lessons have you learned from the experiences of family or friends?  Any advice to share?

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153 thoughts on “Heart attacks and other silent killers

  1. A 45 year old man collapsed and died during our school fundraiser. Many of the people there are up grading our health scrutiny. I hope that saves some people.

  2. It would be ever so awesome if doctors weren’t so condescending and snotty if you turn out not to have a fatal illness.

  3. Well, that’s terrifying — I would have tried to go back to sleep and told DH to go to work.

    The problem is that I have generic stuff that makes me feel “off” all. the. time. When my asthma kicks up, it feels like a weight on my chest (I don’t have the kind that makes mucus, it’s more a spasm kind that constricts airflow). When my reflux acts up, I get dull chest pain and/or nausea. When my thyroid acts up, I’m exhausted. If I went to the ER every time I felt off, I’d be “that lady” whom everyone learns to ignore (I guess if I keeled over in the ER because they didn’t take me seriously, I’d give my family a nice wrongful death suit, but that’s not really the end goal here).

    I just have to hope that my apparently good genes (low cholesterol and BP) mean that something else is more likely to kill me, and that if I do have a heart attack, it will be a sufficiently beyond-the-normal version of “wrong” that I will know to do something.

  4. We spent one long weekend in the hospital because DH had symptoms.
    It was a virus, but I’m still glad he decided to go to the hospital.

    I know several former colleagues that have died from heart attacks. One was a woman at work.

    I think I shared last year that the owner of a local business that I’ve known for many years died last year in her car from a heart attack. She was often stressed, a little overweight and she had a lot going on in her life. She said she had no time for the doctor.

    Many of the symptoms do look like something else so I can see why people avoid going to their doctors or ER until it’s too late.

    I’m deep in the middle of that health care crisis with DH relatives. It’s so frustrating when this all could have possibly been avoided if she ever went to a doctor.

  5. Frank Sinatra Jr. died of a heart attack yesterday. He was 72. I think at age 72 you’re more likely to go to the hospital, and maybe he had known conditions or risk factors. Sr. died of a heart attack, but at in his 80s IIRC.

    Sinatra was in town to do a concert at the Peabody Auditorium on Wednesday night, but died suddenly in the afternoon … according to his rep.
    We’re told Sinatra cancelled tonight’s show when he felt lightheaded. He was admitted to Halifax Medical Center, but according to his rep he said he was feeling better. He suffered the heart attack while still at the hospital.

  6. My FIL had a heart attack about five years ago and I think just had a pain in his shoulder. His girlfriend is a nurse so she insisted on him going to the ER, otherwise he would have probably ignored it and figured he tweaked something. I definitely tend toward not going to the dr., even with the kids. We know someone from my husband’s law school that had a heart attack in his late 30s but I don’t know the full story about symptoms. I just don’t think I would even think about it at this age but it can happen.

  7. In my early 20s, I once had all the classic symptoms of a stroke: confusion, paralysis on one side, slurring words followed by an inability to speak. I knew it could be a stroke at the time and refused to go to the ER or call an ambulance. Very stupid move.

    If you are dealing with someone having obvious signs of a problem who is refusing to go to the hospital, keep in mind that the person is not thinking clearly and you may need to ignore it and take charge. The pill causes heart attack and stroke sometimes, even in otherwise slim and healthy young women. That’s why you aren’t supposed to take it after age 35.

    Luckily, I turned out to have a rare problem and not a stroke.

  8. After spending some time yesterday being educated on “Shared Decision Making” (coming soon to a pop health nyt piece near you) , a patient recalling that they were told, “I’m the boss of everyone and I’ll take over from here” makes me cringe. Would love to hear how informed her consent was for the major procedure she underwent.

    I have a million thoughts about all this. First, I would be skeptical of believing that all these people who pass away in their sleep (or cars) die of heart attacks. We don’t perform autopsies in the vast majority of deaths in the US, so if you are overweight you die of a heart attack, normal weight you die of an arrhythmia. Doctors have to write a cause of death on the certificate if the ME won’t take the case, it has to be specific, and you make it up if you don’t know. Even Scalia had no autopsy! I have very little faith in death statistics for people who die out of hospital and not a tremendous amount of faith in those that die in hospital. Except we all die of cardiac arrest eventually.

    Also, we all hate on the ER doctor for missing the diagnosis, but the reward for saving the patient’s life always goes to the specialists. Which is why I’m encouraging my kids to go into accounting.

  9. ” We don’t perform autopsies in the vast majority of deaths in the US, so if you are overweight you die of a heart attack, normal weight you die of an arrhythmia. ”

    Well, that makes me question the statistics!

  10. After some scares, I am now much more likely to go to the dr or ER. 15 years ago, DH called me at work on a Friday afternoon in December saying his stomach was hurting. At first, I was totally unsympathetic (Too many Christmas cookies? Bad Mexican food for lunch?). But after consulting with the Google, I asked him to call his dr. He did and the doc said he thought it was nothing serious but that he could get it checked out at the ER. DH went to the ER and, after waiting 3 hours (note: folks with sore throats claim pain of 10; don’t tell them your severe stomach pain is a 5!) had a quick exam and was rolled into the OR to have his appendix removed.

    More recently, DH had a bad headache. It was so bad that he went to the dr. who prescribed muscle relaxants and reduction of stress. Later in the week, while I was traveling for work, I started getting weird emails from DH. When I got home a couple hours later, he was lying on the floor and throwing up blood. The kids, little at that time, were taking advantage of his condition and watching Sponge Bob. Off to ER where I am thinking flu or blood sugar issue. Nope; mass in brain. After being stabilized for 3 days, craniotomy along with rehab, recovery, etc. Amazingly, all fine now. So yep, I do not hesitate to go to the ER.

  11. “Many of the symptoms do look like something else”
    +
    “It would be ever so awesome if doctors weren’t so condescending and snotty if you turn out not to have a fatal illness.”
    =
    Recipe for many women to find every possible excuse not to go to the doctor/ER.

    I spent 10 years going to different doctors feeling crappy before my thyroid problem was diagnosed. I got so many condescending psychological pats on the head and being told I “just” needed to sleep more/eat more vegetables/exercise more/lose weight. Why keep beating your head against the same brick wall? It was discovered not because I went to a regular doc to complain about the same symptoms again, but through blood tests after my second M/C.

    I’ve also spent 3 hours in the middle of the night in the ER with shortness of breath/pain in my chest/tingling in my hands/arms, waiting even to be called back. They took my temperature and pulse and BP and decided I was low priority. After 3 hours, the tingling went away, and I was exhausted and had to go to work the next day, so I went home and went to bed.

  12. “Many of the symptoms do look like something else”
    +
    “It would be ever so awesome if doctors weren’t so condescending and snotty if you turn out not to have a fatal illness.”
    =
    Recipe for many women to find every possible excuse not to go to the doctor/ER.”

    +1

    And if you do not have a readily diagnosable disease, it is easier to pat you on the head and send you one your way. I’ve been sick with some form of pneumonia since December and have been seeing various specialists who have no clue what the problem is. Every test for a specific illness has come up negative and I get passed off to the next specialist, who I then need to convince that even 50 year old women need to be able to function. At one visit, I was feeling particularly unwell, and I was clearly unsure of what day it was and what town I was in. The doc prescribed some antibiotics and sent me on my way.

  13. In the 40s, my mother was told that she had menstrual cramps because she was “rejecting her feminity”. Ada will doubtless disagree, but my experience and the experience of others suggests that doctors haven’t progressed all that far when it comes to something they can’t diagnose instantly. “It’s all in your head, dear.” No, it fucking isn’t. Doctor, please just say that you don’t know what the problem is, and you’re sorry about that.

  14. The flipside of this argument it’s that ERs are typically full of women with vague complaints and no objective illness. I am not arguing that they are all attention seeking or faking their symptoms, but they do you not have emergent, life-threatening processes.

    Women tend to utilize healthcare at a far greater rate than men do. They also tend to live longer. Some people connect those two facts.

    I don’t have a lot of answers here, but I think there is not good understanding of the role of the emergency department. Some people with abdominal pain will have life-threatening or lifestyle threatening illnesses. However, these are not necessarily emergent processes. They will require a stepwise work up with a trusted primary care provider. I rarely diagnose Crohn’s disease, MS, and ovarian cancer. These are all sources of vague, systemic symptoms and focal abdominal pain. I try to explain to patients that the ER is to determine if you need surgery or medicine today, anything beyond that requires a process directed by a primary care provider.

  15. Ada, could you outline the techniques to get rapid, effective treatment at an ER. In the past few years, I have taken a battered, bruised husband run over by a harvestor and anothe timeDH with appendicitis, which ruptured during the 12 hour wait for treatment. I had to show the ER doc a picture of the harvestor to get him to understand what my DH had been run over by.

  16. Knock on wood, I have been quite healthy but some women in my extended family developed breast cancer in their 40/50s. Those that did not went on to die in their old age. That and diabetes are two issues. The diabetes though is being managed well by those relatives who have it. If I feel sick, I must take myself to the doctor/ER, because it will be something bad.

  17. +1 on women not being taken seriously. When my mom was in her late 50’s/approaching 60, she started having really bad headaches. This is a woman who just never complains, so I knew they must be bad. At her annual check up every year, she mentioned it, and other symptoms she was having and kept being told it was menopause related. She reached the point where she was having vivid hallucinations while walking to her car in a parking lot, and went back to the doctor who continued attributing it to menopause. She finally refused to leave his office until he did some kind of test, telling him her husband comes and says he feels great, and they still do an EKG and all sorts of other tests every year. The doctor condescendingly consented, listened to her neck, sent her for an MRI to see if she had a blockage. The MRI revealed a tennis ball sized tumor behind her left eye, which the doctor then told her was fatal and she probably had less than 60 days. She got to the specialist who had more positive things to say, it was successfully removed, and 16 years later she is very healthy. So since then, I try to pick female doctors, do some research on my issues myself, and try to advocate a little more strongly if something feels off. Oddly, one of her symptoms was that she could not stand the feel of her clothes on her skin, to the point that she said she could not even remember conversations she had with people because the entire time she was thinking about how much the tag in her shirt was driving her insane. So she was so compassionate with my son with his sensory issues, because she totally got what he was going through.

    Re: the story in the link, I am certain I would ignore it. I throw up a lot compared to normal people, and always have, so waking up in the middle of the night to be sick would raise no alarm bells for me and would not trigger more than the typical concern on the part of my husband. I’ll have to hope for other symptoms.

  18. “Have you ever wavered in deciding whether to rush to the emergency room? ”

    Twice I’ve cut myself accidentally doing something stupid and required stitches, once doing nerve damage which required surgery. Each time I was borderline about going to the ER. And each time I was glad I did.

    I was recently at the ER with DS. We saw in addition to the plastic surgeon who did the stitches, the pediatric doctor on duty and the head doc, just to check in, hear DS’s story on how he cut his forehead. There were at least 2 nurses and 2 techs who also assisted us. The more people that stopped by, the larger I knew the bill was going to be. And, man, it was.

  19. ADA is completely right on the cause of death. Working in geriatrics, my patients die somewhat often. Most of the time you’re just guessing the COD.

  20. “I don’t have a lot of answers here, but I think there is not good understanding of the role of the emergency department.”

    @Ada, only one of the events I mentioned occurred in the ER (the middle-of-the-night shortness of breath/pressure/tingling). My 10 years of condescending head-patting was all through PCPs and specialists. It’s just like what Rocky said: when they can’t find a clear answer, they default to the assumption that it’s all in your head.

    I am used to being taken seriously in every other aspect of my life. (Well, except for car salesmen, and I totally use that to my advantage.) It just floors me that as an educated, professional woman, when I go to the doctor’s office, I still get treated like a clueless rube who can’t figure out that antibiotics don’t treat viruses.

  21. “I am used to being taken seriously in every other aspect of my life. (Well, except for car salesmen, and I totally use that to my advantage.) It just floors me that as an educated, professional woman, when I go to the doctor’s office, I still get treated like a clueless rube who can’t figure out that antibiotics don’t treat viruses.”

    It isn’t just women. The last specialist I saw, my husband came with me. The doctor started talking about some medicines to take and DH asked what part of the biological process of the presumed infectious agent the medicine would disrupt. The doctor made a sarky comment about DH having taken biology. I was thinking, “Dude, a significant part of DH’s professional life involves disrupting biological processes, why are you so threatened?”

  22. CoC, do you go to WP for emergency room? That’s generally our go to for DD. We’ve had a wide range of experiences when we’re there, but I don’t really like the other choices.

  23. I never know if I should go to the ER. When I was pregnant with my first, I had a very minor issue. A friend at work convinced me to go to the hospital. Turns out I was in full blown labor in the second tri. I was super low priority when I arrived and sat around for a long time. Then they did an exam and some tests and freaked out.

    I have taken my oldest for breathing issues on different occasions. On different occasions, I have been yelled at by the ER staff for not calling an ambulance and then basically been asked why we are there, not much is wrong. And his symptoms were basically the same. And my husband is a doctor and I always consult him first about whether to go!

    It is hard. Minor symptoms can mean minor issues. Or they can be a BFD!

  24. One way to be seen quickly in the emergency department is to have markedly abnormal vital signs. I suspect the author in the cited piece had a very low blood pressure that was causing her sweating, vomiting. That is the hallmark of a right-sided heart attack. Low blood pressure is always a life-threatening emergency and I suspect that’s why she was seen right away.

    It pains me to say this, and I rail against it in the emergency department all the time, but if you’re bringing your kid in for fever, a temperature of 104 will be seeing much faster than a temperature of 98.6 that was 104 at home and had Tylenol.

  25. When Mr WCE had racing heart, eventually diagnosed as afibrillation, he called me from the hospital parking lot to ask whether he should be at urgent care or the emergency room. I told him I didn’t know, and, since he has a responsive primary care office, to call and ask them. His primary care office told him to come there immediately, had him hooked up to the EKG machine within 20 minutes and got a record of the symptoms. He ended up on medicine to slow his heart from 150+ bpm and eventually had a cardiologist referral, because the problem hung around for a couple weeks and is likely to recur, but in this case, the primary care office did a great job.

    It was also WONDERFUL because records of previous EKG’s were available and transmitted to the cardiologist. I am skeptical of relying on records transmission among our local primary care, urgent care and ER offices.

  26. Another way to be seen quickly is to go to a community emergency department. Preferably one that is far from a bus line. Your central and academic emergency department will be full of psychiatrically ill patients, intoxicated patients, and medically complex patients. These will absorb staff’s time and energy.

    Agitate for a better mental health care in your community. I have worked in places where we have psychiatrically ill patients in the emergency department for three or four days. This impacts our ability to provide care to everyone.

    If you are seen by a PA or NP and feel you are dismissed, ask to be seen by a physician. If they are reluctant to help you, state, “don’t you have a written policy that patients can be seen by a physician if they so request?” I’m sure they do. You will be treated like a troublemaker, but you have a second chance to make your case.

    Rate your pain as a seven out of 10. I respect and take that much more seriously than 10 out of 10 pain.

  27. I agree that there is a lot of confusion as to when to use urgent care vs ER. On our neighborhood online site, someone was complaining and warning everyone off of a new boutique ER that opened near us, because they charged her $2K for strep throat. The issue was that her insurance denied the claim because strep throat doesn’t require an ER visit. She should have gone to her doctor or urgent care, but that is not the ER’s fault. We have a 24-hr nurse line with our insurance, so I always call them first if I’m not sure where to go. For kids over 13, they talk to the kid instead of the parent. So the times I’ve taken a kid to ER, I have the recommendation of the nurseline to fall back on if I have an insurance problem, but so far I’ve never had an issue.

  28. Worst experience ever was showing up at the ER as a very pregnant lady. I had coughed, heard a loud pop, and was immediately in blinding pain. I called my OB who said to go to the ER.) I was dismissed at the ER and sent up to labor and delivery (bounced along in a wheelchair over a bumpy courtyard, etc.) where a nurse yelled at me about putting on a gown so they could attach a monitor. I was in so much pain I couldn’t remove my shirt or get out of the wheelchair they’d stuck me in, but she thought I was being a skittish mom about a monitor or just difficult about following directions. Eventually they brought the monitors over to me in the wheelchair for 30 min and, as I’d told them, I was not in labor. I then ask what they can do about my pain. Oh, nothing in L&D. They needed to bounce me back across the hospital to the ER. Ultimately they figured out that I’d cracked a rib. (Pneumonia + 6 months pregnant and baby taking up the lung space.) But it took hours, they did things along the way that increased my pain level dramatically, and they were rude and condescending in both departments.

    Ultimately a fantastically kind ER doc took pity on me and said that he was pretty sure I had a broken rib, but he needed to x-ray to diagnose it. He had a plan to shield the baby and still get the x-ray and then they could treat me. He apologized for how shitty my entire experience had been and was the only one there who treated me like a human and not like an annoyance.

    That woman in the article? I’d have gone back to bed too. I’ve only ever gone to the ER as an adult when I was in blinding pain, and i can’t see dealing with the crummy attitudes for something subtle.

  29. This is why boutique emergency departments make sure that they have their patient satisfaction surveys completed before patients are billed for their services. I bet the patient with strep throat was highly satisfied with her experience, until she realized what the bill would be. Emergency departments, boutique or not, are for when you think there may be a life-threatening emergency.

    I often have very sad and unpleasant conversations with parents in the middle the night who rushed in when their child awoke with ear pain. I am not good at ending the encounter well when I explain to someone who has waited three hours that the current standard of care, for most kids, is ibuprofen for acute ear infections.

  30. “Emergency departments, boutique or not, are for when you think there may be a life-threatening emergency.”

    So, where do you go when you are hurt and need immediate treatment, but it isn’t life threatening? E.g Car accident, stitches, asthma attack?

  31. One way to be seen quickly in the emergency department is to have markedly abnormal vital signs.

    Like me. I went to Mass General with a resting pulse of 160 and a temp of 106. I went right from triage to a bed in 30 seconds. I told this story before but the triage nurse yelled over to the Dr. “This kid’s tacking out at 160.” And the Dr. said, “Eww.” That was kinda scary.

  32. Lauren — Lawrence is closest to me so that’s where I’ve gone for emergencies. My experience has been mainly positive, except for what has seemed like long waits sometimes. Once I ended up at Bellevue in the city, and I quickly learned I was a more upscale patient than what they usually see. It was “interesting”.

    I can only remember one time where I had a doctor act in a condescending way. Because the tests he ran did not show the condition I had tentatively self diagnosed, he declined to answer my few questions. He basically said I shouldn’t worry (and shouldn’t waste his time). I never went back to him, and about a year later the tests actually came out positive for what I thought I had back then. But mostly my doctors have worked with me, even in cases where I have “expected zebras when I heard hoofbeats”. (I almost always expect the worst possible outcome, even if I don’t verbalize it.)

  33. I saw a presentation by the owners of this practice a couple of weeks ago. https://www.dispatchhealth.com/ This is the wave of the future – ER care that comes to you. They triage the people with life-threatening emergencies to go to the ER, but they can handle about 75% of patients who would otherwise go. They can do EKGs, IV fluids, etc. They have an average wait time of about 45 minutes, and you’re in the the comfort of home while you’re waiting.

  34. So, where do you go when you are hurt and need immediate treatment, but it isn’t life threatening? E.g Car accident, stitches, asthma attack?

    Urgent care. Obviously this depends on the severity of the injury, but if you just want to be “checked out” after a car accident, urgent cares can handle that.

  35. “Urgent care. Obviously this depends on the severity of the injury, but if you just want to be “checked out” after a car accident, urgent cares can handle that.”

    And when urgent care is closed?

  36. “One way to be seen quickly in the emergency department is to have markedly abnormal vital signs.”

    ITA — the ERs function SO well when there is an obvious emergency. That one time DS’ croup had gotten to the point he could barely breathe, the urgent care dr took one look and saw that DS was using his axillary (??) muscles (basically, using your chest muscles to help you breathe because your diaphragm can’t do it alone), explained that that was life-threatening, told us where to go, and called ahead. When we arrived, they whisked us back and had DS on meds before we even completed the intake.

    Ironically, they bumped DS in front of a middle-aged woman complaining of chest pain. . . .

  37. I always forget about Lawrence, but I should consider it as another option.

    I’m very familiar right now with three Long Island ERs due to my inlaws. The experience at the sleepy community hospital is vastly different than the large university hospital even though it’s all one large hospital group now.

  38. The urgent cares around us all close by 6 or 7 pm. I went to one last year at 6:45 pm and I had to beg them to see me. I had pneumonia. With something like that, I could have waited until the am. But what if it was stitches or a car accident? Doesn’t seem like waiting until the next day is feasible.

  39. Emergency departments, boutique or not, are for when you think there may be a life-threatening emergency.

    Well, you need to explain that to the primary care people who tell you to go to the ER for absolutely anything other than a sore throat.

  40. We’ve had to go to the ER a few times for asthma stuff and a few other things. The one time our DS was admitted, we knew it was a big deal. Asthma + RSV = 5.5 days in the hospital. I learned a lot about billing and being an advocate for the patient. We got very good care by the hospitalist, but they still made a couple of mistakes that were shocking. One we got medication that was on the list as having an allergy to. Fortunately, we were wrong about the allergy. Second was that they missed the RSV diagnosis. Only after asking on the status of the test did the nurse check. She had said, “He doesn’t have RSV.” Checks chart. “Oh, he has RSV. No worries. We don’t change our care plan.” Immediately after care plan changed.

    We had to take the other kid to the ER by ambulance per the nurse hotline for croup. He got an epi nebulizer (or something) and recovered so well that we didn’t see a doctor for 2.5 hours after getting there by ambulance. That was a very expensive 3 mile drive.

  41. Here is a sobering story: a friend of ours had a stroke that went undiagnosed for 2 days. Evidently, he had been dx’ed with high blood pressure 2 years earlier, but since he and his wife are both into “natural products” and meditation, he never took the prescribed meds. When he had the stroke, he had the classic symptoms (one side drooping, impaired speech) but neither he nor his wife knew the symptoms. When he finally went to the ER, his blood pressure was so sky high that he was told he should have been dead. He has a 12 year old kid, and works at a high powered media job – and they really need his income. Unfortunately, he has had to take a medical leave of absence.

    Folks, treat your high blood pressure and know the symptoms of a stroke!!!!

  42. The urgent cares around us all close by 6 or 7 pm. I went to one last year at 6:45 pm and I had to beg them to see me. I had pneumonia. With something like that, I could have waited until the am. But what if it was stitches or a car accident? Doesn’t seem like waiting until the next day is feasible.

    Then you go to the ER obviously.

    The urgent cares are generally open until 10 p.m. from what I’ve seen.

  43. Before my DS2 was dx;ed with cancer, he was very sick for over a month. We visited the ped and the pediatric ER at a major pediatric teaching hospital over, and over, and over. We were pretty much camping out at that ER for weeks. He was even admitted for a week. And yet, despite the fact that I was certain it was cancer, and told them so many times, they refused to run a CT scan. He was a textbook case of an abdominal cancer. The ER just blew us off, over and over.

  44. It looks like there is significant regional variation in when urgent care offices close.

    Our only emergency room visit was for stitches and the incident happened at ~8:10 PM so urgent care was already closed.

  45. Oh, and Lawrence was not the ER that misdiagnosed him. They messed up with another kid of mine, discharging a toddler who was so severely dehydrated that he ended up admitted to another hospital 6 hours later.

  46. “He got an epi nebulizer (or something) and recovered so well that we didn’t see a doctor for 2.5 hours after getting there by ambulance.”

    @TC — I was stunned by how quickly and well that medicine works — in our case, within like a minute or two he was breathing 100% normally and sound asleep (which only made me even more angry that his PCP had ignored him for a week — seriously, it’s *that* easy to fix??). The ER still kept him for the next @3 hrs, though, because they explained that kids can have a rebound effect in when the first dose wears off (he did, though it was much less significant, and one more dose took care of it).

    So just think of it as paying for a “very expensive mobile nebulizer service,” and the follow-up wait at the hospital as rebound precaution. :-)

  47. The three urgent care places nearest to me close either at 5pm or 8pm on weekdays, and are either closed or have shorter hours on weekends, which is when you actually need them.

  48. My oldest has received so many doses of racemic epinephrine for croup but his pedi won’t do it at the office (once during a hospital stay he got it basically every 3-4 hours for a couple days. The doctors had told me at most he would need 2 doses. They were wrong.). He says it is because it can cause the heart to do wonky things in some cases so they like to be at the hospital for it. I would have liked to have had it at home but no dice.

  49. Good advice on not understating your pain. My ’10’ would be — you know what, I’m not going to describe the details out of courtesy to the guys, I’ll just say that it was unmedicated, related to a post-childbirth emergency, and about 2 points on the scale worse than normal childbirth.

    So anyway, I wouldn’t normally be giving a ‘7’ to much and it’s helpful to know that I should more or less define it as “SERIOUSLY THIS HURTS.”

  50. LFB – I’m grateful that he was able to recover so quickly. My DH still feels foolish about going by ambulance to the hospital since we weren’t even seen in the ER for so long due to the neb in the ambulance working so well. We had a fire truck and an ambulance at our house (I was at work). The kids at the home daycares on our block were very excited. Overall, we got great care.

  51. tcmama – the time I got yelled at for not calling an ambulance was a time when my son needed the racemic epi for croup. We drove him in the middle of the night in no traffic and got their quickly and they still yelled at us. So, you probably did the right thing.

  52. “Good advice on not understating your pain. My ’10’ would be — you know what, I’m not going to describe the details out of courtesy to the guys, I’ll just say that it was unmedicated, related to a post-childbirth emergency, and about 2 points on the scale worse than normal childbirth.”

    Good to know. I gave birth without pain medication because, “I want an epidural” was unclear to medical personnel. Nothing has come close, including the broken leg. So, now, everything is a 7.

  53. tcmama – My understanding is that we are very lucky with the level of medical care that we have around here. From what I’ve experienced in other parts of the country as well as what family and friends have gone through, I’m pleased with the options we have.

  54. “My DH still feels foolish about going by ambulance to the hospital since we weren’t even seen in the ER for so long due to the neb in the ambulance working so well.”

    So he’d feel better having driven there himself and had your kid be even sicker on arrival, because then he’d have been taken back more quickly when he finally did get there? That is totally illogical — the goal is to get the kid treated ASAP so he doesn’t die, so congrats, he’s a total success! You didn’t pay for the world’s most expensive Uber; you paid for immediate medical treatment that just happened to be on wheels (and could only go to the ER).

  55. I’m curious if the increase in High Deductible plans will lead to an increase in death by heart attacks. If I’m looking at paying a few thousand dollars for that ER visit, I might just think to myself that I’m coming down with the flu that is going around.

  56. “I’m curious if the increase in High Deductible plans will lead to an increase in death by heart attacks.”

    How do you test for a heart attack? EKG? Is it pretty straightforward to know what to look for? Can it be done at home?

  57. Lemon – I agree we have great health care options here. And even knowing that, it was eye-opening during my older son’s hospital stay, how important it is to be paying attention and to ask questions and to confirm what care is being provided. Also, trying to figure out the bills for an ER admitted hospital stay took me a long time to track down, and I have an MBA and work in finance in the insurance industry. I can only imagine how hard it may be for some with less education/experience.

    LFB – it is irrational that he feels foolish about it. I find it fascinating, because he doesn’t get hung up about money or paying for stuff. I think he feels like he over-reacted even when I explain to him that it was the nebulizer that helped so much. DH would be the one to ignore health symptoms. On the other hand, when he does mention that he is feeling ill or in pain, I know it is bad.

  58. MM, thanks for heads up about Lawrence. DD doctors are all WP or children’s hospital so we probably won’t end up there.

    I do feel grateful for some of my doctors based on some of the comments here. I rarely feel that they’re not listening to me, or blow off further testing.

    I need a new endo because my doctor retired last year. I went to his replacement because I knew her, but I really didn’t like her at all. These comments are making me realize that I should switch before it’s a big health issue vs. annual visit.

  59. Also, I saw on the news recently that those boutique ER places that Denver has are illegal here. So at least I don’t need to worry about that.

    Medical billing is another beast all together. I often utilize an advocate (company provided perk) to interpret and fight the hospital/clinic on billing. So often they have it wrong, which makes me think that they do it on purpose to try to make up for the losses they take on those uninsured who never pay.

  60. “DH would be the one to ignore health symptoms.” — Oh, well, now it makes perfect sense. People who avoid going to doctors usually think a doc isn’t necessary unless it’s literally life-or-death, which means so any time you go and it’s not life-or-death is an overreaction, which means you feel foolish. Sitting there with a seemingly-healthy kid will totally trigger that feeling (“see?? see???”). The fact that the logical part of his brain knows he actually *did* need to go can’t completely defeat that emotional response.

    FWIW, my DH is very similar — shortly after we were married, I knew his pain was really bad when he actually agreed to let me take him to the ER (turned out to be a ruptured disc, not the pulled hamstring he tried to write it off as).

  61. The hesitation I feel about going to the emergency room is a combination of uncertainty about the severity of the condition, the idea of wasting time, and the feeling of looking foolish. We had an incident recently where someone in my family had an allergic skin reaction, which I did not think required a trip to the hospital. But I was overruled and a trip was taken, and it turned out not to be an emergency at all. The ER doc referred us to an allergist.

  62. “He had a plan to shield the baby and still get the x-ray and then they could treat me.”

    How did he treat a broken rib?

    When I had a couple of broken ribs, my MD told me there wasn’t much he could do unless I needed something stronger than ibuprofen for the pain.

  63. There was a conversation going on about staying close to home or going far away to college. It should not be the make or break factor in selecting a school, but your kid making a trip to the emergency room or even to urgent care hundreds of miles away can be quite a stress-inducing event. Especially when no one will give you any medical information because you’re only the parent.

  64. “Rate your pain as a seven out of 10. I respect and take that much more seriously than 10 out of 10 pain.”

    I’m thinking that if the pain is 10 out of 10, it is so debilitating as to be obvious, and also likely precludes a coherent response from the patient. Or perhaps any coherent response would be less than civil.

  65. Hmm, in the case of broken ribs, the pain might be a 6 of 7 most of the time, but jump up to near 10 when you sneeze or cough, i.e., so intense that you need to just stop whatever you’re doing and wait for the pain to subside.

    Ada, would that description of pain get taken seriously?

  66. CoC, good point. I guess when my kids go thousands of miles away for college, one of the first things they need to do is to identify nearby ERs and Urgent Care clinics in case they are needed.

  67. Finn– Painkillers. I was unlucky enough to have a muscle spasm near the broken rib. So broken bone that was constantly twitching = horrible pain. I gave birth to 3 babies with no pain meds, and that broken rib was exponentially worse. Apparently morphine was the painkiller of choice for pregnant women, being studied quite a bit. I was in too much pain to care. If they couldn’t get the pain under control, the alternative proposed (I believe this was around 34 weeks? Hard to remember now) was c-section.

  68. Well, I don’t know that morphine was studied. But I suppose it was used for a long enough time that the medical folks felt secure in the choice? Truly, what I’ve learned is that in a true emergency, I didn’t have the wherewithal to ask questions.

  69. I’m thinking that if the pain is 10 out of 10, it is so debilitating as to be obvious, and also likely precludes a coherent response from the patient. Or perhaps any coherent response would be less than civil.

    The definition of the pain scale is “0 is no pain and 10 is the worst pain you’ve ever felt in your life.” I think it would be very common for people to be in the worst pain of their life and not have it be debilitating. My 10/10 pain was when I had a spinal headache following a procedure where I had an epidural block. I was leaking spinal fluid, so if I lay down for a while I was fine, then it would take about 15 minutes of sitting/standing before the headache hit full force. That was more than enough time for me to drive myself to the ER.

  70. I know that both DIL and DH had trouble making people listen to them in their recent crises.

    DIL was brushed off in face to face encounters two or three times over six weeks (she has just moved, no primary yet), and finally had to sit down and refuse to leave the clinic until she was properly seen. As soon as the right physician examined her, it was a full court press. Her form of cancer is most often found in women under 40 (pre mammogram age) and in people of mediterranean or african descent. Hence the survival statistics are awful. It is a good thing she is a white UMC Ivy League physician’s daughter and stubborn when it counted.

    DH called in several times because he was feeling so bad, but he didn’t have pain and wasn’t classically dizzy, so finally the cardiac nurse gave him an appt in ten days. I called up and had a fit, and they told me that I was telling them that he was lying in response to their questions. So since he was driving over to a branch office of the practice for his bimonthly eye shot that afternoon, I said to him, when you check in at the intake desk tell them how you feel and ask for a BP check. He did it to placate me. It was something like 180/120, so he was whisked off for his week in the hospital.

    The physicians and other medical staff who treated both of them and the general quality of medical care received were top notch. Once they got through the well guarded gates they were fine. But in both cases, so it is not simply a question of gender or geezer bias, it was necessary to throw a fit, to violate the suggested procedure and timetable, to say no, I am really sick here and why won’t you pay attention to me.

    That is the frustration that so many of us have experienced. We are good do-bees, going in for checkups, calling attention to a problem, and then being told, go away, you’re not dying here. Well, wait a little while. Lauren’s step MIL may be a foolish person who avoided doctors, just like some of the natural remedy only folks I know who don’t see a doc until their cancer is stage 4. But how do we know whether at 18 a complaint was mistreated and made worse before better, or at 35 a doctor or nurse lectured on wasting precious medical resources over nothing.

  71. Funny DD – My DH makes the same argument (everybody has 10/10 pain at some point, and why wouldn’t they be in the ER when that was happening?).

    The reality is that I do not believe that you have 10/10 pain if you are sitting up in bed, texting on your phone with one hand and eating a hamburger with the other. I do not believe that you have 10/10 pain in your ankle when you walked in without a limp. You do not have a 10/10 headache if you march yourself out to the nurses station to start yelling that you haven’t been seen fast enough. You are unlikely to have 10/10 pain if you have a heart rate of 60 and a blood pressure of 110/65.

    I think of 10/10 pain that is so bad, nothing could make it worse.

    See also: http://gomerblog.com/2013/08/patient-still-a-10/

  72. How do you test for a heart attack? EKG? Is it pretty straightforward to know what to look for? Can it be done at home?

    They order blood tests like CK-MB and Troponin to measure the chemicals your heart cells give off when they are damaged. Could you do it at home? Sure, if you buy one of these:

    http://www.devinemedical.com/Abbott-03L7701-Clinical-Chemistry-Analyzer-p/mck-861537.htm?gclid=CJvvuOzKyMsCFcUdgQod5HQPAQ&zmam=36263310&zmas=1&zmac=1&zmap=MCK-861537

  73. “I said to him, when you check in at the intake desk tell them how you feel and ask for a BP check. He did it to placate me. It was something like 180/120, so he was whisked off for his week in the hospital.”

    This suggests that when one feels poorly, or has some sort of unknown medical distress and is unsure of a course of action, one thing that could be done at home is to measure BP. We have a couple of BP meters at home, inherited from FIL, that we really should use more often.

  74. “This is the wave of the future – ER care that comes to you”

    College DS became so ill on a recent trip to San Francisco that DH called one of these practices, which had rave reviews online. He spoke with one of the docs and we decided to wait until the next day because the doc on call did not have the IV kit with him. Next day DS was better so no need for an IV, but I would definitely look into this option again in the future. Having a doc come to your hotel is much more appealing than heading to an unfamiliar ER in an unfamiliar city late at night. But I could not stop thinking of the doctor who came to Hyman Roth’s hotel room while the hit man was hiding behind the curtains.

  75. ADA – my cousin is a nurse and she is constantly posting gomerblog stuff on Facebook. Very funny stuff. She also naturally has a very wicked dry sense of humor.

  76. “You do not have a 10/10 headache if you march yourself out to the nurses station to start yelling that you haven’t been seen fast enough.”

    But with a broken rib, you might experience momentary 10/10 pain when you take in a breath to facilitate yelling.

  77. It is surprising to me to hear how it seems nearly universal to believe you have been not taken seriously by the medical establishment. Personally, none of my interactions with medical providers are standard – it is always a bit of an awkward position to be the patient.

    In my opinion, there are a number of factors, likely synergistic.

    I think you have gates guarded by someone who is not ultimately held responsible, and who may not have enough time/knowledge/desire to figure out what is going on. I am often appalled by what I hear triage nurses say to patients.

    Some doctors don’t communicate well (well, probably all don’t communicate well some of the time, some don’t communicate well all of the time). So, their nonchalance about your symptom is not actually dismissive but it feels that way.

    I am continually told by patients that “I was seen for X and they told me nothing is wrong.” I have never in my life told a patient that “nothing is wrong” — I have said that “all of our tests are normal, and that is a really good thing. There are some things that don’t show up on our tests, or take some time to evolve, which is why you need close follow up/return to the ER if you are not getting better.” “It took 6 month for this pain to get severe, it may take a few weeks to get to the bottom of what is going on.”

    Misunderstanding (or lack of communication) about the process. For a pregnant woman (with viable pregnancy, usually >22 weeks) who has any complaint between the clavicles and the knees, there will be a brief assessment and then evaluation by labor and delivery. Brief assessment usually means vital signs. All ERs have had pregnant patients come in for something that appears non-OB in natures (threw my back out, green diarrhea, etc.). These supposedly low acuity complaints wait in the ER waiting room for 4 hours. When they are finally evaluated, the “threw my back out” turns out to be preterm labor, with a crowning 26 week fetus. The “green diarrhea” turns out to be ruptured membranes with meconium (water broke) – and baby is now struggling. Most ER nurses can tell you a sad story of a intruterine fetal death that could have been avoided had the patient been sent to OB sooner. So, pregnant patients who have normal BP and HR will have the health of their pregnancy evaluated before any other non-life threatening complaint. Tulip’s story is they way things should have worked – though clearly she could have been better informed as to the rationale. Also, in a busy ER, I would ignore a patient who has responded to treatment by EMS for croup/asthma/allergies – they are (hopefully) monitored, which means I can see them when I can get to them.

    Totebaggers are really the 1% intellectually. Which means they are a super tiny fraction of a typical ER population. I worked at a suburban ER in a struggling area for a few years. I could go several shifts and not see an employed patient. It could be a week or two between patients with an advanced degree. It is only in the past year or two that I have had frequent contact with patients who use the internet to look up their symptoms. The ER population does not look anything like the general population. If you see 40 female chest pain patients in a row who have extensive, negative evaluations, you may be dismissive of number 41. Also, physicians in general are good at pattern recognition. Most of the situations where people feel ignored are likely due to being somewhat outside the pattern. Physicians should not get too complacent, but we all do in certain situations.

    I am not trying to make a lot of excuses, but to provide a window into the other side of the story. The article today says that “most women would have ignored these symptoms”. In my experience, most people with these symptoms have absolutely nothing wrong with them. It is possible for both of these to be true at the same time.

  78. “I’m curious if the increase in High Deductible plans will lead to an increase in death by heart attacks.”

    In my sample size of 1, I would say yes. My BIL had what he knew to be a stroke on a Saturday – one side of his face was paralyzed and he couldn’t move that arm. But rather than go to ER, he waited until Monday and went to his regular doctor. When he had the heart attack, he got out of bed and took 2 aspirin and tried to wait it out, but the pain was so bad he couldn’t take it and drove himself to the ER. His portion of the bill, after insurance, was $5K. This is for a guy who makes probably $45K a year, and pays child support out of that. He had some more heart issues last weekend, but did not go to the hospital because he can’t afford another $5K bill. I believe his lack of good insurance will contribute to an otherwise preventable death for him.

  79. Re Urgent Care vs ER, I’m wondering if there isn’t a good reason for an entrepreneur to open up Urgent Care clinics very near ERs. I’m thinking that after an hour or so of waiting, a lot of wannabe ER patients might head over to the UC clinic.

  80. MBT, I completely agree. I would support a tax to pay for “basic” healthcare, with “basic” defined by “the treatments we can afford for everyone for the next year, based on the $ designated for healthcare at the federal level and the benefit of the treatment in QALY.”

    The problems of defining “everyone” and determining “the benefit of the treatment in QALY” are left as an exercise for the reader.

  81. A big heart attack is obvious, when it is happening, on the EKG. As is any arrhythmia.

    A small heart attack may not be apparent on the EKG, but by definition, will show an increase in cardiac enzymes (trop, ck, etc – the test that Rhett pointed to) starting 3-6 hours after the event (and that elevation will last probably 7-14 days). You could check troponin at home, but you would have to wait until 6 hours after your symptoms start to have a definitive answer.

    Chest pain, related to cardiac disease (plaques in arteries), may occur, but not be part of a heart attack. It may be a sign that the big heart attack is about to hit. This is called unstable angina, and is the bane of all ER chest pain evaluations. The vast majority of chest pain (with normal troponin, and normal EKG) is not unstable angina – probably less than 5% is unstable angina, when you take all comers. But missing it is a big deal.

    This is where shared decision making comes into play. Scroll to the middle of this article and look at the graphic:

    http://epmonthly.com/article/beyond-heart-building-a-better-chest-pain-protocol/

    We are moving towards using decision making tools like this – helping patients to understand what a negative evaluation means.

  82. Ada – totally makes sense why you wouldn’t have seen my kid after he was responding to treatment. I thought the ER handled our situation correctly. DH still felt foolish though for the reasons LFB explained.

  83. Finn: the vast majority of ER patients cannot be seen at Urgent Care – they have medicaid or no insurance and they can be refused at the UC. Well-insured patients may go to the UC, further depleting the funding base of the ER – so definitely not in the ERs best interest to siphon that population off.

  84. “We have a 24-hr nurse line with our insurance, so I always call them first if I’m not sure where to go.”

    The health coverage provided by my previous employer was through an HMO that included this service, which IMO was great. I never had to go to ER while covered by them, but my understanding is that if the 24-hr nurse line tells you to go to ER, they will also call ahead to the ER.

    Our pediatrician is part of a practice of about 6 pediatricians, and they take turns being on-call when their offices are closed, and encourage us to call their answering service any time we have a medical concern. When we’ve had to take our kids to ER, the pediatrician on call would call ahead to the ER, and in one case met us there, which likely saved us from some of the non-optimal interactions described here.

    BTW, the HMO I used to have also would send us a handbook full of common medical symptoms, along with some explanation, and what to do– call 24-hour nurse, go straight to ER, drink lots of liquids and monitor, etc.

  85. cost of college – yes, we had to live through that scenario when DS went to emergency room during his freshman year of college, halfway across the country. Luckily there was a world class hospital right across the street, but it was so stressful to deal with it over the phone. It happened during crew practice, and his coach stayed with him, but they didn’t know if it was appendicitis, a hernia, some t****cle (don’t know if that is considered a bad word!) problem or what. It turned out to be a kink in the tube coming out of one of his kidneys. He had surgery back at home during the summer.

    DH was out of town and I wasn’t sure if I should fly over to be with DS (DS later said NO!! – he wouldn’t want anyone to think he had a mother). DH and I had a conference call with a doctor in the ER after many phone transfers, and even though he probably wasn’t supposed to talk to us since DS was over 18, he gave us some general information about what they had looked into, what tests they were running, etc. All I had gotten initially was a quick call from DS to say that he was at the emergency room, and he might be going to have surgery depending on what was wrong!

    DH very kindly handled the subsequent billing nightmare between our insurance and the various departments at the hospital. It was months of back and forth “you should pay; no You should pay”, but if finally got resolved.

  86. I would advise finding how far your student will be from a level one trauma center when looking at colleges. We did this when looking at summer camps because we are used to having many choices in a dense metropolitan area. This may not be the case for some college towns.

    Even if you research, and find that your child is near a great hospital…stay involved when your kid is sick. I have two friends that are doctors, and their daughter got sick when she was a freshman at college. The university was attached to a hospital so she got medical care. The problem is that all of these privacy issues/HIPAA may prevent you (the parent) from staying involved – even if you’re a doctor. She almost died, and they finally went to the hospital because it was so difficult to handle from a distance. A similar thing happened with a friend’s kid at a large midwestern state U. Many of these kids don’t realize the consequences of taking/mixing Tylenol, Advil, Z pac flu medications and alcohol. What starts as a cold, flu or respiratory can turn into a dangerous situation if their liver or other organs stop functioning due to too many medicines. The kids don’t realize that they have to report every medicine that they are taking when they go to the ER or Urgent care.

  87. BTW Ada and DD, many thanks for your posts from the provider perspective, which have been enlightening.

  88. “he probably wasn’t supposed to talk to us since DS was over 18”

    Question for the esq types: Is this something we can address beforehand, e.g., a standard authorization our over 18 kid can sign to allow medical care providers to share his medical information with us?

  89. When DD was diagnosed with type I she spent a week in an urban children’s hospital to get her stabilized and train us to give insulin injections. It became apparent very quickly that we were not the typical parents the Doctors and Nurses were used to. The diabetes educator was stunned I already knew how to read a nutrition label and could add/subtract/multiply in my head. It was frustrating for me, but got better when a different educator on the second day asked what I did for a living, After learning I worked in finance she went at a much faster pace and was wiling to get much more detailed in responding to my questions.

  90. Finn – now we have a real balance scale and a home BP monitor for his daily weights and BP. But not back then.

    My two California students had to get through a lab accident (minor electrocution) and severe poison oak. There were no funds or vacation days for mom to fly out to nurse them through it. They also only came home twice a year at Christmas and summer. They managed.

  91. I have had several co-workers in the situation of a child away at school and needed medical care. One guy on my team stepped out of a meeting to take a call, walked back in and said it was a call from an ER doctor in his daughter’s college town, saying he couldn’t share any details but that the father should come right away. I cannot imagine driving yourself to the airport and waiting for a flight under those circumstances. I would be about to crawl out of my own skin.

  92. We’ve always tried to find MDs that are willing to answer questions and not be defensive. Fortunately, we found a great pediatrician, at least from that perspective, who has been very open and respectful, and who treats us as partners in maintaining our kids’ health. As the kids have gotten older, he’s also increasingly included them in medical discussions.

    There was one MD in his practice who was not so open. Once when our regular MD was on vacation, we saw that MD instead, and he became very defensive when we asked him the same sort of questions we normally asked our regular MD.

    We made sure not to see him again if we could help it, which was made easier by his retirement a few years ago

  93. Question for the esq types: Is this something we can address beforehand, e.g., a standard authorization our over 18 kid can sign to allow medical care providers to share his medical information with us?

    They would need to bring it to every provider they see. Usually there is a form on the intake packet where you can specify who the practice can release information to.

  94. I can’t imagine what Ada goes through in the ER. I have two facilities I round at that are traumatic brain injury patients and the stuff some of them try to pull to get medications and such is amazing. I can talk to staff who can fill me in on their issues, but Ada has people like this coming in off the street. I’m sure it makes her wary of everyone.

  95. BTW, this is a reminder that we should update our contact cards. A while back, DW made some cards for us and the kids to carry around with emergency contact info. Perhaps if we have some legal documents executed (medical power of attorney?) we should have those names listed as well.

    I should also make sure that DW and the kids have ICE phone numbers designated on their phones.

  96. I learn something every day. Finn, I did not realize that electrocute was a portmanteau or combined work from electricity and execute. The term has been extended in ordinary language to non fatal electric accidents. Electric shock is a more accurate term, although walking around with a piece of defective apparatus stuck to your hands until you managed to pull the plug out of the wall socket by brute force (working alone in the lab, protocol violation) and having your life saved in great measure by your three inch platform cork sandals was a very close call.

  97. The medical issues and how far away DD wants to go to college are something I worry about, but she doesn’t seem to want to go too far, in fact I’m starting to worry she will want to live at home forever – 17.5 years old and no interest in getting her drivers license. I did tell her she couldn’t go to the local private university, way too close and I want her to have a college experience. She does handle all of her medical care now – except for navigating insurance and ordering her prescriptions. I’m happy to handle that until she is off her dad’s insurance at 26. I’m not as happy about the prospect of driving her to her doctor’s appointments forever.

  98. Finn – probably your kids wouldn’t have that form on them when they had to go to the emergency room, so it may not be of much help.

  99. “probably your kids wouldn’t have that form on them when they had to go to the emergency room”

    Perhaps a pdf file stored on a phone?

  100. If your kid is conscious, they should be able to call you and explain what is going on. If they cannot fully explain, they should be able to hand the phone to a doctor and say please explain this to my parents.

    If they are not conscious, medical decisions need to be made by the next of kin. This should be a parent. I believe that the parent may have been told that they need to rush to the hospital without giving an explanation. However, that is a terrible breach of duty by the physician and is by no means the norm.

  101. “I have said that ‘all of our tests are normal, and that is a really good thing. There are some things that don’t show up on our tests, or take some time to evolve, which is why you need close follow up/return to the ER if you are not getting better.'”

    Ada, I wish you were my doctor when I went to the hospital — my experience is that this degree of thoroughness and patience is rare (although my PCP is pretty good). Although to be completely fair, it’s the bad ones that stick in the head longer than the normal/good ones. I have had to learn to specifically ask “what should I look for to tell me things aren’t getting better/are getting worse and I should come back/call my doctor?”

    Which, actually, is a good habit to have in any event and probably saved my cat’s life last month, so I guess it all works out in the end.

  102. Ada and DD – I second the thanks for sharing your knowledge today. It helps to know what is “normal” and not rely on worst-case examples.

  103. I have worked with a college student population. I have often offered to call the patient’s parents and explain what is going on. Most of the time the student says yes, but occasionally they will say no. I also will wait until a parent arrives to go over test results, if that is the student’s wishes. The majority of visits to an ER for a college age population will involve alcohol or illicit drug use.

  104. When I have a problem but don’t know why, I will describe the major symptoms in a sentence or two and ask “can you please walk me through it as you do your differential diagnosis, so that I can add any detail that might be relevant and make sure I understand what you are ruling out and still considering.”

    When there is a really bad possibility, I have also asked what percentage odds they would assign to it being the diagnosis. It’s a lot easier to wait two weeks for the MRI results when you know the doctor thinks there is a 5% chance of a malignancy vs. 60%.

    IME that gets a positive response here.

    Generally even if I have researched the symptoms I do not volunteer my own diagnosis, unless it is really minor or I know the doctor really well.

  105. “The term has been extended in ordinary language to non fatal electric accidents.”

    Actually, in industrial settings, people are much more precise about this term.

    ““probably your kids wouldn’t have that form on them when they had to go to the emergency room”

    Perhaps a pdf file stored on a phone?”

    This is admittedly different from my experience, because I was on my own health coverage from 18 on, but what are you so eager to know?

    When I was a rising senior and “in charge” of one of the groups of new freshmen, I had a kid who, on several occasions, would lose consciousness as a result of stress. So one of the early mornings, the juniors are yelling for everyone to wake up, and they’re throwing the metal trash cans down the hallway, and this kid–Adam was his actual first name–just winds up on the floor of his room, totally passed out. So we called the ambulance, and I rode with him to the ER (in town), they checked him out, gave him some fluids, and sent us back in an hour or two. I told the actual commissioned officer in charge of us when she came in that morning, and I ended up telling the Commandant about it because it had gone into some report and he wanted to know, but I don’t think it ever occurred to us to call his parents.

  106. I have had medical personnel refuse to give me any info about my college kid’s medical condition. No bending of the rules, and it wasn’t a situation involving drugs or alcohol. A pdf form probably would have been a good solution.

    When my kid traveled to Africa (alone), the travel medical insurance company had a release form that supposedly allowed them and me access to all his medical information. It would be nice if insurance companies had such a form for domestic situations.

  107. Milo – I wanted to know what the heck was wrong with my son that led him to being taken to the ER by his crew coach – the doctors didn’t know at first, and surgery seemed to be quite likely (if it was appendicitis or some of the other possibilities). I guess he was in terrible pain and throwing up, but that was all I knew. We were hoping that we would be told if he went into surgery, but that would only have happened if he had the time (and inclination) to call us, or the coach let us know.

    Now, I will say that as a young adult I would never have thought to call my parents about anything less than impending surgery, so I can kind of put myself in DS’s place, and understand what you guys did.

  108. Although to be completely fair, it’s the bad ones that stick in the head longer than the normal/good ones.

    Absolutely. I can recall in full detail the a$$hole dr who said to DD (who was 11 at the time and in the hospital because of headaches that drove her to tears everyone morning) when she said her pain was a 9, “10 would be having an arm cut off and 9 would be childbirth, and you’ve never been through either of those, so I don’t think you’re pain is that bad.” He went on to say, “You’re just going to have to deal with it until we see if the topamax works” and discharged her without bothering to try to diagnose a cause for her headaches. (She saw the eye dr the following week and he took one look and said “she has a lot of pressure back there, she really needs an MRI.” It turned out she had very high cerebral spinal pressure.)

    I don’t remember much about the MD who saw DW in the ER a couple of months ago and took great care of her. I don’t remember the urgent care provider who took care of the cellulitis in my hand. Etc.

  109. Milo,

    I agree. I’ll defer to Ada as to whether the presence or absence of a parent going to materially impact the successful treatment of a kinked ureter.

    Isn’t the whole reason you send them off to school so they can learn to navigate these systems on their own?

  110. I have had medical personnel refuse to give me any info about my college kid’s medical condition.

    As well they should. It’s vitally important that they know that anything they say will be kept in the strictest confidence. They can’t be stringing ADA along with lies worried she’s going to tell you.

  111. I thought of another story from when we were deployed, and one of the guys who worked for me, who was only about 19 at the time, developed some eye issue, losing vision, but I don’t remember the specifics. The one lone corpsman we had was clueless about it, so we came to periscope depth and got patched through to a physician back home who, upon hearing whatever the specific symptoms were, told us that if we didn’t get him to a hospital, he would go blind permanently. Fortunately there was a German destroyer just a few hundred miles away, and they agreed to help us, so we each started racing toward each other at full speed and transferred him off, then they raced just close enough to land so that their helo could carry him the rest of the way. It all worked out. I’m not sure when his parents were ever informed.

    He invited me to his wedding, but DW and I already had plans to be away for the weekend, but we were sorry to miss it because, apparently, the bride got into a fight with some of the guests and the police were called to break things up.

  112. Fortunately there was a German destroyer just a few hundred miles away, and they agreed to help us, so we each started racing toward each other at full speed

    70 knots combined?

  113. Rhett – I agree that my presence wouldn’t make a difference, as long as he was getting care. It turned out that once they diagnosed the problem they treated it with pain medicine and instructions on how to avoid getting into that painful state (don’t drink too much water, etc.). He did not have the surgery until the following summer.

    But, it was the not knowing and the worry that it could be something awful, and it is your child.

  114. But, it was the not knowing and the worry that it could be something awful, and it is your child.

    Oh, I totally agree. You just need to weigh that against the delay in treatment or mistreatment that could result if he is reluctant to tell the doctor exactly what happened. I’d have to
    imagine that of all the life threatening ER visits by college students a fair percentage are due to shenanigans kids would prefer their parents not know about. Who or what did you disd ranking very high on that list.

  115. It very well could be, because I don’t remember those specific details, since I was working in the nuke plant at the time, so it may have been a vectored rendezvous point. And you can’t just get to the nearest shore, because it’s not a friendly part of the world, so there’s an optimization that could be done based on the speed of the two ships and the speed and range of the helicopter. I believe this is Calculus, where you do minimize/maximize equations. The last time I’ve seen that sort of thing (grad school) Excel solve function was expected.

  116. Rhett – I see your point. I would not want that situation to happen – not telling the whole story because he/she is worried about what will get back to the parents.

  117. I told you all about my mini stroke a few months ago. While I didn’t think that the shoulder neck numbness I experienced was any different than the numbness that occurs when you sleep funny (I had a cold and fell asleep on the couch so attributed it to that), that symptom plus a few weird tingles earlier in the week should have been the sign to go to the ER before I had the big attack.. After many many tests, the doctors finally uncovered the narrowed artery in my brain. I guess the only good thing is that the location of the clog means that if I have another stroke, I’m likely to just experience paralysis and other physical issues not mental or emotional deficiencies. I’m taking drugs to help prevent another occurrence and it appears that they are working. I’ll see in another few months if the narrowing has improved.

  118. Milo, that approach also explains why “an extra 50% off 50%” is a worse deal than “an extra 40% off 60% off” or “an extra 30% off 70% off” or any of the various sales in ladies’ clothing departments.

    I’m pretty good at arithmetic, and I still don’t understand why stores price things with such complexity.

  119. “I’m pretty good at arithmetic, and I still don’t understand why stores price things with such complexity.”

    Typically, to maximize profit.

    Don’t you think some people will think “an extra 20% of mechandise already marked down 20%” sounds better than “36% off?”

  120. A few years ago, DH had severe pain in his chest and stomach. He has heartburn but this was extremely severe and he felt like he was getting a heart attack. He drank water, took OTC antacids but nothing helped. He asked to be taken to the ER. That got me really worried and went. We were seen right away, whisked into this heart clinic inside, fully equipped to test whether you are suffering from a heart attack. The treatment was great. They ran all the tests, while we waited in this very comfortable clinic. DH just had extremely severe heartburn. They gave him medication and we waited for his symptoms to subside. The tests were negative. We were amazed at the facilities here, fully expecting way worse. DH is much more careful of what he eats after that. No more heavy food for him.

  121. I suspect only people who don’t have to know the final price are participants in such sales. I’ve noticed them at Ann Taylor and Kohl’s, but never at Target or Walmart.

  122. I appreciate the input from folks in the medical field too.

    Ada– I understood why they wanted the monitors, but given the pain, I didn’t understand why they couldn’t attach the (very portable) monitor in the ER. The process, which made sense in the abstract, took a few hours before I received any pain medication, and in the meantime they bounced me all over the hospital. In the interim because of the muscle spasm and constantly being shuffled around, I was in really bad shape. I understand that women in labor can experience weird sensations, and that labor and delivery nurses don’t treat broken bones. What I didn’t understand was how it was possible that the practice in place led to me remaining in so much pain for so long while the things the hospital did to rule out problems actually made me feel worse. Perhaps alleviating serious pain isn’t the goal once they know we’re going to live? (That reads more facetious than intended.) As the human in pain, I wanted to not be in pain more than I wanted just about anything in that moment.

  123. Target has other sneaky ways for discounts. I finally downloaded Cartwheel and started using those Target coupons. Target will also price match, and they give gift cards for certain items. I find the Target discount to be tricky to fully calculate when it includes buy one, get one 1/2 off plus gift cards if you spend x.

  124. Thank you Ada & DD for your insight.

    I like the shared decision protocol, particularly if it’s standardized and uses the patient’s signature like the form linked at 4:10. So far I have not seen anything like that.

    “Isn’t the whole reason you send them off to school so they can learn to navigate these systems on their own?”

    Yes, but having family or someone you trust to support you in a medical emergency is a nice thing that almost any of us would like to have. I would think a military institution with a more formal organization of people in charge presents less of a potential dangerous situation than most colleges where no one is “in charge”. In our case the college had a tight residential system, so the RA and RM could step in if needed. It’s good for a young adult to learn how to make decisions like “do I feel well enough and is it safe to walk across campus to the ER at 3 in the morning or should I call someone”. One case I know involved a criminal assault on city streets that the kid didn’t think was serious enough to get medical attention, but the parents wanted to know more details. Another one involved a more serious assault where the parents rushed to the college city and stayed for about a week. If a young adult doesn’t want to share medical information under any circumstances, that’s certainly his prerogative.

  125. One of my 18 yo’s doctors does not even allow me to make her appointments. Yet I noticed this same office sent the bill to me and not to my daughter.

  126. “it may have been a vectored rendezvous point. And you can’t just get to the nearest shore, because it’s not a friendly part of the world, so there’s an optimization that could be done based on the speed of the two ships and the speed and range of the helicopter.”

    I don’t know why, but that made me think of this: http://www.nytimes.com/2016/03/20/magazine/the-secrets-of-the-wave-pilots.html?rref=collection%2Fsectioncollection%2Fmagazine&action=click&contentCollection=magazine&region=rank&module=package&version=highlights&contentPlacement=4&pgtype=sectionfront&_r=0

    There’s a comment in there about the NA resuming teaching navigation by sextant because of worries about over-reliance on GPS in the age of cyber attacks.

  127. completely off topic, but relevant to this group.
    It looks like I am going to buy a car. Details later. But what I want to point out is that the car “expert” pricing sites should only be used as a starting point…there is room to move at least a little lower even than truecar. This is for a new car, albeit last year’s (2015) model.
    List price $53,775
    kbb.com “fair purchase price” (in the zip code where I’m buying) $46,782
    Edmunds.com “true market value” $45,493
    truecar.com “Estimate” $41,257
    The price I’m getting $40,616

    Took 3 phone calls. More later/over the weekend.

  128. Awesome, Fred! I wait with bated breath.

    I may need you to commute down here for my next vehicle — I’ve always enjoyed it, but, dang, you are impressive.

  129. “There’s a comment in there about the NA resuming teaching navigation by sextant ”

    They must not have dropped it for very long.

    I think there are still sailing races to Bermuda that prohibit the use of electronic navigation, although you would still keep the devices on board for emergency use. I can’t seem to confirm that, but only dug up this:

    http://bermudarace.com/looking-back-a-navigators-race/

  130. “Perhaps alleviating serious pain isn’t the goal once they know we’re going to live? (That reads more facetious than intended.) ”

    Could be that the fact that you were pregnant had something to do with their lack of concern about pain management. I have given birth twice without pain meds. I asked and begged each time for pain meds, but the only time I got them was when we realized that DH role in the delivery process was to be firm and advocate for me to get pain meds. The other times I stated at each prenatal appointment and at the hospital that I wanted pain meds, but couldn’t get the nurses/doctors to call the anethesiologist.

  131. “but the only time I got them was when we realized that DH role in the delivery process was to be firm and advocate for me to get pain meds.”

    After I delivered my twins, I was getting pain meds through (I guess) the epidural. After complaining for several hours that I was in a lot of pain, despite pushing that damn button that is supposed to give you more meds, and DH saying, oh the nurse will check it when she comes back, my mom (Bless her heart!) went to the nurse’s station and gave them hell. Turns out the needle had come out and I was not getting any pain meds at all. For hours. While they took out the packing from my C-section and other internal stitches.

    I was stunned at how deferential DH was to the nurses and doctors and was so glad my mom stepped in. No one was taking my complaints seriously at all.

  132. My sister – many, many years later still gives the anesthesiologist the stink eye when she sees him (its a small town). For each of her boys births it was too late to giver her an epidural.

  133. An aside on treatment of minors: in many states, children as young as 13 can seek treatment for mental health or sexual concerns without consent of their parents. Also without parents having access to their charts. Depending on the system, the insured person may get relatively detailed bills, however.

  134. @Milo — hah! Alas, I still need something that at least masquerades as a back seat.

  135. Good-looking car, though — they seem to have taken a page from the new ‘Vette, which looks better than anything Chevy has put out in decades.

    Also, no stick — the only thing I’d consider without a stick would be a Maserati or a Tesla, just because they’re so freaking gorgeous.

  136. Yeah, it won’t be gracing my driveway, but I was surprised by how much I like its look.

  137. Cordelia– Anything is possible. I think there were people who would have wanted to help with the pain but couldn’t because of policy. I gave birth three times with no meds, and this was seriously worse. The only other time I had anything worse than this, I arrived at the ER on an ambulance, was identified as “we’re going to call this a ten for pain” and whisked away. (They still couldn’t help my pain for a good 24 hours, but that wasn’t for lack of them trying.)

  138. OT- while having dinner last night with a friend we hadn’t seen in a while, she told of how her mom started not feeling well one night and went to bed early. Her dad thought it might be serious and got her to a hospital, where his instinct was confirmed– she’d had a heart attack. She hung on long enough for her kids to make it to her bedside.

  139. My sister – many, many years later still gives the anesthesiologist the stink eye when she sees him (its a small town).

    Yeah, I’m still mad about not getting the epidural for my first birth. I swear if you’re not crying and carrying on and calling for your mother they just don’t believe you’re close to delivery.

  140. “I swear if you’re not crying and carrying on and calling for your mother they just don’t believe you’re close to delivery.”

    Late, but I have to throw in here: I arrived at the hospital after my water broke, and was barely dilated. I was second trimester, so they weren’t sure they were going to recommend delivery (apparently, they can hold off if you’re not in active labor, I don’t know). Anyway, after hours of suffering through contractions, but apparently not complaining as much as some, the nurse said, “I’m just going to check – some people can get pretty far without much complaining.” Turns out I was dilated to a 6 and they needed to hustle to get the anesthesiologist up in time.

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