A prolonged visit to the VA Medical Center
I spent 2.5 days in the ICU at the VA Medical Center near me and I share some blame in the severity of my illness. That illness is Clostridium difficile colitis and it is not as I originally believed, caused by eating spoiled food.
It almost certainly began on Monday. I had to go to the VA for a routine check-up. I was sent to the lab for tests. I had to "fill the cup" for a urine test and while I washed my hands as instructed before filling that cup, I neglected to do so after finishing. Given how C-diff is communicated, that's probably where I was infected.
It didn't hit until Tuesday evening when I began having severe diarrhea and vomiting, accompanied with nausea. I went to the ER where they pumped me full of fluids, gave me some anti-nausea medication and ran some labs. After a few hours, they wanted to keep me for observation and I convinced the doctor to let me go home. Big mistake on my part.
I got sick again a few hours later but figured that if I kept hydrated it would eventually pass. I was wrong on that part as well. Things worsened Friday afternoon and Saturday morning I finally gave it and went back to the ER.
I've battled hypertension (high blood pressure) for many years. Never had to worry about hypotension before. That's when the blood pressure of a person is too low. Any readings below 90 over 60 is considered hypotension. My BP when I was admitted to the ER was below 80 over 50. The ER staff said at that level a patient would normally be disoriented. I was completely lucid throughout the day, but it was that low BP that resulted in my being sent to the ICU.
* * *
I'd never been in the ICU at the VA Medical Center before. The building has been going through renovations recently and the ICU ward looks very new. They have one nurse assigned to take direct care of every two patients. The nurses who took care of me had a lighter load with me than whoever else they were caring for. I could get up and go to the commode on my own. They had me on a liquid diet at first, but that was changed to soft food by the end of day one.
The two doctors who were overseeing my care while I was in the ICU were very engaged in my care and I believe they did a great job. Their attending physician was entertaining to listen to as I eavesdropped on the review of my condition and treatment proposals. He made me laugh aloud when he said they should include an HIV test in my next blood draw. Sorry Doc, but it's been so long since I was last potentially exposed to HIV, there was no possibility of that test coming back positive. Unless it was a false positive of course. It would have had to have been some strain that could lie dormant for a number of years.
* * *
After spending Saturday and Sunday nights in the ICU, on Monday afternoon I was moved to another ward. Instead of my vitals being checked hourly, which makes sleeping tough, they were only checked every four hours. I had two new doctors, one of whom seemed very engaged in transitioning me from ICU to being discharged to go home, and the other who was more interested in observing the other.
The ward had one nurse for a number of patients. The day nurse, James, was awesome. The night nurse, no so much. At one point at 4 a.m. on Wednesday morning, I asked for some more water. The LVN who was taking my vitals said she had to talk to the night nurse. When the night nurse came in two hours later to give me some medications, I mentioned that I'd asked for water two hours ago. She brought me the water without an apology but did admit there had been a miscommunication between her and the LVN.
The doctor who I mentioned was observing put in an order that the head of my bed was to be kept at a 45 degree angle. That's the norm for patients who have congestive heart failure, which I have, but I don't need the angling of the bed. That's because I don't have orthopnea, a condition where you develop shortness of breath when lying down. I have lost count of how many cardiologists who have examined or treated me who find that hard to believe, but it's the truth. As a result of this doctor's order, my sleep on Tuesday night was horrible.
* * *
Wednesday morning brought a visit from the doctor who wanted to get me home to finish healing and she told me that there would be one last test and then I'd be released. They'd held some of my regular medications while I recovered from my low blood pressure and they wanted to give them to me and then see if that caused my BP to crash. It didn't, and I was given the all-clear after 1 p.m.
Last time I was an inpatient, they'd had me walk down from the ward to the discharge center. This time I got a ride in a really nice wheeled chair. Several of the staff we passed in the hallways mentioned to the man pushing the chair how lucky he was to have use of this new piece of equipment. Finally, just after 2:15 p.m., I was able to walk out through the sliding glass doors I'd walked in through Saturday morning.
People talk a lot about the wait for treatment at the VA. I can tell you one thing from what I saw when I walked into that parking lot. This lot was filled to complete capacity, including the spaces that are normally blocked off to make it easier to move around from row to row. There were a number of cars circling like hungry vultures, eager for a space to fill. That tells me that like other VA facilities, in spite of constant expansion, the West Los Angeles VA appears to be near, at, or over its capacity to treat outpatients. With the competing needs of finding space to house homeless veterans, continue to provide outstanding care to all eligible veterans, and dealing with the inappropriate leasing of space on the VA campus to non-VA operations, there needs to be more attention paid to the upcoming settlement of that lawsuit. You know the one, the one that questioned the VA's choice to provide land for UCLA to construct a baseball stadium. The one that questioned leasing space to an exclusive (and expensive) private school located to the North of the VA Campus. Veterans need to be the priority.
I got sick again a few hours later but figured that if I kept hydrated it would eventually pass. I was wrong on that part as well. Things worsened Friday afternoon and Saturday morning I finally gave it and went back to the ER.
I've battled hypertension (high blood pressure) for many years. Never had to worry about hypotension before. That's when the blood pressure of a person is too low. Any readings below 90 over 60 is considered hypotension. My BP when I was admitted to the ER was below 80 over 50. The ER staff said at that level a patient would normally be disoriented. I was completely lucid throughout the day, but it was that low BP that resulted in my being sent to the ICU.
* * *
I'd never been in the ICU at the VA Medical Center before. The building has been going through renovations recently and the ICU ward looks very new. They have one nurse assigned to take direct care of every two patients. The nurses who took care of me had a lighter load with me than whoever else they were caring for. I could get up and go to the commode on my own. They had me on a liquid diet at first, but that was changed to soft food by the end of day one.
The two doctors who were overseeing my care while I was in the ICU were very engaged in my care and I believe they did a great job. Their attending physician was entertaining to listen to as I eavesdropped on the review of my condition and treatment proposals. He made me laugh aloud when he said they should include an HIV test in my next blood draw. Sorry Doc, but it's been so long since I was last potentially exposed to HIV, there was no possibility of that test coming back positive. Unless it was a false positive of course. It would have had to have been some strain that could lie dormant for a number of years.
* * *
After spending Saturday and Sunday nights in the ICU, on Monday afternoon I was moved to another ward. Instead of my vitals being checked hourly, which makes sleeping tough, they were only checked every four hours. I had two new doctors, one of whom seemed very engaged in transitioning me from ICU to being discharged to go home, and the other who was more interested in observing the other.
The ward had one nurse for a number of patients. The day nurse, James, was awesome. The night nurse, no so much. At one point at 4 a.m. on Wednesday morning, I asked for some more water. The LVN who was taking my vitals said she had to talk to the night nurse. When the night nurse came in two hours later to give me some medications, I mentioned that I'd asked for water two hours ago. She brought me the water without an apology but did admit there had been a miscommunication between her and the LVN.
The doctor who I mentioned was observing put in an order that the head of my bed was to be kept at a 45 degree angle. That's the norm for patients who have congestive heart failure, which I have, but I don't need the angling of the bed. That's because I don't have orthopnea, a condition where you develop shortness of breath when lying down. I have lost count of how many cardiologists who have examined or treated me who find that hard to believe, but it's the truth. As a result of this doctor's order, my sleep on Tuesday night was horrible.
* * *
Wednesday morning brought a visit from the doctor who wanted to get me home to finish healing and she told me that there would be one last test and then I'd be released. They'd held some of my regular medications while I recovered from my low blood pressure and they wanted to give them to me and then see if that caused my BP to crash. It didn't, and I was given the all-clear after 1 p.m.
Last time I was an inpatient, they'd had me walk down from the ward to the discharge center. This time I got a ride in a really nice wheeled chair. Several of the staff we passed in the hallways mentioned to the man pushing the chair how lucky he was to have use of this new piece of equipment. Finally, just after 2:15 p.m., I was able to walk out through the sliding glass doors I'd walked in through Saturday morning.
People talk a lot about the wait for treatment at the VA. I can tell you one thing from what I saw when I walked into that parking lot. This lot was filled to complete capacity, including the spaces that are normally blocked off to make it easier to move around from row to row. There were a number of cars circling like hungry vultures, eager for a space to fill. That tells me that like other VA facilities, in spite of constant expansion, the West Los Angeles VA appears to be near, at, or over its capacity to treat outpatients. With the competing needs of finding space to house homeless veterans, continue to provide outstanding care to all eligible veterans, and dealing with the inappropriate leasing of space on the VA campus to non-VA operations, there needs to be more attention paid to the upcoming settlement of that lawsuit. You know the one, the one that questioned the VA's choice to provide land for UCLA to construct a baseball stadium. The one that questioned leasing space to an exclusive (and expensive) private school located to the North of the VA Campus. Veterans need to be the priority.
posted by me at 9:49 PM
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