Friday, July 08, 2005

Teaching Hospitals and Rejection

There are many benefits to coming to a teaching hospital for your health care. The attending physicians are usually some of the best in the country; however, there are also disadvanatages.

At Vanderbilt, the worst time in the world to be admitted to the hospital, especially in the ER, is during the first part of July. This is when the first-year residents start, and they really have no idea what they're doing. In addition to this, sometimes you get a cocky attending that is trying to be all suave and prove himself as a doctor to these little underlings. I had a first-hand experience with one of these attendings and his first-year student almost exactly a year ago.

After a liver transplant, a patient has two tubes for draining bile fluid coming out of the right lower portion of the abdomen. (I may post pictures later if there are no objections to show what I'm talking about). Before I went home from the hospital, these tubes had to (literally) be ripped out of my stomach. The physician will remove the stitches that were holding it in and then yank it out. YELP! (Remember, there are two tubes). The first one that was removed was done so by a resident (not a first year) and he did it without numbing me. I didn't cry, but my eyes did tear up and I forgot to breathe for a moment or two. When I had the second tube removed the next day, a different resident decided that it would be nice to numb me first, so that one was virtually pain-free. These tubes did leave pretty big holes in my stomach, so I did have to have stictches after the tubes were removed.

A week or so after I was discharged from the hosptial, I got my first experience with Dr. BigShot. I immediately didn't like this guy, but he is an actual attending physician so I was pretty sure that he was at least going to be good at what he does, especially with his title in the department. But he decided that the stitches from the drainage tubes were ready to come out. Since I had nearly 40 staples in my stomach in addition to these stitches, I was pretty excited. He asked the nurse to do it, but she said she would be more comfortable with him doing it, so, he decided to show off and show her how to remove them. Instead of being nice with me, he tried to do it all quickly and in one motion, which, translated, means that he pinched my skin very hard with the tweezers and then cut me with the very, very sharp scissors. I was not happy. Neither was my husband or my mother, who watched the entire procedure.

Fast forward a week, around July 11, just 11 days after the first year residents started. I had been feeling very, very crummy. I had blood work done in the morning as I usually did 3-4 times a week. At about 2:00, I got a phone call saying that I needed to come right back to the hospital because I was rejecting. So, my mom, my husband and I all hopped in the car and headed back to Vanderbilt. (At this point, even getting in and out of the car was not fun. It required having a pillow and moving it around in various positions while I got in the car, and then once in, it went in between my abdomen and the seat belt because it hurt to have the seat belt rubbing against my staples.) We got to the hospital and found out that I had to have a liver biopsy to make sure that the blood work was correct. I was expecting to be taken down to have a CT guided biopsy where I am nearly asleep and they stick a little needle through the skin to biopsy a small piece of tissue. Instead, they took me back immediately into the clinic (a regular exam room). I was not happy to see Dr. BigShot walk through the door, his resident in tow. Apparantly, they had called him out of the operating room to come biopsy me. He was in his scrubs, and he was in a hurry. He layed me out on the table and got all of his tools together, resident watching it all. The sweet, sweet nurse was also right there next to me. Doc gave me a shot of something to numb me, and then proceeded to remove three of my staples.

Me: I can feel that.
Dr. BigShot: Give it a second, the meds will kick in.
Me starting to sweat
Nurse: Do you need a wet cloth?
Me: Yeah
Dr. BigShot (poking at my chest): Can you still feel that?
Me: Yes
The nurse puts the wet cloth on my head. I start to lose color. The doctor opens me up.
Me: I can feel that
Dr. BigShot: Well, I'm almost finished. I can keep going, or I can give you another shot. I think I'll keep going.
My eyes roll back into my head
Nurse: Let me get you another wet cloth.
The nurse is stroking my head and trying to get me to cool down and not pass out.
Doc snaps off a piece of my liver.
I yelp.
Doc: All finished. To resident: Sew her up, will ya?
Resident: I don't know how.
Doc gives me a stitch to show the kid how, kid finishes, me feeling every little poke and tug.
Doc and resident rush out back to OR.
Nurse: Why don't you just lay there for a few minutes until you're ready to get up. Someone is just going to have to wait for this room....take as long as you need.

I glanced over at Rick and my mom, who both had horrified looks on their faces. Honestly, it took place so quickly that they didn't really have time to jump in and say anything. My poor husband was almost as pale as I was. He said, I saw your liver.

Poor Rick. The poor guy can't even clean up a little dog poo without gagging and nearly getting sick. I don't know how he could stand to sit there and watch the madness that had just occurred.

That wasn't the end of my ultra-terrible-bad day. After my biopsy, I had to go have an ultrasound. I couldn't take it any more. Before I could even get to the waiting room for the ultrasound, I broke down. I was in so much pain, and I was angry. I couldn't believe that some butt-head of a doctor would do such a thing to a patient. Did I mention how much I was hurting? I sat in the ultrasound room, full of people, crying my eyes out for some pain relief. My mom found a nurse for me and she said that it would be okay for me to take some pain meds (I wasn't supposed to eat or drink anything prior to the ultrasound). I probably horrified those people in the waiting room. They were all looking at me with expressions ranging from sadness and empathy to "she-needs-to-get-it-together" glances. I finally settled down a little, only to be taken back and have my sore, bruised liver be pushed and proded on by an ultrasound technician. She was great, though. She did the best she could to cause me as little pain as possible.

Luckily, I have connections in GI and the liver transplant departments. My boss in my lab justsohappens to be Dr. BigShot's boss, too. Hubby was on the phone in an instant with my boss telling him what happened. I was also sure to complain to every other transplant surgeon about what a jerk that guy was, and I was also sure to request that I never, ever saw him again.

I did see him once more, a couple of months later. I was having a bout with CMV and had to come in and be tested for it. He was the only doc available, but he sure was nice to me that time........


At 4:16 PM, Blogger Andrea said...

Just the thought of the pain you have experienced makes my tummy weak. Bless your heart, Amanda.

I can only pray that all of the pain and agony is behind you know and you have nothing but years of health ahead of you.

At 8:59 PM, Anonymous Anonymous said...

What an absolute perfect example of what a horrible "bedside manner" is. I hope someone opened up a large can of whoopass on Doc BigShot.

At 4:52 AM, Blogger Tony Arnold said...

I am so glad you are writing this Amanda. I also want to find Dr. Bigshot and punch him right in the nose (or liver).

Your husband is a great man not to have gone after the guy.


At 3:44 PM, Blogger Jacinda said...

I ran across your blog and just wanted to send you some encouragement! I'm so sorry you're having to go through all of this and hope things get better soon! I had my 2nd child in a teaching hospital, so I know a little of what you're talking about. It's great b/c of the "titles" and the "advanced technology" etc., BUT sometimes I did feel a little too much like a number rather than a real patient. ((hugs)) to you!

At 7:16 PM, Blogger Amanda said...

Thanks for the comments, guys. I'm careful to warn anyone I know that is going into Vanderbilt's liver transplant program about this guy.

And just for everyone's information, if you ever go into a teaching hospital and a resident approaches you, you can request that an actual attending see you. You do not have to be subjected to a student. In my experiences, the cheif residents are great, but those guys had better be because they're incredibly close to being an attending physician.

At 10:02 AM, Blogger DigiGirl said...

This comment has been removed by a blog administrator.

At 10:05 AM, Blogger DigiGirl said...

Ouch! I had sympathy pain just reading that.

Ok, my turn!

When I was in college, I had health insurance through the University of Arizona. So I had to go to the University Hospital clinic if I had any health needs.

Well, I had to go for my annual womanly check-up. So I made an appointment and three months later, it was my time to go! I requested the female doctor I had the previous year because her bedside manner was excellent.

Come appointment time, I was told that Dr. XYZ was on vacation, and Dr. ABC would be seeing me today. So i'm sitting on the table wearing nothing but the paper robe and in walks Dr. ABC. Well, Dr. ABC was NOT A FEMALE, and Dr. ABC was a rather handsome, young resident and I was immediately mortified. I didn't know if I should get up and run away, or laugh uncontrollably at the irony of the situation. I did neither. Although the thought of me running down the clinic halls in the paper robe made me want to laugh even more.

So the exam went on. The doc had a great bedside manner, and of course there was a female nurse in the room to make sure the tools were warm and that he didn't take an abnormally long time during the breast exam portion of the show. :)

Well, turns out the doc hadn't done too many of these exams before and had to call in a second opinion. He calls the attending and has HIM take a look under the hood. Well, not only is the attending a MALE, but he has another attending from some other teaching hospital following him around that day. Also a MALE!

Ugh. Here I am in a paper robe, and there are three men and one woman intensely focusing on my swimsuit area. Is this a pelvic exam or a fraternity party? I wanted to crawl into a hole and die.

Needless to say, I recovered from the situation with minimal emotional scars. Sorry if I grossed you out with this story. I just had to get it off my chest!

At 10:42 AM, Blogger Amanda said...


I would have been mortified!

I always try to tell myself when I'm at "that" appointment that he's a doctor that sees this multiple times every day...but that still doesn't help.

One guy doctor is bad enough. I couldn't imagine what it would have felt like to be on display to three of them!


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