16 hours in the ER; 16 hours well spent

Long wait times in hospital emergency departments are a persistent problem around the world. The American College of Emergency Physicians in a paper on ER overcrowding reported:

"The news media have given great attention to the crowding “crisis” in emergency departments as if this were a recent development. However, as far back as 1987, after sustained and unsolvable problems with crowding, the first statewide conference on crowding was held in New York City. . ."

Recently, The London Free Press ran a story reporting that ER wait times at London Health Sciences Centre (LHSC) University Hospital (UH) have been as long as 19 hours. The newspaper went on to bemoan the fact that patients with serious conditions were "spending hours in the ER." Although this is all true, this is not the whole story.

Less than two weeks ago I spent 16 hours in emergency at UH. Those 16 hours may well have been the most import block of time in my entire life. Those 16 hours led directly to my undergoing emergency surgery for a life-threatening bowel obstruction.

Two mornings earlier I had awakened with a severe pain in my gut. By mid-afternoon I was at the St. Joseph Urgent Care Centre. The service was fast but that is all I can say for it. When nothing concrete could be found to explain my pain before the centre closed at six p.m., I was told an unnamed virus was the probable cause, given a shot of morphine for pain and sent home. I asked to stay overnight for observation but was told that St. Joe's does not have any rooms for that purpose.

An interesting aside: This lack of rooms is a main reason St. Joe's fared so well in the CBC Rate Your Hospital report. Patients appearing on St. Joe's doorstep who are exceedingly ill, possibly dying, are  shipped off to University Hospital. UH takes the patients, the responsibility and the risks. Meanwhile, St. Joe's accepts the accolades for its lower than usual mortality rates.

Now, back to my story. As soon as the morphine wore off, the pain returned. I suffered all night. My difficulty with keeping stuff down, a problem dismissed by the doctor at St. Joe's, was now a constant. As I take meds for my heart and other meds to prevent stroke, I feared I was losing these all-important pills when I got violently ill. By late afternoon I called the doctor at UH who monitors my meds. I was instructed to get to the UH emergency department immediately. This was serious.

I arrived by ambulance at the ER shortly before five in the afternoon. I was parked in a hallway but I was not parked and forgotten. An EKG was done and I believe blood was taken for testing. I'm not sure how long I was in the hallway. I really didn't care. The pain had been so severe that I was just grateful to be in the hospital where I was receiving something for the pain.

At some point in the early evening an ER cubicle became free and I was moved to a small bed in the ER. I met with an ER doctor who immediately ordered x-rays. He was concerned I might have a bowel obstruction. I did.

It seems a tight band had formed around part of my small intestine. Why it formed was not clear but what was clear was that it had to be removed and soon. The tight band was shutting off blood flow to a section of my intestine and if not removed soon would irreparably damage the constricted intestine. If the band was not removed soon, surgical removal of the damaged section of intestine would be necessary.

But the doctors in ER faced another complication. I take Pradaxa. This is an anti-coagulant or a blood-thinner in common parlance. Unlike coumadin, there is no easy way to reverse the effect Pradaxa has on blood's ability to clot. Major surgery can result in life-threatening bleeding in patients taking Pradaxa. Discontinuing Pradaxa a day or two before surgery is the usual answer but my doctors did not have that luxury.

A CT scan was ordered. A couple of hours before the procedure I was given a litre of a contrast-enhancing fluid to drink. The surgeons needed to know exactly what it was that they were up against. A CT scan was the answer. An MRI might have been another option but not in my case. I have an ICD/pacemaker in my chest. For me, MRIs are not an option.

Served cold the contrast liquid was not all that difficult to drink. The nurse divided my dose into two 500ml portions. I slowly consumed the first 500ml during the first hour. The nurse thoughtfully put my second dose on ice.

Normally, I was told, I would have been given close to two litres of the contrast-enhancing fluid but as I was slated for surgery first thing in the morning the volume of the dose was kept to a minimum. One never has anything by mouth before surgery and here I was drinking a full litre of liquid. As soon as the CT scan was complete, a young doctor threaded a tube through my nose and down my throat into my stomach. He pumped what he could of the contrast-enhancing fluid out of my stomach.

At 9 a.m. I was in the operating room. Thanks to the CT scan the surgical team had determined the exact location of the offending intestinal band. The lead surgeon, an expert in laparoscopic surgery, a minimally invasive surgical approach that does not require splitting the abdomen open, led the team down a surgical path that would skirt the Pradaxa bleeding risk. Brilliant.

After about three and a half hours I was wheeled into the recovery room. When I was asked if I needed another shot of painkiller, I said, "No. The pain is gone."

I had spent 16 hours in emergency. A reporter searching ER records would learn a patient at LHSC University Hospital spent 16 hours in the ER but would not learn that those 16 hours saved the patient's life.

I send my heartfelt thanks to the young doctors, the team-leading surgeon and to the nurses in the ER, the nurses in the recovery room and the nurses on the eighth floor where I eventually found a room. What a fine team! They saved my life.

Thank you!

Understanding ER Wait Times Information

What does “ER Wait Times” mean?

An ER Wait Time is the total time that someone who visits an ER looking for immediate, unscheduled care spends in the ER. The measurement of wait time :

• Starts when a patient registers or is triaged (“triage” is the process for deciding which ER patients need, or are likely to benefit from, immediate treatment).
• Ends when the patient is discharged from the ER or is admitted to a hospital bed.

During the time that a patient is in the ER, doctors and nurses may be treating the patient's condition or ordering tests and waiting for test results so they can decide on  the best course of treatment/

Some months after I wrote the above post, I had another event. This time I had a severe chest pain that left me doubled up. The pain then moved from my chest to my back and eventually settled in my chest. I spend all day in emergency. I was given another CAT scan and when nothing was found I was pushed to the side but not forgotten. It took a full day but before I was released I was given a three page document detailing the findings of the CAT scan.

Again, the wait times information looks bad. Eight or more hours in emergency seems unbelievable on the surface. A reporter might roast the hospital for this. Me? As the patient who has spent these on-the-surface unreasonable times in the ER, I'd still give the ER staff a big thumbs up. I feel my time spent in ER was time well spent. In fact, I'm alive on account of it.

Priests for Life, maybe, but certainly not Priests for Truth

Should Baby Joseph have been given a tracheotomy by the London Ontario hospital and returned to the care of his parents? Or would another medical approach all together have offered the infant life instead of the almost certain death of simply being taken off the ventilator?

These are not questions that I can easily answer. But now that the baby has been airlifted from London to St. Louis Missouri where he will receive alternative care, these questions will have an answer. Maybe.

But what was clear if you followed the Twitter tweets and Facebook posts was that many people distrusted the doctors at the London Health Sciences Centre (LHSC). But if the reportedly terminally ill child has left London, the cloud of mistrust and controversy remains.

Priests for Life, based in Staten Island NY, posted a statement boasting "Father Frank Pavone of Priests for Life Leads Covert Mission to Rescue Baby Joseph." The story says the mission was accomplished "under cover of darkness."

Covert? So how did the fathers disguise their operation so as to not alert hospital security and  under the cover of darkness secretly spirit Baby Joseph away?

The short answer: They didn't.

The London hospital cared for Baby Joseph right up until the American medical team in an air ambulance took over. There was no covert operation. And it certainly was not conducted under the cover of darkness. The transfer may have been done at night but those Canadians are quite advanced; they have lights!

End-of-life decisions are difficult, especially ones involving infants. Such decisions are hard on everyone involved: mothers, fathers, other family members and on the doctors, nurses and other hospital staff providing medical treatment to the failing child.

When I read the claim by Father Pavone that Baby Joseph needed "a hospital that cherishes life over the bottom line," I shook my head. That is just what the dying child had in the LHCS. I know this for a fact from my own personal experience.

Also, as a former newspaper photographer I've spent a lot of time over the years taking pictures of children receiving treatment at the Children's Hospital at London Health Sciences Centre. The hospital, its doctors, nurses and staff do not deserve the nasty, uninformed attacks they have taken since this matter went viral on the Internet and in the American media. They certainly should not be subjected to phone and e-mail threats as has been happening.

Ian Gillespie, a columnist with The London Free Press, addressed this very issue in a recent column. He spoke with Lisa Cann, a mother with a 14-year-old son who must struggle to live. Her boy has help with his health struggles - the LHSC.

Cann told Gillespie:

During the past nine years she and her son have made 25 visits to the emergency room, more than 100 pediatric medical day unit visits, 55 radiology visits, more than 50 visits to a gastro-intestinal clinic, more than 450 weekly pediatric appointments, at least seven calls to 911 and close to 20 extended hospital stays. This week, they went back for yet another surgical procedure.

And through it all, Cann says she’s seen nothing but top-notch care and compassion.

LHSC kept Baby Joseph alive for months. He was under their care from October on and it was months before they recommended removing the boy's breathing tube. They ran every test and explored every option. This is not the conduct of a hospital more interested in saving money than saving lives.

Whether you agree with the Canadian hospital's decision or not, there is widespread support for their position in the medical community throughout the world. This is not just according to the hospital but according to the father of Baby Joseph. Moe Maraachli spoke to me of the frustration of trying to find a hospital to take his son. "I've talked to doctors throughout Canada, the United States and Europe . . . ," he said, then stopped and shook his head. He was unable to finish.

The parents of Baby Joseph sought the medical opinion of physicians at the Children’s Hospital of Michigan in Detroit. Physician experts at the hospital wrote the LHSC:

"We do not feel that we have anything to offer Joseph that has not already been given to him under your care” and "there is nothing that the Children's Hospital of Michigan has to offer Joseph that has not already been done for him in Ontario".

When Priests for Life present themselves as major players in the success of finding a suitable hospital prepared to accept little Joseph, they are not lying. It is clear that they work with a rather unique hospital in SSM Cardinal Glennon Children's Medical Center of St. Louis.

What I find so disturbing is the angry and very nasty tone of much of the discourse, especially that coming from the Priests for Life. Many distrusted the Canadian hospital; I distrust the highly charged statements released by this religious group. I find their statements self serving and worse I find them dishonest.

It is time for the priests to stop the posturing. It is time for the Fathers to work at getting out the truth. Stoking fiery emotions of hate, anger and misunderstanding, emotions already glowing red hot when it come to this issue, is not the right response; It may not even be Christian.
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Baby Joseph myths

Fox News in the States has done a good job of politicizing this story with fabricated facts. They put enough spin on the story to make any viewer dizzy. LHSC put together a page dispelling some of the false and misleading information being spread by groups such as the Priests for Life and Fox News.

Read Just the Facts on the LHSC website.

When I watch a video featuring the Fox News Medical A team I can't help but think of George Owell's Ministry of Truth in his novel 1984.

A Recycled Blog

I'm shutting down my original Rockinon blog and I am moving some of my favourite posts to this site. I'm not being lazy; I'm recycling.

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It’s a weird world when David Gough, the blogger covering environmental concerns for The London Free Press, comes out against a bylaw designed to stop the practice of idling a car for more than a minute.

Gough wrote: “Five minutes makes sense, one minute just seems to be cutting it too close.”

He goes on to argue that dropping his son off at the arena might easily force him to idle his car for more than a minute while his son putzes around undoing his seat belt, turning off his video game and getting his hockey bag from the trunk. Gough says he could see his son costing him money.

Dave, the idea is to turn off your car. It’s easy. It’s fast. It’s green. And, it’s old fashioned.

That’s right, old fashioned. When I was a boy, my father never let his car idle for more than a minute — not even in winter. He had been told by a mechanic that the manual choke made the carburetor fuel mix richer and this could cause a soot-like build-up on the plugs. This dirt, the mechanic said, caused engines to run-on when turned off.

Furthermore, the mechanic said the engine oil pump was not efficient when the car was idling. It worked best with the car underway and the engine reving higher.

Four decades ago, my father taught me: If you are stopping for more than a minute, turn off the car. If my dad could do it, we can all do it. And, my dad wasn’t even green.

Hot enough to fry an egg . . .

Monday it was hot enough in London, Ontario, Canada, to fry an egg. I thought of using the hood of my car but, I didn't. I'm curious but not that curious. I used my wife's car.

I considered going to the wrecker's in order to find a flat, black painted car panel but it was too far to drive. I don't have that kind of spare change.


The phrase may be, "It's hot enough to fry an egg . . . " but truth is that it is the sun that does the work. Air temperature alone will not do it. Eggs need a temperature of 158 degrees Fahrenheit to cook.

When I was a boy we used to go swimming at Point Pelee and it was a long walk from the parking lot to the beach. The sand felt hot enough to cook an egg, it sure played havoc with our feet, but a egg would have been safe. I'm sure the sand didn't hit the magic 158 degree temperature.

Hot sidewalks won't do it either. Even if you could find a sidewalk that hit 158 degrees, the raw egg sitting on the concrete would quickly lower the sidewalk surface temperature. Sidewalks are out.

But cooking an egg on a clear-sky, hot summer day is possible. Check the picture. A fried egg. I accepted sunny side up. I wasn't going to push the moment. It was fried around 1 p.m. daylight saving time in London, Ontario, Canada, on August 17th, 2009, while some of my neighbours watched.

Frying an egg under the hot sun may be possible but there are some tricks involved. We are not talking cheating here but physics. If you are going to get this to work you need to think like a scientist and a magician. Consider why this is a still picture and not a YouTube video. A little banter while you cook will help folk from noticing the little things -- the very important things.

As further proof that cooking an egg is possible -- difficult but possible -- I submit this link to a site where a fellow examined the temperature of the hood of a black-painted car sitting in full summer sun. He got a reading of 160 degrees Fahrenheit.

Or check out this story from Las Vegas, Nevada. The reporter for the Review-Journal in the American desert city recorded a temperature of 190 degrees Fahrenheit on a black SUV driver's door and a couple of vehicles had dashboards hitting 179 degrees Fahrenheit when parked full in the sun.

This little bit of fun does have a serious side. Don't ever leave children or pets inside a parked car. Folks have have fried eggs inside cars. Don't fry your loved ones. This is not a joke. The Dallas Morning News took the temperature of a car, and not a black one, left in the mid-day sun with its windows rolled up. The air temperature inside that car hit almost 140 degrees Fahrenheit. We may live in Canada, not in Texas, but our summer sun must still be respected.

And if you like to sunbath think of my egg and then think of basal cell carcinoma, squamous cell carcinoma, and melanoma. Sunny side up is fine for eggs but not so good for people. I know; I've had treatments for sun damaged skin.

Cheers,
Rockinon

Addendum: Just learned from my wife that the children at the summer camp where she works were kept inside today as there was a heat advisory in effect. Guess I picked a good day to write my first weather story. And it wasn't even a slow news day.

The Deforested City

London likes to be known as the Forest City, even though the nickname may have originally been an insult. London, the city deep in the forests of southwestern Ontario — an unimportant, little hick town lost in the middle of nowhere.

The city is looking at how to improve the downtown. Nothing new here. Ever since I moved to London, more than three decades ago, the rallying cry has been, "Downtown revival!"

I remember when paving stones and trees in the sidewalk were part of the answer. Paving stones appeared everywhere downtown. Not only were they more visually interesting than concrete, taxpayers were told that in the long run paving stones would save the city money. Work that in the past would have necessitated the destruction of the sidewalk and the subsequent installation of a new concrete pad would now be completed by lifting out the paving stones, setting them to the side and when the work was completed the stones would be placed back in their original positions. This hasn't happened. The stones are lifted, scrapped and asphalt used to patch over the repair — all very messy.

I also recall when sidewalks lined with shade-giving trees were being promoted. Cuts were crudely made in the concrete sidewalks, steel grates to protect the trees, while allowing ample water to reach their roots, were installed. The trees were planted, sometimes multiple times. It appears now the city has given up, at least along this stretch of York Street shown on the left.

The paving stones have settled and to make walking safer asphalt has been used to eliminate the ridge that could trip walkers. In the centre where there was once a tree, there is now a circular patch of asphalt. The only green is supplied by weeds struggling through the steel grate.

I believe this is a symbol, a sign — a sign of defeat. The ideas were, as they say, half-baked. The dream of a sidewalk beautified by a long, row of green trees is dead. On the right, the grate has been removed, as have the paving stones, and the entire square patch of earth asphalted over. Not even a weed will be allowed to grow.

Why didn't the trees flourish? Possibly, they died because the dream was never healthy. Before we plant trees in the sidewalk, maybe we have to plant trees in people's minds. And before that, maybe we have to plant the desire to create a better, a more beautiful downtown in people's minds. It is clear from the lack of care exercised in the cutting of the original concrete, in the lazy, oh-so-ugly asphalt maintenance, that even the city did not take this beautification program seriously.

Maybe the city had the right idea a few years ago when they opted for brightly painted metal trees, works of art, for the downtown. Oddly enough, some folk are again calling for the real thing. Before we change the trees, we need to change the attitude, the mindset, of Londoners.

Home Concert Featured The Laws

I'd never heard of home concerts. Friday night my wife and I attended one at the home of Christine Newland and her husband Walter Bietberger. Christine is the principal cellist for Orchestra London in London, Ontario. They are a cool couple and I'm not surprised that these two brought live music into their home and shared the experience with friends.

Christine and Walter's home concert featured The Laws, the husband-and-wife singer/songwriter team of John and Michele Law from Wheatley, Ontario. Their appearance, along with that of Nashville guitarist Brent Moyer, was not a one-off, unique event; no, it was part of a movement which is opening new venues to performers. One musician remarked Friday night, home concerts beat playin' bars.

There is a Canadian website, from the east coast, dedicated to home concerts — Acoustic Roof — but this is not simply a folksy Maritimes' movement moving west. I found references to home concerts being held everywhere from Arkansas, in the southern States, to various towns throughout Canada.

The Laws have performed on stages throughout North Amercia and have completed three music tours of Australia. They have been featured on Entertainment Tonight Canada and the PBS series Legends and Lyrics. The PBS site compares The Laws "to some of the greatest duos of all time... The Everly Brothers, The Louvins and Emmylou Harris and Gram Parsons."

In the words of host Christine Newland, it was "an incredibly magical evening."

And now, listen to The Laws . . . and if you only have time for one, my choice is Away about Michele sleeping in her husband's shirt when he is away. My wife smiled when Michele talked about the obvious inspiration for the song. My wife liked to iron my shirts when I was away on an out-of-town assignment, or simply working the night shift.




Visit Reverb Nation for more of the music of The Laws and to purchase. Enjoy.











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