Acetaminophen addict

Being at a teaching hospital and being an unusual case, I probably got larger groups of medical students, interns, etc. than the average patient. My belly was gently mashed daily by at least 10 people. It is not normal to be able to feel your spleen, but you could easily feel mine- like I was going to give birth to an alien- it was a somewhat firm and slightly protrudant mass right below the end of my rib cage on the left side. So medical students were very happy to do my physical exam. A couple of them even said "wow" when they did it. And then there were the surgeons. We had discussed the removal of my spleen on multiple occasions and it was decided that trauma surgeons would be the best option. Having some medical knowledge, my biggest fear about this surgery was "bleeding out" (hemorrhage).  My red blood cells and platelets were extremely low which can be a real problem if the spleen were to be nicked during surgery. And I could not really get a blood transfusion before hand- the spleen would gobble up the cells before the surgery, so how were they going to control the bleeding? (brief side note- the spleen usually cannot be biopsied or even partially removed because of it's vascularity (lots and lots of blood vessels). When spleens rupture or are damaged, hemorrhaging is the biggest complication). These thoughts made me very nervous, so I voiced them to my surgeon. "It is not terribly common that I get to remove a spleen that isn't ruptured. I'll be able to find my landmarks easily and I don't anticipate many problems because you are healthy, but if it does start to bleed for any reason, I know how to stop the bleeding -every thing will be fine." I don't know how to explain it, but surgeons in particular get a glint in their eye when they are faced with an unusual surgery. I knew that the operating room would be full that day and that they would be learning from me and my rogue spleen.

I almost hated to disappoint that surgeon! Because I was certain I had a fungus and I was going home- no surgery for me!

Then my fevers came back. I guess inherently I am just a pleaser.

When the fever started yet again I knew it was time to part with the spleen. We had said our good-byes and at this point I was running out of options.

Unfortunately, on my way to see Dr. Yoda that day, we were rear-ended less than 1/2 mile from the clinic (by a distracted driver- don't text and drive people – that few seconds of inattentiveness cost the driver's insurance company a lot of money). I started to have some belly and back pain almost immediately. I was taken to the nearest ED (emergency department) for evaluation (and promptly sat in the waiting room- another day, another post) and transported via ambulance to Vanderbilt ED. I had been really trying to avoid Vandy ED. And I would like to confirm that it is a really crazy place. Really. I got to spend about 30 hours there that day. The staff and doctors were great, but really 30 hours? When I was finally transported to a room my fever was out of control. All I wanted to do was get some rest, some Tylenol and get mentally prepared.

Remember my Mt. Calavry Post? If you review it, you will see part of my misery that night was brought about by a reduction in Tylenol doseage. The same reduction happened AGAIN when I was transferred to a room from the ED. Why would they do that to me? I am having constant fever, I am going to surgery tomorrow, I have been doing this circus for a couple of months now…. Let me tell you why. If you reader, right now go look at the bottle of Tylenol in your cabinet, it will say (on the 500 mg dose bottle), you may take 1-2 pills every 6 hours (4000 mg every 24 hours total should not be exceeded). Failure to follow directions as written may lead to hepatotoxicity (liver failure and death). Ok got it. Don't take too much Tylenol and since my liver function was relatively normal, no one was worried about the functioning capacity of my liver. But newer recommendations state that a person should not have more than 3000mg in 24 hours. And the resident on call was not going to give me a dose that would exceed that recommendation. I was livid. When my fever got up to 103 I had the nurse call again. She got orders for blood cultures, and another statement that he was not going to increase my Tylenol. I lost it. I told her to get him on the phone for me. I am sorry that y'all don't know me better. I would say that honestly I am a calm person and I am assertive, but not aggressive and "violent" would definitely not be a word that would come to most people's mind when they thought of me. Right now-I wanted to punch his lights out.

Speaking with him on the phone, I reminded him that I had been taking 1000 mg every 6 hours of Tylenol in the emergency room with no problem, my liver function was essentially normal. This is when he said, "I am only on call this evening, I don't know you. I only have to treat you until the morning and I am not going to give you any more Tylenol." Me: Going to lose it -just breathe "I understand your concerns about hepatoxicity. I will sign any form you need me to, I just want some Tylenol." In a nut shell him, "too bad." Me: after hanging up- hysterical crying and a standing ovation from my nurse for standing up to him.

I do not hold any particular grudge against this healthcare provider and his decision. Each health care provider is licensed by the state and they should defend their licensing, his actions were not neglible or delinquent. But I did not agree with him. It was more the lack of empathy that I had a problem with. I feel that the teams that took care of me at Vanderbilt did an excellent job and were very good patient advocates. So please do not view this as a "gripe session." This is my perspective and my perspective only. There are two sides to every story and you are only getting to hear mine. Let's review what I think the on-call resident should have done. First of all- get to know me, the patient. I assume he could read, I have a chart. Look at it. Second- never ever say, "I'm just covering until said amount of time." Yes- you are covering for a certain person or a certain time, whatever- but you are responsible during that time.  Third and this is a big one…. the patient is in control of their health. I said I understood, I was willing to take the risk of taking the Tylenol. Don't use your "power" to have "power" over any patient.  Non-compliance is starting to look better and better.

So I took some Tylenol from home that my husband brought me (Shhh!). My fever went down to 99.9. I slept.

I spoke to patient relations and the attending physician the next day. Here's the clincher- the attending (the resident's boss) said she would not have given me Tylenol either and was very upset that I broke hospital policy by taking my own medicine from home. So my last point-

Perspective- I am pretty sure that I was statistically more likely to die from my mystery disease, bleeding out during my surgery or sepsis before my liver failed me. And I told the attending physician this. She didn't have much to say. Fortunately, for the rest of my stay I was a patient of the trauma surgeon. I was the 0800 case.

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