It's not what you are eating, it's what's eating you…

Posts tagged ‘#hcmc’

An Open Letter to #HennepinHealthcare’s Emergency Department’s physicians…

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Dear Dr. S and Dr. C (purposely not using last names, for physician’s right to safety and anonymity),

I was in your Emergency Department on 1/15/2019, in the morning around 8 a.m.

I understand as I presented as a very unkempt but for the most part, polite 49 year old obese tobacco using patient complaining about a bad cough, but more concerned about the severe left flank pain that occurred every time I coughed or sneezed that a pulmonary issue might take precedence over a digestive one.

I stopped being quite as polite when I checked my tests online and found after almost 3 hours of being there that I only had a urine analysis and pregnancy test, that was run.

I could understand with your facility being a level 1 trauma center that you may not have had time to read my chart, which doesn’t contain much, as I’m a Fairview patient.

Even though I did have a bilateral salpingectomy with endometrial abalation and d/c at your hospital, over 5 years ago and that my chart while not up to date with diagnoses, is update to with medications I am on, which gives an idea of my health issues.

However, while you got Lisa the vulnerable patient yesterday, you’re getting Lisa the activist today, in hopes it helps with others like me, who honestly thought they had an acute health issue and was NOT drug seeking.

This is what I can’t understand and is unacceptable to me, and when things are that way, I try to say something, make it a teaching moment, regardless of the socio-economics, education and profession of those who’s biases effect how I and others, get treated.

NOT every patient who goes through your ED, is looking for opiates, some of us patients who are obese to morbidly obese, have done everything under the sun, to lose weight (hence my side gig as an activist, like one of 3 GLOBALLY, who helps people in medical and mental health trauma with serious gastric bypass complications, on the scale that I do, as well as other medical and mental health activism that I do).

My visit yesterday at Hennepin Healthcare’s Emergency Department, wasted time and money.

It caused me unnecessary duress, because you have patients with barriers that have a propensity to possibly be violent, which caused enormous anxiety.

But the worst duress I experienced, was the assumptions and absolutely NO questions asked about certain things by physicians, that could’ve made my visit a lot more pleasant.

I did see, after I pushed for a blood work up, that were ordered FOUR hours in to my visit, my labs were good.

I also saw today, that I was prescribed a script that was ordered and filled at your pharmacy of high strength ibuprofen when I have a bleeding ulcer history and NSAIDS are an absolute terrible treatment option for pain for me ( and again, I did NOT ask for ANY medications, nor will I get or take script).

Unfortunately, when the IV came out, my vein spurted which wrecked my discharge paperwork and the pants I was wearing and all over my hands and some of the staff was ready to send me home with no help, until another set of staff saw that I was tired and shaky and helped me and I was appreciative of their help.

For quiet non violent introverts, your Emergency Room department is a terrifying place to be.

As I’m sure it is for a lot of people, introverted or not.

For those of us who’ve been labeled  due to mental health issues, it’s even more amplified, with anxiety caused by patients who are violent and fear of medical professionals who’ve labeled me, in the last 17 years, not just for mental health issues, but because I had bariatric surgery.

And while some staff was great at the hospital, what will leave a last impression from what will be my last visit to your facility, is that a busy physicians didn’t take the time to ask me anything, either assuming I didn’t know or wouldn’t be truthful and while you were nice, once I said something about being upset about that, that’s NOT okay.

So please, for the mental wellbeing of your future patients, if they are ambulatory, alert, articulate and polite, don’t label or practice medicine with preconceived notions about a  patient.

Actually, just DO NOT  practice medicine with any preconceived notions about a patient, like EVER.

As in my case, I loathe seeking medical attention and my visit from yesterday made it that much harder, way harder than it should’ve had to be.

As well as it made it more difficult for yourselves, and I have the utmost respect for physicians (as well nurses and all other hospital staff)  of any specialty, but especially for those who work tirelessly and usually without thanks, in an Emergency Room.

So thank you for your time yesterday and today, and hopefully going forward this will help both patients and physicians in your hospital, going forward.

Respectfully, Alissa “Lisa” Kasen

Update: 1/17/2019, when I wrote this yesterday, I tweeted it to Hennepin Healthcare and to my delight, they actually tracked me down and called me, today,  to address my concerns, which is much appreciated.

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“MD-PTSD”/Part 2

Ok… a couple of days ago, I wrote a blog regarding an unpleasant ER visit at a hopsital close to me, Hennepin County Medical Center on Friday.

Unfortunately for both them and me, I ended up with a bilateral bright red burning rash on both my arms, yesterday. I also had a really bad cough that I had for several weeks and should’ve been obvious to the doctors (I own the cough though,I am a smoker with asthma, and save your judgments, PLEASE) that my cough was an issue but I didn’t make it an issue on Friday because I was UNBEARABLE abdominal pain. I lived with unbearable abdominal pain for almost 7 years ,though, before my gastric bypass was reversed.

I’ve been a Size Acceptance and Fat Acceptance advocate for many reasons, just like I choose to remain in the Weight Loss Surgery community for the same amount of time. One of the many reasons I do activism and advocacy for Fat Acceptance because I’ve been stigmatized by doctors or not treated right. Just because I’m fat. It gets worse if you add that I do have severe chronic pain and mental illness. I’ve NEVER had any co-morbidities due to “obesity”. Almost every health issue I have medically and some mentally is everything I’ve done in my life to get thin and stay there.

There’s a look that I get when people find out, especially if they have an “M.D.” after their name, when they find out I’m a gastric bypass reversal patient but that I’m  fat. I’ve already gone into details of why I gained so much weight before my reversal because of psych meds.

When I try to explain to my friends online and off of the look I get from doctors when they find out I’m a fat reversed gastric bypass patient, I tell them to imagine if they saw a unicorn on crack. Because that’s the look I get from most people not just doctors. It’s the “how does someone have so many FUCKING gastric bypass problems that they get reversed but still are so FUCKING fat again????” (note: if you are curious of where I’ve been pic of me in different periods of time both before and after gastric bypass and reversal is on my all time favorite blog of mine, “Ugly Hurts” . However I look like crap when I’m either walking around Minneapolis or in an acute care facility)

So again, to go back to last night. I end up at the Urgent Care at HCMC, because my cough is causing me problems and I want to rule out issues with my rash (which I realize today when it’s gone, it must have been one of the side effects from Macrobid and I had quite a few) and to rule out pneumonia. I live in the Downtown Minneapolis and we are getting snow, and I didn’t want my cough to get worse and then for me to have to out in the snow, was my reasoning for going to the Urgent Care, last night.

So I get there around 5:40 p.m. last night and am pleasantly surprised that they aren’t busy. I get roomed right away and the nurse is starting to give me trouble because I’m complaining about a lot of stuff, some of it which is my normal. She makes a biting comment that if I mention too many more symptoms, I’m going to have to to their E.R. So I back down. She goes out and this really super nice physician’s assistant comes in.

Other than my adored primary care physician of 16 years, I don’t think I’ve been talked to or treated by any other medical professional with such kindness and compassion without it being inappropriate, in my life.

The problem is that with my cough that brought an occasional left side chest pain, she doesn’t comfortable treating me at all and wants me to go to the E.R. to rule out a possible or potential heart attack. Once she said that, I couldn’t pay much attention to anything else she said. She says that I won’t have to go through the waiting room and that a nurse will be back shortly to take me to a room in the E.R.

By the time the nurse comes back (it was the same one who assessed me), I took one look at the wheelchair and thought there’s NO WAY IN HELL, I am going to back to that E.R.  I try to tell her that politely and she was really rude. I just said that I just left that E.R. less than 72 hours ago in terrible pain. While they did something they didn’t do in my book, enough. And she got defensive about that, I walked out and I could hear as I was walking out, say to that physicians assistant, snidely “she’s leaving”.

Who in their FUCKING right mind would stay? Seriously? Keep in mind, I used to get sent home from Fairview University Medical Center with ulcer perfs and projectile vomiting blood and they wouldn’t even do a test on me. This was long before I ever took any ibuprofen. I’ve drug abuse tested a trillion times. For many years now.

I guess I at first chalked up my experiences at Hennepin County Medical Center in that 72 hour period as not stellar but could’ve been worse. Like Fairview University Medical Center worse, although I’ll give my bariatric surgeon credit. He did go way out of his way at times and he’s an amazing surgeon.

Then I realized something this morning. They do treat pneumonia in their urgent care. As nice as that physician’s assistant was yesterday,I left that hospital almost in worse shape last night because I didn’t receive ANY care last night and I have to wonder if her resistance to treat me was due to weight bias. Meaning if I would’ve been thin would’ve I been treated the same way?

I understand that acute care facilities don’t get into lifestyles. They don’t have the time, especially at a Level 1 trauma center.  At both though my urgent care visit and my E.R. visit they knew I was having trouble eating and had both new onset of symptoms as well as certain things were my normal that are not everyone else’s.

The “MD-PTSD” what I mean when I refer to that, is the fact that I have a lot of horrible anxiety about seeing doctors now. And it’s justified. I’ve been unfairly labeled as an attention and drug seeking hypochondriac with a weight loss surgery failure for so long now, that it’s just going to be almost impossible for me to see any other doctor than my PCP and I find that really sad for me. As well as many of my friends, who experience weight, chronic pain and mental health bias.

Not every patient who’s seeing a doctor is looking for drugs or attention. I understand my circumstances are different because I can be in unbearable pain and get myself to an acute facility, especially one that I only live 2 blocks away. But given the diversity of our neighborhood out here, in Downtown East Minneapolis, I don’t know what it’s going to take for me to see another doctor again.

Just like I don’t know what it’s going to take for all doctors not to label patients. Not every patient who walks in the E.R. and is fat is a walking time bomb. That prejudice fails both thin and fat patience because thin patients have heart attacks, too. Not every patient who lives a more singular existence with mental health and severe chronic pain issues is looking for attention or drugs,just like not every weight loss surgery patient develops a “transfer addiction” after weight loss surgery.

But until doctors who do carry bias that end up harming their patients more than helping them, realize that HARM they are causing to patients, I’m going to be an activist and advocate for people who don’t have a voice.

It’s just terribly sad that as we become more technically evolved, we are getting worse in our judgments of people. Especially at the time when they need compassion the most. When they are medical or mentally sick and/or in crisis. And compassion won’t matter if bias effects a providers ability to provide adequate care.

Note: Again I own my barriers. It bears repeating that I’m not a dream patient. I’m just not a provider’s worst nightmare other than I’m kind of a medical anomaly of sorts. Things like pregnancy, gastric bypass and Mirena, while most women don’t have problems, all 3 three nearly killed me (and no disrespect meant to my children, as they were so worth it) And I really respect with the diversity of people that providers at HCMC have to treat, with some patients who are hostile, if not violent, the threat they are up against everyday. And that can happen to any hospital but it’s more likely to happen at a county hospital.

“MD-PTSD”/The “Hypocratic” Oath….

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I’m using my blog to speak up on what I go through when I have to seek “acute” medical care. Sadly, given how mistreated and labeled, that I’ve been, that “acute” care is the only thing I seek other than bi-annual visits with an amazing primary care physician, who’s been treating me for over 16 years, now, but sadly she’s 50 miles away from me.

I had a 5 hour emergency room visit at Hennepin County Medical Center, yesterday morning , after having issues with severe widespread abdominal pain (which is unusual for me, given my medical hospitalizations for my ulcers, meaning severe ab pain is localized and the same place). It hasn’t helped that my other pain issues are getting worse. So below will be an open letter to the Emergency Room departments that have continually not taken me seriously, and while I see their side (I’m obviously NOT dead yet, but that’s nothing short of a miracle. I’ve been wanting as not only as a Medical/Mental Health activist, but as a patient, who doesn’t have a prayer, usually in an ER and how that’s adversely effected my life. I’ve also had problems with Methodist (which I’ve only been once, over 3 years ago and obviously at the ER where I had my gastric bypass and my gastric bypass reversal. And given what happened post suicide attempt at North Memorial Medical Center (being nearly committed after 1 suicide attempt and being on a psych ward for 35 days), those are the ONLY 4 hospitals that I’ve been to, in the last 20 years. I can’t travel anymore due to my disabilities and I haven’t left the state of Minnesota for almost 10 years.

I’m haunted actually that as an activist that I’ve put this off. I have some great sources of support, but I try not to bother people because those who really help me out, have other responsibilities.So when I’m in a medical crisis, I’m kinda on my own. It makes me super sad to think about those who have barriers though and feel sort of like me, like I don’t matter or that because I have medical and mental health disabilities that I’m screwed when seeking medical attention, other than as I said, I have the BEST Primary Care Physician, on the planet. The problem is that I’m too medically complex to have thrown so much on her. But at least I have her. I think about those who are vulnerable and alone (like I am ) when in medical crisis and they don’t have anybody. And I don’t really either.

So here’s my “open letter”  to Hennepin County Medical Center and Fairview University Medical Center, but I’m sure this happens in EVERY emergency room, nationally, sadly to ANY  patient who has BOTH mental health and medical diagnoses. I will address what I call the “war/whore of prescription drugs” in an upcoming blog. I’ve enough to say about the topic on hand.

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Dear Hennepin County Medical Center and Fairview University Medical Center,

I was in the ER, early Friday morning on November 7th, 2014 around 5:30 a.m. I understand that HCMC IS level 1 trauma center. I live 2 blocks away from it. I hear and can see the ambulances, all the time. I have an idea, as I am medical and mental health activist and blogger of what your patient population consists of, being very diverse in it’s makeup of it’s patients. But most of HCMC’s patients are the indigent. I’m sure that for non-acute care, it’s a little more diverse and not as many indigent patients. But if someone has the means to go to an ER that doesn’t have as much as a safety risk (I mean no disrespect to the Minneapolis police presence that is there, and necessarily so) that I’m sure they will go somewhere other than HCMC.

I always have severe chronic pain. IF I went to an E.R.  every time I was in severe pain, I’d be going to an E.R. every day. I did go to HCMC’s E.R. a couple of months ago, when I had on a late Saturday night, this summer, severe abdominal pain and vomiting, but knew better not to go on a Saturday night, which unless I’m 99.5% sure that I’m actually dying, the risk I put myself to walk 2 blocks away from my apartment building is NOT worth it.

However, yesterday my abdominal pain was UNBEARABLE. I figured my best chance of getting a diagnostic and treatment would be on a weekday and I couldn’t bear it any longer.

So I get seen by an E.R. resident or intern not too long after I get there. He starts proceeding, while politely a conversation that leads me to believe in this instance, with his line of questioning that I’m a PREGNANT drug seeking hypochondriac, prescription and street drug abuser, after I have to hear a bunch of “are you sure” types of responses. It’s hard enough for me to take the Green Line (public transit train that goes from DT Minneapolis to Downtown St. Paul), I haven’t left the state in almost 10 years. No, I haven’t been to Africa lately and I don’t know anyone who has been. So hopefully ruling out Ebola and reinforcing the fact you think I’m a total idiot, was abundantly clear. And given the fact I had my FALLOPIAN TUBES removed, LAST YEAR at your hospital, I don’t know why it was freaking hard to stop the pregnancy line of questioning…

Just breathing was extraordinarily painful. I was also polite. I was pretty direct in asking for diagnostics and drugs and if your E.R. doc would’ve asked me the last time I had an IV shot of any narcotic, I would’ve been able to tell you it was over 3 years ago at FUMC of Dilaudid in 9/2011 (and my PCP had to intervene when I ended up with an impinged nerve as well as abdominal pain, that month and it took me going to 2 different ERs other than the one at FUMC which I went to, and it took her calling and speaking to 3 different doctors in 3 days in 3 different hospitals for something to be done, both tests and medication. I had such a bad experience with another E.R. doctor at FUMC in 2/2013 of treating me like a drug seeking hypochondriac and my doctor calling her and she didn’t do anything other than give me a bag of compazene and Protonix when I was projectile vomiting blood and had atypical migraine after migraine. While I realized 3 weeks later, I was able to correlate my problems with Mirena, I shouldn’t have had to be put through the HELL I was in that 6 hour visit, where the E.R. doc from the start was defensive with me. I did file a grievance Fall of 2013, because I knew I was going to raise money for Fairview Amplatz in honor of Zach Sobiech, which I’m also doing in 2 weeks, again).

I could tell I had already been labled, I asked for at least IV Protonix and Compazene for my nausea and the tests. The only thing I got was an IV shot of Compazene and a bag of fluids, until it was shift change about 90 minutes into my visit.

At least with the 2nd team, brought a diagnostic (CT scan with contrast) . But I did get funny looks from some of the doctors. They acknowledged that if I had a gastric bypass and a gastric bypass reversal  that I had to have had some pretty bad residual complications. However, saying my pain levels couldn’t be too bad when I didn’t react to the hard prodding of my abdominal area, was kind of of unnecessary. I was too tired for theatrics and unless any of those doctors would poke my eye out with a pen, you would’ve just been met with quiet resignation and sadness that was starting to build.

As I got into the later part of my encounter yesterday, I started getting slightly agitated. Which in me, means I started getting up and walking around. Part of that, is that other patients were starting to scare me, as the E.R. got busier and also I knew there was a very good chance, I was going home, in the same amount of pain, that I came in with. And that happened to me so many times in 2010, that was one of the major reasons why my bariatric surgeon chose to reverse me. Because he knew I was getting to the point that I was going to let myself die versus actively seeking medical attention.

I understand that my using a lot of ibuprofen and that I am a smoker,  makes no sense to MOST doctors given my G.I. history. It’s been recent of the last 2 years and the reason why I use ibuprofen in large strengths because it’s sometimes the only thing that works. That causes me to be non compliant with PPIs, to prevent having ulcers. While doctors can say, don’t take the ibuprofen. IF I’m in horrible pain, can’t do anything because of it, my current prescription meds aren’t working, what am I supposed to do, then????

I have pain meds. I have a monthly prescription for a C2. I used to bring all my drugs to FUMC and it ABSOLUTELY did not change the way that I’ve been treated. I’ve had some amazing providers at both HCMC and FUMC. And the thing I have going for me, is that when I’m treated with respect, it’s so unusual to me, that I’m almost obnoxious with expressing gratitude when I’m just acknowledged as a patient who’s in an enormous amount of physical pain and emotional pain. Both to providers and on social media, I acknowledge my gratitude.

However, I’m not using any doctor or emergency room, or am I making myself sick on purpose or even subconsciously. I’ve never had any visitors, for many medical hospitalizations, other than when delivering children for ANY medical hospitalization I’ve ever had, other than the 3 surgeries I’ve had and they were “one time only” visits. If I was purposely making myself sick to get attention by ANYONE, I would’ve learned a long time ago, that it won’t get me any attention and there is no agenda I have for taking ibuprofen other than it works when my pain meds don’t, and when the ibuprofen doesn’t work and I have unbearable pain that could be a symptom of a need for acute care attention, that’s the ONLY time I go to an emergency room.

I hope I get an apology from HCMC. FUMC already wrote me off, when they didn’t take my grievance seriously, which was also fueled by a friend who had an accidental overdose with street drugs and not one person knew or would think she’d have a street drug problem. With Heroin.  Nor did she ever get labeled. Or treated with the blatant disrespect that I’ve had to endure and she was a weight loss surgery complication patient, too. But I’m labeled all over the place because I have mental health history.

I understand, because a lot of my “in real life” friends as well as social media peers are medical and mental health clinical professionals. I understand this was very wordy. But this is the point I’m trying to make. I at least know of my barriers. I also know what’s my normal for my physical health in the realm of pain and what’s not. Because I’ve put on my family, one suicide attempt, I’m not going to kill myself, just because a few busy E.R. doctors, politely at least this time, treated me like a drug seeking hypochondriac.

HOWEVER, your next polite, quiet in an enormous amount of pain, physically and emotionally patient, may end up committing suicide. The uncontrollable physical and emotional pain that some of us have and we aren’t capable of being outraged (which is a good thing) there has to be people who’ve already committed suicide and will do so.People can only take so much stigma and rejection. Especially if they are in an enormous amount of physical pain and are not being taken seriously.  That’s what my intention is with this blog so that this doesn’t keep continuing on to others.

Until, EVERY physician realizes that they have just as much responsibility to not harm patients’s psyches (even if their psyches are ALREADY broken) as well as the rest of our bodies. And if that’s not taught in medical school, well, IT SHOULD…..

Thank you to every clinical provider who actually takes the time to read and digest what I’m saying. And it’s hard for me to be concise, given my disability levels. And an amazing thanks to my PCP who’s always treated me with the utmost respect, even when disagreeing with me.

Respectfully, Alissa “Lisa” Kasen

Note: Given the advocacy I do for people with some major barriers, and I own my barriers. Patients are not necessarily right all the time. I’ve said and done things to providers (angry words not actions, although my behavior is kind of strange, you’re gonna havta read my 1st blog that talks about the HELL I went through post suicide attempt. Maybe it might make it easier to understand it’s definitely hard for me to be inpatient who remains in bed in a hospital, after everything I went through in 2008, even I’ve been deathly ill) that I’ve had to apologize for. And I have….

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