Sunday, August 19, 2007

Part 2 - A&E

We had to give my details at reception, name, date of birth, address, next of kin, usual stuff. All a bit difficult when you can't speak more than a croak or two and keep stopping breathing. Still a formal requirement though. Even when the details of an accident involving a cupboard door corner to the throat have been given. I made squiggly signs with my hand, but it took Siobhan to tell the receptionist that meant I wanted a pen to write down my details rather than trying to talk which by then I'd realised was making things worse.

The receptionist told us it wouldn't be long before I was seen in triage, and it wasn't. I was taken through and seen by a nurse I'd seen on a previous A&E visit. A nurse who claimed to know all about EDS. Siobhan explained to her what had happened, as I couldn't speak well enough at that point, my throat spasming too much, stopping me from breathing if I tried. Toes wandered back in towards the end of the triage assessment, he works in the same hospital. She told him she'd categorised me as yellow, so I'd be seen fairly soon, and as there was nowhere to put me in minors, I'd be safe in the waiting room as he was with me. Spending most of my life with the EDS undiagnosed and the label of attention seeking/mental has taught me a thing or two, and I knew both that she was making a bad clinical decision, and that it was personal. Whether that was directed at me or Toes I had no idea. Nor could I be bothered to do anything about it. Breathing was far more of a priority and frankly hard work.

Toes and Siobhan wheeled me back out to reception and we sat there and waited. When I was fine I was fine, but when I wasn't I really wasn't. My throat was continuing to spasm down hard every so often stopping me from breathing in. It still wasn't lasting more than a minute or two and I was getting used to it, not too worried it would carry on longer, but still a bit frightening when it was happening. Toes disappeared off a few times, looking for colleagues he might know, concerned that I'd been sent back out to sit in the waiting room.

After 20 minutes or so, the friendly looking man we'd seen coming in and out came and called me in. We'd thought he was a nurse the way he was coming out into the waiting area, and interacting with patients, but he was a senior registrar, in fact the most senior doctor in the department, and I'd noticed him keeping an eye on me earlier when I was struggling to breathe. He took us back through into the triage area, obviously none to happy with the nurses assessment and did his own. He asked me what happened, and with the help of Siobhan I managed to explain. The difference this time was that he actually did understand EDS instead of just dangerously pretending to. We managed to communicate that I'd dislocated my hip, so fallen, dislocated my collarbone and thyroid and we thought larynx too. His eyes got a bit wide when I croaked that I'd dislocated my thyroid, and he asked how I thought I might have done that. The easiest way to explain was to take his hand, place his fingers gently to my throat, and dislocate my thyroid gland back and forth. His eyes got very wide at that point and after giving me a chance to recover from the spasm that triggered off, laugh kindly at my attempts to tell him I was fine and there was nothing wrong with me I was being taken straight off to majors. I heard him very firmly telling the previous nurse that he didn't care if there wasn't any space they were to make space. If they didn't have it in 'resus' then majors would do.

The doctor wheeled me through himself and found a room in majors. A nurse came in to throw a sheet over the trolley, and that was the last contact with any nurse I had. The doctor came back in, introduced himself properly, turned on the oxygen and told me to put the mask on. He wanted to have a look in my throat, so needed me to open my mouth, at which point my jaw promptly dislocated. I gave it another go, and he managed to get a brief look. I was able to speak a bit more by this point, and so could better explain to him both what had happened and what was happening now. Mostly I tried to tell him I was fine. Nothing wrong. He seemed to find that highly amusing. He said he'd spoken to the doctor on call for ENT, and that she was already on her way in, that he expected I would need to be 'scoped' and that he was going to give me some hydrocortisone straight away. I tried to insist there was no need and my throat spasmed shut again.

The doctor went off and came back with the kit to put a drip in my arm, and the hydrocortisone injections. He chatted away to us while he put the drip in, asking about whether I was good with needles (just good at ignoring them) and joked a little about the strange position I'd naturally contorted myself into on the trolley.

By this time I'd realised that the reason my chest hurt so much was that one of my ribs was dislocated. Siobhan had let the doctor know when he came back into the room to do the drip, and after checking it, he asked if I could put it back myself. I said not a rib, but that he could. I was extremely impressed that he didn't make a fuss about unnecessary chest x-rays, and once I'd given him the go ahead, attempted a reduction there and then. The rib was determined to stay out though, so after a couple of attempts we both agreed it was best left out.

Shortly after that the on call ENT doctor arrived, surprised I think to be apologised to for wasting her time and dragging her out on a saturday night. She quickly assessed the situation, by this time a few hours had passed since I'd fallen and hit my throat, and the spasms were getting further apart, my speech much easier though my voice was exceptionally hoarse at best. She checked with Siobhan to ensure that my normal speaking voice wasn't hoarse, and I didn't usually cough the way I was, and after a quick feel of my throat/neck area and exclaiming over how incredibly lax and hypermobile it all is she decided she wanted to go ahead with the scope. She also said she'd really like to keep me in in case she had to take me to theatre, but after seeing how much I panicked at the mere mention of staying over night she said she would leave that decision until after the scope.
She went off to get the scope and prepare, and the doctor from earlier popped back in to say he was going off shift and hoped I'd be ok. We thanked him very much for all his help.

By that time I needed to go for a pee. I slid off the trolley to find I was still in full spaz attack mode. I had nothing stable in my entire body. Hips, knees, ankles, SI joint, all were flicking in and out of their sockets randomly and rapidly. Siobhan part held, part dragged me towards the toilet. To get there we had to go through the middle of two large groups of nurses, it must have been shift change. As we went to the toilet, despite being polite and lucid I was stared at with the disdain I'm sure they rightly give to vast numbers of weekend drunks, and received the same treatment on the way back...from both groups. Now, I'm used to the odd member of the public feeling that they can randomly accuse me of having been drinking if I'm flopping all over the place in say the supermarket, which is hurtful enough, but its far, far worse when 'that' look comes from supposedly highly trained professionals during an emergency medical situation. Not one of the nurses offered any help, asked if we needed a wheelchair, or in fact did anything but blatantly and openly stare.

We got back to the room just as the ENT doctor was coming back with the 'scope'. She looked at me in a totally different and perfectly acceptable way, laughed along with us, and asked if things were always this difficult for me. Talking was easier by this stage, but still hard work, so Siobhan explained things to her, including that my thyroid can dislocate, but wouldn't usually cause this kind of problem, and she very rapidly grasped that the problems were most likely being caused by the internal laxity of my throat, allowing it to fall shut on itself, spasming as a reaction to the dislocations, unlike in a non-EDS person who's collagen is nice and strong and not like melted runny chewing gum.

Whilst she was setting up her scope kit she said that ideally she'd like to keep me in for observation, even if everything was ok, but when she saw how frightened I was by this, she asked why. I told her I'd only been diagnosed with EDS for about 3 years, and before that I was 'mental'. That by now oh so familiar look flickered across her face, shock, horror, disbelief, comprehension, shame, understanding, compassion. Siobhan explained that actually although I was able to cope in hospitals as long as I thought I was going home, due to all my previous experiences staying overnight was beyond what I could cope with emotionally. I said I wasn't stupid and nor did I want to land her or the previous doctor in any hot water so if something was badly wrong on the scope then I would do as she wanted, but if it was 'just' spasming, then I wanted to go home. Please. Please.

She popped the scope in my mouth to warm it up, then into my nose and got me to swallow it down into my throat. I can think of better ways to spend a saturday night, but I've had far worse done to me. Fortunately everything was ok, nothing broken or torn inside my throat, just red, and a little swollen. The spasms were getting further apart and I was more able to cope when they did happen, so she was happy to let me go home if after a further 45 minutes without any oxygen I'd not had any problems. Siobhan was staying with me anyway, and promised to keep a close eye on me, having already chatted to the doctor earlier about handling these kind of issues, I suspect she may have agreed that in the absence of any repairable problem I'd be better off being cared for at home rather than by ward nurses rushed off their feet.

The doctor explained a little about laryngospasm, and said she was sure I'd dislocated my larynx and was now experiencing these spasms as a result of that. She was insistent that if I had any difficulty in breathing, had any noisy breathing, or got worse in any way that we were to come back in immediately.

She went went off, popping back in around 20 minutes later to check on me and give us a chance to thank her very much, then we waited another 30-45 minutes, with no further problems, and at the end of that time Toes reappeared and we started to sort ourselves out to go home.

2 comments:

having my cake said...

The attitude of the nurses on your journey to and from the toilet was unforgiveable. Is it such a rare illness that they have never heard of it? Certainly it was not something I had ever come across. Was it just over-exertion on the shopping trip that led to the attack?

BenefitScroungingScum said...

I'm sad to say that the attitude of the nurses was nothing unusual to me, and that although on this occasion the doctors were superb, I've yet to blog about how appallingly badly and unprofessionally I was treated by a great many doctors in the past.
EDS was always said to be a rare condition, but I suspect its more under diagnosed than rare, the current figures are suspected to be 1 in 5000 people, so not ridiculously rare, but it's not well taught at medical school and even a physiotherapist (who should know about it) told me she'd never heard of it recently.
Being over tired means I get more 'wobbly' but I was just unlucky and caught my collarbone and throat on the cupboard corner when I fell.

Overall though I think the biggest problem in terms of attitude is that I look much younger than I am, am attractive and laugh at myself...it doesn't fit the typical perception we all have of disability...which is alot to do with why I started this blog.