Wednesday, June 17, 2009

The Case of the $11,000 Case of Gastritis

The Friday following dinner at Ramblas was very stressful at work, and in the middle of the afternoon, I started having chest pains, which I have experienced now and then over the past six months. On this day, the pain was greater and more persistent than ever before.

I’d taken BART to work for some reason or other (i.e., not ridden my bike) and had planned to take BART home, but I felt so lousy when I left work that I took a cab to El Toro, where I got a tofu burrito which I expected to restore me to full health, which it didn’t.

I called Tom and said I was having chest pains. He said to call my health insurance provider. The lady there said to call an ambulance and go to the emergency room. That sounded expensive, so I asked if I could call a cab and go the emergency room. “That’s fine,” she said, “but do it right now.”

I called the cab and went outside to wait. While I waited, I considered that I might actually be having a heart attack and would never see my green home state again, which caused me to burst into tears. After five or ten minutes had passed with no sign of a cab, I asked Tom to go ahead and call an ambulance, and a fire truck and ambulance came flying down the street ten seconds later the wrong way with sirens blasting, as I stood on my porch having a good cry. (Naturally, one of my grilling nemeses came home just then. Of course.)

I was helped into back of the ambulance by a particularly good-looking paramedic and Tom hopped into the front seat with the driver. At some point, we had a police escort through the rush-hour traffic. I was given nitroglycerin in the ambulance, which didn’t seem to help, probably because nitroglycerin doesn’t help gastritis.

In the emergency room, they stuck EKG patches to me and perhaps started an I.V. They gave me two more doses of nitroglycerin and a cocktail of stuff for gastrointestinal problems, just in case. Nothing seemed to help. They were going to give me morphine in a last-ditch effort to get the pain to go away, but I said I’d rather not take that, and didn’t.

I was wheeled to another department for a chest X-ray, and blood tests were performed.

Tom, good friend that he is, sat in the waiting room for several hours holding my backpack, out of which he’d dug my insurance card. I assumed they would eventually say, “We can’t find anything; go along home,” but instead they said, “We can’t figure out what it is; we’d better admit you.” This was on a Friday night, as mentioned, and there was talk of having me stay in the hospital all weekend! Tom brought in my backpack and I explained to him how to feed Hammett, and then he left, which was kind of a lonely feeling.

Then I was wheeled into a big elevator and up to the telemetry unit, where I stayed until late the next morning. I actually slept rather well considering that I had EKG patches all over me, an I.V. stuck in the back of my right hand, oxygen tubes in my nostrils—turning over was not possible—and received periodic visits for further blood tests.

At approximately 3 a.m., the nurse assigned to me, who was darling, said my latest blood test had revealed elevated cardiac enzymes, which was startling; all prior tests, including the X-ray, had been normal. The only abnormality was my low pulse rate of 50 beats per minute. (Normal adult pulse rate is 60-100 beats per minute; frequent worrying about whether people may or may not grill in the future can bring it down, like mine.)

Ooh! The Internet says “well-conditioned athletes may have a healthy pulse rate lower than 60 BPM.” That proves it: worrying is excellent exercise.

However, they repeated the blood test, got normal results, and concluded the determination of elevated cardiac enzymes had been in error. I should say I continued to feel the original pain all night long, and even when I left the hospital the next morning, it was still there. But by then it was clear that there wasn’t anything going on with my heart.

By the way, the reason I hadn’t called my doctor’s office to say I was having chest pains was that my primary care provider is an AIDS specialist, so I hate to bother her with my little chest pains or dripping blood or throbbing goiter or whatever. I secretly suspect that she thinks that if I’m able to ride my bike to her office, I have nothing to complain about, which is probably more or less correct.

I knew that I would probably talk to her lovely and very competent but eternally harried assistant, who would say, “I doubt you have heart problems. Do you have a family history of heart problems? It’s probably heartburn. Take a Pepcid.” And that is exactly what she did say after my stay in the hospital, the difference being that after my night in the hospital, I believed her, whereas if I’d called her before going to the emergency room, I would have just kept worrying that there was something wrong with my heart.

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