Monday, April 12, 2021

so, what happened?

well, i left here early on saturday morning, with the idea being that, if i was feeling queasy from the blood test three days on, then i'm better off getting to the hospital in the lowest volume period. what did i want them to do?

i realized at that point that i needed iron immediately, but i was also hoping that the hospital might have better access to a hepcidin test than the local blood labs, as they might have more reasons to test what is essentially a liver hormone. so, i was hoping they'd test me for hepcidin to essentially determine whether i was having an emergency or not - if my hepcidin levels were to come back elevated, it would indicate that my abilities to absorb iron were almost nil and i'd need some kind of serious intervention almost immediately. but, if my hepcidin levels were to come back low then i guess i'd have to take some iron pills and hope it works.

i was expecting a lengthy wait, but i brought myself there in the dead of night with the hopes that they'd deal with me at the dead of night and i didn't see a doctor until around 10:00. see, this is an emergency room, and it's not like i don't get it, but the logic they use is so absurdly restrictive - i have to actually be passed out from low hemoglobin before they'll treat me, i can't just be feeling like i'm going to pass out, and concerned that i'm running on iron fumes. i mean, it doesn't take a lot of foresight to look at my lab results and realize that, while my hemoglobin is merely running just a little low at the precise moment, my ferritin is rapidly depleting and it's just a matter of time before i am actually passed out, and then what? there's nobody here to call me an ambulance.

so, the nurse gave me some attitude, but i asked her to tell the doctor to look at the lab results and it'll be obvious why i'm here once he does. i didn't look like i was dying, granted, but all they'd have to do is look at the lab results...

now, i should point out that i verified that the results would be available during triage. in fact, i had the nurse double check it for me and she was able to read off the results, for me. for that reason, it wasn't necessary to print the patient reports that i had on usb key in my pocket.

unfortunately, when the dr finally shows up, he pretends he can't access the data - which was just utter, steaming bullshit. we talked a little about potential causes, agreed that i don't seem to be bleeding anywhere, and eventually got into a disagreement over the availability and utility of the existing lab results, and the subsequent utility of his assessment without looking at the data. this doctor then made a series of comments that were contradicted by the lab data, which he refused to consult, even when i pointed it out.

you couldn't script a more absurd encounter.

before i tell you what happened next, i need you to really understand the context here. i had three completed lab reports done in the last month that were quite detailed in scope, and this guy decides he wants to diagnose me without looking at them. i didn't go to the er to consult a clairvoyant, i went to the er to ask for some direction from a doctor; what happened was baffling, and there's no explanation for it besides base stupidity on behalf of the doctor. of what value is this doctor's diagnosis - whatever it is - if he refuses to look at the data, and just makes it up by looking at me, instead?

what he ordered was a complete blood count. again. he was not interested in monitoring the ferritin levels, which were the source of the hemoglobin. i pleaded with him to look at the existing blood work instead, and he refused. i told him i was in here in the first place because i was feeling oozy from the last blood test three days ago, and he seemed entirely unconcerned. so, i told him not to bother and stormed out.

while i understand that the er is reactive by design, this is one of those situations where their refusal to look ahead by even a day makes them come off as borderline retarded. i mean, these people would be terrible at chess - they don't even look two moves ahead, and they yell at you when you ask them to. it's a complete lack of any sort of foresight, and it's intentional - it's by design. any halfways competent, reasonable person would look at this and declare it dysfunctional and idiotic. but it is what it is.

he didn't care what my hemoglobin was yesterday, and he didn't want to hear a logical argument about what it's obviously going to be next week, without intervention. the sole, important consideration to him was what my hemoglobin levels were at that exact time, which is retarded.

the one piece of useful information i got from the doctor is that he didn't know what hepcidin was, why it was important or what i was even talking about. he did not believe that a hepcidin test had ever been ordered at the hospital, and he didn't seem to know why somebody would order one, or how to read it if it were ordered, anyways.

so, i tried to get the basic fact across - if he prescribes me pills, and my hepcidin is too high, i'm going to be in here in a week looking for a transfusion. why not just order the test?

and, the actual reason he couldn't order the test is because he didn't know what i was talking about. ok. fine.....i get it...

after storming out, i ended up at the clinic i intended to go to in the morning before i got oozy and fadey and the doctor there at least looked at the lab results - and then agreed with me. but, she didn't know what hepcidin was, either. this doctor had to get iron injections herself, not that long ago, and told me i shouldn't be apprehensive about it. so, maybe i sort of fluked out there in finding a doctor with some experience with low iron, who was willing to prescribe as a result of that.

so, i went home and took my first iron pill - and felt nothing from it.