Sunday, February 9, 2014

How is a medical emergency defined?

Last weekend during an agonizing migraine I had my son call my acupuncturist to request an emergency house call. But she was booked until that evening. I had become dehydrated from vomiting and couldn't swallow water or food. My condition was getting worse. Finally in desperation I asked my son to call 911, and to tell them I needed fluids administered and pain medication.

When the ER team arrived, I was vomiting naked on the bathroom floor. I tried to explain that I could not put clothing on, because the pressure produced by even the lightest clothing triggers migraines or makes them worse. Just getting out the house and downstairs to the ambulance was difficult. My vertigo was quite bad and I did not want to be carried.

Inside the ambulance they administered an anti-nausea agent, Zofaran, via a shot in the arm. I vomited again, but my nausea and the terrible pain subsided quickly. They checked for signs of stroke. I became spacey and disoriented from the drug. I felt as if I were drifting along beside myself outside of my body. I considered what it means to be chemically altered. I remembered: not knowing whether what I am feeling is artificial. I remembered the way one neglects to maintain a sense of reality on pills – because one must accept the artificialness in order to accept relief. In order to quell the pain, it is necessary to quell and alter normally occurring emotions. Considered another way: For people with brain disorders, in order to feel anything at all, we must feel everything. Even the things people aren't really supposed to feel.

They administered fluids and two pain medications via IV in the ER ( I believe one was Demerol but not sure) There was still some pressure and aching in my sinus and head after this administration. The pain drugs did not seem to make a big difference; I was already relaxed and nodding away from the first drug. They checked again for signs of stroke and I was very thankful for this attentiveness. I hadn't been able to sleep overnight, so I was desperate for sleep while I lay in the ER, but it wasn't easy and I just wanted to go home.

In the ER they asked why I called 911 that day, despite suffering migraines sometimes daily. I have never used emergency services in the past, except to get stitches once as a child. I explained that I was becoming dehydrated and had no way to reverse my condition once it had advanced. They explained that I needed to see a doctor for a follow-up.

"These medications we're giving you are available as a prescription, you know. You need to have something at home as a back up"

Of course, they were being logical. But how to explain that our healthcare system is not logical? That I had to cancel my neurologist appointment the previous week due to lack of insurance? That my expected Medi-CAL coverage has not yet been approved? That I could not pay a doctor or pharmacy because my untreated disabilities prevent me from working*? How to explain that my arrhythmia, vascular irregularities, and Bipolar put tryptopans off limits? How to explain the difficulty of swallowing a pill while vomiting, and that when pills comes back up, the coating is gone, and they burn your esophagus and cause distress? How to describe the logic of nasal sprays not being covered by Medi-CAL for those who need them? And finally, how in the world to explain to a healthy person that the pain and distress experienced during migraine can make you suicidal?

I was in one universe and they were in another. It seemed impossible to bridge this gap in my state. Maybe the best answer to their question would have been: we have a national healthcare system that creates medical emergencies, by allocating services and treatments in a way that is illogical, inefficient, and immoral. Hopefully it will slowly get better over time.