Testing Confusion

I've been in the hospital quite a lot in the last year and a half. Over that time, I've come to the opinion that hospitals have to be among the hardest organizations (of comparable size) to manage. Considering how many systems have to be integrated to deliver effective medical treatment, the complexity is not at all surprising. But from the patient's point of view, everything comes together at the POT (Point of Treatment - not sure if that's original coinage or not.) This often resides in the person of a nurse. These people bring their skills, education, compassion and patience to the party, (along with negative traits, of course, as the individual case may be) but behind them stands an army of people, places and things. Any failure in that chain has the potential of showing up in the care the nurse delivers.

I had an example of that last night and this morning. When the night nurse came in, he looked at the doctor's orders and announced that I needed to be fasting for tomorrow's (today's) CT scan. I objected that I hadn't had to fast for the first one. He said "well that's what the orders say." I grumbled a little as he looked deeper into the oracle's window. Then he announced that the notes said that the CT scan and another charming test called the TEE were to be given "perioperatively." This was a new word for me. It means "during the operation." It made some sense that they might do a TEE at the same time as the ablation. But it was absurd to think they would do that with the CT scan. Interpretation of the results takes time. The data from a scan is handed to a lab on a CD. They process it and build a 3D model of the area of interest. All this work has to happen before a doctor gets so much as a glimpse at the images. Anyhow, I didn't believe that the CT would be on Sunday. Sure enough, this morning they withheld my breakfast. I whined about it again, with results similar to the ones I got the night before. I asked the nurse to see if she could find out when the scan was going to take place. After telling me they have no way to tell for sure (which I know is generally true) she went away. When she came back she announce that it was scheduled for 10AM. This all happened at 7:30 AM. I thanked her and grumbled some more to myself. But ten minutes later, the wheelchair showed up, and I was on my way to the CT lab.

When I got to the lab, I asked the technician about the fasting requirement. He said "oh, it's not necessary for a scan in the chest . Some patients get nauseous with the contrast [dye] and we don't want them aspirating their breakfast." I was still cranky, so I said (to myself) "They know that I don't get nauseous with the dye." The drill for this second test was nearly the same as the day before. One difference was that they injected a testing quantity of the dye, and timed how long it took to reach my heart. From this I inferred that the problem with yesterday's test was that the timing of the dye and the imaging hadn't worked out well. I have an irregular heart rate. It's therefore difficult to predict the diffusion of anything through my circulation. So they went with a direct measurement to find the rate. They ask you to hold your breath while the imaging is happening This get's rid of some of the motion in the chest. But something I didn't know: it also slows the heart rate. But my heart is sometimes perverse. When I held the third breath I took in response to the techs instructions. My heart rate dropped by a third. It went from ~120bpm down to ~80bpm! This is the lowest measurement I've seen since I was admitted. It makes me wonder if they should just have me hyperventilate all the time, rather then doing the surgery. Or perhaps I could avoid surgery if I am regularly exposed to impressive high tech spinning magnets, or being on my back while a hot flash runs through my body. Whatever, the hot flash washed through me about half a second after the tech told me to breath. They had missed the picture again.

When I got back to my room my stone cold breakfast was waiting for me. I had them nuke the nukeable parts and ate it. The food here is actually pretty good. It's not just green jello as a friend says. Warmed over, it's less appealing, but I was hungry so I didn't take much notice.

The surgeon was by and said I wouldn't be subject to yet another CT scan. He also confirmed that I would have the TEE tomorrow (Monday) morning, followed by the ablation the next morning. This means I'll be fasting two days in a row. But at least I'm forewarned, and I can get the grumbling out of my system by writing about it here. :)

The TEE test is a doosey. I had one after my surgery. I'll blog about it tomorrow while the experience is fresh. That is, while the drugs are still working.