A mystery, wrapped in an enigma

[drwex]

...and baked with a fluffy crust of WTF.

Short form: I'm home at the moment, from the ER. Again. Essentially a rerun of last Sunday. Without which I really could have done. Same song and dance, with some amusing variations like big blotchy hives that didn't go away even after 100mg of Benadryl. I went into the ER with the express intention of getting an answer as to what's causing this, as well as symptoms treated. One out of two.

Once again Winchester gets pretty high marks. They were overloaded bu still managed most of what I needed and everyone treated me well.

The doc spent a good amount of time listening to the story and overtly holding his own judgment back. He felt it wasn't worth subjecting me to another CT after he reviewed the first one. So he did a bunch of blood work, a couple of x-rays of my intestines and determined... that we have no clue what's causing this. Last time they did blood work (a week ago Sunday) my white cell count was off the chart - double the high end of normal. This time: normal.

Which could be interpreted to mean that I am not cultivating some kind of infection. That'd be GOOD, since it meant I didn't pass anything on to people I was in contact with lately. That would also be BAD because it would mean we have no idea why this is happening, what triggers it, or when it might happen again. Can you imagine how un-thrilled this makes me?

I got all my records from Winchester sent over to my PCP. Next step is probably to see him and get a referral to a GI specialist.

Comments

[docorion.livejournal.com]

"I went into the ER with the express intention of getting an answer as to what's causing this, as well as symptoms treated."

If you, or anyone else, goes to the ED with the expectation that we will, like Dr. House, keep you there until we find out what is wrong with you, moving heaven and earth to figure it out...get used to disappointment.

One of the hardest things for non-ER docs to get used to in emergency medicine is something we call diagnostic uncertainty. That's the fact that we will, during the course of a shift, have about a 50/50 split between the people to whom we can assign a firm diagnosis, and the people for whom we're just not sure what it is. And the latter are sent to their own doctors for eventual diagnosis and treatment. All we do for that group is stabilize and control symptoms, as much as possible.

Hope you get it figured out, and feel better, soon.

Corollary to the above:

[edichka2.livejournal.com]

It's been said that the main task of an ER doc is: getting patients out of his/her ER. In other words, figuring out who needs to be admitted, and who can safely go home.

If you were listened to and treated well, and your symptoms improved, plus you got some useful rule-outs diagnostically, then it sounds like a pretty darn respectable ER visit. I've certainly seen worse.

Good luck with everything,
- Eddie

Re: Corollary to the above:

[drwex]

No, I don't expect that an ER doc will keep me in the ER - usually I'm itching to go sooner than they want to let me. Nor do I expect them to move heaven and earth. But they do have the ability to get a wide variety of stuff done fast.

What I expect is that an ER doc has seen a wide variety of stuff and applies her knowledge without bias. By contrast I think of the allergy specialist who, having spent 30 years in his profession, was convinced my problems were allergies and when confronted with three sets of negative results was at a loss to figure out what else to do. The answer I got this time ("We don't know - go see a GI doc") wasn't what I'd hoped for, obviously. But it was the most realistic assessment, given the available diagnostic data.

So, yes, this was a top-notch ER visit.