Posts Tagged ‘St Joseph Hospital’

A Week in the Life of a Stoner

May 23rd, 2015 7 comments

xray with kidney stone Kidney Stone

X-ray similar to mine








My husband Mike and I were sitting in a roomful of nurses, one of my favorite groups to be with.  We were attending the lovely annual dinner that was sandwiched between two full days of meetings with the Maine State Nurses Association.  I was so happy to be there.  I basically dragged Mike along, but he was pretty happy when they served up a beautiful prime rib.   Then during dessert,  ZING…. flank pain…not bad yet, but there.  I turned to Mike and said “I don’t know if I am getting a kidney stone or what!”   We left shortly after that.  We were camped in our travel trailer at Blackwoods Campground in beautiful Acadia National Park.  The meetings were in Bar Harbor, Maine, the nicest setting I could imagine.  Before getting stoned, we had enjoyed 2 gorgeous days of camping and touring around.

All night, I labored with the unrelenting horrid flank pain.  The camper was electric hook ups there. No cell phone service either!   Although our RV is 30 feet long, that little middle space wasn’t much of a place to pace with kidney stone pain, nausea, shakes, and clammy skin.  In hindsight, I should have gone to the Bar Harbor ER.  But, my first 2 kidney stones only caused me a single day of pain and eventually they passed on their own.  I was being stoic and thinking, I can handle this on my own.

Not this time.

If I had gone to the ER that night, maybe I could have skipped the next several days of misery.  I made a stupid choice.


We, or HE packed up our stuff and we drove home in the morning.  I was loaded up with ibuprofen and so the pain wasn’t bad, but I felt like shit warmed over.  I hated to miss the second day of meetings because a Facebook friend was going to speak about Patient Advocacy for Nurses.     I got home and started drinking water like a camel.  That night, the pain was back, in my back, in the black night.   UGH.   No doubt, I had to be seen by someone who knew more  about kidney stones than I did.


Sunday we trooped off to  St Joseph’s ER, where I got a cursory tap on both kidneys (this was my physical exam), a urinalysis and culture, antibiotics and 4 Oxycontin pills.   Yup, you have blood and Nitrites in  your urine Kathy.  Advice, follow up with your primary care and a urologist and drink tons of liquids. mmmmhmmmm.    No xray or CT scan done.  I was actually ok with that until the next round of unrelenting pain.  I am into Choosing Wisely, until wise choices are not made.  In this case, they probably should have done at least an xray. This was partially my fault because I never want more tests or medicines than necessary.

This stone is different from my other ones.


Monday I crawled around my house thinking this bitch of a stone will pass.  It HAS to.  I’m feeling sick, constipated, and very miserable with pain.  I have drunk gallons of water and strained the gallons of pee.  Nothing..  And when old women are crabby AND constipated, they take Milk of Magnesia.  No need to discuss this further because not everyone reading this will be a nurse or doctor.


I called St Joes for my urine culture results.  Negative.  I asked if I needed to take the rest of the Bactrim.  She said “yes”, and “no further follow up needed”.   Apparently she didn’t know about me, and my pain and  my kidney stone.  Then I called the urologist that the  St Joes doctor recommended, thinking that I could skip right to the expert and avoid another visit with my Primary Care in between.   They would not give me an appointment until I had blood work and a CT scan and I would have to get those ordered by my primary care doctor.  My stone and I were being held hostage for more tests.  Finally, I called my primary care doctor.  They got me in within a few hours.  He is my fave!!  He got my history and ordered, not a CT, but an abdominal film and blood work. Then he gave me Flomax. It did help to reduce the pain, but it didn’t go away.    I tossed and turned all night again with that stabbing constant  pain.  There was a pattern…when I wanted to lie down and sleep, that made the pain worse.


I called for my blood results and was told that my parathryoid hormone level was elevated but my blood calcium was not.  How about the xray? (by biggest concern)   No result on that yet, and the doctor is running 45 minutes late, and he might not  get to it today, but we will let you know as soon as we get the reading….that’s what I was told.  I waited all day long thinking maybe he would get to it, but they never got the reading of my xray from EMMC imaging  that day, and in the busy-ness of the day, nobody called to get it.   Another night of misery coming right up.


First thing in the morning I called the primary care office again.  Before I got my question out, the med tech said, “I am going to call over there (EMMC)  right now”.  And so she did.  I have a 1.5 cm or about a 3/4 inch kidney stone, one that will not pass on it’s own.  The radiologist apparently did not think this was a significant clinical reading and didn’t share this information with my doctor after he read my film.   I saw the xray myself, and I knew that the stone was at least 1cm….twice as big as my last one.  I assumed because this stone was large, and would not pass on it’s own,  that the reading and report out would be called to my doctor very quickly.

Now the fun really begins.

I really needed  a urologist. My PC faxed a referral to a urologist we had discussed during my office visit. This was not the same one that St Joes recommended.    When I spoke with that GU office these were their comments “We can’t give you an appointment until the doctor sees your lab and xrays.  He is in surgery until this afternoon.  I have to talk to my supervisor about this and she is out of town.”  And then the kicker, “he only does procedures at Bar Harbor or Blue Hill Hospitals.”  NO WAY am I circling back to Bar Harbor. I am too sick and miserable.  And we have two hospitals right here in Bangor.  So, my PC (primary care) called Urology Surgery, an affiliate of Eastern Maine Medical Center.   At first they said I had to jump through the EMMC ER hoop (one of many so far)….I must go to the ER to get the urologist on call.  OK, so now I am both sick and pissed off (get it?).  I asked for the phone number and I called them myself.  I firmly told them that I have a diagnosis..with X-rays, urinalysis and blood work to match, and I have visited an ER and my PC already.  NO WAY am I going to add EMMC ER chaos, cost, and time to this.  And I need to be taken care of.  Guess what.  That did it…I had to blow up just a little bit first, but I got into that office within 2 and half hours and I got the nicest, kindest, sweetest, most talented GU surgeon ever.  He almost made me cry with gratitude.  He knew I was sick by looking at me. My struggling kidney had already caused a rise in my creatinine level. By 5pm I was being wheeled into the EMMC OR for a ureteral stent placement, step one of two to rid myself of this stone.  Everyone from the GU office, to the EMMC registration, to Patient intake, to preop, to OR to recovery room, anesthesia….all kind, caring and skilled.  These are the names I remember..Courtney, Bev, Paula, Sue, and of course Jonas, my surgeon.   They met my needs before I knew I had a need.  Paula, my recovery nurse, helped me to the bathroom to pee for the first time after the procedure.  She said…”you probably won’t pee yet, you just feel like you have to.”  Her colleague said, “if she pees, Paula, you have to do a pee dance.”  Paula did a pee dance..because, although it felt like I was passing glass…I peed!!!  YAHOO



.Ureteral stent

Lessons learned.

1. Don’t self diagnose.  When your body is screaming at you with pain, pay attention.  Do something about it right away.

2. Always bring an advocate, whenever and wherever you can.  I am still unclear about how my stone will be removed, because I was so sick when I went to the Urologist’s office.  I do remember something about lasers.  It was a mistake not to bring Mike to the exam room with me. He is my trusted partner and extra pair of ears.

3. Don’t take no for an answer when you are getting dismissed, delayed or disregarded…and it won’t matter how good your people are…there is always some excuse or reason why your needs can’t or won’t be met when you need them met.   Be persistent and advocate for yourself/your loved one.

4. Say thank you, frequently and sincerely.  I thanked everyone over and over.  I thanked my surgeon immediately when we very first met and we were shaking hands.  I will write notes of thanks for the excellent care I received at EMMC and in the surgeon’s office.

I am two days with my spanking new ureteral stent.   This has allowed my brutalized left kidney to pass urine, despite my big stone.  I am pain free.  I have taken only 2 advil since my surgery.  I am eternally grateful to my surgeon for pushing his scheduler to get me into surgery in 3 hours rather than in days.  Her response to his request “are you kidding me?”   She was obviously annoyed , but he didn’t back down.  He was advocating for ME!  She could steam about it all she wanted and she did, but she got me in.

I don’t share my story to get sympathy….I share it hoping to help patients to advocate for themselves and to be persistent when healthcare needs are not being met.

I also share in  hopes that my caregivers, throughout this ordeal, will learn to simply do what’s right for their patients.  Take care of them.   Sick, miserable patients don’t want to hear excuses or be delayed.   Patients want the right care, at the right time and in the right place.

My relief from pain and sickness came after almost a full week of battle, fighting for myself.   I am still facing another GU procedure to remove the stone and the stent.  Then maybe..just maybe… .a parathyroidectomy.  I don’t anticipate any more battles, but my husband and I will be on alert and advocating for me.

The reason I get kidney stones.

The reason I get kidney stones.









Transparency in Hospital Billing and Costs

April 8th, 2013 1 comment

I was seen a month or so ago for floaters and flashers in my left eye, in  Bangor, Maine.    I walked out of EMMC ER without being seen,  because of a very poor  and unprofessional reception, watching a suffering young woman being ignored, and a very long wait time.  I went across town to St Joes.  I was nicely welcomed, quickly and efficiently triaged, waited an hour in an exam room, and was seen by a competent and nice nurse practitioner for about 5 minutes, maybe less.  I had no medicines, no sterile instruments, no diagnostics, no treatments,   and nothing extra.  I walked out with instructions and an appointment with an ophthalmologist the next day.  I had a good experience of care.

Grand total   $1313.85.  HOLY CRAP!

I looked up St Joe’s list of usual ER charges online.  My charges, on my itemized bill were way out of whack.  So, even though my copay will not change ($125), I called St Joe’s billing inquiry line.  The lady was very nice until I asked to participate in the weekly inquiry meeting where they will discuss my bill.  I want to know what they have to say about my bill and be part of the discussion.   It was obvious that this was really really weird for them to deal with someone who actually wants transparency and details about how they came to this wild price for my visit.  She finally relented and said she would tell the supervisor who participates in their billing inquiry meetings that I want to be there.

I asked the billing lady if she has ever heard of the concept of “nothing about me without me”.  I know that this generally pertains to collaboration and communications about our actual care and plans for it, but why not billing and costs.

After reading Rosmary Gibson’s new book. Medicare Meltdown, I fully realize how important it is for healthcare consumers to fully engage in all aspects of quality and cost in healthcare.  We need to protect our ability to access and afford healthcare, because Hospitals, providers, medical device and pharmaceutical companies, for profit companies and others are usurping all of the the top of the fresh milk bucket of healthcare. They do this with predatory pricing and charging of all patients, and getting what they can from all payers, public and private.      If we do not engage, our existing systems will not survive.

$1313.85 for a 5 minute visit is outrageous and unexplainable….and I want to know details about how they came to that astronomical price.  We all need to become inquiring minds when it comes to healthcare costs and quality.

Flashes and Floaters, oh my

March 11th, 2013 1 comment


March 5, 2013

When getting up from my chair yesterday, I saw a  lighting like crescent shaped streak in the periphery of my right eye.  “Hmm, that’s weird” I thought.  I quickly dismissed it because it was  instantaneous and painless and I could see fine.  Well, it kept up all day long.  Then later in the afternoon, after putting make up on under bright lights, I had a big black worm like floater.  It looked like soot from a candle.  I have had that off and on ever since, along with just rare “lightening like” flashes.  I had an important meeting last night, but before I went, I called my primary care doc.  She responded quickly and recommended that I get my eye examined sooner rather than later.  It was probably dumb, but I went to my meeting about healthcare first, and then to the Eastern Maine Medical Center ER.  I know, my eye should have been my primary concern…we only get two of them.

At approximately 9pm, my husband Mike  went with me to the EMMC ER.  This is may alma mater.  I worked as a triage nurse in this very same ER in the 90s.  It has changed a whole lot since then…and not at all in good ways.

The first thing I had to do was go through a TSA like screening.  “Walk through here, put your purse here, remove pocket contents, walk through the scanner, come over here and get your purse, etc etc.  They did not frisk me however.  The Bangor TSA did frisk me from head to toe last week.  I think it’s time for some profiling.  An old lady like me is 99.99% unlikely to be a threat to anyone.

Next I went to the registration desk.  I stood there for a few minutes while 2 young women had their backs to me about 6 feet away.  They chatted and obviously did not know I was there, so I moved the chair in front of me and made a noise.  No response.  Then just as I quietly said “excuse me”, the security guard came over to alert them to the fact that I was standing there waiting. They finally turned to look at me. I had begun to sit down at one widow, but was quickly told to “come over to this chair”. There was no Please and no Thank You.   I followed my direct order.   The young woman who registered me might as well have been a robot.  She never said “hello”,  and NOT once did she make eye contact.  She was cold and lacked empathy as she mechanically ‘registered’ me.  Her “triage” question was “What’s going on tonight”.  She got the job done, but I could have done just as well at a kiosk with no human  being part of it, similar to printing out a boarding pass at the airport computers.   I was instructed to “sit over there” and wait and the triage nurse will come get you.  There were not many people in the waiting room and I figured (wrongly) that it wouldn’t be long.  The triage nurses are behind closed doors with glass and blinds blocking their view of the waiting room.  A young woman and her mate (husband, boyfriend or partner) sat about 15 feet from me. She was trying to lie on her side in an upright chair.  She was crying and so was her mate.  She was clutching her abdomen and obviously in agony.  My observation was that nobody paid attention, nobody cared, and nobody monitored what was going on in that waiting room.  I was appalled.

When Mike noticed  the sign that said the wait time was  2 to 3 hours to be put in a room, I made a quick decision.  I guess if they put that sign up, we “patients” should be patient and willing to just accept that.  Even if we are in agony, and crying in pain, like that poor young woman I described earlier,  we are expected to wait.  NO, that is not acceptable.  I made a phone call to the competitor, St Joseph Hospital, and I was told that the wait would not be that long.  I told the triage nurse and the cold distant registrar that I would be heading across town  to the competitor.  The nurse looked a tiny bit surprised, but said “oh, ok, that’s fine”.  It seemed that this was not the first time this had happened…and I would guess it happens a lot of the time. As a nurse, I feel guilty that I did not offer to give that poor suffering young woman a ride over to St Joseph Hospital with us.  As a patient, I had absolutely no regrets that we left.   As both, I am very sad that by my observations, the EMMC ER has not improved in customer service and efficiency of care.

St Joseph Hospital reception was a complete turn around from EMMC.  I was warmly greeted, with eye contact and a smile. The triage nurse took me back to the triage room immediately after I took my coat off.  She was about my age and I knew her name, although we had never met.  We connected immediately.  I chatted her up while she efficiently triaged me.  We continued our conversation behind a closed door in the ER exam area.  She is a long time ER nurse and knows so much.  I waited over an hour in that room after she left.  She walked by and asked if anyone had been in to see me.  I said ‘not a soul”.  It was only about 5 minutes later that a Nurse Practitioner came by to examine my weird eye.  He was kind, thorough and efficient.  Aside from a boring hour in the exam room, my visit to St Joes was excellent.

Today I will see an ophthalmologist.  I hope my retina is intact and where it belongs and I have a good feeling that it is.  My ailment is not life threatening at all, and  I do realize that.  But, I fear that even if it had been, my greeting at the EMMC ER would not have been much different, unless I arrived in a speeding ambulance with lights flashing and a warning to the triage nurse. (Update: my eye is detached retina.)

When I worked at the triage desk at EMMC, my desk faced the entrance door, and the waiting room.  There was no barrier.  The registrars sat perpendicular to my desk and they also faced the door and waiting room.  We all watched what was happening there, even while we registered and triaged other patients.  Once a patient had been signed in, we were responsible for observing them and caring for them while they waited.  It seems now that nobody is watching or caring about the patients who are waiting in the waiting room.  Improving privacy for patients and safety for patients and staff has to somehow still allow for observation and care of patients who are waiting for emergency care.  Sometimes those patients need attention because their triage status can change.

If I had the opportunity, I would go to EMMC, sit down with their ER leadership and tell them exactly how I felt about my visit last night.  Maybe I will send a letter and offer to do just that.  If my brief encounter is any indication, my alma mater has not improved over the years, it has gotten worse. I am sad to be saying that.  I know some great nurses who work there, and I suspect that these things I have mentioned are systems problems…like work overload, understaffed, clogging up of the flow because no in patient  beds are available, no beds are available because there is no staff to accept them  and poor coordination of care.  As in most cases, it is a mess that needs to be fixed from the top down.   My letter will go out to the EMMC Chief Nursing Officer tomorrow……