Part, the Second

So. There I am, in the back of The Big White Taxi, my blood pressure is 116/68, pulse is 72, mood is grouchy.

The paramedic, bless his heart, has agreed with me that I am not — as a matter-of-fact — having a heart attack. He has run another 12-lead using his EKG and has shown me a strip which shows mild ST elevation on just about every lead, and is busily trying to find a vein.

As he is rooting around, he asks, “Don’t like hospitals?”

“I had this exact same pain last year. I thought I was having a heart attack, so I had my lady drive me to the ER — did you know that the ER doctor association at Big City Hospital doesn’t accept County insurance? — spent four hours in the ER, to find out that it was pleurisy, given steroids, anti-biotic, Aleve and a bill that I finally got paid off this past month.”

“Ah,” he grunts.

“I’ve got a really good vein in the back of my right hand. Everyone hits it. Pop that cast right off, and you’ll be able to see it from orbit.”

He gives me Ye Olde Hairy Eyeball and keeps checking my left arm.

“Since then I’ve had about six or seven flare-ups. Same type of pain, same location, just not nearly as bad. The first time I hied meself over to Big City Urgent Care, waited for four hours and was told I was having esophaegeal spasms, told to take Aleve, and if I had further episodes, that I might need anti-anxiety meds.”

I wave my cast at the paramedic, who still seems to have not found a vein to his liking. He starts eyeing it speculatively.

“The second time, I went back to Urgent, got the same answer. And did you know that the labs that Urgent uses don’t take County insurance? Yeah, me neither. I also got the distinct impression that even though I don’t like pain meds and frequently refuse to take prescribed pain meds, that the folks at Urgent were suspecting me for fishing for an opiate scrip.”

My bad luck, the paramedic hits the vein above the cast first try.

“So the next two times, I went over to Bugscuffle Clinic and Tyre. The doc over there diagnosed it — both times — as ‘chest wall spasms’, suggested Ativan the first time, and Xanax the second, along with a gentle noodge to make an appointment to see the travelling psych doc. So. I double-dose on OTC Aleve for three to five days, it gets better, no muss, no fuss.”

And we pull up to Big City ER, the first person I see is the charge nurse.

“‘Dog,” sayeth that worthy, “What the hell?”

“Not a heart attack,” I snip, for the umpteenth time, as the paramedic says, “Called to Bugscuffle Clinic and Tyre for AMI.” We go through the Standard Report, and next thing I know I’m in an ER cubicle with Charge Nurse and a padawan. Introductions are made, and then Charge Nurse says, “Remember what I said about ‘Special Needs’ patients?”

Padawan nods her head enthusiastically, “They’re iron-assed, bull-headed, and mule-stubborn; too [deleted]ing ornery for their own good, and too [deleted]ing stupid to go to a hospital instead of dying.”

“Yes. And this is their king.”


“Given the history, and the presentation, what do you think we have here?”

Padawan frowns at me, “Umm … pericarditis?”

“Very good. Here’s the ECG strip, see the ST …” The two of them wander off, leaving me to my ownsome until Chris shows up, followed shortly by my lieutenant, AEPilotJim and my lady love.

Long story short, some time later a doctor wanders in, announces that there have “Been changes” to my EKG since the Great Pleurisy Incident of 2011; that a heart attack “Cannot be ruled out” and I’m chucked into a bed in the brand-new Cardiac Care Unit.

Several hours later everyone has gone home, I’m working my way up to “Irritated” from “Peevish” and I open my eyes to find a stranger sitting beside my bed. At midnight. In a hospital. Figuring someone had wandered into the wrong room, I cock an eyebrow at him.

“Oh. Hello,” sez he, “I’m your cardiologist.”

“I don’t have a cardiologist.” I reply, somewhat snippily, I admit.

He grins, “You do now.”

We size each other up for a moment, and I announce, “I am not having a heart attack.”

“Nope,” he replies, with a great deal of relish, and more than a touch of confidence, “You are not.”

“Great! So I can go home?”

“Charge Nurse called me. We had a long talk, and I’ll make a deal with you: You let me do one quick check to verify the pericarditis, and if you feel up to it when I’m done, you can walk out of here with my blessing. Deal?”

I figure, what the heck, nod in assent and my new cardiologist puts the flat of his hand against the left side of my sternum and pushes towards my right shoulder-blade.

The world goes grey, shot through with red flashes. I really, really want to scream, but it hurts too bad to breathe. It feels for all the world that I’ve just been kicked in the chest by a bus, and the damned thing has parked a tyre on my shoulder blade and is spinning out.

When everything comes back into focus the doc says, “I don’t think you’ve ever had pleurisy. I think you’ve been fighting pericarditis for the last year. I don’t like hospitals either, but you’re 45, diabetic, and your heart is pissed-off at you. Spend a night or two here, we’ll get you started on colchicine, echo your ticker to see if there’s any damage, and send you home. Deal?”

You know, I really couldn’t argue with that.


Mental note: Let's not do that again.
Pericarditis, and you

36 thoughts on “Part, the Second”

  1. I'm glad you finally got the right diagnosis. Unpleasant as it was, there's something about a clinical test that makes it immediately apparent to the patient that Something's Wrong, in a way far more persuasive than a number on a lab printout.

    As I commented over at AD's post on your case, I hope they gave you a critter bone to gnaw on while you're incarcerated at the vet.

  2. "…Padawan nods her head enthusiastically, "They're iron-assed, bull-headed, and mule-stubborn; too [deleted]ing ornery for their own good, and too [deleted]ing stupid to go to a hospital instead of dying…."

    I never knew we had a king, but I defer to the proclamation by the charge nurse.

    Long live the king.

  3. Yeah, my pleurisy was definitely NOT positional.

    Glad they know what's really wrong, and got you on the right treatment.

    Get well soon!

  4. Folks at Bugscuffle Bait & Bandage must be either mighty brave or mighty foolish to be warming up the clinical cattle prod. I admire your restraint in not demonstrating your Santa killing technique on them.

    That being said…

    Some of us kinda enjoy your scribblings and would appreciate it greatly if they were to continue. To that end go find yourself a quack that talks a bit of sense, visit him or her regularly, and for Offler's sakes do as they tell ya.

    Pretty please with a curvaceous red head on top?


  5. Yep, occasionally the 'right' person shows up at the right time, and it this case you got a Twofer- The nurse AND the Cardiologist! Good on them! 🙂

  6. Old NFO: It sounds like the padawan maybe gets an honorable mention for calling it right, too.

  7. I'm pretty sure I read somewhere that having a "bad cold" can result in pericarditis…so that bout of pneumonia could have done it. You may not have had a heart attack, at all – just diabetes + pneumonia.

    I'm glad you're okay, at any rate, and I'm going to go with BGMiller and ask you to please continue to visit a doctor regularly, so you don't die. You dying would suck.

  8. I hope you are healing up fast, Dawg! Take care of yourself.


  9. Damn! And it only took a year to find a sawbones with sense. Please listen to the guy…..I'm selfish, want more of them stories you tell so damn well! Prayers and good wishes on the way. JohninMd.(help!). B-)

  10. Long live the King!

    It sounds somewhat like my misadventure with appendicitis, though the docs got the diagnosis right. But the "bullheaded and mule stubborn" part sounds familiar.

    I also have to congratulate you for nearly dislocating a couple of my ribs as I laughed 'til I couldn't breathe at your write up of this.

  11. You are hysterical all the fricken time.

    Super glad you were in the right place and the right time.

  12. Found in wiki:

    As a drug predating the FDA, colchicine was sold in the United States as a generic drug for many years. In 2009, the FDA approved colchicine for gout flares, awarding Colcrys a three-year term of market exclusivity, prohibiting generic sales, and increasing the price of the drug from $0.09 to $4.85 per tablet. This subsidized privatization of publicly owned intellectual property is part of a broader trend toward theft from the public domain.[23][24][25]

    OUCH! does your county ins cover this?

  13. Glad you've finally gotten the correct diagnosis, LawDog. I can relate: been there (for other stuff), done that, got the freakin' T-shirts. Rest up and get better.

    Long live the King! With the emphasis on "live" and "long."

  14. Glad you have found a Dr worth the ammo to shoot. Now if you just LISTEN to him and follow his directions….

  15. Dog, this isn't something I'd normally say to another guy, at least not this way. I know you enjoy being bull-headed, I'm that way myself a bit, but… please take care of yourself. You'll join the einherjar soon enough, doubtless your place is already reserved, but the world doesn't have enough people like you in it and we really can't afford to lose you.
    I'm an adult-diagnosed Type I diabetic myself. I'm 40+, and due to a line of duty injury that resulted in the diabetes and some other problems had to leave the Army somewhat unexpectedly. I'm not doing what I want to do, what I feel I was MEANT to do… and I suspect that you feel somewhat the same way. Your jail gig isn't QUITE what you really want to be doing, the diabetes and wear on your body put restrictions on you that you aren't used to. Believe me, I know. I'm still not where I really need to be, but I'm working on it.
    …and you HAVE to adjust and adapt. Too many critters would roam free without you, and too many people respect, adore and depend on you.

  16. Young Padawan needs a dinner on casa de Lawdog, methinks… if you can make the grumpy bastard (excuse me, patient) laugh a little, the rest of the night will go better.

    Now listen to the cardiologist, or we may need to issue Mrs. Lawdog her own personal cattle prod with your name on it!

  17. I would appear to this reader that you keep inventing new seams at which to fall apart. Stop that! And maybe consider taking a page from Gunny’s book and find a way to de-stress. Perhaps not at the library… But ya gotta do something to give yourself a break! Just not the kind you gave yourself on that critter!

  18. Dog – I don't often comment but, as we're the same age (if not gender) and having been in the same career as you (got out due to county politics) and having recently been diagnosed with diabetes, I feel I must say this….

    Wise up and listen to the cardioguy. He'll get you back on your hindpaws and, by keeping up with him and his advice/orders, he'll keep you upright and get you back to Full Duty Fitness in the least amount of time possible.

    I know how much fun it can be to be a cantankerous pain in the tookus, not to mention tweaking the noses of the less than stellar intellects around you, but you can't do that if you're down and out with some ailment that doesn't have to be a Career Ender.

    Get better, the thoughts of myself & my LEO Hubby are with you and yours.

  19. Dawg –

    Far be it from me to attempt to diagnose from afar, but considering your relatively young age, your heredity (northern European-based) and accumulation of medical "concerns", you might want to discuss with an open-minded doc (and truly open-minded ones are darned hard to find in this neck of the woods) the possibility that you might be gluten-intolerant, or more specifically suffering from Celiac disease. It is frequently the un-diagnosed underlying source of many of the maladies (among others) that you seem to be dealing with of late. I discovered I had it a couple of years ago. Explained a lot about earlier maladies.

    Here's the URL for an interesting article regarding JFK and many of his health issues and the possibility they were Celiac related.

  20. First of all, keep on the mend. As you can tell from the other comments, there are quite a few of us who enjoy your, um, colorful essays.

    Second, I can relate to the relief of finally getting a correct diagnosis. After three(!) prostate biopsies by a urologist convinced he had to excise mine to save my life, I found another who actually took a look up there and found a kidney stone that had been causing all the PSA excitement. So when you are feeling put upon about your misdiagnosis, just read what is done during a prostate biopsy and think of me on my hands and knees asking the doctor if I will ever play the violin again. And as Forrest Gump says, that's all I have to say about that.

    Get well and continue to regale us with tales of the moderately disgruntled.

  21. Wait a second….

    That was a fair bit of typing…

    You took your cast off again didn't you?

    Tsk tsk…
    Dog… I am disappoint…


  22. *snort*

    Three hours of six finger typing per post!

    The cast is still firmly, attached — alas.

  23. All Hail King Lawdog! (I don't have much use for hospitals or docs myself)

    But on a positive note, now that they know exactly what it is they can take care of it most ricky tick and you will be back to breaking your hands in no time.

  24. Sadly, doctors (and related diagnosticians) are still PRACTICING medicine!
    Took 'em over a year to find out my anemia was lymphoma.
    Thankfully, they did.

    Get better!

  25. Just Googled "pericarditis"; it sounds nasty and unpleasant. Since you have been declared our King, I would respectfully request that Your Majesty please exercise appropriate care with the Royal Personage as well as give all reasonable credence to the Royal Physicians–because I'd hate not to have you to read from time to time.

  26. As someone currently spending far too much time with people with more fancy letters after their names than common sense, I'm saying, take care of yourself. Occasionally, one will get their nose out of those books and do some doctoring.
    And now that I learn we've got a king, I'd like to keep him around for a bit.

  27. And you spent a couple of night in the hospital AND THEN WHAT HAPPENED???

    Obviously, you're not dead…..

  28. "Pretty please with a curvaceous red head on top?"

    Lol! That's gonna be my new begging-line with my boyfriend since I am one XD

  29. Can I cheat? Having been doing this medical gig for a while as a PAC, I've seen Pericarditis look like everything from Acute MI to indigestion with nausea and vomiting.

    Its a tough diagnosis, and with a diabetic, I'd lean more to the "lets see what might kill you right now" than anything.

    Spontaneous Pneumo feels exactly the same, according to my one patient who has had both. She was sure the second episode was a repeat of the first SP, so much that she waited 48 hours before coming in because the first SP was very small and resolved on its own over 2 weeks of watchful waiting.

    I wouldn't have gone all NTG on someone without more evidence than was available, but in todays world of litigation, I can see why she got all batty about it.

    I can't begin to tell you how many patients have tried to blow their cardiac symptoms off as something else, either.

    One guy rode a motorcycle 300 miles, stopped in my ER, was having an MI with elevated Troponins and obvious STEMI and still walked out, rode his bike home, and had his wife bring him back. Another, a farmer, showed up with a 2 day history of chest pain with activity, had an abnormal EKG, and walked out, saying he'd be back when harvest was over. He came back two weeks later, had a 4 vessel CABG and still farms, 12 years later!

    Just because the patient MIGHT be right, doesn't mean you won't get sued if he isn't!

  30. Get well soon! Although it does look like the illness did make for one of the best blogposts i've read in a while!

  31. Glad to hear that you're on the mend; the correct diagnosis usually helps on that score.

    I'm definitely one of your subjects, hating to go to docs or hospitals. I take my cue from my maternal grandfather, a doctor. About 30 years ago, when he'd been a doc for about 50 years, I asked him for the "secret" of long life. He said, "Stay away from doctors, and stay away from hospitals." The Reader's digest version is that there's too much enthusiasm for surgery, to many mistakes that can be made even if that's the correct path (including drug mistakes), and too many opportunistic and drug-resistant bugs. His advice was to eat right, get enough sleep and exercise moderately and consistently – and you should get to about age 85-90 barring an accident or bad genetics. Still, he said, "if your bone is sticking out of your leg, go to a hospital."

    Your latest escapade was a bit north of the leg, but I'm glad you got dragged into that infernal place.

    Long live the King! (Gee, can he make it to the Jubilee like Lizzy?)

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