Not the weekend I hoped for
Oct. 9th, 2017 02:32 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
livTL;DR: I had a medical problem, I got appropriate treatment, and I'm now safe and recovering.
So I picked up a cold at the end of the week. I was feeling a bit grotty Friday evening, but still basically functional. And Saturday I was finding everything unreasonably tiring. I decided to sleep in rather than going to shul, and I agreed withjack that instead of going out for a long walk in the country we would drive into town and have lunch in a restaurant. I was pretty wiped out by walking a few blocks from the car to the restaurant, so clearly hiking was not the right choice for our date.
About 8 pm Saturday evening I found I couldn't really speak without having a coughing fit. I didn't think much of it; it happens that the tail end of a cold often turns into a cough. In retrospect I wasn't being very sensible; I kept saying, "I can't breathe, but not, you know, in a bad way". And I did a lot of panic-apologizing tojack for coughing instead of answering his questions. I decided it was probably a sensible idea to take my inhaler, thinking, well, asthma inhalers don't really work for colds, but it's probably better than nothing. jack went out for an evening walk, and waiting for him to return I found I didn't have the energy to do anything except sit on the sofa and play mindless mobile games.
I had a bad night, but not, I thought, unusually bad for the tail end of a cold. I used my inhaler several more times; more than once in a night is unusual for me, and I started counting to make sure I wasn't taking it more frequently than four hour intervals. In the morning I woke up and called Sunday School to say I didn't think I was well enough to come in. I thought I was probably being a bit of a wimp; I had a mostly recovered cold, and I hadn't slept well, but I wasn't actually ill. On some not quite conscious level I realized that even if I didn't feel particularly "ill", I couldn't manage cycling three miles to the school, or standing up in front of a class and talking.
The effect of my morning inhaler wore off alarmingly fast. By midday I was really struggling to breathe, and counting the minutes until I could take another dose. With the increased clarity that came with being able to get enough air, I thought, you know what, this may actually be bad. I had recently read![[twitter.com profile]](https://p.dreamwidth.org/e0caa790ec10/-/twitter.com/favicon.ico)
tajasel's account of a much worse asthma attack than mine, and I recognized the description far too well. Exactly like Katie,
I called NHS 111 and went through all the triage questions to establish that I wasn't having a heart attack or a pulmonary embolism. I was finding it a considerable effort to understand and answer the questions coherently. Eventually the phone operator came to the same conclusion I had: it was borderline whether my problems counted as an emergency or not, so she'd get someone medically qualified to call me back. I waited five hours for the callback, time I spent mostly sitting on the sofa, propping my shoulders up, sometimes managing conversation but inconsistently so, conserving my energy for walking up the stairs to the toilet.
The person who called me didn't introduce himself and I never worked out whether he was a doctor or a nurse. I was in a pretty bad way by this time, so I think the unsatisfactoriness of the consultation was not entirely his fault. But he spoke very quietly, didn't seem to be taking a history in a systematic way, and sounded basically annoyed that I was wasting his time. I had got to the point where I was ready to advocate for needing medical attention, rather than hoping to be reassured, so I headed off his leading questions which seemed aimed at trying to get me to admit it was just a cold. I used keywords like saying that this was the worst asthma I'd ever experienced, that my reliever medication was not working, that the pain was distracting me from everything else, that I couldn't carry out most activities of daily living. All those things were true, but I felt I needed to make a point of phrasing them exactly how they are written on the checklists. Eventually I convinced him to make me an appointment with urgent care for 10 pm, which he described as
Another five hours, alternating between being scared and in pain and miserable, and feeling guilty that I was the sort of person who turns up at Urgent Care on Sunday night just because I am feeling a bit low with a cold. At some point during thisghoti_mhic_uait turned up to take jack out, and I was trying to reassure them that, yes, I have asthma, but it's never really caused me any serious problems, and yes, I have a hospital appointment, but only because the out of hours service in Cambridge is physically located in the hospital, it's not like I'm actually "going to hospital". Of course it's fine for them to have their date, I can easily get a taxi to the hospital. Actually they compromised, because I clearly wasn't thinking straight; they went out for a meal, but at our local pub rather than in town, and they came home early so jack could drive me, and most importantly accompany me to the appointment.
Urgent Care-inna-hospital was great. No waiting; I had an appointment for a fixed time, so I was seen at exactly that time. We had to walk past A&E which had a hand-written sign saying, we're exceptionally busy, minimum two hours wait. But Urgent Care you can only be referred into via NHS 111 or a GP, so they have reasonable control over how many people they see. The doctor was a complete sweetheart. He talked shop a bit about my research, apparently he'd done a PhD in cancer cell signalling before he decided to become a clinician. He had a really nice bedside manner; he wanted to make sure I understood everything but didn't overwhelm me with information or patronize me. He was fine with my saying, yes, I have a pretty good grasp of the pathobiology of asthma, and he was also fine withjack asking if he could explain anyway. He did a pulse oximeter; I wasn't going to look at the numbers but he reported them anyway, I had 95% oxygen saturation (99% or higher is normal, less than 98% is bad) and a pulse of 130, about twice what it should be at rest. I said I wasn't really at rest because I'd tired myself out walking from the carpark to the clinic, but a normal healthy adult doesn't have a racing pulse or a need to sit down and rest after walking a few hundred metres.
So doc said, you did absolutely right to come in, this is bad. He confirmed the outline of the history but agreed with my self-diagnosis that the cold had somehow triggered asthma, and he could treat that without needing a lot more detail. I had predecided that I wasn't going to quibble if he prescribed oral steroids, even though those are potentially scary drugs and I will have to declare them when applying for travel insurance in future. But I flinched slightly when he printed out a prescription for prednisolone, which as steroids go is among the scariest.
And then we went to the midnight pharmacist to pick up the drugs, which is a bit of a miserable system. They have a glass dispensing window which opens out into the carpark, and it has a decent quality mic so you can speak to the pharmacist through the glass. Standing around in a carpark at 11 pm, discussing medical issues while struggling to breathe was not exactly pleasant. I assume they would have been able to let me into the shop if I were deaf or physically unable to stand in the carpark, but still. At this point it had been about 3 hours since I last took my inhaler, and the cold air wasn't helping, and I was tired and scared, and starting to get incoherent. The pharmacist said I should wait to take the first dose of prednisolone until the morning as it might stop me sleeping, but the doctor had told me to take it asap to control my breathing and I didn't think I could sleep when I was this uncomfortable anyway. I wasn't doing at all well at discussing this with him, so I'm particularly glad I hadjack with me. I kind of fell to pieces when he asked me if I wanted to get a pre-payment card since four prescriptions costs more than a three month card; the pharmacist was trying to be helpful but I couldn't handle even the simplest of financial decisions at that point.
And then we went home and I took the scary steroid and it helped almost instantly. So far the worst side effect that I've noticed is very mild visual hallucinations; about half an hour after my dose I settled in to bed and it looked as if shadows were rushing around the bedroom, even though I know that the darkness in my bedroom is usually entirely steady. I confirmed withjack that the chasing shadows weren't real, and fell asleep. I had no trouble sleeping that I noticed; maybe I felt slightly less sleepy than normal but nothing I could be sure of.
And today I'm off work, at least partly to reassure myself that the medicine isn't making me crazy, but mainly because I am absolutely exhausted after that weekend.
This felt mostly like an example of the NHS working well. I mean, possibly if I had private healthcare I would have spent several hundred pounds (maybe more, I'm never sure of scale) but not had to spend 10 hours of misery before I got seen. But more likely I wouldn't have the option at all because asthma is a pre-existing condition. Worrying about financial and insurance consequences would have been much worse than worrying about whether I was wasting NHS resources and I think on balance I'd rather have the 10 hour wait. At least I got to spend that ten hours in my own home, rather than sitting in A&E triage.
And I disapprove of NHS 111; basically they cut costs by switching from a service run by nurses to a service run by barely trained call centre operators, who can't do much more than run through a checklist as a fairly crude triage. This isn't a cost saving in the long term because it means more people end up in hospital who could have been helped over the phone by someone medically trained, but given the service had to make cuts, it's not a front-line clinical service so it's somewhat more acceptable to cut. In this case it did work pretty well; I was in fact not an emergency on a scale of minutes, and the phone line passed me on to a doctor who got me an appointment within hours, which was medically appropriate given resource constraints. The actual out of hours clinic was run by a subcontracted company, Herts Urgent Care. I have massive political problems with the NHS commissioning private services like that, but again, in this case it worked well; it kept me out of A&E, it meant I could be seen the same day rather than waiting until GP hours today, it got me efficient, good quality treatment. And probably the nice doctor who was doing the night shift gets better pay and conditions than he would if employed directly by the NHS.
At this point, comments I would find helpful are: expressions of sympathy; discussions of healthcare policy. I would prefer if you could skip telling me your own stories about asthma and breathing troubles, and I don't really want to hear any experiences with prednisolone right now. I know that's not very socially appropriate of me when I've just told you a long story about my asthma experience, but I find other people's descriptions of asthma triggering and my breathing still isn't quite right. And prednisolone has an effing scary side effect profile, so I'm trying not to scare myself into believing I have any symptoms, so I would rather wait until after I've finished the course to compare experiences.
So I picked up a cold at the end of the week. I was feeling a bit grotty Friday evening, but still basically functional. And Saturday I was finding everything unreasonably tiring. I decided to sleep in rather than going to shul, and I agreed with
jack that instead of going out for a long walk in the country we would drive into town and have lunch in a restaurant. I was pretty wiped out by walking a few blocks from the car to the restaurant, so clearly hiking was not the right choice for our date. About 8 pm Saturday evening I found I couldn't really speak without having a coughing fit. I didn't think much of it; it happens that the tail end of a cold often turns into a cough. In retrospect I wasn't being very sensible; I kept saying, "I can't breathe, but not, you know, in a bad way". And I did a lot of panic-apologizing to
jack for coughing instead of answering his questions. I decided it was probably a sensible idea to take my inhaler, thinking, well, asthma inhalers don't really work for colds, but it's probably better than nothing. jack went out for an evening walk, and waiting for him to return I found I didn't have the energy to do anything except sit on the sofa and play mindless mobile games. I had a bad night, but not, I thought, unusually bad for the tail end of a cold. I used my inhaler several more times; more than once in a night is unusual for me, and I started counting to make sure I wasn't taking it more frequently than four hour intervals. In the morning I woke up and called Sunday School to say I didn't think I was well enough to come in. I thought I was probably being a bit of a wimp; I had a mostly recovered cold, and I hadn't slept well, but I wasn't actually ill. On some not quite conscious level I realized that even if I didn't feel particularly "ill", I couldn't manage cycling three miles to the school, or standing up in front of a class and talking.
The effect of my morning inhaler wore off alarmingly fast. By midday I was really struggling to breathe, and counting the minutes until I could take another dose. With the increased clarity that came with being able to get enough air, I thought, you know what, this may actually be bad. I had recently read
my asthma was always the textbook definition of well-controlled. But having that essay in mind reminded me that an "asthma attack" doesn't necessarily look Hollywood dramatic, it can just be chest tightness that goes on for more than a few hours and doesn't respond to inhalers. So I was looking up relevant websites, like the NHS patient advice and Asthma UK, and thinking, well, I sort of tick the boxes for an asthma attack, but it's a bit borderline. And I'm definitely experiencing quite severe discomfort in the three hours out of four between doses, but I didn't think I was in any danger of not getting enough oxygen to my brain and tissues. I was also aware that my self-monitoring was kind of shot by not being able to breathe properly, so I decided that on balance it might be a good idea to get a professional to reassure me that I was worrying about nothing.
I called NHS 111 and went through all the triage questions to establish that I wasn't having a heart attack or a pulmonary embolism. I was finding it a considerable effort to understand and answer the questions coherently. Eventually the phone operator came to the same conclusion I had: it was borderline whether my problems counted as an emergency or not, so she'd get someone medically qualified to call me back. I waited five hours for the callback, time I spent mostly sitting on the sofa, propping my shoulders up, sometimes managing conversation but inconsistently so, conserving my energy for walking up the stairs to the toilet.
The person who called me didn't introduce himself and I never worked out whether he was a doctor or a nurse. I was in a pretty bad way by this time, so I think the unsatisfactoriness of the consultation was not entirely his fault. But he spoke very quietly, didn't seem to be taking a history in a systematic way, and sounded basically annoyed that I was wasting his time. I had got to the point where I was ready to advocate for needing medical attention, rather than hoping to be reassured, so I headed off his leading questions which seemed aimed at trying to get me to admit it was just a cold. I used keywords like saying that this was the worst asthma I'd ever experienced, that my reliever medication was not working, that the pain was distracting me from everything else, that I couldn't carry out most activities of daily living. All those things were true, but I felt I needed to make a point of phrasing them exactly how they are written on the checklists. Eventually I convinced him to make me an appointment with urgent care for 10 pm, which he described as
I suppose I can make an appointment for someone to listen to your chest, then. He did at least assure me that I could take 7-10 puffs of inhaler every two hours rather than 1 every four hours. The higher dose still only lasted about an hour, but being mostly able to breathe one hour out of every two was more pleasant than half an hour out of every four.
Another five hours, alternating between being scared and in pain and miserable, and feeling guilty that I was the sort of person who turns up at Urgent Care on Sunday night just because I am feeling a bit low with a cold. At some point during this
ghoti_mhic_uait turned up to take jack out, and I was trying to reassure them that, yes, I have asthma, but it's never really caused me any serious problems, and yes, I have a hospital appointment, but only because the out of hours service in Cambridge is physically located in the hospital, it's not like I'm actually "going to hospital". Of course it's fine for them to have their date, I can easily get a taxi to the hospital. Actually they compromised, because I clearly wasn't thinking straight; they went out for a meal, but at our local pub rather than in town, and they came home early so jack could drive me, and most importantly accompany me to the appointment. Urgent Care-inna-hospital was great. No waiting; I had an appointment for a fixed time, so I was seen at exactly that time. We had to walk past A&E which had a hand-written sign saying, we're exceptionally busy, minimum two hours wait. But Urgent Care you can only be referred into via NHS 111 or a GP, so they have reasonable control over how many people they see. The doctor was a complete sweetheart. He talked shop a bit about my research, apparently he'd done a PhD in cancer cell signalling before he decided to become a clinician. He had a really nice bedside manner; he wanted to make sure I understood everything but didn't overwhelm me with information or patronize me. He was fine with my saying, yes, I have a pretty good grasp of the pathobiology of asthma, and he was also fine with
jack asking if he could explain anyway. He did a pulse oximeter; I wasn't going to look at the numbers but he reported them anyway, I had 95% oxygen saturation (99% or higher is normal, less than 98% is bad) and a pulse of 130, about twice what it should be at rest. I said I wasn't really at rest because I'd tired myself out walking from the carpark to the clinic, but a normal healthy adult doesn't have a racing pulse or a need to sit down and rest after walking a few hundred metres. So doc said, you did absolutely right to come in, this is bad. He confirmed the outline of the history but agreed with my self-diagnosis that the cold had somehow triggered asthma, and he could treat that without needing a lot more detail. I had predecided that I wasn't going to quibble if he prescribed oral steroids, even though those are potentially scary drugs and I will have to declare them when applying for travel insurance in future. But I flinched slightly when he printed out a prescription for prednisolone, which as steroids go is among the scariest.
And then we went to the midnight pharmacist to pick up the drugs, which is a bit of a miserable system. They have a glass dispensing window which opens out into the carpark, and it has a decent quality mic so you can speak to the pharmacist through the glass. Standing around in a carpark at 11 pm, discussing medical issues while struggling to breathe was not exactly pleasant. I assume they would have been able to let me into the shop if I were deaf or physically unable to stand in the carpark, but still. At this point it had been about 3 hours since I last took my inhaler, and the cold air wasn't helping, and I was tired and scared, and starting to get incoherent. The pharmacist said I should wait to take the first dose of prednisolone until the morning as it might stop me sleeping, but the doctor had told me to take it asap to control my breathing and I didn't think I could sleep when I was this uncomfortable anyway. I wasn't doing at all well at discussing this with him, so I'm particularly glad I had
jack with me. I kind of fell to pieces when he asked me if I wanted to get a pre-payment card since four prescriptions costs more than a three month card; the pharmacist was trying to be helpful but I couldn't handle even the simplest of financial decisions at that point. And then we went home and I took the scary steroid and it helped almost instantly. So far the worst side effect that I've noticed is very mild visual hallucinations; about half an hour after my dose I settled in to bed and it looked as if shadows were rushing around the bedroom, even though I know that the darkness in my bedroom is usually entirely steady. I confirmed with
jack that the chasing shadows weren't real, and fell asleep. I had no trouble sleeping that I noticed; maybe I felt slightly less sleepy than normal but nothing I could be sure of. And today I'm off work, at least partly to reassure myself that the medicine isn't making me crazy, but mainly because I am absolutely exhausted after that weekend.
This felt mostly like an example of the NHS working well. I mean, possibly if I had private healthcare I would have spent several hundred pounds (maybe more, I'm never sure of scale) but not had to spend 10 hours of misery before I got seen. But more likely I wouldn't have the option at all because asthma is a pre-existing condition. Worrying about financial and insurance consequences would have been much worse than worrying about whether I was wasting NHS resources and I think on balance I'd rather have the 10 hour wait. At least I got to spend that ten hours in my own home, rather than sitting in A&E triage.
And I disapprove of NHS 111; basically they cut costs by switching from a service run by nurses to a service run by barely trained call centre operators, who can't do much more than run through a checklist as a fairly crude triage. This isn't a cost saving in the long term because it means more people end up in hospital who could have been helped over the phone by someone medically trained, but given the service had to make cuts, it's not a front-line clinical service so it's somewhat more acceptable to cut. In this case it did work pretty well; I was in fact not an emergency on a scale of minutes, and the phone line passed me on to a doctor who got me an appointment within hours, which was medically appropriate given resource constraints. The actual out of hours clinic was run by a subcontracted company, Herts Urgent Care. I have massive political problems with the NHS commissioning private services like that, but again, in this case it worked well; it kept me out of A&E, it meant I could be seen the same day rather than waiting until GP hours today, it got me efficient, good quality treatment. And probably the nice doctor who was doing the night shift gets better pay and conditions than he would if employed directly by the NHS.
At this point, comments I would find helpful are: expressions of sympathy; discussions of healthcare policy. I would prefer if you could skip telling me your own stories about asthma and breathing troubles, and I don't really want to hear any experiences with prednisolone right now. I know that's not very socially appropriate of me when I've just told you a long story about my asthma experience, but I find other people's descriptions of asthma triggering and my breathing still isn't quite right. And prednisolone has an effing scary side effect profile, so I'm trying not to scare myself into believing I have any symptoms, so I would rather wait until after I've finished the course to compare experiences.
