Sunday, January 18, 2009

Is Multiple Myeloma One of Those Magical DXs?

In my business, durable medical equipment and home oxygen there are certain magical diagnoses. For example COPD or Alzheimers. When people call to order something and I ask for a qualifying diagnosis. They rattle off stuff. "Unsteady gait. OA. History of falls. COPD." I interrupt, "We have a winner." Or "History of MI. Hypervolemia. OP. Alzheimers." I interrupt, "Ok, I'm all set."

We've had, in my nearly 14 years with the company, one patient with MM. She got a scooter. But she was Blue Cross and BC is a physician order driven insurance so I wasn't expecting it to be a problem.

So I never thought of it, but Multiple Myeloma must be one of those magical diagnoses. They see ICD-9 code 203.00 "multiple myeloma without mention of remission" and it's your gold ticket.

I understood that the EMTs had to take me to the Jordan. It's a liability issue. They aren't allowed to say ok, when I tell them I'd just like to go home. They have to convince me to go with them. And I was exhausted, so I went along. I was anxious and embarrassed and weepy and I figured that they would check me out and tell me to go home and rest. Someone from work would come get me and take me home. Finis.

But no.

First off, comedy. I had to wait for CT scan and X-Ray until my pregnancy test came back negative. What? Are you kidding me? I've not had many X-Rays but I know they ask if you're pregnant and then you say no and they X-Ray you. I've never heard of anyone needing to actually take a test. I said "Trust me, I am the least pregnant person you know. I have had 7 pregnancy tests since September." I know they just thought I was out of it because I could not articulate that my Revlimid deliveries hinge on negative blood tests for pregnancy. But still this made no sense and no one has been able to explain it to me.

While I was in the ER they told me that my potassium was really low, not critically so, but it certainly could be a factor. I struggled to think if I had read anything about MM and potassium or Revlimid and potassium or ld Dex and potassium. But I wasn't coming up with anything. I was having some trouble answering questions. Not all of them. I was able to respond mournfully that the President was "W"....but sadly, only for a few more days. But I couldn't tell them what my Trazadone dose was. And when they mentioned using contrast for my CTScan I was panic stricken and babbling. I couldn't remember why, but I knew I couldn't have contrast (turns out that MM patients shouldn't have contrast because contrast is tough on the kidneys and your kidneys are already on shaky ground with MM).

Anyway, they admitted me and I was baffled. They had given me a potassium pill. My blood pressure was coming down. My CTScan was negative except for my thyroid being large and I already knew that. I've had it biopsied. It's fine.

So up to the room I went. It was around noon. They told me that my oncologist would check in with me the next day and I could make it overnight, couldn't I? (Now remember, I can't make a big stink......I'm Maggie from X-Company and everyone knows it.) My boss came by with my license, health insurance card, cash, ATM card and my glasses from my desk. Jen came right away with more cash and Frankie and books. I finished "The Given Day" while I was there and started "Sea of Thunder". Frankie went and got me the standard remedy for sick people in my family, a chocolate ice cream soda. I told my Mum and she asked if he remembered chips. He didn't, but I was still happy.

Dr. H came in around 1830 and told me that he wanted to watch me for a couple of days. Days!!!!! I didn't argue, but I spent all of the next morning rehearsing my argument for getting out by noon. Then the nurses said that he wouldn't be by until after his office hours around 1700.

Grace brought my parents down. My father made me pumpkin bread and he brought 3 slices individually bagged for my sisters and I. He also packed a real knife, napkins and butter. My father is a careful orderly man.....you have no idea how I baffle him. They were there when Dr. H showed at 1800. We all listened while he explained that my heart monitor looked fine and my blood work showed the potassium deficiency was corrected......he was disturbed that my pulse was dropping to the 50s and my blood pressure was wildly erratic. So he really wanted me to stay. I look at my father "Do as you're told." Well that's the end of that....isn't it?

OK, this is where my mother rats me out. Dr. H asked how I felt. I felt like shit, I hadn't showered for 36 hours. I was cranky. I had a non-stop headache. The strain of being nice was becoming unbearable. I brightly replied "I feel great!" Dr. H smiled cynically "You do?"

My mother says "You have to watch this one....this one lies." The doctor repeated "She lies?" "Oh yes, she lies."

Thanks Mum. What happened to code-of silence? What happened to punishing the finker?

So I was stuck another night. I wondered how they were justifying this to Blue Cross. After all people are always talking about some friend or relative being bounced out of an uncaring hospital while barely clinging to life. Here I was preparing for a second night.

Then on Friday, Dr. G did her utmost to persuade me to stay a third night.

On Saturday, Dr. K asked me if I wanted to go home or stay. I voted for go home. As soon as he left the room I packed, dressed, stripped the bed and threw all the sheets and towels into the dirty linen container in the hall. I didn't want anyone pointing out that I could stay since I was all "settled in" like Dr. G had said Friday night.

I know they were all perplexed but insurance companies don't often care about perplexed doctors. So I have come to the conclusion that multiple myeloma must be one of the magical diagnoses. Maybe I should get a scooter.

1 comment:

Stella said...

Maggie, you are magical, not your Dx.