I've been waiting to get an appointment with Rheumatology at the VA Medical Center since August. It's now November and until today I had heard absolutely nothing from them about my appointment.
I have, apparently, a pretty bad case of osteoarthritis in my left knee. Had it for years, actually, but I never had it looked at because I could deal with it. I lead a pretty sedentary life, sitting in front of a computer every day and, although I admit I don't get the exercise I should, it never bothered me to the point where I felt like I needed to see a doctor. Yeah, it was pretty difficult to climb stairs or ladders normally, and coming back down was hard, but I would go slowly, one step at a time, and deal with it.
Then back in August the problems really kicked in. My knee swelled up something huge and was literally hot to the touch. The pain was almost unbearable, to the point that I could barely walk from the living room to the kitchen, which are right next to each other. My family had been urging me to get my knee looked at for several years, and now I was in so much pain that I had no choice.
Part of the reason I didn't have it looked at was a lack of health insurance, and I knew that anything major was going to have to come out of my pocket. I couldn't afford to go to the doctor, and even if I could afford an office visit, I couldn't afford the treatment, which I was certain would be extremely expensive. Then I remembered I have VA benefits, and I'd never used them, not even once in the decade plus since I've been out of the military.
When I got out of the Coast Guard, my last duty station sent all of my records and pre-registered me with the VA Medical Center in Indianapolis, since that was the closest one to where I was going to be living anyway. But I never made an appointment, and I had no need to see a doctor back then. Then I moved back to Ohio, and never bothered to have my records transferred over. This was back before they were doing electronic medical records.
A few years ago, however, I gave some thought to having my knee looked at, and on a whim I started the process of registering with the VA again, this time just a short drive from home. I was having knee problems then, too, but I was still in the stage where I could deal with it so I checked the box that said I was only registering in the event I needed to see a doctor there in the future. Once the paperwork was done (relatively easy, considering it's the government I was dealing with) I promptly forgot about my ability to use the VA if needed. I rarely ever got sick to the point where seeing a doctor was called for, so it never crossed my mind.
Then comes this past August and the pain. I'll tell you right now that in all of my life, through broken bones, all kinds of cuts and bruises, and various other injuries, I have never been in as much pain as I was when my knee decided to go all jihad on me. (wonder if that phrase will put me on a terrorist watch list :) )
I had no choice. After laying on my back for three days to keep my leg elevated, alternating heat and ice on a knee that was the size of a very large grapefruit, maybe a little bigger, I had to see someone. I called the VA, and this is where I wished I'd seen a doctor there before.
After all the paperwork had been completed to register me with the VA, they sent me a letter asking me to call and schedule an initial consultation with a primary care physician. I never did. I'd intended to, but I put the letter aside and promptly forgot about it. So now when I called up to see if I could see a doctor, I was told that it would be at least three weeks before I could get in. No fucking way could I wait that long to see a doctor. I couldn't even stand long enough to fix dinner for myself unless it was something that could go in the microwave, so I thought I was screwed and would have to make a trip to the local urgent care and pay for a visit out of my pocket.
But, thankfully, another phone call to see if anybody had cancelled an appointment and could I get in earlier led me to a very helpful scheduler. My total unwillingness to familiarize myself with my available VA benefits meant that I didn't know the VA had a 24/7 urgent care clinic themselves. The scheduler asked me if it was an emergency for me to see a doctor, and I said no, but I was in a lot of pain. She started looking through my file, and then told me what options I had available to me.
First, I had to go in and get my VA ID card. Without that, I wouldn't get very far, but I could do that at 7:00 the next morning if I wanted. I did. Then I could take my brand new ID over to urgent care and be seen by a doctor that day. When I heard this, I told the lady on the phone that I wanted to kiss her, and I meant it.
I got up early the next morning and hobbled to my car, then headed down to the VA, hoping to be the first in line when I got there. Yeah, traffic had other plans, so it was closer to eight o'clock when I finally limped inside. I should note, here, that one of the greatest benefits the VA hospital has is the free valet parking, because making the trip from the already full parking lot was not going to be easy. The other great benefit. Free coffee before 9 AM and after that, Starbucks. I had no idea just how much I'd be needing that coffee, but I was thankful it was there.
The guy at the information desk pointed me to the Maroon Desk (everything is color coded there), so I slowly worked my way down the hall and found a large waiting area full of people as well as another, fairly long line of people waiting to be seen. The desk was maroon, and I assumed the people sitting were waiting on others, so I got in line with everyone else. It took almost an hour of standing there in line for me to get to the front, my knee was absolutely throbbing and I nearly had tears in my eyes, but the lady finally called me up and said "Last name, last 4, and destination".
I gave her my last name, the last 4 digits of my social security number, and told her I was going to urgent care. She looked at me like I was the single most ignorant person in the world.
Turns out, I was standing in the wrong line. The Maroon Desk apparently serves more than one function, and I was in the line for travel, as in to other VA facilities throughout the country. I explained to her what I'd been told on the phone, and thankfully she didn't think me too much of an idiot and passed me off to a cardboard sign sitting right beside her with a stack of laminated numbers sitting below it. Ah, I had to take a number and have a seat. Little did I know just how much the VA relies on the "take a number" system. I didn't care though. The opportunity to sit down was more than welcome, so I took my number and had a seat.
My number was finally called around 12:30 in the afternoon, four and a half hours after my arrival at the medical center. Part of it was my fault for getting in line, but part of it was the fact that three people in the office I was there to see were out sick, and one guy was trying to handle everyone. I felt bad for him, because I'd watched him very skillfully deal with some very irate people and he was doing the best he could, which for a couple of folks wasn't good enough, so when he finally called my number and I went back through the locked door to his office, I offered to wait if he wanted to grab his lunch. He declined and just kept on working as cheerfully as he could.
Since it had been more than a year since I'd registered, I had to take a new means test, which was basically a review of my finances to see how much my visits were going to cost me out of pocket. Turns out, I fell just under the adjusted income level, and I have no copay for visits and free prescriptions. That was the best news I'd heard all day, and it would remain that way.
After getting my ID card and filling out some more paperwork, I was on my way to urgent care. The guy who I'd just seen gave me directions, but I still managed to get lost. I was supposed to make my way to the ER, sign in there, then wait to see a nurse. Ok, but it took me stopping at three desks before I actually found out exactly where I was supposed to sign in at. Found it eventually, a little pad of paper on an old music stand set up at the far end of a waiting room.
I had to be seen by a triage nurse, and it looked like it was a pretty busy day all around. When I signed in, I wrote down my name, the time, and the reason for my visit (left knee pain) so I figured I'd have to wait a while. I've worked in hospital ER's before, and I understand how the triage process works, so I made sure I was in the right frame of mind to wait. Most of the time, if I understand the reasons why, I don't mind waiting, and in this case I knew that I was going to be low on the priority list.
So I sat down in the waiting area with all the other people and managed not to gag on the soap operas that were on the TV, instead entertaining myself by listening in to the other conversations around me. This is where I heard one middle-aged guy say "I'll be damned if I'll ever use government run, socialized medicine." Yes. He said that while waiting to be seen at a VA Medical Center. This was, of course, during the height of government fearmongering about the dangers of healthcare reform so I refrained from pointing out the obvious.
Surprisingly it wasn't long before I heard my name called and I got up to go see the triage nurse. She asked me why I was there (because she had to confirm that I wrote the right thing down on the sign-in sheet, I guess) and then proceeded to take my vitals. Temperature, blood pressure, that sort of thing.
Oops. Something wasn't right. The machine said my blood pressure was 220 over 140. She got a different blood pressure cuff out, hooked it up, and tried again. Same reading.
"Well that just can't be right." she said, then invited me to follow her into the nurse's office where she had me sit in a chair. She left and came back with another nurse, or maybe an actual nurse, I'm not sure, who then took my blood pressure the old-fashioned way. Manually. Same deal. My heart should be ready to explode.
The nurse sat down and began typing in the computer, recording my responses to a bunch of questions. I didn't know of any family history of high blood pressure (it was true, but I was wrong), I'd only had one bout of high blood pressure in my past, when I had seen a doctor while I was drunk (long story), but it seemed to have been fine for years as far as I knew. I didn't have a headache, and the only reason I was there was because my knee was fucking killing me. She asked if I could think of any reason why my blood pressure would be so high, such as medications I might have taken (just 1600 milligrams of ibuprofen) or other drugs, but the only explanation I could honestly give was that I had barely slept for the past three days and I was in a hell of a lot of pain.
Now remember, this is at the emergency room with an ER nurse, so I'm assuming she knows what she's doing. I don't know what her thought process was, but she leaves, and a minute later the other lady (probably just a tech now that I think about it) comes back and hands me a yellow laminated card that says "Urgent Care" on it, and sends me to the Blue Desk, just up the hall.
So I take my card, go to the Blue Desk, and the lady there takes my name and all that stuff again and prints off one of those paper wrist bands hospitals like to use. She puts it on me, and sends me on another walk, this time to the primary care area where the urgent care clinic is. Now, I think, I'm finally getting somewhere.
I walk up to the window, hand the lady there my little yellow card, and she tells me to have a seat. I do, and then I begin to watch the hours tick by again. I think it was about two hours that I waited, again thinking I'm still low priority, so no complaints but I did see four complete episodes of Charmed, which is cool because I like that show.
Finally, and I think it was after 4:00, I heard my name called. Not by a nurse, as the others I'd been waiting with had been, but by a guy who was obviously a doctor. Tall fucker, he introduces himself and leads me back to his office/exam room. I didn't know this at the time, but I guess the docs see their patients right in their office there, which is convenient for the doc, but I'd never seen it before.
He sits me down in a chair and tells me to relax, then immediately gets out the blood pressure cough as he begins asking me questions. No mention of my knee, just more questions about my blood pressure, which was understandable, but was not getting me any closer to getting my knee looked at. This was when I had the very first inklings of frustration begin to arise, way back in the recesses of my mind, but at least I was seeing a doctor so I wasn't going to say anything just yet.
Well, the doctor is in stunned disbelief at my blood pressure, which I suppose he should have been considering I exhibited absolutely no other symptoms of high blood pressure at all. No shortness of breath, no headaches, no fainting or dizziness. Just a knee that hurt like hell. He checked my blood pressure three times over a ten minute period, then walked out of his office without an explanation, but he returned less than a minute later and asked me to follow him.
We walk a short distance down the hall, and he points to a chair right next to the nurses station and asks me to have a seat, saying he'll be right back. I sit, he walks off. A couple of the nurses jokingly ask if I got in trouble, and I laugh, explaining that I didn't know what was going on, and I wait. Since this was my first visit to the VA, I had no idea whether this was normal procedure or not, although I suspected it wasn't normal. Then again, I'd heard numerous people talking about being short on staff that day, so maybe he was looking for an actual exam room and not just his office.
Wrong. When the doctor came back, he explained that he was extremely worried about my blood pressure, and that he was sending me to the emergency room. I know he saw me roll my eyes, but he ignored it and explained that should I have a stroke or heart attack, the ER was much more prepared to deal with it than his clinic.
A what? He was worried I might have a stroke or heart attack in his office? Hell, I'd been there at that hospital since 8 in the morning, so that was the least of my concerns. I just wanted my knee looked at, maybe some x-rays and a shot of celestone or something to reduce the swelling. Not a trip to the ER.
I didn't argue, though. I mean, I did understand that my blood pressure was dangerously high. I really did, but I was in so much pain from my knee and having walked all over hell and back inside that hospital all day that my blood pressure really wasn't my top priority. I wanted the pain to go away, and I was hoping that getting rid of the pain would lower my blood pressure. Still, I stood up to head back to the ER, but he made me sit again. Apparently he didn't want me doing anything at all, and I had to wait while he tracked down a nurse to take me to the ER in a wheel chair. I would have thought it was for my knee, but he explained that it was hospital policy that patients with a heart condition have to be wheeled from point A to point B. Whatever. Let's just do whatever it is we need to do.
I got to the ER and they put me in a room, leaving the door open, thankfully, so that I could hear what was going on. There had been some sort of miscommunication and the ER wasn't expecting me, but they figured it out and a few minutes later a nurse comes in and checks my blood pressure again. Still way off the charts, and now I'm sure my slowly waning patience was adding to the problem, but again, I was being seen finally and that's all that I cared about.
The nurse who I now had was, in my opinion, exceptional. Kinda hot, but she was a very good nurse. Unlike the doctor I'd just seen, she took the time to explain what was going on, asked what seemed to me like relevant questions, and when she left she told me what was going to happen next. At this point, it was just a matter of waiting ten minutes to take my blood pressure again to confirm that it really was that high. If it had been that high on every reading since I'd arrived, which was now more than a dozen times, I was pretty sure it wasn't going to change, but she was nice so what was another ten minutes of waiting?
During that time, I began to consider all the events that had led me here, to the ER, up to that point. It really bothered me that when I first arrived to see a doctor (not counting the admin stuff), I had started off at the ER. The reasons for that were obvious. Walk-in patients didn't feel they could wait a few days or a couple of weeks to see a doctor, so they come to urgent care. If they can't wait, there might be something really wrong with them that needs immediate attention, so triage them at the ER. If they're sick but not in a life-threatening situation, send them on their way to urgent care, but if we uncover something major in triage we'll take them back to the ER where they need to be. Sounds like as good a plan as any to me.
But if my blood pressure was high enough to have the doctor who saw me immediately transfer me to the ER without so much as asking why I was even there, why didn't the triage nurse catch it and admit me when she saw me? If I needed to be in the ER, then it should have been caught in triage because nothing had changed, not from the time I first had my blood pressure taken to that very moment. My blood pressure had been consistently high. Extremely high, but it hadn't changed. The only explanation I could come up with was that the nurse who sent me on to urgent care was an ER nurse, and the ER was extremely busy, not even enough beds for the number of patients they had there. Maybe she was hoping I'd get sent on my way without them having to deal with it and add to their workload. I have no idea, and I didn't ask, but only because I now had a different nurse who I could tell was working her ass off, but was extremely pleasant to all of her patients and coworkers.
Here's the kicker. After ten minutes, she came back, checked my blood pressure, and it was perfectly normal. 120 over 75. At that point, I was stunned. I'd had my blood pressure checked so many times that day that this reading was an obvious outlier. It had to be. But it was normal, and I was tired and hungry and I was getting to the point where I just wanted to go home, so I have no idea why I suggested she should check it again, just to be sure. She probably would have anyway, but I still can't believe I actually suggested it.
So I waited another ten minutes, she comes back, and of course my blood pressure is high once again. Damn. Not that I was surprised, but I had at least a little ray of hope there for a few minutes. Now my worry was that they were going to try to admit me. With blood pressure as high as mine was, I didn't know what the procedure would be, but I did know that I wasn't going to be admitted. They could do whatever else they wanted, but not keep me there.
My nurse left to talk to the ER doc, and a few minutes she came back in. This time she had answers with her, in the form of a shot and a pill. The pill, and I forget what it was called, was to bring my blood pressure down rapidly. The shot was Toradol for the pain in my knee. They were operating under the assumption that my pain was the primary factor in my blood pressure, which I think was a safe assumption because I didn't really have a history of high blood pressure.
Well, they both seemed to work. An hour later my blood pressure was nearing normal levels again. It was still high, but I wasn't in any danger of exploding anytime soon, so I finally got to talk to the doctor about my knee. She ordered x-rays and some blood tests, and a urinalysis just to be on the safe side, and even though I was more than ready to go home I decided to stick around and wait on the test results.
Here's the funny part. Unlike the first doctor I saw, this doctor wasn't as concerned with my blood pressure. It was down, so in spite of what I'd been told was hospital policy, they had me walk down to x-ray to get pictures taken. It hurt, but I didn't care. Anything to get some answers and get out of there.
The rest of my visit was rather uneventful. She got the x-ray results and lab results back and while there were things wrong with me, they didn't merit the time it would take for an ER doctor to handle them. She was busy enough, and I'd overheard enough conversations that I knew damned well there were people who needed her attention much more than I did. A guy in diabetic shock, a stroke patient, two heart problems, and someone with a massive infection that had to be quarantined amongst the dozen or so other patients she had. I had a sore knee, so not once did I open my mouth to complain about having to wait. I knew she'd get to me when she could.
And eventually she did. She said the x-rays looked like my kneecap was making contact with the other bones in my leg, and that was causing the pain and swelling. She gave me a few days worth of Toradol and enough Vicodin to last until I saw my primary care physician, and after one last check of my blood pressure sent me on my way. She also did a couple of other things for me. She ordered an MRI and a consult with orthopedics just to get the ball rolling while I was waiting to see my primary care doc. Those were two things she didn't have to do, but she did.
I got home at 11:30 that night, and the dogs, thankfully, had not pissed in the house. They were ready to burst, but they'd made it all day long.
A few weeks later I finally saw my primary care doctor. Well, she wasn't necessarily my doctor at the time, just doing the consultation and during that process we agreed I'd become her patient. She kept the MRI, but after looking at the x-rays and other test results said it looked more like my problem was arthritis. That surprised me. Usually you don't hear about arthritis in people my age, but sure enough, the MRI confirmed it a couple of weeks later.
So at that point, with my blood pressure under control and me actually feeling much, much better -- I didn't even realize how bad I'd been feeling until my blood pressure was back to normal -- my doctor ordered a consultation with a rheumatologist for my knee, along with follow-up with her 3 months later for other things (blood pressure, cholesterol, etc.).
Well, with all of my other appointments I've received a letter in the mail telling me when it was supposed to happen. If I needed to change it I could, but I was always notified by mail of when I should have one. I have never received anything regarding my rheumatology appointment. In fact, just last week I got a letter asking me to call and schedule an appointment with my primary care physician, the follow-up I mentioned, but the rheumatology appointment was supposed to happen first, or so I thought. Maybe I was wrong.
I called today to schedule my appointment, like the letter said to do, and with flu outbreaks all over they're pretty busy so I won't get in until January 4th. Not surprised, really, and not a big deal. It's closer to 5 months than 3, but it's not an urgent appointment. But while I was on the line, I asked the scheduler if I have anything with rheumatology coming up, and he looks, and he says that I was supposed to have an appointment in October but it never got scheduled.
Great. Well, I get transferred over to the Green Desk, and the lady there checks, and says nope, no appointment. Sorry, can't help you. I ask who can, and she's already hung up. Now, I have to mention that is atypical of my experience with people at the VA. The people I've spoken too prior to her have always been extremely helpful and if they couldn't personally help me, found me someone who could. This lady was just a bitch.
Anyway... now that I know someone has dropped the ball and the lady who was supposed to help me out apparently won't, I make another phone call. I get customer service, tell him the situation, that something got messed up in scheduling with rheumatology, and he says I need to speak to John and he gives me his extension number before transferring me. Again, very helpful.
So I end up talking to John, and he pulls up my information. He sees that yes, there was supposed to be an appointment more than a month ago, but it never showed up on his printouts. While I'm talking to him he goes back and runs his daily process again, just to be sure, and nope, my name doesn't appear even though he can find it in the system if he does a search for my name. But until today he didn't know to do a search for my name, because it never appeared on his task list to schedule an appointment for me.
Now to make a very long story as short as possible, John and I talked for about ten minutes, and in the end I got my appointment scheduled with the specialist who, I hope, can make my knee work properly again. I'm not looking for a cure here, at least not right now, just the ability to walk somewhat normally again. Even better, I see the new doctor in less than three weeks. I did a whole lot of waiting for nothing, but I guess in a way it's a good thing I did, because I managed to help the guy find a bug in their software that hopefully now will get fixed. So yes, if you've read this far, you now feel exactly how I feel. I finally got the knee appointment I've been longing for, and you've finally, after all your suffering, reached the end of this post. :)