Ah, where to start? A week of multiple ERs, and not a little stress.

This particular migraine started on Thursday. Since I get about a migraine a day it might seem strange that I call some continuous and others stop and start anew. Basically, it's about the characteristic of the painful parts--are they consistent with the previous painful parts--and the characteristics of the less painful parts--are they pain free, or merely pain-lite?

Monday I tried to go to the ER. I tried to go to two ERs, but neither of them would give me much in the way of painkillers nor the other stuff in my recommended cocktail. The first ER gave me 1mg dilaudid intra-muscularly, and 25mg of Benadryl. Seems he only wanted to give me two things, and once I told him that dilaudid made me itch he took the anti-emetic off the bargaining table and replaced it with the anti-histamine.

Effect on my migraine? Sweet FA.

The second ER--well, there's a theory that I shouldn't have told them it was my second ER. But I hold onto the conviction that if I tell them everything they'll be able to treat me more knowledgeably.

Maybe not these guys. Absolutely no way they could give me more than 1mg of dilaudid. I'd never be given SIX. I told him to check my records from the last visit, but he said they didn't write things like that down.

Eventually he got through to my GP and my migraine specialist, and was willing to go as high as 2mg.

Effect on my migraine? I lied and went home.

By Wednesday I couldn't go into work. Thursday I got a last-minute appointment with my GP who called the migraine guru and not just had the explicit protocol put in my files for two hospitals, but also called one of the ERs and told them to expect me.

Push comes to shove, going to the ER alone is horrible, but I didn't have much alternative. It took them some while to bring me in, and the doctor who saw me seemed flabbergasted at the dosage, and even more flabbergasted that I've had up to 10mg in one visit. They hooked me up to all sorts of monitors, gave me the cocktail of medications, and lo! It was like unto a beam down from the heavens.

I got my brain back. Oh, a loopy brain until the dilaudid wore off, but a clear one. Ugh. Way too much work and took way too much time.

It's funny--when I go with my normal escort, I tend to get enough medication. When I don't, it becomes a crapshoot. I wonder if he'd be flattered to hear that?

Third's the charm

I waited at UCLA Westwood for hours, and it never felt like I was getting closer to the front of the line. Understandably they had higher priority patients. Much of the ER staff vanished up to the helipads to bring in trauma patients.

So we went to Century City Doctor's Hospital. I checked at it was Dr. Asshole on duty, so we picked up and headed for UCLA Santa Monica. New ER, twice the number of beds of the old ER.

Got through triage in a snap, and got attention fairly quickly. But they started me off with morphine, which didn't hit the headache that well. By the time all was said and done I had 8+mg of dilaudid, two doses of Benadryl, one of Toradol, and an anti-emetic whose name I didn't catch.

Broke the migraine too, nice and solidly. It's over 24 hours since I decided I had to go in, and I'm only having a slight headache right now.

I have to give their ER the thumbs up. Clean, and all the staff was very nice and attentive--a screaming baby was put next to me and they moved me as soon as they noticed.

The completist in me feels I should have tried St John's Hospital, but the rest of me is quite okay with not knowing everything about every hospital within a few miles of my home.

That was the week that was

And I'm focussing hard on the past tense of that title.

Monday I go to my GP, fill out my prescriptions, and come home instead of my normal sociable Monday evening.

Tuesday I leave work before 11am because I need to come home and lie down--the pain is bad enough that I'm having difficulty keeping my eyes open. Some time and two Percocet later I grab a ride to the ER. I like to try and hold out, but this puppy isn't going anywhere and I can't do anything.

Push comes to shove, I have a could-be-worse ER visit with an asshole doctor, which requires me to sneak out the back door. The pain was startlingly bad, but I need to get home for a number of reasons, even before you get to my typical anxiety attack.

Wednesday is not great. Wednesday is the sort of day that would send me to the ER. Except so was Tuesday. I bite down and pretend to be useful and don't seek medical attention. I do get to test the injectable Imitrex, which worked for at least a while. I inform my GP who suggests sticking with injectable, and perhaps stronger narcotics.

Thursday kicks my ass. No point going in to work. I make the decision to lie back down and sleep till almost noon. I end up taking too many painkillers for my liver's health, but we're both still here so it worked out.

But that was a lot of pain. Each of those three days would have recalibrated my 1-10 pain scale all by their lonesome. Together? We're talking post-concussive-syndrome level of pain.

Not sure what I did to provoke that.

But today is Friday. The pain was bad, but not staggeringly so. In fact, the first headache didn't come on until about an hour after I woke up, which is just like a vacation.

And tomorrow is Saturday: my acupuncturist is back in town. I'm hoping he can break the cycle that the ER failed to. Otherwise I'm shackled all too tightly.

About last week

Monday's migraine stayed all day, and worsened towards the evening. I couldn't see any way of making it disappear with what I had to hand, so ER it was.

In many ways the visit was crazy and confusing, but I'd say the most basic problem was that when I woke up there around 3 in the morning, still in pain, I wasn't able to get more pain medication for two or three hours. Report is that I metabolise this stuff very quickly, so the more space inbetween doses, the less efficaceous it is.

I'm not going to harsh on the ER in question for that delay--there had been a fight involving staff and a patient, and my nurse needed medical attention himself. It was just unfortunate all round.

At about 7 they asked the fish-or-cut-bait question, and I decided to fish, to get admitted so they could administer more pain medication and monitor my vitals.

Oy.

Each ER visit costs me $75. Not inconsiderable. Any given admission means the ER cost is waived, but then it'll cost $250.

For a long time Tuesday morning I regarded my breakfast as the most expensive ever, because no one came to see me.

They sent in nurses, to take readings. I complained to them that if I wasn't going to get medication, they should just let me go home.

They sent in a psychiatrist, because they saw anti-depressants on my chart. We chatted, and I finished by telling him that I didn't currently have a drug or alcohol problem, but was considering developing one since I couldn't get painkillers.

That brought Patient Relations in, and my answer to "What can we do for you?" was still the same "Get me a doctor, or get me discharged."

Eventually a doctor came in, examined me, and decided they'd do PCA (Patient Controlled Analgesia). Except he wouldn't write the orders, the pain specialist was.

Great. Another wait. Pretty sure they didn't get going until the afternoon. If not for the free internet access, I would probably have just started walking home. Not only could I take better-than-nothing painkillers there, the food was palatable. This hospital said they served Wolfgang Puck food, but it was pretty disgusting.

For PCA they give a breakthrough dose of 4mg of Dilaudid (I'd had 6 the previous night in the ER), and then the patient is allowed to administer 1mg at a time, no more often than once every fifteen minutes.

Should there be a big gap in there, they start again with the breakthough.

Needless to say, I had a big gap--the IV slipped out of place and blood and saline were being squirted everywhere. Took me forever to get a nurse in (don't have anything happen around shift change), and he made it sound like I'd purposefully removed the needle.

Yeah, sure. That makes sense.

Also during my stay I had a neurologist come in and suggest changing my anti-depressant medication and dosage. He was also very negative about the idea of me actually using the PCA. Unfortunately I'm hella suggestible that way, and did back off it until the pain guy came in again and made me feel silly.

I ended up leaving Wednesday afternoon, still in pain, but a little less. In fact, I felt pretty good until getting out of the car, at which point everything crashed in on me. Taken upstairs, put to bed, waking up a few more times in a lot of pain, but it ended up ebbing to about a 5 by the time I went to sleep.

Hmmpf. Having been admitted to both UCLA Westwood and Century City Doctor's Hospital I really REALLY really don't want to be admitted again.

But mostly I don't want to feel like hospital is the only reasonable option, ER or no.

A tale of two ERs

When I have a migraine crisis, I have a practical choice of two emergency departments. Century City Doctors' Hospital is a nearby boutique-style hospital that has short waiting times. UCLA Westwood is also nearby, and has many more doctors at its disposal, but everyone and their wounded aunt goes there--the wait time is markedly proportional to the severity of your issue, and really, how much does a headache count? All of my inside bits are still on the inside, and the outside bits both attached and outside.

However, my ongoing care is from doctors in the UCLA Medical Centre network. It'd be silly to live where I do and go anywhere else for neuro, GP, pain management, etc.

I don't care about them during a crisis (defined as a headache that's going to mess with my ability to go into work the next day--so I don't have Friday or Saturday crises, and I rarely have crises before 7 or so--those are just really painful headaches). I just care about making the pain get gone.

So I end up at Century City more often than not.

I have to say--some of the care I've received there is excellent. Nurse P is amazing. He's probably taken the most detailed medical history of my headaches any medical professional has tried to get. He cares, and he remembers. The last time I was in there, he spotted me in triage and came out to hold my hand and look sadly at me as I snivelled.

I don't worry about feeling like a drugseeker around him, or around a couple of the other doctors that have seen me before.

However, the single worst migraine-related ER visit was also to Century City, and my ER escort will probably visit his wrath on Dr K, should their paths meet again.

CC won't tell you who's on duty. I've tried calling to ask. Perhaps next time I'll call to ask for Dr. K and see what happens.

The level of care at UCLA Westwood isn't bad, don't get me wrong. I just hate hospitals, and it's hospitallier than most, and I've fallen through the cracks there and ended up spending extra hours just waiting. Given my propensity for anxiety attacks from the various meds, well, that's pretty unpleasant before you get to the part where I'm asking a friend to sit with me and wait too.

But I'm picking up the level of my ongoing care, and the migraine guru wants me admitted for a DHE infusion, and that'll be at UCLA. Also, at UCLA they didn't think I'd been doing that badly, since my visits there were sparse.

Yeah.

That.

My hope is to be admitted this weekend, to UCLA, and maybe we'll call that starting from scratch. Get 48 hours of DHE and see what happens.

I'm currently at 10 days between crises, and that's so not on.