It is the week after Thanksgiving, and I want to give public thanks for a good experience I recently enjoyed as a patient in the United States health care system.
A few weeks ago, I developed an unusual redness and swelling over the outside bony “tip” of my left elbow. At first I thought it was just a bad bruise, but over the next 24 hours, the redness and pain continued to spread down my forearm as well as up along my upper arm.
Because it was the weekend and my primary care doctor’s office was closed, I went to the local ER. They diagnosed the condition known as septic olecranon bursitis (a type of soft tissue infection). The physician checked me out thoroughly and gave me a prescription for oral antibiotics. He also said to come back if things didn’t improve over the next 48-72 hours. Over the next few days, the infection continued to spread despite the oral antibiotics, and I could feel a pocket of infected fluid building up underneath the skin of my elbow, so I went back as instructed.
During my second visit, the on-duty ER physician and staff knew exactly what was happening and they took prompt care of me. The ER physician cleaned off my skin and anesthetized it, then passed a needle into the fluid pocket. She drew off several cc’s of obviously infected fluid and sent it to the laboratory for tests. The staff also drew blood for additional tests, started an IV line in me, and administered a “cocktail” of powerful intravenous antibiotics. The physician also reviewed my case with the on-call infectious disease consultant, and set up an appointment with the daytime infectious disease specialist to take over my care.
The next day, the infectious disease specialist examined my arm, reviewed the lab results, and arranged for me to receive a home course of intravenous antibiotics. The nursing team started a new IV in my arm and sent me home with a packet of medications for me to inject every day into my IV line. They also arranged for a radiologist (one of my partners!) to perform a more thorough ultrasound-guided procedure to suck out as much infected fluid as possible from my arm to help speed the healing process.
After nearly 3 weeks of home IV medication and regular follow-up visits with the infectious disease team, my arm feels much better. Because of the prompt care I received, the infection never spread into my bones or into my bloodstream. I didn’t have to miss much time from work, and I was able to enjoy a good Thanksgiving holiday weekend with my pandemic “pod.
I know 2020 has been a difficult year for many people. But I also have a lot to be thankful for this year, and I want acknowledge the following people:
My girlfriend, TK, who has administered my home IV medications every day with good cheer, meticulous sterile technique, and love.
The ER physicians and infectious disease physician who utilized their training, knowledge, and experience to make a prompt diagnosis and devise a good treatment plan.
The nurses in the ER and the infectious disease clinic who have treated me with kindness and compassion while drawing blood, injecting my medications, and answering all our questions.
My practice partner, SB, who helped clean out the infection using real-time ultrasound guidance to safely remove as much fluid as possible while avoiding injury to adjacent nerves, blood vessels, and tendons.
The pharmacists who mixed my medications to order based on my physicians’ precise specifications.
The pharmaceutical companies whose research and development teams developed an array of potent antibiotics that are effective and safe against my particular infection.
The laboratory technicians who ran the tests that allowed precise identification of the bacterial culprit and the appropriate drugs for treatment.
The medical device manufacturers who created the equipment necessary for the lab tests and the infusion devices that allow me to inject powerful medications directly into my bloodstream from the comfort of my home.
The hospitals that provide high quality 24/7 emergency care for anyone who walks in the door.
(By the way, during this process some of the health workers knew I was a physician and others did not. I did not notice any difference in the quality of care I received in either case.)
If I had contracted this infection 100 years ago, there would have been a significant chance that the infection would have spread to my bones (thus potentially causing permanent damage to my arm) or spread to my bloodstream (possibly resulting in sepsis and death). But today in 2020, my condition is completely manageable by any competent physician and medical team.
The US health system is not perfect. Many Americans who need medical care grapple with difficult challenges of cost and availability. These issues deserve the attention of policy analysts and lawmakers.
But for today’s column, I want to focus on what’s good about US health care. I’m grateful for the many people who have taken good care of me. And I am grateful for all US health workers who do this every day for thousands of patients across our country, sometimes under very difficult circumstances. You should be proud of what you do, and you have my deepest heart-felt gratitude.