Is this serious because emergency didn't think so?
May 2, 2017 1:45 AM Subscribe
Emergency took my black eye seriously yesterday, but ignored my abdominal pain today. It takes a week to get an appointment with my gp. Do I just pop painkillers and hope it goes away?
I had a fall on Sunday morning, knocked myself out and have an impressive black eye, which I took to Emergency on Monday, resulting in tests for concussion and a CT scan to rule out fractures. Since Sunday morning (which I mentioned on Monday), I've had recurrent abdominal pain (about every two hours lasting half an hour, and reaching gallbladder level pain) and it was getting worse about Tuesday (today) 2pm so I went to emergency but kept being bumped back, and back, I felt so tired and unwell and they didn't mind me leaving. At what point should I freak out? (I think I have problems getting treatment because I'm a non-eye-contact, socially anxious female aspie. I think they think I'm full of shit.)
I had a fall on Sunday morning, knocked myself out and have an impressive black eye, which I took to Emergency on Monday, resulting in tests for concussion and a CT scan to rule out fractures. Since Sunday morning (which I mentioned on Monday), I've had recurrent abdominal pain (about every two hours lasting half an hour, and reaching gallbladder level pain) and it was getting worse about Tuesday (today) 2pm so I went to emergency but kept being bumped back, and back, I felt so tired and unwell and they didn't mind me leaving. At what point should I freak out? (I think I have problems getting treatment because I'm a non-eye-contact, socially anxious female aspie. I think they think I'm full of shit.)
Best answer: I'm sorry you're going through this. I would say, you shouldn't freak out because freaking out never helps, but you should take this seriously and get it seen to ASAP. It may be food poisoning or some other simple thing that will hopefully pass, but if you're in lasting pain like this you should get it checked out. I think you should go to the ER. Some ER nurses and doctors are great, but some are just cold as hell. They deal with miserable, agonized people all the time, and they get numb to it. Is another ER available? You may have better luck there. Or if you went back to the same ER, it may be a new shift.
You need to be blunt about your pain. Don't minimize it. Don't be afraid to say things like, "I am in incredible pain and I'm really scared." Even if every instinct is telling you not to make a fuss, you have to make a fuss. I'm terribly shy myself, but sometimes you have no choice but to make a fuss!
IANYD, but are your still going to the bathroom normally, both peeing and pooping? That really matters, regarding abdominal pain. Any irregularities there could go a long way toward explaining this. Are you gassy or nauseated? Is the pain focused in any particular place? Going to the ER with more specific symptoms might get you seen sooner (in case your symptoms match appendicitis or an intestinal blockage or something else urgent). If the pain radiates into your chest at all, mention that. In my experience chest pain gets seen to a lot more quickly than gut pain!
Poor b33j! I really hope you feel all better soon.
posted by Ursula Hitler at 3:57 AM on May 2, 2017 [3 favorites]
You need to be blunt about your pain. Don't minimize it. Don't be afraid to say things like, "I am in incredible pain and I'm really scared." Even if every instinct is telling you not to make a fuss, you have to make a fuss. I'm terribly shy myself, but sometimes you have no choice but to make a fuss!
IANYD, but are your still going to the bathroom normally, both peeing and pooping? That really matters, regarding abdominal pain. Any irregularities there could go a long way toward explaining this. Are you gassy or nauseated? Is the pain focused in any particular place? Going to the ER with more specific symptoms might get you seen sooner (in case your symptoms match appendicitis or an intestinal blockage or something else urgent). If the pain radiates into your chest at all, mention that. In my experience chest pain gets seen to a lot more quickly than gut pain!
Poor b33j! I really hope you feel all better soon.
posted by Ursula Hitler at 3:57 AM on May 2, 2017 [3 favorites]
Best answer: IANAD but this sounds concerning to me. The level of pain (everyone tells me gallbladder pain is unbearable), the frequency and the fact that it is worsening are all troubling things. I'm sorry to hear you felt your pain was not being taken seriously.
Assuming your location is the one that is in your profile (crucially, not the USA), here are some possibilities:
I hope you feel better soon.
posted by Cheese Monster at 4:05 AM on May 2, 2017 [2 favorites]
Assuming your location is the one that is in your profile (crucially, not the USA), here are some possibilities:
- You could consider contacting Health Direct 1800 022 222 - they're staffed by registered nurses and can talk through your symptoms and give you advice about what you should do next.
- If they cover your area, you could call the National Home Doctor Service - their triage is also done by nurses, and if a doctor comes out and examines you and it turns out you do need to go to hospital, at least you will have been comfy at home while you wait to determine that.
- If you live in NSW, ACT, or Victoria or Western Australia you can use those links to check out current waiting times in hospitals near you. There's also stats on My Hospitals for the other states, though they're not real time. Obviously, it's only if you're in a major city that you can choose to go to a different hospital, but some of them report peak usage times which might be worth considering.
I hope you feel better soon.
posted by Cheese Monster at 4:05 AM on May 2, 2017 [2 favorites]
Best answer: Seconding calling Health Direct or the National Home Doctor Service. I've used the first and my housemates the second. They are really helpful. Each time, we were told to go to Emergency, but it was easier to go to Emergency knowing that someone who knew their stuff had recommended it.
And 2nd'ing Ursula Hilter that chest pain gets you immediate admission and a trip in a wheelchair to an EKG.
Write down the exact symptoms and timings/dates, so that you don't get flummoxed when you talk to someone.
Good luck!
posted by kjs4 at 5:52 AM on May 2, 2017
And 2nd'ing Ursula Hilter that chest pain gets you immediate admission and a trip in a wheelchair to an EKG.
Write down the exact symptoms and timings/dates, so that you don't get flummoxed when you talk to someone.
Good luck!
posted by kjs4 at 5:52 AM on May 2, 2017
Best answer: If you're in Victoria, you can call Nurse on Call and they can talk you through things. I've used them before and always been happy with the balance they struck between sensible caution and paranoia.
(If you're in Melbourne and would like someone to come to the hospital with you and be assertive on your behalf, please memail me. It can be hard to advocate for yourself in these situations, especially when you're in pain.)
posted by une_heure_pleine at 5:56 AM on May 2, 2017 [1 favorite]
(If you're in Melbourne and would like someone to come to the hospital with you and be assertive on your behalf, please memail me. It can be hard to advocate for yourself in these situations, especially when you're in pain.)
posted by une_heure_pleine at 5:56 AM on May 2, 2017 [1 favorite]
Response by poster: I'm worried about a ruptured spleen from the fall on the tiles. I'm on the Gold Coast and can't think of anyone to advocate for me. I can tolerate the pain for now - my capacity to deal with strangers has been exceeded. Thank you all.
posted by b33j at 5:59 AM on May 2, 2017
posted by b33j at 5:59 AM on May 2, 2017
Best answer: Alternately, if you call your GP's office first thing tomorrow and explain the situation, they may be able to make a same-day appointment - if not with your usual doc, then at least with someone else in the practice who has access to your records. Lots of practices keep a few slots open each day for urgent cases. You do need to call first thing when they open, though.
posted by une_heure_pleine at 6:00 AM on May 2, 2017 [2 favorites]
posted by une_heure_pleine at 6:00 AM on May 2, 2017 [2 favorites]
Best answer: I hope you're ok. After you get this sorted, maybe consider a new GP? Because if you can't see her or someone at her practice within a day or so of asking, how will that EVER help you when you're sick?!
posted by SaltySalticid at 7:40 AM on May 2, 2017 [1 favorite]
posted by SaltySalticid at 7:40 AM on May 2, 2017 [1 favorite]
Best answer: Emergency rooms work on a triage system. The speed of your entry on the forest visit may have had nothing to do with your symptoms and more to do with the symptoms of others. If your second visit co incided with a serious car accident or other medical emergency or two you would have to wait. A lot of gps save appointment slots for sudden onset problems, ring as soon as they open to try and get one that day, if you can't get in, talk to the receptionist about your options as they will have more idea what is available locally.
posted by wwax at 9:50 AM on May 2, 2017 [2 favorites]
posted by wwax at 9:50 AM on May 2, 2017 [2 favorites]
Best answer: I don't know how things work where you live, but if I really didn't want to take my chances with the ER again I'd go to the doctor's office and sit there until they saw me (sometimes you have to wait until the end of their hours; sometimes they make room for people who need help urgently). If you don't want to go unannounced, you could call and tell the receptionist that you're sorry, you hate to inconvenience, but you absolutely have to see the doctor today and you cannot wait for your regular appointment. I'd be kind of shocked if they didn't make room for you, but if that happens then (a) go to the ER again and do not take no for an answer, and (b) fire your doctor, as SaltySalticid says above. (I have had to make urgent last-minute visits before, and while I've had to wait I've never not been seen.)
That said, it might still be better to go to the ER (or to some other urgent-care type of place, if it exists) because they should be able to run tests more quickly if necessary.
If you feel like you'd rather do anything but face the ER again alone and your doctor is an immoral (imo) ass, just start calling friends. Even if they're not very close friends. Especially anyone you've ever done even the smallest favor for, or who's ever already helped you with anything. Don't feel bad about asking; you're giving them someone to call when they're in the same place.
(One final option, though the others seem better to me: if this is a doable thing in Australia, can you call your healthcare provider and tell them you need them to make you an emergency appointment, asap today, with someone in their network on account of your own doctor being unavailable?)
posted by trig at 9:54 AM on May 2, 2017 [1 favorite]
That said, it might still be better to go to the ER (or to some other urgent-care type of place, if it exists) because they should be able to run tests more quickly if necessary.
If you feel like you'd rather do anything but face the ER again alone and your doctor is an immoral (imo) ass, just start calling friends. Even if they're not very close friends. Especially anyone you've ever done even the smallest favor for, or who's ever already helped you with anything. Don't feel bad about asking; you're giving them someone to call when they're in the same place.
(One final option, though the others seem better to me: if this is a doable thing in Australia, can you call your healthcare provider and tell them you need them to make you an emergency appointment, asap today, with someone in their network on account of your own doctor being unavailable?)
posted by trig at 9:54 AM on May 2, 2017 [1 favorite]
Best answer: I'd go back to ER and wait however long it takes to be seen.
I did actually rupture my spleen once (I'll never do it again) and probably waited three or four hours to be seen. But once I got in to a doctor it was all serious business.
For what it's worth, my pain was very steady, not intermittent at all. But I think you should go in to be properly evaluated.
posted by SLC Mom at 10:23 AM on May 2, 2017
I did actually rupture my spleen once (I'll never do it again) and probably waited three or four hours to be seen. But once I got in to a doctor it was all serious business.
For what it's worth, my pain was very steady, not intermittent at all. But I think you should go in to be properly evaluated.
posted by SLC Mom at 10:23 AM on May 2, 2017
Best answer: Go back to the ER or a urgent care clinic that can do imaging.
I got sent back from a very good US ER with a diagnosis of "it's nothing" when it was, in fact, acute cholecystitis. I got CT imaged a few days later and my gallbladder was not good at all. But the ER only did blood tests and nothing showed up.
You should really go back and wait until you get seen. Find a different place if the last place is just going to do the same thing again, but it could be a number of serious things.
posted by GuyZero at 12:41 PM on May 2, 2017
I got sent back from a very good US ER with a diagnosis of "it's nothing" when it was, in fact, acute cholecystitis. I got CT imaged a few days later and my gallbladder was not good at all. But the ER only did blood tests and nothing showed up.
You should really go back and wait until you get seen. Find a different place if the last place is just going to do the same thing again, but it could be a number of serious things.
posted by GuyZero at 12:41 PM on May 2, 2017
Best answer: It sounds like you didn't get seen by a physician, so just remember that what happens at triage doesn't mean much in regards to how serious your issue is. The triage nurse makes a quick decision based on an algorithm that uses your chief complaint, age, and your vital signs to assess the severity of your illness.
So, your triage complaint would be something like "Intermittent abdominal pain 2 days after a fall". If you had normal vital signs along with that complaint, you likely would not have been given a high acuity. It doesn't mean that you don't have a significant issue, it just means that if you have normal vital signs and it's been 2 days since the injury the odds of a life-threatening issue (like a ruptured spleen) have become much lower, and they determine you can afford to wait. In the same way, if you fell and got knocked out but didn't go to get your head checked until several days later, you would have been much less likely to be seen urgently or to get a CT scan. The reason is that if you're still conscious, not confused, and otherwise neurologically normal after a few days, it has become extremely unlikely that you have a head bleed.
This is just general information about how emergency department triage works and should not be construed as medical advice about your specific case. My point is that algorithms generally are useful but they are also not reliable and cannot give you a true level of severity or any sense of whether you have a serious diagnosis or not. You must be seen and examined by a physician to get a better sense of that (although as GuyZero points out, all human beings and all our medical tests are still fallible). One of the few patients I've seen in the emergency department who came in walking and talking and died during his stay was triaged to the "low acuity" area. Unfortunately, some people even die while they are in ED waiting rooms because of inaccurate triage and lack of reassessment.
Your experience in the ED should not convince you that what you have is not serious, and popping painkillers and staying at home is not a course of action I would endorse at all - from an emergency medicine perspective, we rarely prescribe painkillers for undifferentiated abdominal pain as a rule, specifically because we worry that it will keep patients from coming back and being re-evaluated until it is too late.
posted by treehorn+bunny at 6:38 PM on May 2, 2017 [5 favorites]
So, your triage complaint would be something like "Intermittent abdominal pain 2 days after a fall". If you had normal vital signs along with that complaint, you likely would not have been given a high acuity. It doesn't mean that you don't have a significant issue, it just means that if you have normal vital signs and it's been 2 days since the injury the odds of a life-threatening issue (like a ruptured spleen) have become much lower, and they determine you can afford to wait. In the same way, if you fell and got knocked out but didn't go to get your head checked until several days later, you would have been much less likely to be seen urgently or to get a CT scan. The reason is that if you're still conscious, not confused, and otherwise neurologically normal after a few days, it has become extremely unlikely that you have a head bleed.
This is just general information about how emergency department triage works and should not be construed as medical advice about your specific case. My point is that algorithms generally are useful but they are also not reliable and cannot give you a true level of severity or any sense of whether you have a serious diagnosis or not. You must be seen and examined by a physician to get a better sense of that (although as GuyZero points out, all human beings and all our medical tests are still fallible). One of the few patients I've seen in the emergency department who came in walking and talking and died during his stay was triaged to the "low acuity" area. Unfortunately, some people even die while they are in ED waiting rooms because of inaccurate triage and lack of reassessment.
Your experience in the ED should not convince you that what you have is not serious, and popping painkillers and staying at home is not a course of action I would endorse at all - from an emergency medicine perspective, we rarely prescribe painkillers for undifferentiated abdominal pain as a rule, specifically because we worry that it will keep patients from coming back and being re-evaluated until it is too late.
posted by treehorn+bunny at 6:38 PM on May 2, 2017 [5 favorites]
Response by poster: Found someone (a prospective date I had postponed because of black eye) to bring me in. Admitted immediately. X-ray and bloods done. Fucking amazing pain relief. Thanks team. Appreciate your combined effort in getting me here.
posted by b33j at 11:05 PM on May 2, 2017 [5 favorites]
posted by b33j at 11:05 PM on May 2, 2017 [5 favorites]
Best answer: Well done beej :-)
Sometime soonish, talk with your doctor's practice to find out if/how they do accommodate urgent cases on a same-day basis. This is a thing that happens in life and knowing you have coverage for when it happens is a big deal!
posted by trig at 11:58 PM on May 2, 2017 [2 favorites]
Sometime soonish, talk with your doctor's practice to find out if/how they do accommodate urgent cases on a same-day basis. This is a thing that happens in life and knowing you have coverage for when it happens is a big deal!
posted by trig at 11:58 PM on May 2, 2017 [2 favorites]
Response by poster: Have to see my doc soon to organise an endoscopy. Gastritis. She (ER doc) was really nice when I asked her to rule out a spleen problem (which I knew was a bit over-reaching of me, but Dr Google + anxiety). My GP is my GP because she's easy to get to (on my campus) and she listens to me, which I have found very rare. I could possibly have arranged an emergency appointment with my GP but I knew I'd need tests (bloods, x-rays, whatever) and ER gets them done in less than an hour, my GP wouldn't get results for up to 2 days and I would have had to go off site for anything other than blood / urine, and with the pain x anxiety, I just wasn't capable of it.
posted by b33j at 8:17 AM on May 3, 2017 [2 favorites]
posted by b33j at 8:17 AM on May 3, 2017 [2 favorites]
So glad to hear that you are on the way to getting this sorted, b33j. I have been thinking of you.
posted by Thella at 1:48 AM on May 6, 2017 [1 favorite]
posted by Thella at 1:48 AM on May 6, 2017 [1 favorite]
Mod note: Final update from the OP:
I postponed the endoscopy, lost the paperwork and then months later, went to work to finish a funeral order of service for a friend who'd lost her mother even though I had a terrible pain in my guts. Colleagues found me on the floor, white faced, trying to get up enough toughness to finish it and called an amnulance. (One even sent the document I was working on to my friend, while another bathed my forehead with cold water). I was admitted to hospital with gastro-intestinal bleeding, and haemoglobin levels close to requiring a blood transfusion. I swallowed a camera pill, and they identified the source of bleeding as near the appendix. Once the bleeding stopped, I was released and readmitted two weeks later for a polypectomy. They got 5 of the little buggers and none were cancerous.posted by LobsterMitten (staff) at 7:44 PM on December 10, 2018 [3 favorites]
So if your doc tells you to get an endoscopy, do it.
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posted by fraula at 2:11 AM on May 2, 2017