My Visit to the UIHC Center for Digestive Diseases Gastroenterology Colonoscopy Clinic

People Apparently Like Healthcare Stories

I like to write and share stories, but I’ve been shy about sharing my healthcare experiences. I guess in part because it seems ‘personal’ and also because I can’t imagine that anyone other than family and close friends would really be interested.

Two weeks ago I went to the emergency room with a sever abdominal pain, which eventually turned out not to be life threatening. I apparently pulled an abdominal muscle. Yet, I thought the experience was worth sharing. The ER team was really exceptional, and they deserved a word of thanks.

A few days later, that story had over 5,000 readers around the world and was shared over 1,000 times on Facebook. It was then I realized that people apparently do have an interest in such stories. So, for those who are interested, here’s another amazing tale from the world of healthcare. 🙂

A Nurse with 57 Years Experience

This past week I went to the University of Iowa Hospitals and Clinics for a routine colonoscopy at the Colonoscopy Clinic in the Center for Digestive Diseases Gastroenterology. The clinic seemed very organized and well staffed. As a result, the entire process went as scheduled, despite having many patients in the clinic who were there for various reasons. The nursing staff and doctors with were cheerful and friendly which made the experience more relaxing and pleasant.

I typically don’t like needles. Who does, right? What makes things worse is that my veins are very uncooperative. Even if I drink lots of fluids the night before, most nurses and even trained phlebotomists have a very difficult time finding a good vein. There’s usually lots of tapping on the arm. Then they inevitably say, “Let’s take a look at the other arm,” which ends up being just as bad. On one occasion, it took five different people trying various poking strategies before one was able to get a semi-cooperative vein. That’s a lot of poking.

The night before the colonoscopy procedure, the preparation requires no intake of any food or fluid, even water. So, midway through the following morning, I was super thirsty and very dehydrated.

My primary concern at that point was wondering how they would find a vein for the IV given how dehydrated I was.

Fortunately, I ended up with a nurse who had over 57 years of experience. She was 77 years old, but looked decades younger. We had a pleasant and calming conversation that alleviated my fears. Then when it came time for the needle, I was so relaxed I barely felt it. Amazingly, she got a vein on the first poke, in the inside bend of the elbow where everyone else usually gives up.

We went through the rest of the basic preparations before the procedure which didn’t take long. The IV initially has saline solution to rehydrate the body. Later on prior to the procedure, a pain killer and twilight anesthesia (for conscious sedation) are administered through the IV.

Benefits of a Colonoscopy

Sometime after turning 50-years-old, most people will get a colonoscopy — a fairly simple, quick, and usually painless procedure that can save your life.

Each year in the United States, approximately 50,000 people die of colon cancer, which is ample motivation for getting this procedure that usually eliminates at-risk tissue before any cancer can form.

The most difficult part is the preparation which typically begins two days before the procedure. Your doctor will provide detailed instructions unique for your test situation. There are food restrictions as much as four days before the procedure.

The Colonoscopy Preparation – Four Milestones

There are four significant milestones during the two-day colonoscopy preparation. These instructions may change depending on the procedure and clinic, but here’s what I followed.

  1. Magnesium Citrate. Two days before the procedure, the guidelines state, “drink one bottle of Magnesium Citrate after your evening meal.” It’s a carbonated beverage that comes in a few different flavors. Taken with ice it’s actually not too bad. Before too long, it takes effect in a very noticeable way — and after a few trips to the bathroom you’ll feel totally emptied out. By nighttime you’ll probably be tired and very ready to sleep.
  2. Fasting from Food. After drinking the Magnesium Citrate, there is to be no food. So, a liquid fast begins and lasts about 36 hours. You might want to stay home the day before the procedure because being on a clear liquid diet can make you feel drained of energy and you may have trouble focusing.
  3. Colon Lavage Solution. The night before the colonoscopy procedure, you’ll be instructed to drink a gallon of salty tasting laxative solution that’s created by shaking a powder mix with water. This is probably the most difficult part of the entire experience. The guidelines request that you drink a cup of this solution every 10 minutes over several hours between 4 PM and 7 PM. At first you’ll be able to keep up.
  4. Fasting from Liquid. By evening you will have been without any food for 24 hours, and your body will have no food reserves remaining to be digested or processed. So, it’s an intense fasting experience. I use a sleep tracker, and noticed in the report the next morning some significant improvements with sleep quality, duration, and reduced restlessness. It’s believed that going to sleep on a full stomach with intestines full can result in restless sleep. So, having the stomach and intestines empty may help with sleep. It also helps to be thoroughly exhausted.

The Colonoscopy Procedure

In the preparation area there were about a dozen hospital beds, each with a privacy curtain all in one big open room. I’d not been in a situation like that before where many people were receiving care simultaneously. In retrospect, I think it helped reduce anxiety to have a dozen other people getting prepped for similar procedures. There’s something about a bit unnerving about going through an experience alone. Being with others reinforces the sense that it’s just a typical every-day procedure.

Once I was prepped for the procedure, I was wheeled (in the hospital bed) to the procedure room. As I recall there were three people including the doctor. An oxygen tube was provided (to the nose) probably because the sedation causes shallow breathing. There was also a blood pressure cuff and finger pulse/oxygen monitor.

Depending on how heavily sedated you are, the last thing you remember might be the nurse administering the anesthesia through the IV.

When I woke, I was in the hospital bed in same location as where I’d been prepped. I was a little groggy at first, and then woke slowly. The anesthesia continues to have a calming influence throughout the day. It’s recommended that you not drive or even take public transit for 24 hours after the procedure.

All the Benefits of a Juice Fast Cleanse

Something I’d not anticipated was the energy boost that followed during the days after the colonoscopy. This may be the result of higher nutrient absorption into the body (due to a cleaned out intestine). it’s true that the body is regularly drained of energy from being filled with food most of the time that requires processing. So, emptying it out occasionally is a nice respite.

I’ve done various intense fasts in the past, but that was many years ago. So, I’d forgotten about how the body can have so much more energy during and after a fast.

I was glad I took a day before and a day after the procedure to stay home and rest. It helped make the entire process less stressful.

Overall I’m really glad I had the procedure, and pleased with the care provided by everyone in the clinic. I’m really grateful for the amazing nurse I had helping me before the procedure. I definitely won’t be as anxious when it comes time for the next exam.

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UPDATE

24 July 2015. I got a follow-up call this evening from the doctor who performed the colonoscopy. It was nice to learn that there’s nothing to be concerned about. For some healthcare clinics, there’s no follow-up phone call. Instead a letter goes out, or there’s an update in the online medical service portal (MyChart for UIHC). Having a phone call was a nice personal touch.

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* The Gastroenterology Center at the University of Iowa Hospitals and Clinics is located at 200 Hawkins Drive, Iowa City, IA 52242.

My Visit to the Emergency Room at Mercy Hospital in Iowa City

Each Person is Important

When I was a teenager, I worked at McDonalds. I took the job to earn a little extra money, but over the years I’ve realized that I got much more out of that job than some extra spending money. At least in my case, I really learned, internalize, and honed a valuable work ethic. I was at an age where I was receptive, so it wasn’t a chore I resisted. I also learned that something as simple as a small bag of French Fries is important. Each customer — each person — is important.

We’d use stopwatches to time how long it took for a customer to wait in line, have their order taken, and get their food. My manager told me it was critical to provide prompt attentive service. I was told my work was important. We’d all compete with each other to see how quickly we could provide exceptional service. There was a comprehensive video training program, and we’d get credit for continuing education.

As I continued in life, I held on to the idea that even a simple task such as providing someone with an order of fries was very important and should be done thoughtfully. When I began my career as a computer support specialist, I felt my work was even more important than giving a person french fries. So, I determined that computer work deserved an equal or greater level of attention, responsiveness, and care.

Mysterious Abdominal Pain

Last week I had a sharp pain in my abdomen. It persisted over a few days, so I went to one of the exceptional satellite care centers we have in our area. These are the offices you go to as a first point of contact. They are limited in what they can provide, but they are convenient, fast, and a good way to see a doctor quickly for an assessment of what to do next.

The doctor I saw told me to go to the emergency room immediately. The concern with abdominal pain is that it could be just about anything from intestinal gas to a life-threatening appendicitis or other serious condition.

The ‘Other’ Hospital

I went to the emergency room of a local hospital.* Upon arriving and beginning the check-in process, my first question, was how long it might be — considering the pain I was in. My wife asked and got the response, “I don’t know,” from the person at the check-in window. My wife persisted, “Will it be an hour? Two hours? Four hours?” The answer came back again, this time a little more rudely, “I really don’t know.”

I looked around the waiting room, and seeing that almost all the seats were empty, and only a few people were there comfortably reading magazines, I couldn’t imagine why we wouldn’t be seen right away, and couldn’t understand why we wouldn’t be given at least a general estimate of when we might be seen. From the person’s expression at the check-in window, it was clear our presence there was an unwanted inconvenience. While DMV offices are known for a long wait and sometimes poor service, at least you get to take a number and know where you are in the queue.

Just getting to that ER was challenging. The narrow winding road with multiple unexpected sharp turns, and painful potholes, arrives at a confined dead-end entrance area where you’d imagine a loading dock to be. The few parking spots close to the door were already taken. Then there was the entrance. Sliding doors. Enter the first set of doors on the right. Then the next door requires you enter on the left. Trying to move in a serpentine motion isn’t so easy when you’re not feeling well. Then there were obstructions to reaching the check-in window. It was like an obstacle course. They certainly weren’t making it easy or convenient for people.

After some time went by, with nobody in the waiting room getting called, it was clear that things weren’t just moving slowly. They weren’t moving at all. We decided to cancel the check-in, but by then there was nobody at the check-in window and no hospital employees in sight. Hmmm… “How do we even get out of this?” I didn’t want to get an emergency room visit fee. Finally the grumpy person returned, and we told them we’d be going to a different hospital. They gave no response. Just a smirk.

Emergency Room Experience at Mercy Hospital

We went as fast as we could to Mercy Hospital in Iowa City. The hospital was easy to find. The emergency room entrance was easy to get to. There was abundant parking close by.

We entered and were immediately attended to by a cheerful person at one of the many check-in windows.

After my previous experience, I thought I should ask how long it might be before I could see a doctor.

“It’s an emergency room, so right away,” she responded smiling, but also looking a little perplexed.

I explained, “It’s just that the last emergency room we visited was very unfriendly and they wouldn’t tell us when I’d be seen by a doctor. They said it might be four hours.”

She smiled and said at Mercy they try to have people with a doctor in triage within 5 minutes of their arrival. “Would you like a warm blanket?” she asked. “Not right now, thanks,” I replied.

I felt like I was flying first class or checking in at some kind of fancy resort.

I asked where the restroom was.

She responded, “It’s right over there. Here, take this,” and handed me a urine sample cup. In most doctor’s offices you sit in the waiting room, and then after a while see a nurse who gives you the sample cup, but only if its deemed necessary, and usually after you’ve already gone to the bathroom.

The moment I stepped out of the restroom the doctor was ready to see me.

So, I was being seen and cared for in minutes after my arrival.

A few more minutes later, there was a team of nurses and doctors surrounding me working on diagnosing what might be causing my abdominal pain — asking me various questions to rule out bladder infection, pancreatitis, bowl obstruction, appendicitis, hernia, and various other possible causes. “You may need to go into surgery,” one of them told me.

Comprehensive lab work was done with blood and urine samples. A full CT scan was performed by two technicians.

In all, I think there were about 12 medical professionals attending to me, including the doctors, nurses, CT technicians, lab technicians, and other staff.

It was the kind of care you’d imagine a dignitary or celebrity getting — but that’s just apparently how they treat everyone.

Well, the good news is that the sharp pain was apparently caused by a pulled abdominal muscle. I just needed to rest up and get better. After knowing it wasn’t something more serious, my worries subsided and the pain subsided (with the help of the pain medication they gave me in my IV line).

I was home in time for lunch — rather than still writhing in pain at the other hospital.

The prompt and caring service at Mercy reminded me of when I was younger, working at McDonalds, learning that if bag of fries is important, then certainly something like caring for a person’s medical needs should be more important and deserving of fast, professional, compassionate care. It helped me to set a standard of excellence in the most menial of tasks, so I’d always excel beyond that in other areas.

Painful experiences are always difficult, but I can say I’m glad I had the opportunity to visit Mercy Hospital that day.

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P.S. Thanks! To those who’ve asked… Yes, I’m feeling much better now. Thanks! 🙂

P.P.S. Comparison Data. I didn’t discover it until later, but ProPublica has an online ER wait time comparison guide based on data collected between April 2013 and March 2014. I’m not sure how representative that data is a year later, and don’t know how accurate the data collection was. It would be nice to have a national map showing real-time data collected live from hospitals across the country.

P.P.P.S. Praise & Criticism. It’s always a good idea to offer praise publicly, and criticism privately. So, I didn’t mention the name of the ‘other’ hospital in my writing. Additionally, while personal experiences are helpful to encourage and coach teams, overall assessments of an institution should be made with longitudinal data from the experiences of many people over time.

P.P.P.P.S Comments. Okay, so it’s been about a week since I shared my story online, and I didn’t realize that people had been posting comments below awaiting approval. Sorry about that! I’ve approved them all, and replied to each one. To those of you who felt I was too harsh on the ‘other’ hospital. I have another story to share from this week about a very positive experience with the other hospital. No, I don’t plan to start a weekly journal about hospital visits. 😉


Impact: The Rest of the Story

When we make an extra effort to go above and beyond in our workplace, or perhaps maybe outside of work we do something nice through a special act of kindness, one often wonders what the impact is. Today, with social media, we can actually see the impact visually. The maps below show people who have read this story, and then were moved to share it with others, who shared it with others, and so on. Exceptional acts of excellence and kindness are inspiring. They encourage others to raise the bar, to do more, to do better, to be better.

For the nurse who is tired after many long shifts, who has had a difficult week, but chooses to set those things aside and give one more smile while focusing on someone in need or in pain… That nurse wonders what impact their kindness has in the world. Here’s the impact.

In the few hours after posting this story, 230 people had shared it, reaching 1,200 readers. After two days, there were 890 who shared it reaching 4,800 people – and the story spread to Europe. After three days, the story had reached Australia, Iceland, Romania, Ireland, and the United Arab Emirates.

The maps below shows the 200 most recent visitors. Click any map for a larger gallery view.

What we do in life, for good or for bad, has an impact in the world. Live your life for good.

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* I didn’t name the ‘other’ local hospital because I really didn’t intend this article to be a criticism of that hospital, but instead a word of thanks to the team at Mercy and a general commentary about the importance of quality customer / patient care. I subsequently received comments from people who are very pleased with their own experiences at the ‘other’ hospital. I’ve also had some very positive experiences with various departments within the ‘other’ hospital. It’s just that their emergency room process and procedures could use some improving.