I had a “freak” accident and now I’m in pain. Thanks urgent care for sending me away with a CD, stack of receipts, and my choice of opioid without proper counseling.

By jingwundersEmotions, Reflections, Support, Trauma

Hi, my name is Jing Wu. I have been supine for days, and I am straight fed up with our health “care” system. On Wednesday, February 13th, I slipped and fell awkwardly on my ankle which transformed my identity from being a healthy, able-bodied adult into an immobile, orthopedic trauma patient with chronic pain. Honestly, life was going pretty well, and I expected at some point there was going to be a counter experience. This piece is a recount of all the steps that happened between when I fell, what could have went better, and what the patient/provider could do in the places where mishaps happened.

I began writing this piece yesterday when I was fresh off the phone with the most ornery and insensitive nurse I have ever encountered. My blood was boiling because I couldn’t believe how something as seemingly straightforward as care for a broken ankle was so complicated. We will talk shortly about how I got to this point of frustration, but first let me share with you some relevant details about what qualifies my stance and colors my disposition:

  1. I have had the identity of a patient in critical and chronic conditions before.
    • Brain injury. I am a severe traumatic brain injury survivor of about 5.5 years. This post isn’t about my experience with brain injury, but the key takeaway is that I know pain, trauma, disability, and what living in seemingly never-ending h*ll feels like. I am at a point where I am mentally prepared to handle difficult feelings, symptoms, and situations where I can still feel frustrated, but I am not surprised, and I also feel capable of adapting and coping with challenges more resiliently. When I had the ankle fracture, I was in a bit (A LOT) of pain. I was intrigued by how I was able to think coherently and direct my care despite my circumstances. If you are interested, you can read more about me at www.themindreset.com’s “Why We Started” section or read other perspectives/written pieces I have created underneath my author name: jingwunders.
    • Surgery. I have had a thyroidectomy in the past where the surgeon damaged my throat in a manner that lead to several challenging post-surgical circumstances. He hit a nerve that controlled my vocal cords and paralyzed one of them. From that experience, I know what it feels like to have surgery be completed successfully in that the goiter was removed, but I also got to see how the quality of life for patients post-surgery are not always a concern of the surgeons providing care. After that surgery, I was mute for quite some time, was not able to turn my neck, was constantly choking on air or anything that I consumed, and I would bleed randomly. Now I am able to speak, but the journey to speaking with clear tone and sound again was not pleasant. I share this history because I understand that surgeries are invasive, that we as patients have no control when we are under anesthesia, and that transitions and continuity of care matter.
  2. I’m actually healthy and really functional despite my medical history. I only went to see a physician for a wellness check-up once last year where I was told, “Well you aren’t boring,” when my medical history was revealed. I do not take any medications, and I am really thoughtful about managing my overall well-being (which is what The MindReset is modeled after).
  3. I’m familiar with the health system from both a tertiary (pharmacist) and primary (public health) perspective. I understand the health system from multiple perspectives. I understand what best practices are for medications, and I understand how the system works. I am not completely in the dark about my treatments, and I vocalize my health needs. I can empathize with both the people providing care and the ones receiving care. At the end of the day though, health care is about treating the patient and achieving the outcomes they desire to the best of our abilities as providers. At this time, I argue that this is where we are:
    1. Providers: Most of us aren’t even close to mastering these critical skills: empathy, communication, and respect. We have a lot of clinical geniuses out there who are excellent in their niche but know nothing when it comes to the bigger picture of what matters to patients. I am appalled by how little providers listen to their patients or pay attention to what they need. Medicine is an art and a science, let us not forget the former. The purpose of this piece is not to get into all the reasons providers are unable to provide optimal care (trust me, from my health professional peers and personal experiences in a variety of inpatient and outpatient settings, the list isn’t short). If there is only one takeaway from this paragraph, let it be that providers should band together for the greater good and advocate for better health care. TALK TO EACH OTHER and turn goals into action, whether it be through minimum time requirements with patients to ensure quality care, consolidating and making insurance more transparent, user-friendly payments or whatever else it may be.
    2. Patients: This sucks, but we have to try and be as informed as we can be. We have to speak up for ourselves. I know this is tough because not everyone knows what to ask. Put simply, we don’t know what we don’t know.  If there is one question you should ask yourself and your provider at the end of every visit, it is: Am I leaving this office with everything I need to take care of myself?

This is in regards to knowledge and physical items:

    1. Do you know how to take care of yourself while healing/recovering?
    2. Do you have the prescriptions you need for your symptoms? What are the side effects of your medications? How do you take them? 
    3. What activities can you not do and what activities are recommended to take the best care of yourself (nutrition, exercise, mental health, work, rest, financials, etc.?)
    4. What are the costs and how can you save money while still getting the most effective treatment?
    5. What resources are available to make sure quality of life is sustained as best as possible?
    6. Who do you contact if you have an issue or question?

It is definitely more challenging for us to keep track of all these things while we are ill, but in the current state of health care, we have to empower ourselves as we collectively work towards a better system. We must advocate too. While we may be afraid or feel alone, every effort we make in speaking up against something that is wrong is important. Our health is a team effort. The people who are supposed to help us should, but we can’t expect to get better without the efforts of our own. Heal and use your voice.

OKAY. Let’s jump into the abbreviated broken ankle saga of the last 6 days where I actually interfaced with the health system…

Wednesday, February 13th – Day of the Fracture – Jing’s first broken bone.

The bone breaks (I don’t know this), and my friend Sara goes to seek care from the gym staff. She tells me that a few other people also rushed to seek help as well. The gym staff come to help me, and this is where the big lesson at this location comes in: ELEVATE the injured area after a sprain. While RICE (Rest, Ice, Compression, and Elevation) has been the golden standard for ages, METH (Movement, Elevation, Traction, and Heat) is an emerging treatment. Regardless of which one is applied, elevation is key. This wasn’t what happened to me, and I vocalized to the attendants: “Why are you asking so many questions I don’t know the answer to? Put me on the ground. My leg needs to be elevated. I’m beginning to get dizzy, faint, and blackout.”

At the gym, the responders’ first actions were to sit me up straight, randomly put an ice pack around my ankle, and asking me a slew of questions which I am sure was part of their injury protocol. While these questions are standard, they should have first stabilized me before jumping into the questions. I was very fortunate my friend Charlie who is attending medical school happened to be at the gym and was able to assist me. He helped me to the ground, grabbed me a gatorade and a Cliff bar, and did a basic assessment. Sara and Charlie were very helpful in getting me out of the gym.

Sara searched for nearby urgent care centers. I relayed my insurance to her because I wanted to go to a place where I was covered. We went to a 24-hour urgent care center almost 30 minutes away (our Uber missed a turn, grrrr). Where upon our arrival, we were told that the X-ray center was already closed, and my wait would be TWO hours. The front desk person told me that I wouldn’t be able to get an X-ray until the next day anyway. In other words, this place wasn’t going to help me. Why advertise yourself as 24 hours if the services your patients need are not available for those 24 hours?

I was shaking from the adrenaline and was highly considering going home and sleeping it off. I am glad we didn’t. Sara looked up another urgent care, and I prompted her to call them first to ensure they took my insurance. The front desk told us to come, so we took another 30 minute journey to this urgent care center (which the Uber driver this time also missed a turn and extended our trip, grrrrr). The whole time we are in the car I have my leg elevated to dampen the pain.

When we get to this urgent care center, the intake person was wonderful. He clearly understood the urgency of the situation and wanted to get me seen by a physician quickly. We were already at the clinic when we learned they didn’t take my insurance. It was getting late, centers were closing, and we had been driving all over the place for an hour so my options were pretty exhausted. I just decided to move forward with care, pay for the services upfront, and hope I could bill my insurance later.

They said the services would be between $20 and $300 (I knew they were going to max it out, spoiler alert, they did and more) and not until the appointment was over did I realize that this didn’t include prescriptions.

Anyhow, I went to the back for my vitals. Best practices would have been for the person taking my vitals to introduce herself, her position, and offer to help me get on the weighing scale. None of this happened. When I was weighed, the final reading was 24 pounds off. Yes, TWENTY-FOUR. She asked me if that was my usual weight, and I’m glad I am aware of what my weight is more or less, so I was able to tell her no. If it had been five to maybe even ten pounds, I could have believed the number. She also didn’t tell me what my vitals were. I requested for them to be shared with me… My blood pressure was a bit high, as to be expected, but I was baffled that my discharge paperwork said I was pre-hypertensive.

Specifically, in a stack of 10 receipt-like papers stapled together, the third sheet said:

“BP, Adult: Prehypertension. Your lowest systolic and lowest diastolic blood pressures today were 123/82.” I’m usually >20mmHg (blood pressure is measured in millimeters of mercury…here’s a link FYI) lower than those numbers, but that’s fine. I recognize that I was in distress. What wasn’t okay is the misleading and generic discharge paperwork I left with. In that first sentence on the third page, I identify four words/terms that one out of five adults would not know. Best practices is to share health information at or below a 5th grade reading level. Best practices would also be to not send me away with an inaccurate diagnosis that represented a snapshot vital statistic but not my natural state. The paperwork encouraged me to lose weight if overweight (though I was quoted to be 24 pounds less than I am at first), to increase my aerobic physical activity (sorry can’t walk), and to stop smoking (I don’t smoke). It shouldn’t be the job of the patient to interpret what on their discharge paperwork pertains to them or not…especially if their predicament affects their ability to function.

Let’s get back to the appointment. I meet with the physician, and she says I need to get X-rays. I’m wheeled over to the X-ray room, and the person (who also doesn’t introduce himself or his role) tells me to “take my time” while getting onto the x-ray table. He doesn’t offer to help me. He just watches me struggle, similar to the person who took my vitals. We get the needed X-rays. They are handed off to the physician, and she returns to the room where Sara and I are sitting.

“Well, your ankle is broken,” she said, “You’re going to have to see an orthopedic specialist.” She pointed to the X-ray and said, “Unfortunately, these things happen. It’s not quite a hairline fracture. It’s almost like a spiralized break. You may have injured soft-tissue as well. You might need surgery.”

Sara and I were listening, but I’m not sure what our faces relayed back to her. She responded sheepishly, “You were in a freak accident. It’s not bad, but it’s still broken. I’m sorry.”

She then proceeded to tell me that I needed to schedule an appointment to see the ortho the next day (even though it ended up being two days later because they wanted the swelling to go down), and then this part shocked me a little.

“Would you like tylenol with codeine, tylenol #3, or hydrocodone?”

Wait, what? She didn’t know I was a pharmacist…patients get asked which opioid they want?! I opted for tylenol #3 because I know how I respond to exogenous compounds. Whenever I ingest any sort of chemical substance, I tend to experience their effects immensely. Tylenol #3 is considered a step down from some of the more potent opioids, and I understood the side effects of this class of medication.

Then another random person came into the room (without introducing themselves or their role) and began splinting my leg in a haphazard way. At this time, Sara later told me, the doctor talked at me while my ankle was being splinted, but it was clear I was busy focusing on my ankle. I realize I didn’t hear a lot of her counseling points, but I was in pain and already knew the information, so it didn’t bother me that what she was saying was necessary. However, if I wasn’t a pharmacist, some of those points may not have registered with me. I realized she didn’t tell me the addiction potential of the medications I was taking and didn’t emphasize what I could do for the symptoms of opioids.

If you have never taken opioids before, this is what you really need to know:

  1. They make you drowsy – I literally was knocked out/”out of it” for hours at a time after taking just tylenol #3. This really disturbed my quality of life and ability to function. In the next post about this subject, I will reveal my work-around where I figured out a way to avoid taking the opioid and still function.
  2. They make you constipated – Taking something like senna docusate, drinking plenty of fluids, and taking adequate fiber will be helpful.
  3. They make you nauseous – Unfortunately, taking with food doesn’t necessarily always decrease this side effect. Request an antiemetic (something that makes you less nauseous from your prescriber).
  4. They have addiction potential – Opioids work really well when they work. Be wary of this potential (interestingly my discharge papers did not tell me what those signs would be…Here is a link with physical and behavioral signs). The longer you take opioids, the increased risk of dependency and/or addiction. There is no better time to be self-aware of your behaviors and your pain tolerance.

So anyways, I came in with a borrowed pair of crutches, and I am told I will get my own pair. I ask how much they would be and my doctor said, “It will be like $70, but I don’t know. We don’t know that kind of information on our end.”

I respectfully declined her offer for crutches because I quickly looked up the price online, and it looked like crutches cost about $20-$23 on the inexpensive side online or in-store. I promptly ordered a set from Amazon (which I will return because I ended up figuring out a way to get them for free – can share later). Nonetheless, I was disappointed by how my doctor didn’t seem to care about the financial burden of my appointment, and indeed when I left, my bill was greater than $300. The actual cost of this visit without insurance was:

  • $129.00 for the ankle x-ray
  • $15.60 for 15 tylenol #3 tablets
  • $176.00 for the application of the splint made of gauze and plastic
  • $147.00 for seeing the doctor
  • -$153.00 was subtracted for the “self-payment” cost

In the end, even with $153.00 subtracted for “self-payment”, my bill came out to be $314.60…more than $10 per minute for service. I left with a painkiller, a stack of paper, a CD of my X-rays, and a large bill.

Overall, the care I received at that urgent care center was fine and pretty standard. I wasn’t upset while I was there, but there were definitely aspects that could have went better. I mentioned the details because those nuances constitute the art of medicine.

While everyone was respectful, they weren’t as helpful or thoughtful as they could have been. And they didn’t ensure I left their clinic with a strong understanding of my care, continuity, or any expression of consideration about how this injury would impact my overall quality of life/health. Some may want to argue that urgent care centers are busy or overwhelmed, but when I was there, I was the only patient.

Are you exhausted from reading about this experience? Haha, it wasn’t even as baffling as my experience at the orthopedic specialist’s office…but that is a post for another day.

Providers – Please make sure your patients leave your clinics well-informed, safe, and feeling cared for.

Patients – Advocate for yourself, ask for help, ask questions, and good luck.

Everyone in the United States of America…let’s not be complacent about the state of our healthcare. Too often we do not reflect on what we should receive and do not act upon what we can do. Call your clinics, report your care, rate your clinics and providers, report to federal agencies your mishaps, and share your story.

Until next time…

By Jing Wu, February 19th, 2019

Editor(s): Jessica Collins

Read part two to the broken bone saga:

Stairs are a mobility-challenged person’s worst enemy, it’s super awkward to be outside, and maintaining self-esteem while temporarily disabled.

Please do not hesitate to reach out to the MindReset community if you are in need of support or are interested in supporting others in an actionable and effective way.

The MindReset is a community of individuals who seek to inspire a social movement geared toward creating a more Supportive, Inclusive, Compassionate, and Kind society where anyone and everyone has the opportunity to thrive.

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