Gut Check

The fire was only the beginning.

As Michelle and I dealt with the aftermath of loosing our horse barn, we were left scrambling to balance existing commitments. For me, that included a scheduled trip to Cypress, California the following Monday to facilitate a three-day Product Definition Workshop for the Value-Based Reimbursement group. I checked with the members of my team to see if anyone could travel with short notice to cover the event. With their own activities already planned for the following week — and Spring Break occurring during the same time period for many local schools — no one had availability. If I had been a participant rather than the lead facilitator, I would have cancelled; but instead felt an obligation to do what I could to make the schedule work. After all, it was too late in the game for the other 25 participants to cancel and rearrange their travel plans to move dates and/or locations.

Michelle and I discussed, and agreed that if we could spend the weekend getting our affairs in order, I would travel the following week. This entailed finding a supply of hay for the animals, establishing a water supply to the larger pasture, and acquiring thyroid medicine for our miniature donkey.

I landed at the John Wayne airport, seemingly without complication. After taking a Lyft to the hotel, I walked across the street to the site of the workshop and spent the next three hours setting up. A coworker happened to stop over, so I joined him for dinner, followed by an evening walk and some additional conversation. At 9 PM I made my way to bed.

I woke up at 2 AM with a sharp pain in my lower right abdomen. I thought, with near-certainty, this must be appendicitis. Either that or a kidney stone. After investigating symptoms, I decided to wait and see if the pain worsened or moved. It did, indeed, worsen… to excruciating proportions by 4 AM, at which point I called my wife in Minnesota and asked if she could help me find a hospital in Cypress, California that would be covered by our health insurance. A few minutes later I received a call from the nurse hotline of our insurance provider, who helped me identify a treatment facility.

I requested a Lyft and waited, hunched over outside. The Lyft driver — Frank, in a gray Honda — picked me up, but then brought me to an urgent care clinic that appeared closed. The nurse advised I go to an emergency room — not urgent care — as I would need a computer tomography (CT) scan and was unlikely to find the necessary equipment at an urgent care facility. The driver insisted this was the correct address. I requested that he wait while I ask the security guard for directions. As I stepped away from the vehicle and towards the security guard, the driver suddenly took off, and left me stranded on the corner, now fully hunched over and struggling to walk upright. The security guard explained the emergency room was several blocks away, and then graciously offered to drive me over on his golf cart. The ride was bumpy and I was in extreme discomfort.

The security guard and I arrived at the Los Alamitos Medical Center emergency room, only to find there was no one stationed at the front desk. After waiting for nearly 20 minutes someone came round the front and checked me in. Then it was another 15 minutes before they took me to a room in the back, provided me with a shot of pain medication, and then left me alone for the next hour and a half.

If this is appendicitis, I thought, the issue is time sensitive, and yet no one has even ventured in to begin the diagnosis process. In addition, the pain medicine they had given me didn’t appear to be working. I lay awkwardly in the bed, twisting and turning as the pain in my stomach proliferated and increased. I seriously considered getting up and leaving, in search of a more responsive emergency room. Finally, the doctor stopped over, asked me to rate the pain level and then offered morphine. “We will need to do a CT scan,” he said, and then disappeared.

A nurse entered the room 10 minutes later, inserted an IV, provided the morphine, and then left. I sat for the next two hours, noxious at first but glad the morphine was finally having an effect.



Finally, an orderly entered the room to bring me for the CT scan. “James?” They asked.

“Robert,” I responded. “James is my middle name.”

“Oh,” they said. “Hang on a minute.” Then they left, only to return 10 minutes later with a new wrist band. “Whoever checked you in entered your first name wrong, so now we have to reorder the CT scan under your correct name. Not sure how that happened but you’ll have to wait a little longer.” Then he was gone.

Another 20 minutes passed before the orderly returned, at which point he wheeled me to the room for the CT scan. Standing was difficult, but I made the transition to the other bed, received the scan, and then returned to my room.



Some time later the doctor stopped in. “We found the root cause. You have a hematoma… that is, internal bleeding in the abdomen, caused by a ruptured blood vessel. Did you experience any sort of blunt trauma?”

“No,” I said. “Would it have happened recently? If so, I didn’t really do anything yesterday other than sit on an airplane.”

“Oh,” the doctor said, “you’re not from here?”

“No, I flew in from Minnesota.”

“It is possible the air pressure changes during the flight would have been enough to rupture a small blood vessel… it’s certainly happened before.”

“I didn’t even know you could do that. Is it really this painful?”

“The internal bleeding is, yes, because it pushes against the folds of tissue, and there are a lot of exposed nerve endings there.”

Then, as the doctor was just about to explain the next steps, a nurse interrupted and notified him there was a phone call. Off he went, mumbling that he would, “be back in a few minutes”.

At one point a nurse entered to draw blood, but could provide no additional information regarding my status and what to expect next. I still had no idea what the treatment options were, or how serious my condition was.

Several hours later the doctor returned. He said a blood clot had formed and I needed to be careful not to dislodge it. I would require another blood test in the next three to five days to ensure my hemoglobin levels had stabilized, and would not be allowed to fly or scuba dive until cleared by a provider based on the results of that blood test.

“I’m scheduled to fly home Friday,” I said.

“I’m sorry, but you’ll have to wait.”

“Should I come back here for the blood test?”

“I wouldn’t recommend it. The emergency room can get very busy, it would cost you more, and you’d end up waiting all day. You’ll need to find a clinic or somewhere else to get the blood test. I’ll be very specific in my notes and will include your current hemoglobin levels so the physician can compare them.”



Then the doctor was gone, and just like that, I was told I could leave. No one helped me navigate the winding passageways to the exit door. No one offered to arrange a ride. No one told me to which pharmacy my order for medications would be sent. I had to read the notes in the discharge paperwork, after walking the better part of a mile in the wrong direction. As I read through the details, a smile emerged, due to the description of my pancreas as “grossly unremarkable.”



While picking up prescriptions at CVS, I was informed my insurance provider would not cover that specific location. I would need to pay out of pocket. That seems about right, I thought, given how my day has gone so far.

I walked the two and a half miles back to the hotel, enjoying the sunshine, processing the information, and looking for places to schedule my follow-up blood test. I stopped en route at three different care providers, only to be told they didn’t have the necessary equipment to process the lab results onsite. It would take a minimum of three business days after the blood was collected to receive the test results.

The next day I woke early, rescheduled my flight for the following Wednesday, and reserved a rental car. Then I facilitated the workshop. We abandoned the pre-defined schedule in favor of co-creating the agenda, in order to accommodate the shorter two day format.

When the workshop wrapped at the end of the week, and everyone else returned home, I traveled to the airport for my rental car. From there, I drove eight hours to Northern California to stay with my cousin for the weekend. I made a few sightseeing detours along the way, to break the monotony of the long drive and make the most of the trip. The first stop was Griffith Observatory, with a view of the Hollywood sign.



The second stop was lunch at The Rainbow Bar and Grill, famous for its long history as a rock ‘n’ roll hangout.



I then spent the weekend with my cousin, trying to rest and recover. On Saturday, the blood beneath the surface worked it’s way into my lower extremities, where I was confronted with severe bruising. When my cousin returned to work Monday, I drove to American Canyon. From there I called the nurse hotline to find a medical facility nearby that would be covered by my health insurance. I was directed to the Sutter Solano Medical Center. Upon arriving, the desk attendant asked if they could see the lab order. I provided them with my discharge paperwork from the ER, and the detailed notes.

“These are the notes from your visit, but we need an order from your provider for the lab.”

“My provider is in Minnesota. The ER doctor said I would need to get a blood test before I can fly back, to ensure my hemoglobin levels have stabilized and there is no further internal bleeding.”

“Unfortunately, the ER doctor did not include an order for the blood test. Without that, we can’t provide one. You would need to see a provider.”

“Can we call the ER doctor to ask if he can provide the order?”

“We can try…” the attendee said, picking up the phone. A few minutes later she covered the mouthpiece to speak to me. “The doctor you saw is off work today. They were going to get someone else, but I’ve been on hold for ten minutes… I think they forgot about me. I’m going to hang up. You’ll need to see a provider to get the lab order. Otherwise, if you don’t mind paying out of pocket, you can walk across the street to Quest Diagnostic and order the lab from them. They allow you to order your own tests, but it won’t be covered by insurance.”

I walked across the hallway to schedule an appointment with a provider. There were no slots available. Reverting to the second option, I ventured across the street and into Quest Diagnostics. Having registered at the kiosk to get my name in the queue, I then waited for two hours. Once my name moved to the top of the list, I provided the attendant with the note from my ER doctor.

“We need an actual order from your provider.”

“Um, okay… my actual provider is in Minnesota. I had a medical emergency while traveling, and can’t return home until I get a blood test showing my hemoglobin levels have stabilized. I was told you’d be able to provide that service, if I paid out of pocket.”

“One minute,” the attendant said, then asked his supervisor to look at my paperwork. She took a brief glance and exclaimed, “We can’t do that; it’s against the law!”

I gave up and drove to Napa Valley. With a day and a half to fill, I explored Yountville, ate dinner at Mustard’s Grill, watched The Batman at the cineplex, and visited my alma mater…



On Wednesday, I boarded the plane and flew home. If I dislodged the blood clot, I haven’t felt it yet.

The health system is failing us. As helpful as the Sheriff, Fire Marshall, and Fire Fighters were while our barn burned to the ground; the healthcare staff I encountered at every step in my journey were the exact opposite. I’m sure the doctors, nurses, orderlies, and attendants are well intentioned. Yet at every turn, there was some policy, procedure, or red tape to contend with. I was alone, away from home, on medication, and suffering from a frightening injury.

When I arrived home, the emergency room medical bill was already there, waiting for me. The priorities seem clear… I just wish my health and well-being were at the top of their list.