2020 week thirty four

Book / Stuff Read
26. How to Architect –Doug Patt
How the Pandemic Defeated America – Ed Yong (The Atlantic)
The Unravelling of America – Wade Davis (Rolling Stone)
The Unravelling of the Unravelling of America – Deanna Kreisel (Medium)

2020 Running to Date
1,905.5 KM

2020 Cycling to Date
1,805.6 KM

Days Without Strava Activity: 12

How to Architect is a cutesy introduction into the world of architecture presented as an A to Z guide, with short introductions into various architectural concepts such as J for Juncture and P for Proportion and culminating with Z for Zeal, the longest chapter of the book in which Patt waxes affection for Ayn Rand and The Fountainhead. The book is an easy read but nothing special, which makes me wish that A was for Ayn rather than Asymmetry so I wouldn’t have wasted my time. The Atlantic‘s long read summarizing the astonishing COVID-19 nightmare gripping the United States didn’t offer anything I hadn’t read elsewhere but it’s a very good collected how-did-we-get-here and worth the read. Wade Davis, an anthropologist at the University of British Columbia takes The Atlantic a step further lambasting America for Rolling Stone but doing so through a highly romanticized comparison to life in Vancouver. Not to have her country shaded, former UBC professor Deanna Kreisel, who recently returned her home to the United States writes a rebuttal that reads more like yet another Vancouver break up letter from yet another exiter. She’s right, of course, but the whole things comes across as a long whataboutism to Davis’ critique. That said I think they’re both worth reading, though. Follow the links above.

I normally follow my pithy reading review with a verbose look back at my week in running. I have not done any running. It has been 12 days since my bicycle crash, and I’ll be neither running nor cycling for the foreseeable future. Instead, I’m going to write about drugs. It’s not a happy story, but it has a satisfactory ending. I hope that my experience never happens to someone else, but I’m under no illusions that this story is going to inspire change. I’m sure it’s happened to a dozen other people since me. I have no way of knowing. On the afternoon of Wednesday, August 5, I was discharged from Lions Gate Hospital in North Vancouver with a single prescription for hydromorphone and instructed to continue following the pain management regiment that I’d received in the hospital. I was given some printed materials on how to put on and take off a shirt one handed and not much else. The trauma coordinator Darren Chan gave me his card with his cell phone and said to call if I needed anything. My care was being transferred to VGH Trauma Centre and I would hear from them. It was on Friday evening we did some math and realized my pain management would run out in 36 hours. I’d been provided with no mechanism to refill the prescription. First thing Saturday morning I phoned Darren and left a voicemail explaining my predicament. His voicemail message assured he would return my call. He didn’t. I didn’t wait. I call Lions Gate and ask to speak to trauma care, and explained the situation and asked for help. The person on the line said there was nothing she could do and that I should visit an Urgent Primary Care centre because no walk-in clinic would provide a prescription for hydromorphone. I asked where and she replied Esplanade and I asked if there was one closer to me in Vancouver. She made a show of being rather put out to have to Google the Hornby Street location for me. The centre opened at 8 a.m. so I gave them a call to see if a long wait could be avoided or, fingers crossed, taken care of over the phone. The automated message said they would neither provide medical advice nor wait times over the phone. At the same time Stephanie had been seeking advice and one suggestion was to call the pharmacy that had filled the prescription—sometimes they’re able to call the doctor for a refill. I was worth a try. Hydromorphone is a narcotic that requires a special prescription written in a special prescription book. The pharmacist was sympathetic, but there was nothing she could do. She suggested I speak with someone over the phone at Urgent Primary Care, so I called them again and held for reception. When I told her my situation she abruptly told me that they don’t dispense drugs and to go to a walk-in clinic. By now Stephanie has spoken with another friend who works in health care who said to just go the Urgent Care and that they tell everyone the no-narcotic message but if I could get in to speak to a doctor about my pain management they would be able to help. We didn’t have any other option. Stephanie drove me down and I took a number and waited my turn.

After a couple hours wait I got to see a doctor, who then proceeded to tell me that the pain management instructions I’d been following were “a lot” and anyway he didn’t have the required special prescription pad. I said that surely he could get one, or at least one page from one. I asked if there was a walk in clinic nearby that the doctor on duty might have one, and he replied that no walk in clinic would prescribe me hydromorphone. I replied that the Urgent Care receptionist told me to go to a walk in clinic, why would they tell me that? He had no answer, but suggested he could ask the other doctor on duty if they had the correct pad. After a few minutes he returned. There was no pad, but he could prescribe Tylenol 3. I replied that my injuries had happened just a few days ago and I really didn’t think it was wise to change up the pain management that I’d been instructed to follow. I asked if there was someone at St. Paul’s Hospital nearby that he could call. He was apprehensive, but finally acquiesced; he would make a phone call and see. He returned a few minutes later, asking, “Hey, are you that cyclist in the news?” He gave me a letter to give to the Emergency doctor on duty at St. Paul’s but made no promises they would be willing or able to help me either. We walked up to St. Paul’s and checked into Emergency. Stephanie couldn’t stay with me because of COVID-19 restrictions, but the intake staff at St. Paul’s were exceptionally helpful and kind. I was fast tracked through Emergency and met with the doctor, letter in hand. I could tell he too was hesitant to write a hydromorphone prescription, but ultimately did. I thanked him profusely and set off for the pharmacy. On a day I should have never left the sofa, I left the house in search of health care support at just after 8 a.m. and didn’t get home until nearly 5 p.m. Back in late July, before my life was changed by a negligent driver, Premier John Horgan suggested in a press conference that the opioid crisis starts with a choice. He’s since tried to walk that statement back, as have Minister of Health Adrian Dix and the province’s top doctor Bonnie Henry. I remember being so disappointed when I heard him say it. My experience navigating the health care for pain management certainly gives me another perspective. What if I hadn’t been able to convince the doctor at Urgent Care to phone St. Paul’s? I was out of options. I’m in terrible pain, and the pain management that I’m on only manages it. It is bearable, and I have a very high pain threshold. What would I have done if I wasn’t able to get a prescription? If this was my experience, what is the experience of others? I cannot be unique. On Monday, August 10, over 48 hours after I left a message with Trauma Coordinator Darren Chan, he returned my call. I was furious. “I don’t check my phone 24 hours a day,” he replied. I reminded him that he gave me his card and said to phone if I needed anything, that I was given no other contact person for assistance. “Why would discharge me from trauma care, and give me a number – the only number I was given – that isn’t even monitored?” He replied, “I’m sorry you feel that way.”

I received excellent care throughout my stay at Lions Gate Hospital. The doctors and nurses were exceptional and professional. There is a huge problem with the way in which I was discharged. I am fortunate that I was able to solve the issues I faced, but I shouldn’t have had to, and no one else should have to either.

– If you’re wondering what the heck is going on, I wrote about it all here: https://readrunwrite.com/2020-week-thirty-two/
– Thanks again for all the well wishes from everyone. I have a very long road ahead of me and your kind words of support really do help.
– My bike is home! It looks in okay shape but I won’t be riding anytime soon, and not before it gets a full safety check at the shop. I’m on the waitlist. Thanks for all the offers to help.
– Some of you have asked about a GoFundMe page; a friend has created one. It feels weird because I think there are much more worthy causes, but if you are so inclined: https://www.gofundme.com/f/todd-nickel-recovery-fund I am overwhelmed by the response so far. Thank you.

3 thoughts on “2020 week thirty four”

  1. Outpatient management needs improvement. How hard would it be to develop a one page “Next Step” strategic trauma care recovery plan and provide it- before discharge- so that a person has a chance to read and discuss the plan and address any concerns before leaving the hospital. The plan should let people know that different hospitals specialize in different fields of care. For example, VGH internal medicine, St. Pauls, Mental Health, Squamish, Trauma. The plan should also spell out where to go for refills and what to expect and also provide health care options like Physio and Massage Therapy to guide a person towards a recovery plan as many people who leave hospital care are left to fend for themselves and figure it out on their own.

  2. Hi Todd. Good to hear you are on the road to recovery and facing down some of the challenges that involves. I wanted to check in and see whether you’d ever be interested in an interview about what it’s like recovering from a bike collision like the one you went through. I’d reached out on your Facebook post the day of the accident but I imagine it was lost in the many well wishes being sent along. Please reach out if that’s something you’re interested in, but if not, that’s fine too and I wish you a smooth and full recovery.

    1. Hi Stephanie, I would be interested in having a conversation with you regarding Mr. Chan’s reaction to this post if you were to have a conversation with him. In particular, I would like to comment on his explanation for why the only support offered to a trauma out-patient is an unmonitored cell phone number. Here is his card:

      Darren Chan LGH

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