A Sunday at Rambam

On Shabbat, David was really feeling quite awful. He ached all over and had hardly any energy. Also, his blood sugars were running unusually high. At some point, he remembered that he had a card in his wallet that comes in every package of one of his HIV medicines, Kivexa. When we took it out, it seemed possible that his symptoms could be related to this drug. So, on Sunday morning he called Dr. Shachar, his HIV doctor at Rambam Medical Center, in Haifa. Then we drove down there to get the problem checked out.

Dr. Shachar took blood for a number of tests. David's veins are always difficult to find and get into, and, before they could complete getting all the blood they needed, David got nauseated and vomited all over. It was quite a surprise to all of us, including David!

Anyway, they sent some of the samples for immediate analysis to the lab, and the results that came back (we waited in the doctor's office) showed that he had lactic acidosis. His blood pH was lower than the normal range, and the amount of lactate in the blood was above the normal range. So, Dr. Shachar decided to send David to the ER (in Hebrew it's חדר מיון which means literally "sorting room") so that these levels could be tested a little later.

Because of some construction that is going on at Rambam, the ER (or at least the part of it, internal medicine, that he was sent to) is in the basement and the room was really crowded. They managed to find a place for his bed near an emergency exit (well, at least that's what the sign said, but that didn't keep all manner of traffic from going in and out that way while he was there!). During the course of the afternoon and evening, they often had beds in the aisle between where they were supposed to be, and, even along the walls, the beds were packed in more than they were designed to be.

The staff there were really good, though. His main nurse, who, I'm pretty sure was native Israeli, asked him right off about what language he preferred to speak in (English, in case you were wondering!) and then proceeded to talk with us fluently. She could even joke with us in English! And she was a good nurse, too. She managed to get a good IV in so that they could take any blood samples that they needed and so that they could get a liter of IV fluid into him.

Early in our stay there (which lasted from sometime in the mid-afternoon until after 10:30 at night!), there was some kind of confrontation with the husband of a woman patient. They made him leave the room, but he began to argue and started to fight with the Ethiopian security man. The security guy was obviously well-trained and was able to control him quite well until reinforcements (at least 3 more security guys) could get there. But the man was still yelling in the hall right outside, and, before long, his wife (the patient) was also hysterical! Anyway, the whole situation eventually calmed down, and the man stayed there peacefully with his wife until she was released, a little while before we left.

As is true in most places, I think, the ER has an interesting cross-section of the local population. And here in Israel, especially in Haifa, it can be quite interesting, indeed! The 2nd most common language heard was certainly Russian (unless it was actually FIRST, before Hebrew!). I certainly heard quite a bit of Arabic as well, though, including doctors and nurses. Although most doctors here seem to be pretty good in English, the one assigned to David didn't speak much English at all. I was able to communicate well enough with her in Hebrew, though, and she was definitely a good doctor.

Eventually, David was sent for the obligatory visit to צילום (imaging). It must be some kind of a policy, because ALL ER patients are sent at one point or another to x-ray or ultrasound. In this case, we went to both, first to אולטרהסאונד ultrasound and then to צילום רנטגן x-ray. When we got back to the ER, his original place, of course, was taken, and his bed had to be one of the ones in the aisle for some time, until a place opened up. Even then, his bed was right against that of an older man, who was mostly sleeping.

Across the aisle from us, a bit of drama unfolded. A seriously overweight young man (maybe 30-something) was wheeled in. He seemed to be in quite a bit of pain, but the source didn't seem too clear. What WAS clear was that the pain increased significantly whenever a nurse or doctor was around. On the other hand, when it was just his family, he could even laugh and joke (in Arabic). I think, though, that he got the medicine that he wanted, and then they sent him on his way.

Next to us (on the opposite side from the afore-mentioned older man), there was an older Arabic woman (with her head covered except for her face) who had a serious problem with swelling in her ankles. Her son, who was probably 40-something, hung around most of the time, too. When they left, a little before we did, they both wished שנה טובה (a good year) and חג שמח (happy holiday) to the staff and to us, in Hebrew, of course. This is a little like Jews wishing people "Merry Christmas" in December in the States. :-)

So, yes, David WAS released from the ER, since the acidity of his blood had reversed and was even little ABOVE the normal range. His lactate level was still a little high, though.

When we got home, he took the problematic medicine (which he had skipped Saturday night), and, sure enough, today he felt achy and very tired, almost like on Shabbat. I called Dr. Shachar again, and they will now have to find a different medicine to replace this one, which, as I have now read, is known to cause lactic acidosis in some patients.