Tag: Ottawa hospitals

The Nuclear Stress Test of the Heart

December 18, 2022

I drove over to the east end of Ottawa to the Cardiovascular Center in a strip mall. It was a bad move on my part to hit the road in rush hour, especially with all the construction going on. It was difficult sometimes to find the lanes toward my destination with all the traffic cones, although this was my second trip there. The first time they injected some dye into the blood flow to track the circulation. This time, they would track the circulation after stressing my heart out.

The Cardiovascular Center is in one of the most inauspicious strip malls. And within the mall, the center is between an optician and a pharmacy. The other small stores in the mall range from dog obedience school and physiotherapy to a Middle Eastern restaurant with Arabic writing on the storefront.

Driving to the Cardiovascular Center made me relax; I usually get nervous going to medical buildings. This place in the middle of a nondescript shopping mall is certainly not like going to a hospital and seeing uniformed nurses and doctors rushing around the hallways with official tags around their necks.

I checked in with the receptionist sitting behind a plastic window and sat down in the waiting room on a seat away from the sun that was shining through the floor-to-ceiling windows, making the room feel like a hot greenhouse.

The people in the room were all older, like me, some required canes for walking. One couple was talking loudly, otherwise, the room was quiet and I read my cell phone to pass the time.

It did not take long for a nurse to call me into a room furnished with a hospital bed, monitoring equipment, and a treadmill. Aha, I thought I will use the latter for the stress test.

Then the nurse asked me to take off my clothes from the waist up and lie down on the hospital bed. She put a blood pressure monitor on my arm while talking to me, then put electrodes on my chest. The last connection was an IV needle.

Finding a good vein to insert an IV is always a challenge for nurses. Although I drank a lot of water that morning to help show veins, and she said that she saw the veins, she could not find one large enough for the needle around my elbow. After poking me twice by my elbow, she put a smaller IV needle into the top of my hand.

In the meantime, we had a great chat about Ottawa that relaxed me and brought down my blood pressure, which is always high when I visit a medical facility, even if it is in a strip mall.

She started my IV drip with saline solution to help the veins; she explained it is used to deliver medications. After the saline solution, some nuclear material dripped into my veins to stimulate the heart. All this time she kept asking whether I felt nauseous, had a headache, was dizzy, or was just lousy. I did not have any of those symptoms but was getting anxious, as I started imagining that perhaps I should have those symptoms if the test were working. But she repeated the same questions in a few minutes, and I assured her again that I was fine and told her if she did not badger me, I could fall asleep on the comfortable bed. The lack of any sickness on my part was a good sign, she said, and that made me feel good.

The nurse also explained that if I felt sick because of the nuclear material, she would give me an “antidote” via the IV. Since I was not feeling bad, I am not sure if she gave me any antidote.

The bottom of my arm, which had the IV in it, was getting painful with pressure building up in it, and told her so. She explained that it is the rush of the liquids coming from the IV needle and because the veins are small in the lower arm, the flow of the liquid puts pressure on the walls of the veins.

The only other impact beyond the pressure in my arm was my pulse rate exploding from its normally low rate in the fifties. Perhaps it was the anxiety of doing the test. While the IV drip was going on, the nurse was in front of a monitor watching my performance.

After a while, she said that it is time to inject some dye into my veins for the “gamma” camera to track the movement of blood in my veins, especially around my heart. I said that was fine with me; she could have put any liquid, even alcohol, into my IV.

When we finished with all the cocktails entering my veins, she told me to go outside into a small waiting room and eat the snacks that they had directed me to bring. But I asked her, “When are we going to do the stressing”? and pointed to the treadmill. She replied that the stressing was already done and explained that the nuclear material injected into me made the heart race and mimic the action of the heart when one is exercising. Ah! So that was it. I did not feel like I exercised at all – I did not sweat – and felt gypped not having the chance to jog on the treadmill for a little exercise, but glad the first phase of the testing was over.

So, I went into a small waiting room and snacked. I was hungry by this time; as I had been told to fast for four hours before the test.

After a half hour in the waiting room, they took me into another room with a dentist-type chair. On the left side of the chair, there was the gamma camera, a huge L-shaped machine that covered my chest, and the left side. She moved the camera over my chest and told me to sit on the left side of the chair so that the other side of the L was next to my left side, where the heart is. The camera buzzed for four minutes and then after a break, we did it over again, for four minutes. Then I was done.

I felt quite relaxed coming out of the Cardiovascular Center. It was not only because the staff were pleasant but also because of the venue. We were in a strip mall, and I thought this visit was more like going for coffee at Starbucks than getting a medical exam. Maybe we should have all medical clinics in shopping centers instead of medical buildings. Now I just must wait for the results, which may come in a few weeks.

Morning Musings

September 18, 2022

You have seen the news on TV and in the papers that our hospitals are short of beds. Patients are in the hallways waiting for an empty bed. Hospital administrators express the shortage of beds statistically: the hospital is 110 percent occupied.

The government is aware of this, but hospitals are expensive to build and take years to construct. So, the shortage is not likely to be alleviated soon.

Part of the problem is patients who need an “alternative level of care” or ALC and not acute care provided in a hospital. These patients are ready to leave the hospital but need a level of care that may not be available in their homes or have family willing and able to care for them. They need to move on to long-term care facilities but may be choosy and not willing to take the next available vacancy wherever they may be.

To satisfy the need for beds, hospitals rent entire floors of hotels to place the ALC patients today at an enormous cost to the public but not to the ALC patients, who get a pleasant room and food at modern hotels. No wonder they do not want to leave.

In trying to solve this problem, the government decided to act: next week ALC patients will move to any available long-term care home vacancy within 70 kilometers or pay $400 a day if decide to stay in the hospital or hotel. A drastic but possibly necessary measure to ease the problem of overcapacity hospital use

I got thinking about who will select the ALC patients to move; who will make the arrangements for the move and what kind of negotiations will take place between the patient and the hospital administrators.

The doctors already have signed the patient into the ALC category. There may be dozens of these patients in the hotels and some still in the hospital occupying beds needed for acute patients. The hospital administration will have to establish a group of people tasked with moving these patients into long-term care homes.

I can see a hospital administrator assigned to a patient searching for vacancies in long-term care homes, not more than seventy kilometers from …is it from the hospital or the address of the patient? Then, he will have to negotiate with the patient over the available choices.

The clock is ticking for the patient at $400 a day. A decision would have to be made soon to avoid an expensive hospital stay. And what if the patient refuses to leave? And may not have the resources to pay for an additional stay at the hospital. Surely these patients will not land on the streets as homeless people?

The family of the ALC patient may get involved; they would like to visit their loved one and would prefer a long-term care home near them. Not only that, but some of these homes have acquired a terrible reputation in the past years because their staff and the ALC patient may refuse to move there.

I see a messy process and a difficult one: how to move ALC patients out of hotels and hospitals peacefully. Arguments with family and the patient may erupt and lawsuits started. And I see a huge amount of additional work for hospitals. Only time will tell how successful the program will be.