|Mary is at work but her arm feels heavy and she notices that the wristband on her watch is getting snug. She is taking off her watch and her friend Sally, another secretary, notices.|
Sally: Hey Mary, are you all right?
Mary: I think so. I don't know. My watch was kind of pinching me. I don't know, by wrist seems to be a little swollen.
Sally: Gee, I wonder what that could be from. Let's see, hold it out next to your other wrist.
Mary stretches out her arms to show Sally her wrists. The left wrist is swollen about _" larger than the right wrist.
Sally: Gee, did you fall on it or anything?
Mary: No. Nothing. It just started to swell and I noticed that my watch was feeling kind of tight.
Sally: Seems like if you sprained it you would have noticed that. Uhmmm (looking closely at Mary's wrists). Pull back your sleeves a bit - it looks a little like your forearm may also be swollen.
Mary pulls up her sleeves and gasps: Oh no, my arm is swollen too. Maybe I got stung or I'm allergic to something? I don't remember hurting myself at all.
Sally: I don't know. I think you should call the urban Indian clinic and see what they say you should do. That's still where you go for healthcare, isn't it?
Mary: Yeah, but the nurse is only there two days a week.
Sally: Well, maybe you'll be lucky and this is one of the days she is there.
Mary calls the clinic. The nurse is not in today. Mary asks for the nurse's phone number at the university. The clinic doesn't want to release it.
Mary says: I need to talk with the nurse and now. I need you to give me the number. If you do not feel like you can give a patient a number where the provider can be reached, then let me talk to the medical services supervisor.
Mary's call is transferred to the medical services supervisor at the urban Indian clinic. Her name is Lizzy.
Lizzy: Hello Mary, the receptionist said that you're having some problems and need to talk with the nurse?
Mary: Yes. Thanks Lizzy for helping me. My arm and wrist are both starting to swell and I need to do something to make it stop. May I have the nurse's phone number?
Lizzy: Are you allergic to bees or anything like that? Or did you fall? Do you think anything is broken? I'm just asking because we may need for you to go to the emergency room.
Mary: No. I don't recall doing anything that would hurt it. It just sort of started swelling.
Lizzy: Well, give me a few minutes to find out where the nurse is working today. You know she works at five different clinics. I'll have her call you. Are you at home or at work?
Mary: I'm at work, but I'm kind of nervous. I'm having trouble typing and my boss needs these invoices done.
Lizzy: Okay, well why don't you put some cool clothes on it while I find the nurse.
Mary: We have a heating pad here from when Sally hurt her back. Should I put that on it?
Lizzy: No, I don't think so. Usually you want to put cool compresses on something that is swelling, but don't use ice. That may be too cold and we don't know what you're dealing with yet.
Mary: How about aspirin to help with the swelling?
Lizzy: No, I'd prefer you to not take anything until you see the provider please. Let me get started on the calls.
Mary: Okay. I'll be waiting and trying to work and get as much done as I can. Mary hangs up the phone.
Sally: What did they say? What's happening?
Mary: Nothing yet. Lizzy is the director and she is really good. She's trying to find the nurse and the nurse will call me. So I guess in the meanwhile, I'll try to get as much work done as I can.
Sally: If you have to leave, I'll stay late tonight to help you finish your work.
Mary: Thank you, but don't the boys have basketball tonight?
Sally: Yes, but Ralph can take the kids and I can meet them at the gym when I get done.
Mary: Thank you a lot. Seems like you've been covering for me for a long time. I'll do the same for you, you know?
Sally: Oh yeah, I know you would. Don't worry about it. I'm just so glad to have you back at work after going through the cancer.
Mary: Yeah, me too. The providers all think I'm going to be fine. Especially since it was caught so early.
Both women go back to work. 40 minutes later the nurse calls Mary.
Doreen: Hello Mary. Lizzy called me and told me you were having some problems with your wrist and arm swelling. Tell me what's happened, okay?
Mary describes the symptoms and no falls or injuries to the Nurse.
Doreen: Uhmmm, okay, Mary I don't have your medical record here, but I had Lizzy pull it to remind me of any problems you've been having lately. You finished your cancer treatment didn't you?
Mary: Yes, I didn't have to have surgery, only chemo. But then the cancer doctor told me she wanted me to also have radiation. So I had six weeks of radiation.
Doreen: Okay, but they didn't remove the lump surgically then.
Mary: No, I didn't want them to cut me.
Doreen: When they did the radiation, was it aimed close to your underarm?
Mary: Yeah. My lump was in the on the outside near the upper part of my breast. My markings for the radiation were pretty close to my underarms.
Doreen: Okay, Mary, do you have a car and can you get to the St. Joseph's Hospital? It is on the east side of the city. Do you know where that is?
Mary: I don't have a car. I can take the bus. Do you know which bus line goes to that Hospital?
Doreen: Let me check (she leaves the phone to go ask the receptionist about the bus routes). Okay, Mary, where are you coming from or do you know which bus lines are close to your work?
Mary: Yes, bus routes 45, 33A, the 110, and the 24.
Doreen: You need to get a transfer from bus route 24 to the 32 going east. The 32 bus route will drop you off at the corner on the same block as the hospital. Can you write that down?
Mary: Yes, I've got it. That's only one bus transfer. Pretty easy. Where do I go once I get there?
Doreen: Ask the receptionist how to get to the "day appointment clinic". When you get there and give the receptionist your name. They'll be expecting you. They'll send you right in to see me, okay?
Mary: Okay, I have to let my boss know I'm leaving, and it will take about an hour for me to get there. Will you still be there?
Doreen: Yes, I won't leave until you get here.
Mary: Thank you for your help. I'd better get started. I'll see you in about an hour.
Doreen: I'll be here.