I am probably the least likely person to have sleep apnea, but I do. Weight is not the issue. I’m a thin guy. If you look at my posterior pharynx with a video laryngoscope, however, you will find that my uvula rests flat against the pharyngeal wall. And that’s when I’m upright. If I’m supine and sleeping, bad things happen.

My sleep apnea is mild, and for the most part I could compensate by sleeping more. My symptoms worsened this year, so I decided to do something about it.

After having a repeat sleep study, I made a trip to the ENT. His solution was to hack out (he didn’t really say HACK) my soft palate and tonsils (UPPP). Initially I thought I might proceed, but after doing some research and thinking about 2 weeks of the worst sore throat of my life, I reconsidered. I also like having a uvula. It’s sort of like a belly button. No purpose, but nice to have.

I did some asking around about other alternatives to CPAP. (If I can avoid it, I really don’t want CPAP.) I keep thinking of Darth Vader. “Luke, I am your father.”

I learned about a program at the University of Michigan where one can be evaluated for alternative treatments. U of M is only 50 minutes from where I live, so I figured there was no harm in talking to them.

Now, this is the part of the story that pains me. I went to Ohio State for college and for residency, so I can call myself a bona fide Buckeye. The rivalry between OSU and U of M is so strong that former OSU football coach Woody Hayes would not allow the bus driver to stop to get fuel until they crossed the state line back into Ohio. Directions to Ann Arbor are commonly given as: “north until you smell it, west until you step in it.” And scheduling a wedding on the weekend of the OSU vs. Michigan game is considered to be in very poor taste. You’d be lucky to get the groom to show up. In spite of my allegiance to OSU, I must say that my experience at U of M was first-class.

They were courteous, competent, and helpful from start to finish. I was most impressed by what amounted to having a concierge with me. As soon as I finished in one place, he appeared out of nowhere to take me to the next appointment. He guided me through the maze of clinics and made sure that there was no confusion about my next step in the process. In exactly 4 hours, I had x-rays, video nasopharyngoscopy (that was really cool), and visited four specialists from different disciplines.

I will probably end up using a dental appliance and a device to wear to keep me from rolling onto my back (positional therapy). The two surgical alternatives seemed excessive for my situation. I guess I’m stuck with the mask if the appliance fails.

On my drive home, I thought about my experience and how it compares to the emergency care we provide every day. For many patients, we orchestrate the acute evaluation and management of problems much more complex than sleep apnea. Trauma patients may see specialists from five or six different services and have multiple studies done in a short time. In some institutions, patients with a TIA can get a full stroke work-up including CT, MRI, carotid Doppler, echocardiogram, EKG, and blood work in an afternoon. This is great stuff, but we don’t really get credit for putting it all together so well. Patients who receive this consolidated coordination of care often lament having to “kill 5 hours” in the ED. They have no clue about how much time it would take to get all this testing done if ordered from their family doctor.

So what does this program at U of M have that we don’t have? One is a special name. The other is someone who will continually tell the patient what they are doing next and how they will get there and back.

I think that a subset of patients who require a prolonged and coordinated work-up should be immediately moved to another section of the ED. Some EDs do this in their observation area. What’s missing is a name that conveys the important work to be done there. Something like “Coordinated Evaluation Center” would work, although it’s not very snappy. Then people would know they are not in the ED anymore. They are in a special place with people who devote their day to the coordination of complex care and the frequent and effective communication to patients and families.

What we do is just as special as the program at U of M. We just need to be better about communicating what we do. I’m sure many of you are thinking that in that process it would be great to have more space to do this. I hear ya, brother (and sister). One step at a time.

Be happy.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo (Ohio) Medical Center. Your feedback is welcome at David.Baehren@utoledo.edu.