rianjs.net

This is one of those stories I really don't feel like telling, but ultimately it will be easier for me to simply write once and point people here rather than re-tell the story 100 times. I haven't edited it for grammar or smoothness. As such it probably won't read that well. But I don't care.

Anyway, some of you know I'm on vacation in California visiting my friend David. Got here Wednesday night, and I'm here until Tuesday (tomorrow). On Friday, we were supposed to go up to Big Bear Lake, and we did. We were planning on going fishing and maybe playing some tennis and relaxing. Unfortunately, I started getting sick on Thursday night. Bloating and waves of pain about once every 3-4 minutes. It felt a bit like lactose intolerance, but taking lactase enzyme didn't help, so it obviously wasn't that.

I didn't want to go to the hospital because I knew what they'd do to figure out what was wrong: more barium and a CT scan. I HATE barium. I'd almost rather die than drink barium. More on that later.

Things got worse as we drove up to the mountains. We didn't think of it then, but it probably had a lot to do with the lower air pressure as we went up. (Big Bear is around 6500 feet up.) Anyway, I had to go to the ER pretty much as soon as we got there.

The hospital was pretty small which was both good and bad. I got brought in to the ER almost immediately, and it's bad because it's just a little out-of-the-way hospital. It wasn't comforting to overhear one of the nurses ask the ER doctor — yes, there was only one — how often something could be given only to hear him get the drug classification wrong.*

So the ER tech took my information, and they started giving me IV fluids to rehydrate me. They had taken an urine sample, and said I was dehydrated. It was dark, but not as dark as it had been the first time I was in the hospital. (See my Crohn's disease category for more.) I had played tennis in the morning and not urinated since. The doctor — who got the drug question wrong — came in, talked to me, and informed me that he thought I had acute appendicitis. I disagreed.

(As a side note: I bled all over myself when the nurse ran the catheter. This has never happened before. Then again I've never had anyone but an IV nurse run catheter, so that could be why. Seriously, it was a mess.)

His examination consisted of putting his fingers on my belly button, my hip bone, and telling me my appendix was there, and touching it. Since the discomfort was actually in my stomach, and about once an hour I burped which gave me some relief, I was inclined to disagree. I am familiar with the concept of referred pain, but I knew I wasn't experiencing it. The fact that my stomach was bloated was also a giveaway.

Mr MD informed me that their surgeon wasn't on that night, so they'd have to transfer me. (Somewhere during this time, they took some X-rays as well.) I wasn't happy about being transferred, but I also wasn't happy staying where I was, knowing I wasn't getting the best care.

They wanted to send me to Loma Linda Medical Center which is a pretty good hospital. Unfortunately, they didn't have the space for me, so they ended up sending me to Redlands — a place I know nothing about, but which would almost certainly be better than where I was.

The people at the Big Bear hospital were certain that I was pre-op, so that meant no drugs. Talk about suck. I really wanted fentanyl, knowing it has a fairly short half-life, but I didn't say anything. The nurse came up with the idea herself, and the doctor agreed, so they gave me 100mcg along with some IV Rocephin (ceftriaxone). I was pretty loopy for about ten minutes, and forgot I was in pain. (The nurse actually asked me if I was still in pain and I had to think about it before I could respond. Oh, the wonders of opiates…)

So I took my first trip in an ambulance. (Had it been the winter, I probably would have been flown by helicopter, which would have been super cool.)

An hour or so "down the hill" to Redlands. Somewhere about halfway through the trip down the hill in between my ears popping, my stomach stopped hurting.

Arrived there. They wouldn't let me off the ambulance gurney. I felt terribly foolish, knowing I could walk and such. Anyway, they hooked me up to a bunch of machines. (Pic!) I felt like I was in the ICU. It was f'n aggravating — all I wanted to do was sleep.

The Redlands ER was pretty crowded. People out in hallways and such. I think maybe because it was a Friday night. I had a room, though. Naturally, they pinched and poked me and such, and I think maybe they gave me some more IV fluids. I really can't remember, I was so tired. I remember David and I sitting there making terribly stupid jokes looking like zombies.

Anyway, it was on the ambulance ride over (no sirens or lights) that my bag of crap got lost. They made me change into a hospital gown, and they had put my stuff in a bag. The bag stayed on the ambulance, along with my wallet and cell phone. I was a little annoyed because I had been texting a few people. All of my family is in the Northeast, and I'm in California.

Another brief side note… shortly after I got to the hospital at Big Bear, I very keenly felt homesick. I honestly don't mind getting sick at home — though it rarely happens — because I'm 40 minutes from one of the medical Meccas of the world. That 40 minute drive becomes a five minute walk from Beth Israel, Brigham and Women's, and Children's Hospital — all of which are Harvard Med teaching hospitals — when I'm at MCP. Not to mention my parents are within an hour's drive, and most of my friends live in Boston. I was very glad David stayed the whole time. I tend to be pretty good humored even under the worst of circumstances, but having family around can help. I missed Kim, too. She's family even though she doesn't know it. I'm happy to say that I was pretty positive up until probably 4am when I just wanted to sleep and they wanted to poke me and such. FFS, I wasn't going to die or anything…

They took some blood — about five vials worth if memory serves. I wanted to strangle the guy. From my other arm.

Anyway, the doc came and talked to me. Nice guy, a lot more knowledgeable and (more importantly) willing to listen. We talked about some things, and right off the bat, he told me that he didn't think it was acute appendicitis, which I already knew. It was nice to have confirmation, though. So no surgery.

Which meant the barium swallow, as I had predicted. 900mL. Woohoo! I told the nurse/orderly/whatever I'd need an anti-emetic otherwise I'd be throwing up on the floor. She kinda snarkily asked me if I had a preference. "Promethazine, ondansetron, whatever. I don't care, but I need something." She kinda looked at me a little funny and made a comment about pharmacy students. She ended up giving me some promethazine, which almost immediately made me sleepy. I told David he might have to wake me up to get me to get everything down in time. He did.

Anyway, they had me hooked up to the machines and whatnot, which set off alarms if various vital signs don't stay within certain parameters. I set off the heart rate one. The orderly came over and examined it and told me my heart rate was up. I told her it was because I hated barium. She told me it wasn't stress related because my blood pressure was normal. I got a little annoyed at her and demonstrated that the alarms went off as soon as I took a swallow.

Some people hate tapioca. Some people hate broccoli. Some people hate chocolate. Well I hate barium. I don't care how "good" it tastes — David thought it tasted good, he's obviously crazy — I do not like it and I never will like it. It takes superhuman effort to suppress my gag reflex. In that respect, it's not unlike tapioca. She left, still convinced that my heart rate was up due to some other cause. Which, of course, it wasn't. As soon as I got it all down, I was fine.

So then came the CT scan some time later. Boring, whatever. The technician was hot, though. We started talking about auto-immune diseases. She asked me if I was taking Prednisone, and I told her "OMG no." or something to that effect. Thanks to Mr. Promethazine, I was pretty out of it and I rambled about how it was better to take monoclonals rather than steroids. (She had arthritis, and was probably 25, a friend of hers had Crohn's disease, so it was a natural topic of conversation.)

She needed to adjust my IV so she could inject iodine, which is a rather warming experience. It was actually kinda neat. Had I not been completely out of it, it probably would have been more fun.

Back to my ER room. Results of the CT scan make it seem as though everything's fine. Which it mostly was, since I wasn't in pain any longer. Probably a bowel obstruction caused by something unknown which later cleared itself up. The Rocephin may have helped, I think. The inflammation in my terminal ileum consistent with Crohn's was still mostly there. I don't know if the thickening was better or worse since I don't know how bad it was in the first place. (I'm curious to see how well the Pentasa performs in a objective sense.)

Some time later they adjusted my IV, redoing the padding and sticky thing holding it in place. Thanks to that, the inside of my right elbow is fairly bruised and is still sensitive, two days later. I also have pinpricks on both sides. It makes me look like a heroin addict. But I'm out, thankfully, my torso mostly intact, and I still have my appendix.

I think I would rather have had all this happen while at home. This whole skipping fishing and a beautiful mountain lake to spend my time in the ER is for the birds.

* The question was how often simethicone could be given. The doc responded "Oh, that's the same thing as cimetidine, isn't it?" — which is certainly is not. Cimetidine (Tagamet) is an H2 blocker; simethicone is anti-gas medication used to emulsify large gas bubbles into smaller ones by changing their surface tension for easier digestion. H2 inhibitors block the release of Histamine-2, thereby blocking the release of acid into the stomach. Ultimately it didn't really matter — cimetidine is usually given 2-4 times a day, and simethicone about 4 times a day. Nonetheless, it wasn't comforting.

Trackback This Post | Subscribe to the comments through RSS Feed