Sunday, March 14, 2010

Do you really want to know what happened?

I have recently been informed that I am not allowed to be in the hospital again for another three years.

This may have something to do with the fact that I have been in the hospital three times in the last year, and only one of those was actually planned.

First was a surgery in March of last year--the planned visit--to have eight fibroid tumors removed from my uterus. I was in for two and a half days. Then there was the accident last July. I racked up another week with that one.

Then there was this visit.

After listening to my parents happily wax eloquent about their time in Florida for three weeks (thanks, Dad, for all those texts with the local temps and the picture of sunset over the Gulf of Mexico), I celebrated their return by waking up with a severe case of the intestinal flu on the last Friday in February. We're talking multiple exits here, people.

It was the only time this year I was glad that school was canceled (this time, for high winds).

Let me tell you, there is something humbling about realizing you're not going to make it to the bathroom and have some privacy before your stomach goes into launch mode again, and you instead offer up your sacrifices to the wastebasket in front of you...with three little girls all watching you and saying, "Awre yew sick, Auntie J?"

Oh, yes. I'm sick, honey. My fillings hurt.

Hubby HAD to go into the office. We both knew it. However, we didn't realize that I was going to get physically ill every time I got up when he left for the office, so I ended up calling S. I begged for help. I could barely hold myself up. I still had to pack for the kids to go to Mom & Dad's, who were rearranging their day to come pick everybody up earlier. Thankfully, she was able to come help. Once Mom & Dad got the kids loaded up, and S and her son left, I retreated to bed, where I stayed the rest of the day, inbetween unsteady trips down the hall to the bathroom, with Mika following me around and Koa thinking it was a grand idea to knead on my stomach.

Self, I said about 3:30 in the afternoon after realizing I couldn't even keep down water, you are going to ACHE tomorrow.

Fever? Check. Chills? Check. Walls that seemed to occasionally swoon? Check. Cats who are uncompassionate? Quintuple check. (Mika was very worried about me.) Hubby called mid-afternoon to say he wasn't sure when he'd be home. I told him I didn't care. I was in and out of it.

Saturday rolled around. I ached from head to foot. My fever was now in the triple digits. I couldn't move without groaning. Mom and Dad offered to keep the kids until Sunday so that I could rest up from what we all hoped was a 24-hour flu, and so that they wouldn't get it. Mom and Dad were planning to come to church with us anyway, since it was our last Sunday at the church where Hubby worked. Large Fry got sick during the night, so ultimately the only one who went to church that day was Hubby.

Sunday...temp still in the tropics. I was starting to feel better and could eat again, but I was getting really tired of Cheerios. Monday? Same thing. Plus payroll week. Yay. Oh, and listen to that! Someone filled my head with Rice Krispies, because my ears are going snap, crackle and pop and starting to hurt. And I had an intercostal muscle yipping at me at about the 10th rib on the right. Great. In the course of my Olympic Flu events on Friday, I'd pulled a muscle.

I was still running a fever Tuesday morning, so Hubby hauled me and the twins out to the walk-in clinic after Large Fry went to school. The PA-C says it's my sinuses again. Z-pack, she says. I should've protested, because my sinuses and Z-packs are a pointless marriage. But I didn't feel all that bad as far as sinuses went. Just a lot of drainage and ouchy ears. I figured this would knock it down. However, that intercostal muscle was now barking at me, and it made it hard to breathe deeply. It felt just like the intercostal muscle pain I had after the accident when I threw my back out so spectacularly, so I didn't question it.

Once Large Fry got home from school, and I'd gotten as much done on payroll as I could, all of us girls go take naps. Hubby went out to get himself a new cell phone. He's still gone when we all wake up, and I was now in serious pain. It had spread to my shoulder and settled nicely in my middle back, all on the right side. I called several chiropractors before realizing that I was not going to find one who takes my insurance. But I do find one who will only charge $40 for an adjustment. I made the appointment.

On Wednesday, Hubby, the twins and I drove the six minutes to the chiropractor's office. The pain in my back and shoulder was bad enough that I couldn't drive. Which hurts worst, shoulder or back? Wellll...since I have to shoulder. It's more constant. I got some relief from the shoulder pain, was instructed to make some dietary changes to help avoid increasing the inflammation, ice the affected areas 20 min. on/40 min. off, and I made an appointment for the afternoon of the next day.

By Thursday, March 4, my back was screaming at me. I had no appetite. The intercostal muscle that was barking at me before wasn't hurting so much anymore; the pain had shifted from the front of my ribcage to my middle back. My shoulder felt great, though. I didn't bother to get dressed until I had to go to the chiropractor's office; putting on clothes was sheer torture. I could hardly breathe from the pain. Since I still couldn't drive, S came over to bail us out again. She watched the kids while Hubby took me up to see the chiropractor.

We're in the parking lot when Hubby asked what level my pain was at, 1-10. I'd said I was in a lot of pain. But I hate that scale, because I hate trying to quantify pain with a number. I sighed (as best as I could; I was in so much pain that I was breathing very shallowly) and tell him my pain number is a 9. Now he's mad, and says we are not leaving that day without some kind of prescription for the pain. I pointed out that the chiro is not a medical doctor and can't prescribe. But one thing was abundantly clear: we HAD to do something about my pain level.

Chiro took x-rays. Nothing wrong with my spine that's caused the increased pain. He can hardly touch my back; even a pound of pressure had me nearly in agony. He said he would fax a report to my regular doctor, and recommended going immediately up to my doc's office to have them write me scripts for pain meds, anti-inflammatories, and a muscle relaxant.

Soooo....we go pick up the kids, and we all trekked out to S-burg. My doctor's office was closed for the day, but the walk-in clinic was open. And, as luck would have it, it's my primary care doc who's on duty in the clinic.

The nurse brought me back. I explained the strange series of events that have brought me this far. She took my vitals; I'm running a fever of over 100. Um...well. Guess that my fever didn't break after all. She asked if I'd done a urine sample yet, in case it's kidney pain. Um, no, because the pain is up too high to be kidneys. Thanks.

My doc came in. I repeated my recounting of events again. (It was not be the last time I told the story for the day, either.) She listened to everything, then whipped out her stethoscope. Heart first, then lungs. "Breathe deep," she told me. And she listened there for a LONG time. I was crying in pain by the time she was done, because inhaling hurt so badly.

In a voice I've never heard her use in the three years I've been seeing her, she says, "I'll be right back." I wiped my eyes and sniffled, realizing this was bad, and half-wished that I hadn't left Hubby and the girls in the waiting room. She came back in with a pulse ox monitor. She clipped it on my finger, and announced, "87 percent. You are VERY sick. You need to be in the hospital."

Wait, what?

"You've got pneumonia."

"Can pneumonia cause the kind of back pain I've been having?" In a word, yes.

"You need to go to the ER right now. In fact," she says, "I think we need to call the ambulance for you."

She disappeared out into the hallway, and a few minutes later, I heard Medium Fry chattering out in the hall, followed by Hubby's voice. Dr. B came back in and led me to another room, where Hubby and the girls are. The nurse came in and put a nasal cannula on and cranked me up to 2 liters of oxygen. I felt a little better as the oxygen started to flow, but breathing is still very difficult. I'm so short of breath.

Dr. B explained the goings-on to Hubby. Shortly, we heard sirens heralding the arrival of the ambulance. The team came in and promptly fascinated the girls. The EMT listened to my lungs, too, as Dr. B explained what the problem is. EMT didn't hear the crackling and other nastiness that Dr. B did. (We both thought her stethoscope was wonky; I could hear me wheezing at the top of my chest without a stethoscope.) The team was really good with the girls, letting them look at stethoscopes and listen and watching them load me on the stretcher. Hubby and the girls followed us out as far as the lobby, where they stood at the big windows and watched me get loaded up. Medium Fry and Large Fry were cheerfully waving goodbye. As soon as Small Fry realized that I was leaving in the "big truck" and she's not going with me, she started crying. My heart just broke.

I asked them where they're taking me. C-burg or C-isle, they say. Whichever I prefer. C-burg, I tell them. I was given a breathing treatment on the way in, while the EMT and her partner peppered me with questions. Some about the kids, some about my condition. Hard to answer questions when you're supposed to be nebulizing an albuterol treatment.

We arrived at the hospital and I wondered how many of my nurse friends are working...three of them work in the ER, plus a friend who's a tech. They shuttled me to a bed and two nurses helped me out of my clothes and into one of those fashionable hospital gowns.

One of my ER nurse friends, Shar, walked by in the hall, and did a comical double-take when she saw me. "What are you doing here?" she asked, incredulous. "Being very sick," I coughed out.

It didn't take long for the ER doc to show up. He listened to me recount (again) the tale of the past week, listened to my lungs, and said, "Sure sounds like pneumonia to me."

Well, goody.

In short order, I was wheeled off to x-ray to have chest pictures taken. "Take a deep breath and hold it," the tech instructed. Riiiiiiiiiiiiiiiiiiight.

I went back to my little section of ER (number 18, if you were wondering). A few minutes later, in walked Jo (the aforementioned tech) and another nurse. They're here to play vampire. Jo drew blood from my left hand, since I've already got an IV in my arm near my elbow. She explained she's training the nurse with her on how to draw blood. Jo's draw went into a bottle filled with a solution. The other nurse jabbed my antecubital vein in my right arm. More blood! Two more bottles with solutions, and then half a dozen vials. Geez. But I knew they had to figure out exactly what I had. As Jo was supervising the other nurse's blood draw, she said to me, "So you weren't kidding about having a tropical fever on all those Facebook posts." I managed a weak chuckle.

Hubby arrived in the middle of all this fun. I didn't think he was coming; T and S had had plans for the evening, which was why we'd picked up the kids before the run to S-burg. He said he'd called them and asked S to come watch the kids so he could be with me. I felt bad that they'd had to leave their pool game to do that. (S told me on Saturday that they were losing, so she didn't feel bad about ducking out.)

One of the original nurses came back in, hanging an IV antibiotic--Avelox. "How long am I going to be a guest here?" I rasped. She looked at me with sympathy. "Quite a while." Oh, yay. She also pushed a dose of steroids in to help with the inflammation, and a dose of morphine to help with the pain. As usual, the flush of heat hit first, and then the nausea. Thankfully, both were short-lived.

The ER doc came back in a few minutes later. "You've got a wicked case of pneumonia in there!" It's in both lungs, he says. A hospitalist would be in shortly to admit me.

Dr. D came in and explained that I have bilateral pneumonia and I'm going to be admitted, since it's severe and I can't breathe without help and I need some heavy-duty antibiotics. They are going to consult with an infectious disease doctor to see exactly what kind of pneumonia I have.

Hubby stayed with me until about 11:45ish, not wanting to leave but yet not wanting to stay too awful late, even though S had said to stay as long as he wanted. I was still waiting on a room. I drifted in and out on a morphine cloud and half-watched tv until they found a place to put me.

About 2a, they were ready to move me to a room. As the nurses wheeled me out of area 18 and sent me on my way to my room, one of them asked if I've seen the chest x-ray. No, I said. "It was white-out conditions in there," she tells us. Oh, fantastic. I know enough to know that's really bad, and dangerously so. I'm really sick.

I'm taken to my room on the PCU floor--the progressive care unit. Not quite ICU, but not quite regular ward. I get hooked up to a heart monitor, which is a "perk" of life on the PCU. I get to tell my story yet again to the nurse who gets me settled in my room. Ironically, she's the wife of the senior pastor of the UB church in S-burg, so we have some mutual friends. Then I realize that I ought to email my sister, who is halfway around the world and a CNP, to tell her what's going on. The seven hours between us means that she responds to my email within half an hour, tells me she's praying for me, and then orders me to get some sleep. It was after 3a by the time I dozed off. My roommate was obviously an elderly lady; she was mumbling and talking a lot in her sleep. More antibiotics were hung and run into my IV--Rocephin and Vancomycin.

The "vampires" came within a few hours, drawing more blood (we met daily about 4:15a). I think I got another dose of morphine. Meds were passed; I got a Lovenox injection. I knew what that was. I'd been on it after the accident; the nurse explained it was just a precaution. Vitals checks every hour or so. Breakfast arrived. Pancakes. Not bad. I noticed I'd been put on a 2g sodium cardiac diet. This was to become the bane of my existence...along with the fact that I was on a caffeine-free ward.

After breakfast on Friday, I talked briefly to the girls on the phone. Small Fry wanted to know if I was still on the big truck. We tried explaining "hospital" to them, but failed miserably. We settled for explaining at I was staying at the "big truck's house" for a little while to help me get better.

I was wheeled down to x-ray again for a repeat set of chest x-rays. I'd been back in my room about an hour or so when I was fetched again, this time for an echocardiogram. Laying on my side to have the ultrasound of my heart done was so hard...I could barely breathe and I was in a lot of pain. That test took about 20 minutes, and then I was sent back upstairs.

Dr. M A (I tried really hard not to laugh at his name, since he was clearly not a championship boxer) came in; he was the infectious disease specialist called in to isolate what kind of pneumonia I had. He explained it was pneumococcal pneumonia, and that pneumococcus was a strain of strep that naturally occurs in the body. Mine had just had a huge party. The reason I had experienced such back pain was because the pneumonia had spread so far into the right lung that it pushed against the meeting place of the lung itself (which doesn't have nerves) and the protective pleura around it (which is chock full of nerves), and it was irritating the pleura. He did not believe that the pleura had been infected, and didn't think it would be, but said he wanted me on IV antibiotics for at least three or four days to make sure that didn't happen. The severe back pain I'd been experiencing was pleurisy, not strained muscles. If all went well, once I transitioned to oral antibiotics, I should be able to go home, provided that the pneumonia was well in check by then. So, possibly Monday. Dr. A also believed that my "stomach flu" that had started off this wacky chain of events was not the flu after all, but the pneumonia starting up. And apparently, my white blood cells did not get the message that the infection was in my lungs, and chose to attempt virus evacuation through more standard flu routes.

Hubby arrived after lunch, having taken the kids out for a big breakfast before meeting up with Mom and Dad to swap vehicles. Saturday was a scheduled visitation day anyway, and Hubby told Mom she could call him at any time to come get the girls if she got too tired. Mom had already decided to keep the girls until I came home.

About 4:30p, the nurse informed me that I would soon be going down for yet another test--this time, a chest CT. "Soon" turned out to be an hour later. I tried valiantly not to freak out over the CT machine and the contrast dye that they would inject into my IV, and focused carefully on the camera on the wall in front of me that was trained on both me and the donut machine. The radiology tech explained that the contrast dye would make all my blood vessels light up like a Christmas tree, and if there were clots, they would show as dark spots.

T and S came by to see me as they were headed out for their Murder Mystery Dinner party, dressed to the nines in Roaring 20's garb (although I have my doubts that Hannah Montana fashions were available then; gotta admit that T made the hat work, though). They said to call if we needed anything. I was envious because they would get to have salt.

After the shift change, I had the nurse change my IV site, since the one in my left arm was really hurting. The new IV port went into my right wrist. She came back in about 8:30, and explained they would be adding Coumadin to my meds. "Do you know what that is?"

A blood thinner. I knew that. Hubby asked the question we were both thinking: "In place of the Lovenox, or in addition to the Lovenox?"

"In addition to."

Throughout a very frustrating conversation, with all of us feeling bad because the nurse couldn't give us the diagnosis yet she wanted to give us enough information to understand what was going on, we were able to determine with some level of certainty that I had a blood clot in my lung. "I guess I'm not going home on Monday," I commented.

Hubby was not happy that she couldn't give us more specific details, but understood. He went to the nurse's station to get the name of my hospitalist, and asked that they page her. Whoever he spoke to there flat-out refused to do so. Hubby had to run home to get his cell phone charger, and was determined he would track down the doctor to get the diagnosis. Since it was after 8p when he returned to the hospital, he had to enter through the ER. He ran across Dr. D there, who asked how I was doing (apparently, I'd worried him quite enough the night before that he remembered me). Hubby said I wasn't doing well at all, explained that we weren't able to get any information, and Dr. D, bless him, came upstairs with Hubby to read the CT results and tell us what was going on.

The results? A LARGE blood clot in my right lung, along with several smaller ones (significantly smaller) in my left lung. Dr. D assured us that there was no chance of the clot (or part of it) breaking away and causing me to stroke out; those "roads" didn't cross, he said. It couldn't get to my brain from where it was.

On the plus side of things (I'm easily amused), I managed to freak out my nurse when she pushed a dose of morphine into my IV too fast, and I got nauseous. She was terrified I was going to vomit, which was a bad combination with the blood clot, I guess, and there was a momentary panic until I assured her it would fade in about 30 seconds. Which it her immense relief. (Mine, too; it's a nasty reaction.)

Hubby spent the night in a very uncomfortable chair, not wanting to be out of my reach throughout the night, just in case I needed him. We were both pretty scared.

S arrived Saturday morning to send Hubby home to get some decent sleep for a few hours; she would babysit me for awhile.

Late morning on Saturday, Dr. M came in to see me. She explained that the large blood clot was much larger than we thought--it was a monster clot, in all three lobes of my right lung. She was calling in a pulmonologist, who would see me later in the day. She stressed that I was stable--they did not expect the clot to do anything drastic. The Coumadin, once it caused my clotting factors to reach the right therapeutic levels, would break up and dissolve the clot and keep it from happening again. I should consider getting a medical alert bracelet, warning that I'm a Coumadin patient, she said. She considered the culprit behind the clot to be a combination of factors: dehydration from my "flu" episode, the inactivity resulting from being that ill, and the birth control pills I was on. The echocardiogram was what had tipped them off that there was a problem--it showed that my right heart was under severe strain as it tried to pump blood to my lungs. That's when the cardiologist had called her and told her I needed a chest CT stat. She was confident that this monster clot had developed quickly over the last week, and that it was more likely due to the three factors she mentioned rather than a belated present from my accident last July. I would need to be on the Lovenox and the Coumadin until the Coumadin affected my clotting factors consistently enough to keep them in the therapeutic range for two days. Only once that happened would I be able to go home.

The pulmonologist came in that afternoon, and explained that he wanted me on Coumadin for at least nine months, preferably twelve. Blood clots in the leg were usually treated for three months, and lung clots for six, but he always preferred to err on the side of caution. And longer treatment time would mean less chance of the clot recurring. He also stated that I was in stable condition. However, the nurses were taking no chances with me until we knew for sure that I wasn't going to explode. Hubby once again spent the night, but this time he was in a much more comfortable chair; one of the nurses had found him a recliner, and we shuffled stuff around in my too-small room to accommodate it. (My roommate had family with her almost constantly as well, her husband and her daughter, so we became this little family of sorts.) S even called to see if we needed her to scoot over to our house and give Po her insulin shot. Hubby asked all our friends to pray for me, by name, on Sunday, expecting a healing miracle regarding the blood clot. My sister-in-law ended up going down to the altar in church on Sunday morning, to be anointed on my behalf.

By Sunday, I was down to being on 1 liter of oxygen and had improved enough that the pulmonologist said he wanted me to start taking short walks. To the bathroom and back was enough for now. The nurses quickly determined that I was not a fall risk, and said I didn't need to call them for restroom trips. In fact, I had the distinction of being the least sick patient that my nurse was responsible for in the PCU. I wasn't sure if that was an honor, or a testament to how sick everyone else was. Dr. A came in again and announced that I was doing quite well, and after the 1p dose of Rocephin via IV, he was switching me to oral antibiotics. I had a lovely hacking cough by this point, so I was constantly asked if I was coughing anything up. It rattled my rib cage and made breathing extremely painful, which was really annoying because I was starting to feel not too bad when I wasn't coughing. My roommate's daughter assured Hubby that she was staying the night, and she would keep an eye on me. He could go home and get some sleep.

On Monday, the pulmonologist said he wanted me to start walking around in the hallway. I was well enough for that, and would need to start building my strength back up. Hubby brought in my fluffy Eeyore robe, and I tried to get up and walk about once an hour. However, I got up and walked twice that morning...and then slept soundly until lunch. It had worn me out. I was also started on breathing treatments every six hours, because my lungs were now so tight and I was coughing so hard. (Albuterol and Atrovent is a nasty combination, for the record.) I was also taken off oxygen altogether around noon.

Monday night, respiratory hooked me up to a pulse ox meter that would measure my oxygen levels throughout the night, to make sure I was keeping up proper oxygenation levels. Rather than use the clip-on finger meter, the therapist wrapped a sticky bandaid-type around my finger and hooked me up. Ironically, the only times the monitor beeped that my O2 levels were below 92% were when I was awake, before I fell asleep for the night.

Having passed the O2-levels-all-night with flying colors, Tuesday morning I was sent down for a repeat echocardiogram. The tech was a different one this time, but the test was much easier on me because I wasn't gasping for breath so much. The tech who ran my first echo came in towards the end to see how I was doing, and remarked that I'd been much worse off when she'd seen me on Friday. She mentioned the rather sizable clot I had in my right lung, and then I pointed out that the clot was not the only problem on Friday, because I also had bilateral pneumonia. Well, no wonder I couldn't breathe!

The pulmonologist came in Tuesday morning, and explained that my clotting factor numbers were just barely in the therapeutic range where we wanted them, but he thought that they would be up sufficiently by the next day, so I could probably go home on Wednesday. He wanted me to keep getting up and walking around, and said he'd like me to consider having a sleep study done to test for sleep apnea. I didn't see the hospitalist until late afternoon; he concurred with the pulmonologist and said that as long as my INR numbers looked good the next day, I could go home. I asked about activity does one function with a monster blood clot in the lungs? He basically said I wasn't to do any extreme or contact sports. "I've got three little kids," I said. "Raising them IS a contact sport." He laughed and had to agree. He also explained the results of that morning's echo--my right heart was no longer under any strain. It was acting perfectly normal. 100% fine. He said I would still be on the Coumadin regimen for the next nine months at least, just to be safe.

Hubby and I chose to believe that the miracle we prayed for on Sunday happened. The clot is gone, or is at least so drastically reduced that it is no longer life-threatening.

Dr. F also said I was well enough that I did not need to be in the PCU anymore, and so they would move me to a different floor for the night, onto a regular ward. It took awhile for my dinner to catch up to me in my new room.

I had one last meeting with the "vampires" (the nurse knew exactly who I was talking about when I commented about 5a that they hadn't been in yet; she said they were just down the hall, and I had a good laugh that was followed by a coughing fit), and then it was a waiting game to see which doc would arrive first.

The pulmonologist won. (He's Indian, and I cannot even pronounce his name, let alone spell it.) He came in about 7a and announced that my INR numbers were exactly where we wanted them to be. I could go home. The clot had resolved itself, he said, or nearly resolved. He was very pleased with my progress and reminded me to keep careful tabs on my diet (I have to watch my Vitamin K intake) and make sure I took the Coumadin precisely as directed.

Dr. F came in a few hours later. He too was pleased with the Coumadin numbers, and said I was good to go home. I would need to have a follow-up appointment with my doctor and an INR test on Friday, to make sure the levels were still where they needed to be. No extreme sports or anything that could make me bleed. He double-checked to make sure my doctor's office had an INR machine, wrote up my discharge orders and the scripts I would need, and scheduled the appointment at Dr. B's. I was good to go.

My nurse was kind enough to wheel me down to my old room so I could say goodbye to my old roommate and her family, and then a volunteer came and wheeled me out of the hospital.

It was wonderful to come home, even if the cats ignored me.

When my best friend JJ and B (her chauffeur and also a friend) arrived, we all went out to lunch...someplace where I could get salt!

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