From Abscess, to Aspiration, to Ambulance: An ER Adventure

by Lorien E. Menhennett

At least the IV stick didn’t leave a bruise on my arm.

That was one of my first thoughts upon waking up Monday morning of this week. Not a typical waking-up thought, but understandable given what I had experienced Saturday and Sunday. I’d had a health care adventure, all of it quite accidentally. The 18-gauge needle down my throat and ambulance ride (among other things) were never supposed to happen. But they did …

It all started around 4 p.m. Saturday afternoon with a trip to urgent care for something seemingly simple – a sore throat. I figured it for strep. Along with the pain, though, I had developed some difficulty swallowing, problems breathing at night, and a slightly muffled voice. The urgent care physician took one look at my bulging left tonsil and told me I needed to go to the ER immediately. “You don’t have strep,” he said. “You have a peritonsillar abscess.”

Peri-what?

Peritonsillar abscess: a bacterial infection of the head and neck that can progress into what is basically a collection of pus that forms next to the tonsil. Severe cases can lead to a muffled voice (check), difficulty swallowing (check), problems breathing (check), and eventually complete airway obstruction (yikes!). Hence the need to go to the ER.

So head to the ER I did, at Rush Oak Park Hospital, which is just blocks from my house. The nurse practitioner (NP) who saw me agreed with the urgent care doctor’s diagnosis, and said she would attempt to aspirate the abscess. In other words: poke a hole in it with a big needle and suck out some of the pus with a syringe.

Gulp.

She and the nurse took me back to the ear/nose/throat (ENT) room, sat me in what looked like a dental chair, and prepared their instruments. As the NP was unwrapping the syringe and needle, my eyes widened.

“What gauge needle is that?” I asked. “Is that a 16?” I would know, having seen the gamut of sizes during my mouse work in the research lab at Northwestern.

She smiled wanly. “An 18,” she said. “I didn’t want you to see it because I thought it would make you nervous.”

For those of you unfamiliar with needle gauges, the smaller the number, the bigger the needle. When it’s about to be shoved down your throat and into your tonsil, an 18 gauge looks like a silver coffee stirrer with a pointy end. Lovely.

Not wanting to decrease my gag reflex, the NP didn’t anesthetize my throat at all, just swabbed the spot where she was going to aspirate with a bit of betadine (a solution to prevent infection). As her hand, and the syringe, neared my mouth, I closed my eyes. And then … owwwwww. When I opened my eyes again, I looked at the syringe. Empty.

After the nurse had suctioned my mouth, I asked: “Did you get anything?”

“Just a few drops of blood,” the NP said. “I’m going to try again.”

Hooray.

The second time was just as painful, with no better results.

After more suctioning and rinsing my mouth with peroxide (“Don’t swallow this!” the nurse said), I asked what was next.

“On to Plan B,” the NP said.

“What’s that?” I was understandably nervous, given Plan A.

“I haven’t figured that out yet,” she replied.

So back to my corner in the ER, where I was given IV antibiotics, steroids, and some painkillers. Shortly after that, I got a head/neck CT scan to see whether the abscess had infiltrated other tissues. It had not, thankfully.

Eventually, the NP came back. “I talked to the ER doctor, and he said you need to be transferred to Rush downtown [an affiliated, and much bigger hospital] to see ENT,” she said. “We’re calling an ambulance.”

By now, it was about 10 p.m. I was exhausted and in pain. Not to mention hungry. I hadn’t eaten since lunch. My plan had been to eat dinner after my trip to urgent care, but that went out the window. At this point, though, because they didn’t know what ENT would want to do, which was a comforting thought, I was NPO (nil per os, Latin for nothing through the mouth, aka no food or fluids).

After what seemed like ages (more like an hour), the ambulance came. One thing about an ambulance ride is that you feel every single pothole in your bones. And there are a lot of them on I-290 heading toward Chicago.

Rush University Medical Center in the city, nearly brand new, is impressive. I had my own room (with lots of bells and whistles) and a real hospital bed (exciting after having been on something resembling a padded cot for several hours). My nurse quickly hooked me up to a monitor and gave me more antibiotics and pain meds. Oh yes, and drew more blood.

At this point it was after midnight Sunday, and I had been up since before 5 a.m. Saturday. But the ER is not exactly a good place to sleep, with alarms constantly going off, people chattering, and an IV sticking in my arm. Not to mention a painfully swollen throat. As I drifted in and out of semi-consciousness, various people came in and out of my room to check on me. My nurse. The ER doc (who took one look at my throat and said: “Yep, that’s a peritonsillar abscess”). A fourth year medical student (at 3 a.m.) who had never seen a peritonsillar abscess before. Yep. Glad to be of educational service.

I had been told ENT would come around 7 a.m. Which came and went. It was 8, then 9, then 10. Finally, two residents came. One of them did all the talking. He basically said there was good and bad news. The good news: “You don’t have a peritonsillar abscess.” The bad news: “You have mono.”

Seriously?

They gleaned this from the CT scan I’d had done at Rush Oak Park, my bloodwork, and then finally their physical exam.

After relaying their news, the residents left to confer with their attending. They all returned a bit later. The attending physician repeated the diagnosis and gave his treatment instructions. For at least a month: no alcohol, no strenuous exercise, at least 8 hours of sleep a night. And basically, no stress. Yeah, right.

“Just from meeting you, I can tell you’re the kind of person who needs to be told to take it easy,” the attending said. “If you don’t rest now, this will return with a vengeance, and you will be on your butt for two months.”

I certainly don’t want that. So I’m taking a week off work, at the doctor’s suggestion, sleeping a lot, and trying to avoid stress. Which is a challenge when you’re in the midst of medical school applications. But I’m doing my best.

While I wouldn’t exactly recommend this adventure to other doctors-to-be, it was very much a learning experience.

For one thing, nurses can make or break a hospital stay. I was fortunate enough to have three fantastic ones throughout this ordeal: Amelia, Carma, and Laura. All three were helpful, kind, compassionate, and responsive, both in big and little things. Doing an IV stick that didn’t leave a bruise. Bringing me a warm blanket. Ordering me breakfast even while I was still NPO, in anticipation of ENT allowing me to eat after their examination (which they did). I felt like a person, not merely a bar-coded patient.

Another thing that struck me was that everyone (up until ENT came) thought I had a peritonsillar abscess: multiple doctors, nurse practitioners, and nurses. This got me thinking about how easy it can be to misdiagnose something – how two different issues, in my case a peritonsillar abscess and mono, can have very similar symptoms and pathologies.

In other words: It takes everyone working together as a team to make the medical magic happen.

One of my first thoughts as I woke up Tuesday, thinking back on all that happened this past weekend:

At least I have fantastic insurance.

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