doc w/ Pen

journalist + medical student + artist

Tag: ER

Tonsillectomy Tales

One surgery, 2 ambulance rides, 2 hospitals, 7 nurses, 8 ENTs (2 attendings and 6 residents), 40 hours in the hospital, and countless scoops of ice cream later, I’m feeling much better. But it’s been a nightmare. If you still have your tonsils, keep them if you can. For an adult, a tonsillectomy is serious business.

Losing mine was inevitable. Since having mono in March (read that story here), my tonsils remained very enlarged, to the point where swallowing was annoying. Add to that recurrent throat infections, and they were seriously interfering with my quality of life. So my ENT agreed that removing them was the way to go.

The surgery was brief, the procedure itself apparently lasting only about 15 minutes. Cut, cut, cauterize. No sutures, just a torched throat. I actually felt OK that night. Third day post-op was the worst. Swallowing ground glass would have felt better than every gulp I took. The thing about a tonsillectomy, unlike most surgeries, is that you can’t rest the affected area.

In the midst of the pain, I developed a bad cold. So along with pain medication, I was taking an antihistamine, a decongestant, and cough medicine. To prevent bleeding after the surgery, you’re supposed to avoid coughing or clearing your throat after the surgery. Needless to say, I was a total zombie. Right before I had my surgery, the ENT resident said to me, “I hope you have a lot of good books to read and movies to watch.” Yeah, right. I was lucky if I got out of bed.

Slowly, things started to improve. Minutely, but noticeably. Then nine days post-op, 7 p.m. to be precise, I started coughing up blood. First phlegm with blood, then just … blood. I’m not normally one to panic, but blood isn’t supposed to come out of your mouth in quarter-cupfuls at a time. Naturally, I called my dad, who lives not far away. Dads—especially dads who are doctors—can make everything right. Right?

“I’m coughing up blood,” I told him. “Can you take me to the ER?”

“If you are coughing up that much blood, you need to call 911,” he said. “They can get you there a lot faster than I can.”

So, somewhat reluctantly, I dialed 911. Put my shoes on, got my purse and phone—somehow I thought to bring my phone charger too—and went outside to wait for the ambulance. It came, flashing lights, sirens, handsome paramedics and all. I stepped up into the ambulance (no stretcher? what about the stretcher?) and off we went to the community hospital. In better times, I could walk there in 15 minutes. Clearly, these were not better times.

The benefit to arriving at the ER in an ambulance, I suppose, is that you jump the queue. Immediately to a curtained-off gurney I went. Vitals taken, throat examed, IV fluids started. My dad arrived soon after to keep me company. He had left a message for my mom; I’m living with her, and she had just left for a church function before I started coughing up the blood. She called back while we were sitting there.

“Yeah, I’m here with Lorien,” my dad told my mom nonchalantly. “She’s covered in blood head to toe. There are these cool blood bubbles coming out of her mouth and nose.”

Laughing after a tonsillectomy is really painful, so I was trying not to—he was totally egging my mom on, as he has done since I can remember. I later found out that she believed him. I guess I can understand why—when she left I was fine, then she gets a voicemail that I’m in an ambulance and on my way to the hospital. She’s my mom. She gave birth to me. Of course she was traumatized.

“I was very fragile!” she told me later.

The ER doctor looked at my throat. She didn’t see any blood or evidence of bleeding. In fact, the bleeding had mostly stopped at that point. She called the on-call ENT doctor at the main hospital in the Chicago. They wanted to see me—at the Chicago hospital. Hence ambulance ride #2. No flashing lights or sirens this time, although I did get a stretcher. About time.

Déjà vu. This was exactly what happened when I got mono. Went to community hospital ER. ENT docs in Chicago wanted to see me. Ambulance ride to main hospital. I didn’t complain, though. Who knew if the bleeding would start again. I certainly wasn’t taking any chances.

Once in the Chicago ER, more IV fluids, more vitals, more doctors and nurses asking questions—not fun, since talking after a tonsillectomy is painful. Once the flurry calmed down, I looked around the room. The wall clock said 2:05. I did a double take. I knew it was closer to 10 p.m. Then I realized I was in the same room as when I had mono. The same broken clock, still broken. Déjà vu indeed.

Observation for 24 hours, and NPO (no food or drink) for the time being. That was the ENT verdict. So I tried to get comfortable. Not easy when you’re hooked up to an IV, a pulse oximeter, and a monitor. Not to mention that with all the IV fluids I was getting, I had to go to the bathroom every hour. At least, that’s how it seemed. But since I was so tied up, I had to call my nurse to unhook me from everything, and then hook me back up. For a person as self-sufficient as I am, being that helpless and needy was very hard to accept. I had no choice.

Since I couldn’t take pills, they gave me morphine via IV. I got four milligrams every four hours, which my hospice mom tells me is a low dose. Even so, it was … interesting. Almost instantly, my whole body felt heavy, invisibly weighed down. The morphine did a little, though not much, for my pain. At least it helped me sleep.

As this was a dedicated observation room, not a regular ER room, it had a normal hospital bed as opposed to a gurney. So I was much more comfortable. It also had a TV, although the first thing I did when the paramedics brought me in was to turn it off. I didn’t want to watch the news, the weather, sitcom reruns, or bad talk shows. I wanted to sleep. As I said, the morphine helped, some. But I quickly realized—or remembered, from last time—that the hospital is no place for resting. It is, in fact, the worst place for a sick person to be. Electronic monitors chirping constantly, people talking, walking by my room. At least I had a sliding glass door, which they allowed me to keep shut, and a curtain. That helped. The worst was the number of people who kept wandering in: doctors, nurses, social workers, volunteers. All had what I’m sure they considered to be important questions. But many of them seemed irrelevant to me at the time.

“Do you have stairs at your home?” was the worst question I got.

Say what? I had a tonsillectomy, not a hip or knee replacement. There’s nothing wrong with my legs. What does it matter that I live on the second floor? I understand that they ask everyone the same questions. But it was overwhelming, especially since my throat hurt so much.

My own ENT—the one who operated on me a week and a half prior—came to see me the next afternoon. Apparently, bleeding around day nine is not uncommon, he said. The scabs on the throat are starting to fall off, and sometimes healthy tissue is torn off too. My throat looked OK, he added. But since my pain was still uncontrolled, he suggested staying another night. I remained skittish, so I agreed. I would get a regular room on the floor soon.

My mom came to visit me that afternoon after my ENT left. It was a nice diversion, after trying somewhat unsuccessfully to sleep all day. At that point, I was on clear liquids (exciting!) so I feasted on green jello and apple juice. Considering how hungry I was, it actually wasn’t bad.

After she left, they took me to a regular room. More nurses, but no doctors this time, more questions. I discovered that they monitored different things on the floor than in the ER. My urine output, for one—what goes in must come out. They checked me for skin breakdown, and I had to wear inflating sleeves on my lower legs to prevent deep vein thrombosis (blood clots in my legs). My wonderful nurse apologized for the hassle.

“This is really for older people,” she said. “But we have to do it for everyone.”

Another night of morphine, in-and-out sleeping, hooking and unhooking to go to the bathroom. The next morning, I was more than ready to leave, regardless of my pain. Around 10 a.m., I unceremoniously took a cab home. And then I took a long nap.

I spent the weekend recovering from my hospital stay. I’m back to work, starting with half days for this week. I’m better, especially on the pain front, but I still don’t feel myself.

Like I said. If you still have your tonsils, do yourself a favor and keep them.

 

Author’s note: Those 40 hours were awful. But I want to thank everyone who cared for me at the two hospitals where I stayed: the doctors, nurses, and other staff. Especially the nurses. Without their help, those 40 hours would have been much, much worse.

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

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.