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Wednesday, November 17, 2010

Appendectomy and Abscess: The Lost Jane Austen Novel?, just my last few weeks in HospitaLand.

Hey kittens;
A few people were asking so I figured I'd lay out my recent adventures into ill-health in one fell swoop, for those who cared to read it - not exactly Adventures in Cape Town, but I have a feeling that wading through the health system on this one is going to be quite the little safari, so maybe there will be a few more chapters down the line.

And speaking of lines, here's a timeline of my recent woes, described in further pustular detail below.  If it's that interesting to you, you can click to make these pictures a bit larger.

The appendicitis attack itself wasn't that bad - at least it came on fast, exhibited classic symptoms, left little room for hemming and hawing, and was a relatively finite expense.  I mean, we aren't talking about cancer here, people.  I got kinda lucky.

1. Nausea, vomiting, generalized stomach ache.
2. Possible fever, increased pain.
3. Pain increasingly localized in right lower abdomen.
4. Pain increasingly feels like being stabbed with something very sharp.
5. Pain increasingly feels like being stabbed with something very sharp THAT IS ALSO ON FIRE.

Luckily, after I posted my symptoms as a status update, Facebook Nation rushed to my aid with a superior diagnosis that convinced me to seek help, despite my utter lack of insurance and trepidation about the cost of an ER visit.

My sister, by the way, nom de guerre Lulu Fishpaw, has been utterly fabulous through this entire debacle, since I had to call her home from work to drive me to BOTH ER visits, and each time she sat there uncomplainingly into the wee hours while my ills were assessed.  Fortunately for her, she can sleep anywhere with just a jacket over her head (so, she explains, people can not see her). But between the ferry service, the innumerable bedside visits and grocery runs for Popsicles and ginger ale and crackers, and the moral support, I send a huge shout out to my sister, who has now quite literally saved my life, in addition to just generally saving my bacon throughout this entire fetid, reeking sewer of a year.

So anyway, the appendectomy removed my already-exploded appendix and left me with three lapro scars: a crown of staples around a slit in my navel, a quarter inch incision about 7 inches directly below that, and another maybe 1" long, also stapled shut in such a fashion that the scar looks something like a "power on" button commonly used on electronics.  And I'll thank you to keep all those jokes to yourself, people.

Despite this abrupt end to my nascent bikini-modeling career, I was pleased and amazed that my exploded appendix, and the 3 litres of water they used to hose down my innards, had all traversed these tiny spots, enabling a much faster recovery than traditional surgery could have. By the following Wednesday, 1 week post-op, I was feeling sprightly as a gamboling spring lamb (a lamb who subsisted on pudding and still needed to haul on the headboard to get out of bed, but still).

Two days later, I felt like I'd maybe pulled a muscle in the removal (not incision) area.  So that bummed me out, because I'd been trying to be careful, but I figured it would sort itself out with rest.  A burning, cramping sort of pain occurred periodically when I was on my back too long, i.e., all the time, but especially at night - so rather than sleep I spent the weekend sitting on the edge of my bed, clutching my side, moaning melodramatically, and folding over occasionally like an exhausted tourist during the last agonizing few seat adjustment attempts on an 18-hour plane trip.  These episodes increased in duration, frequency and intensity, though of course, on Monday when I had my post-op clinic appointment, it faded somewhat, just like the noise your car STOPS making when you bring it in to your mechanic.

But both the clinic doc and the crumpled instructions I had from my first foray into HospitaLand indicated that high fever was a BAD THING, and that a fever over 100.5 necessitated a trip back to see them.  That Wednesday, huddled sweating yet chilled under two comforters, I took my temperature every 15 minutes until it yielded the desired BAD THING, called my sis, and went back to the ER.

At the ER, during a 4-hour wait, the triage nurses took my blood pressure and temperature 3 times, never ONCE showing a fever, though I feebly waved my Walgreens thermometer with which I had charted my febrile ascent as proof of my having passed the BAD THING threshold.  They clearly didn't believe me, though - which, fine, they have to treat emergencies, I get it - but when I finally saw a doctor who took some blood and a urine sample, my white blood cell count was oddly high, given I had no fever, and required them all to take a second look at me (and prompted friend E to note, "Wow, even your physical self is capable of extreme denial.")  In any event:  VINDICATION!  Also, crap, what does that mean?  Also, can you hook me up with some pain meds, doc, like RIGHT NOW? Thx.

The nurses got a lot nicer.  One gave me 1000 mL of freezing cold contrast solution to drink (be still my parched, fevered heart), and in due time wheeled me off for a CT scan that showed a MASS resulting in a tentative diagnosis of SUSPICION OF ABSCESS.  Which sounded like a very dramatic spy movie, perhaps one starring Harrison Ford. 

And indeed an abscess it was, though at least a contained one (ie, not leaking any goo onto my other innards.)  "You can actually feel the hardened form when you press!" marveled an entirely too chipper radiologist resident from the team over at the Special Procedures Department, palpating my aching, sore gut with empathy-free fingers.

Medical solution:  poke a hole in it.

The entirely too chipper Special Procedures team chirpily informed me that there was a, uh, special procedure that could drain me without surgery: they would basically poke me in my mass with a big old hypodermic needle threaded with a stiff wire, remove the needle but leave the wire, and then use the wire to feed a little drainage tube in there.  In effect, they were lancing a big internal zit. "No anasthesia, just sedation, but shouldn't hurt, will relieve your pressure.  Much faster than surgery!" trilled the entirely too chipper resident who was just THRILLED to be performing on me.  "Ops in 45 minutes, sign these waivers! OH, and," he became somber for a moment, "no pressure, this decision is all in your hands. Take as much time as you need." Then gave my mass a friendly pat, and handed me a pen, and waited expectantly while his three Special Procedure-ettes stood looking on smiling.

I hesitated.  "And...uh, recover time is how long?"

"Oh, you'll be in the hospital while it drains, 5, maybe 6 days."


That there was the sound of my financial future, already teetering precariously from the effects of this execrable, damnable year, collapsing under the combined weight of a week of in-patient hospital stays plus procedures - some of them Special! - for which I have NO INSURANCE, repeat NO INSURANCE whatsoever.  When it was just a 2-day simple operation, I had hope I could get by; when I thought maybe I needed new antibiotics at the ER Part II, I figured the ER cost was worth it.  But THIS.  This heralded some 10 years of indentured servitude to Lousiana State Hospital Health Systems.  Decision was mine! Clock was ticking!

Miserably, I signed the damn waiver.  And 30 minutes later, the combination of stress, pain and financial despair caused me to sob uncontrollably on the Special Procedure table (despite the efforts of the sedation technician, who increased my meds 4 times during a 20 minute procedure) while the now slightly bemused radiology resident shoved a white hot probe into my abused intestines and drained me of a sour, blackish looking goo.  A LOT of it.  Later in the week, he would routinely inject 20 mL of a bleach solution into the abscess to kill off the remaining nasties, and even that small amount hurt like a BEYOTCH - the probable limits of the shrunken-down abscess 4 days after the fact.  During my Special Procedure, the mass leaked 300 mL of goo into a freezer bag, that the entirely too chipper radiology team held up for me in amazement and delight as if I should be proud of it.

Which explained the pain, of course: my wee little abscess had manufactured so much pus, it was massively distended!  For those of you less conversant with the metric system than medical professionals must be, let me translate into something familiar:  in essense, they extracted the pus-y, infected contents of a 10-oz martini glass from something the approximate size of an olive.
Woot! Bottoms up!
After that, I just had to hang out while the dregs of the infected goo drained out of me - into, I might add, a lovely translucent bag I was to wear pinned to the outside of my hospital gown.  While I was happy to sleep away my remaining (but subsiding) pain and financial despair, I got REALLY bored.  The pain meds made it hard to concentrate on reading, and me and my roomie (the excellent Martha, about which, more in a second) shared a disdain for television, apart from her devotion to the 5:00 local news and football Sunday.  So I took to roaming in circles in the halls, determined to recover more quickly by walking it off, or at least shuffling it off, in the industrial-blue, elasticized fabric shoe covers given to me by a sweet cleaning lady who didn't want me to get "no staff in my feet." (sic)  Not a primary source of traction, since they were FABRIC, their chief purpose seemed to be to absorb the dirt on the tile floor as I staggered drunkenly along the handrail,  clutching the site of my former mass/current leaky tube, with a bag of infected pus pinned cheerily to my chest, like a heavily medicated Hester Prynne guest-starring on an episode of "House, MD."  Sponsored by Swiffer.
Five days later, I stopped leaking, and they sent me home with antibiotics to eat with my pudding.  THE END.

(Fun fact:  I'd been on Cipro and some other antibiotic - Flagella-something? - while in the hospital, but by the time I was released, the final goo cultures showed that the remaining bacteria had already become resistant to Cipro, so I had to switch to Amoxicillin.  Here's an interesting short piece on antibiotic-resistant bacteria using spontaneous mutation and horizontal gene transfer to speedily work around all the chemicals we throw at them every day.  Cripes. It's a wonder we have anything BUT superbugs.)

Note:  the reason I know I'm lucky, despite all this?  My excellent roommate Martha, who had a bubble of air in her chest from an exploration into her pleura and was stuck in-patient until the bubble shook loose, was an absolute ray of sunshine and made my stay tolerable. She was maybe 60, concerned with the relative lack of rain in her garden this year; shared my love of crime novels, and the aforementioned hatred of commercial TV. She had to carry a little box around that bubbled when she breathed, making a soothing aquarium-like noise at all times that I missed when she went walkabout.  She had survived breast cancer just 2 years ago; lost her husband this past summer after nursing him for some months; and upon her exploratory surgery for pain in her chest (which surgery had caused the bubble), was diagnosed with lung cancer.  Despite all this, she was upbeat in a laconic, Steel Magnolia kind of way, solicitous of my pain and comfort, the absolute favorite of her oncology docs for her charm and optimism, and a generally wonderful person to be around.  She moved in a few hours after I did, and we tolerated each other's 4 a.m. parade of specialists with good-natured banter ("Martha, can you tell your hired help to keep it down this morning, please?"  "Well, maybe if they didn't have to work around the mess your friends left at midnight last night...") and speculated about what would happen if neither of us could ever leave, she with her air pocket and me with my goo, prompting me to create a pitch for a sit-com about 2 long-term patients terrorizing a hospital floor with the ensuing hijinks, to be called "Pus n' Bubbles".  When I left, she was curled up with a James Patterson novel, bubbling away, and cheerily lamenting my early release, her own future totally uncertain even if the air DID emerge from her pleura.   Best of luck, Bubbles.  You saved my sanity and gave me some much-needed perspective, and I'll be forever grateful for that.

If I blog about this all again, it'll be as I navigate the non-insured route through Our Health System, which I anticipate is going to be an utter three-ring circus.  If I can manage it, expect meaningless graphs and charts aplenty.

And finally, THANK YOU for the many kindly wishes for health and recovery you've sent along:  their healing power is proving at least as beneficial as the antibiotics, if maybe not quite so entertaining as the painkillers.

Much love,

1 comment:

  1. Pus and pusability! "Emma" gonna have to never let you leave the state again! Much as I hate that this happened, I'm so glad you're writing again. I felt like I was there. Your true calling. Yes, the charts did aid my comprehension!