20 March 2007

the human pincushion

today began as a good day. thanks to the recent med changes made by mr_dr_do, i'd had a relatively productive weekend (one where i at least slept at night and was awake during the day--amazing how much that helps!) and i got to pbl bright and early, ready to dig in to another case. we'd just switched facilitators the week before (for our pbl groups, there are 8 students and 1 facilitator. the groups shift every semester, while we switch facilitators every 10 weeks or so) and i'd had the miraculously good fortune of getting my advisor, the_godfather, as a facilitator for this section of the term. i cannot even begin to tell you how excited i was by this. the_godfather is an amazing teacher, not to mention one of those rare people who can be honest and diplomatic at the same time. i knew he would mold our group dynamics to the point that we'd become a productive, respectful, and self-sufficient learning group.

when the_godfather walked into the room that morning, he asked me how i was feeling. it was the first time since the surgery that i reflexively and unhesitatingly said, "good!" and really meant it. we began our case, which involved some difficult interpretations of a CT scan, where we were trying to find one of the strangest-sounding tumors you can imagine (a pheochromocytoma). i had the opportunity, in the midst of this, to ask some particularly crucial questions. my colleagues tried to ignore me, but i became more persistent than usual. heck, i was feeling well--and i was very excited about how this case was teaching us to combine neuroanatomy and endocrinology. so, i particularly kept pushing for the group to identify a big glowing spot on the CT scan (in a CT, the stuff that shows up bright white is either really dense, like bone, or something that has picked up a lot of contrast material, if contrast was used, such as blood vessels). after a few minutes of tangents, the_godfather finally said to the group, "and what is that big glowing spot there?" sure enough, it turned out to be the tumor.

By the time we finished reading the scan, we'd been in group for almost an hour. then, all of a sudden, out of nowhere, my gut spazzed out. it was one of those experiences of pain where at first you think, 'oh, that really hurts...but it'll pass...it's probably gas or something.' but it didn't get better. in fact, it got worse. a *lot* worse. i lost track of where the group conversation had gone. i was trying to breathe and desperately hoping i wouldn't throw up on the table. within what must have only been a few moments, though, i broke out into a cold sweat. that's when i started to realize i was in trouble. after about ten minutes of sitting there like this, i finally whispered to the_godfather that i needed to leave. now.

i packed my books and practically ran from the room. i got to my car, hoping, again, that being out in the fresh air might make me feel better, but my pain was increasing. i didn't even think about it--i knew i needed to go to the er. stat. given that my mom, who'd stayed with me for a while after the surgery, had gone back home for a bit, i knew i had a small window in which to get myself to the hospital. fortunately, this new planned urban development (pud) i live in has a hospital in the middle of it, so i only had to drive a few miles.

i got to the er and it was busy considering the size of the small place. it took about 45 minutes before i was brought into an exam room, and, at that point, my pain had already begun to dissipate. i was relieved that it hadn't gotten worse, but also a tad undone by the fact that it had had a sudden onset and such deep intensity. the attending physician finally came in, poked my belly, and said he'd run some tests. he then asked me if i wanted anything for the pain. i didn't, at that point, feel that i needed a painkiller so much as an anti-spasmodic--a medication that would relax my muscles and stop them from remaining in this horrible contracted state. he agreed, and then went on his way. a little bit later, one of the nurses comes in with an injection. i raised my eyebrow at this--the antispasmodic i'd requested comes in a fast-acting sublingual form, as well as tablets, so i was surprised by the choice of an injection. now, my medical history is lengthy and complicated enough that i've long gotten over my fear of needles. i've even had to give myself intramuscular injections before. but i must say that any medication that does not last as long as the injection site remains sore is a medication that really needs to be rethunk. my butt hurt like mad for the rest of the day.

i slowly started to feel better, but still was unwilling to uncurl myself from around the quasi-pillow they'd provided me. a guy, resembling the age of a sixteen year-old, came in and placed my iv. i was surprised--and relieved--that he got it on the first try, as i have notoriously difficult veins. he drew several vials of my blood and then capped off the port in case i needed iv access later. then i waited. and shivered. and waited some more. an er is, truly, a terribly uncomfortable place to be when you're ill. i didn't want to complain--where i come from, er waits are usually about 12 hours long, and that's just to get through triage. so being in this small hospital, i actually felt relieved. it was a busy morning, but i knew that busy is relative. besides, i've worked long enough in healthcare to know when to be patient. the billing rep who came into the room to get my insurance information nearly passed out when i automatically handed her my insurance card, driver's license, and credit card for the copayment before she had a chance to ask. she spent the rest of the morning periodically walking past my room, popping her head in, and threatening to make me work if i didn't get out of there soon.

i think it was about 1:30pm when the doctor finally reappeared (the whole incident had started at just after 9am). he said that all my tests were negative and that i probably was just experiencing irritable bowel syndrome (ibs) from the surgery. that surprised me--ever since my appendix ruptured eight years ago (and wasn't diagnosed for over two months...), every doctor i've seen has given me this wastebasket diagnosis. [a note here: a wastebasket diagnosis is one that is given when there are clearly a constellation of symptoms that people have that can be grouped together, but where the cause is unknown. it's sort of like saying, we don't know what's wrong with you, but here's a label for it. it doesn't describe anything about how or why the problems occur, how it might progress, or even what might treat it best. hence the term, wastebasket diagnosis.] i get it--my bowel is pissed off. but any one's bowel would be pissed off after 2.5 months of purulent infection, followed by two surgeries and a host of other complicating factors. never, though, had my "ibs" ever caused pain that severe. never. nor had i ever read about someone experiencing this type of pain with ibs as the underlying cause. so i was, needless to say, skeptical. he then said he'd give me a prescription of the antispasmodic i'd been shot with; when i asked if it would impair my cognitive function (an important thing to know when one is a first year medical student), he said, "well, do you feel extremely sleepy now?" i didn't feel extremely sleepy right then--but i knew i was still on an adrenaline rush from the pain and my subsequent fear. so, thinking he'd proven his point, he attempted to leave, but before he could i asked about what i should do if the pain comes back this intensely again. he just shrugged, said to take the medication, and basically blew me off.

by the time the nurse came in with my discharge papers, i was angry. it didn't help that the first thing the nurse asked was whether or not i'd driven myself to the hospital. my response: why, yes, i had. to which the nurse replied, "oh. i don't know if you should drive after taking this medication, it can make you drowsy." i pointed out that the doctor had just told me that this wouldn't impair my function, but the nurse read down the sheet, found the section on side-effects, and sure enough, first thing: "may cause drowsiness or dizziness; avoid driving or operating heavy machinery until you know how this medication will affect you." it was a good thing the doctor was gone by this point, because i might have hit him if he'd still been around.

after finally getting the catheter removed from my arm and climbing back into my warm clothes, i left. i stepped out into the sunlight and walked to my car. i got into the car, and that's when i lost it. i just started crying...i couldn't believe i'd just been treated like an idiot by (yet another) physician...i couldn't believe i'd just paid out the nose for this privilege (er visits have a hefty copayment with my insurance)...and i couldn't believe that after all of this, i had no more idea as to what had just happened to me than i did when it started.

i decided to call the dr_do's and see if they could see me. fortunately their office is awesome (i swear, i have never seen a primary care physicians'/family practice office run so smoothly or be so accessible), and mrs_dr_do agreed to see me. within an hour, i was in her office, explaining what had happened. i'd had her as a professor for one of my classes in the fall, but had never seen her as a patient. i was a bit nervous about this at first (i'm really damn picky about who i allow to treat me after what i've been through over the years), but she immediately put me at ease. she was incredibly helpful, gave me advice, and then ordered a CT scan for me. since i could either go for the CT right then, or wait ten days for the first available spot, i decided to take the appointment that evening. i drove from their office to the CT place, which, fortunately, is only about a block from where i live.

i like this radiology center--i'd been there for my second abdominal ultrasound a few months prior, when my gallstones were finally discovered. the staff there is incredibly nice, and they do some neat things to ensure patient comfort--like providing us with scrubs to wear for the test instead of making us wear those ridiculous paper-thin hospital gowns. i felt relieved to be there and eager to get to the bottom of my problems.

unfortunately, however, i hadn't had anything to drink since before 8am except for the awful, horrible, barium contrast material. so i knew i was dehydrated, which is not a good position for me to be in when someone wants to place an iv in one of my veins. i inherited tiny, deep, rolly veins--in short, i'm a difficult stick. some phlebotomists continue to run in the opposite direction when they see me coming, that's how bad it is. but i'd been having good luck with labs in this town so far, so i wasn't overly worried. at least, not after the first attempt. then there was the second attempt. and a third. at this point, i was ready to let the guy do the damn scan without the intravenous contrast. but he said he'd try one more time (and not dig around this time) to see if he could get it. i guess for me, the fourth time is the charm, because he finally hit a vein in my hand and got the catheter to stay in place. by this time, though, i felt absolutely ill. the insides of both my elbows were raw, as were the backs of my hands. it sucked, to say the least.

antecubital fossa
(i.e. inside elbow)

back of right hand

in an attempt to appease me, though, the technician let me look at my CT scans on the computer. it was exciting to know that i could read them; thrilling to know that i didn't have a pheochromocytoma like the morning's patient; and basically amazing to get to see my body on a screen like that. i could see where the surgical clips had been placed during my laparoscopic cholecystectomy--so that was pretty amazing, too.

by the time i left the imaging center, though, i was a complete mess. i came home, tried to write out some of my feelings on this blog, but ended up saving it for publication until later. mrs_dr_do had insisted that i take a narcotic as well as an antispasmodic for the pain (my gut had been so tender when she examined me that i kept apologizing for guarding the whole time), and, although i really dislike taking narcotics, i followed her instructions and then proceeded to sleep through monday night and almost the entire day tuesday.

i was still sore when i awoke, but the medications had clearly helped. what i couldn't shake, though, was the fact that i'd spent a day as a human pincushion...and got no answers from it. the whole experience left me feeling bewildered, frustrated, angry, and a bit horrified that i'd gone from feeling well to feeling like someone was wringing my guts from the inside, within a matter of moments.

the lingering fears remain: will i ever feel better? will i ever have a consistent period of time where my interactions with the healthcare profession as a patient are positive? what the hell just happened to me? is something wrong, or am i going crazy? will i forever be a human pincushion? i guess only time will tell....

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a little disclaimer...

i'm a medical student. just a student. so please, don't take anything i say too seriously. remember that i was an english literature major as an undergrad, so there is much fiction to be found in these pages. do you think i'm telling a story about you or your illness? more likely, you're tapping into my sense of "everyman"--that is, your story resonates with what i write here because it's not so uncommon after all. need help? please, please go see your physician. <--i'm not her. yet. ;-)