Saturday, October 31, 2009

Not a great week (updated!)

My goal in the hospital is to be the boring patient. Everything goes as it should, no complications, don't need anything from the nurses, and I get out as soon as possible. All of my hospitalizations up until this point have been like that. Now that changes.

I came into the hospital with the gall stone problem already, so we've been dealing with some elevated liver enzymes and the stent (tube) that was put into my common bile duct to hold it open (it was getting clogged with cancer cells. Happy thought indeed). So this tube is sitting in the bile duct, running between the liver and the entrance to the intestine. It's anchored into place but it can still move around. Guess what happened?

Yes, the stent moved, but only a little bit. This may mean that because cancer bad boys are dying the tube can slide around more, but what it really means is that it is now poking me and it hurts. That started a week ago and I had to get back on my pain medication pump because a tube poking into your liver from the inside does not feel good. Of course to find out that the stent had moved I had to get an x ray and an ultrasound. On the plus side, the GI (gastrointestinal) doctor who came to see me was very nice and pretty attractive.

Then on Tuesday I woke up running a pretty high fever. Suddenly a little before noon I developed a horrendous, sharp, stabbing pain in my upper chest and left shoulder. It hurt to inhale, it hurt to move around too much. The pain was unbearable, my left arm was a little numb and felt weak. I honestly thought I was going to die of a heart attack or a pulmonary embolism, I was extremely anxious and upset. They put me through a bunch of procedures to check for heart problems and clots - xray, EKG, spiral CT, ultrasound of my shoulder, blood tests. Thankfully all of the tests came back negative, and I eventually got my pain and anxiety mostly under control with my pain pump. I slept sleeping up because lying down was so uncomfortable. I ran fevers again the next day and still felt pretty crappy, tried to take a walk around the floor but only go one lap in because it hurt so much to breathe. Ate a little lunch (big news because the day before I only had some juice), got an echocardiogram (mostly normal but showed some fluid in the sac around my heart) and then FINALLY started feeling better. I was in less pain, was breathing a little more easily, felt like getting up and walking around a bit. I've felt better every day since, but this is the most scared I have ever been. I really thought I was going to die.

So what was this mysterious chest pain that wasn't a heart attack? Pericarditis, or fluid in the sac around the heart. It's apparently a pretty minor problem that they treat with NSAIDs to reduce inflammation, but you wouldn't know that from the evil resident who came to see me. There is a chain of command in the hospital. At the top of the pile is the attending physician, the "real" doctor who is responsible for seeing inpatients. This is a position that rotates among the doctors in each department (like cardiology, neurology, oncology) and changes usually every month or every couple of weeks. Because I've been in the hospital so long I've seen three different GI attendings and two different oncology attendings. Then you have the fellow, someone who is doing post-residency training to eventually become certified in a subspecialty (like cardiology, etc). Then you get the resident, the low man on the totem pole, fresh out of medical school. The resident doesn't actually know much about patient care but they usually have big egos and think they are geniuses. Residents rotate between different subspecialty departments over 3 years to help them pick out what they want to eventually get certified in. They are sent out to examine the patients and take a history of the problem, then report back to the attending and fellow. They all come around as a team later in the day to discuss your problem with you.

I got THE WORST resident EVER from cardiology. I got the feeling that this guy looked stuff up and then wanted to show off how smart he was by telling you exactly what he had learned, no matter how relevant it was. The first time I saw him I realized that he had a terrible bedside manner and worse personality. He said they were thinking pericarditis and had to tell me all the other possibilities and all of the possible long term effects.... yikes. I was rather upset after he left, it was just so much information and I had no idea which parts were relevant and which weren't. I felt much better later in the day when the whole team came by. The attending and fellow couldn't have been nicer and more reassuring - it really isn't a big deal, it clears up on it's own, no need to worry too much but we'll do some more testing to be sure. Fine. Then the next day the resident comes back to review the findings of a blood test they had ordered the day before to see if my heart muscle was involved in the pericarditis. Gordon had already told me that the enzyme they were looking at was barely elevated and he didn't know what that meant, so I had a little bit of information already. Knowing that the resident was an idiot, I decided that I wasn't going to be too concerned when he came in and told me that yes, it meant the heart muscle was involved and that I was at risk for future heart failure. I just discarded it entirely and decided to ask the attending and fellow about it later when they came around as a team.

When the attending and the fellow came in, they talked about the pericarditis again as not a big deal and didn't seem concerned about anything, so I said that the resident had told me that there was some involvement of the heart muscle and what does that mean? The attending and fellow flatly denied that there was any involvement of the heart muscle and said I shouldn't worry. End of story. I hope he got chewed out by them for making things up and thinking he's a genius. What a loser. Luckily he is the only person at the hospital I've encountered like that so far, but seriously! People like that should not go into medicine!! I think he has some kind of problem, like Asperberger's, maybe. Or at least a case of terminal stupidity.

Then to make matters worse, last night they put me under "droplet precautions." They are testing me for a bunch of viruses that may have caused the pericarditis (may also have been caused by one of my chemo drugs) and one of the viruses can be transmitted by coughing, sneezing, etc. Apparently it is now hospital policy that anyone suspected of having anything respiratory is now being put under these precautions, which are that anyone who enters the room has to put on a plastic gown, mask, and gloves, and I am not allowed to leave my room! Not at all, not to walk down the hall to the kitchen to get some water, not to get myself food, not for anything. I am literally a prisoner in my room. This is ridiculous, and everyone thinks it's ridiculous, but nevertheless, I still have to be put under these rules until the test comes back negative.... on Monday or Tuesday!!! Luckily I was able to get a pass out of the hospital today, I should get one tomorrow, but man, I have to get out of this place. I am going to go completely insane. Today is Day 35 and I am ready to bust out of that joint.

In summary, I am fine, the fluid around my heart will go away on it's own and is already much better than it was a few days ago. The weird part is that sometimes when I inhale I can feel the "rub", this weird vibration of the sac and water and heart moving against each other.

In other news, my hair started falling out. More on that some other time.


L said...

Not to defend residents, but one of my husband's friends is more or less a resident in France and he's just getting over a diagnose-the-worst-thing-possible phase. His little cousin broke out with red bumps all over her body and he said it was a rare Caribbean disease. Turned out it was the chicken pox... I think it's one of those cases where you learn something exists and you start seeing it everywhere, even though nothing has really changed. So they learn about super complications, and are convinced their patient has one.

au soleil levant said...

L - I have definitely heard of this problem, that you become a complete hypochondriac in medical school and as a resident. The problem in this case is that the resident acted completely on his own. He decided that I had this muscle involvement without consulting the attending and told me that this was my diagnosis, speaking as though he had the sanction of the attending. That is completely inappropriate, especially considering the fact that he was telling someone who already has some significant health issues and is in the hospital that she is at risk for heart failure in the future in addition to everything else she has to worry about. I'm not so much upset that he thought I had this other complication because of course he can think whatever he wants, but I'm very annoyed that he took it upon himself to diagnose me without consulting someone who was actually qualified to give the diagnosis (like a real, certified cardiologist). Saying something to me is where he crossed a line.

Zhu said...

I feel for you, from the description, the pain must have been bad, not to mention I would have totally freaked out. Yuck.

I agree with you: the resident's attitude wasn't appropriate. As a patient, I would have felt like you.

Sorry to hear about your hair... Fight, fight, fight! (sending good vibes)

Leesa said...

Holy Moly, Mira!! Can you get rid of the Resident Evil?! You don't need that around you! I am glad you're okay right now but I can only imagine just HOW scary that all must have been!
I will write more later but I wanted to check in and let you know I was thinking of you and that I saw your bf here in Lisboa today!!

Hugs, Leesa

Mary Community Farm Kitchen said...

sounds like you had a fun weekend... :-p what a drag.
let's talk on the phone sometime, ok? love you! xx

James said...

Mira, what an ordeal!I think you should sic your mom on the Evil Resident. Mary says you'll be out tomorrow (11/3). Can you come over? Do you want to? Mary will make pumpkin muffins (if you're allowed to eat them!). Rooting for that tres chic hair of yours to stay put!
Just finished Mme Bovary in English, have a little time before class this week & may try a favorite passage or two in French. It's been a long time since I did any French--need your help! Donna

au soleil levant said...

Zhu - thanks for the moral support!

Leesa - how did he get down to Lisbon from Budapest on his broken feet?! :) Evil Resident is gone now because I don't have to see cardiology anymore, but yeah, he was bad.

Mary - ummm, we spoke, so kind of weird to write you a response here :)

Dr WW - thanks for stopping by, and for the invite. I don't know what time they'll actually let me out so tomorrow probably isn't the best day. I'd be happy to help you with the French if you like.