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0800 20th of October I'm on my back watching the industrial foam ceiling tiles, AC intakes and white lights go past. Suddenly we come to a mirror. I see myself: I'm lying on a stretcher with the worst beard ever. My face is haggard. An orderly is pushing the stretcher, Kathy is following, carrying my coat. I take a mental picture. I'm at the University of Michigan Hospitals Emergency Room. We arrive at H9. At least I know it's H9 because someone arrives with a sticker and places it on the desk next to which I am parked. I'm in Hallway 9 and flat on my back because any other position causes severe headaches, impossibly severe, especially standing up. It will take two hours for someone to look at me since the beds and all hallway spots are full, thus the creation of H9 just for me. How did I get here? Let's freeze and go back. The Sunday night before I had started developing fever with intense headaches. I frequently have intense headaches with fever. After four days of the usual treatment (ibuprofen, aspirin, etc.) my fever would go down and then come right back up, and the headaches would not go away. I couldn't move around much and classes were about to begin again. So I decided to visit my primary care physician and ask for antibiotics. I had high hopes because when Kathy had gone to the doctor with similar symptoms a week ago, she was immediately given antibiotics. Clearly I got what she had, and I should be given antibiotics too. 1030 18th of October Before I got to my doctor's office, I made sure not to take my tylenol so that my fever would be high. After four days of fever I looked pretty horrible. In fact, I could barely sit up. I didn't count on the fact that in the waiting room, I would be made to wait an hour while old geezer after old geezer was taken in. Receptionist: Virginia! An hour of this with my 104 degree fever manages to pass somehow. I finally see the doctor. He's only slightly older than me. He looks up and says, "Are you a student?" My gaze must not be kind. "Yes." He asks, "What are you going to be when you grow up?" I don't flinch. "A lawyer. But right now, I need something from you because I can't function very well, and I've been waiting here for an hour." To make a long story short, I don't get the antibiotics. Instead, I am dismissively referred to the ER. On the way out, I call Kathy because I can't drive anymore, and one must drive everywhere in Ann Arbor. I feel so sick. But somehow I make it to her work and she drives me to the ER. It's a zoo. We find out later that it is always a zoo, no matter what time of day or what day of the week. It's surprising for a sleepy town like Ann Arbor. Triage means I'm in a hallway. Remember it's only Wednesday now. Kathy is here with me for seven hours. A physician's assistant younger than both of us decides to run a battery of tests. I'm poked, prodded, stuck with needles when all I want is antibiotics. Chest x-ray: negative. Head CT: negative. Blood tests will take three days for results. Finally, the PA asks, no demands for the third time, that she be allowed to perform a lumbar puncture (also known as a spinal tap). It's the only way to diagnose meningitis, she says. It's quite useless to argue that I've always had headaches with fevers, and sometimes without as well. So I'm wheeled into a room for the first time. Before she does the LP, the PA gives me a single dose of antibiotics. I ask her if it's necessary to do the lumbar puncture if I am already getting antibiotics. "That's the way it's done," she replies. The needle goes in. Liquid fire runs down my leg. Kathy watches the PA draw four tubes of clear liquid from my spine. We wait an hour. The tests are, not surprisingly, negative. No meningitis. We are allowed to go home, and thankfully, my fever goes down for the first time. I feel like I'm starting to recover. 1000 19th of October My whole world is upside down. Every time I sit or stand or do anything but lie flat on my back I get intense headaches. Especially when I stand, the headache is so bad that I can't take more than a few steps. Eventually I figure out that the best way to handle this is to lie flat on my back with an arched lower back. We spend Thursday night like that. 0700 20th of October Kathy reads the discharge instructions. It says, "If headache intensifies, return to the ER." So that's how on early Friday morning I am hobbling in pain across the courtyard to our car. The 15 minute ride to the ER is the most painful of my life. I feel every bump on the road as hot knives slicing my brain. When we arrive at the ER I dive onto a stretcher. They start wheeling me to my usual place, the hallway. All rooms are full already, you see. By 10, an ER physician arrives and explains that I have what's called a post lumbar puncture headache (PLPH). What they didn't tell me on Wednesday, and which we aren't told now either (Kathy finds an article online) is that in young males the PLPH has a 33% incidence rate. There's a hole from where the needle went through my spinal membrane during the LP. Every time I do anything but lie flat on my back, my spinal fluid leaks out, dehydrates my brain, and causes said headaches. The more pressure, the bigger the headache, thus the impossibility of standing. The ER doctor explains that there are two treatments: lie flat on one's back, take lots of caffeine, drink lots of fluids, and hope that the hole heals naturally. This process takes two to eight days in 85% of cases. Or a blood patch. Anesthesiologists perform this procedure, which involves taking one's own blood and injecting it over and around the area where the hole is. The blood clots and seals the hole. Recovery: one hour to one day. The young anesthesiologist comes downstairs to explain the procedure and the risks. If they tear the membrane again, recovery will be even longer. If they inject blood into the spinal area, there may be nerve irritation. I agree to the procedure, even though Kathy and I are both a little suspicious. I ask the ER doctor why he can't perform it. He says, "It's a very simple procedure. We just don't do it, even though it's simpler than a spinal tap." When the time comes, after a two hour wait, we are wheeled upstairs to the OR. I am fitted with electrodes and hooked up to the machine that goes bing! There is a team around us ready to operate. "For a relatively simple procedure it sure looks complex," I say. "It's the way we do things in the OR," says the anesthesiologist. He has to check in with his boss, but we are ready to go. My temperature is checked a final time and found to be slightly elevated. So the boss tells me that they can't do the procedure, because even though the chances are very low, I might have a bacterial infection. If they inject bacteria into my spine, they may give me meningitis. Two degrees lower and they would have done it. I'm told to go home and to come back when my fever drops. They both leave. I remain on the OR table with Kathy sitting next to me for about half an hour, still hooked up to the machines. It turns out that we can't be discharged from the OR. We first must return to the ER. Finally, someone wheels us downstairs. Finally, the ER lets me go home. "Drink lots of caffeine. Lie flat on your back. Sorry it didn't work out. Come back when your fever drops," they say. After seven hours, we leave for another painful, jolting ride back home. It's our third anniversary. 2000 28th of October I'm still on my back. Kathy is doing me the favor of transcribing this for me. My fever is as high as ever. My PCP still won't prescribe antibiotics. When we phoned today, he told us to return to the ER. Today there was a football game with 130,000 people in town. I declined the invitation. Harsh words were exchanged. Moral of the story, my friends: NEVER go into the ER unless you are about to die, especially to a big teaching hospital. On Sunday morning, I was starting to lose it, dizziness, ligtheadedness, general world spinning effects prompted me to wake up Kathy and we drove into the ER for the third time - why? you may ask. Because we had no other recourse. Much to our luck, we managed to get the attention of that rarest of creatures - the senior attending. In about an hour, she had ordered another chest xray, saw the pneumonia without needing to confirm with radiology and (finally!) shot me up with IV antibiotics and prescribed pills as well. It was the 8th day of my pneumonia. She then went and confirmed that last Wednesday's chest x-ray also had had the signs of pneumonia, which had been missed. They kept me there all day Sunday and then discharged me home. Ever since then, I have been slowly getting better, but I still have difficulty sitting or standing up for longer than 5-10 minutes. I want to take this opportunity to salute the American medical profession for their principles and strict stand on irresponsible use of antibiotics on the one hand and their trigger-happy approach to the spinal tap on the other hand. As one ER doctor wrote to me: "Of the otherwise healthy patients who have a spinal tap to look for meningitis in the emergency department less than one case in a hundred will demonstrate bacterial meningitis or encephalitis. Remember that bacterial meningitis is a rare enough condition that when these cases occur they frequently make the front pages of your local newspaper. No one wants to be on the front page of the local newspaper!" So they went ahead and tapped me to make sure that I did not have that less than 1% chance of making the papers! Their efforts to keep me off the newspaper pages will not easily be forgotten. Of course, no one makes the papers because of late administration of antibiotics so I understand why they insisted on 100% proof, disregarding such trivial indications as patient's wife just had pneumonia and responded to antibiotics, patient is coughing, patient has said that he always has headaches with fever, etc.. Ann Arbor, 26 October 2006 |
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Copyleft notice: Copyright (C) 1999-2005 Mustafa Ünlü. This information is free; you can redistribute it and/or modify it under the terms of the GNU General Public License as published by the Free Software Foundation; either version 2 of the License, or (at your option) any later version. |