I really like James Patterson. Every book of his is a lightning fast read. It helps that each chapter is less than five pages. Private Games was no exception.
A mad man has targeted the 2012 Summer Olympics in London. First the chairman of the committee in charge of logistics for the Games is found ruthlessly murdered and beheaded on the eve of the much -anticipated opening ceremony. Peter Knight takes a personal interest in the case when he discovers the victim to be his mother's fiance. During the spectacle of the ceremony that night, a popular track star is poisoned and dies. Thus begins a wild ride as Peter Knight, his employer Private Investigation, and a journalist, try to uncover the truth.
This is very typical Patterson. Fast-paced with more twists and than you would expect. The end is very come from left-field too. Really fun.
Saturday, April 27, 2013
Thursday, April 18, 2013
It All Fell Apart Part Two: Lost Lines, Lost Weight, Found Perspective
So, I finally made it to a room at 5 AM on April 4. I thought I would get to sleep at that point. Not so much. The transport folks transferred me to the bed and then the nurse and tech started doing things to me. First the nurse moved my offending IV to a better position. Then she and the tech put a mattress pad under me the purpose of which I could never figure out. The nurse started doing the typical intake things. She checked my skin, did a social history questionnaire and the other stuff that needs to be done when you're brought to the floor. They also finally stopped the TPN I had come in on. I didn't much care what they did to me as long as they helped me get warm. The good news was my fever was breaking. The bad news was I was having severe shaking chills as a result. I don't think I've ever had chills that bad. My teeth were chattering,my muscles were all tensed to the point that I couldn't move. They piled blankets on me and after a painful two hours, they subsided.
At this point it was nearly 7 AM. Shift change and morning rounds began. Big Academic Medical Center is a teaching hospital That means rounds are a staggered affair. First. you see a medical student, then the intern, then an attending. The med student was the one who did a lot of the work for me. He told me that my heart rate had come down with rehydration but was still high. He seemed encouraged that my fever had broken. He said they'd just observe me until the blood cultures came back. On physical exam we discovered that I had some tenderness over my kidneys. This led him to think that I might have what he called an asymptomatic bladder infection and not a line infection. I know I didn't go to medical school, but wouldn't the fact I had had a fever mean that whatever was going on was symptomatic? Anyway, he finished his exam and left just as the new tech came in to do the first check of my vitals for the day. Any illusions I had had about this being anything other than a line infection were shattered at that point.
My fever was back and my heart rate was back in the 130s. Awesome. Soon, the resident was at my bedside looking perplexed. There wasn't a whole lot he could do until the cultures came back. I settled in to wait for those. In the meantime, I continued to receive broad-spectrum IV antibiotics and fluids since I was no longer getting TPN.\ The reason I continued to get antibiotics is because central line infections can turn deadly quickly. They always err on the side of caution.
Per the GI consulting on behalf of my GI, I could get only IV saline and dextrose for up to a week and be fine. I believed him that time. After taking weeks to be anywhere near human again, I'm regretting following that advice so blindly. The thing is, TPN can't be run through a regular IV. There is a version of it called Peripheral Parenteral Nutrition that can be run through a normal IV. If, heaven forbid, this happens again, I will insist on beginning PPN as soon as I lose my PICC.
Around 1 that afternoon, the medical student came in and said that the cultures had grown staph bacteria. This organism grew on the plastic of my PICC line, even with strong antibiotics on board. The line needed to be removed before we could hope to clear the infection. A few minutes later the resident walked the med student through removing my line and snipping the tip so it could be cultured. I can't remember now whether they cultured the end that had been near my heart, or the outside end. The good news was I was already on the right antibiotics to treat staph. The bad news was that I would be stuck n the hospital until at least Monday. I would need a new PICC as soon as my blood cultures had been negative for two days. The earliest that would happen was Sunday. The thing was the people who placed PICCs weren't in the hospital during the weekends. So Monday it would be.
The rest of Thursday and most of Friday passed rather uneventfully. I had an EKG late on Thursday. I also had orthostatic vitals taken at some point to check my hydration status. I checked out fine.
Late Friday afternoon, I had an echocardiogram to make sure my heart wasn't infected. This is a very real risk of central line infection given the line's proximity to the heart. I am convinced that test irritated the pocket where my stimulator lives. Since that day I have had significant pain in that area. I had Dr. B. check it out before I left since I was on his turf and he said it was fine.
Saturday's labs showed my potassium was low, so Saturday night was spent in tears as I experienced the internal fire that was IV potassium. Sunday was a low-key day. Monday, I had my line replaced and thought I was going home. Turns out my nursing agency had declined to take me back after I was discharged but neglected to say so until a few hours before I was due to leave. So I didn't get homthate until very late Tuesday night.
Since then, it's been a long slow recovery. I lost enough weight that I noticed. We tweaked my TPN formulation pretty substantially this week to help me regain that weight. I am still more easily fatigued than before.
As awful as this experience has been it gave some much needed perspective. Before this, I thought the worst thing that could happen was losing my job. Now I see there are worse things.
At this point it was nearly 7 AM. Shift change and morning rounds began. Big Academic Medical Center is a teaching hospital That means rounds are a staggered affair. First. you see a medical student, then the intern, then an attending. The med student was the one who did a lot of the work for me. He told me that my heart rate had come down with rehydration but was still high. He seemed encouraged that my fever had broken. He said they'd just observe me until the blood cultures came back. On physical exam we discovered that I had some tenderness over my kidneys. This led him to think that I might have what he called an asymptomatic bladder infection and not a line infection. I know I didn't go to medical school, but wouldn't the fact I had had a fever mean that whatever was going on was symptomatic? Anyway, he finished his exam and left just as the new tech came in to do the first check of my vitals for the day. Any illusions I had had about this being anything other than a line infection were shattered at that point.
My fever was back and my heart rate was back in the 130s. Awesome. Soon, the resident was at my bedside looking perplexed. There wasn't a whole lot he could do until the cultures came back. I settled in to wait for those. In the meantime, I continued to receive broad-spectrum IV antibiotics and fluids since I was no longer getting TPN.\ The reason I continued to get antibiotics is because central line infections can turn deadly quickly. They always err on the side of caution.
Per the GI consulting on behalf of my GI, I could get only IV saline and dextrose for up to a week and be fine. I believed him that time. After taking weeks to be anywhere near human again, I'm regretting following that advice so blindly. The thing is, TPN can't be run through a regular IV. There is a version of it called Peripheral Parenteral Nutrition that can be run through a normal IV. If, heaven forbid, this happens again, I will insist on beginning PPN as soon as I lose my PICC.
Around 1 that afternoon, the medical student came in and said that the cultures had grown staph bacteria. This organism grew on the plastic of my PICC line, even with strong antibiotics on board. The line needed to be removed before we could hope to clear the infection. A few minutes later the resident walked the med student through removing my line and snipping the tip so it could be cultured. I can't remember now whether they cultured the end that had been near my heart, or the outside end. The good news was I was already on the right antibiotics to treat staph. The bad news was that I would be stuck n the hospital until at least Monday. I would need a new PICC as soon as my blood cultures had been negative for two days. The earliest that would happen was Sunday. The thing was the people who placed PICCs weren't in the hospital during the weekends. So Monday it would be.
The rest of Thursday and most of Friday passed rather uneventfully. I had an EKG late on Thursday. I also had orthostatic vitals taken at some point to check my hydration status. I checked out fine.
Late Friday afternoon, I had an echocardiogram to make sure my heart wasn't infected. This is a very real risk of central line infection given the line's proximity to the heart. I am convinced that test irritated the pocket where my stimulator lives. Since that day I have had significant pain in that area. I had Dr. B. check it out before I left since I was on his turf and he said it was fine.
Saturday's labs showed my potassium was low, so Saturday night was spent in tears as I experienced the internal fire that was IV potassium. Sunday was a low-key day. Monday, I had my line replaced and thought I was going home. Turns out my nursing agency had declined to take me back after I was discharged but neglected to say so until a few hours before I was due to leave. So I didn't get homthate until very late Tuesday night.
Since then, it's been a long slow recovery. I lost enough weight that I noticed. We tweaked my TPN formulation pretty substantially this week to help me regain that weight. I am still more easily fatigued than before.
As awful as this experience has been it gave some much needed perspective. Before this, I thought the worst thing that could happen was losing my job. Now I see there are worse things.
Sunday, April 14, 2013
It All Fell Apart Part One: Lost Jobs and Long Nights in the ER
It's been awhile. Sorry about that. Life is exceptionally sucky right now.
Remember how I said work was really important to me? Well, I lost that job. A combination of the sequester and my needing to be homebound to get help with TPN led to my being let go. That happened at the end of March.
I spent the last week and a half of March job searching, filing for unemployment, and figuring out how to get my Social Security reinstated. I struggled emotionally to understand how I could be in the position of having to find a job again. It was hard enough interviewing when all I had to contend with were people's attitudes toward my using a chair. Now, I am going to present a whole new set of challenges at some point in the process thanks to GP. Talk about stressful. So things were in major flux.
Then April 3 happened.
I had felt exceptionally tired all day. I didn't think much of it since I'm often really tired. I also had some body pain that was new but I figured was explained by a lowish potassium found on my weekly labs drawn just two days before. As five o'clock neared, I actually took a nap at my desk waiting for my nurse to come. Weird. When the nurse came she unhooked me and I took a shower. I noticed I was weaker and had a harder time transfering than I do normally. Again I chalked it up to being tired. I got dressed while she got my next bag out and ready. She hooked me up, started the pump and started taking my vital signs. She told me my blood pressure wasn't low, but it was very "loud." My pulseox was fine, but my pulse was 135 reading from the pulse oximeter Wow. That machine is finicky sometimes, so she checked it manually and still got 110. High, but I had just been moving around and getting dressed. Then, she took my temperature. She asked me if I felt sick. No, why? My temp was over 100. Because I have a central line, a fever is a huge red flag for infection.
I had my nurse call the on-call GI covering for my motility specialist. She wanted to call my primary doctor. I knew it'd be best to let my GI handle it since I have the PICC for TPN. While we waited for the on-call to call back, I put shoes on and began gathering my supplies to sustain me through an admission if it came to that. The on-call called back and after hearing my vitals said I needed to go to the ER. I got my stuff together and headed out to the metro.
About 45 minutes later, I made it to Big Academic Medical Center. I headed to the ER and checked in. Every time someone took my pulse, they had to check two to three times to be sure it was right The first time I saw what it was, I wasn't all that surprised. It was reading 145, but I was feeling every one of those beats. I was brought back to an exam room fairly quickly.
When they hooked up the monitor, my heart rate ran between 150-160 beats per minute and my temp was hovering around 100. I was sitting still, not running a marathon as my heart rate seemed to indicate.The doc ordered a chest film and blood cultures. The x-ray to rule other sources of infection like pneumonia and the cultures were to check for an infection of my PICC line or in my bloodstream. They drew blood from my line and collected it in a jar that would be allowed to grow after being exposed to air. They drew blood from my other arm as well and collected that sample in a jar that would grow without the help of air. They also wanted a urine sample they could culture to rule out a bladder infection. Thanks to the fever and despite having TPN running, it took nearly three liters of fluid for me to deliver that.
My brother had met me in the ER and was a huge help. He distracted me and turned off my heart monitor every five minutes when it alarmed because my heart rate was so high. The rate began to come down as I was better hydrated, but stayed above 100 for the next two days. My fever trended down too, but was still high enough to be a concern.
Around 10:30, I was seen by the ER Attending. He asked some questions from behind a computer monitor. He decided I should be admitted in light of my fever and tachycardia. I called my dad to let him know I was staying, texted my mom, and then waited to go upstairs. My brother hung in there until midnight, but had to leave at that point. I hung out in my chair for another couple of hours but was transferred to the gurney at 1:30. I busied myself by eavesdropping on the goings-on in the ER. The stories I heard ranged from a woman seeking drug rehab, to a barely-drunk but very angry 19-year old college kid who was apparently there against his will thanks to a contract between the hospital and the university on whose campus the hospital lives.
Around 2 AM an internal medicine doc came down and saw me. She said she wanted them to stop my TPN in case that was a source of the infection. Apparently fungus likes to grow in TPN. Who knew? She said I would be given a peripheral IV in my right arm so that they could stop using my PICC.
The ER nurse had started me on two broad-spectrum antibiotics, Zosyn and Vancomycin which I was on for the duration of the admission at twice daily dosing. She also started an IV in my right hand that ranks near the top of my Most Brutal IV Experiences list. She found a good vein quickly. When that vein rolled, as my tiny red-head veins are wont to do, she FOLLOWED it. This fishing expedition meant an extremely awkward and painful placement into the boniest part of my hand. The bruise that line left is only now starting to fade.
Around 5 AM after nearly 9 hours in the ER, I was finally brought up to the fifth floor where I would spend the next six days.
Stay tuned to find out what grew!
Remember how I said work was really important to me? Well, I lost that job. A combination of the sequester and my needing to be homebound to get help with TPN led to my being let go. That happened at the end of March.
I spent the last week and a half of March job searching, filing for unemployment, and figuring out how to get my Social Security reinstated. I struggled emotionally to understand how I could be in the position of having to find a job again. It was hard enough interviewing when all I had to contend with were people's attitudes toward my using a chair. Now, I am going to present a whole new set of challenges at some point in the process thanks to GP. Talk about stressful. So things were in major flux.
Then April 3 happened.
I had felt exceptionally tired all day. I didn't think much of it since I'm often really tired. I also had some body pain that was new but I figured was explained by a lowish potassium found on my weekly labs drawn just two days before. As five o'clock neared, I actually took a nap at my desk waiting for my nurse to come. Weird. When the nurse came she unhooked me and I took a shower. I noticed I was weaker and had a harder time transfering than I do normally. Again I chalked it up to being tired. I got dressed while she got my next bag out and ready. She hooked me up, started the pump and started taking my vital signs. She told me my blood pressure wasn't low, but it was very "loud." My pulseox was fine, but my pulse was 135 reading from the pulse oximeter Wow. That machine is finicky sometimes, so she checked it manually and still got 110. High, but I had just been moving around and getting dressed. Then, she took my temperature. She asked me if I felt sick. No, why? My temp was over 100. Because I have a central line, a fever is a huge red flag for infection.
I had my nurse call the on-call GI covering for my motility specialist. She wanted to call my primary doctor. I knew it'd be best to let my GI handle it since I have the PICC for TPN. While we waited for the on-call to call back, I put shoes on and began gathering my supplies to sustain me through an admission if it came to that. The on-call called back and after hearing my vitals said I needed to go to the ER. I got my stuff together and headed out to the metro.
About 45 minutes later, I made it to Big Academic Medical Center. I headed to the ER and checked in. Every time someone took my pulse, they had to check two to three times to be sure it was right The first time I saw what it was, I wasn't all that surprised. It was reading 145, but I was feeling every one of those beats. I was brought back to an exam room fairly quickly.
When they hooked up the monitor, my heart rate ran between 150-160 beats per minute and my temp was hovering around 100. I was sitting still, not running a marathon as my heart rate seemed to indicate.The doc ordered a chest film and blood cultures. The x-ray to rule other sources of infection like pneumonia and the cultures were to check for an infection of my PICC line or in my bloodstream. They drew blood from my line and collected it in a jar that would be allowed to grow after being exposed to air. They drew blood from my other arm as well and collected that sample in a jar that would grow without the help of air. They also wanted a urine sample they could culture to rule out a bladder infection. Thanks to the fever and despite having TPN running, it took nearly three liters of fluid for me to deliver that.
My brother had met me in the ER and was a huge help. He distracted me and turned off my heart monitor every five minutes when it alarmed because my heart rate was so high. The rate began to come down as I was better hydrated, but stayed above 100 for the next two days. My fever trended down too, but was still high enough to be a concern.
Around 10:30, I was seen by the ER Attending. He asked some questions from behind a computer monitor. He decided I should be admitted in light of my fever and tachycardia. I called my dad to let him know I was staying, texted my mom, and then waited to go upstairs. My brother hung in there until midnight, but had to leave at that point. I hung out in my chair for another couple of hours but was transferred to the gurney at 1:30. I busied myself by eavesdropping on the goings-on in the ER. The stories I heard ranged from a woman seeking drug rehab, to a barely-drunk but very angry 19-year old college kid who was apparently there against his will thanks to a contract between the hospital and the university on whose campus the hospital lives.
Around 2 AM an internal medicine doc came down and saw me. She said she wanted them to stop my TPN in case that was a source of the infection. Apparently fungus likes to grow in TPN. Who knew? She said I would be given a peripheral IV in my right arm so that they could stop using my PICC.
The ER nurse had started me on two broad-spectrum antibiotics, Zosyn and Vancomycin which I was on for the duration of the admission at twice daily dosing. She also started an IV in my right hand that ranks near the top of my Most Brutal IV Experiences list. She found a good vein quickly. When that vein rolled, as my tiny red-head veins are wont to do, she FOLLOWED it. This fishing expedition meant an extremely awkward and painful placement into the boniest part of my hand. The bruise that line left is only now starting to fade.
Around 5 AM after nearly 9 hours in the ER, I was finally brought up to the fifth floor where I would spend the next six days.
Stay tuned to find out what grew!
Subscribe to:
Posts (Atom)