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.
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