Death by Christmas Lights Saga II

"Sepsis" was the answer my wife heard in response to her question of "What could be causing this?" Although other possibilities were given, this was the only word she heard. My wife began to weep quietly as the emergency room staff scurried around me in an effort to elevate my blood pressure. My gurney was placed in Trendelenburg, elevating my feet above my head. IVs were run "wide-open "to "push "fluids. Everyone's attention was on me. No one, not even me, noticed my wife sitting in a chair in the corner with quiet tears running down her cheeks.  We had lost our first born child, Alyssa, to sepsis 16 years before, to the month. Now she was faced with the possibility of losing her husband to the same.

Test results came back. "The usual suspects "were ruled out. Since no explanation for my symptoms were identified, I was admitted with the expectation of whatever was causing my symptoms would declare itself by morning.  

That night I dreamt that I was floating in a sea of white translucent balloons.  Slowly, one by one, balloons began popping, the pops gradually growing more rapid.  As more and more balloons popped, I could see vague silhouettes of bodies and tops of heads scattered in the distance around and below me.  Suddenly I was awoken by a deafening POP by my head.  A nurse stood over me placing a cold pack on my sweaty forehead.  My clothes were soaked, my body drenched with sweat and covered by cold packs.  She informed me I had a temperature of 105F and was trying to cool me down.  The nurse placed her last pack and left the room.  I went back to sleep.

I woke in the morning to a horrifying sight.  The swelling and dusky, purplish discoloration of my left elbow had extended up to my left shoulder and down to my fingers, which looked more like pudgy sausage links than digits.  The swelling made the joints of my arm and hand stiff and difficult to flex.  

Hospital transport took me to radiology for an MRI of my elbow.  Again, I was treated to the MRI’s cacophonic symphony, only this time I was unable to endure the entire performance.  The loudness of the deafening “duff-duffs”, “blop-blops” “screeeeeches” and “rat-tat-tats” ricocheted and frenzied through my head as severe claustrophobia from being in the tight, narrow tube-like opening of the MRI scanner gradually overtook me.  I shouted “I CAN’T TAKE THIS ANYMORE!”  The test was halted.  Fortunately I lasted long enough before panicking  for them to get “what they needed”.

Later that morning, Dr. Irvine, the orthopedic surgeon, performed a bedside I&D (incision and drainage) of my elbow WITHOUT LOCAL ANESTHESIA.  Before he could finish explaining to me how the local would prolong the pain and procedure, it was over.  Although, I did feel some discomfort, more like popping a zit than slicing through skin.  His assistant then elevated my arm using a sling of gauze wrapped around my elbow extending to an IV pole raised to the ceiling to keep my arm elevated above my heart.  This was done in an attempt to help drain edema fluid from my arm decreasing the swelling, an unsuccessful concept at best.

Early that afternoon the Calvary arrived, Dr. Farin Manian.  Dr. Manian, an infectious disease specialist I had the fortune of being treated by two years previously for abdominal cellulose took charge of m.y case.   With him managing my care, a relaxed sense of relief came over me.  His calm, confident demeanor and assuring bedside manner conveyed “Its going to be OK my friend.  I’m here.”

Death by Christmas Lights Saga - I

“There’s your problem right there,” said the hospitalist as he lifted my left elbow, in my newly occupied room at St John’s hospital, during my admission history and physical.  As I looked at my elbow, I saw a sight that wasn’t there 2 hours earlier in the Emergency Department.  My left elbow had dusky, purplish discoloration and was swollen to approximately three times its normal size.  Finally, what was happening to me started making sense.  However, what was about to come, I never would have imagined.

It was Wednesday, December 1, 2010.  Early that morning I had awoken with night sweats, shaking chills, and a high fever.  With my wife’s help, I headed to the bathroom thinking my symptoms were caused by the Betaseron injection I had administered prior to going to bed that evening.  These symptoms are not uncommon side effects to patients taking betaseron.  I had become all too familiar with them over the previous sixteen years, however, occurring less frequently the previous decade or so...and less severe.

I crawled back to bed, thinking that sleeping the few hours left till sunrise would help me recover my strength.  It didn’t.  When I woke at 6:45, my symptoms had worsened.  “Maybe a few more hours of sleep” I thought. I informed work I was using a sick day and went back to bed.  I woke up at noon feeling even worse.  Unable to open my eyes, let alone get out of bed, I knew it was more than a reaction.  Something bad was happening.  My wife called an ambulance.  

In addition to an ambulance, two fire trucks and three police cars came I’m told.  I have no recollection.  Despite not being able to open my eyes, I mapped the route we took by the turns the ambulance made and was able to fairly accurately tell where we were.  Even in my altered state, the fun loving jokester in me persisted.  When the ambulance was almost to St. John’s Hospital, I asked for the siren to be turned on.  After all I WAS in an ambulance.

Being brought in by ambulance to the emergency room is a great way to avoid the typical several hours ER waiting room wait.  Though I don’t recommend it.

Once in the ER, the scripted, controlled chaos of the medical staff began as it does for any patient brought in by ambulance.  IVs were inserted into my veins for hydration and potential medication administration.  A blood pressure cuff was strapped to my left arm.  A pulse-oximeter was applied to my finger to monitor the oxygen content of my blood.  EKG leads were applied to my chest to monitor my heart rhythm.  Chest X-rays, urine, sputum, and blood were obtained.  All to “rule out the usual suspects”.

As I lay on the gurney in the room, waiting with my wife for my test results, I began noticing a dull, intermittent irritation to my left posterior elbow, the intensity and caliber of which worsened seemingly unnoticed as the hours past.  By early evening, the dull irritation transformed into a sensation of hundreds of tiny little needles, rapidly jabbing into the skin of the back of my elbow.

“Uh, Dr. Yanuck, are you feeling okay?” a nurse asked.  “Aside from being on a gurney with IVs and monitors strapped to me in an emergency room, I’m doing great.” my jokester replied.    Why do you ask?”  

“Is your blood pressure usually 90/60?”

“Ruh Roh.”  This was definitely no side effect.

-To be continued-