Last week I ended my post with the highlights and lowlights (an old guy’s butt) of my second sinus surgery. I thought all was well when I was discharged from the hospital, and I was very happy to be heading home. We headed home mid-morning. I was ready to see my baby boy and put the whirlwind of a night in the hospital behind me. For the first couple of days, recovery went relatively smoothly. I was having to take more pain medication than before, but I figured they had to remove tissue more aggressively with this surgery, so that made sense. My surgery was on Wednesday, and by Saturday I woke up with a swollen eye and what we call in the profession a unilateral mucopurulent nasal discharge; basically, nasty stuff coming out of the left side of my nose. I was able to stay comfortable on the pain medication, but I was maxing out the dose. When I looked at the vial and saw only a few pills left, I knew I would probably need more to get through the weekend, so I called the number they gave me and asked to speak with the ENT resident on call. I discussed the swelling and the discharge with him, which wasn’t terribly concerning at this point post-op. He said he would write me a script for the medication and leave it in the ER of the hospital. I would have to drive 30 miles to Columbia to pick it up as in the state of Missouri, doctors have to write paper scripts for opioids and can’t legally call them in to your local pharmacy. My husband was putting in some extra hours at work, so my mom came over to drive me to Columbia. My mom showed up, we got the baby ready, and headed to Columbia. I had hoped the baby would sleep during the drive, but he was not in the greatest mood and crying. About 15 minutes into the drive, I decided to mix him a bottle of formula to see if he would take a bottle and go to sleep. I got out my thermos of hot water and carefully started to mix the bottle when I felt the sudden urge to vomit. I told my mom, “You need to pull over. Now!” My mom then started freaking out because I had an open thermos of hot water in my lap, and she started yelling, “Don’t spill the water! Don’t spill the water!” She pulled over into a small driveway going into a pasture, and I immediately opened the door and lost my lunch, and breakfast, and possibly dinner the night before, all while the baby was screaming. I was currently cursing America’s opioid crisis for making my life so much more difficult. Nevertheless, we made it to Columbia and got my script. I went ahead and filled it at the hospital to eliminate having to make one more stop. Over the next day or two, I slowly became aware that even the max dose of pain meds I was on was not controlling my pain. I didn’t understand why this was so much different than my first surgery, where I took pain meds for just a couple of days. I’m also a long distance runner and have a very high pain tolerance. Something was not right. I called my doctor first thing Monday morning, and we discussed the possibility of infection. He prescribed me an antibiotic, the same antibiotic I had been prescribed for my first surgery, and I started it that morning. My pain progressed throughout the day. I spoke to my doctor’s nurse, a good friend of mine, and they said it might be a good idea to come in and have some testing done to rule out meningitis or a CSF leak. It was approaching late afternoon by this point, so they told me to come into the ER and one of the residents would direct my testing. I left my baby with my mother-in-law, and my husband and I left for the ER. My mom met us there, and we waited in the waiting room for awhile. I sat there frantically looking for more and more kleenexes as purulent drainage poured out of the left side of my nose. Gross, I know. They ushered us back to the ER itself. It was a busy night in the ER and the individual rooms were full. They had us in the hallway of the ER with dividers in between patients. The nurse came by and I explained the history and told them the ENT residents would be expecting me. I also told her I was in a significant amount of pain, a level 8 or 9 by this point. She said she would get something for my pain. I decided to distract myself by eavesdropping on the person in the ER behind me. I listened through the divider to what seemed like a college-aged guy. He was anxious and complaining about feeling out of it after smoking a bowl of marijuana with five other friends. I wasn't sure if I heard him right at first, but as the conversation went on it was clear that I did. I floated between being amused and laughing to thinking, “Stop screwing around with this idiot and bring me my pain medication!” Who knew the ER on a Monday night could be so entertaining? The nurse came by with my pain medication. As the nurse was about to give me my medication IV, my mom kindly asked the nurse, “Can I go get you some alcohol wipes?” She then added, “The last nurse didn’t wipe down the port before using it, and that bothers me. You know us old nurses. We need to follow protocol.” My nurse agreed to go get disinfectant wipes to wipe down my catheter. My mom was very nice and tactful, and it felt great to have someone so knowledgeable as my advocate at this time, especially since I was only thinking of the pain and everything else didn’t matter at this point. The nurse wiped down the port to my catheter and gave me a large IV bolus of fentanyl. It was the first time in days that my pain level went down to zero. My whole body relaxed and I lounged back in the chair in the ER hallway with a warm blanket. After days of unresolved pain, I finally had some relief. My mom brought us snacks from the kiosk and they took me back to get a CT. Shortly after I returned from CT, my pain came back again. I knew fentanyl was short-acting, but it still caught me by surprise. My pain went from zero to 10 again in a matter of minutes. It may have been the sudden onset of pain again, or just feeling heartbroken that after getting relief it returned again so quickly. I started hyperventilating and having a full-on panic attack in the ER hallway. The nurse came back and gave me another bolus of fentanyl, but I was so worked up that it didn't work very well. On the tail end of my panic attack, the ENT resident showed up. I kind of felt bad for him considering I was pretty much a basket case. After having a high pain level for days, I was just done. I couldn't take it anymore. I mentioned to him that I had been started on antibiotics earlier that day, but I had been on that antibiotic a lot in the recent past. He was very nice and respectful, and he told me he would scope my nose. He took me to a room to scope me, and it was clear I had an infection. He also took a culture. At this point, he thought about changing antibiotics, but he would go talk to his clinician in charge first. He came back, and they decided to keep me on the same antibiotic pending further culture results. After he left, the ER doctor came in. He told me to continue my current pain medication, but they added a muscle relaxant as I was having spasms in my neck from being so tense with pain. My pain level seemed pretty under control when I left the ER late that night. The next day, I actually felt pretty good. I had a recheck scheduled with my oncologist. When I went in that afternoon, I was feeling encouraged. Before my doctor came in, his resident came in to get a history. I mentioned I had been to the ER the night before for severe pain, and they found infection and ran a culture. The resident said, “Wait. Who told you you had an infection?” I said, “The resident. He scoped me and saw puss in my sinuses.” He looked at the computer and said, “Well, you didn't have a fever or an elevated white count.” He took a light and looked up my nose and added, “Yeah. I really don't see anything wrong here.” I was fuming. I didn't appreciate being treated like a whiny sorority girl, especially by a guy with way too much product in his hair. My mom piped in and said, “She's really not one to complain about pain. She's feeling better today, but something isn't right.” I was just about to school the resident on the difference between a localized and systemic infection when my oncologist walked in saying, “Was I right about those antibiotics, or what?” I gave a knowing glance to the resident. I discussed everything with him, and we decided since I was feeling better we wouldn't make any changes to the antibiotic until the culture results were back, which made sense. I went back home and had a wonderful evening with my son while my husband did some farm chores. I even felt up to taking the baby for a walk in the stroller. It was great to finally feel more like myself again. In the middle of the night, the pain returned. My pain medication could only be taken every four hours, and it was lasting me two hours. Which meant I had two hours of agony between every dose. Ice packs gave me some relief, so I was able to get some sleep by balancing an ice pack on my head. When I woke up, my head was throbbing, and I still had at least an hour before I could take my next dose of pain medication. I had never had migraines before, but I could now understand how your whole body shuts down when your head is throbbing. The baby was fussing and my husband was doing his best to take care of him, but then he handed the baby off to me as it was time for him to leave for work. I tried to comfort the baby for a minute or so and get him back to sleep, and then I just started crying and said, “I can't do this.” I had reached a new low. It was bad enough that I couldn't work, but I had reached a point where I couldn't even care for my own child. “What kind of mother am I?” I thought. My husband looked helpless. I looked helpless. He took the baby to my mother's house, catching her off guard when she was barely awake. And in the rush to leave and get to work on time, he forgot the diaper bag. My mom brought the baby back to my house shortly after, frazzled and confused why my pain had returned. I think it caught everyone by surprise as I was doing much better the day before. I sent my oncologist’s nurse a text message (I know her, and she told me I could communicate with her that way). This is in no way an open door to start calling or texting your doctors and nurses on their personal phones. I know this nurse personally, and she told me to text her (probably because she didn’t want to listen to my mouth breathing over the phone). I told her my pain had returned and that I had reached a point where I could no longer take care of my baby or even myself, and that all of my helpers (my husband and the two grandmas) were getting fatigued and reaching their limit. I told her I was getting desperate. I really don't like that word, but I couldn't think of a better word to describe what I was feeling. She said my doctor would like to admit me to the hospital to get a better handle on things. She said she would let me know when my room was arranged so everything would be ready when we got there. My mom was a nurse, so I might be biased, but, of course, it felt like another amazing nurse came to the rescue. I packed my bags and said goodbye to my baby again. I arrived at the hospital late morning. They started me on fluids, took some labs, and took me in for another CT. My doctor came in to see me, and in an hour or so, they had started me on two high powered antibiotics. I was getting the good stuff. I needed to get up and distract myself, and one of the nurses filled me in that 11 laps around the floor was a mile, so I did just that. I walked a mile. As I walked, I thought about how this whole process made childbirth seem like a walk in the park. I slept a little better that night, and my pain was not totally controlled by the next morning, but better. They told me the next morning that culture results were still pending, so they would probably keep me at least another day. I hung out with my mom in the hospital room most of the day. I told my husband to go to work as I knew he would feel better there and be a nervous, antsy wreck hanging out with me in the hospital. My mom showed me an area where I could sneak out the back of the hospital and take a walk. MU campus was right there, so I would take short jaunts around campus. I'm sure the students walking to class were wondering what in the world was this person doing walking around with an IV pole. At least I wasn't wearing the assless hospital gown. All the while, my medical team seemed unsure why I was in such pain, which scared me. No one likes to be in limbo land, not knowing what is wrong or how to treat it. Later that day, culture results came back. I had pseudomonas and Staph aureus. Luckily, there was one oral antibiotic that both bugs were susceptible to, so I could go home on medication the next day. Finally some answers, and there was an end in sight. My doctor came by to visit again the morning of discharge, relieved that I was feeling better. You could tell he cared. I knew I'd have a long road to recovery. I had dropped 12 pounds since surgery (there goes the rest of my baby weight. Woot woot!), and I was currently having trouble holding down my breakfast due to the strong antibiotics I was on. It had also been the longest I'd gone without seeing my son, and I was ready to go home. I had a hair appointment scheduled that afternoon that I had scheduled months before. I had honestly given up on making that appointment as I figured I wouldn't be discharged in time. I think my mom may have mentioned this appointment to my nurses because all of a sudden there were a team of nurses in my room disconnecting me from my IV, getting my medications together, and one of them even went over my discharge instructions while I pumped. They put in a lot of effort to get me out of there in time for my hair appointment. It doesn't seem like much, but an hour in a nice salon after this ordeal was nice. The nurses doing that for me meant a lot. I got home on a Friday and was taking calls again by Sunday. Returning to work and a little normalcy that following Monday was a great feeling. There were definitely some challenges I wasn't expecting. I can't thank my medical team enough for being proactive and getting me back home and back to work, especially my oncologist, his nurse, and the nurses that cared for me in the hospital. Well, maybe with the exception of the cocky resident, but I’m sure he had his fill of patients who had self-diagnosed themselves on WebMD that day. . I really can’t thank my mother, my husband, and my mother-in-law enough. My mother was my hospital advocate. Having been a nurse for decades, she was qualified for the job. My husband and mother-in-law held down the fort and cared for my baby when I was unable to, which also meant a lot. I've learned a lot from this experience. Firstly, pseudomonas will kick your ass. Secondly, I learned that if I wasn't a tough b!@#$ before, I sure was now. After receiving a letter from my health insurance a few days later denying the claim for my hospitalization, claiming it was medically unnecessary (which has since been resolved), I also began to understand Breaking Bad and how dealing with the American healthcare system could turn a nice teacher into a drug lord killing machine. Joking aside, I’m thankful to have weathered the first phase of treatment, despite a few hiccups.
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Jessica Stroupe, DVM
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August 2017
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