L'hopital rule, part 3: l'hopital proper
Continuing the chronicle of how i wound up in the hospital for all of Memorial Day weekend -- and pausing first to note that i'm happy, healthy, and okay right now, that all this happened in the past, though not too distantly -- recall that Friday night i had strange Vicodin-induced dreams of swallowing a lot, which upon waking i realized were related to my now-swollen uvula and my misguided desire to somehow swallow it whole. So armed with a swollen jaw and a swollen uvula, i began my weekend...
(NB: this is looooong, but writing it down feels worthwhile.. perhaps there are a few nuggets of entertainment buried within!)
Day 1, Saturday: First things first -- assess the severity of the situation. Uh, lots of mysterious swelling, difficulty opening my mouth, continued incessant tooth/gum pain, elevated temperature... it is probably necessary to escalate things. (Sometimes i think perhaps i hedge too much...) But how immediate is the problem -- can i like, eat? Turns out i can: at least, i can eat small slices of banana and half-spoonfuls of yogurt. So i spend like a half hour getting some nutrition in my system to prepare for what seems likely to be something of an intense day.
Second things second -- take care of the Kraken. Food and insulin shot at the usual time, and my Skyland responsibilities are discharged for the next 12 hours.
Finally, get in touch with someone. But who? My dentist? My oral surgeon? Dentist's not open on Saturday, but has an "emergency email address", so i send a note there thinking it can't hurt. Pittsburgh Oral Surgery is open on Saturday, though, so i call them up, too. Turns out Dr. Smiga (my current practitioner at this time, the one who evaluated me the other day) isn't in the Shadyside office today, but he's in Mount Lebanon, so i should call there. And turns out it's really hard to get an oral surgeon actually on the phone, but i relayed a message to the receptionist that things had gotten worse, my uvula was now swollen, and i wasn't sure what to do. Then waited for a callback.
I didn't actually get to talk to Dr. Smiga, but the receptionist reported his assessment: uvula swelling is completely unrelated to the tooth (!!?), and i should go to Urgent Care. Well, i believe one of these things, so i take my next dose of antibiotics and head out for a lovely, sunny walk down Centre. (Spoiler alert: this turns out to be the only 20 minutes i get to enjoy the beautiful Memorial Day weekend weather we got this year :P) Somewhere between arriving at the Urgent Care and seeing a physician's assistant there, i texted Rob to enlist his help should i need emergency car services, and in true Rob fashion he's all "Sure thing, just let me know if things escalate". Eventually, the Urgent Care doctor looks me over and says something like, "wow, looks like that tooth infection is really spreading (!!! hah!), we'd better send you to the ER (...?? eep..)", and i text Rob like "escalate now.. Meet me at UPMC Shadyside ER".
This is something of a turning point, because this is when things start to get real. But at the same time, it's kind of a happy moment, because it's the beginning of actually being seen by people who believe i need medical attention -- for the first time in like a week, i feel like things are probably going to be okay, even though i have no idea what's in store.
Anyway, at the ER, i mostly did a bunch of dozing and waiting. Rob and Chris came to hang out, which made the waiting less boring, but still, mostly there was just a lot of waiting. Over an hour or two they collected some blood samples, hooked me up to an IV, asked some bookkeeping questions (including possibly something about being vegetarian? but no, "that'd be dietary*.."), and had an actual real ER doctor look me over. While making small talk with Chris and Rob, i mentioned offhandedly that if we wound up being here for a while (unlikely as it is! i think it was early afternoon still..), someone was gonna have to feed the Kraken and shoot her up with insulin at 10, which Rob take careful note of -- this whole time, Rob was diligently taking copious notes in a tiny red Carnegie Mellon notebook, a strangely comforting and surprisingly useful coping mechanism.
(* more on "dietary" later -- it's basically a euphemism they use to avoid referring to the things they serve you from the hospital cafeteria as "meals", or "food".)
The ER doctor decided that i needed a CAT scan, to see how far the infection had spread (ugh..), and to determine if i needed emergency surgery (ack! what..) or just intravenous antibiotics (now that's more like it..). Lizzie expressed concern in group chat, because CAT scans involve a lot of radiation and are probably overprescribed in hospitals, but after asking the ER doctor some pointed questions, i decided it sounded like a necessary step -- especially if it meant the possibility of not being operated on! So i do the whole CAT scan dance (with contrast, for what it's worth), and ultimately the results show "no discrete collection" of pus (thanks, Rob!), meaning no emergency surgery to drain (phew!), but they wanted to admit me overnight anyway (doh..) and administer IV antibiotics (ooh!).
And so we got serious about the Kraken business. I gave as good a lesson as i could from an ER gurney on administering insulin shots (easier than it sounds, and there are YouTube videos), passed on the keys to Skyland, and started letting it sink in that i was actually going to be in a hospital overnight for the first time in my adult life. (I'd spent some time in a children's hospital in Cleveland once or twice when i was 4 or 5, but my memories of it are spotty at best..) We also made a tentative plan for getting my stuff to the hospital -- surprisingly simple, since i'd been all set up to stay overnight at Skyland already, so my overnight bag basically just needed to be repacked and transferred. Having all my stuff (toiletries, clean clothes, laptop, a book to read) really made a big comfort difference, and i'm super thankful Rob was able to fetch all of it!
Around 4 pm they started administering the first bag of IV antibiotics, and i swear, i could feel my gums deflating in real time! I guess there was a lot of inflammation and bacterial nastiness, and i guess it started getting cleaned up pretty quickly. Actually, can i just pause for a moment to sing the praises of IV medication? I mean, what amazing future technology is this, where the moment you check into a hospital, the first thing they do -- no questions asked -- is fit you with a custom, disposable bio port they can use to send root-level commands to your blood system, bypassing almost all the usual security checks and processing mechanisms. And that shit works fast!
So while antibiotics are shooting directly into my veins and the bacteria in my gums are literally dying instantly, Rob has the brilliant idea to ask if i still need to finish the puny oral antibiotics i've been taking. 'Cause, you know, they're usually pretty clear about that -- finish all of this medicine, even if you feel better, etc. The ER doctor says to me, "What are you taking? Amoxicillin? Yeah, just this once, you don't need to finish that... What we're giving you is basically like amoxicillin... but better... plus something else to make it super-powered." (The ER doctor was pretty great..)
Eventually, after Chris and Rob departed for dinner and daybag fetchquest, i was wheeled up to a posh, corner room with a mini fridge up on the 7th floor of the Pavilion building, in a small, quiet urology ward that had some extra space to handle overflow patients. Turns out this was probably the best room in the hospital to spend a few days in, perhaps karmically to make up for the fact that in the ER, they'd just kinda shoved me off into a corner behind a curtain. I mean, seriously, it was like a hotel room up there..
While i was settling in, figuring out how things worked, i was paid a visit by Dr. Davies from Pittsburgh Oral Surgery, who was apparently the on-call doctor that weekend, and who, in her inimitably excitable yet medically certain manner told me that in fact, we probably would need to do emergency surgery to drain some abscesses anyway (!!?). I was full of questions and concerns -- i'd gotten used to the idea of not doing surgery, and i wasn't particularly excited about the idea of having somebody cut into my neck without giving the matter plenty of thought. I talked with the nurse who was tending me that night and asked why the ER doctor would've said no surgery while Dr. Davies says yes surgery, and she said something about it being Dr. Davies's specialty, so she probably knows better. But i was in no mental state to make a decision on this tonight, so i managed to talk Dr. Davies down to doing IV antibiotics overnight and re-evaluating things in the morning. She promised to return bright and early, around 5 am.
Dietary orders for the day: NPO, which is Latin for don't eat or drink anything. Because who knows, surgery may still be imminent, if things get worse. So now i'm gonna be scared and hungry.. Mobile unit Chris/Rob/Lizzie thoughtfully bring me delicious Ethiopian food, but into the fridge it goes, its friendly comfort to be provided at a later time when my body is less required to be ready for general anesthesia at a moment's notice.
Showered around 9, just before my second dose of high powered antibiotics. Showering was something that had taken a back seat that morning, and i feel like it was an important recentering activity, washing away the day's stresses and clearing the cobwebs from my mind..
Night 1, many phone calls and much thought: I talked to my family a great deal before turning in, since it was my first real chance to have a long phone conversation after this somewhat overwhelming day. In particular, i talked for a while with my brother John, a medical professional himself, to try to come up with some questions i could ask Dr. Davies in the morning to help attain clarity on this proposed surgery. John had some great suggestions, somewhat obvious in retrospect, like "what are other options?", and "what are the risks?".
I typed a bunch of thoughts into a text file, and throughout the night, i kept updating it as i thought of new questions. I was really worried about being pushed into making decisions without a proper understanding of the consequences, and writing down questions and eventual answers turned out to be a really great way of staying on top of my mental state throughout the whole ordeal. And so with sugar plum fairies and medical concerns dancing through my head, i drifted off for a few hours of sleep...