So this is what happened, after we left off somewhere around POD (post op day, if you have not been reading) 36 or 38 or 40.
I had a few good days of feeling an echo of normal after the gabapentin cleared out. Mark went to San Francisco for Memorial Day weekend to see a friend. My breathing got worse. I could only do one flight of stairs before I had to sit for a few minutes. I couldn't understand it. I thought I had pneumonia, thinking I'd been too inactive while under the influence of gabapentin. That was the only thing that made sense. No way I had a pulmonary embolism, I was walking still. But I didn't feel good yet. Still. I went to my PCP, and she did a chest Xray. Don't hate on my PCP, because I like her a lot...but she didn't take from the CXR that I had a pleural effusion (and I didn't see the report). That's not weird in primary care, just unfortunate. She prescribed a Zpack on a Thursday, May 26 and told me to follow up the next week. I started the Zpack.
Sunday night, May 31, even I had to admit that something was really freaking wrong. I was laying in bed at 11pm by myself at a 45 degree angle because I just couldn't breathe. The Zpack had done nothing. Something was really wrong. Mark wasn't flying back until Monday. I took myself to the freestanding ER a mile away (which happens to be a UCH freestanding ER), and told them, "Maybe I just need some levaquin." I figured I might as well go, because it's not like I was going to sleep, and Mark wasn't home anyway, so I wasn't needing to drag him to the ER for some Levaquin.
Yes, I didn't really believe I needed Levaquin. I was just telling the cats that. I was still figuring that if I took care of it while Mark was in San Francisco, at least I wasn't dragging him with me. ERs suck. Not on purpose, but nobody likes being in them.
I'm a difficult patient. No, I really, really don't think I need an IV. Please, do you HAVE to? No, I don't want any meds. A D-dimer? Well, okay if you have to. D-dimer's "really high"? Naw, couldn't possibly be a PE. That's ridiculous. I walk. See? I have a Fitbit now, I walk. I can show you. CT scan? *sigh* Oh, all right, if you really have to. But it's not a PE. I'm not panicking. See? I'm annoyed, look at annoyed face. This is not PE face.
Getting that CT was miserable. I couldn't lay down well for it, couldn't hold my breath, and he had to give me contrast twice. I am a pain in the ass patient.
We waited for the results. I watched cooking shows. I let Mark doze off in his hotel, promising to text with news. It was around 1 in the morning at that point. Finally, the ER doc tells me, "You have a HUGE pleural effusion." Really? "Yeah. I think you need to be admitted." That big huh? "Yes." Well. Shit. sigh. All right. Don't call an ambulance, that would be ridiculous. I have to make sure the cats have food first. "The cats? You do realize that most people would be insisting on being admitted to the ICU right now." DON'T. YOU. DARE. put me in an ICU bed. I don't need an ICU bed. You *might* be able to persuade me to go to tele, but no way in hell ICU....all they need to do is tap it. I just need a tap. And yes, I'm going to feed the cats. You get me a bed, I promise I'll go. But there's no reason for the cats to go hungry and I drove myself here....I can drive myself there.
He was a nice guy. He said, "It's actually nice because there is something ACTUALLY WRONG with you. And we can fix it." So you're sayin now is the time to tell you I'm allergic to everything for pain but Dilaudid, right? "It's so refreshing that there's really something wrong with you." Glad I could help.
I asked that he get me a bed at the U, my employer. (I'm texting Mark this, and then I told him to get some sleep.) I went home and fed the cats, wondering nonstop who would be the pulmonary on call. Drove over to the U, went up to the 6th floor (which is transplant) with my overnight back and my Surface with some freshly-downloaded books at 3:15 in the morning, bumping into my nurse, Kelly, on the way. Kelly was great. I had her both nights for the first UCH admission. My day nurses on transplant were really nice too. I feel badly that I can't remember their names.
There's always something about night shifters that I connect with, though. I can't do it myself anymore, but night shift is my kind of people. Somehow.
That week, I got tapped three times. Each time was exquisitely painful. And that's from a woman who's three month postop from chest wall reconstruction and I don't take anything for pain. Oh, and I'm walking around with two fractured ribs.
But I'm getting ahead of myself.
The two nights I spent on Transplant (floor) were a blur, due the sleepless nature of everything. I got tapped by a resident, a Dr. Mike (I've chosen to not use the last names of my UCH docs). I was his 15th tap ever. (I asked after. I didn't want to know.) He got 1.5 liters of fluid out from my right pleural space. I was breathing GREAT in comparison. The hospitalist attending was a nice guy, and sort of patted my hand through it. (Why the fsck they don't get a nurse in the room for these procedures bowls me over.) The first tap was the least painful, probably because less overall pleuritic pain (when lung tissue has friction against the chest wall), because my lungs were essentially floating around in more fluid initially. And maybe because he was using a vacutainer. That's my hypothesis. Might be bullshit.
He stopped at 1.5 liters, because that's typical to not take too much at once. (Most people don't GET more fluid than that in their pleural space, but that's beside the point.) I wanted him to take it all, but I understood why he stopped. I was breathing much better right away. The pain sucked. That's all there is to it.
The second tap was done in Interventional Radiology by a fellow who'd done MANY taps. That tap was the most painful. He was surprised I was feeling anything, but the tears rolling down my face didn't really slow him down. He pulled out of the left, syringeful by syringeful and I felt every single bit. At least I had a nurse to hold my hand, though.
That sounds stupid, my insistence on a hand-holder. That shit hurts. So it isn't stupid.
Throughout this, and at a decent hour, I texted Jim, one of my attending docs. He was in the ICU, so he was looking through my chart and was aware of everything going on. I thought he was "on service", meaning he would be my pulmonologist (and I was relieved in this notion). But he didn't get formally consulted during the first admission, and my memory is blurry (and sleep-deprived) so I don't think I even saw him. I saw Jon, one of my fellows, though. He introduced himself to Mark (who came straight from the airport) as "one of my coworkers." He was wearing a T95 mask, because I'd been put on tuberculosis precautions....the thinking was that since I work in the pulmonary clinic, I may have been exposed to TB. (I made a huge stink about that.) I said, "(Jon), you know damn well I don't have TB. Take off the mask." (He did.)
The working theory of what caused this at the time was that this had been essentially a slow leak building up from the surgery, and once drained, everything would be done. The leak would theoretically heal. They worked me up for a lot of infections. So. I am positive that there are a lot of different viral infections I do not have. So, I guess that's something.
Kelly was my night shift nurse again Tuesday. I had a really great day nurse Tuesday. Likely because I was on TB precautions and the plan was to discharge, I saw my day shift nurse Wednesday for 40 seconds from her arrival at 7am until around 2pm, when we left. I almost said something about that. (i.e. "What did you chart that my lungs sounded like?") I wasn't feeling snarky enough, feeling that karma would take care of that issue. Every other single person had been good to me.
I went home. I said to myself, "Self, maybe it's over now. Really over. With the setbacks and the drama and crap....maybe from here on out...I can just get better." And of course, I kept waiting for the other anvil to drop.
And drop another one did.
Thursday afternoon, Jim called. "Michelle, the tapped specimens grew out bacteria. Both of them." I didn't say much at first. He was gonna bring me back in. And he had to. I have fucking bacteria in my pleural space, I was thinking. And there is only ONE way that it got there.
.....and I'm gonna have to return to the story later, because I'm keeping Mark up. I have to get up early, and so I need to be a good girl, take my Trazodone and go to bed. A lot more happened.