Our Very Own Hospital Escapade: Part 2, A Turn for the Worse

We waited in the hospital room with our eyes glued to the clock.  Finally, 3:30PM rolled around and I was transported down to surgery.  We were told that the appendectomy would take 30-60 minutes, but the nurse told us that oftentimes, it took as little as 15-20 minutes once they got started.  K and I prayed, he kissed me, and followed the nurse to the waiting room.  I don't remember a thing after that, just waking up in my hospital room with my husband sitting next to the bed.  I was pretty groggy, but I felt good.  My surgeon let me know that they weren't able to take out the entire appendix as it looked as though it had perforated (burst) in the past and walled itself off, attaching to my colon and causing that inflammation.  He thought that it had probably burst again recently, causing my pain. 

My awesome nurse got me up and walking around the hallways early the next morning.  I still didn't have an appetite and my diet was limited to clear liquids (think Jello and Italian Ices.)

My folks came to visit that morning and we enjoyed chatting with them for a few hours. Later that evening, I began to feel awful. My nurse was especially adept and after checking my vitals, called the internal medicine team about my condition.  She also contacted the surgery team.  My temperature was 103.4, heart rate was high in the130s, blood pressure was low (85/50), my white blood cell count (WBC) was elevated (this is a marker of infection which they assumed was from my appendix and colon)  In other words, I was septic.  Sepsis requires a number of criteria to be met:

RN.com

My surgeon came in, examined me, and told me that they needed to go back in and likely take out part of my colon and small intestines.  I was in so much pain that I honestly didn't care, I just wanted to feel better.  They scheduled my surgery for the afternoon, but I continued to decline and they bumped me up to the morning.  I remember talking with K, knowing that I was really sick.  I kissed him and we said our goodbyes, just in case. They had to place a new IV as my first one had occluded (clotted off) and then they gave me the anesthetic.  I woke up around 4:00PM and promptly fell back asleep until 9:00PM.  I felt pretty awful at that point and just wanted to sleep.

Of the next three days, I remember very little.  My abdomen hurt and I was continually nauseated.  I had two more different IVs which also clotted due to the "vesicant" medication I was receiving, (vesicant: damaging to the vessels) namely: potassium and phenergan. 

Me getting a CT scan, the fluid hanging in the IV bag on the right is potassium.

The PICC nurse was called to place a PICC line (peripherally inserted central catheter) and I was so grateful!  It meant that my blood draws could be done through the PICC line and that hopefully, it wouldn't clot off because of where the line dripped the medications into my larger vessels.

AHRQ PSnet

My surgeon came in every day to check on me and examine my belly.  At some point, I asked him about B12 supplementation (why did I do that, my med school friends? 😉) but he said that he only took out six inches of my terminal ileum and eight inches of my cecum.  So I'm no longer the proud owner of an appendix or of fourteen inches of small intestine and colon.

More to come, including my experience with an upper extremity DVT (blood clot in my arm) and how it feels to heal in a hospital.

For His Glory,
KCE

Our Very Own Hospital Escapade: Part 1

This January, we learned that you never know what's around the corner.

Over two years ago, I had some vague right lower quadrant(RLQ) pain while we were in Dominica.

Socratic.org

I visited our school's on-campus clinic and they scheduled an ultrasound for 9/18/17, the day Hurricane Maria hit.  So in the hubbub of the aftermath, I didn't get follow-up back in the states.  Later that year, I had more pain, but our insurance wasn't great and I figured if it got worse, I'd go to the Emergency Dept (ED.) Luckily, it seemed to subside and we continued on with school and life.

At the beginning of this last December, I was busy studying for the COMP exam.  I was under a lot of pressure and my pain returned.  Both K and I figured it was likely due to the increased stress from studying. 

Then, on 1/2/19, I began feeling awful.  K sent me to bed around 7:00 PM and that night, I couldn't even turn over in bed without excruciating pain in my belly.  The next day, we drove to K's folks' home and dropped E off before heading to the hospital.  We went into the ED and I told the physician's assistant (PA) about my pain.  They were worried about a couple of different things; they performed some physical exams and then decided that I probably needed a CT scan of my abdomen.  The CT scan came back and showed "a lot of inflammation" around my appendix and in my small and large intestines.  The doctor came in and told me I needed to be admitted to the hospital.  Scared, but relieved, we waited to go upstairs to my room.  The internal medicine resident came by while we were still in the ED and told us that I'd probably be seen/examined by both the gastroenterology doctor (GI) and the surgeon.  We were blessed to have a single room (I didn't share the room with another patient) and got settled in for the night.

The next day, I was seen by the internal medicine team and the GI doctor.  They were concerned about Crohn's disease and told me I needed a colonoscopy.  As a younger person, I thought the day I'd need a colonoscopy was far off in the future, but when they brought in the GoLytely drink, I laughed and started drinking.

Mooremedical.com

My nurse was sweet and offered to flavor the rather salty GoLytely with Crystal Light.  It tasted like a savory lemonade.  I made it through the first four or so glasses before I had to slow down.  My initial goal was just to drink it and get it over with as fast as possible, but that much liquid in my stomach made me nauseated and I vomited up quite a bit of it.  Still, it did what it was supposed to do.  I hadn't had much of an appetite for the last two days, so luckily I think it took less GoLytely than it might of had I had a normal diet.

I slept pretty well that night (for being in a hospital) and woke the next morning to the phlebotomist coming to draw my blood.  My procedure was scheduled for 8AM and they rolled me down to the colonoscopy suite.  The GI physician and anesthesiologist were already in the room and the nurses who did my prep were so kind. The anesthesiologist started giving me the propofol and I stared at the bar holding up the TV; I was out in less than two seconds.

I woke up after the procedure and the GI doctor explained his findings.  He told me that he was pretty sure I didn't have Crohn's just based on the gross appearance (gross meaning what he could see with his eyes, not the microscope.)  Still, they took biopsies, which they let me look at before sending them to the pathologist.  It's a strange feeling to look at pieces of your intestines.  Then, they showed me pictures of inside my small intestine and colon which were awesome!  He told me he'd consult with surgery as he wasn't worried about Crohn's and definitely thought it was my appendix causing all this trouble.  My surgeon came in a little later and told me that he'd scheduled a laparoscopic appendectomy for later that afternoon.  I was nervous for the surgery, but so grateful that I didn't have Crohn's disease.

Stay tuned for the next part of our hospital adventure!

For His Glory,
KCE

Your First Semester at Ross

Studying during the Basic Sciences:

Medical school is hard.  Information flies at you 10 miles/min and at the end of the day, you’re swamped by how much you learned and yet how much you still have to learn that day. I know I cried a lot of tears throughout my first five semesters due to just feeling overwhelmed.

  

First Semester:

Time management is crucial in making it through first semester especially.  You’ll have lectures in the mornings and lab times a few afternoons per week.  This means you need to get yourself a study schedule and stick to it.  I would look at my schedule and make a table of all my lectures so I could check them off one-by-one as I watched them; I’d also make a column for the second time to watch each lecture as well as each time I wanted to complete the practice questions.

Some people attend class so as not to fall behind.  If you need this accountability, go for it!  During my first semester, my baby was four months old, so this mama wasn’t sleeping through the night, at all.  Because of this, I found myself drifting off to sleep during lecture (sorry professors, I promise it wasn’t you, it was me.)  So I decided to use Panapto and it changed my life.  Panapto is the recording service RUSM uses to tape our lectures so you can watch the lecture at your own pace.  I would get up and go to school, hunker down in my cubicle and watch the lectures at 1.5x speed.  If I missed something, I’d rewind it.  If I needed to pause to think about something, I could.  If I didn’t understand something and needed to pull up a different resource, I could.  Yes, lectures took me a little longer to get through, but I felt like I understood so much more at the end of them than I would have had I sat in class. If you suffer from ADHD and get all sorts of distracted, this might not be the method for you, or you’ll be working till midnight every night to finish things.

When you finish your lectures, do not forsake the professor’s practice questions.  These give you good insight into what they think is important and how they might ask questions on the exam.  When I started doing the practice questions, I saw my exam scores go way up!  Do them right after lecture to see what you missed and then give them a week or so after you’ve reviewed the lecture and try them again (if you haven’t memorized the question) and see if you remember the material.

Using Panapto also allowed me to get ahead for lab.  Because I didn’t go to class in the morning, I’d review for anatomy so that I’d be prepared for lab.  I was blessed with two really good lab partners (we were still dissecting cadavers, which I believe will be done digitally now in Barbados) and one, who honestly slacked the entire time, rushing through things and working in a sloppy manner.  On this note, I’d like to say that medicine is a team-sport, you have to bring your A-game because you’re responsible for how your teammates perform too.  If you work hard before lab, all of a sudden, lab becomes a lot more useful to you and not the time-suck people can sometimes see it as. 

                Outside Resources for Firsties:

1. I’d like to say first that Boards & Beyond Review Series is beyond amazing.  I wish I would have known about it in first because I *suffered* through biochemistry.  Honestly, biochem and immunology were so difficult for me.  They throw a lot of immunology at you in first and it isn’t a discipline (one of the things you absolutely need to pass to get through 1^st, the disciples in first are gross anatomy, microanatomy, and biochem) so immunology gets pushed to the side.  BUT IMMUNOLOGY IS SO IMPORTANT.  (I know you read that as “immunology is so important,” but I mean IMMUNOLOGY IS SO IMPORTANT.)  So much of my remaining semesters would have gone more smoothly had I not had to look up simple things week after week because I didn’t understand it in the first semester.  Here’s where Dr. Ryan (Boards & Beyond) works his magic.  After I watched the immunology videos and biochem videos, I felt like I understood it.  Medical school has a lot of information you can memorize your way through, but not really understand.  When I watch B&B, I get it.  I want you to “get it” too.  It’s $19 for a week trial (I’m not paid, I just love it) and if you are struggling with biochem, try it.  Some of the stuff might be a little advanced for first semester, but honestly, those videos are worth their weight in gold.
2. Second, anatomy challenges you, even if you feel prepared.  You have to learn nerves and muscles, and veins, and the brachial plexus.  I loved kenhub.com for their anatomy quizzes and videos.  https://act.downstate.edu/courseware/haonline/quiz.htm has cadaveric pictures you can use to quiz yourself, which proved immensely helpful for the anatomy practicals.  Other people like Netter’s flashcards.
3. Finally, I’d like to say, in first semester, learn what RUSM professors are trying to teach you.  I’ve seen a lot of great students who just couldn’t make it through first because they tried to do too much.  You have plenty of time to get involved, so give yourself the first semester to settle in and grind it out.

You just have to survive first semester.  You’ll find a rhythm that works for you.  It might be different than what everyone else is doing, but if it works for you, do it.

I wish you the best of luck!