Friday, October 12, 2012

mystery elbow

Recovery from surgery number three seemed like it would go smoothly. Sure I had a lot of stitches in sensitive places, but at least I knew what to expect and had been feeling close to great for most of the summer. Bullshit comes in sets. I should know this by now. Just as I am getting sick of my head swimming from painkillers and my guts aching from the stuff you have to take to keep the painkillers from making life rough later (please accept my guarded lavatory euphemism), the elbow on my dominant arm spontaneously develops some sort of cellulitis/arthritis combo. I went to the ER with an elbow that had received no trauma but was huge, red, and nearly immobile. I am between PCPs right now (working it out with insurance), and my immunocompromised body doesn't have time to wait on paperwork when a possible infection is involved.

I waited in the ER for four or five hours before I was seen. It isn't particularly unusual to wait a long while, especially if trauma patients come through. but this felt excessive. Two men situated at a diagonal over the shoulders of R and I loudly complained to one another about the wait repeatedly and tried to make small talk with any women seated alone. A three-year-old who had clearly hit his little wall was shout-babbling and squealing in toddler Spanish at his parents while shoving his hands in every box of tissue strewn about the waiting room. Exhausted and trying to milk the last bit of cold from a tepid ice pack it took an hour to track down, I was led to a bed in the hall by the Life Flight elevator. I was seen by some surprisingly upbeat nurses and doctors who eventually determined I had cellulitis, possibly MRSA because that's what it always seems to be when I have cellulitis. While I waited for my discharge paperwork, a young woman who looked close to my age but was probably 8 years younger was escorted on a gurney directly across from me by several officer's from the sheriff's department. A doctor was getting frustrated trying to find out from one of the officers what she had taken because the officer wasn't looking at whatever sheet he had that apparently had a list of her choice of poisons. Heroin, possibly meth. I didn't know people combined the two. It seems contradictory like smoking a lot of pot and drinking a cup of coffee, but what do I know? I just watched this filthy, writhing creature restrained by the ankles to her bed and moaning. I was managing a lot of ongoing pain sites but this poor girl was truly miserable. I was glad to go home. 

Doxycycline must be taken on a full stomach or unfortunate hijinks in your digestive system will result. An apple and a beautiful fig galette is not a full meal unless you are four. My deepest regrets to the people on the grain mill outlet's restaurant patio trying to enjoy their lunch. I tried very hard to make it out of sight and past the trees, but when that failed I am pleased at least I made it to the storm drain and didn't dally. I always carry my big, orange water bottle so I hope it made it less terrible to witness when I rinsed the drain off so you wouldn't see the evidence on your way home. I heard one of you point me out. I hope you didn't notice me sitting behind a tree trying to call my fiancé who was still in the store. Or maybe I hope you did see me and you saw how mortified I was and you forgave me in your mind for upsetting your Saturday lunch with the kids.

It only took two days for the redness to disappear, leaving just a bit of dark, puffy elbow behind. Still, stiffness and soreness prevailed. My discharge paperwork included instructions to return to the ER for a follow-up visit so I made a plan. I refilled my prescription at the bottom of the hill, took the tram to the main hospital with snacks and tea all set and checked myself in a little before 2pm. I was triaged right away and there were only two other people waiting so I hoped I would be ready to go by 5:30. The waiting room began to fill up once again with people loudly complaining about waiting, vilifying trauma patients, and giving up on trying to control their children. R arrived right after work and almost immediately a grubby man in a wheelchair started shouting across our laps at a pretty, blonde woman sitting alone. I silently begged her to stop encouraging his awkward, booming, flirtatious chit-chat but alas she was as nice as she was attractive and my patience started to fray when the man's chatter became nonsensical after about seven minutes and continued on for what felt like another twenty. I watched "The Pacifier" starring Vin Diesel four times through, including the additional insult of sitting through ten minutes of doofy DVD menu music each time before the film restarted itself. I had the sense to claim my waiting room territory near one of the only power outlets and my perfectly charged smart phone provided blessed access to the hospital's wifi and thus my Netflix account. With my elbow throbbing from a lack of any good resting position and my stitched bits screaming for heavy drugs or a hot bath, I turned to "Freaks and Geeks" to sooth my rapidly-building distress. I was brought to a triage room where I would be quickly seen by a doctor and sent on my way after waiting over seven hours.

The doctor who examined me was worried infection had snuck its way into my joint. A sweet nurse who went on and on about both our names being Gaelic names meaning "strong" blew my vein trying to take a sample for my CBC. I had been wary of the wrist IV because I didn't care for it at my most recent surgery. My wrist ached for days and is still a bit bruised. I should have asserted myself but I didn't and got a puffed-out wrist full of blood and a wad of gauze wrapped tightly around it. I asked for ice to dull the sensation that I'd slammed my wrist in a sliding glass door. Nurse B had told me they call it the "intern vein" because it's so easy to hit and still she popped that needle out the other side and sent me careening past my wall. I didn't even hit it, I just took my ice pack and sat feeling roughed up while I waited for the orthopedist. 

Gentle guy, that orthopedist, and not too keen on dealing with patients who have hit their limit of taxing  stimuli and are in an unmanaged and exhausting amount of pain. Or, I irritated him by trying to plead my way out of a fluid tap and having a bit of a panic spell when I was told it was the only way to be sure bacteria weren't eating their way through my cartilage. There were other patients who needed attention and here I was sort of losing my cool trying to fight the urge to flee over a needle poking me in the elbow. Finally, despite the supremely unhelpful suggestion from the orthopedic nurse that I calm down and breathe through my nose, I channeled my 20-year-old self who watched as her wrist was stitched up following a freak dishwashing accident. I steeled myself, stared at the denim-covered knees I had tucked up to my chest and tried to find my zen spot. I was allowed to examine the needle before it went in because I am not comfortable flying blind, and the initial insertion was nearly painless. Then there was some manipulation of the needle in my elbow that stung and made me feel nauseous, followed by wrenching and suctioning that sent sickening waves of pain down my arm and into the palm of my hand. I yelled a bit and cursed a bit and it was finally over. Both my arms were immobilized with pain and I lay sprawled on the bed drenched in cold panic sweat. Adrenaline lit up all my cells and made my muscles twitch and I babbled for a minute to R about never wanting a fucking needle in my elbow again. 

I was admitted overnight. If my elbow was being consumed by infection I would need to have it surgically examined and flushed clean. The orthopedic team wanted to begin surgery as soon as the results came back. R settled in to the reclining chair in my observation room and I watched "Skins" and set off the IV regulation machine every ten minutes trying to scratch my nose. The last wisps of adrenaline and anxiety were replaced by complete fatigue by about 2am and I slept fitfully until the orthopedic team arrived at seven o'clock to announce the meager amount of fluid they were able to tap and test showed no signs of bacteria and I was free to go. R took the day off work and we went home to rest.

I slept for two days. My library books are overdue, I have missed a number of calls I still haven't returned, and I went into painkiller withdrawal because sleeping through taking them is an inadequate step-down plan when you have been taking my small dosage for a number of weeks or months. I feel sort of better now: I'm at an energy level that is my minimum for functioning outside my bed, but my elbow is as sore and 90% as stiff. I'll be going to occupational therapy next week for some excercises to keep it from freezing up forever.

All this and still no one really knows what happened to my elbow.

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