It took three trips to the emergency department, and two to urgent care, before I was admitted to the hospital for observation. This is a story of pain and occasional relief, assembly-line medicine, frustration and fear.
Monday, May 6th was a mostly unremarkable day spent in various meetings with occasional bouts of actual productivity. I was feeling a very slight low back pain with just a touch of the old pins & needles in my feet. I needed to talk to a co-worker upstairs before I could leave for the day, and I usually bound up steps two a time. I knew something wasn’t right, though when I hit the first step and my leg didn’t push me up to the next. I slowed down and walked up the steps normally, figuring I was just exhausted, or at worst case had pinched a nerve in my back.
I didn’t think much of it until the next day. I was scheduled to work overnight from home on Tuesday, so I stayed up as late as I could watching Netflix and then slept until nearly noon. I could feel the back pain intensifying, but it was now centered over my kidneys, making me think I was just severely dehydrated. By the time I tried to sit down and work, I couldn’t sit up straight without excruciating pain. I gave in and asked my wife to take me to the hospital – a decision not made lightly, considering she had just gotten our daughter to sleep.
- Emergency Department vist #1: Arrived and was seen by a triage nurse and physician almost immediately. Spent the next six hours getting an EKG, blood draw, CT Scan, CT Scan with contrast, baseline neurological exam and repeating my history to everyone in scrubs. I was released at around three in the morning when a physician in cowboy boots referred me to a neurologist and my family doctor, then told me to go home and take aspirin. I suspect he thought I was drug seeking and turfed me. I took the aspirin and augmented it with 800 mG of ibuprofen, still thinking I needed to fight the inflammation of at least one bulging disc. I called the neurologist’s office and made an appointment with her nurse practitioner – two weeks out.
- ED vist #2: by late Thursday, May 9, aspirin and ibuprofen were doing nothing. The pain was ratcheting up and I needed some kind of relief. I was again seen immediately by a triage nurse and physician, who ordered an MRI of my back, new blood work and EKG. We were sent to the waiting room, where I spent at least an hour trying to sit and focus my way through the pain. A radiology tech finally came out to talk to me and he could see that there was no way I could lay still on the table, so he worked with the ED staff to get me some relief. Relief came in the form of 6 mG of morphine. The nurse pushed the first half and asked if I felt it yet; when I told her I didn’t, she pushed the other half and swept all of the pain and tension away. I was able to lay motionless on the MRI table for about an hour and then I was taken back to an ED bed, where a charge nurse gave me another 6 mG of morphine to hold me over while a radiologist read the MRI, which didn’t show any injuries that explained my symptoms. I was prescribed Flexeril and Percocet and sent home, still feeling pretty good from the last dose of morphine. We picked up the drugs and I started them on the way home. By mid Friday morning, all of the pain was back and then some.
- Urgent Care visit #1: Still working off the pinched nerve assumption, we went to an urgent care facility in the same hospital system as the ED. They looked up my records, I told them that the drugs weren’t effective and they upgraded me to Valium and Vicodin, along with a MethylPrednisone pack to fight inflammation. We went back home, where I took everything prescribed and slept for almost 22 hours. When I finally woke up on Saturday afternoon, I felt like I had been beaten with a baseball bat. I continued the new prescriptions through the night, unable to sleep or even find a position of comfort.
- UC visit #2: Given the choice of what to do on Mother’s day, I would have made my wife breakfast in bed and spent the morning playing with our daughter. Instead, I had her take me back to the urgent care. By this time, I could barely walk. The numbness and tingling was turning into loss of motor control. I collapsed to my knees in the waiting room, and was seen by the same nurse and physician that saw me on Friday. While we were waiting in an exam room, I began to notice neurological deficits in my face. I realized that I couldn’t close my left eye unless I was also closing my right eye. I started doing my own stroke assessment – I looked at my wife and smiled, arched my brows, stuck out my tongue, etc. All displayed some drooping or paralysis on the left side. When the physician came in, I told him we were in the wrong place; we needed to be back at the ED, and he agreed.
- ED visit #3: Arriving at the ED with handoff documentation from the urgent care and clear neurological deficits, I was seen immediately. I’d given my own history so many times that I was now stating it in SAMPLE/OPQRSTI form. A whole new round of standard ED tests were ordered and performed. I was given morphine and Percocet while we waited for results. Sometime around noon on Mother’s day, I was admitted to the observation ward – I guess so they could continue to observe my deterioration.
In all these visits, we had only ruled out possible conditions. I was feeling less and less in control of my body with every hour and no closer to a diagnosis or definitive treatment.