I showed up in the emergency room, and asked the ED doc for some iv fluids and some zofran, and told her that I didn"t need any more than that, I didn"t think, and that I would just leave. She offered me some narcs, I declined. She offered me a ct scan, I declined, and then she said, "will you at least please stay for some labs and for me to curbside gi on how to get you in to see someone before next februrary?", and I agreed. Then, she walked away, for a bit (she had sick people to see, I think), and came back just a few minutes later, and sort of laid down the law. She said unless I stayed for the abdominal ct (I think it was useless, but the ED scans pretty much everybody with tender bellies), the lab results, 2L of IVF, 2 doses of iv steroids, and a gi consult (she said they would come by at 7am), it would be against medical advice. So, I started to negotiate ("How about 1 dose of the steroids and I"ll see the gi doc in a couple of days as an outpatient..."). At some point, the dilaudid started, and every time I tried to get my stuff together to go (or asked my nurse about some discharge papers), they drugged me again. Sneaky bastards. I do have to admit, I was quite uncomfortable, and dilaudid is quite effective for eliminating pain. I wasn"t snowed enough to be considered "chemically restrained", but at the same time, you give 1 mg of dilaudid to someone who"s essentially opiod naieve, and in addition to relieving them of pain, you will releive them of the motivation to sign out AMA, or really to leave at all.
The night was kind of bad. The ED just isn"t a great place to hang out. Between the woman having an MI next to me and the lady yelling at the top of her voice, "bring me more dilaudid you f---ing c-nt!!", it"s just not terribly restful, and everything that is annoying is more annoying when you"re nauseated and having severe diarrhea. (dilaudid fixes that, too!).
Around 8 am I realized I wasn"t going to be able to go home, and even if I convinced them to discharge me or to bring me AMA paperwork, I wasn"t going to be able to work safely. I still was getting lightheaded and profusely sweating just walking to the bathroom, so I finally agreed to stay, and they took me to a hospital room. They actually hid me away on the oncology floor in a very tiny but pleasant and private room wiht a view of the ocean. The one good thing about UC is that if you get admitted to the hospital, there"s always the possibility you could have C.diff, so you always get a medically necessary private room.
The nurses were extremely sweet to me. One brought in movies and books (that I was too fatigued to watch or read). They were very conscientous, and even went above and beyond the call of duty. In fact, my only complaint about the hospital is that the pillows suck. If I"d realized they were going to talk me into staying, I would have brought my own. For a couple of days, I felt too ill to concentrate on reading or movies, but started to spend more time awake. This is the annoying part of being sick. And I got so bored. I tried going for a walk, but didn"t make it very far. Anyway, the nurses and aids would come in and actually chat with me. I felt a little bad about it, because I"m sure that they were busy, but I really appreciated it.
The gastroenterologist was, perhaps, a weirdo. I can"t decide if he"s a good doc or a bad doc. He sort of tread the line between being condescending and setting limits. Apparently he"s the one that suggested the scheduled (as opposed to as needed) dilaudid (and it actually did slow the bathroom trips down a lot) that started in the ED. When he saw me the morning I was admitted, I told him that since I"d tolerated the ct contrast, I could probably go home on some oral steroids the next morning. I told him I really wanted to go to work, that it was a new job, and my first one out of training... blah blah blah. He listened for a little bit, but then stopped me, and said, "If you won"t stay for 48 hours of IV steroids and until you"re eating 3 meals a day on oral prednisone, then your gut won"t heal, and we don"t have anything else to talk about. " And he basically threatened to fire me if I left before his conditions were met. Now on one hand, I can see how he was probably right. I was a little anemic and a little dry on admission. On the other hand, well, he really was kind of bossy about it. On the third hand, I hope this doesn"t mean that he"s going to yell at me all the time as my doctor, "cause I"m not into that. At the same time, he was, in other ways, very nice. I was explaining that I had been on prednisone for most of the last 2 years, never had a sustained remission, really, and that I"d gained like 40-50lbs on the prednisone. He told me, "Of course you did, almost everybody does, and we"ll get you off the prednisone". And he told me a plan. And a plan in case the plan fails. And, aside from being bossy about staying in the hospital, he was pretty nice. And I guess, as a doc, I know that there are times when I just have to put my foot down to my patients, but usually it"s about something serious, like the fact that they are putting themselves or their baby at risk of death by leaving the hospital. Not about the merits of inpatient vs outpatient treatment. So now I"m wondering how nice of a guy he"ll really be. I mean, maybe he really did think it was vital for me to stay in the hospital? Or is he really a bit of a jerk? Everybody says he"s the best guy for inflammatory bowel disease in the northwest, but nobody says he"s the nicest guy around. At the same time, if he gets me feeling well consistently and off the prednisone on a long-term or permanent basis (without a colectomy), do I really care if he"s a nice guy? I mean, nice is better than mean, but good is better than nice. My UC was, apparently been mismanaged by a pretty nice guy for a while, so maybe I should just be glad that I get to trade nice for good?
The rest of the hospital stay was the same. Too much dilaudid, too much food, which I forced myself to eat so that they would be sure to send me home. And the last week has been pretty good. I was home on Saturday, back to work on Monday, and I"m on call this weekend. The weird thing is? I feel so good now, I think I"ve probably been sicker for longer than I would have thought, if that makes sense. I haven"t felt this good in maybe a year? Even the prednisone side effects, which are annoying (sleeplessness, increased apetite, weight gain, hot flashes), are worth it to feel this good right now.
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