A new experience

I have a list, and I’m pretty sure that everyone else probably has the same list. I call it my “worst experience of my life” list. The problem is that I keep adding to it. And of course, I now have a new experience to add to this list that for some reason, just keeps growing. Let me tell you about it.

Tuesday morning, I got up looking forward to a good day. Monday night, I had taken my last dose of oral chemo medication for this round of therapy. Typically, after this, I can start looking forward to a week or so of feeling better before I start the next round of chemotherapy. The day began well enough. I went to the hospital to have my blood drawn as I am supposed to do twice a week after chemo. I returned home, relaxed for a few minutes as Patti got ready to go over to our daughter’s house to watch our two grandkids. We try to help out when we can since Mariah (our daughter) works two days a week as an MA in the family practice office where I have worked for the past 6 years.

Anyway, Patti left a little after 8:00 a.m. and I was here alone (Patti always worries about leaving me alone here asking me if I am sure I will be alright). I checked a few e-mail messages and answered a few then went into the kitchen to have a bowl of cereal. I ate well, watched a little TV news, a couple of minutes of “The Price is Right” and then called over to the hospital to check on the blood work results. At about 10 minutes after nine, I began to feel a little chilled. I checked the thermostat - the temperature was 72 degrees. Within minutes, I was shaking all over and didn’t feel very well. I decided to crawl back into bed to get warm for a while.

Shortly, I began to experience the most violent and severe shaking I had ever experienced in my entire life. I don’t think in all my years of medical practice that I have ever seen anyone shake as much as I was except maybe in a grand-mal seizure. This shaking went on forever. I finally called Patti and told her I needed help. I ached all over as if someone had beaten me with a ball bat and I was still shaking so uncontrollably that I just couldn’t stand it. Patti arrived just before 10:00 a.m. and at just about that same time, everything started to settle down.

Patti swears that she will never leave me alone again. She says that I looked horrible. She called the oncology nurse at the Huntsman Hospital in Salt Lake to report what was going on. They advised us to go to the ER here in our area to get checked.

It took every ounce of strength to drag myself out of bed and get to the car. I had been shaking for nearly an hour. We went to the ER at Timpanogos Regional Hospital in Orem, Utah, the ER where I had moonlighted as a PA for nearly 4 years. I know most of the docs there and many of the nurses and this is where I go for my blood draws because of my central line. They can draw blood right out of my line without having to be poked in the arm twice a week.

So, ultimately what happened is that I had a fever of 102.5 degrees. Blood cultures were taken (one sample from my central line and another from my arm) and I was admitted to this hospital because when the ER doc called the cancer hospital, they had no beds. I was able to request a very good internal medicine doc that I have worked with and known for a number of years as my admitting physician since I haven’t had a primary care provider forever. There are advantages to working in the medical field. The hospitalist that was on call for that day isn’t one of my favorite people – I won’t go into details about that, but I was thrilled that the doc I asked for was willing to admit me.

I was placed on IV antibiotics (Imipenem) and placed in an isolation room on the 4th floor of the hospital. I ran a fever for another 24 hours but felt much better on Tylenol. My initial blood pressure in the ER was 87/59 so they gave me fluids as well.

Ultimately, the blood culture drawn from my central line grew out bacteria known as streptococcus viridans. This was interesting because the blood culture drawn from my arm showed no sign of bacterial growth so the infection was within my central line. It has been in place since February. The next task was to get rid of the central line.

The concerns for my doc were the fact that I had rheumatic fever when I was 19 and ended up in a hospital in El Salvador for two weeks for treatment and the fact that my mother had bacterial endocarditis (an infection within the heart) that ultimately destroyed her aortic valve and resulted in her having two valve replacement surgeries in the early 1960s when that kind of stuff was experimental. This particular strain of bacteria has the potential to cause bacterial endocarditis. Great. Just what I need at this point in my life.

A wonderful (patient, kind, conversant, jovial, etc.) general surgeon was called in to remove my central line. She worked on it for about an hour and could not get it to release and come out. Try as she might, it was just stuck somewhere. I could feel tugging clear up in my neck as she worked on it. You see, the central line is a plastic tube that enters my chest at about heart level just to the right of my breast bone, tunnels up through the skin, over the top of my collar bone and then enters my jugular vein and into the top chamber of my heart. This is the way I receive fluids and drugs for my chemotherapy.

Finally, the surgeon decided to call one of the vascular surgeons in town. She explained the situation to him and he showed up in about twenty minutes. After about 30 minutes of him gathering supplies and getting his gloves on, putting on sterile drapes and so forth, he took one look at the central line, said, “Oh, I see the problem.” I heard a snip and felt nothing. He pronounced that he was done and I thought he was pulling my leg. He reassured me that he was indeed done and that was that. He put on a bandage, recommended that I not cough, sneeze or lay flat for 24 hours and let him know if I needed an new line put in because he’d be happy to do it in about a week if requested.

As a result of having my central line out, I had an IV started in my right hand to allow for infusion of the IV antibiotics and fluids. I had an echocardiogram of my heart Friday morning – results still pending.

I am feeling much better. In fact, I feel better now than I have for about a month which makes me wonder if this infection wasn’t smoldering for some time.

I am already scheduled for placement of a new central line on the 4th of November at the Huntsman Hospital. I will also be getting a new chest CT that day to see if the new chemo drugs are having any effect on the cancer. I’ll also have an MRI of the primary tumor site to see if there is any discernable regrowth at the excision site.

The worst part of this - that I am adding to my “list” - is the violent and uncontrollable shaking that started on Tuesday morning. I have never before experienced anything like that and I hope to never do so again. I hope my list is completed. I would be just fine with that.

Many, many thanks to everyone that helped! The ER staff, the hospital staff, my internal medicine doc, the general surgeon and the vascular surgeon, family and friends who called. I am so thankful for their kindness and genuine care. I am so blessed.

Jim