Zeus Births Athena

Hi, guys.  I know those of you who aren’t friends on Facebook are surprised to see me posting in the middle of a weekday.  It’s been a fun interesting few days.  I’m home because I have viral meningitis.

Now, don’t freak out.  I said VIRAL meningitis.  This isn’t the scary thing you hear about on the news that you should get vaccinated for before college.  It’s just like the flu, only in your brain.  Which, frankly, still totally sucks and hurts like hell.  I swear my head went into labor on Sunday.  I just kept waiting for a Greek goddess to pop out.  My head hurt so much that I didn’t even want to read!

The headache started Sunday morning and didn’t get better.  When it was still getting worse at 8 that night, I called my mom and said I couldn’t wait until Monday to see a doctor.  We figured it was a migraine.  But I had other markers for meningitis, and my CRP was elevated, so I agreed to a lumbar puncture (aka spinal tap… this pain chart goes to 11). I mean, it was going to be clear, but better safe than sorry.  When the attending came back with the results… “Sooo… It’s viral meningitis.”

My mom has decided that the PGY-2 who first saw me was doing a happy dance in the hallway because as soon as he saw me he said he was worried about meningitis.  He was right.  But his bedside manner could use a few more lessons with our standardized patients…

Obviously, they were going to admit me.  I mean, I was textbook viral, but it could have been an idiopathic bacterial infection.  The next doctor I saw was one of our IM residents.  (Yes, all of my doctors were colleagues.  That’s what happens when you work at a med school and go to a teaching hospital’s ER.)  At work we regularly joke about the different personalities of the different specialties.  They’re stereotypes, but they’re often so true!  She felt bad because it took so little time to take my history.  I mean, I’m healthy.  Except for the meningitis.  She told me I was the sickest person she’d admitted that night, but she had the shortest history.  Did she forget something?  No. I assured her she hadn’t.  So she asked to see pictures of Anna and showed us pictures of her nephew.

I finally was officially admitted at about 6 am on Monday.  I was beat.  My head hurt.  The lights were too bright.  (Photosensitivity goes along with the meningitis headache.)  My back hurt where they did the lumbar puncture.  (Poor PGY-2.  He had to do it twice because he didn’t get the needle in straight the first time. But I got another shot of lidocaine before he tried again, so the second time didn’t hurt at all.)  My arm hurt because the IV was in my best vein, right inside my elbow.  (Yes, that meant I couldn’t bend my arm far enough to reach my mouth. And, yes, I am right-handed.)  And there’s nothing quite as comfortable as a hospital bed.  (I also have some swampland for sale in Florida if you’re interested.)

So they gave me a IV drip of normal saline, massive doses of antibiotics, and an antiviral that treats herpes simplex in case it was caused by that.  (That’s the only viral meningitis that has a treatment.)  And they told me I was a fall risk, so I couldn’t get out of bed unless someone came to help me.  Seriously.  So not a fall risk.  My head hurt.  Period.  My bathroom trips consisted of someone turning of the bed alarm — that’s right, an alarm would go off if I got out of bed but according to my dry erase board I was allowed to be “up as tolerated”… sure, if they’d turn the bloody alarm off!

I digress.  Someone would come and turn the alarm off, unplug my IV pump from the wall (I still had to take the pole and all its bags to the teeny tiny bathroom with me), and watch me take the pole and practically sprint to the bathroom.  They stopped sticking around to “help” me back to bed after a while.  By midday Tuesday, they decided to just leave the alarm off and let me unplug the IV myself.  I was really glad.  Between the massive doses of antibiotics killing all my gut bacteria (yay…) and the massive quantities of saline being pumped into me, I felt like I had to go to the bathroom All The Time.  It was nice not to have to ask for help I didn’t need and then wait until someone got there.

I was on a floor filled with people getting hips and knees replaced.  I’m sure I was the youngest patient on the floor.  Which, no surprise, made me the healthiest.  And sickest.  Simultaneously.  My attending suggested we change that to the healthiest most infected person because I wasn’t really sick as long as the pain was controlled.

Pain control.  <sigh>  The problem with pain control in the hospital is that, unless on a morphine pump, the person in pain is not in control of the pain control.  This was an issue after my C-section, too.  My pain meds were rarely on time, and it’s hard to maintain control if they’re late.  Honestly, that’s the biggest reason I’m happy to be home. My alarm is set for every four hours.  It goes off, I take whatever it tells me to (ibuprofen or acetaminophen).  I don’t have to wait until the nurse brings me my meds and scans my bracelet.  I know my pain control is handled best when I’m doing it myself.

When they did the day-to-night handoff on Tuesday, the nurse told me that my 24-hour bacterial culture was negative.  When I saw the attending on Wednesday, he said he wasn’t going to wait for the 48-hour culture because the test had been started at 1 am and not read until the afternoon, so it was really a 36-hour culture.  I was liberated from my IV and slated to start on oral analgesics with a discharge on Thursday.

I was soooooooo glad to get rid of the IV.  I still had the hep-lock just in case they needed the line, but I wasn’t hooked up to anything and the machine was turned off.  And it was finally quiet (mostly) in my room.  That pump sounds like a dot matrix printer.  The nurse told me another patient had asked why it sounded like there was a kitten purring in his room, but that’s not what it sounds like.  At first, I was thinking it sounded like a typewriter, but it was definitely a dot matrix printer.  One of the really old ones that had to run across the entire line even if there was nothing to print on it.

So it’s Wednesday, and I’m feeling tons better, and my mom and I are hanging out in my room (since I was still quarantined until infectious disease cleared me), and someone comes in.  She has a gown and gloves but no mask (that being the key item that hospital personnel were to wear in my room) and announces that she’s from patient services.  She had some Medicare paperwork for me to sign.

“I’m not on Medicare.”

“Well, are you on disability right now?  Maybe you have one of those joint plans?”

No…  I’m on PTO right now.

We all had a good laugh.  She thought it was odd that a patient with my birth year was on her list, but maybe it was a disability thing…  She stayed and chatted for quite a while.

Anyway, at about 4, my resident came back to tell me that my viral culture was back and positive for enterovirus.  Since they now knew what had caused the infection and that there was no treatment other than pain control, I was free to go, unless I wanted to spend another night.  And while she was there, the nurse came to announce that ID had cleared me and no one had to wear masks around me anymore.  It was a party in room 254.  I called my mom, and by 5, I was being discharged.  I’ve never had my release processed so quickly.

I would have written while I was still in the hospital, but the IV in my right arm was so awkward that I didn’t feel like trying.  Instead I actually made voice memos on my phone.  I’ve never used them before.  I’ve just never been a voice memo sort of person.  I listened to them to make sure I didn’t miss anything I wanted to mention and they’re totally Radio Diaries.  I was going to delete them, but I’m not sure I want to.

Okay, this next part might get a little, well, ranty.  The TL;DR version is doctors who should know better have freaked out my daycare.

So. <huge sigh>  Remember that party in 254?  While that was going on, I got a call from daycare.  It came up as “No Caller ID”, which usually means daycare, but they knew I was sick and that Anna was with my parents, so why would they be calling me?  I let it go to voicemail.  After everyone left, I checked my message.  Anna’s fine, but we need to talk to you urgently.

You see, I have meningitis.  How do we know Anna doesn’t have it?  (Um, because she clearly doesn’t have it?  It’s not something that you get asymptomatically.)  I mean, is it safe for her to be at school?  Because there’s another parent who has it, too (also enteroviral).  The lead teacher in Anna’s room is pregnant.  There are two other teachers who are pregnant.  Their OBs told them those children needed to have a clear test showing they didn’t have meningitis in order for them to go to their prenatal appointments.  One even went so far as to insist the pregnant patient have a clear meningitis result.

Okay.  I get daycare freaking out. They heard the word “meningitis”.  They didn’t hear “viral”, and even if they did, they don’t know that there is a HUGE difference between viral and bacterial meningitis.  They don’t work in medicine.  I understand them being scared.

But doctors?  Obstetricians go to school for a long time.  You know one of the things that’s covered in med school?  The difference between viral and bacterial meningitis.  You know what else is covered in med school?  That there is only one way to diagnose meningitis and that’s with a lumbar puncture.  And NO ONE is going to perform that test on an otherwise healthy person.  If my CRP had been normal, I probably wouldn’t have had one.

I am beyond pissed that physicians WHO SHOULD KNOW BETTER are telling their patients that they can’t continue to be seen until they have a lumbar puncture even though they have NO SYMPTOMS of meningitis.

What they don’t know is who they are dealing with.  What they don’t know is what I do for a living.  For those of you outside the world of CE, I’m going to give you a little lesson in practice gaps.  A practice gap is the difference between what healthcare providers (HCPs) should be doing and what they actually are doing.  Let me give you an example of a knowledge gap.  All HCPs should know that the only way to diagnose meningitis is through a lumbar puncture.  And here’s an example of a performance gap.  HCPs should not be telling their patients to get a test that is not medically necessary.

Woah.  Wait a minute.  That’s what they just did to my daycare.  And little do they realize that I know who’s in charge of OB/GYN Grand Rounds at both hospitals.  Yeah.  I’ll be talking with them when I back at work on Tuesday.  Clearly they need a reminder about how this whole meningitis thing works.

For the record, Anna is still at school.  She went with a note from the doctor that included a statement that it was completely unfair to say she couldn’t go to school because I got sick.  He and I had a nice mutual grumble about it at my post-discharge follow-up today.  Then he cracked my back.  It was all good.

And I do have to add that daycare was much calmer after I talked to them.  The director actually said she wishes she’d talked to me before she called the other family.  But like I said, I don’t blame them for being scared.  They don’t work in healthcare.  But the people who do should not have given them the advice they were given; they should know better.  And I’ll do my best to make sure that they get a refresher course so that this doesn’t happen to another family in the future.

Okay, rant over.  I’m home.  I’m feeling better, mostly, as long as I keep taking my pain meds. And I’m looking forward to picking Anna up from school.  She’ll spend a couple more nights at my parents’ while I get my keel evened out, but I’ll go for dinner and leave after bedtime.  I definitely needed a break (obviously), but I do miss her.

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