Sick in the city - Intern becomes patient

In a lot of ways, this blog entry is the most enlightening, but different experience I have shared so far. It’s also very personal because in this situation, I am the patient, undergoing care at the Christus Muergoza Hospital (Hospital UPAEP) in Mexico.

I believe the infection began the Saturday night of my birthday and of course, no birthday is complete without a night of drinking. At some point in the night, I realized that I had to pee after every single beverage, which I contributed to “breaking the seal” theory. I didn’t think too much about it. Sunday was a fairly normal day, and then from Monday on I started to feel progressively worse. I had hot flashes, abdominal cramps, loss of appetite, but figured I was getting my period earlier (there was a little blood in my urine) and experiencing more intense effects because of the new birth control I started a few cycles back. I followed my usual course of action, popped a bunch of Advil, drank mass amounts of water, and shoved a few Tampax in my purse. Then I began to feel exhausted, the Advil weren’t solving the issues for very long AND.. I won’t lie… I was kind of an emotional mess. I cried a bunch because learning Spanish is frustratingly hard and I was so so so tired. Ignoring the suggestion of my boyfriend (who I will refer to as R.) to go to the hospital, I decided to wait it out until the monthly culprit arrived. Another sign to my stubborn brain, should have been on Tuesday night, after having a fit of tears and pillow-talk, well you know.. one thing led to another. I’m not saying it was BAD, but my body just didn’t seem as sensitive or right. Once again, I kept my thoughts to myself and figured it was because I was having such bad PMS cramps. I know. Stubborn.

Now we find ourselves at Wednesday. After barely getting any sleep Tuesday, I was so grateful to have classes, lunch and then time to go home. I felt pretty awful all day, not hungry at lunch and ate a peanut butter sandwich for dinner since the thought of cooking or eating anything else made me gag. Getting into bed, I pulled on a sheet, a blanket and a comforter. R. looked at me like I was nuts (we are in Mexico..) but I had goose bumps and the chills. R. fell asleep in 0.2 seconds like most men and I spent the next hour or so trying to stop my teeth from chattering. My body was convulsing – immediately reminding me of the time when I was a 10 years old, and woke up vomiting and convulsing in the middle of a summer night in New York – scared, but more exhausted, I finally passed out. Sometime later in the night or early morning I woke up burning hot. In a panic, I threw the blankets on the floor, waking up R. in the process. I don’t remember much after that until it was getting close to time to wake up for classes and there was no way my body was getting out of bed. I do remember pain, lots of pain, and then being cold again. I also remember telling R. I think I have a urinary tract infection, starting to put together some of the pieces that had occurred since the Saturday before. R. ran out to buy a thermometer, took my temp and turns out I was running a high fever of 100F or so. Being unable to make excuses for my condition any longer, I dragged myself out of bed, threw some clothes on and gagged at any breakfast options. By the time we got to the hospital Thursday morning (which I was thrilled to see, as I had taken a tour of Christus Muergoza back in January when I was a student with NYU), I was running closer to 102F and FREEZING.

I was admitted directly into the emergency room around 10am, and the doctor came to see me almost immediately. The first priority was addressing the fever while waiting for the results from my blood and urine tests. After explaining the pain to the ER doctor, he said that I either had appendicitis or a urinary tract infection (highly common in women). “Appendicitis” freaked me out a little bit, but I was sure that it was a UTI.  I was hooked up to an IV for the first time in my life and pretty much passed out while R. took care of my insurance information and admittance papers. I should also mention, that I hardly speak any Spanish so my translator boyfriend has been amazingly helpful throughout this entire experience. I have no idea how I would have kept it together if I couldn’t understand the treatments or diagnosis. At some point we were bored while waiting and decided to google the causes and symptoms of a UTI. If you’re wondering what a urinary tract infection is, it’s when an infection occurs in your bladder, urethra, ureters and in more complicated instances, can spread to your kidneys. Not surprisingly I had all of the symptoms. Something interesting, the bacteria that causes a UTI is found in your gastrointestinal tract (Ahhhh E. Coli), and is common in women because of the close proximity between the anus and vagina. So, lucky us, being sexually active can increase your risk for a UTI. Why does this not happen in men!?

Sure enough, the ER doctor comes back a few hours later to tell me that I have a urinary tract infection but he wants a Urologist to take a look at me since the infection was so bad in my kidneys. I was feeling much better now that the fever had broken and I slept for a bit, so I was mortified when the doctor also said I would have to stay overnight. The rest of Thursday included getting my first sonogram… on my KIDNEYS and X-Rays. Don’t forget I’m still on the IV, and they bundled me up like an enchilada every time I had to be moved somewhere in a wheelchair. Very attractive. R. had fun with the sonograms, he kept making baby jokes and taking endless fotos of the kidneys I was pregnant with.

The Urologist was kind of a jerk. He came in and punched my kidneys which OBVIOUSLY hurt, and put me on antibiotics. That’s when I no longer felt good. I managed to eat ½ of a smuggled peanut butter sandwich and some cranberry juice. Trust me, if you saw the hospital meals here (or anywhere) you would not eat them if you’re life depended on it. Unless you’re R, because he clearly enjoyed it. This made me feel better because the ladies who bring the meals are the sweetest people in the whole world, and it was like disappointing your grandma if you sent the tray back untouched. I was pretty exhausted the rest of the night and managed to sleep quite well despite the nurses coming in at all hours to change IV bags, meds, check my temperature, blood pressure and all that jazz.

Friday was stressful in a different way. I ate half of a mini donut for breakfast and then puked it up. Meals were not an option for the rest of the day, as the nausea got progressively worse. At least R. enjoyed the rest. Not to make too much fun of him, he hardly left my room so he was hungry enough to eat my hospital food. The Urologist came in for 2 seconds in the morning saying he needs me to pee in a cup right AFTER I had already gone. When you’re not drinking anything, that kind of news pisses you off.. it was like my one shot for the day was gone! Amazingly I managed to keep throwing up even on nausea meds. Finally, later in the day I managed to pee and the Urologist came in to tell us that my abdominal pain and nausea was caused my too much intestinal matter (poop) blocking my intestines. Most of this conversation was being translated to me, but I assure you.. the words “enema” did not sound appealing. Luckily R. was pissed off at this doctor who clearly didn’t pay very much attention to me as a person, or my file. After a few discussions with the hospital admin (who had given me the tour during January, was a fellow NYU student and happened to be a friend of R.), the Urologist decided to get his act together. He came in and although sticking to his “intestinal” theory (which is impossible considering I hadn’t eaten anything since Wednesday and had pooped the day before), he decided to refer a Gastro-Intestinal specialist to us. That was a relief since there is nothing more frustrating than a doctor that believes his thoughts or plans of action are the only reasonable ones.

            **SIDENOTE  - There are a lot of doctors out there who well.. think their word is golden. They don’t have much concern for the doctor-patient relationship, actual concerns or requests of the patient, or with the collaboration between other medical professionals. This will become clearly evident as a dietitian working in a clinical setting. Some doctors will not be willing to appreciate or acknowledge our area of  expertise. The truth is however, we know the full relationship between food intake, health and patient recovery.. as well as an understanding of the emotional and physical stresses to a patient that can’t eat, is malnourished, or at risk for becoming nutritionally compromised. Our     field will eventually gain more respect, as doctors and other health care professionals will come to understand that a patients’ NUTRITIONAL  STATUS can help or hurt their recovery process. If the underlying causes of a condition are nutrition-related, the condition can not be properly treated until all of the underlying ones are.**

Oh I should also mention that the Urologist suggested I take a mild laxative mixed with juice. Mind you, I hadn’t been able to keep anything down at this point, but I was trying to have faith that it might solve the “intestinal” theory and relieve some of the pain. The photos of me drinking brown orange juice are priceless. I look quite disgustingly sick at this point, and about 20 minutes later I puked my brains out. So much for that approach.

The Gastro-Intestinal doctor came by around 8pm. I lie down and make painful faces as he pokes and taps the areas of suspect. The tapping part is kind of funny, it goes from sounding hollow to a solid THUD below my rib cage on the right side… hello enlarged liver! So the “intestinal theory” is out and now liver complications are in. Possible causes include Hepatitis or a reaction to the medications. The only way to be sure is to wait for the morning and run more blood tests and take a sonogram of my  intestines. Not thrilled about having to stay another night, I couldn’t ignore that the pain was definitely not getting any better. Speaking of the pain, it’s hard to explain the type of pain that a kidney infection and swollen abdomen cause. In part, it’s similar to the worst cramps you’ve ever had in your life (if you’re a woman) combined with nausea, hunger, and more nausea. It’s almost like when you’re so hungry that you get nauseous but the thought of food makes you gag. The doctor also mentioned that kidney infections are some of the worst pain you can experience. Fortunately, women can tolerate more pain than men – hey the doctor said it, not me! According to him, he has a male patient with a similar infection and the man was screaming like a girl. My method of dealing with the pain was to somehow convince my body to sleep. It only works for a few hours at a time, but those hours are glorious.

I also would like to discuss the nursing staff or “enfermeras” at the hospital. They were all consistent in coming in to check on my temperature, blood pressure and heart rate. I know that there’s machines that monitor those sort of things today, but I’m sure they’re costly and probably not more accurate than doing it by hand. My only issue with it, is that the nurses would constantly come in ALL night long. There’s nothing worse than being gently woken up at 3am in order to have your blood pressure tested and to tell the nurse how many times you’ve peed. Try falling back asleep after a few times of that… it makes for a very restless night. Especially since sleep was my way of avoiding the pain! I can’t complain though, I would much rather experience too much attention from the nurses than too little, that’s for sure.

That brings us to Saturday. I woke up not feeling so great and nauseous. Once again, time for blood tests and sonograms. They wheeled me down to the lab, all bundled up like and enchilada again. This time they weren’t looking at my kidneys, since the infection was under control, but at my liver and spleen. Surprisingly my liver appeared normal, spleen was slightly enlarged but other than that everything was fine and the abdominal pain and bloating remained a bit of a mystery. Luckily, the blood results showed that my liver was functioning perfectly fine so the Hepatitis possibility was out. In the afternoon, the Urologist and Gastro-Intestinal doctors came to my room with R. standing in-between then asking a million questions and translating bits and pieces to me. Looking up at all three men from my hospital bed, still chained to the IV, I couldn’t help but feel like a guinea pig. They all looked confused and kept pushing my over-extended abdomen, like the answer was magically going to pop out. Trust me, the only thing that was going to pop out at this point was farts or water. By this point I was so sick from hunger I requested a bunch of Ensure. The doctor suggested I try a liquid diet anyways, so I might as well go for something with actual calories. With my nutritional background, I knew that there was no way I was going to feel any better if I didn’t start eating something. As soon as I finished the first Ensure, I felt 10 times better. The nausea was gone as well as some of the abdominal pain. I started sitting up, typing, showered and put real clothes on (I only wear spandex and cotton shirts anyways). For the first time I felt like I was back on the road to recovery. Two and a half Ensures later I was starting to regret my decision. Partly from the IV, and partly from the dense Ensure, my whole body slowly became swollen. I noticed my legs, ankles, breasts, and worst of all – stomach had become gigantic. At some point I was standing in front of the mirror naked, horrified that I looked 3 months pregnant. I assure you, any woman would be mortified. Once again, R. found this highly entertaining and we managed to joke about it for the rest of the day. If I thought that the abdominal pain was bad before, this was equally as painful. The pressure on my abdomen was pushing on my diaphragm – limiting how much I could breath in and out.  I felt like a 40 pound Thanksgiving turkey that’s about to explode. The Gastro doctor came back and when all I could say was “estoy llena!!” he smiled and told me I went a LITTLE crazy with the Ensure. Listen, you wouid too if it was the only thing you could ingest in 3 days! Being the natural fatass I am though, I started craving mashed potatoes and asked R. to call the kitchen. Let me tell you something, those were the best damn mashed potatoes I’ve ever had in my life. I was willing to risk exploding for them.

We also had visitors that night. A friend and his mother-in-law, which are practically family to R. came in and cheered up the slightly gloomy hospital atmosphere. Don’t get me wrong, R. and I had a lot of good laughs up to this point, especially about me looking pregnant or like I would float out the window if I wasn’t tied to the IV, but it was nice to see other people again. Speaking of family, have I mentioned mine? Oh boy. Well… I doubt that any parents with a daughter that’s hospitalized outside the country would feel all warm and tingly inside. Thank goodness for Skype, so I was able to chat with them. Since they could see me (mostly at the times when I was feeling better), they were slightly relieved. Plus the fact that R. refused to leave me helped to ease the situation. I also did my part by sending the funnier photos, like the my butt peeking through the back of my hospital gown and my cheesy  smile while eating the world’s best Mexican mashed potatoes. 

Before sleeping we decided to go for a walk and do some exercising. This is when I realized R. could have a future as a personal trainer. I doubt I mentioned it, but he’s a runner and very active. He’s actually training for the Chicago marathon (yeah, me… not so much. But I like to watch him run by while I walk.) I did a whole routine of leg stretches, bending, some yoga positions. I basically felt like I was doing prenatal yoga. Saturday night passed like all the rest. Hard to sleep, especially since I’ve only been able to sleep on my back and I’m one of those fetal position sleepers. After more interruptions from the enfermeras, and I suppose sometime around 3am I felt pretty awful.  My eyes felt like they wanted to pop out of my head and my nose was bleeding. I also still felt like a stuffed turkey. I washed my face, stopped the bleeding, and walked around in circles. I suppose I managed to fall back to sleep at some point.

Sunday I woke up pretty excited because TODAY IS THE DAY I get to go home! Still feeling a head cold, I took a shower and felt a little better. I was so thrilled I even ate my cereal and a donut for breakfast. I gagged a little when they took the IV out… I didn’t see it go in so I didn’t realize it was a 2 inch long plastic needle that was in my arm. Surprisingly, I hadn’t been weighed at all during my stay so when R. found a scale I eagerly jumped on. Big mistake. If I was pale before, you should have seen my face when I realized that I gained 6kg (which is MORE THAN 12 POUNDS) in my 4 days at the hospital. No wonder I looked like I should be rolled down the hallway. Traumatized and feeling exhausted, I managed to be all smiles when the doctor came in. My only question was “is this swelling going to go away, and if so, when?” Once again, if you are a woman, gaining 12 pounds in a matter of days WITHOUT eating is like hearing that your dog got hit by a car (alright maybe I’m exaggerating slightly, but I mean, seriously… even my SPANDEX were too tight). Yeah yeah, I know, the important thing is that I’m on the mend and I’ll make a full recovery. I just can’t help but be a bit depressed by the fact that it took me 10 minutes to reach my feet to put on sandals. R. is pretty thrilled that my boobs are huge (not that they were that big to begin with).

Thankfully the doctor approves my discharge from the hospital, writes me a prescription for more antibiotics and painkillers, and gave me a big hug. It’s moments like this that frustrate me for not being able to express myself in Spanish. I would have liked to thank him from the bottom of my heart instead of having it translated, but I’ll spend the next few days practicing my Espanol and writing thank you cards to some of the hospital staff. Thinking I was home free, I realized there was still that little matter of payment. I literally closed my eyes and held my breath as R. told me how much the bill came to. All I can say is THANK GOD I got sick in Mexico, because there is no way in hell that 4 days at the hospital would cost that little in the US. I would have owed thousands and thousands and thousands of dollars. I’ve always had health insurance, but I am no longer eligible now that I am not a full-time student anymore. The way it works in the US is, that you can receive insurance under your parents until you’re 25 as long as you’re a full-time student. Since I graduated in May, I am now officially screwed. To continue my same health insurance, it will cost me $400 - $500 USD PER MONTH. I don’t know about you, but I’m broke. Yeah, bye bye health insurance. I think health insurance alone is a reason for me to stay in Mexico.

After getting over my shock that I could actually afford my hospital stay, we had to go through the whole discharge process which was exhausting and took a few hours. Finally, we made it to the car and I were on our way home! Ok, I won’t lie, we stopped at Walmart (did I mention that Mexican’s L-O-V-E Walmart?) and I bought jelly, Kraft Mac-and-Cheese, my drugs at the pharmacy and tampons. Yeah, it’s not bad enough that I’m already terribly sick and bloated, but I got my period today too. Basically, I can barely move and the thought of even doing anything exhausts me. But being home, in my own bed, is the most amazing feeling in the world.

I’m still not back to my normal, healthy self, but given a few more days, the infection will finally be gone and the antibiotics will be out of my system. I can’t pretend like it was the worst thing that could have ever happened to me – I am thankful that it was only a few short days at the hospital and I will make a full recovery.  I’m looking forward to my beach weekend in Veracruz at the end of the week (hopefully I won’t be mistaken for a beached whale). Despite any of my complaining, I can not even begin to tell you how blessed I feel, to have undergone such an experience, with the man that I love. I learned more than I could imagine about myself, my profession and about my relationship. You know what they say, “whatever doesn’t kill you, makes you stronger.” Cliché, but it’s the honest truth. Sometimes as healthy, normal human beings, we forget that we are mortal, and that there are more important things in life than the annoying daily trials.

This experience has been the most enlightening compared to any interning opportunities. Although nutrition wasn’t a huge factor in my condition, it was still an issue. Most of all, it has taught me to have empathy for the patients we will be responsible for. Empathy involves understanding the emotional and physical condition of the human being that we are meant to help. Patients will be confused, upset, depressed, disappointed, scared, hungry, not hungry, uncomfortable, homesick and just plain sick. Especially if they are alone or in a foreign country, don’t speak the language, or a number of other reasons. No one enjoys being in pain and away from their home. It’s a frustrating job working with patients, especially if they can be difficult or demanding. That’s ok. Our job as nutritionists is to: improve the quality of life for the patient. Never, ever forget that. 

INTERN ADVI CE

1.    Have empathy for your patients

2.    Our job is to improve quality of life

3.    Our job can be frustrating: patients can be difficult and so can doctors or other health care professionals – deal with it! 

4.    Don’t treat a patient as a number, treat them as a person

5.    If underlying causes of a condition are nutrition related – not addressing the patients’ nutritional status can hurt their recovery

 

Much thanks and love to everyone – S.T.