What to Do When You're Sick After Hours
BY Thomas Arno, M.D., F.A.C.C.
PUBLISHED December 05, 2016
Editor’s Note: This piece was submitted by a contributing writer and does not represent the views of CURE Media Group.
Sunday, 12-4-2016, I sit with my dog and write my cancer blog. I have no idea who reads these, but given the email yesterday, I'm gathering quite a few people do. People wonder how long it takes to write a page or two? My mentor, who is a professional author, can tell you how long one page takes! My book took nine to 10 months and is 140 pages. It’s on sale now and called “Self Examination.” Yes, shameless self promotion is not beneath me. When you finish reading this, you will know why this is a critical book to read for your education as a patient.
Well here we are Taxotere treatment number five day seven. Last chemo will be Dec 12. Chemo no. five had just been one big pain in the rear end! I was warned, from day two to just about day 14, I had severe side effects. As I just noted, I was cautioned by three others – treatment five of Taxotere will be the worst. Everything felt doubled— fatigue, bone pain, no appetite, on and on one can list. To me, that made no sense. If cumulative, treatment six would be the worst.
Looking at Thanksgiving week, having family here with guests was great! Seeing my family where the youngest is near 30 it is beyond fantastic. Add my wife's cooking and I'm in heaven. Mood-wise, I am OK. Sunday morning starts off with a whimper...great, but feeling warm and a bit chilled. I grab the thermometer to see my temp is 99, which is no big deal. Day seven counts are headed south, so I'm used to this neutropenia-induced temperature. Unfortunately, this is not the case. By noon, my temp is 101, and I am chilling at 101, and by 4:00 p.m. 101.6.
So, I called the doctor. He places me on Tylenol and Levaquin, a fluoroquinolone, all by phone. This is why I wrote a book – I would have examined the patient. I felt terrible; it was disturbing as this was new. Barb, my wife, took one look at me and knew, and she called the doctor. I would insist on examining a patient like myself, but those days are gone.
So off to lie down. My dreamland was interrupted by rigors and a temp of 103, then 103.8. I call the doctor on-call who tells the nurse to tell me to see my doc in the morning (it is 11 p.m. at this time), take more Tylenol and one more Levaquin. I was not impressed. I'm going to leave it here as to be blunt what I said: it’s definitely not what I would do. As noted, I would examine the patient, given I am neutropenic. Neutrophiles are the white cells that fight infection.
I saw my oncologist at 8:15 a.m. Blood cultures were drawn, CXR taken. He commented that all of this should have been done last night at 11:30. I agree, but I could not get by the nurse. I did voice my displeasure. Welcome to 21st century medicine.
My labs showed an infection that results in most people being hospitalized! I could have had gram negative sepsis, when a certain bacteria produces toxins and lowers blood pressure; it can be fatal. My blood pressure in the docs office was 100/60 – normal, but 20 points lower than my normal. By morning, my temp was 98. I had no memory of Sunday. I did receive fluids and two IV antibiotics in doctor’s office. With one more temp spike, I would be admitted! Since my temp was 98 and after fluids blood pressure 125/75, I felt better. I did go home, but I will be taking my temperature every two hours. If I have any temp, any rigor (chill), I will be admitted, PERIOD.
My temp never went up again, but it drained me. Add company—I was so happy to see my kids, I just had zero energy. Everyone in my family is in the medical field, my son M.D. Ph.D. soon, and was aghast by the care. I'm not going to tell you what the blood cultures grew, but I'm furious at the care; my doc was frantic. For the rest of week, I just slept and woke up greeted as many people as I could. All my kids wanted me to rest, so old baldy, did that and feel asleep in a chair I think in mid-sentence. Anyhow, here it is Sunday. I have no memory of the prior Sunday or Monday, other than seeing doctor. My wife did tell me some of the words and sentences I tried to say—clearly I was delirious. This week definitely feel better, but I was warned, chemo five will be hard; they were correct. I never want to go through a temp close to 104 with delirium, loss of memory and God knows what else I did making my wife's Thanksgiving a memorable one, and not positive.
Why did I, an M.D., write my book "Self Examination" which is very hard on medical establishment? Events like Sunday and Monday should not occur and be cured by phone. I was lucky. It's why I always put my patient first, even ahead of family. Please read it if you’re a patient......it will answer many of your questions. You’re the patient; you are the boss, always remember that. I should have been more forceful to be seen, but being so ill, I did not have the energy.