All Posts

On The Other Side

This weekend I got to be on the other side: I got to be the patient.

I learned a few things:

1. IV Morphine is ah-ma-zing for pain relief but bad for coherency.
2. Diagnosis of exclusion is just as frustrating for patients as it is for doctors.
3. Some doctors can be really stupid.
4. I make a bad patient.

For the past few weeks I’ve had this nagging pain in my right lower abdomen. The pain would wax and wane and would get really bad for about an hour at a time and then it would go back to its baseline discomfort.  Initially, I assumed it was an ovarian cyst, as I’ve had a few of these before.  But on Friday, the pain got really bad and it stayed bad for hours.  Finally, after arguments with DH, I went into the ER to get it investigated.

I was quite tender all over and I had all the positive signs that suggested appendicitis.  I had the full work-up and the Dr wanted me to go straight for a CT scan instead of an ultrasound.  I objected just on the premise that if all the other tests came back to suggest appendicitis, I wouldn’t really need imagining anyway.  So, I got the morphine, I went for the ultrasound, had the bloodwork, and then I waited.  No one came to talk to me for a long time, so I assumed that nothing alarming was coming back.  Turns out my bloodwork was pristine, my urine was beautiful, and the ultrasound was inconclusive.  I was happy that I didn’t need an appy (primarily because I didn’t want surgery, but also because I am on surgery right now, meaning that the people operating would be my current residents/attendings), but I was disgruntled that I had no answer for the horrible pain I was having.  The new Dr on shift came up with an explanation that I had an ovarian cyst and gave me a prescription for naproxen.  He told me to come back if things got worse.

Well, as I was leaving, I could feel the morphine wearing off and the pain coming back.  I took a little detour to use a computer and looked up my own ultrasound report: Appendix within normal limits and a 1cm follicle on right ovary.  WTF.  Does this guy even know what he’s talking about?  1cm follicle does not a cyst make…  So, I went home with my non-diagnosis and the intention of sleeping off the pain.  But a few hours later, I was still in a lot of pain and the anti-nausea medications they gave me overnight wore off (quite suddenly it seemed) and I was almost sick on my own shoes.  I couldn’t even swallow my own saliva without gagging.  Back to the ER I went.  By this time I was overtired, angry, nauseous, and I just wanted things to be over.

The new Dr (quite literally new, it was his first shift at our ER) came in to talk to me and explained that he went over all my paperwork from the night before and he wasn’t sure what else to do for me.  He decided that Pelvic Inflammatory Disease was his new top differential for me.  (WTF…) He asked me if I had an STI’s (No… you guys even screened my urine, which was clean, by the way), if I had multiple sexual partners (because you know, we have to ask), and then I started getting even more mad.  He said he wanted to do a pelvic exam, and possibly take out my IUD and start me on the usual antibiotics for PID.
“I don’t understand how PID can be at the top of your differential when I have no risk factors, I have no white count, and I have no signs of infection, besides fairly localized right lower quadrant pain.  If you want to do anything with my IUD you can get a gyne consult first.”
And that right there is why I’m a bad patient… He responded by saying that I was within my rights to refuse a pelvic exam from him.

So, off I went for that CT scan, finally.  And of course, it came back showing no appendicitis.  In fact, it showed nothing, except maybe some excess stool in my large bowel.  This guy’s new diagnosis: constipation (even though I’ve been having fairly regular bowel habits).  I took my prescription for some heavy duty laxatives (almost equivalent to a colon prep), demanded some zofran to take home with me, and away I went.  I was now no further ahead than before, except that now I had a nice CT dose of radiation straight to my ovaries, just to find out that nothing is wrong and that I’m in pain for no apparent reason.

This whole ordeal gave me fairly good excuse to call in sick for my last call shift of the rotation (was supposed to be yesterday) and I stayed at home, with my RLQ pain and dealing with the fall-out of my laxatives.  And, after all that… still in pain.  Oh well.  At least I don’t need surgery (yet)… I could go for a colonoscopy today, if I really wanted to… And I don’t have a tumour (isn’t that the bright side to everything?)

12 thoughts on “On The Other Side

  1. Oh my goodness! I hope you will feel better soon. I have no inkling what could be the matter but I hope you find doctors who can figure it out. Hate being a patient too these days – med has definitely made me very impatient.
    (P.S: I love the “1cm follicle does not a cyst make” part. Will remember that!)

    Like

    1. Thanks! I think, in addition to being more impatient, I am also more skeptical. I see what happens on the other side and I wonder if what I hear is the truth. For example, yesterday I went and read my own CT report. Turns out the ER doc wasn’t completely honest with me about the whole “constipation thing.” The radiologist commented on stoll in the large bowel, but otherwise , the CT was completely normal. The ER doc basically made up his own explanation… Lovely.

      Like

  2. My first thought after you told us that it wasn’t your appendix or ovary was a kidney stone… but the CT would have picked that up and there would have been blood in your urine. Hmm…. these kinds of cases are always frustrating. I hope you feel better soon!

    Like

    1. Yeah, they put that on the Ddx… at least it makes more sense than PID! I was actually doing some reading last night and I stumbled across “chronic appendicitis.” One source said there is controversy over whether it is really a diagnosis since the hallmark of appendicitis is its acuity. However, it exists on uptodate, so it has to be somewhat accurate, right? Anyway, the criteria are RLQ pain for at least 3 weeks, fitting with the picture of acute appy, but no white count and normal imaging, and pain is resolved after appy removal. Interestingly, there is also evidence to suggest that up to 30% of appendicies removed from an acute condition show evidence of chronic inflammation and fibrosis.
      So, maybe not so far fetched after-all. However, I just have to decide if it’s worth looking like an idiot when I ask one of the general surgeons about it… especially since I am currently on their service 🙂

      Like

      1. I would totally ask one of the surgeons about it!! My colleague had a patient with a similar presentation and it did turn out to be the appendix, but by the time she presented with acute symptoms, she had ruptured her appendix! Thankfully she recovered well.

        Like

        1. Funny you mention that because in my reading I found that people who suffer from symptoms of “chronic appendicitis” are more likely to perf and have worse outcomes because they become accustomed to, or ignore the pain until it is too late.

          Like

    1. Thanks! So do I! I had another bout of really bad pain last night and I just don’t know how much longer I can let this go on. I don’t want to be that difficult patient who always comes back with the same complaint and no explanation… especially not in the hospital where I work. It’s a pretty small community here, if you know what I mean 😉

      Like

  3. Have you had a bout of gastro in the last year? I was getting severe abdo pain (admittedly, not in the RLQ) and the only explanation I could come up with was a post gastro IBS. The initial bout of gastro was months earlier. It is now over eighteen months since that original gastro attack, and fortunately the abdominal pain has stopped. I’m back to normal. I hope you are soon as well.

    Like

    1. I’ve heard of that before… Unfortunately (or fortunately, I guess), I have’t suffered from any bouts of gastro in the recent past. I wish I had, just because maybe that would be a good explanation.

      Like

Tell me what you think, I'd like to know...

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s