As in nature
I did stir
A kamikaze threesome
Making their presents known
Joined by white-coats
Hopefully not fallowing me
As will bee
Or not to be
Did they no
I would swell
With more than pride
At their deathly pricks
And the shock to come
Working best under
A life long
A pin cushion
Buy day and night
Nature’s suicide cheated
Eventually in choir
This poem is autobiographical, inspired by a bee sting, actually three yellow-jacket stings, that I got a couple of days ago. Such a tale is made dramatic as I am allergic to bee stings, and without quick treatment I would be dead. I was tearing out English ivy from my front yard bed when I felt three stings in rapid succession, probably within 5 seconds, before I even saw the attacking insects whose nest in the ground I had apparently disturbed. At least one yellow-jacket followed me as I went into the house. I had to deliberately maneuver to prevent it from following me into the house.
Fortunately, just two days earlier, I had picked up my epi-pen (to inject epinephrine/adrenalin) from the pharmacy. Unfortunately, I had it sitting on the couch where I had planned to read the instructions at my leisure — I had not (read, I had sufficient leisure). Unfortunately, I was not entirely sure whether it was better to read the instructions and self-inject or seek emergency room treatment forthwith. Being only five minutes from St. Vincent’s Medical Medical Center emergency room, I chose to race off to the ER. I grabbed my epi-pen just in case things took a turn for the worse on the way. Fortunately, I was not experiencing any significant symptoms yet. A yellowjacket chased me out to my car, and again I quickly maneuvered to keep it out of my car.
As I sped to the ER I could feel my hands tingling and getting itchy. When I got to the emergency room, there was no intake person at the front desk. She was at another desk taking down information from another patient. I tapped the prescription box containing my epi-pen on the counter to get her attention and announced that I had been stung by bees several times, that I was allergic to bee stings, and that I would soon be going into shock. She stated that she would need to collect my personal information first. I deftly and quite accurately tossed my prescription box to her and I said that it should contain the pertinent information. She equally deftly caught the box — perhaps she was well-experienced with such procedures. Fortunately, I had seen my new primary care physician within the last week or so, so my current information would be readily available on the computer. I then carefully laid down in front of the reception desk as I had passed out in the ER the last time I was in this same ER for a bee sting reaction, and I did not want to add any injury to insult. She asked why I was laying on the floor and I explained to her. She said that they would get me in a wheelchair. I said that I would get off the floor when I got a wheelchair. She seemed discomforted by my lying on the floor. I comforted her by saying that I am sure that their floors were clean enough for me to pass out on them. By this time, I noticed that little white welts were forming on my arms and legs. My whole body was flush and my heart was racing. Given the circumstances, I think that I was rather calm; though I don’t think I was perceived as being the most patient patient. I was not entirely convinced that the emergency room was necessarily best geared up for emergencies. This was also based on my previous experience with a bee sting reaction in the same emergency room where they made me sit in the waiting room waiting for medical triage. In this experience, as the shock took hold, I indicated to the intake person that I was getting light headed. The next thing I remember I was being lifted onto a gurney, as I had passed out and slumped off my chair to the floor. Fortunately, this did not add any additional injury; though I did take some insult in this. The doctor later told me that she feared I had stopped breathing, which apparently moves you up the triage priority list real fast! Later, I would half-joke that I would fake passing out in order to get seen more quickly. Lying on the floor with full lucidity was my real-life compromise, given that this was no joking matter.
Okay, back to the situation at hand. I started to feel pressure around my ears as the swelling and welts continued to bloom. After a few minutes, a man came to me and asked me what I was doing on the floor. I explained it to him. He said that they did not have a wheelchair available, and he asked me to stand up. I stood up and walked with him to the intake room, sat down in a chair next to a computer, and I started answering questions. He clacked away on the keyboard in what seemed to me a rather routine way. After measuring my heart rate at 166 beats per minute (about what my heart rate would be if I was running full speed), his sense of urgency seemed to pick up. He made a call. Another person came and walked me to an exam/treatment room. He left me there alone and said that someone would be there soon. I couldn’t help but wonder how long. I laid down on the exam table and waited for a couple minutes, though they seemed like very long minutes to me. At this point, there we so many welts on my arms, legs, and body that they were beginning to merge into essentially one large metropolis of welts for each section of my body..
When a nurse arrived in the exam room, she started asking questions and attaching me to a blood pressure cuff, oxygenation sensor and EKG leads. Then, a doctor arrived, asked some more questions (plus some of the same), and did some physical exams. The nurse inserted an IV and the doctor ordered epinephrine. I noted that the dose they gave me was identical to the dose in my epi-pen. [They explained later that one should always inject the epi-pen immediately after an offending insect sting. I know that now. The nurse later offered to show me how to use the epi-pen and was confused by a different design than with what she had experience -- apparently, a new technological, perhaps technical-illogical, innovation sometimes called progress.] I couldn’t help but laugh at the absurdity of the front desk person coming in amidst all of this and having me sign their consent to treatment form. Was their any expectation that I would read this legal document then and there?! Perhaps my (im)patient antics to that point, as well as not refusing the ongoing treatment, constituted a legal definition of desire/consent for treatment, but the lawyers must have their way. My only comfort in that absurdity is that the crooked, illegible, left-handed signature on the form will not likely garner the highest price on eBay upon my postmortem celebrity value.
They sat me up and gave me an oral dose of prednisone, a steroid to bring down the swelling. Even with the fast-acting epinephrine in me, my reaction got progressively worse. My face was swollen and numb, feeling something akin to that experience after dental anesthesia. While I had no difficulty breathing, I did have substantial discomfort like gastric reflux pain at the base of the esophagus. The doctor indicated that my abnormal EKG could be an indication of a small heart attack, though he did not state any connection to my “esophageal” pain. I did remember all those ads for not mistaking a heart attack for mere indigestion.
At the height, or perhaps depth, of my reaction, my EKG went abnormal and my blood pressure was 56/30 (normal is 120/80). The doctor said that the abnormal EKG reading might indicate a lack of oxygenation to the heart. They were quite stunned and concerned with this extremely low blood pressure. They were perhaps even more stunned that I was still conscious! To provide additional motivation, I informed them that I am much more fun when I am alive. Fortunately, my sense of humor was largely intact. I was on the edge of consciousness/unconsciousness for perhaps five minutes or so, as they tilted the exam table feet up and inserted another IV for additional medication(s). I definitely had a heightened concern during this time as I strongly prefer my unconsciousness to be long bouts of normal sleep. While I meditated on the thought of my potential death for a few moments, I had a fairly high confidence that I was in good enough hands to keep me alive, if perhaps not conscious. While getting the attention of a team of emergency room professionals may take some time, once you’ve got their full attention, they are quite capable. Fortunately, my EKG was normal within five minutes after the abnormal reading, and my blood pressure started to normalize. The “emergency” had climaxed, and I was about to move into the chronic patient hood.
As I was recovering in the ER, the doctor explained that he would like to admit me to the hospital so they could quickly get a cardiologist consult in-hospital, who would likely order and conduct a cardiac stress test that next day. They had already tested immediately for blood enzymes that would indicate a heart attack, which proved negative (which is good). They did the same test again after two hours, which was again negative. Still, the doctor explained that it could take 24 hours for the enzymes released from a damaged heart to show up on this blood test, and he wanted to repeat this test every six hours. I inquired as to whether my state of anaphylactic shock might, in fact, be an “informal” cardiac stress test, and that an abnormal EKG under such conditions might actually be quite normal. He said that could be the case, but that they like to have controlled conditions to interpret cardiac stress reactions. The alternative would be to see my primary care physician, get a referral to a cardiologist, who would order a cardiac stress test if so desired. Of course, this would all likely take several weeks. I consented to being admitted, partly because of the simplicity and alleged speed of the process, but also because on the observation ward I might get better management and discharge planning for the allergic reaction which would take many days to treat and get back to normal. I consented to being admitted to the hospital.
After about a total of five hours in the emergency room, I was admitted to the observation ward of the hospital. It was almost 7 pm. The nurse speedily did the appropriate intake just before the 7 pm shift change, put me in the one-size-fits-none hospital gown, hooked me up to monitors and various gadgets, and we were off. To make another long story shorter, I could have managed my post-sting allergic reaction — the blooming of welts and itching — better at home. As is well-known, sleeping well in a hospital is a lost cause. For example, I wrote the above poem after being woke up by the phlebotomist at 3 am to take my blood and during the ensuing a 2-1/2 hour ordeal to get two over-the-counter pills (Benadryl), one at a time, to control my blooming welts and itchiness.
I was under an NPO order, which means you can’t eat or drink anything, due to potential testing needed the next day. So, I was poorly rested and without food or water while waiting. As I like to say: a hospital is no place for sick people! Instead of the cardiology consult happening in the morning as they stated as their prediction, I didn’t see the cardiologist until after 2 pm and some uncertainty as to whether the order for the consult was put in. This consult lasted less than 10 minutes, basically asking me if I had any heart difficulties when I exercise — of which I do not. He matter-of-factually confirmed that an abnormal EKG reading when in anaphylactic shock is quite normal, even expected. He still recommended a stress test but kind of laughed when I asked if they were going to do it that day. I did manage to get out of there by 5 pm, even getting a meal in the hours waiting for discharge.
Fortunately, I have medical insurance, unlike in my previous hospitalization for a bee sting (when I learned the hard way that I was allergic to such insect venom). I am curious to see the bill. Nonetheless, I served society well as a job creator. Plus, I am deeply grateful to live to see another day! May we all cheat death occasionally and be patient with the annoying details…