On Monday, July 17, 2017, I was stung by a yellow jacket. I am allergic to bee stings and the like. This is the third time I had been stung by a bee since I found out that I was allergic to bee stings [see here for account and poem about previous bee sting]. If untreated, a bee sting would cause anaphylactic shock and probably death. The first line of treatment for bee stings in people who are allergic to bee stings is an injection of epinephrine. This can prevent the onset of anaphylactic shock.
Fortunately, I had an epinephrine autoinjector. Unfortunately, this autoinjector had been expired for two years. I had not refilled a prescription for a new epinephrine autoinjector, since the most common brand, Epipen, which has 95% of the United States market, has in recent years been price gouging consumers who rely on such a life-saving device and insurance companies who may pay for it. I could not bring myself to be held hostage to a price gouging pharmaceutical company, even though my insurance would pay 100% of the cost. Since acquiring the company that manufactured EpiPens, the new company (Mylan) kept raising the price until it was 600% more than the original price. Such entrepreneurial genius was rewarded even more by granting the CEO of the new company a 700% pay increase. Not being a complete fool, I had researched if expired epinephrine autoinjectors retained their effectiveness past their expiration date. I found that given reasonable storage temperatures, the bulk of their effectiveness was maintained even years past the expiration date. Thus, I decided to wait until alternative products were available or until the offending price gouging company made their price reasonable.
So, back to the story. After being stung, I looked quickly in the neighbors driveways to see if a car was there and somebody might be home who might be able to drive me to the emergency room. No such luck. So, I injected myself with the epinephrine autoinjector. Since I don't have a car, I rode my bike to the emergency room at St. Vincent Hospital about a mile and a third from my home where I was stung. It was a nice sunny day in the low 80s. I rode there vigorously on my bike. I was feeling pretty well and had no welts blooming like in my two previous bee sting occurrences.
When I walked into the emergency room, there were two people at the desk and one clerk. After waiting a few seconds after receiving no greeting or acknowledgement of my presence, I asked if somebody was available to provide medical triage for me. I indicated that I had been stung by a bee, that I was allergic, and that I was in danger of going into anaphylactic shock. The clerk called for another person. This person turned out to be another billing clerk. This person took my personal and health insurance information and asked no information about my current emergency. This person walked me through two big double doors into a hallway where I was told to sit on a gurney and wait for help. I was left unsupervised. I was in partial line of sight of the emergency room nurses station. After sitting there for a few minutes, a man in scrubs moved into my view. I asked him if I could get some help, and asked him somewhat facetiously if this was an “emergency” room. He very nonchalantly said that he would see if somebody could assist me. Some minutes later, someone came to ask me questions. They took me into an emergency room examining room. This was about 10 minutes after I had walked through the front door.
They immediately hooked me up to many of the usual devices, such as a finger oxygen monitor, a blood pressure monitor, and EKG leads. Eventually, they gave me an IV. Apparently, my heart was racing, not too surprising since I was having a serious allergic reaction, had an epinephrine injection and a vigorous bike ride. However, the EKG showed abnormalities, which they diagnosed as atrial fibrillation. Atrial fibrillation is where the upper chambers of the heart send signals sporadically so smooth, coordinated, regular blood flow is impaired. My heart rate was moving back and forth from about 80 or 90 up to about 160, which is my maximal heart rate. To my knowledge, I had never previously experienced atrial fibrillation. They were concerned that this may be an underlying condition, triggered by the stress of the sting allergic reaction, and/or the epinephrine, possibly in conjunction with vigorous exercise. I indicated to the nurse that if I should die that they should throw my dead body on the lawn of the corporate headquarters of the pharmaceutical company practicing price gouging for epinephrine autoinjectors, i.e., EpiPen made by Mylan pharmaceuticals.
While they were monitoring the atrial fibrillation situation, they asked if I wanted an ice pack for the bee sting site on the back of my hand which was red and swollen. I said “sure.” They brought in an elongated icepack about 3 inches wide and 15 inches long. Oddly, the covering seem to be somewhat insulated so the cold didn't seem very cold. The physician noted that this device was meant for another purpose — though she did not indicate what purpose. My hand wasn't suffering too badly so I didn't worry about it much. It just struck me oddly that's some ice in a plastic bag would have done nicely at probably a thousandth of the cost.
At about 50 minutes after arriving in the emergency room, I was given prednisone, a steroid to keep the swelling down and fight back the allergic reaction. Fortunately, I was not blooming in welts as in my two earlier experiences with bee sting reactions, both of which were not initially treated immediately with epinephrine.
Their primary concern seemed to be the atrial fibrillation, which they continued to monitor. I half-jokingly submitted that the atrial fibrillation may simply be due to my broken heart over the Senate republican health care bill. The doctor did not disagree. The supervising physician first recommended that I'd be admitted for further testing and observation. After some questioning about the nature of this, I pushed back somewhat, partially based on my two previous experiences at the same ER and hospital where I was hospitalized for further testing and observation and my experience proved that this was not useful and perhaps even hampered by treatment and recovery. I have recorded one of these bee sting experiences elsewhere in my blog.
Eventually, after the atrial fibrillation did not resolve on its own, they gave me some heart medicine, and within five minutes or so, my heart settled down. While this atrial fibrillation event lasted for quite a while, perhaps an hour and a half or so, I was feeling pretty well physically and mentally, with only one five or 10 second bout of heart racing where I felt moderately distressed — but, then again, I don't get distressed too easily.
The doctor indicated that my thyroid stimulating hormone test was high normal, that is, 4.75 in a normal range of 0.5 to 5.0. They thought that this might be a possible indicator for low thyroid activity which could contribute to an atrial fibrillation condition. They asked that I be retested in three months. They were encouraged by the fact that I had no other risk factors and was in excellent general health.
They ended up discharging me without any additional request for my hospitalization. This pleased me. I was glad to be saved a day locked up in a hospital. I was glad to have likely saved the health care system another few thousand dollars. Plus, I was planning to attend a health-care protest the following day at noon, where I had planned to read a poem I composed specifically for that event, dedicated to our own Sen. Rob Portman, who has been equivocating over how many millions of Americans losing their health insurance is acceptable.
In the discharge process, I requested a refill prescription of my epinephrine autoinjector, given that it was a generic or less expensive competitor than from the EpiPen manufacturers. I indicated that I had done some research on this before, and that if they wrote the prescription more generically such as epinephrine autoinjector rather than by a brand name, then a less expensive version may be available. They researched this and discovered that only one local pharmacy chain carried a less expensive version. This wasn't my usual pharmacy, but it was about the same distance from my home. The less expensive version was $109 versus the up to $600 for the EpiPen.
I am very grateful that this bee sting occurrence ended up being less serious as far as the allergic reaction than in my two previous occurrences. Apparently, my two-year expired epinephrine autoinjector worked just fine. I'll have to wait and see if this atrial fibrillation occurrence is due to an underlying condition or simply brought on by the very stressful conditions of an allergic reaction, epinephrine and vigorous exercise. I am still aghast that in none of the three times I've gone to this same emergency room have I received prompt medical triage. It seems to me that without prompt medical triage, it is somewhat difficult to actually consider your emergency room an actual “emergency” room. Sadly, they are quite efficient at getting your billing information promptly, but it as to dealing quickly with whatever emergency you are presenting with, that is another and another and another story.