Monday, September 23, 2013

A Light at the End of the Tunnel

It was such a relief to confirm that the proverbial Light at the End of the Tunnel” was not an oncoming train.  It simply is the difference between what the letters “R” and “S” signify in the acronyms MRSA and MSSA.  The former stands for “Resistant.”  The latter stands for “Susceptible.”  They are in fact exact opposites as far as bacterial behavioral patterns go.

The error was not borne of panic at what I earlier characterized to be a near-doomsday scenario.   Rather, it was simply forgetting to apply the most popular of Reaganisms in Foreign Policy, namely, “Trust but Verify.”  It all started with the tiny print in the thirteen-page “Clinical Report” from the hospital.  When the home health care nurse read the diagnosis allowed as “high grade MRSA,” it sounded very similar to what I heard discussed about when I was in the Critical Care Unit ward at Stony Brook University Hospital.

Thanks to the feisty reaction by my wife, Krystyna, at the full implications of having to live with somebody infected with MRSA in the same household.  It meant she had to maintain two sets of dishes and utensils, two sets of laundry, and to disinfect my footsteps with Clorox or Lysol anywhere I’d venture within the house.  She adamantly felt that the health care system had no business sending me home if I had MRSA.  I should have been institutionalized so that I did not become a threat to family and friends and the community-at-large.

She was prepared to do battle with anyone who disagreed with her when she telephoned my Infectious Diseases physician.  The good doctor promptly assured her that somebody made a mistake somewhere because he was the one who wrote the “Clinical Report” and there was no mention of MRSA in it.

Independently, I started examining the fine print that I heretofore entrusted to the nurse.  I was relieved to find no mention of MRSA therein but only MSSA.  While this allows me to approach my 69th year in the sun on somewhat a different light, I’m getting more curious to hear from Rommel about his conversation with the attending physician at Stony Brook.

Someone somewhere in this entire episode failed to communicate accurately.  No wonder my daughter, Renata, is sporting for a fight and busily looking for a medical malpractice lawyer she could rely on.  Volunteers, or referrals anyone?

Sunday, September 22, 2013

Afloat in the Vortex of Uncertainty

On 29-Jul-13 my wife Krystyna discovered before she went off to work that I was running a temperature of 99.5F.  By the time the Catholic Home Health Care nurse found me home, circa 11:30am, it had gone up to 102.0F which prompted her to call an ambulance to take me to Stony Brook University Hospital emergency room.  By 20:00 hours that night, the fever was at 105.7F.  I was refrigerated in one of the rooms at the Critical Care Unit.

It was certainly a far cry from Mr. Roberts’ boredom on sailing “. . . from Tedium to Apathy and back again, with an occasional side trip to Monotony.”  The closest comparison I could come up with from my memory banks was my protracted bouts with Malaria as a high school teenager.  I assure you both episodes were anything but monotonous.  They were more akin to indulging in blindfolded hopscotch along the vortex-envelopes of delirium ever uncertain whether to hold on and stay afloat or just give in to the delicious seduction of complete surrender.

On hindsight, it was a blessing that I had gone through the delirious experience with Malaria and without the benefit of any medical assistance at that.  Then, I just toughed it out and weathered the storm.  I dared say I came out ahead at the end else I would not have been here to tell the story.  The point was, surrender never even factored into the equation.  The sense of déjà vu had sufficiently blunted off the bite and implications of what could otherwise have been construed as a desperate situation, this time around.

Just to stay on the record, here’s how:

·       Diagnosis: High grade MRSA (an acronym for Methicillin-Resistant Staphylococcus Aureus, a bacterium that is resistant to many antibiotics);
·       Treatment Protocol: Think A Hail Mary Pass in American football—i.e., give it all you got and hope for the best;
·       Prognosis: Heaven knows, Mr. Allison, the WWII movie—i.e., your guess is as good as mine or anybody else’s for that matter.  You can never tell for sure until what you were afraid of may happen had happened and there was nothing left but to react to the new events.

When I regained access to cyberspace after a fifty-day hiatus attendant to my serial stints at the hospital and the rehab center, I scoured the web for every bit of literature on MRSA.  There is a relative preponderance of case histories in the extant literature.  However, the most remarkable aspect of my findings had been the absence of any case history where the patient was completely cured from or rid of the infection even for a moderate duration.  If it sounds like a death sentence for me, to be nonchalant about, the other side of the coin would be that if there is nothing I can do about it, I might as well live with it the best way I can.

There is something in this near-doomsday scenario that I find sort of perversely fascinating.  Firstly, it explains a lot of the otherwise enigmatic behavior, bordering on the evasive, by the medical care providers at the hospital.  For instance, every day during the first week to ten days of my hospitalization, blood was harvested from my veins presumably for bacterial culture and routine laboratory analysis.  I was periodically informed that all tests and cultures came back negative for whatever they were trying to detect.  At the same time, I was told that the I.V.-administered antibiotics should continue around the clock, just to leave no stones unturned.

At some point, I found the attending physicians’ explanation of my condition to be so unintelligible to my medically uninitiated mind, I requested her to brief my nephew Rommel who holds a doctor’s degree in medicine that I might be able to glean from him and more satisfactorily learn about what was going on with me.  The net effect was to put closure to the question.  I have not spoken to Rommel about it since then but I’m content that should something “unexpected” happen to me he should be able to brief the rest of the clan on his conversation with the physician.

Secondly, it puts into proper perspective the series of non-diagnostic results obtained from the various attempts to isolate and identify the source of the infection.   There was an initial hypothesis that the source of the infection was most likely wherever the stents were anchored to my blood vessel attendant to the endovascular repair of the aneurysm.  There were even suspicions that some of these anchor sites could be leaking.  None of these was ever confirmed nor completely ruled out.  It did add two questions I need to ask the vascular surgeon when I see him on Tuesday, 24-Sept-13, viz, if a leak did exist between the stent and the blood vessel,

a)   How does he propose to fix the leak; and
b)  Would not the leaked blood accumulate between the stent and the walls of the vessel constitute “dead blood,” and potential source of lethal blood poisoning?

Finally, there was an attempt at radioactive isotope tagging of the infected blood platelets so that they could be easily located should they congregate with some “usual suspects” site localization such as my artificial cardiac aortic valve, the stents of my four cardiac bypasses, or the most recently installed stents for the abdominal aortic aneurysm (AAA) repair.  As luck would have it, no such localization was detected: non-diagnostic result—i.e., the infection is throughout my blood stream.

I managed to transform myself from the walking biological time bomb before the AAA repair to a walking biological disaster after the blood infection.  In the unsolicited view of the Catholic Home Health Care nurse who conducted the initial  evaluation last Tuesday, 17-Sep-13,

After the post-hospitalization six-week regimen of I.V.-fed antibiotics followed by a four-week regimen of oral antibiotics (Cephalexin 500 mg and Rifampin 300 mg—both stink like swam sewers), if I’m not done with the infection, I’m practically as good a being done for.

If this is a binding verdict, I don’t know whether to mourn or celebrate.  But having known myself for a good part of sixty-nine years, I probably just take it in stride.  Life is too precious to waste worrying about circumstances over which I don’t have any leverage.

Incidentally, and for the record, having experienced the malarial chills I earlier reported, on the day after the AAA endovascular repair in a hospital room at The Good Samaritan Hospital, I definitely classify my present malady as an HA-MRSA, i.e., a healthcare-acquired MRSA in contra-distinction to what is designated as CA-MRSA or Community-acquired MRSA.