Room 717

I thought it was just simple diarrhea. It started Friday afternoon, barely two hours after having lunch. By six in the evening, I couldn't go home on my own because the episodes were becoming more frequent and I've started vomiting anything that I'm taking orally.

I felt I could handle it with oral hydration: after all, that's the basic thing to do in cases of diarrhea - adequate fluid intake so you won't get dehydrated. Over the weekend, I had the worst diarrhea I ever had in my entire life. I was vomiting once in a while. I had very poor appetite. I never had fever but I decided to start on antibiotics anyway. I had really bad leg cramps at night that I couldn't get up to go to the bathroom when I needed too. I thought my potassium levels were going down so I decided to take Kalium durule. By Monday, the episodes were become less frequent and I felt I was actually getting better. I felt I was ready to prepare to go back to work and prepare for my residents' exam.

I went to the hospital on a Wednesday just check on those exams and have them photocopied. It was a good thing that my mom forced me to bring our helper along because when I go to our office, I felt dizzy and I just couldn't stand up. I asked my friend to go to our office so she could take a look at me. She said I looked dehydrated and had a rash (what rash?) and she decided to have some labs done. When the results came back, we were shocked - my creatinine was 809, my BUN was 34 and my potassium was 5.5. I knew I had to be admitted.

Of course it caused a stir among my consultants and residents. We all know that diarrhea could lead to dehydration but severe dehydration and acute renal failure? My residents were the ones up and about looking for insytes and fluids at the ER, doing my admitting orders and looking for a vacant room in the hospital. Since most of my veins were collapsed, I think it took about 15 attempts - from our sharpshooter interns, residents and even med techs from the blood bank - before my training officer (later, my attending MD) decided to give it a try and thank goodness it was successful. I don't want to be referred for a cutdown for heaven's sake! Next, they couldn't find a single private room - then my friend finally said that it wasn't for a relative but for the chief res of the department and viola! they found a room in about ten minutes. Oh man. A few minutes later, I was brought up to Room 717.

Remember the rash that my friend was talking about? Oh it wasn't a rash, it was mottling. My attending ordered an ABG and when the results showed metabolic acidosis (pH =7.036!). Oh my goodness, my kidneys were giving up on me. My consultant asked my if it were okay to have a nephrologist on board. I took a deep breath and agreed. At least there's someone there just in case I'd need a dialysis. I was getting about 4 liters of IV fluids a day so naturally, they had to monitor my urine output. Err... foley catheter? No thanks. My monthly period came at the most inconvenient time and it was so difficult to measure output in a very crude way. I was also started on IV Sultamicillin and boy, now I know why kids cry whenever you push their meds too fast. I was given dopamine but I was having chest heaviness and shortness of breath so we stopped it.

Since we were monitoring my chemistries, I had daily blood extractions - and it's a good thing that I can tolerate that. They had to repeat my ABG so I had no choice but to have a needle down my wrists again. I swore that I would never ever order an ABG again on another patient unless it absolutely necessary. OMG, that was one of the most painful things ever done to me. In fact my nephrologist caught me crying during one of his rounds and he asked me if there's anything wrong. I had to tell him that the med tech had two attempts before being able to get a good sample. That was the last ABG that he ordered.

Thankfully, I did respond to antibiotics and aggressive hydration. I was discharged after staying in the hospital for a week. Now not everyone gets renal failure from dehydration right away - maybe my kidneys were affected by Salmonella (my blood workup showed reactive Salmonella IgG) or maybe I had rhabdomyolysis (this is the breakdown of muscle tissue) from the severe leg cramps that I had. Whatever it is, I'm glad my kidney bounced back to it normal function.

When someone gets sick, the entire family becomes involved and this proved to be true in my case. My mom took a leave from her work to take care of me. My father would go to the hospital everyday so my mom could take a rest in the afternoon. My siblings would visit me in the evening to bring us dinner or just to hang around and tell me stories. My PGH family - my residents and even the secretarial staff would also drop by once in a while just to keep me company. I am truly grateful to my co-residents who had to take over my duties during that time.

I know this is probably one of the unusual reasons for admission and in fact, my consultant discussed my case among my first year residents during one of their M & M conferences. This is really one of the stickiest situations that I got myself into - I was scared and yet I had to reassure my family that everything's going to be okay. I always tried my best to be strong and to be tough but there are times when I feel that I just needed to someone to calm me down and hold my hand when some doctor or med tech sticks that needle through my wrist and arteries. Not even the best doctors nor the best medical technology available could come close to a caring touch, gesture or understanding.

If a patient needs his hand to be held, I'd gladly do it. Sometimes that's all that matters.