Bad Doctor

In the beginning of my Lymphoma Journey, I had a Bad Doctor. The most excellent Dr. V referred us to a surgeon to have a port-a-cath placement with ultrasound guidance and an underarm lymph node dissection for biopsy. Both procedures were done at the same time in an outpatient surgical center. I went straight from the surgical center's recovery room to the hospital for my first chemo.

It did not occur to me at the time to wonder why I wasn't having those procedures done at the hospital, since I was going there anyway.

 

 

The day after the surgery, my underarm surgical wound was draining at lot of lymph fluid. It was soaking the very thick bandages the nurses were applying and soaking my bedclothes and bedding. A nurse said the wound was not completely closed and reported it to Dr. V, who called Bad Doctor to come see about it.

 

About 8:30 PM, Bad Doctor came into my room, late, acting furtive and sneaky. He looked very unkempt and smelled bad. I'm pretty sure he had been drinking. He did not wash his hands even after I pointed out the hand sanitizer and gloves.

 

First thing, he starting scolding me for "telling everyone in the hospital" that he hadn't sutured my surgical wound. I promptly told him I didn't say anything to anyone, that I was sick in bed and couldn't even see it!

 

He had brought a stapler, a suture removal tray, and steri-strips with him. He said he could staple the wound but that the fluid would get backed up and I would get a swelling the size of a baseball under my arm! He was putting pressure on me to tell him what I wanted him to do.

 

My husband was down the hall, in the lounge, making family phone calls. I picked up my phone and told Bad Doctor I wanted my husband. Bad Doctor starting yelling at me!! He said he didn't have time to wait for my husband to get there as he only had 5 minutes and his wife was waiting in the car. Again, I snapped back at him, "He's in the hospital"! I have never had a doctor be so rude to me.

 

I buzzed the nurse and asked her to locate my husband. I think they both ran to my room. And surprise, Bad Doctor suddenly became Mr. Nice Guy when my husband walked in. My husband, the nurse, and I unanimously decided to send Bad Doctor away.  He left the room muttering something about God's will. Indeed. 

 

Was Bad Doctor really going to remove stitches and staple my surgical wound, in his allocated 5 minutes, there in my room, without sterilization or anesthesia of any kind, without even washing his hands??  Probably so.

 

I learned later that Bad Doctor does not have any affiliation or surgical privileges at the hospital! So that is why I had the surgery elsewhere.

 

 

And this was not the end of dealing with the after-effects of Bad Doctor's shoddy and nasty work.

 



 



Hospitalization and the 9 Diagnoses

Here I am, sound asleep, receiving a blood transfusion and antibiotics.

My first chemo didn't go well. This was as bad as it would get.

Because I was so symptomatic, I was admitted to the hospital and the first R-CHOP was done there. I was discharged home on the 5th day. Four days later, I went to Dr. V's office for labs. My blood counts were very low--red, white, platelets--everything. Nothing was even close to the normal range.  And I had fever, so back to the hospital we went. Did I mention I felt miserable?

While we waited for a hospital room, I received, at Dr. V's office,  IV fluids, antibiotics, and a Neulasta shot to stimulate my bone marrow into making more white blood cells. I progressively felt worse and worse and left Dr. V's office in a wheelchair.

I remember getting to my hospital room and changing into one of their lovely gowns. I remember meeting my nurse. I remember pain setting in. I have tiny fragments of memory of several days. I remember being surprised one morning to learn that I had been in the hospital for over a week!

This is why I was hospitalized:

Neutropenic Fever
MSSA Port Infection s/p removal
SIADH
Stage III transformed Marginal Zone Lymphoma
Left pleural effusion s/p Thoracentsis
Pancytopenia
Anemia s/p PRBC transfusion
Hypophosphetemia and Hypokalemia
Deconditioning

Needless to say, we had to look up most of those words.

Things I know from my husband and his notes:

Day 1: Fever, shaking chills, temp up to 103.9; finally got hydrocodone for pain; Ativan; Clonodine after a tough round of fever with high BP and heart rate; by 1AM, vitals back to normal, temp to 100.

Day 2: (Pictured above) Hemoglobin down, transfusions ordered; Oxycodone and Morphine added for pain; 4PM CT scan and ultrasound done, more fluids, antibiotics, Albuterol for Wheeze (new today).

Day 3: Fluid in left lung, will see lung Doctor; lymph nodes shrunk somewhat; white count still way down. platelets about the same, hemoglobin up; Pulmonologist  says left lung less than 1/2 aerated; when platelets and blood count go up enough, will use needle to remove fluid from around lung and test to see if it is from the lymphoma; platelets are at 30, he wants a count of 60 to do procedure.

Day 4: Platelets 50; red cell improved; white not yet--still at 0.0; port must come out, Staph Aureus;
sodium down, limit fluids; 1 PM port removed.

Day 5: Platelets 75, still low; white count not up; sodium level 118, low, salt tablets ordered; Cipro and Unasyn ordered. Nephrologist ordered 3% sodium infusion, 100 ml. to raise sodium without adding water; kidney function good, but R is seriously retaining water and this dilates her sodium level and causes confusion, etc; water intoxication; sodium at 115; if it drops after infusion to 113 then it's off to ICU; 11PM Good News! R's sodium back to 118.

Day 6: Sodium up to 124; Platelets 123; white counts and Neutrophils up; all good news; may get PT today; may get lung procedure today or tomorrow.

Day 7: Thoracentesis done using a needle to draw off 1200 ml. fluid; fluid was bloody but no sign of infection; 1200 ml about 1/2 of fluid present but stopped due to pain and coughing from pleurisy which should subside in a few hours; 1PM chest x-ray showed normal but 02 saturation went down to 86%; got 2 lpm  02; level went quickly back up.

Day 8: Blood good; electrolytes good; sodium 124; phosphorus still low; no infection from lung fluid, will know more tomorrow; will add hydrocodone and d/c morphine; wound care nurse teaching.

Day 9 through 11, I can remember!  I started getting physical therapy; the fluid from my lung was negative for lymphoma; blood counts good. I was discharged on Day 11 with 11 prescriptions, a walker, orders for home health physical therapy, and a 1 week delay in Chemo #2.

View from my Hospital Room

Port-a-Cath Placement

That first day I saw Dr. V, he ordered the placement of a port-a-cath (a central venous catheter), a small device, about the size of a quarter, which looks like some kind of transmitter. It is surgically placed under the skin of the chest, then an attached catheter (tube) is threaded underneath the skin and inserted into the jugular vein in the neck. This allows infusions without the need to have an IV started in the vein each and every time. I have had chemo and other medications, blood transfusions, and blood draws for lab tests, all done through my port.

This is the device causing the bump, which is not "accessed", on my chest in the photo above. To use it, a special needle called a Huber needle is inserted into the port's septum, the silicone center of the port. When a needle is in place, the port is "accessed".  My port has been accessed for up to a week, then it has to be changed.

This is a Huber needle. The needle is inserted into the port using the little grip that looks like a clip. The padded part rests flat on the chest and the little clip is folded down like a butterfly. The whole device is taped into place. The port is now accessed and ready to use. The blue cap is removed, then syringes and other specially made catheters can be screwed into place. The clamp is used for stopping the flow while the port is still accessed but not in use or while catheters are being changed.

Here I am with my port accessed, receiving an infusion. It really is convenient because both my arms and hand are free. I can used my computer, Kindle, eat, and all the things I do, while passing the hours I sit in this recliner.