aggiepie's tabulas

Last Thursday, I had my appendix taken out. The symptoms started Tuesday afternoon. I was having OPD when I started having this gnawing kind of pain over the epigastrium, with a score of 6/10 on the pain analogue scale. I was wincing every now and then as I felt a peristaltic wave churn up in my stomach  (with apologies to the patients for my pained expression!). The symptoms were nonspecific and I initially dismissed it as a case of dyspepsia since it was quite reminiscent of my pre-boards stress gastritis experience last year. Self-medicated with a PPI and then even went on duty that night.

Skipped dinner and opted to just lie down in bed while awaiting referrals/calls. Wasn't exactly feverish, but I didn't feel well. Admitted patient G.M. around 12 midnight, and had first bouts of retching  while I was writing my admitting notes on her. Admitted patient B.V. at 2 in the morning. Received referral for patient C.D. at 3 in the morning. All the while, the pain was persistent, made somewhat bearable only by walking partially hunched. Sir Jessie who was also on duty that night, and Ma'am Ayi & Papa Dudz who were also spending the night at the callroom, already suspected it to be acute appendicitis by virtue of abdominal pain + nausea + anorexia + "AP Walk". Other differentials: 1) Mittelschmerz (but I was only 4 days post-LNMP). 2) UTI. 3) Ectopic pregnancy. Jokejokejoke!!!!  I saw Ferdie after the 3 AM referral and had him check if it was indeed AA (Surgery resident that he is), but he was non-commital since the pain was (still) periumbilical, hasn't progressed in severity and I didn't have any fever.

Come Wednesday morning though, the pain has localized to the right lower quadrant, and when Roman examined me, I already had direct and rebound tenderness, and positive Rovsing's and psoas signs. My fellow residents then insisted that I be admitted, lest it be AA in impending rupture. I was in denial!!!! I didn't want to be admitted and have an IV cannula up my veins for the first time. I refuse a DRE and a Foley catheter. And I wouldn't want to be seen in all vulnerable glory on the operating table by the people I work with in the hospital!!!!

But my colleagues were persistent. Ma'am JenMan called up "The 10-minute appendectomist/30-minute cholecystectomist" Dr. A'Ericson Berberabe. Sir Richie was the one who inserted an IV cannula up my then-virgin veins and hooked me to IVF. Roman sent my blood to the labs, which results he retrieved later, to reveal a WBC count of 20! Natzi got me a room but since there was no available single one, I had to share a room another patient--G.M.--whom I admitted the night before.

Spent the whole Wednesday sleeping off  the tummy ache until my head hurt from too much sleep.  Was checked on from time to time by the Surgery residents and by my fellow Neuro residents; Natzi, Cha and Sir Mel even had their dinner in the room, while I just watched coz I still didn't have an appetite. VS monitored q 4 by the nurses. And pre-op antibiotics were loaded which really stung man!

Mom arrived the next day, just several minutes before my OR. I had to change out of my clothes and into a flimsy hospital gown. I buried my face under the sheets as I was wheeled along the hospital corridors and into the OR complex. With the exception of Dr. B, it was an all-woman team that attended to me (which I specifically requested for). I was gently helped on to the OR table. Placed on flexed left lateral decubitus and a spinal block was done (which ain't so different from the lumbar taps I perform on my patients) to numb me for the procedure. Sedated with Midazolam. Fell asleep during most of the procedure and woke up in time for OS counting and closing.

At the PACU, Mommy was there, as well as my fellow residents. One of the first things I noted (neurologist that I am!) was a motor and sensory deficit up to the level of T3. As the spinal block progressively wore off, I found myself charting the last normal sensory level by dermatome. When the LNS was at T10, the wound started to hurt. By the time I could already move my legs, I was transferred back to my room (I still had a sensory deficit in saddle S2-S4 distribution).

I was so knocked out from the day of the OR, and my profuse apologies to the people who visited for my lack of hospitality (Maffy & Loffy, Christine & Tita Jing, and Phoebe, Lexi, Dawn, Lau, Pau & Chatch). But the ff day, I was already up and about and feeding. Dr. B. didn't discharge me until yesterday though.

Now I am on vacation leave--somewhat a fulfillment of one of my birthday wishes, and that is to wake up late* and NOT have patient responsibilities. (* My body clock's still got me up by 6 am though, only for me to realize that "Hey I am excused from work today!" and then I try to get back to sleep. )