Intake & Admission

Part 3 of the Gallbladder Saga

We left off having arrived at the Emergency Room and speaking with the doctor about keeping me at the hospital to figure out my pain and symptoms.

I was put into a section with a bunch of those comfy recliner chairs to wait for another ultrasound and for a room. When I arrived, no one else was there, so I picked a spot in the corner near the washroom. That way I could be easily seen by the nurse's station and could get to the washroom fairly easily. (These are important when you're having unknown internal organ issues). It also becomes much more important when these chairs start filling up with patients. Within an hour or two, there were around 20 patients in that section sharing 2 washrooms in the middle of a busy Emergency Room. The corner seat was pretty perfect.
These chairs are usually reserved for people eventually being admitted or for fast-track issues.
For instance, when I have to go in for severe dehydration, instead of taking up a private room, they will often start an IV and send me into one of these recliners.
This time, it was because I was waiting for my own room.

While I waited, two different physicians came to speak with me. One from Surgical Service and one from Internal Medicine. It was still unclear as to whether or not it was the liver or the gallbladder, so these physicians were trying to decide which floor (which service) to admit me under. If it was the liver, I would likely end up in the Internal Medicine unit, but if it was the gallbladder, I would end up in the Short Stay/Day Surgery unit.
The decision, however, could not be made until we did another ultrasound. I was kept as comfortable as possible with pain and nausea medications while I waited, watching whatever programming was on the communal television, and visiting with my husband and, eventually, my parents.

This second ultrasound was one of the highlights of the week - not because of the test itself but because of what I saw when I left the test.
The ultrasound was painful, as usual, but relatively simple. The technician searched around and pressed and poked and prodded and asked me to breathe in and hold my breath, like any other ultrasound. At one point she looked extremely confused, though. She kept rooting around like she was looking for something.
I was just trying to get through the damn thing, and I know they can't say anything, so I closed my eyes and grit my teeth. At the end, she told me to hold tight, that she needed to check something with the radiologist and that he may need to come in and speak with me.
Ummm... okay?
This has happened to me before. It isn't often good news. Sometimes there is a mass or cyst that they have to analyze, or maybe a sign that something needs immediate attention. I tried not to think of these things.
So I waited. And waited.

When she came back, I was told that I could go.
Then, as I was being wheeled out of radiology, I saw my technician standing in front of those anatomy posters, scrutinizing the bowels.

I had forgotten to mention that my large intestine was removed.

Bahahahaha.
Soooooo funny!
Poor girl.

Even in that much pain, it was a light moment.

But then, there was a problem.
A big problem.

I started experiencing more pain in a more familiar area. Rather than the upper right GI symptoms (which were well controlled by medication), I began having these intense cramping pains in my upper mid-abdominal area. Over the next couple of hours, the more it hurt the more pain medication they would give me, but it wouldn't last. In fact, it was getting SO MUCH WORSE!
At first I thought maybe an intestinal HAE attack from of the stress of whatever the larger issue was. I thought maybe it was a Crohn's flare. All I knew was that it started to feel like I was being ripped apart from the inside out. I could not stand or sit or talk or even think. I monopolized the washroom. I cried. I called out for someone to 'please help me'. Then, after spending HOURS in this crisis state, I realized it might be an allergic reaction.

Turns out I am intolerant to another medication.

The pain was so horrific, I believed it was possible that my pancreas had burst, or my intestine had ruptured.
This intolerance sits as one of the top 5 pains I have ever experienced.

Once they gave me a different medication for pain and more anti-nauseates, the cramping pain began to settle. It still took over 4 hours to realize what it was and to act on it - through no one's fault. I was given a private room within the ER (with an attached washroom) to wait in until I received a longer-term room. I felt so guilty for monopolizing a washroom, but I also could not physically leave the washroom for more than 10 seconds before running back in. It was awful. There was also this poor man having to complete bowel prep (by drinking a jug of laxative) who also had to share the two washrooms.... so he wound up taking up one washroom and I took the other, until I was moved. It was a really unfortunate situation for everyone.

By the early morning hours on Wednesday, when it was lightening outside, I was moved into a room on the surgical floor. It turns out the ultrasound showed at least one gallstone.
This was a relief to me - the culprit seemed more likely to be my gallbladder. They continued with medication and more bloodwork and started their investigations.

By Wednesday afternoon, I waited to be sent for something called a Hyda scan. I was not able to move well, I was vomiting and in pain, headachy, and slept the most part of the day.
The Hyda scan itself was interesting.
They injected me with something called CCK and a radioactive dye, which forced my gallbladder to contract and work, then they took images similar to a CT scan. This meant that I soon found out what gallbladder cramps felt like. It was a deep kind of a burning pain, not sharply painful, but definitely uncomfortable.
I always find it interested to actually know what it feels like to have pain in specific organs.
It was explained that when the CCK is injected over more than 5 minutes, patients often feel more discomfort. They did mine over 10 minutes, then took pictures.
But that wasn't enough.
So then they did a second round of CCK, injected it over an HOUR, then took more pictures.
Omg. So ill. AND it triggered some more of those abdominal cramps! Luckily for me, the more it moved through my system, the more bearable the cramping became and the less pain I experienced.
Phew.

Then the results:
I had at least one gallstone, some sludge stuck in my bile ducts, and a "poor-functioning gallbladder". Even with the hour of CCK, the gallbladder was extremely slow. The surgeon suggested we remove it - that if I kept it, I would likely have more and more of these episodes until it had to be removed anyways. They still wanted to watch the liver, but it was seeming more evident that it was the gallbladder at fault.

After the Hyda scan, the ultrasound, and finding out about probable surgery, I was also scheduled for an ERCP. This is where they take a scope, stick it down your throat, through the stomach, and into your small bowel, widen the sphincter that carries bile from the Common Bile Duct into the Duodenum, and helps remove sludge and gallstones from that main duct.
I needed this procedure to remove a stone from the Common Bile Duct and to ensure that other stones could easily pass through. I was not looking forward to the procedure itself (I had had one before and it was highly uncomfortable), but I was interested to see if my symptoms improved after removing some sludge and gallstones out of that narrow common bile duct.

As I mentioned in one of the previous parts of this saga, calling the GI-on-call on Tuesday evening was a mistake.
The day before the ERCP, I received a phone call from my GI nurse.
I was told, repeatedly, how inappropriate it was for me to call the GI on-call before going into the ER. My nurse, by this point, had been informed that I was scheduled for an ERCP and a Cholecystectomy, but wanted to let me know that patients are not to call on-call specialists, and that the switchboard should not have put me through. (I would like to mention here that there was no convincing or pushing on my end. I simply said to the person on the switchboard "Could I possibly speak to the GI on-call", in audible tears, and was instantly transferred).
Of course, I will not do that again unless explicitly instructed to do so, but being reprimanded while in the hospital awaiting surgery felt mildly inappropriate...

Nothing like worrying about an ERCP, impending surgery, still not entirely out of danger in regards to my liver, and being called (shortly after vomiting) to be reprimanded. That just sucked.

So, there I sat, on Thursday, feeling guilty for making an inappropriate phone call, vomiting, and awaiting an ERCP.
You would think it would be a simple cass of prep and procedure.... it wasn't.