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06 August 2012

"I'm Fine", and other Stories.

I had anorexia (loss of appetite), the correct pain
symptoms, elevated CRP, slight nausea, but normal
WBC, and no fever for a score of 6.
 So, last Monday I felt crummy.  Not a specific, put-your-finger-on-it set of symptoms like coughing up a lung or vomiting; just...unwell. Yucky enough that I stayed home...Tuesday it evolved into a generalized abdominal ache. By Tuesday night, the ache had become actual pain and had moved to the right lower quadrant, or "iliac fossa" (when doctors wish to sound doctor-y).  I asked Anne, my housemate and another med student, to do an abdomen exam on me. Sure enough, I had pain over McBurney' point and Rovsing's sign, which are signs of acute appendicitis.  However, I did not have a fever and was not chucking my cookies, so I decided to try an ibuprofen (which fixes almost everything, right?) and go to bed. No sleeping ensued.  By 3 am the pain had gotten bigger in the dark and I was trying to pick the most opportune time to present to ED ("not during heart attack prime time: 5-7 am; not during handover:, I guess I should go now") So I decided to wake up Rob to take me to hospital. I must say he was a gorgeous man and got up to ferry me to the Prince Charles Emergency.  I was seen within 10 minutes of talking to the triage nurse.  Clinically, it was appendicitis, but I wasn't running a fever and did not have an elevated white blood cell count, which are also suggestive features (see the MANTRELS Scoring system).  They did an ultrasound to rule out any gyne problems and look at the offending appendix, which indeed appeared angry and inflammed.  Then I was seen by a surgeon and admitted to the ward by 8 am.  I was fortunate enough to have friends doing their rotations at Charlie's, and Kelsey and Emily came to visit and have a bit of fun as they prepped me for surgery at 4 pm.  By this time I was on morphine for pain and could play along:
"What does appendicitis sound like?"   "Like Nickleback."
When I arrived at operating theater, I was greeted by more familiar faces. The anesthetics team I had learned under only a few months before was putting me under. They promised they'd take good care of me, and I could believe them, because I had watched them at work.  I woke up after surgery feeling less pain and horrible-ness than before.  The nurses were beyond wonderful. One of my roommates had animated conversations in her sleep, so I got up and wandered the ward four times the first night, since the earlier you get moving post surgery, the better you tend to recover.  The next morning the surgeon did his ward rounds and explained that we were fortunate, as the appendix was inflamed and indeed needed removal; however it was neither perforated nor gangrenous, which would have necessitated extra days in hospital and more extensive surgical work during the procedure. I spent the rest of the day in hospital getting IV antibiotics, and was discharged by that evening.
  From ED presentation to admission to surgery to discharge was only 44 hours!
Scumbag Appendix!
Friday at home was a slow day, but I no longer needed any pain medication by the afternoon, and even managed to make Rob supper by the time he came home from work. I am amazed at how soon I am feeling well.  Once again, Prince Charles Hospital staff has reason to  be proud.  And by way of post script: Cephalexin tastes and smells terrible, and permeates your breath. But it still beats sepsis.
I guess this is all part of studying medicine immersively?

The Saturday (3 days post op!)  following, Rob and I attended the Queensland Symphony Orchestra presentation of Lord of the Rings. It was a neat way to experience the movie, as it was played on the screen with subtitles. The orchestra and choir with soloists played the entire Howard Shore score for "Fellowship of the Ring".  It was a brilliant performance!

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