“Dr. Kirstie”

“Dr. Kirstie”
Survivor

It was February 14, 2015, Valentine’s Day, when I was admitted for septic shock. Looking back, I was already experiencing early signs of sepsis before I was admitted. However, it was the last thing on my mind, being a healthy 26-year-old, with no previous medical health problems.

A few days before admission, I had an IUD taken out. The IUD came out in pieces, with one of the arms of the Paragard missing. A pelvic ultrasound was performed. Indeed, one of the arms of the IUD remained in my uterus. Besides confirming its location, there was no immediate course of action at that time. I went home and on the same night, I started experiencing fever and chills, which later turned into vomiting and diarrhea. I even saw a nurse practitioner and was diagnosed with viral gastroenteritis. She instructed me to drink fluids with expectation that my symptoms would self-resolve.

A day goes by and my symptoms worsened. I started to have severe left lower quadrant abdominal pain. I then told my husband to bring me to the emergency department. When I was brought to the ED, my blood pressure was extremely low; I was febrile, with increased respiratory rate, and signs of acute kidney injury. I was immediately given 3 L of fluids with no significant response to my blood pressure. I was in septic shock.

The doctors could not find a source of infection and since I was having severe abdominal pain, they decided to perform a surgical exploratory laparotomy. I was brought to OR and a 5-6 inch incision was made from belly button down to rule out bowel perforation. They did not see any signs of infection, perforation or any abdominal abnormality. However during the surgery, I received another 6 L of fluids, which then caused pulmonary edema, and I had to be intubated. I was immediately transferred via ambulance to a larger facility, and admitted to the ICU.

I was in a ventilator in the ICU for several days. I was given vasopressors and broad-spectrum antibiotics. I remembered waking up several times extremely confused and in pain, with a tube down throat. I couldn’t eat and couldn’t speak. I was very afraid. I woke up in the ICU and my last memory was being taken to the OR. I was severely disoriented. I was not aware of my diagnosis, what has happened, and why I was intubated.

I remember having my parents and my husband in the room. I tried to communicate with them through writing. Per my family, after a few days I started becoming delirious. I remembered there were several times that I had hallucinations of being in hell, and that I was being punished. I had pain all throughout my body. I was put on restraints; since I tried to pull the breathing tube out once. I couldn’t move, I couldn’t speak, and I couldn’t eat. No one can tell me when I’m going to get better, and when I’m going to be extubated. I was trapped and, at that time, I didn’t understand why. Before this, I was always a very positive person, and very excited about life, however for the first time in my life, in a moment of desperation, I thought that it would be better if I would just die.

More workup was performed to figure out the source of infection including hysteroscopy, and bronchoscopy. However, blood cultures, and sputum cultures all came back negative.

After a week in the ICU, I was finally extubated and was allowed to breathe on my own. My vitals stabilized and I was re-located to medicine wards for observation, and several days of antibiotics. After two weeks I was finally discharged home. When I first got home, I could barely move. Before hospitalization, I was a very active individual running half marathons, and participating in triathlons. When I first got home, I could barely stand up long enough to take a shower. My family had to help me get through day-to-day activities. I was very deconditioned and all my muscles had atrophied from being critically ill, and being bed bound for weeks.

Thankfully, I got my strength back after forcing myself. I went back to clinical rotations just a few days after discharge; I was back to the hospital working as a medical student. The same hospital I was admitted. Looking back, I should have given myself more time to recuperate, but I didn’t. I pushed myself hard to graduate on time. I was barely keeping up with morning rounds and trying to look ok when I wasn’t. I was climbing the stairs slowly dragging my feet and using my arms. My strength eventually came back. However shortly after, I started having a terrible problem that I still have at this point.

Two weeks after discharge from the hospital, I started having chronic daily headaches. I never had them before and this headache did not respond to medications. I went to the doctor and had a full work-up including head CT and brain MRI, which did not show anything. Eventually the daily headache broke and it became more episodic. However, I was still having it 3-4 days a week. I decided the headaches are not going to stop me at that point and I kept going to be able to graduate on time, which I did. Last May 2015, I graduated medical school and became a doctor.

However, my struggles were far from over. Shortly after graduation, I started internal medicine residency with very little break in between. Residency is the time when doctors get trained to be doctors. We are trained to finally apply our medical knowledge into real life tasks and take on responsibilities on our own. We learn a lot for a cost. The hours are long, and the work is very demanding. I work on average 70-80 hours a week consisting of 14-hour days, with no weekends and holidays. I was exhausted and my headaches got worse. As a type A person, I kept pushing myself until I couldn’t stand it anymore. Not only was I having chronic pain and was starting a new very demanding job, I was also adjusting to the new location away from family, and separated from my husband who was away doing his clinical rotations as a medical student. I was extremely overwhelmed. There were many days where I can’t see past that given day without wanting to give up. I remembered crying everyday, and was extremely depressed.

Some days I felt as if I was intubated again. I couldn’t move and there’s no way out. I can’t quit since a doctor cannot practice medicine without residency training, and if I quit all my hard work will be for nothing. There were several times I thought it would have been better if I just died when I was sick, except I don’t want my family to be sad.

I finally told my program director about what I’m going through and they told me I can take a break if it gets really bad. I was then told to see a neurologist regularly. I was hesitant to take leave of absence since this will put me behind on my training. The neurologist placed me on several medications, however, still could not figure out the source/cause of my headache. Although the medications helped with my headaches, the side effects of the medications made me fatigued, nauseous, and tired all day.

Just recently, I was in the ER several times for worsening of nausea, abdominal pain, and vomiting. Based on imaging, I was found to have fecalization of my small intestine as well as uterine mass pressing on my sigmoid colon. The mass, as well as the medications I was given for migraine prophylaxis could have slowed down my gut motility that it caused severe constipation. Up to this point, I still experience nausea, and epigastric pain with meals.

Life did not become easier, but I became tougher. I kept going even though I know I can’t. I placed my trust in God that there’s a reason why all of these happened to me. I continually asked for God’s strength everyday, as I know there’s no way I can do it alone. Because of this, I’ve learned to appreciate life and to make the most out of every pain free day I have. With God’s grace, I know that someday, I will realize the true reason behind all these suffering. Already, I have felt that I became a more compassionate doctor, and individual. As this year ends, I’m hopeful that next year will bring more joy, and hopefully less challenges.

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