A Day in the ER

November 09, 2011

We spent the day in the ER yesterday. Surprisingly this was a good thing.

About 3 am Tuesday morning Sibylle was up with a feeling of nausea and some pain in her upper abdomen. Usually a cap full of Pepto Bismol soothes her stomach and she is fine. The Pepto didn’t work and her pain only got worse. She was able to vomit at least once, but that also didn’t bring any real relief. By 7 am she was feverish, covered in sweat, and in a great deal of pain. I suggested that we go to the emergency room. After a few moments Sibylle agreed.

The intake process at the ER was quick and Sibylle was soon in a bed covered with a heated blanket. The first medicine that was administered was to quell the nausea, and then she was given a shot of Morphine for the pain. The nausea subsided fairly quickly but the pain she was experiencing continued. She said it was up high, just under her sternum, and stretched around her right side, under her rib cage. There was also a second band of pain low in her abdomen, behind and below her belly button.

When the Morphine didn’t work she was given a dosage of Dilaudid through her IV. This is a powerful painkiller and it did the trick. I could see the lines of pain on her face melt away as the drug took hold.

The hospital performed an ultrasound to image her gallbladder and surrounding area. They had already done some palpitations of her abdomen to make sure it wasn’t her appendix. The results of the ultrasound showed some “sludge” in her gallbladder, and some dilation of the bile duct and pancreatic duct. Apparently sludge in the gallbladder isn’t unusual or always cause for alarm. The doctor was more concerned about the duct dilation he was seeing.

The next step was to perform a CT, or “cat”, scan with a contrast agent. Sibylle was given a cup full of what looked like weak lemonade to drink. She said it was delicious - of course this was the only fluid she had been allowed to drink for several hours. During the scan itself she was injected with another contrast agent through her IV port.

The results of the CT scan showed that both ducts, the gallbladder and pancreatic, were within the normal range for size. Also there was no evidence of injury or disease in the gallbladder. No evidence of gall stones or thickening of the bladder walls.

The time for the two procedures, and waiting for their results took until early afternoon. Her nausea was returning, as was the pain. She was given a third shot of anti-nausea medicine (the second had come with the liquid contrast agent as it sometimes gives people nausea), and a final dosage of Dilaudid. The ER attending doctor came in and discussed what they had found, or rather not found. The good news is that there doesn’t appear to be something wrong. The less good news is that we still aren’t sure what is causing her symptoms.

Our next step is to see our primary care physician and schedule an endoscopy. Using a scope the doctor can visually see the lining of her stomach and even, I guess, the upper portion of her intestine. The scope will be combined with a nuclear agent to allow visibility of the gallbladder and the ducts in question.

In the meantime we’ll be having blander food, with smaller portions to try and avoid the miserable experience she had on Tuesday. We have a prescription for both a painkiller and anti-nausea agent in case her symptoms return.

Going to the ER is not any one’s idea of fun, but it was the right thing to do in this case. The staff there was helpful, concerned, and very good about taking care of Sibylle. Just knowing that we weren’t alone was helpful. And seeing her relief as the pain medicine did its job was priceless.

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Mark H. Nichols

I am a husband, cellist, code prole, nerd, technologist, and all around good guy living and working in fly-over country. You should follow me on Twitter.