Called in Sick

Jr Nurse Watches Over "Papa"

Well, it didn’t take me long.  I haven’t even been at my part-time job for two months and I had to call in sick. I thought I was imagining things when I felt weaker and short of breath last weekend.  I had just found out earlier in the week that my blood hemoglobin was down to 10.  I had been enjoying more normal 12-13 range readings for a couple of months.

Tuesday I was watching the girls when I started to feel a little chilled in addition to my usual lethargy.  Also that increasingly nagging back pain!  I was really looking forward to naptime.  And when it came, we all three feel asleep quickly.  When I awoke two hours later, I definitely felt like I was headed for sick time.  The girls left and I drifted off to slightly feverish sleep in the easy chair.  I awoke again when Tish came come, only to wander off to bed.  The rest of the night was familiar and predictable.  My temperature slowly rose from 99.8, to 101.2, 102.2, 103.2 before finally maxing out at 103.4.  This rise despite judicious doses of acetamenophen.  It broke about two in the morning with me and my bed drenched in sweat.   Tish was wrestling with the question of whether to call the doctor.  I, in my delirium, argued against this – no other, more bacterial symptoms that might respond to antibiotics – no cough, shortness of breath without exertion, no nausea, vomiting or diarrhea – just another viral onslaught that my body’s defenses would have to fight off on their own.

The next day no additional symptoms except the beginnings of sinus congestion.  I was exhausted and slept nearly all day, getting up in the evening to watch TV.  I felt even better the third day.  I spent most of the day in my accommodating recliner, watching news shows and old movies.  I thought that I might even be able to go back to work my short 3 hour shift on Friday morning.  I did get a little lightheaded whenever I stood so I sat back down after just a few minutes.  Deconditioning – that should clear up with a good night’s sleep.

Friday morning – no headache, no back pain.  So far, so good.  I got up to make myself breakfast.  I started to feel a little dizzy and short of breath.  I made myself push ahead.  But soon I collapsed in my chair, breathing hard.  This happened a few more times when Tish dialed a number into the cordless phone and handed it to me.  “The clinic” she said.  I related my three day history to the nurse.  The doctor called back and said I should come in.

I took a shower and Tish fed the girls lunch.  I had to lie down a few times before I was finally dressed.  We all piled in the car.  Tish dropped me at the curb on the hospital while she went to park the car.  I ambled up the the sixth floor.  By the time I reached the clinic I felt quite winded and dizzy.  My vision even started to fragment.  We were both surprised that oxygen saturation was 98%, a very acceptable value.  I stumbled awkwardly to an exam room with the nurse’s assistance.  My blood pressure was 96/69, on the low side though I usually run low.  She drew blood cultures and blood counts.

Nurse Ann - photo by Sophia

I was used to feeling better once I sit down but I was still short of breath and feeling very distressed.  I told Ann, my nurse, that I felt like I needed to lie down.  She was leading me to a room across the hall when we were joined by Jennifer, another nurse.  Tish has just arrived with Sophie and Isabel in tow.  The nurses were discussing whether to walk to the the oxygen saturation machine, the girls were asking Tish a zillion questions, and I, with a nurse supporting me on either side, was feeling increasing faint, breathless, and tipsy.  Everyone decided the shortest route to the bed was the best choice for now.

It took me ten minutes to regain my breath.  The girls hugged close to Tish, looking concerned and tentative.  The doctor came in with the two nurses and I has hauled to my feet again.  The dizziness and breathlessness began anew.  This time with Dr. Jansen on one arm, they retraced their measurements.  My O2 sats were still 97-98%.  But the blood pressure machine was unable to get a reading.  One of the nurses removed the machine cuff and attached a manual one.  The doctor had his finger on my radial pulse.  The nurse heard a faint pressure at around 88.  The doc concurred that my pulse was weak.  I tried to narrate my sensations as I experienced them.  The room was not spinning exactly, but my world seemed to be breaking apart, my legs giving way.

They lowered me to the bed and started IV fluids at 500cc/hr.  My hemoglobin had fallen to 9.6, perhaps as a consequence of being dehydrated.  My platelets had also fallen to 69 thousand (normal 150-300,ooo).  Somewhere in my narrative it came out that I had probably forgotten to take my supplemental cortisone while I was sick.  Since my transplant my adrenal function has never recovered to normal.  The viral infection had caused further stress to my adrenals, increasing my body’s need for cortisone at the same time I had forgotten to take my usual dose.  The result – something called orthostatic hypotension. When I stand up, my blood pressure plummets, causing me to feel dizzy and gasping for air.  The body normally increases heart rate in order to compensate the lowered pressure.  For some reason my body did not do so.

So they gave me some IV hydrocortisone and finished the litre of fluids.  My dose of cortisone was increased to 50 mg a day for week, then reduced to 37.5 mg.  I need to stay hydrated, especially with humid days in the 90’s.  Dorothy came to pick up the hospital to pick up the girls.  They have been very well-behaved but were starting to show signs of not having had naps.  They had delighted the staff, especially when it came time to see how I would do walking down the clinic hall.  As she had seen the nurses do, Sophie grabbed my one hand while her little sister followed suit by grabbing the other.  They walked me down to the office to show the doctor how well I was doing.

Today, after two doses of cortisone, I am feeling better.  I called Vine and Table to say I thought I could work a shortened shift, maybe four hours.  Right now I am feeling a little puny.  Writing this post has been a little tiring.  Re-entering the workforce after six years sabbatical has been a measured experiment.  I am due at work in two hours.  Wish me luck.

Bedside Angels


About Dennis Pyritz

Dennis W. Pyritz, RN, BA, BSN, has been a cancer nurse since 1987 and a cancer and bone marrow transplant survivor since 2004. In December 2001 he was diagnosed with t-cell prolymphocytic leukemia (T-PLL), a rare aggressive form of chronic lymphocytic leukemia (CLL). Dennis was treated with the then new monoclonal antibody, alemtuzumab (Campath) as this disease has a median survival of 7.5 months. He achieved a 26 month remission but relapsed in February 2004. He was retreated with Campath and went into a second remission. In August 2004 he underwent an allogeneic peripheral blood stem cell transplant with his brother, Mark, as donor. Dennis has remained in remission since - a near miracle. Throughout his career as cancer nurse and patient, Dennis has had the opportunity to speal to both lay and professional groups. Dennis has spoken on cancer topics and survival issues across the country as well as in the United Kingdom, Norway, Austria, Portugal, Honduras, Panama, Guatemala, Trinidad, United Arab Emirates, Jordan, Cyrpus, Israel, and India.

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