This article was originally published in April 2018, and it is a true-life incident!
Last Sunday, I was browsing the net after a late breakfast and suddenly something happened that had never occurred before in my life. The next 36 hours, I had to experience things which literally has changed my life for the good. I was admitted at a hospital for one and a half days and this article is about that.
It all started with an abdominal pain that worsened in two hours and got so severe that I had to be rushed to the hospital! Intravenous cannulas, numerous blood tests, ultrasound scans, a Ryle’s tube insertion and an enema, came and conquered me in the next 12 hours.
As a Doctor, I have inserted many Ryle’s tube, but when the same tube went inside my nostril, something changed inside me. The way I think! There’s a lot of events that I have to tell you, but right now, I’m going to the same hospital for my first ever Gastroscopy. Hopefully, I’ll be back in two hours and then, I’ll finish this article with all the details and how I felt on crossing roads and becoming a patient for a few hours.
Now, that I’m back after the gastroscopy, let’s get started.
The pain was vague and was mostly on the centre of the abdomen, but it was not getting relieved with time. I took an oral Pantoprazole in vain and when I couldn’t tolerate the pain any longer, my wife went to the hospital and brought a loaded syringe with pantoprazole 40mg. About one minute after taking the shot intravenously, something terrible happened.
My heart was trying to leap out of the rib-cage, both by hands went into a clawing posture and there was numbness all over my body. I could feel my vision blacking out and my mouth drying up so fast, I was collapsing! My wife looked at my eyes and said in a panic tone that I was pale. I had no idea what was happening. After drinking some water and lying down for a few minutes, everything except the abdominal pain came back to normal state. Our one and a half year old son was sleeping when the post injection episode of twitching happened. I should admit, my wife’s courage to withstand such a situation particularly when there was no one else at home that time. She took control of the situation and we rushed to the nearest medical college at Pariyaram without any further delay.
At the emergency department, I thought I was getting special care as both of us were doctors. My light head found it hard to think when I heard someone standing nearby exclaiming that she couldn’t appreciate my blood pressure reading!
“Please start an IV line”, I mumbled lying there still wondering what could be the cause of the abdomen pain.
After about 30 minutes and half a dozen phone calls, my hospital staff, 3 junior health inspectors had rushed to the hospital to help us. The doctor who examined me, came to me and said that all my blood tests including blood sugar, electrolytes were normal and that after starting the IV fluid, my blood pressure was also under control. Now, I wanted to know when they were going to take my tummy’s ultrasound scan and for that they had no reply.
Fifteen minutes later, the Surgeon who examined me told that they had sent for a serum amylase test to rule out pancreatitis and still they had no idea whether a scan could be done or not. Why? Because, it was a Sunday!
The tramadol injection was not showing any effects and my pain was still going strong. After 2 hours, when my light-headedness and dryness of the mouth finally subsided, I started to experiment sitting and lying down in various positions in an attempt to lower the pain. Lateral, supine, sitting, crouching, stooping forward, nothing seemed to work. I was drinking more and more water every few minutes and still, nothing really helped.
Anoop, Santosh and Sanoj, who had rushed to the hospital to help me were busy trying to find out alternate diagnostic centres from where an ultrasound scan could be done. One of them was engaged with my baby boy, who was greeting everyone at the emergency department. Finally, when my thoughts had began to migrate to my misfortunes of being an emergency department case, a nurse came and conveyed us the good news that the sonologist had reached the hospital and so, we could do the scan there itself. She also, gave me a test dose of diclofenac potassium, as tramadol was not at all effective.
Half an hour later, I was taken to the ultrasound scan room on a wheelchair, my first ever trip! The final year radiodiagnosis intern was very friendly and he did a detailed scan ruling out appendicitis, pancreatitis, any peritoneal fluid accumulation. I had “non-alcoholic fatty liver disease” and that was it! But, NAFLD wouldn’t cause acute abdominal pain, then what could it be? The scan showed my stomach dilated extensively and my small and large bowels were collapsed. Could it be gastroparesis?
The Surgeon had ordered to admit me, and do a Ryle’s tube aspiration. I was put on “nil per os” (NPO, which means “nothing by mouth”) for the night and my CECT abdomen was scheduled for the next day. As the room was not ready after the scan, I was taken back to the emergency department. The diclofenac injection had slightly reduced my pain, but it was the Ryle’s tube which had made all the difference.
Inserting a Ryle’s tube is a tricky task and I have done it several times mostly for the palliative home care patients. If you’ve seen the movie, “Iron Man”, it’s the same tube that Robert Downey, Jr (Tony Stark) pulls out through his nostril. All said and done, it was now my turn to experience how it felt!
The first attempt failed, because I opened my mouth and the tube came out through the mouth. The second time, I gagged, chocked but it went in and my goodness, it was an unforgettable experience. As soon as the tip of the tube had reached my stomach, water that I had drunk in the last 6 hours splashed out onto my face, hair and suddenly as if by magic, the pain disappeared! The usual procedure of using the stethoscope to confirm the position of the tube by pushing air and listening for the air sounds was not needed in my case! Half an hour later, the nurse who had a 20ml syringe aspirated another one litre approx of water from my stomach. I was relieved, my pain was gone and now I had a new problem to face, the tube stuck in my nose!
I was finding it almost impossible to breathe through the nose and every time I swallowed some saliva, I could feel the irritable foreign body lying back in my throat. It was really an uncomfortable feeling and I wanted to take out the tube then and there. But, I was not allowed to. I was the patient, and not the doctor.
As I was not permitted to take any food or fluid through mouth, (NPO), there were 5 pints of different IV (intravenous) fluids on my orders. At 1.00 AM the other day, I needed to sleep a bit and the only thing that was stopping me was the tube. So what could I do other than follow what Iron Man did, right? I thought, if any more aspirations had to be done, let them put another tube whenever required. Because, at that time, I had to sleep and this tube was way too uncomfortable. Did I mention the sneezing and all? Oh you should have seen me, blow my free nostril after sneezing 7 times in a row!
I dozed off immediately after taking out the tube and slept for 3 hours in my small room on the seventh floor of the hospital. The door, of this room couldn’t be locked from within the room and so I woke up when the nurse came in to change the empty IV fluid bottle. After that, I couldn’t sleep as she visisited me every 30 minutes for taking blood samples, giving me the urine cup, and at 5 AM she said, there’s an emema to be done in preparation for the CECT. Now, I did it, but I’m not going into the details here. It was only at 7 AM that the nurse had noticed me without the RT and she simply asked, “did the tube came out by itself?”. I could only smile to that question.
Now it turned out, for the CECT I have to drink 2 litres of water mixed with this contrast dye. By the way, CECT stands for contrast enhanced computed tomography. If that was the case, why was the doctor last night asking me not to take out the RT after aspiration? I don’t have a clue. I felt good that by removing the tube without anybody’s permission, I did the right thing.
A new 18 gauge IV cannula was inserted for the purpose of injecting the contrast and after the doctor’s rounds (which was uneventful), I went to the CT room for my yet another first in life experience. The CECT study was also normal and now, as the Gastroenterologist who does endoscopies was not present that day, I was discharged in the evening.
Today, I did my gastroscopy and it was over within a few minutes. It was done by one of my senior at the college, Dr Satish Balakrishnan. I’ll write another article if needed on this topic later.
I have to admit, it’s only when we experience these medical procedures, that we will be able to understand the pain involved. Every failed attempt in putting an IV cannula, every attempt in inserting a RT or any other tube for that matter, the time this tube remains in our body, everything counts. I’ve never thought of these procedures the way ever before as I can think now. Last week was difficult and yet, I think it was for the good.