Friday, October 12, 2007

Bad joke

It sounds like the set-up for a bad joke: "Why did the blonde go to the ICU for a cold?" Unfortunately, the punchline is not very funny at all, as it seems the Perversity Goddess is determined to fuck with my life in a very serious way.

The knee is progressing along, although I'm still not completely off my crutches, but I caught a cold from the babies, and had two severe asthma attacks back-to-back -- one Wednesday night which sent me to the ER, and another one Thursday morning, which won me a scenic 12-hour tour of the ICU.

Thanks to high doses of IV steroids and enough albuterol to leave me climbing the walls, I'm out of immediate danger and have been stepped down to a regular room. I was supposed to be released in the morning, but I had another attack after getting up to take a shower. Thankfully, it was less severe and was stopped by my rescue inhaler, instead of needing an extended series of nebulizer albuterol treatments, so at least the drugs are having some effect.

However, I don't think that my doctors or I will be comfortable sending me home until we're all sure I won't be getting brought back in an ambulance. If I can't stand up for ten minutes without starting to get into trouble, I probably don't need to be that far away from help. At a guess, I'm thinking maybe tomorrow afternoon or Saturday morning is probably a more realistic option.

Right now, nobody is talking to me very much about what the future holds -- they've mostly been worried about helping me move enough air. From my talks with my doctors and my med-student brother (who has actually been a part of my care team -- he's on the ICU rotation), I can expect to go home with a pretty big dose of prednisone, and to repeat same at the first sign of upper-respiratory infections. Short-term, they all seem pretty confident that the steroids will eventually do the job and get me sorted out. There's also been some question about giving me a little bit of insulin; while I have never had the slightest sign of blood-sugar issues, even during a twin pregnancy, steroids can do bad things here. I tested high last night, although it wasn't really valid, coming half an hour after a large turkey sandwich and a sugar cookie.

However, reading between the lines, this probably isn't the last time I'll be in the hospital -- once you've had an asthma attack of this severity, you can expect to have another. I don't know what diagnostics I'll need in the days and weeks to come, but I know there will be some, and that my entire treatment plan will be revised. I'm worried about a lot of the long-term fallout: how will the steroids affect my bones (which may already be somewhat questionable, per my blood tests)? what will happen as my lung function naturally declines with age, in 10, 20, 30 years? what will happen if I get pregnant again, which can worsen asthma in some women, and how will the treatments affect an unborn baby?

There's a chance I could be in the very early days of a pregnancy right now, too early for betas or HPTs to show. If I am, there's a small possibility that the drugs could increase the baby's risk for some birth defects, although certainly less than if I keeled over. The asthma will also put me at higher risk for some complications like preterm labor, low birth weight, and pre-eclampsia. It's worrying, but then so is everything else.

Right now, I've got so many mixed emotions. Obviously, I've been terrified, and I'm not exaggerating when I say that I could have died from this if I hadn't gotten prompt treatment. I had a few moments when I really did fear for my life, and my pulmonologist must have too; as soon as he walked in his office door and saw me, he literally greeted me with "I'm sending you to the ICU right now." Asthma is serious stuff, and apparently mine is a lot worse than anybody expected. Before my trip to the ER, I didn't even have a rescue inhaler, because I've never had an attack bad enough to need one -- usually, I just get pretty sick and wheezy with colds. Now, I've been instructed to never be without one, ever.

And on a minor level, it is highly aggravating to have this happen before I've even healed from my knee surgery, to not be able to maneuver my crutches very well because of my IV, to know that I'll need yet more help caring for the babies for a few more days, to spend an endless few more days in the bedroom of which I am heartily sick.

In some ways, it's almost like being diagnosed with infertility all over again. Wednesday morning, I had mild asthma which required no attention beyond twice-a-day Advair and occasional checkups. Today, I have severe asthma, and it has just become a much larger part of my life. I'll need to do more daily maintenance, such as peak-flow monitoring, and see a doctor more frequently. I can expect to take more medications, including some with systemic side effects. I'm looking at some long-term alterations in how I manage my health, and some lifelong increased risks of adverse, even fatal, events, and I can't pretend I'm not upset about this.

However, I also have some things to be grateful for. I'm profoundly glad just to be alive, and to live in a time when asthma treatment is so advanced. It is a huge relief to know that I'm in the best hospital in the state, under the care of some truly excellent physicians. I have complete confidence in their ability to do whatever can be done to diagnose and treat me. I think I'll be back to normal in a few days, even if it is a new and more precarious normal.


Nico said...

Jeez, you really can't catch a break, can you? I'm glad that you're over the worst of it.

Eva said...

Oh Emma, I'm so sorry! What an ordeal. I'm also relieved you seem to be through the toughest part, and hope that the short term and long term prognoses are even better than expected.