Story -

Imipenem Vs. Epinephrine

Imipenem Vs. Epinephrine

Massachusetts General Hospital, December 2014: Plyonephritis– Fever, Fatigue, Flank Pain
     It’s only been a month since I’ve been dating this guy, and I got my Elastigirl diagnosis. There’s no one else available. My mom is two hours away, my friends are studying for finals and I’m out of options. All my friends and I have a system where I can let them know how I’m feeling by giving them a charge percentage of my body. Anything below 50% gives cause for concern, tonight’s a 10% charge kind of night, the emergency room was imminent. My back hurt, chills set in, and a fever shortly arrived after. Fuck. This is my kidneys, again.
     We play the ten more minutes game. Maybe this is just a flare. Ten minutes and nothing is better. This goes on for about an hour before I decide to call my on-call doctor, whom recommended the ER, again.  Having seen my labs from the previous week finalized, the doctor advised I bring a friend just in case. Great, that’s code for borderline sepsis. Again.
     So, we jump in a Lyft and get to the MGH ER around 1am, right when things are picking up in the middle of the night. The hospital is almost at capacity, so we are going to have to wait for a bed to open for me to be seen. My doctor had called ahead to the alert the staff so that I could be placed in isolation. Despite the hospital being at capacity the triage nurse was standing out front waiting to escort me to a special waiting bay. As he started checking me in, and taking my vital signs I was quiet, so he looks over and asks Zack,
     “Does she look pale to you?”, Hey newbie, this is what sepsis looks like. I could hear the gears turning in Zack’s mind, his anger fuming about why the nurse would ask such an obvious question, but through clenched teeth he replies, “Yes. She’s very grey.” 
     They triage nurse says that I’ll still have to wait and puts me in the isolation waiting bay with all the other infectious disease threats. The nurse puts me in a large chair, so Zack can sit next to me, but the uncontrollable shivering hasn’t let up and no number of blankets, jackets, or leeched body heat helps. It was close to 2:30am when I was finally called back into the pediatric isolation treatment pods.
     The medical team wastes no time now, the nurses buzz around setting up my IV and medications, as precious golden hours of treatment time have been passed and the clock is still ticking away. As Zack settles in for the long haul ahead, he shimmies into the plastic chair trying to get cozy, and takes out my favorite book, Watership Down by Richard Adams, and read,
“The rabbits became strange in many ways, different from other rabbits. They knew well enough what was happening. But even to themselves they pretended that all was well…” 
     “Her fever has spiked, let’s start the antibiotics down here. Did you get all the blood you need?”         

     The doctor had come in while I wasn’t looking and started asking the nurse both speaking in hushed questions, as they started their sepsis protocol, half listening to the story themselves. 
     “… for the food was good, they were protected, they had nothing to fear but the one fear; and that struck here and there, never enough at a time to drive them away.”
     “This should help you feel better sweetheart. We are going to run this first dose of antibiotics down here while we wait for a room to open upstairs. I hope you brought something to do, because you’re going to be here a while.” Great, I’m going to miss my finals. 

Boston Children’s Hospital, March 2016: Pizza - Anaphylaxis
     We were at dinner in the dining hall and I had never had pepperoni pizza. Hmm, this  an interesting mouth feel, it’s spicy. I had my friend try some, and she thought it was fine, not spicy at all. Zack went to grab me some milk and my chest had started to feel tight. Not again. I used my inhaler. Again. And, again. Zack saw it was getting harder for me to breathe and excused us from dinner to walk me back to my dorm. I was coughing, whistling with each inhale.
Zack sits me down in my bathroom, and calls Kendyll, she has a nebulizer and that’s the last thing I can try before calling for help. I had already taken my anaphylaxis protocol of Zantac, Zyrtec, and Benadryl. A lot of Benadryl, enough to sedate a horse. Kendyll knocked on the door, and within minutes we had gotten me hooked up to her pulse oximeter and nebulizer. My oxygen was dropping, and my heart was pounding, so it was time. She poured the juice in, cranked it to high, and I sat there, trying to force the vapors into my closing airway. Kendyll left for class and told Zack what he already knew. The nebulizer didn’t help, instead all I was doing was coughing up interstitial lung fluids and mucus. I’m going into anaphylactic shock. That dumbass allergist didn’t give me an EpiPen.
     “Zack, call campus safety and ask them to call 911, I’m going into anaphylaxis.”
Having drilled this, Zack had campus safety’s number in his phone and asked very politely to send over the campus EMS team while we waited for the ambulance.
     “She doesn’t have an EpiPen, please have campus EMS bring two.” Good boy.
     So campus EMS come in and a crowd of 5 pack into my closet sized bathroom. They start hooking me up to their monitors, which immediately alarmed: 
Heart Rate: 161 Oxygen: 90% Blood Pressure: 80/50
     “Were you guys fighting before we came? She seems pretty worked up man.” I heard one of the EMS ask Zack.
     “I swear to god if you think she is having a panic attack she will kick you guys out on your ass before you can blink. I wouldn’t suggest that idea again while you’re within earshot asshole, I’d….”
      “… like the Epipen now please.” I managed to rasp before coughing violently.
      “We don’t have any on campus.” The supervisor said as I coughed up about of cup of fluid onto the bathroom floor. He radioed for another ambulance and for an ETA on the first one, slightly panicked.
     After what seemed like an eternity, the real paramedics showed up, loaded me onto the stretcher and into one of the two advanced life support ambulances.
     “Has she ever been intubated during her anaphylaxis events?” The medic asked Zack.
     “This is her second anaphylaxis and actually this one is less severe than her first one.”
     “Katie have you ever been intubated before when you have felt like this? Do you want us to help you breathe?” Apparently, Zack’s answer wasn’t good enough. I shook my head no, and the EMT put on an oxygen mask as best he could while I was still coughing up fluid. Maybe this is what dry downing feels like. No one had stabbed me with an Epi yet, and they claimed it was because I premedicated at home. They could only watch and intubate if needed. Even in the ER, they just offered Ativan, something I had only read about being used in anaphylaxis. A rash had started breaking out on my arms and I said, “Why not?” and downed the pill. Within ten minutes I could breathe again, and the rash was gone. They sent me home with an Epipen.

Boston Children’s Hospital, April 2016: Granola Bar – Neuro-Anaphylaxis
     I’m sitting in class and hungry, I brought a safe snack, my favorite granola bar. A Cliff hot chocolate flavored granola bar. It’s fantastic, hmm, my mouth is kinda itchy and I don’t feel right. Breaking out the Benadryl. Breaking out my inhaler. Puff. Puff. Puff. Puff. Text Zack.
     “Honey, I need you to come get me, I think I’m having an asthma attack. If I’m not better by the time you get here, you’re going to have to Epi me.”
     I made it out of the classroom and onto the floor, Zack found me and helped me stand up. Now he’s carrying me to Campus Safety. Campus Safety wheels me to Health Services.
     “Katie this isn’t a drill is it? Where’s your Epi?”, Lauren the NP asks.
     I hand it to her. I can’t talk. I’m shaking, panicking. My brain hurts. Neuro-Anaphylaxis.       Lauren didn’t waste a minute and injected. Funny that didn’t hurt as much as I expected. Campus safety calls for an ambulance. Lauren yells at Zack for not injecting me sooner. It’s not his fault, I didn’t ask him to, don’t be mad at him he did everything I asked.
     The paramedics arrive and try to get me into the stretcher, I can’t move, or walk since I’m shaking uncontrollably from the Epi. My brain hurts less, and I can think. I can breathe. The paramedics decide to go to back to Children’s.
     So, they rush me into the trauma bay and the doctor orders the team to start their anaphylaxis protocol, and to start my IV, -oh its already in? That was easy. -  and the paramedic pulls the ER doctor aside to brief her on my list of food allergies. Benadryl, Steroids, and Zantac course my veins, and the nebulizer they give me now is working. Now I can really, actually, breathe, the doctor assured me that the shaking would stop when the epinephrine wore off.
     Zack hasn’t let go of my hand the whole time. 

Beth Israel Deaconess Medical Center October 2018: Tacos or Chicken – Anaphylaxis
     “I am Moana!” We all sang, but me with more effort than usual. It was girl’s night, so a nebulizer could wait until after the movie. 
     So, I wait and instead of relief with the nebulizer, panic rushes through me and I run out of my room for some quiet and to call my mom. I text my friend Ally who is in my bathroom to meet me outside. I have my epipen in hand. My mom won’t answer her phone, but Ally comes out into the hallway and sees the epipen. She’s about to grab it when I reach for it and take it out of its protective case. My lungs are vibrating, its like there are bees in my chest. 
“Ally, I need to do this.” I grab my Epipen, pull off the blue safety cap, “Can you hold me hand?” She does, and we count together. One, two, three. Click. Hold. One, two, three. Rub leg.  I ask Ally to call campus safety, who send the RA, the professional on call, and EMS. 
“Our safe word is Apricots!” The RA shouted to Ally, the professional on call, and myself as I tried to calm down more, the panic came strong with this one but what else do I get for waiting? In retrospect I probably should have injected again while waiting for the ambulance. The RA was good intentioned, but I wasn’t panicking because of the hospital, panic is a side effect of histamine being released in the brain. 
     The RA shouted our safe word, and oh great it’s the same crew from last week from when Ally went into anaphylaxis. My allergist asked me the next time I go into anaphylaxis to come to his hospital, so that’s what I told the paramedics to do. Yes, please take me to my least favorite Boston hospital where the one time the IV tech let me bleed out on the floor because he couldn’t start an IV, that sounds like exactly where I want to go when my lungs are closing. After the usual pleasantries were exchanged the praise started. 
      “You injected yourself! Can you walk? Here let’s lift you into the stretcher! You get epi-shakes? You poor dear! You did the right thing!” The EMS lady leaned into me with more and more praise. Even as we rolled into the ER, she continued her praise to the doctors. 
The praise didn’t fall on deaf ears, but I was still having trouble breathing so the trauma team rushed around me and hooked me up to a Y-port IV. This is a special IV where you can connect two syringes of medications and inject them at the same time, usually very slowly. Maybe she was overzealous, but the nurse SLAMMED them into the IV. 
     “I think I’m going to be sick.” My stomach was turning, I was dizzy, and thought I was going to pass out. All I could think of, as they pulled the curtain shielding Ally away, was that if I passed out that I really hoped I wouldn’t wake up intubated. Dylan and Garnet would watch Dolly until I got back so at least that was taken care of.  Just don’t throw up. Dear god, out of all of this I swear if I don’t throw up I’ll be eternally grateful. I can’t handle that, please not now. If I throw up then I’ll need another epipen because nausea isn’t necessarily anaphylaxis but more than that qualifies and then we have to start all over! Just let me breathe, please let me breathe. 
The trauma team conversed among themselves for a moment as one nurse grabbed a bin, and another nurse readied an Epipen, just in case, as she heard the lead trauma doctor ask his attending, “Do you think she’s rebounding?” WHY ON EARTH IS HE ASKING THAT? HE’S THE DOCTOR RUNNING THIS TRAUMA! HE SHOULD KNOW IF MY ANAPHYLAXIS IS COMING BACK! After the attending asked the nurse how fast she pushed the medications, she was more convinced that the medications were working, and the awful feeling in my body was just a natural response to coming off epinephrine. If that is the case, then dear god I feel bad for drug addicts because the only thing I can imagine being worse is getting Narcan-ed. As I slowly improved, the nurses and doctors continued their praise, they all agreed that they wished every allergy patient was brave enough to self-inject. I mean that’s what you’re supposed to do.

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A Lonely Journey

Wow! What an incredible story, Kaitlyn. Thank you for sharing that. I was entranced by that when I was reading it! You're a brave, intelligent girl, and a great writer. Your story was told beautifully, and suspensefully. 
Take care of yourself. 
Thanks, 

Matthew. 

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author
A Lonely Journey

You're welcome Kaitlyn. 
Can't wait to read more. 

Matthew. 

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