Cliches of cliches; you don’t know what you have until its gone. Most people take their health for granted, something you wont do after this story.
January 27, 2012. A rash started to present itself all over her body, not a bothersome one. The rash appeared to be like tiny purple freckles, something the patient referred to as Dalmatian spots. She had other symptoms as well feeling lightheaded every time she stood, bleeding gums, and a very pale look. Unbeknownst to her all these symptoms were related. A doctors appointment had been made. Her doctor unsure of what the rash was, ordered a blood test.
January 28, 2012. Five in the morning, the telephone rings, her doctor is on the other line their is a sound of urgency in his voice. The results from the blood test are back, her platelet levels are extremely low. A foreign term to her and her family. The doctor had ordered for her to go immediately to an emergency room. He suspects some sort of blood transfusion will be necessary.
January 28, 2012. Three o'clock in the afternoon, she is already registered as a patient in the hospital. The low levels of platelets is so dangerous that internal bleeding is a very imminent possibility as well as bleeding in the brain. The young woman and family unaware of how big of a problem this was.
Just in time, the doctor walks in to explain what platelets are.
“The functions of platelets are related to the clotting of blood. Because of their adhesion and aggregation capabilities platelets can occlude small breaks in blood vessels and prevent the escape of blood.”
In simple terms they are what help clot the blood.
“ An average number is between 200,000 - 250,000, this particular patient has 2,000 platelets.”
Obviously very low and very dangerous. Its explained that a blood transfusion will not be necessary, only a transfusion of platelets. Half an hour later, one Benadryl (to avoid an allergic reaction), one Zantac (to avoid ulcers), and one IV later the transfusion is done.
January 28, 2012. Later that night another blood test is ordered, to see how much the transfusion helped. The results, 5,000 platelets. Nothing more can be done today. The young woman and family optimistic that this problem will soon be resolved. Optimism something that goes against the nature of the patient. Little do they know that what they experienced today will be their lives for the next month and a half.
February 11, 2012. Exactly two weeks after the patient was admitted to the hospital, she is being discharged. Two very long, very painful and very stressful weeks. No progress has been made on trying to combat this disease, this ITP. During those two weeks, a bone marrow biopsy was done. A bone marrow biopsy that includes cutting a hole in the hip bone, and getting to center of the bone and extracting a sample of the sponge like tissue. A painful procedure that had to be done to evaluate the production of blood cells, more specifically platelets. A couple of hours later the doctor had the results, her bone marrow which is what produces platelets and other blood components. The bone marrow was so suppressed from the medicine she had been religiously taking for the past 18 months, that her body has stopped producing platelets altogether. Backtrack, the medicine she had been taking, was to kill the brain tumor she has lived with all of her life. This medicine, this form of chemotherapy has these type of side effects, but the patient was unaware of such drastic repercussions. The patient was trying to fix one problem when another arises. Prognosis, “The bone marrow will start to heal itself once the chemo is completely gone from her body.”
“That should happen in about 14 days, no special precautions are needed” thats all the hematologist has to say. The patient has no reason to doubt him, he is one of the best doctors in the hospital the patient was told.
February 12, 2012. Home sweet home, or so she thought. She still was experiencing the same symptoms as before, lightheaded ness, bleeding gums, and exhaustion.
February 13, 2012. Bright an early, her primary care doctor calls again. The patient is told that she already has an appointment to see another hematologist. According to him this problem is not just going to go away without some sort of intervention. Another blood test is ordered, the patient is used to being pricked more than once a day. Bad results, 3,000 platelets another transfusion is ordered. This process has become the patients daily routine, and it will be her routine for the next month.
31 days later, 3 different medicines, a permanent IV, and an allergic reaction later, surgery to remove her spleen is ordered. Her spleen because thats where the platelets are being massacred, a word the patient used. The patient was being put thru hell and back, you could see that life wasn’t present in her body anymore, she was going thru the motions of this disease. She was going thru the motions arm and arm with her mother, although it seems that this disease had hurt her more. The patient felt like she was nearing the end of the road. She had little faith that this surgery would work.
March 20, 2012. A sleepless night, she has been waiting for two blood transfusions. As of five o’clock in the morning they hadn’t arrived. The transfusions were to be given to reduce the risk of excessive bleeding during the surgery. The time has come, she says good-bye to her parents and brother. The emotions are overwhelming that the four of them crying out of fear because of the risky surgery. She enters the operating room, a bright room, everything is white. The patient says to herself that the room looks nothing like the medical television show House. She is put on the operating table, the anesthesia is starting to take effect. She feels as if her body is sinking into the table, as if she were becoming one with the table.
March 20, 2012. Three o’clock in the afternoon, she slowly starts to open her eyes. She is in an Intensive Care Unit room, where she will spend the next three days. The first image she sees is the image of her younger cousin staring at with fear and sorrow. She is connected to many machines, that all she hears is beeping and buzzing. The patient has a tube going down her nose into her stomach to suction all the remaining blood, a very painful process. She is hooked up to an IV narcotic machine to minimize the pain. Being the fighter she is, the nurses would have to give her the medicine because she did not like taking it. Once left alone with her brother, her parents left to go to the cafeteria. She tells her brother with tears in her eyes and her voice shaking, that she is sorry for not being strong enough. Her brother trying to ease her pain, tells her that she is the strongest and bravest person he knows. Or something to that extent, the medicine was putting her back to sleep. Although the pain would wake her up soon enough.
The moment had come time to hear the results of the blood tests post surgery. Two hundred and fourteen thousand platelets, normal. A sigh of relief, the family is very pleased to hear those types of results. The excitement was short lived because for the next three days those levels would continue to drop.
March 25, 2012. Discharge day, a great day. The patient is discharged but with no pain killers, although she is still in pain. She is a firm believer in that what doesn’t kill you will make you stronger. The four of them would finally get to go home and sleep. She has told the rest of her family that she would like the day off, no visitors, she would like to rest. They have some trepidation about what the next few days will bring.
March 26, 2012. First doctors visit since the surgery. The routine is slowly coming back, blood test, results 17,000 platelets. Something new, instead of a transfusion a medicine is going to be given, a medicine they had already tried. The medicine is given to start and activate the bone marrow into producing platelets. Fast forward to another week of the same thing.
April 7, 2012. A Saturday, there is only one nurse in charge on the weekends. Again the routine, blood test and wait for the results. Although nobody was expecting the results to be so good, 50,000 platelets. Not normal yet but the fact that her body was no longer killing the platelets and starting to produce them, was a great achievement. The news was so overwhelming that the nurse and her mother were tearing up. A milestone had been reached. Now keep in mind this did not mean the problem was solved. This just meant that the combination of medicine and removing the spleen was working. The patient would not reach remission until August, a couple months later. This was a step in the right direction after so many steps backwards.
The journey wasn’t over though, she now had to start and live a “normal” life. The patient had no idea what that meant because for the couple of years she had solely focused on trying to get healthy. She had been trying to reach remission for the brain tumor as well. That in it of it self was a big problem because since the tumor was active, she was struck with symptoms of a stroke. Some of them were weakness on side of her body, balance and coordination problems. Which meant she could no longer walk on her own or do anything on her own. That slowly was getting better as well. The patient was still left with pieces of the puzzle she didn’t know how to put back together in her life.
My parents are both surgeons and after the stories they tell, I've never wanted to be a doctor. There is no clean state in medicine. You can't go back to how things were and try to narrow down the 'bug'. Everything you do changes the state of the patient in all sorts of ways and often you can no longer depend on what you knew about the patient before you made the change. And the stakes are so high. I can't imagine how they do it.
Her team of doctors are great, but she has an unusual case. She knows that any information they gather from her will be valuable to someone else in the future.
Currently, she is trying to regain her "normal" life back. Simple things like going to the movies, is now a more complicated process, due to her motor skills. She has a great team of physical therapists that work with her weekly. She has been improving her physical strength. Last week she walked part of 5K for charity, to fight against brain cancer. (her tumor is benign, but in a place that causes problems.)
Thanks again to everyone who responded to this! I lurk more than I participate on HN...
Yup, this is the reason I could never be a doctor. I just can't imagine how they deal with the stress. It's really insane.
To donate platelets, you have to do a test for cytomegalovirus (I have no idea what this is, but am negative), and I think a few other minor things. The big issues are all the standard (over?)conservative blood safety issues from the Red Cross/etc. -- heterosexual forever, not in the UK more than a minimum amount of time, no tattoos in the past year, etc. The hard one for me was travel -- it's a year ban for malarial countries.
I used to donate whole blood, but I'm A+, so there's not a huge demand. I did "whole warm fresh blood" transfusions a few times in war zones when the hospital ran out (since I was specialized IT support staff and not really needed for the emergency, but was in the hospital already). Apparently for trauma the new gold standard is WFB vs. component therapy, but outside of the military and maybe sports, it's hard to have a population of healthy pre-screened donors who will donate quickly.
Source: http://en.wikipedia.org/wiki/Iatrogenesis#Incidence_and_impo...
I never expected this to end up on the front page. Thanks everyone!
1) gmail (and most other email providers) is really good at filtering spam out
2) spammers are much more likely to just buy email address databases in bulk than scrape the web for them these days and if you have an email address you use with any websites your email is probably already present in these databases.
Google is an amazing place to work. But when loved ones visit, I'm not actually sure what there is to _show_, you know? I mean, there are amusing sculptures (google "stan the tyrannosaurus") and volleyball courts, but we all know that's not amazing. There are great free cafeterias, and snacks in the MKs and on-site laundry and a dozen gyms and .... but come on, now that I've told you that, how much extra value do you get from seeing the gym? Whee, brightly-coloured bikes!
And I can't show anyone the awesome stuff we work on, because it's confidential and besides how would my parents (or whoever) understand why it's awesome, beyond what everybody already knows about Google?
tl;dr: I haven't figured out how to give good tour. Thought at least when guests come I feed them well, on the company dime.
I was massively impressed when I visited.
You could not make me return, not for Ruby or Perls could she Lua me back there.
Strength and Patience.