So I guess I'll tell you a little bit about arm infections-- so long as we're on the subject.
They stink.
The IV juice burns when it floods into your veins. Part of the pain is psychological, just from picturing the different fluids mixing with your blood, pushing those red blood cells into the artery walls. That leads to the rest of the pain: The pressure inside those veins from the added fluid, stretching and filling-- ripping them at the seams.
The skin bruises around the hole, making the area more sensitive than it needs to be. Any touch-- any hint of feeling or pressure, and the brain recoils in horror, afraid that the needle inside might break off and float its way deeper into your body. What if that needle shoots, forced with the new pressure, until it drives itself into your heart? That little needle keeps me awake all night.
They sent me away from the hospital because they didn't have any beds. The triage nurse said that I should have been admitted, but I'm young, I live close enough, and therefore, I can make my way back to the E.R. every 8 hours. I can wait for triage and re-register and wait again for an opening-- to see a nurse, or heaven forbid a doctor. I can sit and wait for an hour before they give me more antibiotics. Every 8 hours. For 56 hours. I can go home and sleep for 5 hours, try to wash my face and brush my teeth and then go back to the hospital. I can be in agony every time I put on my coat and it brushes my IV hand or my infected elbow. I'm young. I live close. They're out of beds—my pain doesn’t count.
But I can't complain because it's free. I don't pay and I don't die, so I can't complain.
Every couple of 8 hour visits, a doctor looks into my elbow--into the hole that they made, that they dug from the infected tissue. Twice they cut off more dead--necrotizing-- flesh. It makes me cry and gasp in pain while Marit squeezes my hand tighter and tighter. My knuckles turn white as I grip the edge of the bed.
We’re not squeamish, but it makes me dizzy when Marit describes how deep the wound goes—past these pink layers of… me. I shiver as she relates it to a cut of beef. My swollen hand keeps leaking pus all the way down through the elbow, leaving my pink hole with a yellow colour. The skin around the hole looks tired and sore—just wanting to be left alone. I refuse to look.
The forceps are cold and it sends shooting pain through my infected arm. I'm turned on my side so that I can't see the gruesome display, but Marit is facing me and her face turns white as her eyes grow wider and wider. She gasps when I gasp and her hand gets tighter around mine.
At first I don’t know what’s going on—I can’t see what she sees, but eventually I mouth the words: “She’s cutting the flesh!” and a tear streams down Marit’s face. She nods.
The lights are bright and the pillow is hard and I'm focusing on everything I can other than that pain. That stabbing, burning, hateful pain. I just want it to be over.
"Keep taking deep breaths."
I choke one half pretend-deep breath in before coughing and gasping it out. Marit's hand gets tighter still, to the point where it makes my fingers hurt as they press into each other. It's a welcome sensation--something else to focus on.
Then more IVs. More fevers and chills. More rotten flesh.
Marit and I joke about how much life sucks and how much god hates us. The walks to and from the hospital are nice-- a reprieve from forceps and rot. Fresh bandages make me smile because they're so clean. It doesn't take long for them to soak through in blood and pus, but every eight hours I’m back and they get changed again.
On the first night they gave me drugs so that I wouldn't remember the operation. Apparently I was awake and screaming and crying in pain, but I have no memory. I woke up in pain, with a giant bandage on my arm and Marit holding my hand, crying. She keeps letting out broken sentences between gasps and pants: "You... it looked... I just wanted to... and you wouldn't stop..." The only way to calm her down is to reassure her that it wasn’t me—that I don’t remember the pain.
The second time, I didn't get those drugs. The second time, I had a grip on the bed frame and white knuckles, grit teeth and a few tears. Marit had my hand and my eyes. The second time, I didn't scream.
900 mg clindamycin, antibiotics-- the dose is so high that it makes me dizzy and nauseated. My world begins to spin and get dark while my whole body shakes with chills and fever. Somewhere, I can hear my teeth chatter. I can hear Marit asking the nurse if she can turn the IV down.
"Does it need to FLOOD his VEINS so fast? It's making him sick."
They don't like her attitude, but she doesn't like that they disrespect us so. We've been waiting for hours for this IV, number four of seven, and the nurses don't seem to understand our frustration. Each time they write us a slip so that we don't have to wait the next time we come in, eight hours later. And every time when we show up, they take our slip and tell us to wait until they call our number... then to wait until they call our names.
Some nurses, mostly the younger ones, are amazing. They're gentle and happy and fun. The older ones are jaded and rude to us. They don't ask us to wait patiently in room 8, they order us to sit. They treat us as just another task that they have to tend to-- another pain in the ass in their long day. Occasionally, the old nurse takes so long to get to my IV that Marit finds a younger one and asks her pleasantly to help us. I suspect that's what the older nurse wanted in the first place.
For them, this is just another day. Blood and pus and sweat and tears-- there are stains on their scrubs daily, if not mine then someone else's. It makes no difference to them. Yet, sometimes if you thank them just right and really let them know that you appreciate them, they'll smile as they pack your wound with warm, gentle hands.
So they slow the drip on my IV and some of the dizziness subsides. The fire on the back of my hand dulls a bit as the veins are allowed to shrink a little to their former size.
When they pack the wound, the nice nurses always apologize for the pain they’re causing me. I tell them not to worry—that I’ve had worse, and that they’re providing for me a necessary service. I need them. One young French nurse smiles as she agrees that she dislikes having to pack my wound more than I dislike having it packed. When I wince, she gasps and returns doubly gentle. I fall immediately in love with her.
The antibiotic pills follow the IVs—still 900 mg three times per day. I’m convinced its enough antibiotic to kill a small dog. No nurses laugh at that joke because they know that I’m right. It’s an incredibly high dose and the pharmacist questions the prescription.
“Yes,” I tell him, “the bacteria are antibiotic resistant.” He frowns as he puts the little pill bottle into a plastic bag. As he’s listing off the side effects, my mind wanders.
Antibiotics kill bacteria. But bacteria are living organisms that live in populations and reproduce. The Darwinian laws of natural selection apply. Every bottle of penicillin thrown aside or bar of antibacterial soap adds to the selection pressure. All of the weak bacteria are killed and only the strong—the resistant—are left to breed. They multiply. We increase the dosage. They become immune. We increase the dosage.
Doctors have been over prescribing antibiotics for a generation and these are the consequences. The once cure-all is fast becoming obsolete as bacteria advance the arms race around our defenses. They have to, or else face extinction. It’s natural and beautiful—but terrifying. We’re the cause of our own disease. We’re sowing the seeds of our own plague. We’re creating the bacteria that are causing infections we can’t cure.
A week later when another nurse is changing the dressing on my wound, I joke that I’m the beginning of an epidemic. It’s not funny because it’s true.
