Saturday afternoon I was preparing to travel with Babygirl again, back to the tertiary center for a routine visit with the transplant team. Traveling in the Northeast in January requires a bit of planning. I wonder now what people did without Weather.com? I looked at the weather, both at home and our destination. Nothing looked too frightening. But then I checked the halfway point, and holy cow! Ice storm coming!
I grew up near Buffalo, so snow doesn't frighten me. But I have a VERY healthy respect for ice. It's a very bad thing to land in an ice storm in a car.
So I looked at times, predictions and probabilities, and planned on traveling down on Saturday afternoon instead of Sunday. I set up the CAPD (I tried a large Styrofoam cooler with the heating pad in it - it worked well, heating five bags without overheating) and started the first run, which starts by draining out the one hundred or so cc's of fluid left behind by last nights' machine treatment.
I can barely describe my utter horror when I saw what was draining into the bag. It was thick, bloody fluid mixed with fine swirls of white - the first time the fluid has been anything except crystal clear. I made my first freak-out call to the dialysis nurse.
"Can you read through it?" Huh?? Well, actually, no, not at all. "You need to bring her up here right now." Umm, well, actually, we were just about to start off in the opposite direction! After some haggling we finally agreed to collect some of the fluid, take it to the local lab, and get back to her with the results. In order to do this, I had to drop a liter of fluid in, let it incubate for an hour, and drain it out. THAT bag was so nasty that some of it clotted in the bottom of the bag when it settled. I drew out four syringes worth of fluid, labeled them and headed across the street to our local hospital.
I don't know how many of you are familiar with HIPPA laws, the rules protecting patient medical record privacy. They also govern what doctors are and are not allowed to do with lab tests. Even though I'm a doctor, I'm not allowed to order tests for anyone except my own patients, and I'm not allowed to look up results on tests of family members. Seriously, violating these rules could cost me my job. So I called ahead, discovered that a friend was covering the ER and asked her to order the tests and accept the results. Then I had a little trouble with the lab.
I guess it just isn't every day that someone walks in with peritoneal dialysis fluid. They had an issue with whether or not I was competent to produce such a specimen, and whether they could legitimately accept it. So from the time I discovered the ick and the time the lab started working on it, more than an hour and a half had gone by. And if those tests show infection, I have a ninety minute drive in the wrong direction ahead of me. And the initial tests take nearly an hour.
Finally they called with results - no organisms seen. White cell count low, and cell types arguing against bacterial infection.
There is a relief so profound that it is actually nauseating.
And the cause of the ick? Retrograde menstrual flow. Yup - blood going up through the fallopian tubes instead of down. So I have to wonder, are we preventing endometriosis here by flushing this stuff out? And if blood can flow UP, why doesn't the dialysis fluid flow DOWN?
When I speculated about this out loud, my nephew asked me to pass him the brain bleach.
We ended up traveling very early Sunday morning. We missed the ice storm, but we got to watch the cars sliding around on the news after we got there. The transplant team says she's doing well, see you in three months. At least by then it will be spring.
And it will be almost exactly a year.
DeeDee
No comments:
Post a Comment