A Med School Memoir

A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses.

-Hippocrates

Last time I updated, I mentioned that I’ve been sick recently. What I failed to mention was what happened. Well, even though it’s a little embarrassing, I’m going to share my most recent experiences with being a patient.

First, it should be noted that I’m a really healthy guy. I’ve been a vegetarian for 8 years, I work out 3-5 times a week, I don’t drink too much, I don’t smoke (except when I drink, which again, is rarely). I’ve never done hard drugs or engaged in risky sexual activity. I’ve always been a firm believer that a healthy lifestyle is important in maintaining overall health. To that end, I’ve been successful. I’ve never been hospitalized or sick for more than a couple days with a cold or flu. I’ve been lucky.

Until recently.

It all started innocuously enough. About three weeks ago, I went to get a mandatory physical exam for medical school. It should have been a routine physical consisting of a nurse taking a handful of vital signs, a doctor listening to my chest, looking in my ear, nose, and throat, and checking my reflexes, then telling me I was in good shape at the end. Really simple. And I almost got away scot-free, but as I was buttoning up my shirt after the doctor listened to my chest, he noticed a red bump on my arm with leading edges that ran from my armpit to my elbow. To me, it just looked like a really big mosquito bite. He asked me what it was, but I had no idea. I hadn’t even noticed it yet.

I mentioned that it might be a brown recluse bite. I had seen them in the house recently, and they’re out in large numbers this time of year. I’ve had one bite me before, and honestly, it wasn’t all that bad. It hurt like a mother for a few days, but I was fine.

But my doctor insisted that I get a shot of antibiotics (ceftriaxone) as prophylaxis against possible infection, along with a prescription for another antibiotic (doxycycline) to follow that up over the next week. He was afraid it might be a tick bite infected with Lyme’s disease. (Not likely, considering I don’t spend a lot of time outside, but whatever.) That shot stung REALLY bad, but at the time nothing else of note happened. I left the doctor’s office feeling fine, having marked off one more item my ever-growing list of things to take care of before starting medical school.

A few hours later, however, things got bad. I felt my blood pressure drop as I got light headed and my heart began to pound out of my chest. I went to the bathroom to check myself in the mirror and noticed that I was developing a diffuse rash over my entire body. On top of all that, I felt like I had a fever. I called my doctor, and he thought it might be an allergic reaction to the rocephin, since my sister has shown an allergy to ceftriaxone in the past. (I had never taken it before.) I was given a shot of steroids to treat the allergic reaction, and sent home.

Okay. Fine.

Over the next few days, however, the rash didn’t get better. It settled into a dark red rash around my trunk and groin, along with dark red patches along the tops of my feet. I wish I had pictures to share, as it really was bizarre–it looked like I had developed port wine stains over a large percentage of my body. Not to mention the itching. No amount of benadryl would make the itch go away completely. To top it all off, the bite on my arm was getting worse every day.

At this point, I was referred to an Infectious Disease specialist in order to rule out the possibility that the thing on my arm was a MRSA infection. He took one look at my arm, and concluded that it had most likely been a brown recluse bite–like I initially figured. He also hypothesized (like my PCP) that I had probably had an allergic reaction to the ceftiaxone, thus spreading the spider venom throughout my body, which explained the weird rashes everywhere. It was recommended that I be given steroids a couple more times, and he put me on another antibiotic (clindamycin) to prevent my arm from getting any more infected. (Which I don’t think it ever was in the first place.)

Things got slightly better over the course of the next couple days, and I went back to work on a Monday morning. But that’s when shit got REAL bad. Within a couple hours, I had run to the bathroom three or four times with progressively worsening diarrhea. Without getting too graphic, I’ll just say there was a large watery volume, but it never got completely out of control. Within a few hours however, I was getting dehydrated, despite forcing fluids and taking electrolyte supplements. So… I went to the Infectious Disease doctor again. He told me I could discontinue my current antibiotics, as my arm didn’t look infected at this point, and he thought I probably just had antibiotic-associated diarrhea. Despite that, he wanted to put me on yet another antibiotic to treat a possible infection by Clostridium difficile. (For those who don’t know, C. diff is a nasty bacteria that exists naturally in our gut, and is normally kept under control by our naturally-occuring bacterial flora. Heavy use of antibiotics–especially Clindamycin–can kill your “good” bacteria and allow C. diff to flourish.) I opted to not take any more antibiotics for the time being, however, hoping that it wasn’t anything too serious. And for the next few days, things got better. My rash went away, and I stopped itching, and my diarrhea went away.

Then, on Thursday, July 3rd, I was at work again, when the diarrhea returned. This time it was more brutal than ever. I was on the toilet several times an hour until there was nothing left in me. I continued to fight to keep my electrolytes up, too, but that didn’t work. I started getting severe muscle cramps and pain. (Meanwhile, everyone was telling me that I was fine, and not to worry.) At any rate, I went on flagyl (metronidazole) to fight what the Infectious Disease doctor thought now was surely C. diff. This time, I was more than happy to take the flagyl. Fortunately, the diarrhea subsided within a few days on the new meds, but it was a very tough drug to take. It made me feel light-headed, extremely anxious, and all-around weird. On top of that, all the antibiotics and steroids I had taken in the last few weeks left me with an oral thrush infection. One morning I was brushing my teeth and I noticed that my tongue looked like it had a white shag carpet on it. I called my doctor again, and I was promptly prescribed an antifungal medication (fluconazole), which didn’t work, followed by a different one (nystatin swish and swallow)–which has worked, but at a glacial pace.

After more than a week on the flagyl, my diarrhea had gone away, but I started having panic attacks. I went to the Infectious Disease doctor one last time. He told me I could safely go off the flagyl, even though I still had a few doses left. He also gave me a small prescription for Xanax in case I had any more panic attacks.

Hopefully, this is the end of my illness. What started out as a spider bite that probably didn’t even need medical attention turned into a two-and-a-half week long debacle. It has been quite an experience. I’ll admit, when I was in the midst of everything, I was scared. While I never felt like I was going to die, it wasn’t exactly comforting to know that people can and do die from C. diff all the time. Fortunately my case was relatively mild and caught early on, but it was a wake-up call. It made me realize how fragile our health can be, and how important it is to maintain good health while you’re able. Once illness sets in, treatments can always cause complications, so it’s important that you try to be otherwise healthy.

Which reminds me. Otherwise-healthy 26-year-old males don’t normally get oral thrush. Sure, steroids and antibiotics are risk factors for thrush. But in my personal experience, I have seen other things cause thrush as well. One particularly horrifying possibility in specific came to mind again and again–I was scared out of my mind that I had AIDS. My uncle is dying of AIDS, and one of the first things that happened to him that made him realize something was wrong was oral thrush. Forget the fact that I have none of the risk factors–I managed to scare the piss out of myself because–and I’m ashamed to admit it–I didn’t know. I had never been tested for HIV before, and well, AIDS would have explained all my sudden ailments rather well. Sure, I can see now that this idea was fueled by a mix of anxiety and paranoia. (That’s what reading too much about your illness on the internet can do to you.) But at the time, that uncertainty–the unknown possiblity that I might be infected with AIDS–played a large part in my panic attacks. I told all my fears to my ID doctor. He laughed at me, and said, “I promise you, you don’t have HIV.” He had me tested anyway, to ease my mind.

I’m fine, thank god.

It’s very humbling to think that all of this was brought on by coincidence. If I hadn’t been at the doctor’s office the morning I got bitten, I probably would have just had a normal reaction to the venom. My arm would have had a nasty hole in it, and I would have been fine in a week or so. Instead, I got WAY too much medical treatment, all of which gave me a dozen side effects, from which I’m still recovering. At this point, the spider bite has practically healed up completely, and yet my thrush is still lingering, and I’m constantly worried that the pressure in my bowels is the harbinger of a C. diff relapse.

In the end, while I’m not exactly glad to have been sick, I think this has been a valuable experience. I haven’t been sick much in my life, and yet here I am, going into medicine to heal people. How am I supposed to be a good doctor if I don’t know what it feels like to be sick? I know that a short bout with a spider bite and diarrhea and thrush isn’t the same as Hodgkin’s or AIDS, but it has been very eye-opening nonetheless. In the last couple weeks, I have been scared shitless by an illness that makes no sense to me. Hopefully now that I’ve had that experience, I can use it to better treat my patients. In the future, when I’m treating a patient who is scared shitless, for whatever reason, I hope I will be able to think back on how I’ve felt in the last couple weeks and use that memory to make myself just that much more empathetic. It’s nice to think that I can use this whole experience to become a better doctor.

We’ll see.

Tags:   antibiotics · brown recluse · diarrhea · HIV/AIDS · illness · medications · MS-0 · panic attacks · side effects · spider bite · thrush2 Comments