The majority of the following post was initially written in 2015, a few months after the events. As I wrap it up and click “publish,” it is December 12, 2021, several years later. Easier said than done. Going back to edit this type of a post years later is a bit tricky when the memory doesn’t cooperate. At the time I wrote this I was in my 3rd year of residency, just a few months away from graduation.
Parts I and II can be found here:
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Frustrated we kept pressing on. Allison followed up again with GI who decided to refer her to a different surgeon who said we could treat it as a therapeutic and diagnostic operation. If it worked and the pain went away then the gallbladder was causing the pain.
On November 10, 2014 she had her gallbladder taken out. She went home the same day. Within a few days she started having pain in the upper and right upper part of her stomach again. It was slightly different. This time it was waking her up each day between 2-4 AM. I was concerned that this was a post-op complication so we took her into the ED. The ED ran scans and said she was fine. Imaging looked normal. They gave her more pain pills and sent her home.
At the follow up appointment with the surgeon, they wondered if the pain was due to nerve pain that sometimes occurs after an abdominal surgery. They said it would probably go away.
Unfortunately it did not. She continued to have the pain daily. It would wake her up and be so severe she had to walk around the house. By the time it was tolerable she would have to get ready for work. By noon the pain would finally subside completely. She would come home in the evening, exhausted and go to bed early because she knew she was waking up between 2-4 AM again the following day.
When the pain woke her up on the Saturday before her admission she figured it was her normal, agonizing morning routine. Except the pain never completely went away. It stayed at the “tolerable” 5 out of 10 level.
And that finally brings us to this admission day — December 30, 2014. Initially we went to the Urgent Care. They tried to relieve the pain but as it continued they finally lost hope of sending her home.
When we were finally transferred to the ED, Allie explained the whole ordeal to the NP. Honestly, the NP looked like she was in over her head. She tried to relieve her pain with IV pain medications but this only took the edge off and made the pain tolerable. The NP repeated the ultrasound (which we knew would be normal.) Finally she said she would ask Internal Medicine to admit her because the outpatient workup had failed thus far.
At that point I left the hospital. I went home to get her things since I knew she would want some items from home. While at home I sent out a page to the Internal Medicine attending. I had no idea who it was, but I knew they would be holding a pass-around pager.
By the time I returned to the hospital the attending was about to see Allie. The attending actually arrived before the intern who arrived minutes later. We spoke and she said Allie would be admitted for pain control and then GI would see her in the AM.
We finally got upstairs around 11:30 PM. I asked the clerk who she was admitted to. At the time I almost hoped she would be going to a teaching team so I would know the residents. Instead, she was admitted to the hospitalist service under Dr. X who was one of the “big guys” in the hospitalist service. The nurses got my wife settled and I walked off to find somewhere to sleep; fortunately I knew of places in the hospital where I could grab some hours of sleep.
In the morning I was back at her bedside, waiting. It was odd. I’m usually the one making rounds on patients. Not waiting at the bedside to talk to the doctor.
The first doctor who arrived was a GI fellow who I knew. He was a resident like me during the previous academic year and we had worked together. He said that Dr. X had called him early and said Allie was a wife of one of our residents and needed to be seen quickly. So the GI fellow was there before Dr. X had even had a chance to come by.
After deliberating within the team, the GI service decided to do an esophagogastroduodenoscopy (EGD). During the procedure they thought they found the culprit responsible for all the pain and suffering. The sphincter of Oddi, an area of smooth muscle that is at the end portion of the common bile duct and pancreatic duct, is supposed to relax and allow the contents to exit into the small intestine. In some patients, this sphincter doesn’t function properly and is too tight. During the EGD, they found that her sphincter was tight and performed a sphincterotomy.
Allison was admitted on Dec 30. She finally was able to go home on January 4, 2015. We had the typical holiday + weekend skeletal crew which mean that everything slowed down.
We went home hopeful but also apprehensive.
