my life 2008

A new installment from the queen of offbeat ailments.

About ten days ago, I noticed a small sore on top of my right middle finger, between the first and second knuckle. It was a small pustule on an insignificant patch of red. It looked like a typical pimple, although I remember thinking at the time that that was an odd place for a zit. Nonetheless, I promptly popped it. I got a bit of clear liquid and nothing else. Again, this seemed odd, but thanks to my short attention span, I was immediately distracted by something bright and shiny, and forgot about it.

During the next two or three days, the area remained angry, prompting me to squeeze it more and occasionally suck on it (like it was a snakebite, I guess--why do we do these things?). Meanwhile, I went on with my life, teaching and stuff.

I went to a going-away party at Old Chicago's Thursday night, and I remember noting in the course of the evening that the area was a bit swollen and tender. It looked normal enough, though.

Friday morning, I woke to discover that my middle finger, the two adjacent fingers, and half the back of my hand was swollen and painful. The area was hot to the touch. A tiny indented scab marked the site of the original pustule. I quickly discovered that I couldn't hang my hand at my side because the blood pressure was too great and would set my hand to throbbing. I called the hospital at the Academy and was given an appointment for 10:10. I drove to work (shifting left-handed), prepared some lessons, arranged for people to cover my classes, and went to the hospital.

The doc diagnosed me with cellulitis, which is basically a staph infection, albeit a potentially dangerous one. He drew a line around the infected area with a pen and said, "I'm placing you on a course of antibiotics. If the infection has spread by Sunday morning, go to the emergency room and have them give you an antibiotic IV because that means the antibiotic I prescribed isn't working. Don't mess around with it." He prescribed Percocet for the pain. I took my meds and went home.

Saturday, the area seemed to improve, although I had some flare-ups. Sunday morning, the area looked almost normal--you could see my knuckles, even--and the only redness was around the scab. It was a strange redness, though. The area was hard to the touch, like there was a marble in it. It was still warm, and felt like it was burning if anyone touched it. All-in-all, though it looked as though the infection had receded to its origin. One of my colleagues called to see how I was doing, and I told her I was fairly certain the antibiotics were working, and that I should be at work the next day.

When I went to bed Sunday night, however, the back of my hand was swollen again, and the infection had reached my wrist. More frighteningly, a distinct red line ran from that area toward my elbow for about six inches along the top of my ulna. I decided a trip to the emergency room the next morning would be (literally) what the doctor ordered. If the pain woke me and was clearly increasing, I'd go sooner.

(By the way, the Vicadin just kicked in good; that took just under an hour. However, when it does kick in, it works well for me, so the relief is worth waiting for. And by the way...you never really appreciate comfort until you're subjected to mind-numbing and unrelenting pain for hours, and it suddenly is taken away. To whomever invented Vicadin: thank you!)

I woke this morning to a throbbing hand and arm. The sore itself, on my middle finger, was huge and seemed to have a pulse of its own. The swelling of that one finger was at its natural limit, stretching the skin so tightly that the pressure itself was nearly unbearable. I struggled into a pair of jeans, t-shirt and hiking boots (snow on the ground), took my morning dosage of Percocet and antibiotic with a glass of milk, grabbed a travel mug of coffee, my laptop and some reading, and went to the ER.

The Percocet, while subduing the pain enough for me to drive, interfered in a couple of ways: it reduced my fever and swelling, making diagnosis more subject to guesswork than usual, and it elicited a lecture from the doc about driving under the influence. He was right, of course, but I've found pain to be more of an obstacle to safe driving than painkillers (but then, I'm careful to take a low dosage).

I explained the situation and my concerns to the physician's assistant. He reassured me that I was wise to come in, and the docs would fix me up, beginning with the intravenous antibiotic.

After only three tries, the young lab tech got my IV going. This happens to me from time to time. Apparently, my veins look like a vampire's dream, but their structure isn't conducive to IV feeds. The tech found a convenient vein in my right arm, where I'd be the most comfortable after the IV was in, speared the vein, and...nothing. The area bubbled up, which demonstrates he'd hit the vein, but he couldn't get any blood. He switched to my left forearm, and the same thing happened. He apologized profusely. He is usually the IV star, the one who can get the vein when no one else can, and he didn't know what the problem was, honestly. He got it on the third try, and I sat, full of holes, working on my paper for the next hour.

The ER PA and attending doc had the orthopedic PA come look at my swollen digit during this time. He requested an X-ray to ensure the bacteria hadn't penetrated the bone, and asked them to send me to ortho after that. He wanted me seen today.

I got the X-rays, then waited about two hours for orthopedics. I didn't have an appointment and the surgeon was busy. They sought his advice before proceeding--a precaution that gave me a warm fuzzy. He found time to drop by around 1:30. I was starved and tired and my hand throbbed. He said the joints don't seem infected, so an incision to drain the finger would probably be best. I was to then return for a checkup on Wednesday; if I don't show improvement, we'd talk about surgery to clean out the infection. When he left, the PA recommended I get something to eat at the coffee shop and take another Percocet before we proceeded. And thus it was that I was munching a chocolate muffin and sipping coffee through the traumatic experience that followed.

He sanitized my hand with iodine, then injected local anesthetic into the back of my hand. Ahem. INTO THE BACK OF MY HAND. I can take needles, but don't stick things INTO THE BACK OF MY HAND. I've had IVs there, and they weren't that awful, but this was nothing so tame. First, he inserted the needle between the second and third bones and injected a couple of cc's, then TWISTED THE NEEDLE to a new area and injected more, then SHOVED THE NEEDLE A COUPLE OF MILLIMETERS CLOSER TO MY PALM and injected some more. Then he moved the needle between the first and second bones and did it all over again.

In the interest of propriety, I'll spare you my monologue during the procedure. People in the waiting room probably thought the doctors in the ortho clinic had trapped a wild animal. To be fair to the PA, he did mention right before the first "little stick" that this would be the most painful part of the procedure.

It didn't deaden the area, either. He had to inject more on either side of the hurt finger. Fun. Then he took a scalpel and made an incision on top of the infected finger between the first and second knuckles--down to the ligament--squeezing it to "get the junk out," then spreading the edges of the incision to open the wound as much as possible (as I munched my muffin and watched).

He found no "junk." The swelling was all swollen tissue. However, I now have an open wound that can (we hope!) drain and thus reduce the swelling.

By the time he finished, the local anesthesia was wearing off in the only area that counted (the uninfected part of my hand was dead for the next four hours). One of the techs fashioned me a splint to keep my hand immobile and wrapped me up. I asked for Vicadin for the pain I foresaw in my future (and indeed was already tasting).

I went by the office to pick up the papers I had planned to grade today and encountered my boss. He told me to get someone to cover my classes and stay home tomorrow. Tomorrow, Prog grades are due, and my ungraded papers may be a bit of a problem. It looks like I'll be grading left-handed.

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