Chapter 7: Life Will Change
I hope Chapter six brought you all some much needed break-time (cough, I mean medical learning time for the interns) at work yesterday. Another hero, Dr. Clark Chen and his neurosurgical team dived into the right side of my frontal lobe yesterday afternoon and scooped out a nice piece. Thanks for leaving the good side in there! (we think). I am currently recovering in the neurosurgical ICU and am now around 12 hours post-op. We will know more specific pathologic details soon, but for now, let’s not think of that. As a wise monk in Thailand recently told me, “Be happy. Smile. Do not cry. Find happiness and spread this to your family and others.” I agree with this wise monk. So, let me continue to type some self-proclaimed funny stories and keep pretending to think I’m hilarious. Thanks all.
Jet lag is still very real even after partial-brain removal, so here I am, sitting in my hospital bed at 5am, trying to pass the time with another blog entry. I’ve always had a tough time ignoring self-imposed deadlines. Yesterday, pre-partial brain removal, I had time to write chapter six detailing the wild ride of my tumor diagnosis and bossy request for direct hospital admission in Thailand. I find the next few sections of the story particularly interesting, so let’s keep going from there.
As mentioned, S helped me to quickly pack up my apartment (filled with as much beautiful crap as my actual apartment back home) and grabbed us a cab to the hospital. When we arrived at the front entrance, where we had been instructed to meet Dr. P, we were immediately given a mask and hand sanitizer (Chinese coronavirus scare was in full force) then ushered upstairs to a semi-abandoned clinic, the same clinic in fact which earlier in the day had been bustling and full of patients was now left open for a single physician (the poor neurologist still there from this morning) and a few last-minute patients triaged upstairs from the ED.
I entered the dimly-lit clinic room and faced the neurologist, Dr. A. from earlier in the day. I asked him if the radiologist had sent him my scans yet; he said he had just received the report. I have only wonderful things to say about the medical care and clinical care teams in Thailand. I received excellent care and my own medical opinions were accepted into the care plan. The major difference, however, is that it seems culturally, many patients in Thailand do not advocate for themselves in quite the same way our patients often do in the USA. If a patient disagrees with a care plan due to their own medical knowledge, that of a family member, or an online resource, this is often a fair discussion topic in the US. Physicians expect this. In Thailand, however, this does not seem to be the case. Patients usually enter into the clinic room, received a diagnosis and a care plan, and ask very few clarification questions regarding this plan. I would likely be a very annoying patient in Thailand. This time, however, I entered that clinic room with my own medical opinions and knew I could not hesitate to say them. I was worried, to say the least, about the baseball-sized abnormality I could easily identify in my now least-favorite travel photograph in my cell phone collection.
Dr. A, Dr. P, S and myself discussed a hospital admission plan together. As medical residents, S and I had already been discussing what plan of care we would likely decide on for an admission such as this at our home institution. We both figured an anti-epileptic, likely Keppra, would be important to start urgently. Additionally, an antibiotic (in case of brain abscess on the differential) might be smart. We knew in a normal situation, we would be discussing this case urgently with neurology and neurosurgery. However, without their expertise, we debated stating high-dose steroids. Although associated with some risk, the impressive swelling on my MRI made us decide that yes, likely steroids should be initiated fairly urgently. We told this plan to Dr. A and Dr. P. They agreed to start Keppra and dexamethasone. Neither were as convinced about starting an antibiotic. This was an interesting dilemma. In America, one could argue we start antibiotics far too frequently without appropriate indications. However, one could also argue that one dose of antibiotic for a possible brain abscess is not the worst idea in the world. Dr. A said “we don’t think this is a brain abscess.” OK, but, do we know it’s not one? I asked. “I guess not." was my response. Ok, then put me on some damn ceftriaxone and we can stop it tomorrow when the radiologist gives us the final report, thanks. I was reaching my limit of crankiness at this point. The medications, antibiotic included, were brought upstairs with me to my hospital room around 30 minutes later. Sorry to my infectious disease attendings reading this who may think ceftriaxone was a foolish move :)
As a female patient and also a provider at the hospital I was being admitted to, I was fortunate to receive a private room. This room was on the 11th floor and had an incredibly gorgeous view from the open-air patio (yes, you read that right) which ironically looked out over Doi Suthep Mountain and had a distant view of the Wat Phra That Doi Suthep temple I could see from my hospital bed. Life works in funny ways.
That evening, I saw one nurse. She gave me my medications and told me to push a call button if I needed her. I did not see another physician or care team member until 8 am the following morning when the “American breakfast menu” including a cold hot dog and fries was delivered to my room.
S acted as my advocate nonstop for the following 24 hours. During that first evening in the hospital, there was much work to be done. S found all of my medical records (all on paper, no electronic records available, and all written in Thai), took photos of them, and proceeded to send the records and imaging results to every neurologist and neurosurgeon either of us had ever worked with at our home institutions. S made endless phone calls to our clinic preceptors back home and together an incredible, supportive team arranged for the “fastest medical evacuation flight” out of there in history. Most of this miracle work I credit to S, who actually typed up my complete medical history and filled out all the paperwork requested from the global health insurance flight company from a collection of my medical records (in Thai) that he had tracked down around the hospital in the middle of the night while I sat in bed, sedated from Keppra and simply in shock. After hours of work, by midnight the first day of my admission, S was able to send my entire medical file (including complete records and medical recommendations he had already tracked down from neurosurgery colleagues back home in MN) to my neurologist in Thailand, Dr. A, and simply requested him to sign at the bottom if he agreed with our plan. We knew waiting for Dr. A to fill out all these forms would simply take too long. By1:00 am, forms were delivered via email and a flight plan was set in motion. I would be leaving Thailand in 36 hours on a first-class Delta flight (brain tumor perks, nice!). You really can't make up a story this good, huh?
My brain is a little tired here, people. I think delirium is setting in because I am now craving coffee and breakfast from the hospital cafeteria which has never happened in the history of my life (no offense hospital cafeteria, but I have somewhat snobby food tastes). I’ll have to continue the story later. Thanks for reading!
Fondly,
Courtney
© CB2020