Most people in their 20’s and 30’s assume they’re going to wake up tomorrow. They believe they’ll get to make good on their plans a few weeks, months and even years from now. Death is a thing that happens to old people, therefore, they have plenty of time to worry about that later.
Not for me. Death is a constant companion of mine. Whether it’s talking to my patients every day about diet and exercise to avoid heart attacks and strokes, or trying to prevent my patients from dying from the flu, pretty much my whole career has been geared toward stalling the inevitable: Death.
But, there’s another reason it’s not too far from my mind:
My personal brush with death
It was July 4th weekend during a rare holiday off at the end of my 3rd year of residency. I was optimizing my holiday in the most millennially cliché way possible: Starting my day off right with a green smoothie in the Ninja, composting the leftover fruits/veggies in my DIY Pinterest inspired compost bin and heading out for an Instagram worthy arm-in-arm walk with my husband and two dogs. It was my dream weekend.
As I was throwing out the compost, I heard the familiar buzz of an insect flying too close to my ear. I swatted it away, opened the lid to the bin and out flew a dozen or so bees/ground wasps (still unsure even to this day). “Ugh.. how annoying,” I thought to myself, but still threw in the compost and slammed the lid back in place.
Too late!
I felt a sharp sting at the angle where my right jawline meets my neck, followed by a full force self-inflicted slap to kill the bugger. The slap was nothing in comparison to the excruciating pain as the stinger emptied itself of all its poison into what felt like my carotid artery. Pain started radiating from the location of the sting up and down my neck instantaneously.
I ran to the washroom and tried to look at it in the mirror. For all the pain that was inflicted, it just looked like a little red spot. After inspecting for any retained stingers, I washed it out with soap and water, took a Zyrtec as we were out of Benadryl and remarked to J, “Well, I guess we’ll see if I’m allergic! Let’s go walk the dogs.”
Famous last words…
Within 20 steps from the house, I knew something was wrong. The dog leash in my hand didn’t feel normal. It was like the skin of my hands was starting to get too tight. The sting location began to throb even more – did I get stung again? I reached to touch my neck, but got distracted by my lips. Was it just me, or were they swelling?
That’s when it hit me – I was going into anaphylaxis.
I mentally calculated the time to when my lips, tongue and neck would close up on me and cause my untimely death – I had maybe 10-15 minutes? In the meantime, J had already walked 10 feet in front of me.
“You have to take me to the ER,” I said as calmly as I could.
“I’m sorry, what?”, J questioned with an appropriate look of confusion on his face.
“I think I’m having a reaction to that sting, and we need to go NOW.”
I started to panic at this point – I could feel the prickly sensation of all the blood draining away from the top of my head. I knew my blood pressure was dropping because I was starting to go into anaphylactic shock. Quickly turning on my heel, I dragged the dog up the driveway to throw him back into the house.
The countdown in my head ticked down: 1 minute.
As we got into the car, J gave me one incredulous look that said I can’t believe you’re overreacting this much. “Just drive,” I spat out. 3 minutes.
On the drive to the hospital, I felt myself bottoming out just as the anxiety and terror started to rise. Bad combination. My blood pressure was getting so low I couldn’t stay sitting upright without feeling like I was going to pass out, so I laid my seat as flat as it could go. All of a sudden, I felt an intense urge to scratch my stomach, and as I lifted my shirt to get to the spot, I gasped in horror as I saw hives coalescing into a huge welt in real time.
I could see J’s realization that something was actually happening. “Just keep driving and drop me off – there’s no time to find parking,” I mustered. 8 minutes.
When we arrived, I bolted out of the car through the sliding doors and ran to the front desk which fortunately did not have a line of patients checking in. It took all my effort to stand on my two feet and yell, “I got bit by a bee!”
The triage nurse smirked and replied condescendingly, “Don’t you mean stung?”
Briefly my annoyance surfaced and almost gave me enough strength to pull the doctor card, but I knew it would be ineffective in this situation. I looked like a 15 year old with a crazy look in my eyes and a botched lip job – not credible.
So, I said the next best thing, “I can’t breathe.”
The nurse then sighed, “All right, let’s get you in.”
A medical assistant brought out a wheelchair, sauntered me back to a curtained emergency cubicle, handed me a gown and said, “A nurse will be with you shortly.” 12 minutes.
At this point, I was already blacking out. Somehow I managed to get the gown on and flopped onto the bed. As I laid there focusing on breathing in and out, waiting for someone to come in, I heard the tick tock of the tv show 24 counting down the last 3 minutes of my life.
This was it. After all my time, hard work and effort invested into becoming a doctor, I was going to die in my training hospital because the triage nurse was too interested in being clever rather than actually recognizing someone in anaphylactic shock. I had half a mind to walk out into the hallway and demand an EpiPen, but that would have required the ability to breathe and stand at the same time, both of which were a struggle currently. I took consolation in the fact that at least J wouldn’t have to watch me die.
As soon as I thought this, J busted through the curtain with a nurse at his side. She took one look at me, said, “Let’s check your blood pressure, shall we?” and threw a blood pressure cuff and pulse oximeter on. It was an eternity with the beeping sounds getting further and further away. Blood pressure finally resulted: 60/30.
The entire ER descended upon me all at once
Everything was a blur. People were grabbing at my arms and legs trying to find IV access, but after 13 attempts, nothing. A nurse arrived declaring she had an EpiPen and immediately slammed the needle into my thigh.
30 seconds passed by… and nothing happened.
I was still free falling into a black void. I looked up at the ER doctor standing at the foot of the bed who said, “We may have to drill into your bone to get fluids through something called an IO…” My gaze moved past him and settled on J who was perched by the head of the bed looking like he was sucker punched in the gut. I ignored the doctor and said to J, “They might stick a breathing tube in. It’ll be ok.”
Saying those few words sapped the energy out of me. The effort to breathe was too much and the void was becoming more and more welcoming. But I knew I had to keep trying. I craned my neck back in an effort to open up my airway all the way and closed my eyes. The last thing I felt was a solitary tear streak down my face.
There is a danger in knowing too much. I spent 18 minutes counting down the seconds to my death. I knew how it was all going to go down academically – dilation of the blood vessels causing low blood pressure and volume redistribution, histamine release from mast cells, so on and so forth. I had treated anaphylaxis before, and it seemed so simple then.
But, working my way through anaphylaxis as it was happening to me personally was a totally different beast. To see it coming and be completely helpless despite knowing all the right answers – devastating.
A sharp stab to my right thigh shocked me out of my stupor. My eyes shot open and I saw a nurse holding another EpiPen to my thigh. Within 30 seconds, my lightheadedness improved. Another 60 seconds later, my hives and lip swelling seemed to stabilize. Magically, at the same time they were able to finally get an IV in, and saline flooded in as quickly as it could.
After a 3rd EpiPen, I finally turned the corner and was informed I would need to be hospitalized in the ICU overnight. Before they transferred me to the ICU, I asked the nurse what colour I was categorized as, red being the worst and purple being the least life threatening à la ROYGBIV. She replied, “Orange… but you should’ve been a red.” The overachiever in me nodded in agreement. (s/n: I mean, go big or go home, am I right?)
One of my attending doctors that I worked with admitted me to the hospital, with a look of discomfort that I completely understood. It’s jolting when one of your peers is sitting in that gown. We’re not supposed to be the sick ones – we’re the healers.
She scurried out of the room and prescribed me IV benadryl. As I was about to drift to sleep from the high (s/n: IV benadryl is no joke), I turned and said to J, “You know, when we were hiking last week I could’ve gotten stung there. I could have died. Good night!”
So many fitful dreams since that night. Visions of my death plague me about once a quarter. It’s usually a variation of:
- Only having 2 EpiPens but needing that third to save me
- A swarm of wasps/bees that I’m helpless to fight off
It’s been a blessing
One of the reasons I’m so sensitive to things that make me unhappy is due to the fact I’m so acutely aware of my own mortality. All the things I’ve ever worked toward mean nothing when my only goal in life is to breathe past my swollen throat and tongue. It puts things in a perspective I wouldn’t have had otherwise.
Sometimes the point is not grasping for the next best thing – it’s about actually living.
Sure, I could live in fear of the next bee/wasp venom sting, both of which I was ultimately allergic to. Every step outside is a gamble – bees, the brokers of my death are EVERYWHERE. I could limit my exposure to situations that put me at risk. But that would prevent me from going on long runs in the country side, enjoying the fragrance of wildflowers by the road. It would forbid me from hiking and seeing amazing vistas. It would prohibit me from gardening, even though I’m really bad at it. It would ban me from going on the backpacking trip I’m planning this summer.
Fear would stop me from living my life.
Fear is a powerful tool. It can prevent you from doing the things you want to do OR it can propel you to opening the doors to unimaginable experiences. Facing death can remind you no matter what plans you have in store for yourself, life can take you in the opposite direction. It’s up to you as to how you harness the power of this emotion.
If you could count down the seconds to your last breath, what would you regret? What would you wish you would have done before the very end?
Go out and DO IT. We’re not promised tomorrow.
Harrowing story. To think, you almost died partially because you were mis-triaged and because someone lost the thread of the true purpose of their job in the haze of doing it day in and day out.
Triaging is hard, needle in a haystack hard.
I’ve never had such an experience. We like to say you cane learn from other people’s experiences/mistakes/succeses, but there is something remarkable about being the one having the experience that is really solidifying. That stove isn’t hot until you touch it no matter what someone else says!
How many epipens do you walk around with?
I keep 2 Auvi-Q’s with me at all times, but I’ve got like 10 expired Epipens as backups at home. One can never be too safe!
Of course, that’s an ironic statement because I regularly wander into the wilderness where there is no cell phone reception and it would take hours for me to return to civilization. I used to coach my friends before our hikes to be willing to take a bee/wasp sting for me.. now it’s just understood 🙂