How I Ended Up in the ER on my Summer Vacation

“Look, there it is on the left,” said my boyfriend Scott, pointing at the Lobster House in Cape May. I looked up from my book – “Swimming to Antarctica” by cold-water swim champ Lynne Cox.

I was excited but at the same time was nursing a terrible problem.

If you’re a woman, chances are that some day you’ll have a "UTI," a urinary tract infection. These annoyances are quickly fixed by antibiotics.

If you’re me, however, the situation is much more complicated.

In 2011, I had a kidney transplant, due to taking the drug lithium for nearly 17 years, to manage my bipolar disorder. My daughter Sarah gave me one of her kidneys, which allowed me a second chance in life.

What we didn’t plan on was that the life of my kidney would be jeopardized by frequent urinary tract infections.

The symptoms are unmistakable: fever and chills, exhaustion and the indescribably horrible feeling that you have to pee every 10 minutes.

Once these symptoms begin, they don’t let up until I’m on the eighth floor of The Tower Building, Einstein Medical Center on Broad Street, lying in a hospital bed, designed by a master torturer.

As nurse Katy rolled me onto the Transplant and Oncology Unit from the ER, the nurses greeted me as if we were old friends: Funso from Nigeria; Crystal, whose daughter will enter kindergarten this fall; Andrea, Mary and Bob.

I also met a patient named “Jack,” who was having trouble with his transplanted liver.

“Oh my goodness!” I said when I learned he’d been on the unit for eight whole months.

I often saw him on his laptop when I passed his room on my endless loops around the unit, pushing my intravenous drip bag, in my cute little blue booties. 

Like Jack, I brought my laptop for what I thought would be meaningful hours reading the online Times, watching movies, and working on a short story for my next writing group.

But when the laptop clicked on, the screen was white as snow. Something had broken.

Hopefully Medicare will pick up the tab.

What made my four-day stay halfway tolerable was the staff. Whether it was the nurses, the food service people, cleaners, doctors in training, each was a gem of kindness and compassion.

“Anything I can do for you before I leave?” each one would ask.

Doctors would arrive early in the morning, around 6 am.

The wildly popular transplant surgeon Stalin Campos, MD, originally from El Salvador, knocked on the door with his students in tow – I call them “ducklings” – hugged me and said, “Ruth I really really like you, but I don’t want to see you this much.”

This was my fourth visit.

The genesis of the UTI is that the enemy bacteria takes up residence in the bladder.

“The bacteria travels up from the skin and up through the urethra. It can go into the bladder or the kidney itself,” said Sarah A Perloff, DO, FACP, program director for the Infectious Diseases Fellowship and associate program director of the Internal Residential Program.

Like Campos, she is always followed by her own ducklings, mostly female.

Dr. Perloff and I go way back to my first urinary tract infection.

I was relieved to see her. She and my transplant team would put me on the right antibiotics to chase out the evil invaders that were making my life miserable.

She told me they had a series of antibacterial IV’s (intravenous drips) for me since they wouldn’t know the name of my particular bacterial infection for several days.

Meantime, they would infuse me with a few medicines that should help. Welcome  Invanz, Citrobacter and all. Do your dastardly work!

In fact, within one day, my symptoms ceased and I was ready to do the impossible – go home.

“You know what I like about you?” I said to Dr. Perloff, whose hobbies include bike-riding, gardening and knitting. “You spend time with me. You listen to me and answer all my questions in an unhurried manner.”

“I make a point of it,” she said smiling. “I know people like it.”

After she left, there was another knock on the door.

It was two men in white lab coats – of course! – and I couldn’t fathom who they might be.

John introduced himself:  John Knorr, PharmD, BCPS, Transplant Clinical Pharmacist. Student Clerkship Coordinator.

Quite a nice-sounding title, don’t you think?

He told me he was the pharmacist for the transplant unit. At his side was his student. He took a list of my medications and then I brought up a question that would determine the rest of my life.

After my kidney transplant, I acquired insulin-dependent diabetes from the antirejection meds, which were now Prograf and prednisone. I was on a campaign to get off the prednisone, in the hope that the diabetes would go away.

“Not a good idea,” said John. “Your Prograf also heightens your sugar level.”

Though I hated hearing it, at least I knew once and for all: stay on your meds and accept the gift of life with all its Faustian complications.

I confess I’m a terrible patient. Boredom is my enemy. And that dreadful bed I lay in while the medicine coursed through my body.

“Look!” said Maxine, one of the women who changed the sheets. “Your bed has a sinkhole from where you lie down.”

Ah, validation.  I’m a psychotherapist so I know how important it is to hear one’s subjective feelings upheld by a third party.

After the doctors would leave – the highlight of the day – I’d wonder how will I get through the day. 

After all, I now felt fine, but the invisible enemy within had not yet been conquered.

Visits by Scott helped immensely. Since we live next door to each other he gave me reports on our garden: zucchini aplenty and tomatoes swaying on the vine. He brought me two crunchy fresh salads to snack on.

The mini-tragedy of the broken laptop was joined by another one. Blind as a bat, I wear contact lenses. I lost one of them.

In a gallant effort to find the blue-tinted lens, I got down on my hands and knees, not easy when you’re 67 years old, and scrubbed the entire floor with wet paper towels.

“It’s got to be here somewhere,” I told myself but never did find the darn thing.

Friday, the day I got there, they wheeled me in for an ultrasound to my kidney to show if the blood vessels were working properly. Which technician would I get? Gensi, the Albanian? Jeff the bearded one? Or Wendy?

The test showed my kidney was in fine fettle. My daughter Sarah would be proud of me. She and I both know I exercise and eat right to preserve her precious gift. Diabetes kills kidneys. I lost mine once and don't plan to again. 

I told myself to stop complaining and commanded myself to finish the latest New Yorker before the next one arrived at my door. I’ve never finished a single issue.

On Monday morning, the transplant team said I could go home. Nurse Bob gave me the news before he stuck me in the belly with my insulin before lunch.

This is where one must be very very patient. Now the wait begins for the massive amounts of paperwork to be prepared. This takes hours. There was only one thing to do. March around the floor again in my blue booties.

I learned from Mark, one of the cleaners, that when a patient leaves, the furniture in the room is moved to the side and the whole room scrubbed clean. I’d witnessed it a couple of times.

Could it be that when I left, my missing contact lens would be swept away into the sudsy water?

Dr. Radi Zaki, head of the transplant unit, came up with a plan which we hope will permanently oust the infections.

I’ll take a low dose of Bactrim every day.

Every day when you’re out of the hospital is a beautiful day. In fact, every day is beautiful. I’m sitting here sipping cranberry juice, as advised by Dr. Perloff, and watching for the hummingbirds at the feeder.

WARNING SIGNS OF KIDNEY FAILURE, (from the Internet)

See http://www.mayoclinic.com/health/kidney-failure/DS00682/DSECTION=symptoms

GOOD KIDNEY HEALTH, from NHS online (NHS.uk)    

http://www.nhs.uk/Livewell/Kidneyhealth/Pages/Loveyourkidneys.aspx