For the past several months, I have been doing everything in my power to avoid the emergency room. I remember reading the e-mail that stated that there was a confirmed COVID-19 patient in my local ER, in isolation. I sobbed. You see, my “go to” ER isn’t some big entity where isolation rooms can be easily accomplished. No, this is a tiny twelve room ER that can sometimes squeak out a magically room thirteen in the hallway if a situation warrants it (and yes, I have been in “room” thirteen before).
There’s no hospital attached to my local ER. Severe cases are transferred by ambulance to the larger hospital within the same network. When my local ER first started seeing me, they would urge me to seek care at the larger and more equipped emergency rooms. But after over two years of visits, they have gotten to know me and realized that they are more than capable of filling me up on IV fluids and solu-cortef injections. I typically do not require the elevated care that they cannot provide. After being traumatized multiple times in larger ERs within larger cities, this small emergency room close to my house has become a known safe place for me.
I go there. They treat me well. I return home Clearly Alive.
But even with our long history together, that still doesn’t mean I want to make an ER visit during a global pandemic outbreak!
And yet, on the morning of June 20th, that is exactly what I found myself doing.
During this extended time of “Safer at Home,” I have slowly been trying to get back into shape. This journey started with my “7-Day No-Added-Sugar Meal Plan That’s Actually Doable” experiment back at the beginning of the year. Next, I added in low stress walking around my neighborhood. No expectations, no goals, just get outside and breath some fresh air (with hopefully limited grass). Most recently, I was doing a 21 day yoga boot camp via a DVD my mom bought back in 2016. My goal for these lifestyle shifts is for them to be sustainable. I want to be Clearly Alive without constantly having to obsess over being Clearly Alive.
But let us return to the trigger.
On Friday, June 19th, I had a bad case of cabin fever. I was feeling particularly overwhelmed and frustrated. There was so much I wanted to do, and yet I also felt like I had no control over anything. My empath heart is still aching at the situation in the USA right now. I decided that I could go outside and take a walk around my neighborhood to just disconnect from the online world.
The walk accidentally turned into a bit of a run when the thunder clouds began to roll in. I was over a mile away from my home and I did not want to be caught in the threatening downpour. As I was not planning on taking a brisk jog, I did not up my medicine at all on my cortisol pump. This was also during the evening (when my cortisol rates are the lowest) and it was my second workout of the day after I included my 20 minute yoga session that morning.
I finished my 1.7 mile walk / run and realized that my body was overheated. I changed out of my sweaty clothes, took additional salt tabs, and did not think much more of the adventure.
3AM: Uh Oh…
At 3AM, my body jerked itself awake. I began to get “That Headache” and I was frustrated. You see, “That Headache” is my ER migraine. It is one of the most trusted signs that I am not doing well and the only thing that will stop it is IV fluids. But I didn’t want to go to the ER! COVID-19 is still a thing! I don’t want to go to the place that draws in sick people!
As a compromise, I decided to give myself a bolus using my cortisol pump and immediately switch my pump rates to what equates to essentially a triple dose of medicine. I was hoping that I caught it early enough to stop the spiral worse. I did not want “that headache” to send me to the ER!
6AM: I am getting worse, not better…
At 6AM, I awoke again with the frustration of “that headache” getting progressively worse and not better. In addition, I realized that my stomach was upset. This was not a good sign. Typically, after I empty out my guts in the toilet, I am drained of all energy and find myself collapsed on the bathroom floor unable to move. I knew I was on that trajectory, and I knew it was dangerous. It is a clearly defined pattern, and I was following it.
But, I could modify the trajectory.
Knowing that a trip to the bathroom normally leaves me sprawled out on the floor unable to move, I decided to do something different this time.
I mixed up my emergency injection shot before making my way to the toilet. That way, after all energy (and stomach) was drained, I would not have to worry about having the mental capacity to mix up medicine and wait for it to be ready. I could just jab myself with a needle and hopefully crawl back into bed.
After the bathroom episode, and the shot delivery, I slowly crawled back into bed hoping that would be the end of the ordeal.
8AM: “That Headache” really only means one thing…
When you live every day with a chronic illness, it is important to learn to listen the the signs and symptoms that your body gives you. I firmly believe that your body will tell you exactly what it needs. As such, I have learned over the years how to categorize my headaches / migraines from different triggers. I know what is an allergy headache. About a year ago, I learned what mono headaches felt like. Then there are the monthly “Yay! You’re a female!” migraines that I am sure most menstruating women can relate to.
But the worst one of all is “That Headache.”
Picture someone having a hand behind your right eyeball. With that hand, they grasp onto that right eyeball with their finger nails and begin to twist and pull. But the pain just doesn’t stop there. It shoots down the entire side of your right neck. If you move wrong, you’ll vomit. Focusing on anything in the room becomes difficult. And no amount of painkillers touch it.
“That Headache” tells me that I need IV fluids. By 8AM, it had been telling me that I needed IV fluids for over five hours. I wanted to remain in denial.
“I don’t know what to do.”
To try to gain clarity, I texted a close addy friend with the simple question “Are you awake?” Technically, I knew I could call my parents and they would immediately answer. But I also did not want to wake them up at 5AM on a Saturday (yay for time zone differences!). She did not respond immediately, but another friend happened to text me as I was waiting for her response.
I explained to him my current situation, and how I was unsure as to what I should do. He asked what my options where. I told him…
- I could just suffer.
- Or, I could suffer, but go to the ER while I still could drive.
- Finally, I could suffer, but wait longer until I got to the point where I could no longer drive and I required an ambulance.
“Amber. Go now while you still can drive.”
I thanked my friend for telling me just go to the ER, as I needed someone to point blank tell me something so obvious. I grabbed my purse and headed out the door in my PJs. As I was driving, my close addy friend text me back confirming that she was awake. I immediately called her.
She could tell in my voice that I did need further medical intervention and that I was making the right decisions. She remained on the phone with me until I safely arrived at the ER. Now the drive to my local ER is less than two miles away on one two lane road. There are no traffic lights and there is only one right turn. If I had still lived in Dallas, I would not have driven myself.
“Do you need a wheelchair?!”
When I arrived at the ER, the parking lot was empty. I parked my car and slowly started to make my way to the front door. As I approached it, a security guard in a mask rushed outside and asked, “Do you need a wheelchair?!”
“Yes. That would make this process go faster.”
I could tell my energy was rapidly starting to fade, and that if I had waited any longer I would have been unable to drive. The nice security guard wheeled me up to the registration desk, where additional plexiglass shields had been installed.
I was the only person in the entire waiting area. After taking my information, the registration man handed me a mask and wheeled me over to another section of the waiting room. Before he left me, he told me one thing.
“You made the right decision to come before you got worse.”
As I consider myself a regular at this ER, I looked around to notice any changes due to COVID-19. The biggest change was the posted signage informing everyone that there would be no visitors allowed. This didn’t really affect me that much, as I typically end up in the ER alone.
The New Triage Procedure
Typically, triage involves being wheeled into a side room where a nurse takes all your information. At a later point, they take you back to your actually room. However, this has changed since COVID-19. A nurse came and fetched me to bring me back immediately to a room. There was no triage nurse nor separate holding area. There was just my nurse, collecting my information in my room.
I explained to her my situation similarly to how I have laid it out in this blog post. As soon as she hit submit on her fancy computer, the ER doctor walked into the room. I did not hide the fact that I had already given myself 100 mg of solu-cortef three hours prior. He told me he had no issue with delivering another 100 mg via IV and immediately starting fluids.
Within another few minutes, I had an IV in my arm and medicine in my system.
“What’s it been like?”
My nurse was absolutely amazing. As such, I decided to chat with her and pick her brain about the COVID-19 situation, and if she, as a front line worker, saw any end in sight. She informed me that ER visits were actually down as people have been reconsidering if they truly need to go. This is good news for our Adrenal Insufficiency Community. We fall into the category of “required ER visits” and now we compete less with those that abuse the emergency room. This was evident in my low wait time.
She did mention that she expects to see another uptick in the numbers in the fall, as all viruses pick up speed in the fall. But masks help slow the spread, and she wishes that people would continue to be empathetic and stop turning COVID-19 into a political fight. Viruses are apolitical. Our response to them should remain apolitical.
She wore both a mask and a face shield with every interaction she had with me. I asked her why outside of every room there was a red tape outline. This was to help visualize an isolation area. For patients that require isolation, the tape exists so that they can quickly set up physical boundaries in order to serve as tangible reminders to “be careful.” For patients like me (no fever, no COVID-19 symptoms, just Addison’s Disease), isolation procedures were not required.
“You already look so much better.”
My face is very easy to read. I turn pale when I am not feeling well and I am unable to maintain eye contact. However, load me up with some IV fluids and some steroids and I return to my spunky self. Anyone who has seen this transformation is amazed. When my bag of fluids finished, my kind nurse came back to remove my IV. She commented on the transformation.
Both she and the ER doctor confirmed that I made the right decision to seek help before things got worse. Now, the decision was still not taken lightly. By the time I drove myself to the ER, I had already been battling with “that headache” for over six hours. But I sought out intervention at six hours instead of waiting ten or twelve.
The earlier we intervene to stop a crash, the less intervention is required. It only took one bag of saline to stabilize me this ER trip. Typically, I require two or more. And perhaps, if I had thought to increase my medicine during my walk / jog, I would have required zero bags.
But I shall not berate myself on the “should haves.” I will take notes, and try to adjust better for the next adventure. And I shall celebrate the victories. This trip had several victories including mixing of a shot before I needed it and seeking emergency medical before the requirement of an ambulance.
I went to the ER during the COVID-19 Pandemic.
And it empowered me to remain Clearly Alive.
If you require emergency medical care, do not delay it because of COVID-19. The healthcare systems have put in place policies and procedures designed to keep you safe while you are treated.
I would like for all of us to remain Clearly Alive.