Well, I’m hot blooded, check it and see
I got a fever of a hundred and three
Come on baby, do you do more than dance?
I’m hot blooded, I’m hot blooded …
Sorry … this isn’t a Hot Andrew* Diaries post.
I waited a full 24 hours to see where my fever would go. I knew I had a fever. I could feel the heat of my own breath as I exhaled and my body ached from head to toe. My face burned, despite stripping down to a tshirt and undies, then I cocooned myself back up in my fluffy red housecoat because of the chills. I piled on more blankets, then pulled them off in an attempt to reduce the fire within. My temperature had – to that point – remained under the 38C threshold by .1 to .5 degrees. The Fever Card given to cancer patients says go to Emerg if you have a temperature of 38C for an hour or immediately if it reaches 38.3C.
So, I waited.
I must admit I wonder why we treat all fevers. While I understand that febrile seizures are a minor risk, that’s like shooting every bear because one might bite you. In the very young or very old or critically ill, suppressing a fever might be a good strategy. Stressing an already stressed host, the benefits of the fever might outweigh the cost expended. An infant who can’t regulate their internal temperatures should be medicated. They are more at risk for seizures. But I am fifty-one … and I have never once had a seizure. A fever is a body’s natural way to kill whatever is biting. Raise the temperature and make the environment inhospitable to invaders. If my temperature approached critical thresholds like 39.5C/103.1F, I would pay more attention to reducing it. Otherwise, I usually leave my body to do the work and ride out the storm. But this time, the flu-like aches sent me searching for Tylenol Extra Strength every four hours.
I’ve never had cancer before, either, but my body is obviously trying to rally an attack on someone. Today … we believe it is strep throat brought home by my son. I was at the nadir – the lowest point of my chemo cycle when my body would have critically low white blood cell counts, but that is expected. The virus took that opportunity to move in and start the party. Without an immune system, the infection could become systemic in a matter of hours. That is considered a medical emergency.
Our core body temperature follows the natural circadian rhythm. Our lowest body temperature usually occurs around two hours before we awake, then naturally spikes higher in the late afternoon. That’s why your kid is raring to go to school and comes home looking like a zombie. “He was fine this morning!” Add a menstrual phase in there for women, and our nervous system resets the core temperature. We are little furnaces while ovulating and progesterone rages within.
Thermoregulation means we are beings who have the internal ability to regulate our body temperature between certain boundaries via our autonomic nervous system. The ANS is the part of the nervous system responsible for control of the bodily functions not consciously directed, such as breathing, the heartbeat, blood pressure, temperature and digestive processes.
So how does the body stoke the fires? First it changes that set-point to trick your body into thinking it’s cold (chills and shivers). Then the vessels that supply the skin with blood narrow. This process, which is called vasoconstriction, reduces sweating and causes the body to retain more heat than it loses.
My temperature followed this natural progression … down in the morning then escalating quickly Monday afternoon. Worse … my headache and body aches were pounding the shit out of me. By 4pm, I knew I had to head to Emerg. It was 38.3C – emergency threshold level – and climbing quickly. It was 38.7C by the time I arrived at the hospital an hour later.
Since my temperature had played cat and mouse with the threshold for a day, I figured I could ride it out until late evening or Tuesday morning.
Nope. It got worse just as rush hour began.
Have you been to an Emergency Room at 5pm on a Monday? Everyone who waited for their workday to end is there. Kids who got hurt playing soccer at school. People who came home from the cottage with twisted ankles. Heroin addicts crashing from last night’s high and crawling in from their day-long blackout. “Nurse, can you narc me up?”. I should have taken a photo of the poster on the Emergency Room wall patiently explaining why they won’t prescribe narcotics and yes they will refer you to a rehab program. Why don’t we yet have good after hours clinics and programs for patients? The strain on the Emergency Room is visible. There were a few true emergencies like compound leg fractures and heart attacks. Code Blue was called in Emerg twice last night. Even with my Go Directly To Emerg card, it took three hours before I was called into an examination room. My son with a sore throat was called in and released an hour before I was even seen.
Once in, they started working on me immediately. Bloodwork and broad-spectrum antibiotics while we awaited the results. My blood pressure – which is normally very low – has crept up to a dangerously high number. Stress, chemotherapy and now a fever have contributed. I can actually hear the whoosh whoosh whoosh beat through my Cartoid artery. I knew I was feeling worse than the last time, because I had no desire to raise my head – in public for the first time with just a chemo cap – and photograph the journey.
The doctors are covering all the bases, so they then gave me a fungal-slash-antimicrobial antibiotic. I cringe at the thought of all this shit being pumped into me but what can I do? Once that was done, the pump automatically switched over to 1L of IV fluids which they cranked into me at high speed … you should have seen that IV Infusion Pump and my lines dance! Just before 10pm last night, I was told that my WBC was 0.4 so they would admit me again in isolation. The nurse held up the x-ray technician to sneak me in for a chest exray just before the shift change. They left me in the IV Lounge with a psych patient assigned her personal security guard and a former drug addict going for surgery (on what I don’t know) until 1am then transferred me for warehousing in a Reverse Isolation Chamber. Double door entry because the room is pressurized. Everyone gowns, gloves and masks up to come in. Alarms go off if the doors are held open longer than 30 seconds. It’s like a self-contained bachelor pad with living, sleeping and toiletry all cramped into one room. I slept with the roar of a hurricane racing through the ceiling tiles and vents. At least I could control the lights and the TV channel.
Penicillin arrived around 2am, then more IV fluids with sodium and potassium since my electrolytes are off. Something else at 4am. The vampires came for more blood at 7am.
It’s been 24 hours since I ate … so I clapped like a happy seal when the breakfast tray arrived just before 8am.
The vampires took three more decanters full of blood, swabbed my throat and told me to return breakfast into a potty so they could send it off in a vial to test for c. difficile. I’ve already peed in two cups. I’ve had doses of pain killers and my Neupogen shot in the belly … it will tell my bones to increase production of white blood cells so I can fight off infection.
My ears and throat are showing signs of a viral infection, so they have to help my body fight it. However, I must be feeling better because I spent the day researching fevers and the autonomic nervous system and circadian rhythms. Fascinating stuff, our bodies. Truly a miracle that it all (mostly) works so well together. That’s why you got the 911 on fevers.
Beds are a premium. There are no beds in the Oncology ward so I will miss my cray cray nurse Rebecca*, but I will make new cray cray friends in the Cardiac Unit. They sent someone down to interview me for the bed. Sickest wins.
I will update from the other wing.
Oh, wait … they switched my ward again. Still stuck in Emerg. Almost 24 hours.
The indignities!!! They settled me into the Stroke Ward with a lovely view of the Parkwood Estate butt then wanted a bum swab. Really?? Yuck. If it’s going up my ass, I want it to be fun …
No visitors! I’m back in isolation. I’m quite exhausted anyway … physically and emotionally. This sets my chemo back yet another week.
P.S. I have to blog about loneliness at a later date. While sitting in my IV Lounge chair I saw a frail elderly woman arrive at the Emerg doors and not know how to get in. I asked Terri to get up and help her. Hours later while I was en route to exray, I saw her – sitting alone – still dazed and confused – with a fresh cast on her arm. She looked so lost and forlorn. Broke my heart to see her alone. Those were the only tears last night. For her. I texted Terri to ask if I could bring her home. God help me if I am ever than alone. In my 80s – with a broken arm – sitting in the fracture hall in Emerg at 11:30pm. I’ll pull my own plug.
*Name(s) changed to protect the guilty and the innocent!