So a short time back, I almost died.
Since living is important to me, and since I made some mistakes during this incident, along with some good choices, I thought I would offer them for your consideration.
The problem started off simply enough. I went to my dentist for a cleaning. I have a very good dentist, and trust him and his staff implicitly. The cleaning went well, and besides some jaw pain from being in the chair with my mouth wide open for an hour, there were no complications. I had a client with an emergency in MS, and the weather wasn’t such that I could fly down, nor did I have a charter service that could get the power supply to the customer, so I drove it. After a 12 hour round trip, the jaw seemed worse, but I had another trip, this time to Dallas on the books. I grabbed a night’s sleep and headed to Dallas. In Dallas the next day I noticed some swelling and the pain was worse so I headed to an urgent care and had things looked at. Leaving with pain meds and antibiotics, I finished out the rest of the day, and hit the bed. The next morning, things were much worse, with my jawline fading under the swelling. Now I was convinced I was in trouble, and headed for the ER. Since I didn’t know Dallas hospitals that well (although I travel to Dallas often), I called the urgent care for a recommendation.
A little research goes a long way.
I should have saved my dime and gone to the web instead. The urgent care referred me to a local hospital (which I found out later was owned by the same company), that was fairly far down most of the lists of quality for Dallas. The ER was quick and competent though, and I was admitted to the hospital with IV antibiotics flowing and feeling fairly good about getting on things so quickly. A CT had shown nothing of note, and so the idea appeared to be to hit the infection hard (white count up) and see if it fell over. The next morning however, things were even worse, with the swelling going under the chin and up the cheek.
It was also at this point that I figured out that this hospital was in way over their head. Nobody had a clue what was going on with me, they had lost the first set of blood cultures they had pulled and had to pull a second set. They had nothing set up for the next morning other than wait and see, and with my condition worsening, that wasn’t good enough for me. I called Mrs Dr Jernigan and asked her to fly down and help me get to someplace worthwhile.
No matter how far down the road you have traveled, if you find yourself on the wrong one, turn around.
The hospital was not happy with me wanting to move, and went into damage control fairly quickly. However, I was firm about leaving, and in their defense, they did start working to transfer me to the hospital I wanted to go to (Baylor Medical Center in downtown Dallas). They also went pretty much limp on my care, which I find unforgivable. When I accused them of this, there were more excuses, but by that point I was ready to walk out the door, and did as soon as my wife arrived. My quick departure probably saved them from the wrath of the Doctor of Chemical Engineering discussing the shortcomings of people who can’t keep their hands on cultures (and make stupid statements about them taking a week to get results). The hospital couldn’t seem to get the transfer to work in the timeframe I wanted, so we walked out to drive the 8 miles to Baylor ourselves.
Don’t mistake the appearance of action for actual action. If things aren’t happening fast enough, do something yourself instead of relying on people who may have other things going on.
Baylor was very, very good. They compare on many levels to Mayo Clinic (my gold standard for care). The ER quickly established that I was in serious trouble, and got numerous professionals on my case. I got one of the best nurses I have ever had dealing almost exclusively with me (and the gallons of stuff they wanted pumped in) and with a new CT and other x-rays had a couple of the surgeons from the Dept of Oral surgery looking at me. The only problem was, they couldn’t see anything causing the problem.
Good professionals don’t dither, they consult.
The Dr who had looked at my case that night took the films the next morning to the chief radiologist. The second time around, and with a more experienced set of eyes, they found the problem. The back molar had split all the way through the tooth vertically, and had perforated the mandible. The infection had started there, and despite being pumped full of antibiotics, they were not helping because there was a reservoir of infection to repopulate things as the antibiotics killed things off. The problem now was that the swelling had gone all the way under the jaw to the other side, the swelling on the right was up to the orbit of the eye, I had lost my chin in the swelling and the left side was going up the cheek as well. I couldn’t open my mouth enough for a tooth removal under local, and my airway was becoming compromised.
The right guys have the right resources.
Despite it being Memorial Day weekend, Baylor got an OR team together, and wheeled me into surgery. The less said about that the better, they had to intubate me while still conscious, which I fortunately don’t remember much of. Good surgeons, good anesthesiologists and good care got me through the surgery, and with the tooth gone and drains in, the infection started abating. Another week would pass before I left the hospital, and several weeks before the swelling went completely away, but the surgery was the turning point.
Hear hoofbeats, expect horses, not zebras. However, don’t discount zebras until you see the color of the coat.
The tooth cleaning was a red herring. It had nothing to do with the problem. The split tooth was the issue and was not even obvious from a CT scan. I was fortunate that Baylor had people who would not let it go and kept looking until they found the answer. They had the right people (College of Oral Surgery) and the right facilities to do the job and they kept going until they had the problem nailed. They were not afraid to ask for help from other resources and they wouldn’t just let things proceed until the problem became obvious (which in my case would have been at the post mortem).
While this is a tale of staying alive, the lessons here transfer quite easily to other situations.
