The Quinsy Report, part 1

My throat was starting to feel sore. My wife Christen and I were driving to Ann Arbor for our niece’s graduation party on a Saturday in June 2011, and I sang louder along to the Gram Parsons tribute CD, trying to stretch my tightening gullet. Later at the party I found myself looking for the coldest, numbingest drink I could find.

On Sunday the pain had increased, so I went to urgent care. The nurse said there was a sore throat going around. She put me on an antibiotic and prescription-strength ibuprofen. She did notice I had a tissue in my hand to sop up the saliva I couldn’t swallow. She seemed to reflect for a moment, and I went on my way.

On Monday my pain was so bad and my throat was so swollen that I could talk only with difficulty. I canceled my summer class meeting, and Christen insisted that I go to the doctor. I agreed on the condition that she would make the appointment and drive me there. Dr. Kuebeck looked into my throat and made a worried face I’d never seen on that cheerful, confident man. Christen remembers him saying, “Oh, Geoff!” He couldn’t even tell where my uvula was. He immediately got me an appointment with Dr. Merrell, an ear, nose and throat specialist.

Dr. Merrell was calm as he examined me. A medical student was shadowing him, and he narrated everything, which allowed me to follow the diagnosis in real time. Within two minutes he told me I had a peritonsillar abscess, also known as quinsy. An infection of the soft, folded tissue around the tonsils, where there are a lot of opportunities for bacteria to take hold. He almost seemed glad he could easily identify a condition he had often seen as a doctor in the army.

Symptoms of quinsy: swelling, severe pain, trismus (which I had previously known as lockjaw), and something called “hot potato voice.” Since then I’ve tried to imitate this croak, and it doesn’t work. It’s hard to constrict your throat on purpose, and to mock swelling. Maybe one could try it with an actual hot potato.

Dr. Merrell aspirated the abscess, which relieved the pain a little, and gave me prescriptions for a powerful painkiller and antibiotics. He also put me on probiotics, since the antibiotics would attack my normal bacteria and give me the oral fungus called thrush.

That night I was sitting on the couch waiting for everything to take effect. It didn’t seem to be doing much. Christen went out for her usual Monday-evening knitting social. The phone rang. It was Alice, a neighbor whose husband Jim had a degenerative disease that tried his patience and hers, and made him talk slowly and stiffly. Alice said that Jim was hearing loud music in the neighborhood and wondered if I could go locate the source.

Getting out and taking a quick walk around a block or two—it turned into more of a stomp —seemed like a good distraction anyway. I found a party with moderately loud recorded music. I noted the address and stomped home to call Alice. I explained my problem and tried to hot-potato the house number. She said she wanted me to talk directly to Jim. The conversation between his laborious creak and my puffy scratch was the strangest verbal exchange I’ve ever had.

This episode had increased my distress. My throat was sorer, and pain had whipped me into generalized anger. Christen got home, took one look, and went into alarm mode. She called Dr. Merrell, told him the meds were hardly working, and asked what to do. He told her to take me to emergency. She repeated, “Are you saying he needs to go to the hospital?” “Yes, there’s nothing more I can do.”

 

The Quinsy Report, part 2

sometimes you don’t know

a word until it gets you

like quinsy got me

 – senryu from June 6, 2011

 

It was around midnight when Christen drove me to Wood County Hospital. My excellent patient advocate (she without the hot-potato voice) explained what I had. I felt some mental relief because we were getting some serious care, including my first CT scan ever. Dr. Merrell didn’t have admitting privileges at Wood County (he had implied some unpleasant falling-out), so he and the emergency room people negotiated a move to St. Luke’s, about 15 miles north in Maumee.

A cheerful ambulance crew arrived, a big dark-blue male presence among the light-blue-scrubbed ER women. They had “Life Flight” patches on their uniforms, so for a moment I thought I’d be helicoptered. Oh, no! Was it that bad? On the other hand, I hadn’t flown in a chopper in decades! No such luck—it was just the same company that ran the Life Flight. But I was getting my first ambulance ride. I watched out the back window as familiar landmarks peeled off on Route 25. The ambulance guys cracked jokes the whole way. Somehow I joined in, hot potato or no hot potato.

Christen had gone home for some well-deserved sleep. She didn’t get much. When I got to St. Luke’s they took me right to the ICU. The nurse there needed information from me, but I was indisposed, so she called Christen. It was now about 4 a.m. I was thirsty. My throat hadn’t let me drink anything. They couldn’t give me a drink in case I needed surgery. I did get a stick with a pitiful little sponge on it that held maybe three drops of water.

When they moved me from admitting to an ICU bed, I had been awake for twenty-four hours, I’d had virtually nothing to eat or drink, my throat was screaming, and there was a patient on the other side of the curtain who I gradually figured out was going through alcohol withdrawal, with the attendant DTs. The room itself had something basementy about it. I think they were doing some renovation.

Thinking I might have to run my German for Reading Knowledge course from the hospital, I had brought my laptop. Now, in the early hours of June 7, I started to communicate with the outside world. (I had announced my diagnosis on Facebook the day before.) This Facebook post is dated 8:16 a.m. on June 7, 2011:

over night I was admitted to St. Luke’s Hospital in Maumee and I’ll be here at least all day and likely overnight. So far, surgery is not indicated–aggressive antibiotics and pain meds, but they haven’t ruled it out either.

How innocently hopeful this message looks. Those who know me, though, will see evidence of great disturbance in the lack of initial capitalization in the first sentence. Of course, my sisters weren’t exactly thrilled that I advertised my situation to the Facebook world before I emailed them privately to tell them what was going on.

By the time I made that post, I had been put on IVs with antibiotics, nourishment, and periodic pain medication. I was also getting oral painkillers every four hours. I was finally able to moisten my mouth, but I still couldn’t swallow. I was getting good at monitoring my blood oxygen on the readout, and breathing extra if needed. Extracting spit and drainage from my mouth with a little turkey-baster-looking thing was one of my major duties. A nurse named Ryan, an Army veteran, was taking good care of me. It was time to wait for the ICU to do its magic.

Digression: Quinsy Lore. Dr. Merrell had told me that George Washington died of quinsy. Later, when I told that to my dentist (by way of medical update and survival brag), he said that wasn’t quite right. Washington had quinsy when he died, but he died of the treatment, not the disease. The old-school army doctors who treated him relied on bloodletting. They didn’t pay attention to the younger doctors, who were starting to get a better idea of infection and its agents.

Michel “What Do I Know” de Montaigne was another famous quinsy sufferer.

The word “quinsy” came into English, not surprisingly, from French. Ultimately it goes back to the Greek words for “dog” and “collar.” Here’s a brief etymology from Google:

Middle English: from Old French quinencie, from medieval Latin quinancia, from Greek kunankhē ‘canine quinsy,’ from kun- ‘dog’ + ankhein ‘throttle.’

In other words, I was suffering from what you could call “dogthrottle.”

 

The Quinsy Report, part 3

During my time in the hospital, I couldn’t speak very well, so I wrote notes to people, especially Christen and our son Coleman. These are my slightly edited notes from my “St. Luke’s Hospital” pad.  I’ve tried to arrange them chronologically as much as possible. Warning: there are occasional references to bodily secretions, excretions, and products of infection.

Swallowing can’t get through drainage

Coughing is painful

But if I let the drink mix w/the yucky stuff, I can suck it out of my mouth w/ that thing  [A device with a bulb and a tube that allowed me to remove fluids from my mouth because I couldn’t swallow.]

 I fall asleep and dream immediately and my brain turns the constant babble of ESPN in[to] things I know and care about, include (sic) German! Very imaginative [See section on hallucinations below]

 It’s going to take a long time

Swelling is reducing, but that means more drainage

I was dying for some water, but they did[n’t] want to give me any in case they decided on surgery. Then when the[y] brought it, I couldn’t drink!

But my mouth is finally moist.

Staff has been great    Merrell is great.

 [To Coleman] The ambulance attendant really liked Mom. – How long have you been married, he asked. [To Christen] He was impressed by your sense of humor.

 I seem grimmer than I am. I am tired and I have to be patient and avoid what causes pain.

New phase: We have saliva!

Tea is soothing but make (sic) me cough.

 I was falling asleep during every sentence in emails & on facebook   Morphine!

******

Feeling better + morphine = frequent drifting off

You guys have raised my morale. (Even if not my morals)

 I’m only sleeping

 Der Nachbar ist alkoholsüchtig und wird dafür behandelt. Er hat Halluzinationen, delirium tremens.

[This is German for “My neighbor is an alcoholic and is getting treated for it. He has hallucinations, delirium tremens.” I guess I thought I had to be discreet and use a secret language even though I was writing.]

 I’m just gross.

I gave myself a “sponge” bath today & used no-rinse shampoo. I was schrecklich! [schrecklich = awful, terrible]

 [In margin] febreze [I think this was an analogy to no-rinse shampoo]

 *******

 I have no desire to eat food. The prospect is too painful. Drinking is more attractive, but I’ve resigned myself.

 He’s hard of hearing, obv. [This might be a joke about why the nurse didn’t understand me.]

 They had to find the right antbio (sic), for understandable reasons. They had to get the authorities to prescribe it, understandably.

[Interesting account of the challenge of finding out just what was eating me. The hospital needed permission from the CDC to administer one of the antibiotics I was getting.]

Beats surgery, which also only treats symptoms.

 ********

SOME PEOPLE ASK, DON’T UNDERSTAND, INTERRUPT BUT THEN DON’T LISTEN THE SECOND TIME. I END UP SAYING THINGS 3 X.

[This happens in normal life too, of course, but it’s harder when you have hot-potato voice. I told about a funny instance of misunderstanding on Facebook: Me: can you bring me a urinal? Nurse: what? a Coors Light?]

 I’ve been seen by Merrell, 2 internists, 2 infectious disease people.

[I assume this means experts in infectious diseases, not people with infectious diseases. You never know in a hospital.]

[Here Christen must have asked me how long Merrell talked to me:]

NOT SO LONG

BUT HE’S VERY EFFICIENT AND KNOW [now?] I GET IT

 *************

IT’S REALLY GOOD TO HAVE YOU HERE!

 He says we have [to] assume tomorrow, probably more. He said you said, he’s (me) got to get out of there! He said, he’s got to get better, and that’s when it possible

My mood is much better, as you can maybe see.

I’m going to write a blog called “The Quinsy Report: adventures at the morpheme morphine boundary.”

[It took me five years, but here I am doing it, but without the cute reference to linguistics.]

 It reminds me alot (sic) of when Mr. C [=Coleman] had the embolism. We were in the midst of it before its seriousness sank in (for me).

[A little more than a year before, our son had been hospitalized with a pulmonary embolism.]

************

Swallowing always presses the abscess site.

 Tell me about yourself. [I think we had just decided I shouldn’t try to talk so much.]

 I FORGET WHERE I AM SOMETIMES

 I think the pain med is kicking in. Also the ADRENALIN!

 When I drift off like that, I have to let it happen. Sorry to be rude.

 

 I slept a ½ hr amid noise, but it made a difference. I’m slightly less psychotic

Last night no more than ½ hr

 

That played @ 5:30 am today

that loud WTF?

[Must refer to some music or something on the PA system]

 

but ma (sic)

 

 turn off alarm plse [The alarm went off when my blood oxygen got too low.]

It hurts too much.

Talked to Merrell today.

The[y] got the culture — at least 2 kinds [of bacteria] & one might be resistant to most antibios

 

They got the right one today. A CDC person had to approve.

He says if it were “bad” it would be 2x as big.

[I think this refers to the externally visible swelling. I hadn’t seen myself in a mirror for a while.]

 

Looks like a goiter!

Washed it (thoroughly this time) w/ no-rinse.

 Please pull curtain & bring urinal to me. Thanks!

 *********

I got the idea last [night] of getting the IV Morphine and then getting the oral ½ hour later. Reduces pain of swallowing.

[This was my clever solution to the problem of not being able to swallow the oral pain medication: let the IV morphine sink in first. They had been administering both at the same time, every four hours.]

 It takes me 1 hr. to write a short email. I drift off 4-5 times per sentence.

 I’ve had a real hard time relaxing, but Jo brought me an extra pillow and I’ve got to find a good way to relax so I can sleep. I’ve realized I am not getting enough restful sleep.

 I’ve also realized that I’ve been afraid of suffocating on mucus and pus but I don’t think I feel so scared anymore.

 Hallucinations

The sleeplessness, pain, and morphine combined to give me hallucinations. I saw bugs scattering across the sheets. Talking heads on the constantly running television would be singing the news or speaking in German. But there was always a rational part of my mind monitoring all of this. Here are some notes about hallucinations (which I call “morphine morphs” at one point).

One of [the] morphine morphs ESPN

“Santa Claus is ahead by a nose!”
(Rudolf’s of course)

 When they were talking about a cook book a little while ago [on television] in my dream it was a book about the third (secret) scion of an ancient noble family.

 I’ve been hallucinating today. I thought you (sic) purse was Scout just now. [Scout is one of our black cats.]

[This is from Facebook]

My brain has been been making rapid, full-fledged decisions about what I’m seeing or hearing, not weighing evidence and letting me decide. The results have been hilarious, if unnerving. Example No. 1: a reference on iTunes to Neil Young’s album “After the Goulash.”

A Facebook correspondent asked: Would it be off-topic to just say that’s a great album?

 To which I answered:

Not at all. Coleman and I saw Neil Young in Detroit in May and he drew much of his material from After the Goldrush. After The Goulash, in case that’s the album you meant, is by a polka band called Neal Jung and the Synchronicities. They’re also known for the party favorite “Let’s Drink Ourselves into Collective Unconsciousness.”

 

The Quinsy Report, 4^th and final part

I stayed in the ICC (as St. Luke’s calls its intensive care unit) until Thursday afternoon, two and a half days after my admission. During that time I was transferred from the basement-like area to a brighter ICC room.

On Wednesday I was able to eat a little. I could nip small bites of the institutional hamburger and gingerly chew the soft meat parts, but tiny bits of gristle that I normally wouldn’t have noticed were still too big and firm to get past the dogthrottle.

Unlike some people, I am happy to sit in bed and have people wait on me. Christen and Coleman visited me each day, but we figured out that not talking too much and not being distracted were important for my healing. Nobody needed to hold a vigil at my bedside.

I was on line a lot, informing my family, posting on Facebook, and running my summer class. I wrote that I was typing “partly in the manner of archy the cockroach because it aint easy to type with [one] of those damn e.t. fingertips on.” (I’ve since learned that the device is a “pulse oximeter.”)

On Thursday afternoon I was moved to a large private room in a regular ward. It felt like a big hotel room. It wasn’t as noisy as the ICC, so I could start catching up on rest — I can’t exactly call it sleep. I went on line and ordered my first Kindle, which I thought would be a good way to entertain myself during my convalescence at home.

They released me from the hospital at 3:30 pm on Saturday, June 11, according to a note in my health log, which I then used at home to keep track of my medications. I was taking Lortab, an opioid with acetaminophen; Bacid (lactobacillus acidophilus), to restore my normal intestinal bacteria; Augmentin (amoxicillin); and Fluconazole, against thrush. I took my last Lortab on Sunday and moved to prescription-strength ibuprofen for pain. I’m lucky that I had no desire to keep taking the opioids.

I had to do jaw exercises to work against the trismus. I gave myself a free pass to eat as much store-bought tapioca as I wanted to, having discovered the delightfully named “Kozy Shack” brand.

I returned to my classroom and let my students do most of the talking. They were translating German to English, so that was pedagogically sound anyway.

My notes tell me that on June 22 I went off the ibuprofen and but still had symptoms: “Some earache, discomfort swallowing (not pain). No pill [i.e., no opioid] for 1.5 weeks.” On June 23 I wrote: “On Wednesday I finally started feeling better, more energy, out from under the shadow of the quinsy.”

Over the next few days I recorded fatigue, discomfort, and “a sense of roughness and slight swelling in the throat.” On June 30, 25 days after the onset, I took my last antibiotic pill. Some symptoms persisted into July.

At a follow-up appointment, Dr. Merrell said that I’d had “one big, bad infection.” One of the worst he’d seen.

So that’s the Quinsy Report.

 

Epilogue

As hospital veterans might have guessed, it was (at age 55) my first time as an inpatient.

I know many people who’ve had much more complicated, chronic, and devastating illnesses. Mine was a medical adventure with a happy ending.

I didn’t even have to get my tonsils out. The part of my brain that monitors and makes fun of stuff was kept very busy. I felt like I was getting the care I needed, and most of the time I wasn’t afraid of the worst.

When I tell this story, I say that if you’re going to have a life-threatening disease, quinsy is a good one to have, because you can recover completely and there’s little chance it will come back.

A few weeks later, my sister emailed me a link to an article about septicemia, asking if that’s what I’d had. No, I said, the infection hadn’t breached my blood vessels and spread throughout my body. Although it could have.
I’m sure glad I didn’t see that article while I was still in the hospital.