On Friday evening Karen started feeling bad. She puked once that evening and through the rest of the weekend had flu like symptoms: Sweats, achy joints, and a low grade fever. Then, on Sunday, Karen suddenly turned yellow. Her eyes were especially yellow, and her face was a shade of yellow-orange. We both knew this was jaundice and immediately thought "liver failure." We quickly decided to head into Mayo Clinic's ER. While Karen packed her stuff - toiletries, change of clothes, lactase enzyme pills, laptop - I called the 24 hour "emergency" number Mayo gave us and spoke with an oncologist who said it wasn't as urgent as we thought and to simply call Monday morning. They could arrange some bloodwork and an appointment then. We called first thing Monday and left a message, but Mondays are always the busiest and we didn't receive a call back until after noon. But they must not have had any openings in their schedule because they told us to just come in to the hospital instead. In the past nurses have told us Mondays' always have the longest waits in the ER, and the shortest waits were during the hours of 3am to 9am. So that was frustrating. It was probably the longest we ever had to wait with Mayo. But to be fair they did get the blood work and urinary analysis started while we were waiting.
That evening, a CT scan showed that lymph nodes near her liver had become enlarged and were pressing on her bile ducts, preventing them from draining. When these get blocked, bile builds up in the liver itself, and bilirubin builds up in your blood. Bilirubin is an orange-yellow pigment that occurs normally when red blood cells break down. There is a procedure where they can put a stint in your bile ducts to keep them open, so Karen was kept NPO until morning when the gastrointestinal (GI) team would be around. They seem to put your on an NPO diet whenever you check in for an emergency as surgery might be required and they like you to have not eaten or drinken anything before any surgery.
We did get to see the GI team Tuesday morning. They said the procedure has a 1 to 2 percent chance of causing pancreatitis due to the proximity of the bile ducts to the pancreas. We were told it's very painful and for someone in Karen's situation the risks outweigh the benefit of removing the bilirubin from her blood. They strongly recommended skipping the procedure. If the bile ducts become infected, or she begins to have other symptoms, such as itchy skin, then they would recommend the procedure at that time. So Karen is not only staying yellow, but missed a day's worth of meals for nothing.
The urinalysis they started while we were waiting in the waiting room not only showed the bilirubin, but a UTI. They now believe her discomfort and low grade fever were from this and unrelated to the bile ducts being blocked. That seems like quite a coincidence to me, but they insist spontaneous infection of the bile ducts, even during a blockage, is quite rare. Karen was started on a broad spectrum IV antibiotic that first day to treat both the UTI and a possible infection involving her liver. They have since begun culturing the bacteria found in the urine to look for a good oral antibiotic she can take at home after leaving the hospital. Like Karen's previous UTI, there seems to be some difficulty finding an antibiotic she can take via mouth that will work on her UTI. That's the last thing holding back our discharge and return home.
