As doctors like to say, when you hear hoofbeats, think horses, not zebras.

Opinion

When the doctor unexpectedly becomes the patient

By Leana S. Wen

Contributing columnist

July 5, 2023 at 6:00 a.m. EDT

https://www.washingtonpost.com/opinions/2023/07/05/health-care-emergency-room-hospitalization/

Two weeks ago, something terrifying happened. I went to bed Sunday evening feeling fine, then woke up Monday morning gasping and with pressure across my chest. No matter how fast I breathed, I felt as though I couldn’t get enough air.

The days that followed were a serious wake-up call: Though I’m trained as an emergency physician, I wasn’t prepared to be on the other end of the stethoscope. It’s a reminder that no one — even healthy people — should let their guard down.

I knew immediately that I needed emergency care, but my initial concern was for my children because my husband was away in London. As I waited for a babysitter to arrive, I thought through the possibilities: At my age, it was unlikely to be a heart attack, but could there be heart muscle inflammation? Could this be a blood clot? Or a collapsed lung?

By the time I arrived in the emergency department, I was so short of breath that I couldn’t get out more than a few words at a time. My blood-oxygen level, which should normally be 95 to 100 percent, was in the 80s. I also had a fever, headache and abdominal pain, and my heart rate and blood pressure were elevated.

A nurse quickly connected me to a monitor and drew blood. An EKG showed there was no blockage in my coronary arteries, and a chest X-ray ruled out a collapsed lung. My white blood cell count was 23,000, more than double the normal value, suggesting an infection. Tests for the coronavirus and other viral pathogens came back negative. A CT scan showed no blood clot, though it did reveal abnormalities consistent with pneumonia, so I got started on antibiotics.

Because of persistent low oxygen levels, known as hypoxia, I was admitted to the hospital. My doctors weren’t convinced that the degree of hypoxia was explained by the CT findings, so they looked for additional causes. One test showed evidence of heart strain, and two others screening for autoimmune diseases such as lupus came back positive. Thankfully, further investigation found that the heart strain was likely the result of my difficulty breathing and the autoimmune findings were because of inflammation. I was discharged after the antibiotics kicked in and my oxygen levels improved.

As I recover and reflect on my hospitalization, I am deeply grateful for the superb care I received. Yet despite the compassionate and competent treatment from the entire medical team, I was frightened and disoriented. I’ve treated countless patients with shortness of breath and diagnosed many with pneumonia, but it was very different to go through the process as a patient.

Throughout my hospital stay, I thought about what I would do if I were treating someone in my shoes. I would have advised that recovery takes time, and I would have reminded myself to accept the most likely explanation. As doctors like to say, when you hear hoofbeats, think horses, not zebras. Pneumonia is common, I would have reassured myself, and we know how to treat it.

Still, I couldn’t help but wonder whether I were the exception to the rule. I made things more complicated and probably pressed for unnecessary tests as a result. Rationality is easier when you’re not the one in the hospital bed.

In retrospect, self-pity got in the way of my diagnosis. I perseverated on how a healthy person such as me could suddenly become so sick. I exercised regularly; in fact, just days before, I’d completed my first triathlon. When I stopped being so defensive, I realized there were warning signs. I’d been traveling a lot and was feeling run down. I wasn’t feeling quite right during the race but had pushed through fatigue and body aches. The day before my hospitalization, I brushed aside vague chest discomfort.

Putting these facts together, I realized the pneumonia was likely brewing for days before fully manifesting itself. This wasn’t unusual, nor was my surprise at how ill I became. Other healthy patients who fall ill don’t expect it to happen to them.

What’s ironic is that I did expect illness two to three years ago. Before the availability of coronavirus vaccines and treatments that prevented severe illness for most people, I was on high alert for covid symptoms, as was everyone I knew. We promptly tested ourselves at the slightest cough. We tried to get enough rest to maximize our immune response. Those of us with young children made plans for child care if we became infected.

When the threat of covid started to recede, we stopped living so defensively. My recent illness has been a reminder not to do so. Anyone, no matter how fit or healthy they think they are, can become sick at any time. Don’t ignore warning signs. Be sure to seek medical care early. And as I am learning for myself, it’s okay to slow down and prioritize your own health and well-being.