Well, took my second bus ride of my life today.
My fault. I forgot entirely to warn the bartender to not use Carpano Antica vermouth in my Manhattan. How's that for a properly posh reason to get transported?
I have, sometime in the past five or six years, developed a fairly strong allergic response to ... something. I don't know exactly what it is. The one factor in the highest percentage of my attacks has been Carpano Antica. Up until now, the vermouth meant that I broke out in urticaria (hives) over the top half of my body (yes, they stop pretty much precisely at my waist, It's weird, but I'm grateful). I have had that same reaction at other times when I'm not drinking in a restaurant - but those other times have involved walking outdoors in the rain under pollinating trees. I've had two attacks in those conditions that were much more severe than the Antica response, where my hands, lips and tongue swelled. One attack resulted in my syncope in the shower last year during marathon training, which caused the first bus ride to rule out cardiac issues (those were emphatically ruled out, which is why I went on to run the marathon).
Today I was having dinner with my brother, something we had both been looking forward to as we both process the loss of our dad. We had been there 45 minutes or so and just started our entrees, and I'd just finished the Manhattan, when I felt the flush and the itching start and said "well, shit." He immediately asked if I needed to leave to go home or to find a Benadryl - I usually carry them, but hadn't brought my work backpack to meet with him. I said nah, I'd just suffer the itching for the 45 mins because by the time I reached a drugstore, took the pill and it took effect, it'd be roughly the same timeframe.
A few minutes later, though, I felt my tongue and lips start to swell, and I started having trouble enunciating because of that. My brother put down his fork and said "Let's call 911."
"NO! Not into a fucking restaurant, my throat is fine!"
"Well we need to do something, you look awful and I'm worried about you."
"Shit, you're right, where's the nearest urgent care?"
We looked it up, and there was an open one five blocks away. He waved me off. "I got the check, go, go."
So I left, and fast-walked (mistake, in retrospect) the five blocks to the urgent care place. I got in and there was literally nobody in the waiting area so I just walked to the desk and said "Hi, I'm having an allergic reaction." The receptionist looked up at me and startled and said "Please let me have your ID and insurance card," while already reaching for a phone. I put them on the desk, and as I did so a medical assistant came out of the back and said "Follow me please" and took me into an exam room. While she was measuring my blood pressure and pulse and blood O2 sats, the MD came in, looked at me, and visibly paled.
"Do you carry an EpiPen?" he asked urgently. Which was the point at which I realized that huh, maybe this wasn't just a simple hives attack.
"No, I don't, never had one prescribed," I told him.
He turned to the assistant. "Epi kit, stat, please."
She launched off her chair and out of the room while he started rummaging in a cabinet for (sigh) syringes and various gear. I resigned myself to a more invasive treatment regimen than I had expected or hoped for, given that I hadn't collapsed or felt faint. "Doctor, my throat is completely fine, I'm not having any trouble breathing."
"Not right now, you're not. Were you expecting your lips and tongue to swell up this far?" he asked slightly sarcastically, still rummaging.
I conceded the point. "No, of course not, sorry, I'm just not looking forward to this new experience." That got a laugh as he turned around.
"Don't worry, this doesn't hurt badly, it goes in the meaty part of the thigh." The assistance came back with one of those ubiquitous blue plastic trays with a dose bottle in it and a blister packed hypodermic needle. "Thanks. Let's get him a Benadryl as well please, oral." Then he mated up the needle onto the syringe and loaded it from the dose bottle and (still visibly moving quickly, although carefully checking dosing and expiry dates on the bottle) slammed it into my leg. "Okay, this should start relieving your worst symptoms within a minute or two, please keep telling us how you feel."
"Uh, okay, nothing yet."
He turned to the assistant and asked "Did you make the call?" She nodded.
"What call?" I asked.
"EMS. If we give Epi we have to send you to an ER for observation for several hours, because there's something called rebound shock - that's when the epi wears off before the attack is over, and the inflammation comes back. If that happens, we want you in the best equipped place possible because the rebound can sometimes be worse than the attack got before you got the Epi. This is why if you ever have to use an EpiPen you always go to the ER anyway."
"Oh." Well, fuckity fuck.
"How do you feel now?"
"Mostly the same. I think my tongue is a little better." He looked relieved at that, and I heard sirens from outside. "Shit, is that for me???"
"I hope so." He took the plastic pill cup the assistant offered him and handed it to me with a cup of water, the bright pink of a Benadryl in it. "Take this." I did.
As I was handing back the cup, four or five super beefy NYC firefighter/EMT types came walking into the room carrying packs of gear. One of them looked at me. "This the patient?"
I waved, the only one sitting on an exam table in my underwear. "Hi."
"How are you feeling?" the EMT asked.
"Uh, mostly the same, slightly better maybe?"
"He's had the epi," said the doc, and they lapsed into medical/procedural language. The front desk receptionist came in and quietly handed me back my ID and insurance card, which I'd almost forgotten about, and I thanked her. The doc said to me "I've put in a scrip for an EpiPen for you, the ER doesn't always remember to do that. Carry it. Don't be stupid, okay?"
I hung my head. "Thanks, Doctor, I will do my damn best."
I followed the EMTs out and there was an entire freaking fire engine parked out from with the lights going. "Wait, was that for me?"
One of them laughed. "Yeah, we were closest. That's your ride though." He pointed behind the engine where a NYC EMS ambulance was just pulling up. I headed over, and the door opened to let a pair of EMTs out, one white haired and one younger, both men.
"You my ride?" asked the older one. I nodded. "Okay, good, you're walking. Get in here."
I climbed in and found myself looking at the bench and gurney. I sat down on the bench and started belting myself in. The EMTs followed me in. The older one started removing the bags of gear that had been piled on the gurney and looked at me. "Nah, get on the bed."
So I did. They belted me in. They started their own medical chat, but the long and short of it was, they had to put a line in me. As they started to prep, I said "Hey, just so you know, I tend to syncope during phlebotomy after the first try…"
The older EMT (Strong, his shirt proclaimed his name to be) grinned. "Thanks for letting us know, we'll wake you up if we lose you. Keep talking, let us know how you're doing." He turned back and stuck my hand with what felt like a firehose with a needle on it. I started humming and looking at the ceiling in the other direction while they fussed. "You got valves in your veins, kid." (nobody's called me kid in decades, given the gray in my hair, but he was fully white-haired, so OK).
"Is that bad?"
He laughed. "Nah, not good or bad. But yeah, you're...hmm."
"I've been told I'm a bad stick, is that what you mean?"
"Yep! Okay, it isn't just me." He pulled the needle out and tried another site. I said "Okay, I'm getting a little woozy over here."
"You gonna be sick?" (EMTs hate cleaning up ambulances.)
"No, don't think so..." but I realized I was talking pretty slowly.
There was a confused period. I don't think I fully passed out, but when I next remember looking at the ceiling properly, and hearing them, they were asking me to talk back to them. "Hey. Hey, yeah, I'm here."
The younger one asked "Do you wear a pacemaker? Have you talked to your doc about a pacemaker?"
"What?!?!" I said, alarmed, which increased my awareness. "No! My heart's fine, I just ran a marathon!"
"Calm down," the older EMT said to the younger, "That was just vasovagal, remember, he warned us about it, it's fine. Look, his pressure's back up."
"What were my numbers?" I asked.
"You got down to 80 over 35, and your pulse was around thirty five. So, you know, not great," he laughed. "But you popped back up before we could get the salts or the shots out."
The good news was that while I had been mostly not there, he'd gotten the line in my other hand, and they started giving me fluids and steroids in the form of Solu-Medrol. My hives had mostly stopped itching, and my tongue and lips were definitely smaller albeit still swollen. We got on the road, and they took me to NYU Langone (whew, that's where I wanted to go) and took me into the ER. We bantered on the way in. There was a brief moment of confusion when the woman ahead of me in triage turned out to have a last name that was the first two syllables of my last name, and we all had a slightly hysterical laugh. "So, any tips for me for next ride on how to be a better bus passenger?"
Strong laughed. "Nah, you did great, if they were all like you, shift would be a cakewalk."
"Well, 5 out of 5 stars, would call again, do you guys prefer Yelp or Google reviews?"
My wife had texted me telling me she was on the way, and by the time they got me into an ER bay, she arrived. I felt terrible; on my way to the restaurant she had texted to tell me our cat had thrown up hairballs (not abnormal) but there was a quantity of bright red blood next to the vomit (definitely abnormal) and the vet had said 'yes, bring her in.'
"Hon, did you take Stella in?"
"No, you idiot," she said. "Stella's fine for now, when I offered her more food she ate it right up, so she'll be fine until we deal with this. She doesn't seem to be in any distress, and they said the blood could be from the chin infection and bleeding we're treating her for, she could have cracked a scab while heaving, and that's why it's not mixed in."
"Oh."
Anyway, not much else to report. I was there the requisite four hours, during which they gave me more Solu-Medrol, famotidine (Pepcid) and Benadryl - all intravenously via the line put in by the ambulance crew. The Benadryl whacked me out immediately, I went into a gray haze and my wife told me later my lips and face went pretty gray, but they had my wired up completely and my pulse and BP didn't really drop much, so they said it was the normal Benadryl drowsy multiplied four or five times by dose and IV administration.
The doctor showed back up exactly four hours later and checked me out and said "Okay, let's get you out of here. I've sent a scrip for an EpiPen and some Prednisone to your pharmacy, take the latter for four days and avoid exertion." So I guess I'm not doing The Great Saunter on Saturday :-(
So now I guess I need to exercise consumer therapy and find myself a really cool murse or other small bag I can keep Benadryl and an EpiPen in, since it's clear I can't rely on my backpack being next to me. Maybe I can find a geek bandolier...