December 10 – Wisdom. What was the wisest decision you made this year, and how did it play out?
Is there some law that says that these prompts will become more and more challenging as the days progress?
Some might consider this a cop-out of a response because it seems like a rather easy decision to make in the grand scheme of things, but here goes…
One September afternoon, clad in sweatpants, I was watching television when I reached down to scratch something on my leg. To my horror, I noticed an odd, spotty rash covering both of my legs to my knees. It was a tad frightening, but I didn’t think much of it because I was also suffering from a horrendous cold. Cold viruses can precipitate rashes. And besides a cold and a rash, I felt just fine.
Fast-forward a week.
Now things are getting serious and this rash has started migrating up my legs to my torso. The spots are bigger, too. They look like chicken pox marks, but they don’t itch and are relatively uniform in size. They also appear to be under my skin. I visit my primary care physician whose puzzled look is all I need to know that something out of the ordinary is taking place. The dermatologist I see is less puzzled, but his interest is definitely piqued. I get a visit from two residents since I am now definitely out of the ordinary. After a skin biopsy, I am diagnosed with Henoch-Schonlein Purpura or HSP. A vasculitis of the skin that is usually found in the pediatric population! No one is exactly sure of it’s etiology, but it seems that the cold virus caused my immune system to run amuk – it started attacking me! The tiny blood vessels of my skin were under fire.
So this is good, right? We’ve figured out the mystery and a little course of steroids ought to clear that rash right up.
This is all true, except for the fact that where one finds HSP, one also tends to find kidney trouble. I add a nephrologist to my health care team who looks at my blood and urine samples and recommends a kidney biopsy. The skin biopsy was easy enough – a little pinch and done. The kidney, however, is one of those pesky, internal organs! Only reachable via ultrasound and a very long needle. Suddenly, I’ve gone from a healthy 25 year old who cares for patients to a 25 year old patient. And one who faces the possibility of renal disease and/or failure.
The wisest decision I made this year? It would be the one where I decided to have a kidney biopsy. I could have chosen to continue on the steroids and have my nephrologist follow my condition through regular blood and urine tests, but the biopsy is the gold-standard test. The only way to see what is going on inside my kidneys and get a definitive diagnosis. It also means undergoing a relatively painful procedure and an overnight stay in the hospital to monitor for post-procedure bleeding.
One would think it natural to make the choice to have such a seemingly necessary medical test, right? I worried, though, about how my new illness wold effect my ability to finish my nursing program. I was just starting my final semester and dreaded the thought of not being able to graduate in December. Clinical rotations are very difficult to make up once missed. What if the biopsy showed something terrible and I required more complicated treatment like dialysis. What if I needed a transplant? What if the medications I had been prescribed had unbearable side effects?
I reasoned, though, that my health was far more valuable than my education. I will say that a kidney biopsy is something to be avoided if at all possible. It is very unpleasant to have to lie on one’s back for 6 continuous hours. It is also unpleasant when you feel ask if a mule has kicked you in the lower back for several days. It is wonderful, however, when the biopsy reveals that, aside from inflammation (that the medical community likes to refer to as IgA Nephropathy), your kidneys are a-ok and probably going to make it for another 20 years. I’ve developed a pretty close relationship with my nephrologist and I take a veritable pharmacopia of pills each day to keep my organs happy, but I would say I made a wise decision, indeed. I even get to graduate on time!