The big, ugly 'R' word!

Hello readers, It's been a minute, and in that minute I've had quite a ride.

Getting back to work has been good for me, I felt like I was back on route; my days busy, my routine reestablished and my passion reignited.

I rejoined my colleagues in the Family Medicine rotation, a rotation spent at the clinics dealing with day to day illnesses and ailments, as well as some rare and more complicated cases. Our calls are done in Casualty/ER/Trauma/Emergencies - whatever you'd prefer to call it.

On my very first day back I was on call - this means a 28-hour shift. To say I was nervous would be putting it lightly. Almost all doctors get pre-call jitters. Calls are so unpredictable and can be tremendously demanding, so it's absolutely normal to feel somewhat apprehensive before one. Well, combine that with being off work for 3.5 months, recovering from an AI disease and burnout and you've got yourself a nervous wreck - ie Me.

To say the call was intense would be a magnificent understatement. The day was spent in the polyclinic and from 4-pm I started in Casualty. There was a huge overflow of patients that hadn't been seen in the clinic and were sent to Casualty to be seen there. We triaged/sorted through those patients and sent most of them home, explaining we were only handling emergencies. Next, a multi minibus pile up happened and the Casualty was swamped with MVAs (Motor Vehicle Accident patients). We began attending to these patients and clearing the queue. A patient then arrived who had been bleeding and had almost bled out completely, as white as a sheet and barely conscious we managed to stabilize her and called an ambulance to take her to the hospital I'm normally based at. Soon after a patient was brought in who had been shot through the chest and spinal cord - the same process of stabilization and referral happened. Right after that, a patient who had had a massive stroke was brought in, intubated(tubed for ventilation) and needed to be bagged (breathed for with a bag) whilst waiting for an ambulance to arrive. We waited and waited but no ambulance arrived, so we grabbed a less advanced ambulance service who was dropping off another patient and begged them to let us accompany the patient to the hospital, which they did. I arrived back to a seizing child, asthma attacks, stab wounds, assaults, burns, who were all seen to. A child who was barely conscious was then brought in during the early hours of the morning, despite our best efforts, we couldn't save their life.It broke my heart into pieces and hurt even more when I had to tell the parents that their baby was gone.

In casualty, there is no time to process what you are experiencing or dwell on what has happened. Soon after that, a 4 month breech stillborn was delivered and the mom was sent to the hospital for high blood pressure. 5 major resuscitations in a clinic Casualty that only has the basics, such as fluids and medication. It was the most intense call I have ever done, and it wasn't only me that felt that way, the nurses and senior doctor that worked with me agreed.

Despite it being indescribably demanding, physically, mentally and emotionally, I felt alive. There wasn't even one point when I felt like I needed to rest, I had endless energy and a passion burning so deep that I didn't want to stop. I remember thinking to myself, "So this is what it is meant to feel like, this is how it feels to work whilst being healthy. This is magical! Finally, this is who I am meant to be!"

A few days later I picked up the flu that had been circulating. What I like to call "Death Flu". It knocked me down for almost 3 weeks, I just couldn't seem to recover from it. I kept working and pushing myself through it, but never really felt like I had recovered. Last week I noticed my energy levels were depleted, I had a mouth ulcer and felt completely off, but I put it all down to the flu. My body was giving me signs but unfortunately, I was not listening.

Last Saturday, the pain started. A pain I know all too well, but still, I did not listen and brushed it off for being a bout of gastritis. On Sunday I felt terrible, I took a PPI (treatment for Gastritis/stomach ulcers) but felt no relief. The stomach pain worsened and became more and more familiar - it felt like Pancreatitis. I was hunched over, unable to do almost anything without writhing in pain. Eventually, I messaged my Prof (My Rheumatologist), and he called me immediately. After asking what I was feeling, he decided then and there to admit me.

I couldn't believe this was happening, I hoped so desperately that this was unrelated to the Wegners and was maybe still gastritis or even a flare of the Pancreatitis, but please let it not be due to my disease.

The first set of blood tests were promising, my C-ANCA was still negative, my IL6 was lower than ever, pointing towards this episode being unrelated to the Wegners. A Gastroenterologist took over my management, calling it "Acute Abdominal Syndrome". I had an ultrasound, MRCP (MRI of the pancreas), gastroscope, an endless list of blood and urine tests, but alas, no overtly obvious cause could be found. I was kept on clear fluids, not allowed any food and managed with strong pain medication. And then, a blood marker came back low - C3.

Complement C3 is a protein that plays an important role in the immune system. It forms part of the complement system, which produces inflammation to protect the body from foreign materials, infections and dead cells. In Autoimmune diseases, owing to the chronic inflammation, C3 is constantly being used up, and because of this massive consumption from the continuous inflammation, the levels drop.

I was lying in my hospital bed, reading through my results (bad patient I know, but hey at least I can interpret it all), when I noticed the low C3. I sent a picture of it to Prof and he called me back immediately. "Cayla, I saw these results earlier and it is definitely an indicator that you are having a flare. It is strange that the rest of your markers are normal but I've learnt with you that the weird and wonderful happens and so we will take this as a flare". I was absolutely devastated. All of my hard work and dedication to getting myself into remission has unravelled, and it has all happened so soon.

Thinking back, I started to blame myself. I have been a bit relaxed on the diet, I haven't been putting in the time to do the self-work as much, I haven't been taking things slowly at work, I've been pushing myself a bit... This is my fault, I'm to blame.

It has taken a lot of reflection and self-love to realise that IT IS NOT MY FAULT. Yes, there is always going to be something you could have done better, you could always have been a little more dedicated or healthy or less stressed...

However, life happens, and nothing is ever perfect. Most importantly, these diseases are unpredictable and OUT OF YOUR CONTROL, no matter how well you follow your protocol or how committed you are to your health, AI diseases can and do relapse and surprise you. You cannot turn on yourself and beat yourself up about it, that way you let it win. What you should do is pick yourself up, dust yourself off, and start fighting all over again. Remember, you survived it! Each relapse will allow you to understand your disease a little bit better, you'll begin to know yourself a little more, and it will make you so much stronger and provide the skills you need to fight even harder. IT IS NEVER YOUR FAULT.

So as I sit here now, in this bed, no one really has a cooking clue what is wrong with me currently. Yes, it's scary to know that even the best team sometimes doesn't have the answer. Prof believes it may be Pancreatitis again that isn't presenting how it usually would, the gastroenterologist believes it's Vasculitis of my bowel vessels. To differentiate, an excessively expensive test would need to be done and it wouldn't change the management, so it isn't really worth it. All I know is that it hurts like hell and I feel horrendous, but I will get up again, stronger than ever, and I will kick this in its butt all over again.

Never stop fighting! No matter what!

Have a healthy and happy weekend.

Sending love,

Cayla

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