So Tired
April 28, 2002
The sun had not started peeking over the rimrock of Billings, Montana as I opened my eyes and looked at the clock. 4:30am. OK, time to get up and meet Andrea for our morning walk. I rolled out of bed on the opposite side of where I had slept because it was empty. Rick, my husband, had gone to see his brother and mother; he would be gone at least another week. Fighting the fatigue that had plagued me for the last couple weeks I got in the shower and hoped the warm water would help me perk up a bit. I walked 2 miles every morning; that must be the reason I have been so tired.
Andrea and I were nurses, I at an insurance company, she on the oncology floor at one of the local hospitals. We had met while working at an urgent care clinic and become friends. She had left the urgent care clinic in favor of better pay and benefits at the hospital and I had left shortly thereafter for the better pay and new experience of being a utilization review nurse at an insurance company. Both positions afforded new experiences for us and we spoke frequently about the challenges these changes brought us. Now Andrea was attending school full-time plus, working two 12-hour shifts on the weekend plus she had a family. My own situation was bad enough, one of the nurses I had worked with quit her job to get married and I had taken on her entire case load which stretched my workdays to 12 hours five days a week, plus I had also gone back to college full-time to continue working on a degree in social work. But just now this exhaustion was getting the better of me. I now had a new appreciation for the term 'fatigue'.
Stepping carefully from the shower I wrapped a bath sheet around me and went looking for clothes to wear to work. I selected a loose, comfortable dress, slipped it on, and then pulled on white cotton socks with my tennis shoes. I toweled my hair, combed it, brushed my teeth and walked to the kitchen. My three goldfish were hovering at the top edge of the aquarium waiting for breakfast. I fed them, grabbed a protein bar from the fridge, and got my purse. Carrying some black shoes I left the mobile home, locking the door on my way out. 5:15am, hmm, pretty good; I meet Andrea every morning at 5:30 for our walk.
Daylight was now streaking the sky over Billings but the sun was not yet high enough to be a nuisance yet. I drove to Andrea's house in the Olympic Park subdivision; that was one of those new subdivisions on Billings 'west end'. There was supposedly 10 miles of sidewalks in Olympic Park and we were taking advantage of them. There were also many small parks in the subdivision where we could see rabbits and birds during our walks and they added to the enjoyment. As I pulled the car to the curb in front of the house I noticed that my friend had been planting some more flowers the night before; soon her flowerbeds were going to be alive with all kinds of glorious colors. I admired them as I waited for her to come out the front door, I didn't have long to wait before she came to the front porch with a Diet Coke in one hand and her walking shoes in the other. 'Nice outfit', she giggled, looking at my dress and tennis shoes.
'Oh well, I guess that's what I get for taking a desk job. Not like some people I know who hang with the school kids all day and get to wear jeans and sweats' I teased.
'I think I'll stick with being Nurse Ratchett in the hospital,' she said.
We began walking, I was breathing pretty hard before we had gone our first block, and Andrea gave me a concerned look. We approached a park bench and I dropped wearily onto it. 'I think I better cut it short today,' I told her.
'Oh yeah, you better!' She replied, 'Have you made an appointment to see a doctor yet?'
'No,' I told her 'I think it is just the weather or maybe seasonal allergies, I really don't think there is anything major going on.'
She stood up and turned to face me, I got the full benefit of her best Nurse Ratchett look. 'You listen to ME missy,' she was shaking her finger at me and I had the feeling I better pay close attention even if I was several years her senior 'You will call TODAY and make an appointment to get this checked out something is going on and we really need to know what it is.'
Yeah, okay, I knew she really meant business. I knew her well enough to know that if I didn't address this myself she would be calling and making that appointment for me. There were enough local physicians that knew both of us that we could and sometimes did pull rank on each other. We got up from the bench and completed the walk to her house at a leisurely pace. I was panting so hard when we arrived that she went inside to get one of her albuterol inhalers and insisted I take two hits off of it. We sat on the front step until she was satisfied that my breathing had returned to normal then we said goodbye and I got back in the car.
The morning traffic had started to build up when I pulled onto King Avenue to make my way to work but it was still early enough there wasn't too much. I stopped at a coffee shop to get my morning cup of coffee and Louie; the young man who worked there every morning called out, 'Half a cup of decaf?' I nodded yes. He got a tall cup and filled it halfway with decaf as we joked about my shoes not quite matching my dress. I paid for the coffee then went to the condiment bar where I added half and half then filled my cup the rest of the way with Dancing Goats coffee from the refill jug on the bar. Louie waved at me on my way out the door. I liked Louie, he reminded me of the Shaggy character on the Scooby-Doo comic. Probably a starving college kid, but I was always there during a busy time of day so I guess I'll never know.
I pulled into the parking lot at work and opened the car door. Setting my work shoes on the ground outside the door I slipped off my tennis shoes then pulled off my socks; swinging my legs around I slipped my feet into the shoes on the ground, reached behind me to pick up my coffee and my purse, then heaved myself to my feet. A sudden wave of dizziness swept over me and I dropped back into the car seat. Panting for air, everything seemed to spin before my eyes and I set the coffee back down before I dropped it and spilled it all over the car and me. My breathing slowed after a few minutes and the world quit spinning, I felt less like a rag doll. Once again I attempted to exit the car and this time I was successful. As I walked across the parking lot two of the resident ducks appeared, I watched them waddling along, quietly quacking to one another in a conversational manner, quite oblivious to the presence of humans and seemingly at peace with the world. They reminded me of two elderly gentlemen going to have morning coffee. I couldn't help but wonder what was going on in the duck world that had generated that much gossip.
Later in the day I called a physician referral service and got names and phone numbers of several doctors who were taking new patients. From the list of names and short biographical sketches provided by the referral service I picked a 33-year-old doctor who worked in a clinic located between my house and office. 33 was young enough to still be open to new techniques and discoveries; young enough that maybe I wouldn't outlive him. I figured if I liked him that it would be convenient for Rick to start seeing the same doctor. I got on the phone and actually made an appointment for two days later. In the past I had seen Andrea take the wind out of a 250-pound drunk; I was not going to cross her, even if I was still bigger than her.
Doctor # 1
I usually try to avoid mentioning the fact I am a nurse when I am on the receiving end of health care. Sometimes, however, a doctor actually reads the forms I fill out as a new patient and notices this fact.
'So, Gayla, I see you are a nurse.' Said young Dr Anderson.
'Yes,' I replied.
'And what brings you in today?'
'I am extremely fatigued and I get short of breath with minimal exertion. I have also been having trouble with my balance and a lot of nausea.'
He looked over my 250-pound figure knowingly and said, 'So, do you ever exercise?'
I told him that for the past two months I had been walking two miles every morning but this problem had started about three weeks ago and seemed to be getting worse.
He looked in my ears, down my throat, into my eyes and listened to my heart and lungs. Then I lay back on the table for him to palpate my abdomen. It seemed that all was in order. 'I think you just have a virus. You should start to feel better within 10 days, it seems to be going around, I have seen a lot of this in the last couple weeks.'
That afternoon at work I took my computer keyboard off the slide-out tray it was on and put it on my desk so I could prop my elbows on the desk. I was entirely too tired to lift my arms.
Annette, my manager, came around that afternoon to consult on a case. 'Are you all right? You look awfully pale.'
'Oh sure, Dr Anderson said I just have a virus of some kind and I will be better in about 10 days.'
'Well, go home early if you need, you look like you feel really bad.'
'Just tired,' I assured her.
I worked until 5pm then got in the car and headed for Montana State University Billings for my night class. Last semester I had taken four night classes and got 12 credit hours, this semester I had to take an arts credit that was two nights a week so I had to take pottery, (the only art class that was available at night) and two healthcare administration classes on campus plus an internet psychology class. Six weeks into this pottery class we were just starting to make bowls.
The instructor must have had a difficult time relating to people; he took clay very seriously. He had taken weeks to 'introduce' us to our clay. I had been the object of much amusement at work as everybody asked how the pottery class was going. 'Oh, tonight we get to meet our clay.' 'Does that mean you are going to MAKE something?' 'Oh, no, that would mean that we would have to TOUCH the clay. We aren't that far yet.' Peals of laughter would follow those exchanges. We watched weeks of film on the history of pottery. We learned about types of pottery. We saw how the kiln worked. We saw how to mix glazes. Finally, after 5 weeks we got to 'engage' our clay. (That means we actually got to touch it!) Now we were making bowls. We had to make 4 bowls apiece. I wearily worked and worked on my fourth bowl. They each had to be different but all of them had to have a 'foot' of some kind; unique wasn't in me tonight. I was so tired I could hardly hold my head up. Several other students were going to come in Saturday morning and finish up so I decided to join them.
On the way home I picked up a burger and fries at Burger King and went home. Bone tired again. 10 pm, home, feed fish, bed.
Next morning on my way out to the car I suddenly found myself on the ground. Hmm. I didn't remember falling, but here I am on the ground. Get up, get in car, and go to work.
10 days later
'Well, what brings you in today?' Asks Dr Anderson pleasantly. He had greeted Rick, who had returned from visiting his family.
'I seem to be getting more fatigued and the shortness of breath appears to be getting worse. I am more clumsy than usual; I have fallen a few times. Now my friend, Andrea won't let me walk with her in the mornings because she checked my pulse and found it was 132 and irregular. She said something about not having the energy to do CPR at 5:45am.'
'Hmm,' he said, trying to look like he was thinking. 'Maybe we need to put you on an inhaler to loosen things up a bit and that might make you feel better while all the spring allergens are out. I'll bet that when things quit blooming you will be better.'
'I'm willing to try, but don't you think some blood tests or maybe a chest x-ray would be a good idea?' I was tired, I was exhausted, this had been going on too long and I really wanted to get on with my life. I wanted an answer.
'Oh no, insurance companies don't want to pay for things like that until conservative measures have been tried. There are no indication for anything like that.' He smiled and handed me a prescription for an inhaler and an allergy medication.
Rick and I stopped for lunch at a sandwich shop before he took me back to work. As we sat in the car and ate buffalo salami submarine sandwiches we discussed the doctor visit. I was quite upset that Dr Anderson didn't seem to take my problem seriously. Rick didn't really offer an opinion. I gave him my prescriptions to fill after he dropped me off then he returned me to work.
