It wasn’t one of the vipers we knew, we know where many of them live, and see them. In general they avoid you, and usually will not even bite unless provoked, like picked up or stepped on. We don’t do that…
We just came up from the lake, Sanna was walking and nursing Marlowe (5 days old) in the garden, on a mowed lawn, right behind her dad, the thing wormed out and maybe thought her big toe was a little mouse? it bit and she kicked and it stuck til she kicked it off into the weeds.
Then she came inside to say, hey you need to take Marlowe, I got bit by a viper. we got out the prednisone and called 112, but they said not to administer the steroid (though they should have recommended to do so) and said the ambulance would give cortisone.
The ambulance drivers got there and joked a bit and didn’t seem to take it seriously at all– admittedly, most bites are relatively benign, like wasps, but they made her walk to the ambulance, and sit, with leg not raised…! The ambulance promptly got a flat tire. They had no spare, so they called a new ambulance. we beat them to the hospital. They forgot to administer cortisone. Sanna’s stomach starts to ache in the ambulance, the drivers say “it’s probably just nerves.”
Then in the emergency room, Sanna’s foot is huge and blue, started to go up the leg… it hurts a lot lot lot. Her stomach is hurting.
An hour later the young studly doctor comes by, and needs to call the poison information center in Stockholm to figure out what to do. His worry seems to be that any breastfeeding might be compromised by meds…? Ok, here’s basic triage: who is sick and who isn’t. The baby is not sick. Can the baby live without breastfeeding? Yes, in fact, we’ve been making fake breast milk available in grocery stores for quite a while. So, this indicates actually treating the patient, instead of worrying about that.
Here’s basic poison bite treatment for those of you who didn’t grow up near rattlesnakes: 1) steroid or anti-inflammatory, 2) antihistamine/epinephrine, 3) antivenin. OK, usually antivenin isn’t indicated unless the patient is acute. (plus it’s fucking expensive.) But it is recommended as early as possible. I would think especially so for a woman who gave birth days ago and is down a few pints of blood.
So into the next hour, still no meds. I’m getting angry. Sanna is going into anaphylactic shock, her blood pressure is dropping. She starts to cramp. I’m looking for a nurse, none around. The BP/HR monitor is beeping as the BP is now 80/50, she starts vomiting. I collect a half liter of vomit and eventually hand it to a nurse and point to the BP/HR monitor which is beeping madly. Hey, guys, anaphylaxis indicates the full treatment regimen!
Dr. Victor Mill comes back and measures the swelling, and leaves to call somebody again. No treatment.
4 hours after the bite, a nurse finally comes in to administer cortisone and pain meds. I am livid, and ask her why on earth they have waited so long for this and she snaps at me that she is just doing what she is told! So we realize that despite a preponderance of Vipera Berus in the area, in fact all over Europe, these people have no clue about what to do about even a bee sting.
Sanna is moved to a ward room. We get a new nurse, a competent one, Lena, who is trying to assess what the hell is going on here. Dr Mill comes by and I can’t stand it so I say, Victor, what the hell are you thinking? Didn’t they teach you basic triage in med school? Don’t wait on treatment for those you can help. Plus, the normal regimen, check it out! come on! Her leg is black and blue and swelling to the knee now.
Nurse Lena is like, what? This woman needs a damn breast pump immediately, she’s a nursing mother! Milk production would stop! What meds have you had? No antihistamine? We’re moving her to ICU immediately. I can hear her chewing out the doctor a little after this, then in the elevator she says to me, “Sorry I’m not talking to you about what’s happening, I’m trying to get it done.” Excellent person. The chewing out the doctor scene reminds me a little of Nurse Jackie.
In the ICU, they hook her up with oxygen and add Ketagon to the drip. Way better pain relief, plus it won’t transfer to breast milk. Eventually she seems to be in good hands so we get to drive back to Grecksnäs, about 35 minutes. I see Dr Mill on the way out at about 2am, on the phone, who says he’s getting the ViperaTAb* sent from the Örebro hospital by taxi. I’m carrying Marlowe so I just look at him and we go. Marlowe sleeps all the way home, but I know she’s gonna wake up. When we get home I stay up till 3:30, but she sleeps till 5 when I need to get up and heat some fake breast milk. First night as a single dad! shit. I don’t know how a person could do this alone. Sleep again till 9.
The next day, Sanna appears a bit better so they move her back to the regular ward, and we get a decent doctor. Her leg, however, is still painful and swelling, the black and blue is moving past her knee. They are starting to measure the circumference of the leg regularly, the idea is that if it is 5cm larger than the other leg, then it’s definitely indicated to take the antivenin. One calf is 33cm, the bit one is 37. The thigh is 43, bit one is 47 and rising. They have these ballpoint pen marks on her leg to show where the swelling is/was and where to measure… they never actually cleaned the wound itself, now that I think about it…?
A new doctor every day, today is Dr Danica Poparos, a very nice young Croatian woman. She seems completely on top of it, and is horrified to hear the story of the previous day. She takes initiative and calls the Poison Information Center (http://www.giftinformation.se/) in Stockholm and talks to the snake expert, Christine Karlsson-Stiber. She starts to get some actual information from them about the process of a Viper bite and the treatment, and whether any envenoming affects breastmilk, or if would contain some histaminic reactive chemicals. So Marlowe gets a proper breast feeding after 7pm (24 hours after the bite), which hopefully allows milk production to start again. Of course the milk Sanna pumped was never taken care of anyway, they didn’t refrigerate it. So Marlowe gets another night with papa feeding her the fake milk. She’s pretty good about it, though the “newborn use nipple” bottle delivers a lot of milk! She eats 50ml, waits, then eats more, first at 3am, then at 7am, when Sanna’s dad is awake, so he takes her after and I get to sleep till noon! Sanna actually gets some sleep too, morphine-assisted.
Next day is Saturday, Marlowe is one week old today. Sanna’s leg is completely black and blue, the thigh is now 48cm. Rather than continuing to try to leave and come back every day, they offer to get me a bed in the room so Marlowe and I can stay and Sanna can feed her. I actually learned this on the way to the hospital, so we aren’t really prepared, but whatever.
Every day we have to explain what’s going on again, it seems the charts are incomplete and Dr Poparos is writing a complete chart. Some days the nurses and orderlies are ok, some days not so. For example, the nurse says to Sanna to mobilize and try to walk on the leg, but when she gets the foot below heart level, not only does it hurt like hell but then it swells more and the swelling spreads, and the bruising. Sanna asks what the reasoning is behind moving but the nurse doesn’t know. Sanna asks, is that good enough for you not to know but to simply recommend something that is apparently causing more problems? She hums a bit, well, the bed is the patient’s worst enemy, la la la… Sanna says, until I hear a good reasoning behind this, forget it.
I’ve been scouring resources to find out everything I can about viper venom and treatment. It’s actually all there, on the internet! The Poison center has the diagnostic and treatment steps on their website, and there are of course numerous papers written on it all over the place. Of course mobilization is contraindicated until after the swelling!
The new Doctor comes in later, another Aryan stud. He hears the full story so far, measures the leg and immediately says, it’s 5cm bigger so we will treat with ViperaTAb. Alrighty, then! We ask if he knows of possible side effects, he says we should put it into perspective of losing a leg! The nurse come in for the injection setup. A little bit later they come back and say they can’t find it. They fucking lost the antivenin. (This stuff is apparently like $2000 a dose! No wonder they seemed hesitant to administer, maybe it’s only for special people.) The doctor come back and says, so we can’t find the antivenin, but it’s ok it’ll get better anyway! Don’t worry about losing your leg! Ha ha! That’s bedside manner for ya.
My little bed is a set of slats that occasionally fall through and drop me on the floor. We’ve been asking to see the head doctor for a few days now. On Sunday we finally get to, but only after Sanna’s parents raise hell in person, …and just as Marlowe needs changing, and of course when I try to do this quickly, my bed breaks and I fall through to the floor, which is probably very illustrative for the doctors. Once again we explain every thing that has happened so far and wonder why they are so clueless about actually treating the situation. Strangely the head doctor is another Croatian lady, she seems slightly defensive of her hospital of course, but the evidence is there. She claims she’s gonna get things done, and schedules and ultrasound on Sanna’s leg to look for blood clots. And again orders the ViperaTAb, delivered from the hospital in Örebro.
The ultrasound is inconclusive, as the guy can’t see the arterial flow below the calf. He wants to do it again later. They kicked me out of the room for the ultrasound, which was uncool as Marlowe peed all over me and the diapers were on Sanna’s bed. The she screamed for a long time in the hallway of the X-ray lab, that must have been fun for people. I get really freaked out when she screams and I can’t do anything, the ineffectiveness of being the father and not the mother. Combined with the fact that I’m desperately trying to understand what people are saying around me in Swedish which I don’t know very well, and I starting to get dizzy myself.
We get back to the normal ward and they are moving our room to where they can actually fit two hospital beds so I can actually have a real bed, which is super cool. (But sadly a crappy TV in this room, and no bathroom, which is super tough for Sanna who can’t walk!) Parents come and bring some food from the grocery store which is awesome, as hospital food seems to be a universally hideous proposition. A fairly smooth night, thank god, with feeding, and sleeping on all parts. The leg, however, has now passed the 72-hour mark, which is supposed to be the culminating point of the envenomation. Still swollen and Sanna’s stomach hurts a bit in the night, in fact the leg hurts a bunch because they forgot to administer pain meeds the entire day! Duh.
I have to say, there is a vast difference in the attitudes of medical personnel, especially younger doctors. Some people are interested in anatomy and physiology and their actual profession and some apparently are not. Some of the nurses even seem to be factory-worker bored, and your call inconveniences them. Others are awesome. I worry that people become doctors without thinking, I want my doctors to be people full of interest and wonder about the human body in all its myriad weirdnesses, its biochemistry and biomechanics. I don’t like seeing any medical folks who aren’t, clearly. Some of the nurses and interns on the ward are ‘just following orders’ and others are pretty awesome. I love the awesome folks. Interested people are interesting.
We wake up and the head doctor comes in with the Aryan dude and another doctor whom we saw in the ICU (strangely again while I am changing Marlowe…?) They are saying the leg is starting to unswell, and Sanna is going to be fine eventually.. Still another night of observation?
The parents have been on the phone with the snake lady from the poison info center who confirms that the proper treatment would have prevented a lot of this, but it’s pretty much too late now. She’ll get better on her own. Like a pioneer lady! Giving birth amid poisonous snakes!
I should note that the other hospital we were at last week, in Karlskoga, where we delivered the baby, was excellent. Their midwives are known all over Sweden, and all the people that worked there seemed pretty great!
“My wife got bitten by a viper and all I got is a barfed on t-shirt”
*ViperTAb is a specific antibody to the proteins in viper berus venom, apparently the process for making the antibody is owned by a US company, licensed to a Pharmaceutical Corp in the UK called Protherics, and distributed in Sweden by the unfortunately named Swedish Orphan Co.