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A man’s life turned upside down by pneumonia and Stevens-Johnson Syndrome

Jenna Podjasek, MD
Conditions
April 14, 2023
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An excerpt from Particles in the Air.

As he sat in the empty waiting room several hours later, Forest couldn’t recall how he made it through the remainder of the morning. He had never felt so terrible in his life, even as a child. His chest and ribs were exceptionally sore from three days of near-constant coughing.

I’ve worked too hard on this opening to be sick now. I just need antibiotics and a good night’s sleep. I’ll be fine by tomorrow.

He glanced at the clock, eager to get back to the office. He would have to skip lunch. That was fine. He didn’t have much of an appetite anyway. His tongue and mouth felt as if they were on fire, as if he had gulped a full cup of hot tea.

“Forest?” a young woman in scrubs called from the doorway.

Forest nodded. He stood and silently followed her to an exam room, coughing into his elbow.

He noted her slight, almost imperceptible frown as she took his vitals. He remained quiet, swallowing small sips of water from his smart hydration bottle, afraid speaking would trigger more uncontrollable coughing.

Dr. Reddy entered the room moments later, awkwardly pushing a cart with a computer. His forehead wrinkled and the corners of his mouth turned down as he stared at the screen. He looked to be well past retirement age, small and stooped, with a bald pate as shiny as a polished bowling ball. White tufts of hair sprouted from the sides of his head, reminding

Forest of a baby bird.

He closed the door behind him and looked straight at Forest, not saying anything for a moment.

“What brings you in today?” he finally asked, not breaking eye contact.

“I’ve had this annoying cough and fever for a few days. It seems to be getting worse. This morning, my mouth and lips began to hurt, and my eyes feel gritty.”

He shifted uncomfortably on the exam table.

“Anything else?” the doctor asked.

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“Well, this is kind of embarrassing, but my skin is irritated and painful, umm, down below. It hurts to pee.” Forest shrugged.

“There is nothing I haven’t seen before,” he said simply. “No need to be embarrassed. How high was your fever?” he asked.

“It was around 102 this morning.” Forest turned to cough into his elbow.

“Any sick contacts?” Dr. Reddy’s gaze had returned to the screen. His voice was dry, professional.

“Not that I know of. But there is something going around the office. There were a number of people who called in sick today.”

“It says here that you don’t take any medications. What about herbal supplements, vitamins, anything over the counter?”

“When I remember, I take a multivitamin. No herbal supplements.”

“Any recent travels outside the country?” Dr. Reddy eyed the computer with mistrust as he pulled it closer. He pecked at the keys with one finger, looking up to the screen and back to the keypad with each letter.

“No, I live in LA. I’m here on business, but I haven’t been out of the country in at least a year.”

“Hmm.” The doctor stood slowly, his knees cracking. “Let’s take a look at you,” he said as he washed his hands.

Dr. Reddy was silent as he examined Forest. After listening to his heart and lungs, he took his time examining his eyes, throat, and genitalia with a penlight.

Finally, he sat back on his stool. He looked at Forest with a serious expression, his eyebrows pushed down into two fuzzy punctuation marks.

“We need to admit you to the hospital right away,” he said without preamble.

“But—”

The doctor held up a hand. “Let me explain. First, you have signs and symptoms of community-acquired pneumonia. There are extensive crackles throughout your lungs and your oxygenation saturation is below normal. Your temperature is currently 101.5. This alone would be enough to send you to the hospital for IV antibiotics.” He looked at Forest sternly.

Forest remained silent as panic and desperation seized him. He had put everything he had into this project; he had a million things to do before the grand opening tomorrow. He couldn’t miss it.

“Second, on examination, you demonstrate classic signs of a rare type of secondary response, probably due to the infection, evidenced by distinctive erosions and ulcers on your mucosal membranes—eyes, mouth, and genital area. This is called Stevens-Johnson Syndrome and it’s something we take very seriously. SJS is classically triggered by medications but, in your case, I suspect it’s from infection with a specific type of bacteria called mycoplasma pneumoniae.”

Forest opened his mouth to protest but closed it again as the gravity of the situation washed over him. He felt the first stirrings of fear as he studied the doctor’s solemn expression. Suddenly, he wanted to sleep. He wanted it more than he had ever wanted anything before.

“All right,” he said.

Dr. Reddy rolled his stool toward the door. He opened it without rising and called into the hallway, “Katie, please place Forest on four liters of oxygen and recheck his pulse oximetry.”

He turned back to his computer as he continued to speak. “We need to directly admit him to the hospital. Please have reception call an ambulance, and then contact Northwestern to give them a heads-up. I’ll put in an admission note.” Peck. Peck. Peck.

Forest cautiously lowered himself back on the table, the white paper cover bunching and tearing. His lower legs hung uncomfortably over the side. He stared at a small brown stain on the tile ceiling. Katie entered and wordlessly placed him on oxygen, looping the tubing behind each ear.

How did I get here? I was absolutely fine a few days ago. Running four miles and doing strength training every single day. In the best shape of my life. Now, I feel like … like I’m dying.

Jenna Podjasek is an allergy-immunology physician and author of Particles in the Air. Stay connected by following her on Twitter @JennaPodjasek and Instagram at @JennaPodjasekauthor, where she shares her inspirations, sneak peeks, and glimpses into her life beyond the pages.

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