Josie's Journey

The Dreaded "Tilt Table Test"

"I really hope she doesn't have something debilitating," Elaine said. "Will it make her uncomfortable? I would hate to have to do all this testing for nothing."

"I can assure you that the testing won't be unnecessary," the doctor said kindly. "It may not be completely comfortable for her, but she's a strong girl. We're running blood tests at the moment as well, and the results should be back once the physical testing is finished."

The doctor stepped out of the room to call in the technicians. Josie's mother came over to her. "Hey, sweetie. They're going to run some tests to make sure you're okay," she explained as the technician wheeled out Josie's bed. Josie just nodded weakly.

The doctor and techs moved the bed to the elevator and pressed the button for the third floor. They took her into a large room with an ultrasound machine, which connected to another room containing a table covered in straps and wires. Josie glanced over to it and felt her anxiety rise - it looked like a medieval torture device! She closed her eyes as the cardiologist technician started an echocardiogram, the cold jelly giving her goosebumps. They checked her heart with the monitor and ultrasound, then pressed a button to send the video of the testing to the main cardiology department. Then they connected several leads to her chest to run an EKG, which checked the rhythm of her heart.

Then came the dreaded "tilt table test" - so that's what that freaky table was for. She was laid down on the table, strapped on, and had more leads connected to her. They set up the continuous blood pressure monitor and the arm cuff blood pressure monitor, then started an IV. Once they saw that everything was ready, they tilted the table to a slightly upright position. They waited for a while - Josie thought it was about twenty to forty minutes - then took another test, then another, going on seemingly forever. Her blood pressure was quickly dropping as they kept her upright, and her pulse rose to compensate. Ten minutes later, her blood pressure had dropped low enough that she passed out on the table, but a few minutes later she came to. When she did, she felt horrible; she was dizzy and her head was spinning, and a wave of nausea came over her. The technician lowered the table back down to horizontal, allowing Josie to recover for a little while.

"Time for the second round," the technician said cheerfully. He injected some sort of drug into the IV that Josie had in her arm. They slowly began to tilt the table, just like they had before. They continuously monitored her vitals, just like they had before.

When it was all done, they transferred Josie back to her usual hospital bed, and wheeled her back to her room.

"Rest for a while, Josie," a nurse said kindly. "The doctor will be back in a little while to tell you the results of your testing. Until then, you need to get some sleep. It's too late."

— — —

The results of all the testing helped the doctor to diagnose her with Postural Orthostatic Tachycardia Syndrome, also known as POTS.

"It's caused by a dysfunction of your autonomic nervous system," the doctor explained to Josie once she was back in her room. "Postural means it relates to your posture - whether you're sitting, standing, or lying down. Orthostatic has a similar meaning, that you're upright or standing. Tachycardia is an abnormally high heart rate. All this comes together just to mean that when you go from sitting to standing, your heart rate jumps abnormally high. In your case, your blood pressure also drops, which causes your fainting."

Josie laid there, in shock from the news. Her mother Elaine, a perfectionist who was nearly obsessed with finding answers, immediately began asking questions and writing down the answers in a notebook she carried everywhere. Josie tried her best to pay attention, but her shoulder ached and throbbed as she laid there.

After the doctor left, the same nurse came in from before.

"M-my shoulder hurts so badly..." Josie said to the nurse. "Please..."

"We know," she responded gently. "The doctor has agreed to give you something for the pain. While you're here, we're giving you a small dose of Dilaudid through your IV. After discharge, you'll have a two or three day supply of low-dose Percocet."

After the nurse left, Josie's mother sat down at the edge of the bed and took her hand. "How are you feeling honey?"

Josie groaned slightly as she looked at her. "I'm super nauseous... P-probably the concussion," she murmured as she placed a hand over her mouth. She swallowed hard and closed her eyes "M-mom... trash can... I'm going to-"

Josie had emetophobia - she was afraid of the sound of vomiting, the feeling, the action itself. She knew that she was about to, and it made her extremely anxious.

She leaned over a bin, retching uncontrollably. Elaine hit the 'call nurse' button near Josie's bed and held back her daughter's hair. After twenty minutes of vomiting, the nurse finally came in with medication.

"Sorry it took so long, sweetie," the familiar woman said as she entered. "This is called Zofran, it will stop your vomiting and take the edge off of your nausea too."

Her head ached as she laid back and closed her eyes. The nurse, who she remembered was named Nevaeh, removed the bin and brought in a new one, in addition to an extra blanket for her patient.

Josie laid there for a little while, finally feeling soothed after the medication. The doctor came back in once again and she sat back up in bed.

"We are happy to say that you won't have to stay overnight. But you are excused from school for the rest of this week," her doctor told the mother and daughter. "I've brought an informational pamphlet about POTS, as well as a referral list for several doctors. There's a list of cardiologists, and rheumatologists as well. Your nurse and I suggested you see one because of your joint pain and the shoulder dislocation. We're recommending genetic testing, but you'll have to have the rheumatologist confirm it."

"I've written a prescription for two days of a very low dose of Percocet to treat the pain from your dislocation and concussion. In addition, you will need to wear a soft cervical collar and a sling for the next ten days. Nurse Nevaeh will be back very soon to discharge you."

The nurse guided Elaine through the digital discharge, disconnected Josie's IV, and placed her in a foam collar and a soft blue arm sling. She took some puke bags from the hospital room and put the paperwork in her purse. She carried her daughter's backpack out to the van and let Josie borrow some sunglasses so the light didn't bother her head.

Elaine drove home with the radio on a low volume and watched as her daughter slept in the seat across from her. She sighed softly as she drove, happy when they finally pulled into the driveway of their home. "It's been a long day," she sighed.

— — — — —

Josie went straight to her room when they got inside. Elaine set down her daughter's backpack beside the bedroom door. Josie laid down and got comfortable, grateful to finally be in her own bed.

Elaine researched and chose two specialists from the list, then called to set up appointments. She was really concerned - she had thought Josie was fine. She now realized that Josie had just been worried about upsetting her, and had never told her about how she felt. Her phone rang, interrupting her from getting lost in thought. It was Josie's school, calling to make sure she was okay. Elaine explained the situation and promised to drop off her daughter's school excuse the next day.

She hurried to finish scheduling an appointment, then finished the chores that she was working on before having to rush to the hospital. When she was done, she made herself a cup of tea, and sat down on the couch with their family pet, a sweet golden retriever named Carl. Elaine grabbed the remote and surfed through the TV channels until she found one playing one of her favorite movies. She put her feet up on the ottoman and snuggled up with the dog, finally settling in to relax.

All this was shattered when she heard a loud bang from upstairs.