Friday, November 22, 2013

The Improbable But Very Real Adventures Of Curmudgeon

Allow me to begin this post on my improbable but very real adventures by quoting from Kurt Vonnegut’s God Bless You, Mr. Rosewater:
“The most exquisite pleasure in the practice of medicine comes from nudging a layman in the direction of terror, then bringing him back to safety again.” 
My regular readers know that I have been battling a persistent breathing problem since last year.  I finally consented, after repeated severe prodding, to visit a pulmonologist (lung specialist) to determine why I was suffering from a hunger for air.

After a series of tests, it was determined that my lung capacity was 50 percent.  I was diagnosed with COPD and some form of restrictive lung disease.

Most recently, my lung specialist suggested that I change my blood pressure medication from Lisinopril (generic for Zestril®) to Diovan® in an effort to rid me of a persistent cough that is seen in 1 in 20 patients who have taken that drug over a long period of time.

His hunch was right and the cough is finally gone.  In my post “The Doctor Will See You Now”, I underwent several more tests ordered by my lung specialist to determine exactly why I am always so short of breath.

They did not go well and the same day that I miserably failed my stress test he set up an appointment with a cardiologist, who then ordered me to have cardiac catheterization.

I had five days to imagine the worst outcomes.  At first, I was brave.  Each day that passed I became more and more apprehensive.  Hell, who am I kidding?  I was scared.  I was told if they found a blockage I would receive coronary angioplasty with stenting to open up narrowed or blocked segments of a coronary artery.  If the blockage was significant, then the only alternative would be bypass surgery.

I awakened at 4:30 AM the day of the procedure and made sure that my neighbor would be able to take care of my little dog Sophie while I was gone by setting out her food and some pee pee pads if she had to do her business before Roy came over to feed her.  I had already made arrangements with him that if things went well that he would pick me up at the hospital after I was released and that he would drive me back to the hospital the next day to pick up my car.

I left the house at 5:30 AM and arrived at the hospital early.  I checked in at the desk and was escorted to admitting.  After all the paperwork had been issued, the admissions clerk walked me to the Coronary Care Unit.

The very, and I do mean very, young nurse waited for me to take off my clothes, put on the very sexy gown and the special socks she laid on the bed.  A few minutes later, she reentered my room and tried to place an IV in my left arm.  She struggled for 20 minutes without success.

I was patient, but to a point.  When it appeared she was going to be unsuccessful, a seasoned nurse named Camille entered the room and took command.

She looked at the orders and saw that I was to receive an IV in both arms.  While she worked to do that the other nurse shaved my lady parts.

Having no luck trying the conventional way, Camille decided to go all Vin Diesel on my ass and used a tourniquet above my elbow and one around my wrist.  I was watching the clock that hung on the left wall above her head.

She began at 7:15 AM and was done at 7:27.  She hurt me because my vein was too deep and it wiggled.  Then she moved to my right arm.  Again she used two tourniquets.  The clock read 7:31.  She finished torturing me at 7:49 AM.  She apologized profusely for the pain.  I told her it was alright. 

At 8:15 the cardiologist walked into my room, sat on the bed, asked me how I was doing and proceeded to tell me that there was a cardiac emergency and that my catheterization procedure would be delayed until sometime after noon.

The paperwork that I had been given when I left her office last Thursday prepared me for this possibility.

She could see my disappointment and offered to have breakfast sent to me.  It was a token of her compassion I guess.  When the food arrived it was a bowl of grits, two scrambled eggs neatly folded and two pieces of limp, dry toast.  There was also a cup of coffee which I do not drink.  I hit the call button and asked if I could have a cup of hot tea instead of the coffee.  The nurse obliged.

To pass the time I watched TV, nodded off, got up to go the bathroom with my IV drip stand in tow, returned to bed, watched TV, nodded off and got up to go the bathroom, etc, etc.  Time doesn't seem to pass in the same way in hospitals as it does in other places.

Unable to amuse myself any further, I took a look at the clock and saw that it was 1:30 PM.

I turned on my cell phone and called my friend at the beach to keep her updated. Thankfully she didn’t answer so I could just leave a voicemail and then called my neighbor to give him a heads up.

I turned off my phone and dragged my IV stand over to the nurses’ desk and informed them that I was tired of waiting.

Camille acknowledged that I had been extremely patient and offered to call upstairs to find out how much longer it would be before they could take me.

I went back to my three-sided room with a curtain and lay back in bed.  Shortly, Camille came in and told me that they were cleaning up the room and that I would be next.  My simple question was, “What time will that be?”  Camille’s answer was 2 o’clock.  I said, “OK, but by 2:05 if they haven’t come to get me I’m pulling all this shit out of my arms and I’m walking out of here.”

Camille said, “No, honey, you can’t do that!”  My answer was a simple, “Watch me.”

At 1:57 PM, a man dressed in operating room garb, booties over his shoes and a blue surgical cap came with a wheelchair.  He was smacking his chewing gum.  Something about that pissed me off.

He loaded me into the wheelchair, put the footrests down and threw a blanket over my legs and off we went.  We got out of the elevator on the third floor and he put me in a room that had two chairs and nothing more inside.

He said he’d be back.  Moments later he reappeared advising me that he was looking for someone to take me to the cath lab. 

The guy came back a few minutes later telling me that he couldn’t find anyone.  Naturally, I wasn’t feeling very confident about this chain of events and being the smartass that I am asked him if I was starring in an episode of Candid Camera.  He didn’t have a clue what the hell I was talking about.

From 2:11 PM until 2:28 PM I sat all alone in that room.  I had my hands on the brakes of that wheelchair and was within a whisker of unlocking the wheels and rolling my ass back to CCU when a man dressed in scrubs appeared out of nowhere and introduced himself as Dr. Price.

He informed me that the procedure from the AM ran longer than anticipated and that my cardiologist would not be performing the procedure.  He would be doing it because, as he stated, “I’m the night guy.”

At this point, I didn’t care.  He pulled up a chair and sat down in front of me.  He took one look at the IVs in both of my arms and scowled that they were “unsatisfactory”.

I said, “Look, that’s the best the nurses could do” and recited the amount of time it took to insert them.

He said if my veins were that difficult to stick that it would be his suggestion to go in through my groin for catheterization.

Highly perturbed and excessively tired by this time I said, “That’s effing wonderful.”  He didn’t particularly care for my comment and offered to reschedule the procedure.

That was a bad move on his part.  I had a “Come-to-Jesus meeting” with the guy saying, “Listen doc, this is just a job to you, but this is my life.  I’ve put everything in my life on hold to have this procedure done today.  I’ve taken Family Medical Leave time off from work to have this done today.  If you have to do this by going in through the groin then that’s what you’re going to do.”

He agreed to proceed and walked out saying he’d back in just a moment.  When he came back he had two nurses in tow.  They were pleasant young women who could see that I was highly agitated and promised to give me drugs to “settle” me down.  One grabbed the handles of the wheelchair and the other one led the way to the cardiac catheterization lab.

It was so cold in that room that I was certain there had been a blizzard in there just moments before.  The nurses had me remove my gown and guided me onto the table.  They immediately placed a blanket that had been heated over me.  “Thank God,” I thought, because I was turning into an icicle.

They set up a tray with all the needed instruments on it, prepared my leg and shaved the fuzz around the area where the catheter would be inserted.  They repositioned the C-arm right over my head and chest and the doctor stepped up to the table.

They guided my arms into some kind of channel so they would be immobile and one of the nurses stepped to my left side and told me she would be giving me 2 mg of midazolam and 50 mcg of fentanyl to “relax” me.  I thought to myself, “not a moment too soon, honey.”

When he felt I was “relaxed” the doctor warned me that I would feel a pinch and a stick.  He was numbing the incision site at the femoral artery.  We waited together for the numbing to begin and then he said, “You’re going to feel a stick.”

I don’t know exactly how long I was on that slab of ice called a table.  I guess the drugs were doing their job.  The next thing I knew the procedure was over.  They moved the C-arm away and the doctor told me that there were no blockages.  I was relieved to hear that.  He gave me four paper copies of the angiography images of my heart from the procedure and placed them in my lap.

I laid there watching the nurses remove all the leads and electrodes (there were more than a dozen of them).  It was a bit like watching comedian Tommy Cooper do his “rope trick”.

The nurses helped me back into my gown and rolled me onto another bed and took me back to CCU.

When I got back to my room it was 4:14 PM.  Camille entered and strongly advised that I lay perfectly still with my right leg kept straight.  “Don’t cross your legs, honey, and don’t sit up.”  I acknowledged her instructions and relaxed.

A little later she came back with all kinds of papers and an interesting document.  It was a patient brochure that explained the vascular closure device that was used.  It even came with its own serial number.  (Proof, your theory about stuffing Wonder Bread into a leaking pipe apparently has some merit.)

I’ve already explained above that I’m not much of a “waiter” so I asked Camille how long I would be “resting” before I was discharged.  She said, “Three hours.”  Then she quickly asked, as if to divert my attention, if I would like some dinner.  I said I could nosh a little.

In short order a lady carrying a tray asked me my name and date of birth and gently placed the tray on the tray table, raised the head of the bed so I could reach my eats and encouraged me to enjoy the feast she had set before me; boiled baby carrots, two slices of semi-tough turkey and what was clearly instant potatoes with some brown glop masquerading as gravy.  None of it was seasoned.  I was ravenous so I ate it. 

They gave me a glass the size of a thimble filled with Diet Coke.  I needed more to wash down that awesome meal and rang the call button.  Camille came in and saw me sitting up and nearly had a conniption.  She barked for me to lay down.

She checked my blood pressure, pulled off the sheet at my right foot and felt for a pulse then went off to get me a can of Diet Coke.  Thank God, I thought.  At least I won’t choke to death.

By now it was 6 o’clock.  One hour left before I was to be discharged.  I had to pee.  So I got up grabbed my IV stand and walked the short distance to the potty.  Apparently Camille had been distracted.  When I emerged from the head Camille saw me and, yes, she had another conniption.

“Are you trying to get me fired?”  “No,” I said.  I just want out of here.  She grilled me on whether I had someone here to take me home warning me arduously that I wasn’t driving myself.  I directed her to the bag sitting next to the bed and asked her to retrieve my cell phone.  I called my neighbor Roy and put it on speakerphone.  She could hear every word we said to each other.  I told him to arrive at 7:00 to pick me up.

This made Camille happy.

I asked her if we could expedite the discharge papers and she agreed.  Back in a flash, Camille had a handful of papers with instructions about what to do and what not to do when I got home.  Then she came across some good news.  She said my heart ejection fraction is greater than 55 percent.

Ejection fraction is a measurement of the percentage of blood leaving your heart each time it contracts.  During each heartbeat cycle, the heart contracts and relaxes. When your heart contracts, it ejects blood from the two pumping chambers.  When your heart relaxes, the ventricles refill with blood. No matter how forceful the contraction, it doesn't empty all of the blood out of a ventricle. The term "ejection fraction" refers to the percentage of blood that's pumped out of a filled ventricle with each heartbeat.  An ejection fraction of 55 percent or higher is considered normal.

Camille smiled a broad smile and asked, “Do you know how lucky you are to be a diabetic and have a healthy ejection fraction?”  I said that the Good Lord has done a fine job of taking care of me and that I was lucky to have a wonderful, caring nurse such as her.

I thanked her for all that she had done. 

She asked me to sign the paperwork but fudge the time of discharge.  It was 6:30 PM.  I wrote in the time as 6:50 PM.

She allowed that I should have the IV removed from my left arm but insisted that the one in my right arm wouldn’t be removed until closer to my discharge.  I pouted a little bit but jumped out of bed and began getting my clothes back on.

I checked to make sure I had everything ready and Camille came back to remove the IV shunt from my right arm.  I was free at last.  She walked out to get a wheelchair for me and when she came back she said she had seen Roy and promised I would be right out.  And I was.

I jumped in that car and told Roy to floor it.

When I walked in the door at home I loved on my furkid Sophie walked to the bedroom and put on my PJs.

Today is Friday.  I’ve been out of work for three days.  I’m going back tomorrow.

To all who posted their thoughts and prayers, I thank you.  Your prayers for me were answered.  I’m one lucky curmudgeon to have friends like you.

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