The assassins had failed again.
I was in ICU, enduring incorrect meal orders, bouts of tedious questioning about how I was feeling (often including the assurance that I had been in great health before whatever they'd done to me during my toe repair surgery), breathing exercises and blood draws.
"No, I came here to get my broken toes fixed," I said, "not for symptoms of respiratory problems that I didn't have before the anesthesia procedure I asked not to be done."
Let's see, broke toes Tuesday night, surgery Wednesday evening, awake again Thursday, so it was Thursday when the orthopedist showed up in my ICU room. I liked him. He was an entertaining mix and usually managed to find a smile.
"Hey, you were one hundred percent right," he told me. "I heard about what happened after the surgery. We should not have put you under."
Did he know how to bring an apology, or what? Granted, not so hard when you're not to blame, but still a great apology.
"I'm sorry you're having trouble," he said, "but on the bright side, our part went great. How do your toes feel?"
For the toes, hey, no problem. There was no pain, no tingling, no numbness, and no discoloration. There was (and at this writing remain) a long steel pin extending from beyond the tip through to the base of each toe (the little piggy that had roast beef and the little piggy that had none; weeweewee is fine), but no pain. Based on people's poorly hidden reactions, I'm going to assume it's supposed to hurt. I'm quite content with not having that part of the experience. I'm not sure If that costs me experience points in this game, but I'm sure I took that into consideration when I created the character and I'm not going to start second-guessing myself this far into things.
I really felt like most of my inability to take a deep breath was more connected to the irritated feeling in my throat. It was less like a sore throat and more akin to sprinting in cold weather. Trying to breathe deeply would set off coughing after a couple of seconds. If that was due to the double intubation, it should heal, right. Of course, I was also coughing up bloody phlegm. No, I hadn't been doing that before. Someone actually asked me about how I normally dealt with these symptoms I was--Hey! Stop. Wearing a white coat doesn't make you smart. I don't normally deal with any of these things or have a primary care provider because I normally feel freaking awesome. I pay attention to what I eat, drink more than a gallon of water a day, exercise daily, and don't have to listen to doctors who make me feel worse than when I came to see them for a simple mechanical fix.
This patient's humors are out of balance! Time for another bloodletting!
There were a few bright spots to my stay in the hospital, with doctors, nurses, nurse assistants and even volunteers among them. There were also idiots who, sadly, probably don't know who they are because they failed to register either my sarcasm or my blunt honesty.
Saturday, my oxygen saturation maintaining at an acceptable level with supplemental oxygen, I was moved from ICU to a normal patient room. I was still being given antibiotics, a blood thinner, and not enough food. The hospital's idea of a normal diet was something I really wanted to use some of my free time to discuss with whoever was in charge of nutrition for the place. It consisted of far too many carbohydrates and not enough protein and so many things that I just wasn't going to eat.
The attending anesthesiologist came for a visit a few hours after I'd gotten to my new room. She claimed to be sympathetic, but also maintained that she would make the same decisions again. She also expressed one theory that I might have experienced a negative pressure pulmonary embolism, something that was known to occur in higher mass patients. I failed to see the logic in insisting on a procedure that was a known risk for a patient because of his body type when another options was available and requested. We failed to reach a point of agreement.
Sunday, I stopped using the supplemental oxygen. My tongue was still half-numb, which I found as bizarre as the fact that over two weeks later it still hasn't fully recovered all sensation. Regardless, I was and remain very dedicated to deep breathing. Blame it on all the years of martial arts training. It meant enduring a lot of coughing, but I was forcing more breath after each coughing fit so I persisted. I think I mentioned lots of free time, so I was back to notebook scribblings interrupted by bouts of exercise. I received a visit from another orthopedic doctor. I'd seen different people from orthopedics every day. This one seemed nervous. His voice was shaky and so was his handshake. The nurse and I decided he must've been one of the eight men who'd had to wrestle me after surgery.
My vital sign readings had gotten back to normal, for me, and there were rumors I might be discharged. Hooray! There was also talk of a chest CT scan. Much of Sunday was spent waiting on word of which event was going to happen. The scan won out and happened late that afternoon. *sigh* Chest X-rays before and after I was awake hadn't shown them anything conclusive, the doctor claiming that there was too much muscle to see through well, but that he didn't see anything of concern.
From the CT scan, they decided that I'd been left with a pulmonary embolism, blood clotting in each lung. I'd progressed to exclusively dry coughs, no blood, but the next step in the plan then was to be blood thinning therapy, dissolving the clots over the course of several months. That was also going to mean ongoing doctor visits for monitoring to make sure that my blood to poison ratio was kept at an appropriate level. To begin the process, it was also going to mean keeping me in the hospital where they could monitor me until they managed to achieve the desired level before releasing me back into the wild. That resulted in another week in the hospital, feeling well but trapped, futile pokings by people hunting for blood vessels, and a doctor who learned to deliver updates with an apology and on the run.
Nice guy, but he liked to stay out of arm's reach.
Now, home again and being mindful of my skewered toes, I've begun dealing with the inefficiencies and stupid questions of a primary care physician and waiting on lab work. I've yet to encounter any part of all this that's made me unhappy about having as little interaction with the medical profession as possible over the years, nor to make me think I won't resume that practice ASAP. It always seems to come back to bloodletting, doesn't it? The trappings have gotten prettier over the last seven hundred years, but a hospital's still a gilded cage at best and there's still so much guessing going on in there. I'm waiting for somebody to come at me with stone knives and bear skins, realizing that my theory about a voodoo doll likeness of me out there somewhere with sharp pains in its foot may not be so far fetched.
There's no place like home.
Monday, July 28, 2014
Friday, July 25, 2014
17488--Avoid Waking Up with a Crowd Around You
"Shattered" was the word they kept using.
The toes I thought I'd dislocated and probably broken, X-ray images showed to be shattered. They still didn't hurt. Straighten them out, splint them, and I'd be on my way. That was my plan. It had a simplicity I liked and I trusted my body, as usual, to heal the damage I'd done to it. The doctors had something more complicated in mind.
Their plan involved pins. They wanted to insert long, steel pins into my toes. My smiling orthopedist apparently had a secondary specialty in witch doctoring.
"Oh, you need surgery," they said. "We need to set the bones properly and insert pins to hold the toes straight. Plus, you've broken the skin, so we need to open that wound and disinfect it."
Twelve hours and suddenly somebody's concerned that I had been bleeding. At this point, my priorities were pushing food and water back to the top spot and toe yanking was starting to sound pretty good again.
"Oh, no, you were right not to yank them," the orthopedist said. "That would've been bad."
That from the medical professional whose first impulse had been to grab my toes and start trying to move them. That part was something I knew would happen and that, when it did, it would be an orthopedist doing it. When I called him on it, he laughed like he'd been caught in the cookie jar.
"We're going to get you scheduled for surgery right away," he said.
"Well, can we just do a local anesthetic?" I asked. "Numb it, fix it, and I can be out of here?"
"We'll probably do a general anesthesia and just put you out."
"I don't mind being awake," I said. "Just do a local and we can be done that much faster and I can be on my way."
"Well, you'll have to talk with the anesthesiologist about that," the orthopedist said. "Have you had problems with anesthesia or surgery before?"
"No, I just think it would speed things along to not have to put me under and wake me up," I explained. "One less complication."
"You'll see the anesthesia team before surgery," the doctor said. "Talk with them about it during prep."
"Oh, I will."
From the emergency department examining room, I was taken to a patient room to await my turn on the day's surgical schedule. It was becoming late afternoon and nurses would bring up food and water a few more times, then tell me it was good that I hadn't had anything. My stomach remained unconvinced, but stomachs are like that. In lieu of sustenance, I continued a steady regimen of vital sign checks and the quiz about my name and birthday. Yes, I only have one name. No, it wasn't the day for cake. Mmmmm...cake.
Appropriately gowned and finally transported to OR prep, I had a chance to talk with an anesthesiologist about staying awake. Now, they're all about keeping you alive while you're asleep. My desire to remain conscious was taken as an odd choice to be stubborn about.
I suppose as a resident, her response of "I'll need to get my attending," didn't come as much of a surprise. When both doctors came in, we did our dance again, but the attending was much more insistent that general anesthesia was the only viable path because of the very involved procedure I was about to undergo. For my part, I just needed to stay still. Honestly, with just a local, the comfy bed, and nothing else to do, I'd probably have dozed off on my own.
They wheeled me into the OR and the ortho guys decided that my heavyweight status made me a great candidate for doing surgery right on the transport bed rather than having to move me before and after. Like I said, comfy bed, so no argument from me. The logic seemed sound and we engaged in witty banter and trivia quizzing until...Well, until whatever the anesthesia team did to put me to sleep. Apparently, it also interfered with short-term to long-term memory transfer. I have no recollection of the anesthesia being started.
My first recollection of new memories began the next morning through the cloying fog of half-sleep. I'd been lashed to the bed. The railings felt different. I couldn't really open my eyes, but it was a different bed. I had a hazy memory of a prior dream about being a superhero doing the man dance with a gang of villains. There was a tube in my mouth and throat. It was irritating so I tried to bite through it while working on breaking my restraints. When I felt somebody come near enough, I grabbed his wrist. The communication process had begun.
There was some blather about asking me if I knew where I was and remaining calm as becoming agitated again might result in keeping the breathing tube in longer. I guess I'd been strapped to the bed for a reason. I was also told I had to stop trying to chew through the tube. So many rules that would've been unnecessary if they'd just removed the tube. I let the first nurse go and got the next pair to understand that I wanted something with which to write. That bit of communication seemed a lot harder than it should've been. They weren't impressing me.
Going unheeded once more, I was told that they were waiting for doctors to arrive on rounds to make the decision to remove the breathing tube. That was as irritating as the tube itself. The story I was given was that I was uncooperative with the nose mask, so I was intubated (a breathing tube was stuck down my throat). While the orthopedic surgery went well (the fix I came for), extubating (removing the damned tube) and reawakening did not. Bloody phlegm came out with the tube and my oxygen saturation level was dropping. They said they also tried to wake me during this, but whether that was before or after removing the tube wasn't made clear. Whatever the sequence, in my sleep, I fought whoever was around me. Ultimately, this became eight guys struggling to hold me down while I was re-sedated and re-intubated. At least that made the vague memory of my superhero dream make sense. And why I'd been strapped to the bed.
Waking up in ICU wasn't part of the plan. Awake, though, I was able to convince the docs to remove the tube. Then, I was able to get back to answering the endless cycle of tedious questions and finding my way back to taking deep breaths again. Still, the question of what had gone wrong lingered. I wasn't supposed to feel worse than when I'd arrived and more than a day had gone by without food, water or writing. All that needed correction. Priorities.
NEXT: Guesswork and Bloodletting
 |
| Left: Fragmented and askew / Right: Steel pins added |
Their plan involved pins. They wanted to insert long, steel pins into my toes. My smiling orthopedist apparently had a secondary specialty in witch doctoring.
"Oh, you need surgery," they said. "We need to set the bones properly and insert pins to hold the toes straight. Plus, you've broken the skin, so we need to open that wound and disinfect it."
Twelve hours and suddenly somebody's concerned that I had been bleeding. At this point, my priorities were pushing food and water back to the top spot and toe yanking was starting to sound pretty good again.
"Oh, no, you were right not to yank them," the orthopedist said. "That would've been bad."
That from the medical professional whose first impulse had been to grab my toes and start trying to move them. That part was something I knew would happen and that, when it did, it would be an orthopedist doing it. When I called him on it, he laughed like he'd been caught in the cookie jar.
"We're going to get you scheduled for surgery right away," he said.
"Well, can we just do a local anesthetic?" I asked. "Numb it, fix it, and I can be out of here?"
"We'll probably do a general anesthesia and just put you out."
"I don't mind being awake," I said. "Just do a local and we can be done that much faster and I can be on my way."
"Well, you'll have to talk with the anesthesiologist about that," the orthopedist said. "Have you had problems with anesthesia or surgery before?"
"No, I just think it would speed things along to not have to put me under and wake me up," I explained. "One less complication."
"You'll see the anesthesia team before surgery," the doctor said. "Talk with them about it during prep."
"Oh, I will."
From the emergency department examining room, I was taken to a patient room to await my turn on the day's surgical schedule. It was becoming late afternoon and nurses would bring up food and water a few more times, then tell me it was good that I hadn't had anything. My stomach remained unconvinced, but stomachs are like that. In lieu of sustenance, I continued a steady regimen of vital sign checks and the quiz about my name and birthday. Yes, I only have one name. No, it wasn't the day for cake. Mmmmm...cake.
Appropriately gowned and finally transported to OR prep, I had a chance to talk with an anesthesiologist about staying awake. Now, they're all about keeping you alive while you're asleep. My desire to remain conscious was taken as an odd choice to be stubborn about.
I suppose as a resident, her response of "I'll need to get my attending," didn't come as much of a surprise. When both doctors came in, we did our dance again, but the attending was much more insistent that general anesthesia was the only viable path because of the very involved procedure I was about to undergo. For my part, I just needed to stay still. Honestly, with just a local, the comfy bed, and nothing else to do, I'd probably have dozed off on my own.
They wheeled me into the OR and the ortho guys decided that my heavyweight status made me a great candidate for doing surgery right on the transport bed rather than having to move me before and after. Like I said, comfy bed, so no argument from me. The logic seemed sound and we engaged in witty banter and trivia quizzing until...Well, until whatever the anesthesia team did to put me to sleep. Apparently, it also interfered with short-term to long-term memory transfer. I have no recollection of the anesthesia being started.
My first recollection of new memories began the next morning through the cloying fog of half-sleep. I'd been lashed to the bed. The railings felt different. I couldn't really open my eyes, but it was a different bed. I had a hazy memory of a prior dream about being a superhero doing the man dance with a gang of villains. There was a tube in my mouth and throat. It was irritating so I tried to bite through it while working on breaking my restraints. When I felt somebody come near enough, I grabbed his wrist. The communication process had begun.
There was some blather about asking me if I knew where I was and remaining calm as becoming agitated again might result in keeping the breathing tube in longer. I guess I'd been strapped to the bed for a reason. I was also told I had to stop trying to chew through the tube. So many rules that would've been unnecessary if they'd just removed the tube. I let the first nurse go and got the next pair to understand that I wanted something with which to write. That bit of communication seemed a lot harder than it should've been. They weren't impressing me.
Going unheeded once more, I was told that they were waiting for doctors to arrive on rounds to make the decision to remove the breathing tube. That was as irritating as the tube itself. The story I was given was that I was uncooperative with the nose mask, so I was intubated (a breathing tube was stuck down my throat). While the orthopedic surgery went well (the fix I came for), extubating (removing the damned tube) and reawakening did not. Bloody phlegm came out with the tube and my oxygen saturation level was dropping. They said they also tried to wake me during this, but whether that was before or after removing the tube wasn't made clear. Whatever the sequence, in my sleep, I fought whoever was around me. Ultimately, this became eight guys struggling to hold me down while I was re-sedated and re-intubated. At least that made the vague memory of my superhero dream make sense. And why I'd been strapped to the bed.
Waking up in ICU wasn't part of the plan. Awake, though, I was able to convince the docs to remove the tube. Then, I was able to get back to answering the endless cycle of tedious questions and finding my way back to taking deep breaths again. Still, the question of what had gone wrong lingered. I wasn't supposed to feel worse than when I'd arrived and more than a day had gone by without food, water or writing. All that needed correction. Priorities.
NEXT: Guesswork and Bloodletting
Tuesday, July 22, 2014
17485--Back in Action
Or How I Spent My Impromptu Summer Vacation. I've been away for a bit. To say the least, far longer than I wished to be. That part's over now and, back at my keyboard once again, I can share a little.
Growing up on copious amounts of heroic fiction, long ago added "avoid being strapped to a lab table" to my guidelines in life. Who needs that sort of headache? No one. That's who. Still, medical captivity can descend with blinding swiftness.
I didn't see it coming any more than I did the fall. Just after 11 on a Tuesday night, I meandered from my lair to take the dog out. He likes it, I prefer that he does certain things outside, and hanging out with him keeps me from acting like a hermit. Routine became less smooth upon my return to seclusion. So I took a fall. Big deal. I've fallen before. I'm not perfect, after all, though blessedly resilient. As usual, I felt undamaged as I picked myself up and laughed about my momentary clumsiness. Part of life. This time, though, I noticed something a little different: a couple of my toes were...askew. That explained the metal *clink* I'd heard. My bare foot had managed to kick one of my dumbbells as I passed from vertical to horizontal. Between being distracted and my own curious pain tolerance, I didn't realize I'd made contact.
"Well, Hell," I said, "that's not right. I probably need to get those checked out."
There was no pain so I was still mostly annoyed, but the logical part of my brain was being pretty persuasive. It even managed to talk me out of yanking and straightening the maligned digits myself. Bother. Off to the ER. So much for a night of writing punctuated by other interruptions of activity.
Thus began the latest of my rare interactions with medical practitioners. This toe mishap seemed like something that needed to be dropped in their laps. Though I resigned myself to this and the ensuing tedium, even with the emergency room visit exceeding all reasonable expectations of duration, those first twelve hours of waiting would soon be fond memories. My dip in the maddening waters of surreality was only beginning.
NEXT: Avoid Waking up with a Crowd Around You
Growing up on copious amounts of heroic fiction, long ago added "avoid being strapped to a lab table" to my guidelines in life. Who needs that sort of headache? No one. That's who. Still, medical captivity can descend with blinding swiftness.
I didn't see it coming any more than I did the fall. Just after 11 on a Tuesday night, I meandered from my lair to take the dog out. He likes it, I prefer that he does certain things outside, and hanging out with him keeps me from acting like a hermit. Routine became less smooth upon my return to seclusion. So I took a fall. Big deal. I've fallen before. I'm not perfect, after all, though blessedly resilient. As usual, I felt undamaged as I picked myself up and laughed about my momentary clumsiness. Part of life. This time, though, I noticed something a little different: a couple of my toes were...askew. That explained the metal *clink* I'd heard. My bare foot had managed to kick one of my dumbbells as I passed from vertical to horizontal. Between being distracted and my own curious pain tolerance, I didn't realize I'd made contact.
"Well, Hell," I said, "that's not right. I probably need to get those checked out."
There was no pain so I was still mostly annoyed, but the logical part of my brain was being pretty persuasive. It even managed to talk me out of yanking and straightening the maligned digits myself. Bother. Off to the ER. So much for a night of writing punctuated by other interruptions of activity.
Thus began the latest of my rare interactions with medical practitioners. This toe mishap seemed like something that needed to be dropped in their laps. Though I resigned myself to this and the ensuing tedium, even with the emergency room visit exceeding all reasonable expectations of duration, those first twelve hours of waiting would soon be fond memories. My dip in the maddening waters of surreality was only beginning.
NEXT: Avoid Waking up with a Crowd Around You
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