Taken for Granted

My last entry was on 1/27/2017 and a lot has happened in the interim. As a matter of fact, a lot seems to still be happening. After I wrote this first sentence, the phone rang and I spoke for 30 minutes with a nurse from Providence about my hospital stay. Yep, hospital stay. On the night of January 27th I ate a small amount of leftover roast beef and potatoes and soon after began to have the same bloating, cramping pan-abdominal pain that I'd experienced the week before.

I sat in my chair in the front room trying to make sense of what was happening. I sat there all night trying to decide if I would be able to weather whatever this was and survive it. Foolishly hopeful in considering whether this would pass and everything would return to normal; whistling in the graveyard.

I tried to lie down a couple times hoping to find a comfortable position but there was no place to go.

In the morning I got out of bed at 0900, took a shower and then told Sue that I was very sick and needed to go to the hospital. The 27^th was, of course a Friday so the next day was Saturday and the regular world of healing services would be hard to connect with. I tried to call my doctor’s office as a courtesy and then I put on a hoodie and off we went to the ER at 1000, ready to face whatever might happen.

Karma aligned with me that Saturday. I think it recognized that I had made considerable progress by surrendering to my fate and this worked in my favor. We drove to the ER in Sue’s car and immediately found a parking place near the entrance. When they asked why I was there I told them abdominal pain, when they asked for a pain score I told them 8. I had been at a 7 for most of the night but I was a solid 8 by then. They found me a slot in the ER immediately and I was seen by a very nice ER doc with within about 20 minutes of walking through the door.

By about 1130, I had an IV and some pain meds that worked very well and allowed me to breathe and relax a bit. I went to CT about 1220 and had an abdominal survey done.

Sue went to the OR and saw who was available and on call and when she told me that Dr. B was available for anesthesia I realized that everything was going to be all right.

I met with the surgeon, a young, bright and competent fellow, known and liked by Sue and who, even though I really had no choice, I decided to explicitly trust with my fucked up body. Although, I’m sure that he would have rather passed me on to someone else.  

He told me that after review it was clear my gallbladder was trying to kill me and he was willing to join the battle on my side. We went through my history and physical and made a date in the OR for later that afternoon.

Dr. B came by to visit and formally accept the case. It was good to see a friendly face and touch base before he began what was, I was sure, not going to be a fun case.

At that point I could have been shunted off to a room on the floor to await surgery, but instead I was allowed to stay there in Bay 11 there in the ER. I was made very comfortable and people I knew began filtering in one at a time to say hello and wish me luck. It was a very good experience and I was happy to see each person that showed up. I felt abnormally relaxed and comfortable with my situation, even as unsettled as it was.

Now there may be a tendency to say; of course I was relaxed, I'd received pain meds to make me relaxed. But while the meds took away most of the pain and let me breathe and think, I believe that I was comfortable at that point because I had given up control and left it in my recliner back at home. I had given myself over to whatever was going to happen and I no longer struggled to control or even influence my course down the wild river that I had chosen to ride.

Ben and Ashton came to the ER and sat with me while I visited with well-wishers and waited to go to surgery and the time passed in a pleasant almost sweet way, like the last few hours of a family reunion. Then they announced it was time to go to surgery and I said my farewells and off we went.

I rode to the OR on the same stretcher I had spent the afternoon on. We went to OR room 8, a room I was very familiar with. I’d spent a lot of time in 8 and as I rolled into it, I though briefly about past times in that room.

I saw Dr. B waiting there with everything ready. I knew Dr. B’s wiley ways and that my induction was to be a very fast ride that would begin without much warning. I said hi to the circulator, my friend G, and to the scrub, who I didn’t know. They monitored me up and put on the safety belts and then said goodbye as B put the oxygen mask on me and I took a couple deep breaths. I felt the buzz of the lidocaine in the IV followed by a slight burn of the Propofol and I knew everything was going to be all right.

A moment later I awoke in the recovery room, even though from my viewpoint, the place initially looked unfamiliar to me. I felt confused, but I also knew that that was normal and that it would pass. I was in the recovery room and that meant surgery was over and I wanted to let everyone there know that I was thankful for their help.

An early part of my plan was to let the good people do their work and to stay out of the decision loop until I was capable again.

Lying there in recovery, I saw Dr. B, my surgeon, the PACU nurse, then Sue and a little while later I facetimed with Ben (but I don’t think I saw Ashton). The surgeon said that they hadn’t been able to do the case closed and so I had a full incision. I remember the pain across my upper abdomen, annoying but not severe. I coughed to show I was with the program and moved a little crap up the line. They showed me that I had a PCA hooked up and I asked if it really worked. In the back of my mind, I’d always secretly harbored a suspicion that PCAs were a type of placebo therapy but I had nothing against them. After all, I know that you don’t have to believe in placebos for them to work. The people at the bedside assured me that it worked and I pushed the button and drifted away, a new believer in the therapy.

I don’t know how long I was in the PACU, but I don’t think it was overlong. Probably about an hour. That would be standard. I remember looking at the clock but I didn’t really care what time it was, I was through surgery and felt safe and on track.

Soon they said it was time for me to go upstairs and I think I thanked everyone. If not, I meant to. I remember the ride through the hallways. It was Saturday evening in the hospital, another familiar time to me. The hallways were darkened and almost deserted. I remember seeing a couple other people on the ride up the elevator.

We went to room 728 and I barely remember the move onto the bed but I made it. Over the rest of that night I got into a routine of waking up and pushing the button to drift off again. My stomach hurt and it seemed they were constantly taking my vital signs and giving me meds. For some reason almost everything was IV except for my metoprolol, which was p.o.

They started me on ice chips, which they were quick to point out was only to wet my mouth and that I wasn’t supposed to drink the water, but the ice melted quickly each time they brought me some and so I tried to just take small sips to wet my mouth. I had no appetite and I hurt. My stomach felt distended and I think the next morning or so they changed me to a clear liquid diet and encouraged me to eat jello or popsicles or soda pop or anything from a clear liquids list. None of it sounded good to me but I tried.

My abdomen hurt and everybody asked me about passing gas or vomiting and I said no. Everyone listened to my stomach. Half of them said they heard bowel sounds, half said there were none. There weren’t any, I knew that, but I did what they asked.

They asked if I’d been drinking clear liquids, I said yes, they asked me if I’d thrown up, I said no. So they decided, everything was OK and moved me to Full Liquids which includes stuff like yogurt, dairy, pudding, broth. None of it sounded good but I tried to eat it because they wanted me to.

My surgeon had left town to visit his family so the other members of his group came by to round on me. I knew and trusted them all and enjoyed seeing them. They were all very nice to me. They, of course, noticed that I had no peristalsis, and put me back on ice chips and until bowel sounds returned. They all said the same thing. My gallbladder infection had been large that it had shut down my bowel function. It would take some time for my peristalsis to return and then they would move me along the diet progression to get me eating again. I didn’t mind, my appetite was gone and nothing sounded good.

And so it was, that on the second postop day, Sunday night, the 29^th of January, I began a fast that would go on for 10 days, until Tuesday February 7^th.

All this time, I had another problem working in the back of my mind. Sue had made arrangements starting at least the previous year to take a vacation and travel to Cuba with a couple of her sisters beginning on February 11^th and it looked as though I was going to be sick and she might feel like she should stay home to help me recover. Sue and I have not always had the best relationship and I didn’t want to be the cause of her missing this chance to travel with her sisters, so I was trying my best to do everything to make this recovery as quick as possible.

But nothing was moving along, bowel and stomach-wise and it was obvious that I had a gastroparesis in which the stomach has also given up and gone to sleep. I was constantly nauseated and growing more distended and uncomfortable every passing hour. I’d had an x-ray on February 2^nd (which was my son Ben’s Birthday, which I missed) that showed I had a paralytic ileus but nothing definitive concerning the stomach. The surgeon on-call came up and gave me this news like it was good news, I probably wouldn’t benefit from a nasogastric tube. In truth, I was a little disappointed. While I would have begged and pleaded to avoid an NG tube, I wasn’t getting any better and secretly wished for one in hopes of breaking the log jam or at least getting some relief from the nausea.

Every time I spoke I would get the hiccoughs, reflux and the taste of rotted meat and gun powder would come into my mouth. Increasing, I would have stomach contents rising into my mouth (rising gorge) and I would swallow it back down.

So for another day and a half I put up with an expanding stomach and increasing nausea. I had a male nurse named M who was very skilled and accommodating and also realistic; a "real deal clinical nurse.” He was great, the kind of nurse I wish I could have been.

I think everyone was waiting for me to vomit while subliminally telling me that I shouldn’t and I have to tell you that my thinking was not clear throughout my hospital stay. In fact, at times, it bordered on light psychosis.

On Sunday Feburary 5^th, M was in my room talking to me about the state of things and he said he thought I needed an NG and I agreed but levelled with him that I was nervous and unreasonably afraid of the tube insertion and that’s when he played the one card the real nurse can always play in the patient’s care and favor. He told me to trust him. He’d put a lot of NG tubes in and he would get me through it.

I agreed and he got the tube prepared and I got myself ready. I sat up as much as I could, laid a towel down my chest and abdomen like a giant lobster bib, and I got my puking bag in my hands. He told me the plan. He put the tube into my nose and inserted it a little and I gagged which was enough for me to vomit a goodly amount right into the bag. I signaled I was OK and off we went. It was very uncomfortable but only lasted a few seconds. He hooked up the suction and the drainage began and it went on and on.

Before we taped it to my nose, I begged him to make sure it was in far enough. He did and assured me that everything was good. Good nurse!

Even thought I’d vomited sitting up, there was very little mess. Most of it went into the bag with a small amount landing on the towel. Cleanup took a minute.

When the drainage had ended, we totaled what was in the bag and the canister and the total was just over 2200 mls. I was declared the winner and felt immediately better, even though it felt as though I had a large Lego block stuck in my throat. I could feel it every time I swallowed and I swallowed at least twice as often as I usually did.

As much as I hated the NG, I was happy to have it in place and reluctant to have it taken out unless I was sure I no longer needed it. The next, Monday, my surgeon reappeared to assess how things were going. Every time I saw the powers that be, I let them know that I needed to be home in time for my wife to make it to her adventure and they would respond with noncommittal answers. Truthfully, without that deadline I would have been happy to let things take their course, and to let discharge happen the same way I got on the conveyor belt for admittance.

Throughout my long days and nights in the hospital, I texted with my family every chance I got and every time I did, I tried to tell them that I loved them. On the surface, it seemed a little needy as I lay in the hospital bed, but as I look back on it I recognize that I wasn’t looking for reassurance that they loved me back. I really wanted them to know that I loved them. My course in the hospital had already take several unexpected turns and my surgery had been fairly good sized in terms of danger, and while I felt pretty comfortable in my situation, I realized that this was exactly how things could take the wrong turn and end badly. I had had this conversation and thought thousands of times over my years in the hospital. It comes with the realization that “LIFE TURNS ON A DIME.”

I could have an MI, a pulmonary embolus, an arrhthymia, a stroke. Any number of things could happen to knock me off cleanly or wound and weaken me enough to undo my life a little more slowly. There were a thousand little traps lining the way out of the darkness and in reality, I knew well enough what I had on my side was chance, a set of organ systems willing to keep things together a little longer and some small spark of conscious will to create and nuture the best thoughts I come up with. Nothing more than that. There was no right or justice or divine intention to uphold me there. What I had was what I came with and what I could sustain. I knew that because twice I felt it slip. Twice I felt myself giving up and for no more reason than I was exhausted from not sleeping, hollow from not eating and in a little pain. Everything else was in place to make my play for life work. I was in the hospital after all and not held up in some cave off of a forest trail.

At any rate, I’d seen people in this same place, slip from the hands of those around them, without warning or explanation, and while it might sound melodramatic to say it, there was only one thing I needed to let my family know no matter what happened; that I loved them and I knew that for sure.

Periodically during my stay, I also took time to reflect on the CT and abdominal findings, or more specifically lack thereof. I did not have a large cancer growing in my abdomen or chest. While I hadn’t stayed awake nights worrying about that, it was one of the things that came to mind while I was awake at night. I don’t believe that this is unusual for a 64 year old man or woman. In general, there is a unspoken agreement we have with life along the lines of “Don’t ask, don’t tell.” I would rather be taken by surprise than to go through years of pointless worry and suffering. As my friend Fred Campos taught me during a talk on pain control, Albert Schweitzer was posited that- Pain is a more terrible lord of mankind than even death itself...

I would count Fear as a co-conspirator to Pain in that thought. Like Punxsutawney Phil, my state of health is known only briefly before it returns to its normal hidden position. Who knows what will be growing in my abdomen in a year’s time. I must be aware and thankful now because this reassurance is ephemeral, like birthday wishes. I am thankful for my life and family right now and must let them know that. No matter how annoying that might be to others.

I will end this part for now. It is more than I was intending to write and but less than necessary to cover my thoughts. It is however a good start.

More later,

(1120 PM, I read this again it's really badly written. I will try to re-write it soon)

(Photo by Michal Dzierza)