Hello friends in internet
land!
Last we spoke I was having
some issues with swelling and bemoaning my drainlessness after the radiologist
declined to put one in. That was last Wednesday. I neglected to tell a short
story about that process which I will share now, along with some drama that has
followed. It’s Sunday July 3rd …
The swelling has gotten
bad enough at this point that without the hernia belt on I can’t be upright for
more than 5 or 10 seconds without the burning pain where one would hope to not
have burning pain. I call the kidney doc on-call, an old favorite nephrologist
of mine who has worked with me on and off since the beginning. While he’s never
been my primary nephrologist, I like him a lot. He hears me out on the
discomfort and prone-ness and sends me to the Emergency Department, radiology
being closed for the evening. The hope is to get a better sense of what’s going
on down there through scans and possibly (my hope) get something done about it,
either “tap it” to temporarily drain it, or put in a drain.
C drives me over to the ED
– it’s about 430 in the afternoon. Things are pretty quiet so I’m able to lie
down on a bench in the waiting area. The check-in triage process feels
interminable; sitting up gets progressively more painful, and the guy entering
my information (truly, everyone I’ve encountered in any ED) seems to be erring
on the side of diligence and congeniality. In my calmer moments I appreciate
this, but as it happens I’m tempted to take over the computer and enter the
info myself. Eventually C and I are lead to a small ED room, I lay on the bed
with some blankets under my butt to attend to the swelling. We wait. A doc pops
in after about an hour and we like her immediately. She’s older than most ED
docs I’ve met, late 50s, and everything about her put us both at ease. We
didn’t pass an hour with her popping in to check on us, give us an update, even
if there was nothing new to tell us. After a consult with the same kidney doc
who sent me in (she knew and spoke highly of him), I got a CT scan to get a
sense of the swelling. After another consult with the nephrologist and one of
the surgeons, she scheduled a drain placement for Tuesday afternoon (Monday
being the 4th). The ED doc was ready to send us home, about 4 hours
into our visit, but she wanted to do a second lab draw to double check my
potassium level, which was a little elevated. Rather than making us wait for
the results, we exchanged cell phone numbers so she could text me with the
result, or I could call her if she forgot. As in her personal cell phone. It
was a singular ED experience. I had never had that sense of being cared for and
attended to by an ED doc, and while I was surprised by her sharing her personal
number with me (a first in my 15 years of working closely with doctors), it fit
with the sense of relationship and connection she extended to us during our
stay. I still feel it.
As you know, my Tuesday
appointment with radiology did not end with me getting a drain. The ultrasound
showed most of the swelling where drains dare not go, so it was called off.
Thursday, I saw the same nephrologist at the kidney clinic, and after giving me
a once over and hearing about the severity of the pressure on my business, he
scheduled a second drain placement for Friday afternoon.
For this placement, rather
than walking into fluoroscopy (the ultrasound rooms), getting a local
anesthetic and walking out with a drain, I went to surgery pre-op to get
sedated, get an antibiotic treatment and prepped for the placement in an OR.
The difference, I was told, was in the doc, though I suspected my beat-up belly
might have had something to do with it.
The pre-op area is where
I’ve gone for my abdominal surgeries, where I was four weeks ago to get prepped
for the transplant. Just getting on the elevator to go down one floor, to the
surgery area, I felt an anxious dread.
There are three stages
before going to the pre-op area to get changed and prepped for surgery. First I
check in at a front desk, where I give my name and birthday and am given my
file. Next I register at a second desk. Here the procedure is confirmed for the
first of several times, and more data is entered. Then I go to the surgery waiting
area. This is a compartmentalized room with about a dozen small sitting areas
for families to wait for their loved ones. I’ve been here before, but always
before a major surgery, and again I can feel myself begin to resist all this,
wish I was elsewhere, struggle to breath calmly. A man across from me is on the
phone having a banal conversation. When a name is called he leaves. A few
minutes later an intergenerational group of 8 get up and leave. After about 40
minutes, I hear my name, hand off my file and head to the pre-op area. My
clothes go into a bag and I put on the poofy shirt. I’m sweating but my feet
are freezing. My blood pressure, which has been low for two weeks is suddenly
too high, from 120/80 to 170/110. There’s talk of treating it before the
procedure, which could mean a 2-3 hour delay. The radiologist’s nurse stops by,
then the radiologist. An IV is placed. I ask that I get vanco rather than
cipro, a different antibiotic less likely to cause a recurrence of c-diff.
Having been told that sedation and antibiotics are non-negotiable, I learn that
both were negotiable. I didn’t want sedation, crabbed about it to C and my
kidney team because it meant I needed a ride and an IV. But the IV is in, so I
might as well enjoy the ride. They will deal with my BP in the OR, it still
doesn’t occur to me that it is high because of my anxiety. Eventually I’m
wheeled to an OR.
I’ve been in ORs for a
number of different procedures. Unlike waiting rooms or fluoroscopy rooms where
patients tend to be more aware of their surroundings, ORs are spare,
utilitarian spaces. There is the OR bed, more like a platform, that I scoot
onto from my pre-op bed. Next to me are scanning machines and a bank of
screens. There are more screens along the wall, but otherwise the room looks
surprisingly low-tech. There is unused space, a lot of shelving and closed
cabinets, a second room through a small window, and one chair along a wall.
While I’m not cold here, ORs tend to be cooler than the rest of the hospital. I
remember, half in the bag, going into an operation realizing how cold the room
was without feeling cold myself – that out of body disconnect that comes with
sedation.
In the room with me are
three other people, masked up, their eyes friendly and indifferent. I know that
at a certain point my memory will give out; that while I will be awake,
speaking and listening and thinking, I will not have any memory because of the
sedative versed. The nurse and techs know this of course, and I sense their relationship with me
is in no small way informed by this. The effect of the sedation on my memory
creates an unsettling lapse in time. I am on the OR platform, making small
talk, trying to joke, the doc poking around a bit, double checking scans, then
I am in recovery, noticing my sore belly, then listening to a nurse explain how
to manage the drain, then in the car on the way home. As the nurse is showing
me how to empty the drain, I scoff at my mom making a video. I’ll remember
this, don’t be silly. I don’t feel altered, but I am.
During a permacath
placement when I was first diagnosed, I remember wanting to explain the theory
of relativity during the procedure. I remember going in wanting to, and then
having no memory of saying anything at all. I was later told by the surgeon
that I had in fact talked about relativity, and that the anesthesiologist
titrated the sedative based on my clarity.
That was last Friday. I’ll post
the rest of this drain saga later. Thanks for reading!
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