Knocking on Heaven’s Door
May 6, 1998
I realize the Dylan lyric is overused in these situations, but it still seemed appropriate. So, here’s the story:
This all started Friday morning, I think. I woke up around 3AM, with maybe a touch of insomnia, and basically was restlessly thrashing around for the next few hours. At around 7AM, sweating heavily through a hot flash, I started to get up — thinking of an earlier start on the day, given I couldn’t sleep anyway — and immediately had to vomit. Luckily, the bathroom is right next to the bedroom, so there wasn’t an awful mess.
What I threw up was black stuff, nothing resembling, even remotely, the chicken-fried chicken I had for dinner the night before. There was a lot of it. Because I was sick last month, I called my doctor’s office to make an early morning appointment. I was worried that I might be relapsing with the hepatitis. They got me a 9:30 appointment, which let me rest and try to sleep a little before going. The little nap didn’t help. Luckily, the office is basically down the street, and all I had to do was flag down a cab.
When I told my doctor that I threw up, he asked me what the vomit looked like. “Black”. “Black? Are you sure it wasn’t brown?” “No, it was black.” After doing a couple of tests (Yes, my first rectal exam, to check for blood in the stool. No, it was not fun.), he concluded that I had thrown up dried blood, and that it wasn’t a coincidence that digested chicken-fried chicken looked like coffee grounds. It was then a question of whether I’ll get to the hospital by cab or by ambulance — I was bleeding internally, perhaps enough so to pass out on the way there. He checked the vital signs, and there was a visible difference between my pressure and pulse rate when standing and when sitting. My heart was working harder to keep a limited amount of blood moving against gravity. The ambulance was there in about five minutes. The ride wasn’t smooth; how could it be when you’re running red lights? I got extremely woozy in the ride over, and the wheelchair waiting at the ambulance bay was a good thing.
Roosevelt Hospital’s Emergency Room looks nothing like that thing on TV. It’s larger, darker, and more rationally arranged, with administrative and work desks next to each bank of exam rooms instead of being located in a dramatically central island that allows Gateway Computer product placements. It’s unclear if any of the doctors and nurses there were playing out prime-time soap operas in the supply room, and it’s unclear if there were patients in other rooms with funny, touching life stories to tell their nurses. At no point did they wheel in a schoolbus full of kids who were caught in a chemical spill on the way to the zoo.
It took a little while for my exam room to be ready. I spent the time waiting next to one of the desks in the obligatory wheelchair, watching this crazing person mutter to himself, occassionally yelling loudly at no one, while walking in circles in his small space. Relatives were in there with him, gently guiding him away from the exit and from places that he might hurt himself. I did feel much better about his proximity once I realized he was blind.
The first thing they did was put an IV in me. My doctor’s and the ambulance’s reports indicated internal bleeding after all, and my vital signs were showing it. The main thing is to get fluids in my body, to replace what was leaking out. The IV needle hurts like hell. It’s not like the pricks you feel when they’re taking blood samples or when you’re being innoculated for measles. It’s a bigger needle, and it’s dug in deeply so it can’t be easily dislodged, and so it can put a lot of fluid in you quickly. I apparently also had some sort of reaction to that first IV, sweating heavily and almost passing out. I’m told some people react this way; there’s a name for it, but I can’t remember what it is.
A little while later, they put a tube through my nose and down to my stomach to drain some of the fluid. They give you a pain killer, a spray for the back of the throat, but nowhere else. The tube going up the nose actually isn’t that painful. The hard part was getting the tube the rest of the way down. You get a cup of water with a straw, and you’re supposed to drink the water while the doctor pushes down the tube. Drinking the water makes everything go in the right direction, and it closes off the breathing passageways, so the tube doesn’t go down a lung accidentally. I didn’t get the swallowing thing right the first time, and just sat there gasping for a minute before he tried again. I made sure to drink the water in time with the tube being pushed that time around.
Surprisingly, you get used to the tube and the IV reasonably quickly. It’s uncomfortable, the tube in particular when coughing, but manageable. You just sort of lie there and drift.
Somewhere along the line, I think I fainted. The blood pressure was too low, I think, but I started to revive once they increased the IV fluid flow.
The main emergency room procedure happened a little while later, once the gastro-intestinal specialist got there and made sure everything was ready. This was something called an endoscopy, basically putting a fiber-optic camera and assorted tools down my throat to look around. They gave me sedatives before this, put me on my side and went in. I don’t remember most of this, mainly because I was drowsy from the drugs. I recall throwing up a couple of times when the endoscope was in there, and a nurse with a suction tube cleaning the mess up. I also recall hearing the doctors working, something about moving to the next position, extending a needle and injecting. Move-extend-inject happened many times.
In all that black murkiness that was my stomach, they found an ulcer with a blood clot forming on it. This is where I had been bleeding from. The endoscope had an attachment to coat spots with some concoction, which stopped the bleeding.
We learned later, after the blood test results came back, that I had lost close to half my blood in this. The blood statistic people looked at was the hemoglobin count. It’s normally 40. At the lowest point, when I was stabilized, mine was 23.
That Friday afternoon and evening, I think I threw up coffee grounds, it seemed, everytime I sat up, either to move me or to examine me. I guess I was just clearing the debris out my stomach.
There’s that standard visual motif in movies and TV, where the camera looks up at the hospital ceilings as the bed is being wheeled around. I suppose it suggests helplessness. It sort of works that way, but not really. Usually, you’re a lot more disorientated than a camera can show. The ceiling whooshes by unclearly, and there’s no particular feeling of helplessness, just whooshing, and dizziness. But, then, in my case, a lot less blood was getting to my brain, and the existential particulars may have escaped me.
I was eventually transfered to the intensive care unit, a busy place with many beeping machines that attach to you through a variety of skin pads and tubes. They put two more IVs in me, one on the back of each hand. It still hurt like hell, but I didn’t same reaction; it just hurt. They also put in a urinary catheter, to monitor the urine output on an hourly basis.
Let me tell you, the urinary tract was not designed for plastic tubing to be pushed in the wrong way. This, understandably, was the most painful thirty seconds this weekend. No more details, beyond noting that, after this catheter was in, and after these IVs were placed, I felt transfixed, like a butterfly pinned on some collector’s display case. While the immediate pain went away, I just didn’t feel like moving, and slept — such sleep that I got — through the night the position I started in.
The ICU is where they monitor you continuously. The machines, of course, would sound an alarm if there was something wrong. A nurse would also come in every hour or so, to jot down a variety of readings, and drain various containers, noting how much was in each container before pouring it out. Every few hours, they’d draw some blood to run whatever tests they do. Through the night, they put some five liters of saline in me, restoring my blood pressure to normal and bringing down my heart rate to something reasonable.
There was a surgery team briefed and standing by, in case the bleeding resumed significantly. The extra IVs were also a precaution: if there was a new leak, they could put a lot of fluid into me quickly, hopefully preventing a crash and giving them time to operate. One of the surgeons told me the next day that, thirty years ago, they’d automatically operate on patients with bleeding ulcers. These days, the medicines and technology are so good, they don’t have to in most cases. The work with the endoscope was sufficient for me.
There’s an awfulness in the alternate scenarios. I could have thought I was well enough to try to go to work; maybe I’d leave early, but I’d be able to take care of some things I hadn’t finished the night before. Those “sick passenger” announcements, to explain why the whole West Side IRT was stopped? That could have been me. Such thoughts encourage some forgiveness in subway delays.
I think the worst case scenario would have been throwing up, not realizing coffee-grounds vomit was a bad thing, and going back to bed to try and sleep it off. A couple of hours later in the ER, I was showing clear signs of shock from the blood loss, and, in this alternate world, I may not have been able to coherently use the phone in the apartment to call for help. There are occassional news stories of elderly people dying undiscovered, among their pets; Hercules the beagle and Mittens the cat would have to fight over “dinner”. Besides friends’ allergies, I suppose that’s a reason not to have pets, though I suppose a lemur capable of dialing 911 would be a good thing.
One thought: the modern hospital is basically a machine to provide 24×7 services. This may be a trite, obvious observation, but the systems that exist to do this are startling. There are of course shifts of doctors and nurses, rotating through the day, a tag team of medical professionals, that, in some sense, can be close to anonymous. I don’t remember the various shift nurses names, and I must have seen a dozen doctors. A few are important — my own doctor and the gastro-intestinal specialist, who was calling the shots — but most rotate through without their names or faces being remembered particularly well. A few stopped by during the weekend, and I did remember seeing them, but not always the context, except in certain cases: “ah, this is the one that put in the catheter.”
The informational glue that lets all this happen is the patient’s chart. The next team will look in on you quickly, probably give you an exam on their own, but most of the important information is on the chart, and is passed from shift to shift. A lot of writing happens. Small notes indicating blood pressure at such and such hour, doctors writing descriptions of the procedures they just performed, so the next shift will know what’s happened. My perhaps delirious metaphor is of meshing gears in an old clock, with patients as one gear, the medical staff as another, and that swinging/ticking mechanism as the chart. And for the most part, it works.
Saturday morning, I was moved to a regular room. The main dangers had passed, and the patch on my ulcer held up. I had two transfusions that day, in the afternoon and then late at night, putting two units of blood in me. This brought the hemo count from 23 to about 30. I’m told it put some color back in my face. After the second one, I didn’t get dizzy after sitting up in bed for a couple of hours.
They also started to feed me Saturday afternoon. I was on a liquid diet for the next three meals. A “clear liquid” diet, actually, which was composed of juice, tea and jello. There are other variations of “liquid” that include milk and soup, and something called a “brat” diet. It took a while to figure out that BRAT was an acronym, rather than something for pesky kids: bananas, rice, applesauce and tea. Harmless food. We skipped these varieties, and I was on solid food for lunch on Sunday.
People complain about hospital food, but I didn’t actually care. It was the first “real” food in a while for me. Yes, the quality could be described as “Salisbury Steak Day” at Southpark Elementary, but it was good to have to chew something.
Monday morning, they did another endoscopy, basically to check if the ulcer was indeed sealed up, and to take a biopsy of the surrounding stomach tissue. The biopsy will show if I have this particular bacteria that promotes ulcers. If I do, I’ll have antibiotics along with the Tagament. This endoscopy was much better than the first one. I hadn’t eaten anything the night before, so there was no goo in the stomach to get in the way, nothing the throw up while the scope was down there. It was close to painless, though I was drowsy from the sedatives through the rest of the morning. The ulcer looked fine; no new signs of bleeding.
It’s not clear how and when the ulcer got there in the first place. I could have had it all along, causing the minor stomach problems I had in March. The stress of the hepatitis flare-up last month and my taking aspirin the previous week — for minor back pain — may have caused it to bleed on Friday. But the aspirin itself could have done the damage; almost every doctor asked if I had taken aspirin, or commented on the fact. The head of the surgery team commented, “Do yourself a favor and buy namebrand aspirin next time, or take Tylenol,” as I have cheap-ass generic aspirin from Duane Reade. Generic aspirin apparently is less uniform than Bayer, and an undisolved bit, lodged in my stomach, may have burned an ulcer into the stomach wall.
Tuesday morning, they did a liver biopsy, to finally see the state of my liver after the jaundice last month. If I hadn’t been sent to the ER on Friday, we probably would still have scheduled the procedure, because of some odd numbers for the liver functions in last month’s blood tests. Since I was in the hospital anyway, seeing a gastrointestinal specialist, they did it at the end of my stay.
A liver biopsy involves sticking a needle into the liver, between the ribs. This hurt less than you’d think, certainly less than the urinary catheter. Pain killers were liberally applied, and the actual tissue extraction is a quick stab a short way into the liver. The stab caused me to convulse, as if being punched in the ribs, but there was little pain. They actually did the jab three times to get a good sample. Waiting for the biopsy, and watching them pull the various needles out of the sterile bags, was much worse than the actual procedure. Lying on your side for six hours, to make sure the entry point closes up properly, was perhaps the most annoying part. Yes, people sleep on their sides, but generally not with a large bandage underneath, and not fixed in that position for hours. The legs get tired quickly.
I’ll find out the results of this on Monday, on the follow-up with the specialist. The ulcer, while scary and dangerous, is a passing thing, a solved problem. Long term issues with my liver will be with me until they’re able to make a clone me to harvest organs (Medical ethics issues? When it’s between you and your clone, mano a mano? Ha!), though, hopefully, it’s sufficiently early to treat most problems with better diet and drugs. Or at least I hope so.
Besides writing the majority of this on my laptop — I’ve been dying for e-mail since Sunday, by the way, but the phone system seems to be a PBX that’ll fry my modem if I try to connect it — I spent my waking hours reading. I plowed through a small pile of magazines. “Time” and “Newsweek”: these are two news magazines you shouldn’t bother reading if you have the “Economist” in the same pile. The other news weeklies just look bad next to it. Someone brought “People”; make sure you vote for “Harry The Angry, Drunken Dwarf” for the 50 most beautiful people. I also had the “Utne Reader”, and I remembered why I gave up reading it a while ago: the articles are basically New Age fluff. “Discover” magazine was good, though. I read, with particular interest, this article about growing new livers in tubs. I think more funding for this line of work is needed.
The bulk of the reading was “The Odyssey”, the Fagel translation. It’s actually a quick read the second time around, much faster than when we did it in class. Odysseus is back in Ithaca, plotting vengence on the suiters. A book cart goes around the hospital floor, offering John Grisham novels, but who needs that when you have Homer? Actually, one thing about the Fagel is that he uses 20th Century colloquialisms, and these are jarring next to the more Homeric constructions. Gray-eyed Athena does such and such, and returns to Olympus, “Mission accomplished.” Ugh. He also seems to rely a great deal on ellipses to segue from one scene to another, which feels cheap.
Nintendo GameBoy sucks. I can’t believe people other than night watchmen buy these things.
I received a very nice Paint-By-Numbers set, something from an English lakeside. One associating that popped into my head was the Japanese film, Fireworks/Hana-Bi. I’ll leave this reference a mystery, to encourage people to see this movie. Film Forum, last I looked. In any case, I’ll hopefully paint this during my rest period this week. I had thought of re-mapping the color-number pairs, to achieve something psychedelic, but maybe next time. The English landscape doesn’t have any florescent colors, anyway.
I had the room to myself most of Saturday, but someone moved in on around midnight. He was in the next room, housed with an apparently crazed old man who may or may not have talked about the Kaiser stealing his yarn. He’s in the hospital to treat a blood clot in the leg. I suppose I would not have been favorably disposed to my roommate, given that I had this large room all to myself until _he_ got here, but I’ve concluded that he’s one of those Manhattanites that will coo at wicker furniture. He and a friend were talking about cruise ships, which to me cannot be considered without irony after David Foster Wallace’s “A Supposedly Fun Thing…” They’re theatre people, apparently, who, unlike me, are currently able to eat pepperoni pizza. We don’t get in each other’s way.
The roommate did do a neighborly thing on Monday, buying a newspaper for me when I didn’t have change. He also got some chocolates and a card for the nursing staff when he was discharged. Cooing at wicker may correlate with better manners, I suppose. I was the one who wanted to take an electric cattle prod to people slowly climbing the subway stairs, and I perhaps show less charity for that attitude.
I was discharged this morning, Tuesday. The gastrointestinal specialist came by, said I can get off the IV, and gave me prescriptions for something dealing with the ulcer and for iron tablets, to rebuild my blood supply. I signed some forms, and that was basically it. My mom picked me up, which was a good thing. I started walking quickly, in the usual New Yorker breakneck pace. I discovered this cost much more energy than simply padding around a hospital room, dragging an IV tree behind you, and hoping your gown doesn’t fall open to show everyone a full moon. I felt lightheaded quickly. I really do need to just come home and not move quickly for a few days.
Oh, I finally got a look at the last IV needle. Damn, it was 2 inches long. Stuck in me. No wonder these things hurt. I’m told this one in my elbow was relatiely small. The ones in the back of my hands were larger ones, though I didn’t have the nerve to look at them when those came out after the ICU.
Sign from god or not: the Simpsons rerun, that my roommate had on the TV, was the one in which Homer ate some fugu, and may have only 24 hours left to live. He of course does survive, and resolves to spend each day as if it were his last. The last shot, as the credits roll, shows Homer sitting in front of the TV with a box of donuts on his lap, happily munching away to the “Gracie Films” production company clip. In my mind, I’m making similar promises to live a bit more fully, though I fear I’ll wind up with a box of Krispy Kremes in my apartment. Inertia and fear are powerful things. Someone remind me to watch the sun set over New Jersey this weekend, please.
Anyway, that’s the long of it. Thanks to everyone for their support.