Wednesday, August 4, 2010

Emergency, Home Care and Hospital - Trials and Tribulations

I thought I would give a detailed accounting of what I have been going through. I have been blurting and noting on here and Facebook so that friends and family will know what is happening but I think a more detailed account is in order. David, if you are reading this, please read to the end. I am hard on you, but you have to understand my perspective.

First, is how I got here. A litany of bad eating habits and so forth led to the Gall Stones that almost clogged my bile duct on Friday. I must have had a mild attack last weekend and was thinking of seeing my Uncle who is a retired Internist to see if a more detailed examination was in order, but some aspirin made the pain go away, but did not put off the inevitable. My reluctance to go was based not on a fear of hospitals, but a fear of financial ruin if I needed surgery which unfortunately has happened, but more on that later.

Anyway, on Friday, the pain became so intense I was convinced I was having a heart attack. I had fallen asleep being very tired after getting home and it woke me out of a sound sleep. It felt like someone was standing on my chest and I couldn't catch my breath so I called 911 and the fire people came and then the ambulance. My nephew, who adores me, was so worried and ran out to make sure the fire and ambulance people could find my trailer among the many in the park. The fire people are trained in primary first aid, somewhat on a level more detailed than we are at work. They brought Oxygen and an AED (Automatic External Defibrillator) which thankfully was not needed. The EMT's brought more sophisticated equipment and asked me the standard questions and I answered them to the best of my ability. Since it was apparent that I was still ambulatory, I walked out to the ambulance. Such was my need that the fact I was in my underwear never entered my mind. I was hooked up to an EKG and it showed a normal sinus which made me feel better. But there was still something wrong and I needed to see someone.

My nephew rode along with me in the ambulance, riding up front as we went to St. Clare Health Center. St. Clare is one of the St. Louis Metropolitan Area's newest medical facilities with a different take on how room care is provided. More on that later. In a wonderful twist of irony, the Hospital is built on a former golf course. (For those of my loyal readers who do not live in the States, the association of Doctors to the playing of Golf is almost ubiquitous. It seems a requirement of medical men to have a set of golf clubs in the office. Thus the irony). The hospital swallowed up all of the grounds of the course, so it no longer exists. The residue has new McMansions and a retirement home that has been built on the remainder. St. Clare is run by SSM Health Care which is descendant of hospitals run since 1872 by the Franciscan Sisters of Mary in the St. Louis area. Primarily in the St. Louis area, they run 15 acute care hospitals and 2 Nursing homes in Missouri and three other states. St Clare is named for a Catholic Nun who, being born of nobility, gave it all up for helping the poor and downtrodden in medieval Europe in the early 1200's on the Christian Calendar. But I digress.

I arrived in the emergency room having received two doses of Nitroglycerin. This had the effect of lowering my blood pressure as it expanded my blood vessels and really made me feel woozy. After a preliminary examination by the Emergency room Physician, I was x-rayed and then given an ultrasound examination. The questions being asked by the techs led me to believe that the problem was not cardio-vascular in nature, but to do with the liver and gall bladder. After these examinations, my brother arrived with my mom and the whole brood was there. Since the examinations were showing problems there and my liver enzymes were bad, I was admitted and sent to room 3212. A nice wheelchair ride let me arrive at my room at the end of the hall on the 3rd floor.

Now a word about the care and feeding of the patient. One of St. Clare Health Center's philosophies is to really care for the patient. The traditional Nurses station is no longer there, with the nurses put closer to the patient. Each room is a single suite with observation windows so that the nurse doesn't necessarily have to be in the room to observe the patient. Still the nurses are short in number so the call button wasn't necessarily answered immediately, but none of my needs were life threatening and I can understand they were busy. The food was excellent and I partook of a grilled chicken, corn, and green beans with some jello and 2% milk for dinner after I arrived. My brother and the brood left and I spent the night in somewhat of a sleepless state. My brother had brought my trusty netbook and with that, I had access to the outside world through the Hospital's rather undependable Wi-Fi system. Out of my visit, that was the only drawback as I had hoped to play some games with Stephanie only to find out that the game site we play on, Pogo, was one of the sites the Hospital found objectionable and had blocked it. I really think that unlimited Wi-Fi access should be a right if one is incarcerated in a hospital with no link to the outside as our computers have become such a part of us in this day and age.

I had been talked to by the surgeon and I must not have heard or misinterpreted the fact that my surgery was scheduled for Saturday because I was told that such was the case which left me little time to prepare for said surgery mentally. In the end I think this was a good thing in that there was little anxiety present for the surgery. All I know is that they came in and were there to start me down for the surgery. The wonderful thing is that I didn't have to get out of the bed. The whole kit and caboodle was wheeled down to the operating area. Contacting friend and family on such short notice proved difficult as no one answered the phones and I managed to get my Uncle to let him know, so that at least I talked to someone. This led to something rather unfortunate later which I will detail.

One thing that led to me not being anxious was I know that Stephanie was there for me. Stephanie is very special to me, my best friend in a lot of ways. What has happened over the years is that whenever I get into a situation where I feel anxious or bothered, the name pops up and I know she is there in spirit and that make me feel better. I had two prep nurses to get me ready for my surgery both of whom took me down from my room to surgery. One was named Stephanie and God forgive me I forgot the other one. Stephanie was pregnant and starting to show, but it was nice to know that my Stephanie was there in spirit. I also know that Stephanie has had to go through far worse in Surgery than I had to so I know that what I had to go through was pretty much nothing in comparison.

My procedure was Laparoscopic in nature. The surgery is performed with a minimum of invasion by poking a Laparoscope (which is a CCTV on a long tube) through the Belly Button to see inside the abdomen. Carbon Dioxide or air is pumped in to expand the cavity to see the organs. Three other small incisions are made to insert other instruments which the surgeon can see through the Laparoscope and the offending Gall Bladder, Appendix or other such organ removed by the procedure can be seen and removed.

I got down and a man next to me was in recovery having had his appendix removed. Walls separated us so I had no idea how he looked but I could hear his semi sombulant ramblings as I was being prepped. I thought there was going to be a lot more shaving, but I didn't have to endure any of that indignity, as least as far as I can remember. I was transferred to a surgical gurney and wheeled into the operating room and that's all I can remember. From subsequent reports, I was told I am an entertaining patient as I was singing the "Paul the Octopus" song along with some others, but for some reason that one has been going through my head lately. I was awake and in recovery and doing fine. I was back in my bed and after a few minutes of waiting, I was wheeled back up to my room.

Now I got back and I slept off and on, but the unfortunate aspect of not being able to get hold of my brother had an effect on him. He didn't want to leave me. I wasn't dying. But apparently he thought I was. He's always been so sensitive about things like that. I got a short respite when I sent Mom home because she would not stop talking. But he returned and took up residence in the room.

One of the special things about the room was the fact that the furniture converts readily to sleeping places. The built in couch in the wall, a small love seat, plus a recliner by the bed all can be slept in, one way or another. Now, I needed sleep, which I wasn't able to get, but apparently he was since his and the whole brood's snoring kept me awake for most of the night. Finally Sunday morning, I had to put my foot down and send them out of my room so I could get some much needed rest. I got about three hours and when I woke up I couldn't go back to sleep, so the whole brood came back in and would not leave. Such was the off and on for Sunday.

However, there were benefits. One of the benefits of this was the fact that I didn't have to bother the nurses for a lot of things. Going to the bathroom was an experience since it was difficult, if not impossible to get up so I had to use other means. Upon being informed that if I didn't urinate, a catheter would be employed, my body responded in timely fashion. The means employed was a bottle shaped for strictly that purpose. This has replaced the bedpan but it still has some drawbacks. In the state I was in, I could not hold it very well and not being able to see the area in question, I was concerned that I was tilting it to where the offending fluid was going to leak out. So my brother became the "Piss Boy" (as I was not going to give such a duty to his wife or my nephew for reasons of modesty) and thus the inevitable jokes ensued. One may remember the innumerable scenes in Mel Brooks "History of the World Part 1" about the French Revolution where his character was both King and "Piss Boy" who collected the urine of the male nobility. I figured if he wouldn't leave, I would use him.

I guess that in a way, he didn't want to leave because he cared, but for some reason it was hard to fall asleep with them in the room. I hadn't had a problem like that before, but then I have never been operated on before. It bothers me to a certain extent that they didn't leave, but then I didn't have the heart to tell them to leave. I know now why some hospitals limit visiting hours. It is for the benefit of the patients.

Time passed and Sunday rolled around the clock of the day. My surgeon came by to examine my dressing and the first appearance of what I shall call the "Red Alien." Since I am lying on my back, the blood pools in my belly button and upon pulling it out the clot has molded its shape to the belly button. The appearance is somewhat similar to a member of the anatomy which is strictly apparent only on the male of the human species. The surgeon remarked that it looked obscene and that was due to its appearance and not to any complications of the surgery. However, he pronounced me fit to leave and released me to go home.

Finally I could leave the Hospital. I received my instructions and prescriptions. I was free. Unfortunately, another problem ensued. My brother has three cars. The Ford Taurus Station Wagon is unregistered and thus not legally drivable, but he had chosen to drive his low to the ground Dodge Neon to the hospital, which in my state, being unable to bend over would not have been able to get into. So, my ride home had to drive all the way back to his home to get his van, which sits higher off the ground, in order to get home. Thus I was delayed getting out of the hospital even further because of this. I was preferring the Hospital and wished I could have stayed a little longer because the care was so good and the nurses were nice. I still miss the room.

I went to Walgreens and got some supplies along with my prescriptions. A digital thermometer, some gauze for changing my dressing, some low dose aspirin, some absorbent tampons to use for dressing and absorbing the blood and some band aids to replace those given me at the hospital. I told my brother I would pay him back when I got paid Tuesday.

We got home and all was chaos. My bed has seen better days and the mattress is overdue for replacement so I was going to take up residence on the bed my mother never uses to sleep on because she prefers the couch. However, in order to do so, I had to move my TV in the front bedroom which is designated for my Mom, but which she has used for storage since she moved here. I can't lift anything, so I had to instruct everyone to move things to order. No one really follows my requests but everything did eventually get moved into place. I have a much more comfortable bed which being set higher off the floor was better able to accommodate me in the state I was in.

Changing the dressing I had to do myself. I know how hard it is to get care and to be cared for at home. My Mom is hardly in the best shape to help me since she is 82 and practically an invalid herself. I wouldn't trust my brother, his wife or son to do it because they didn't react well when they changed the dressing in the room. So I have to change my own dressing which was an experience and a half. The first night I changed my dressing, the Red Alien again appeared and I had to wonder if I was losing too much blood. However, I think I did a fairly good job with the first night changing the dressing.

Last night I did some shopping, and I exerted myself, which I probably shouldn't have done but I needed to get a couple of things like a fan for my room, which I can never seem to get cool enough and I am reluctant to turn the Air Conditioning down any more because of my mother's constant complaints of being too cold. I can understand her at her age because her body is more cold sensitive, but man she shuts off the AC and only turns it on when it’s in the 90's. It’s a problem which I will solve in the next month because I will move her into the bedroom I have which I hope a lot of her stuff will also follow. That might kill two birds by granting her a larger room and getting her closer to the bathroom which will help her there.

I changed my dressing last night and again, the Red Alien made its appearance although a little smaller I have noted in retrospect. I have become adept at the dressing change although tonight I was a little off and may have to redo it since it’s sitting a little too high. Tonight there was no appearance of the Red Alien, so I think my belly button has healed to a certain extent. I still feel a little "off." It will be another couple of days for me to return to work so I can be OK there. I have lost no pay because my boss gave me the option of using my vacation time to cover it. Now I have no vacation, but at least I have the money. I hate America. At least I should have some paid sick time.

When all is said and done, this has been a wakeup call in a lot of ways. I only hope that what happens here is a permanent concern about my health rather than something that will fade. I have a penchant for embarking on changes in my life, only to find the task daunting and reverting back inevitably to the old ways. Perhaps this will be a change.

I hope this look into my life was not too intimate. The facts are still fresh, but can be distorted by the fact the anesthetic can and does induce changes in memory. I might have been too hard on my brother. He has always been there for me and I do love him. Although at times he can and does induce stress in my life I can't afford to have.

I want to thank you all for the prayers and good wishes. They helped in a lot of ways. I have nothing more to say at the moment so I will close this tome. More details to follow later as I begin a new road to discover the life of having to now pay for my medical procedure without medical insurance. That is going to be an adventure.

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I am interested in CNG vehicles because they are good for the environment and aren't powered by dead Marines. I still have a little hope for the world. Read the musings and enjoy.