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Edited on Sun Feb-15-09 07:35 PM by Oak2004
My Valentine's Day ran more or less like this:
I woke up and immediately understood that to have postponed doing something about my deteriorating asthma in order to first deal with a broken tooth had not been the right decision (I was blowing in the yellow zone on my peak flow meter and getting breathless from talking.) But I decided to try one more postponement, so that I could get a desperately needed shower (I'm disabled and need help with my showers, and scheduling problems meant I hadn't had a shower for over a week).
I was feeling even more breathless after the shower. I made plans to call a cab to go to the ER. But first I took some peak flows and used my rescue inhaler. The rescue inhaler I had been sucking on like a hyperactive chain smoker lowered my peak flow readings, which were now in the range best described as burnt sienna in color. This was not a good sign. I thought about what my breathing does when I hit cold air, considered the relative ability at handling asthma attacks between taxi drivers and paramedics, and decided to change my planned mode of transport to ambulance.
The ambulance arrived. Good thing: the ambulance crew did bring along my wheelchair (it would have been even better if they had brought the chair cushion). Bad thing: the ambulance crew had me halfway out the building before I noticed I did not bring my jacket. I was wearing short sleeves. Vermont was being all February.
I got to the ER, was triaged, sat in the waiting room, and played mahjong solitaire on my PDA (power 85%). I was not unhappy as I agreed I wasn't in any immediately life threatening state (the point of going, after all, was to prevent reaching that state) and I want sicker people seen first.
The wait wasn't as long as I expected. I was evaluated by a PA who prescribed a short course of Prednisone and a nebulizer treatment. The treatment and first course of meds arrived promptly. Everything is exactly as I expected. I played more mahjong on my PDA (power 65%)
Enter the supervising physician armed with my medical history. "You've had a pulmonary embolism in the past, correct?" Yes, I say, after a botched gallbladder surgery and an even more botched recovery from the gallbladder surgery.
Clue insertion: a common precipitating factor in pulmonary embolism is abdominal surgery (which, it shall be noted, I had plenty of during the Time of Great Botchedness). Pulmonary emboli are deadly things (the odds of surviving one is worse than the odds of surviving a round of Russian Roulette). Doctors (other than Botch Specialists) don't like to miss PE in any soon-to-be-dead-from-negligence patients. And if one has been flagged as ever having had a pulmonary embolism, however easily explained and personally atypical it had been, however many years or decades or millennia ago it may have been, and then present with anything even faintly suggestive of a pulmonary embolism (like shortness of breath (see asthma, above)), non-botch specialists tend to order many many major tests to exclude the possibility that their patient might be one of the soon-to-be-dead-from-negligence variety.
First among the tests is always something called a d-Dimer test. It is very nonspecific, and many other conditions also cause a d-Dimer positive. Did I mention that I have Many Other Conditions TM?
The ritual d-Dimer having been performed, the next step is usually a CT scan. Cue IV nurse to insert a 20 ga. IV shunt in my vein for the CT contrast dye. Except, no human being that has walked this earth has ever inserted a 20 ga IV shunt in any vein that has ever occupied my body, and if one were to be found, it would probably signal the End of Days.
I'm big on body modification. On my upper arms I have multiple instances of a unique form of scarification created by skilled artisans using a device known as a PICC line. A PICC line is something that happens when, in the presence of a particular hospital patient, 80% of a hospital's dedicated IV nurses have been reduced to tears, and the remainder have taken up heavy drinking. Think of it as a kind of semi-permanent spigot attached to a patient's circulatory system, installed so as to prevent any more IV nurses from threatening to jump. While an active PICC line in a hospital patient is a very good thing for staff retention, It is never a good thing for an IV nurse when an ER patient he or she is expected to stick is adorned with this sort of scarification.
It took a while for the hospital IV nurses to put an IV shunt in me. The plural, nurses, is correct: every IV nurse in the hospital had a try at me until the last remaining one, using a portable ultrasound, inserted an extra long IV into one of the deep major veins of the human arm. Consider it a PICC line lite. (PDA power 45%)
At that moment, every individual in their late teens and early twenties on every ski slope in the Northeast fell off a cliff, broke several bones, and was transported to the ER in which I sat. Several dozen other individuals in my city chose that moment to take up a new career as crash test dummy, and were likewise transported to the ER in which I sat. And one momentarily unsupervised toddler chose that moment to explore exactly what can be done with a nail gun and a toddler hand, which caused one panicked and guilt-ridden father to throw said toddler (and of necessity, one nail) into the back seat of his car and transport the two of them to the ER in which I sat.
This bumped me from next in line at the CT scanner to, oh, about 87,125th in line. I played mahjong until the power ran out (about five more minutes). Then I observed my surroundings, largely because they were no longer avoidable.
There were some interesting variants on themes in the ER, which was beginning to resemble a football stadium in population, activity, and volume. Take my roommate, or rather, take one of the many many people to pass through my room while I waited to move up in the CT scanner queue. The woman was in her late teens, and had, predictably, been transported from a Northeastern ski slope to the ER in which I sat. Unexpectedly, she did not fall off a cliff. She was a fellow asthmatic, on vacation from Philadelphia, and from her asthma inhalers, which were also in Philadelphia. After three days on the slopes it became breathtakingly apparent that the trial separation from her inhalers was not going well. She received the standard Prednisone and nebulizer regimen, but as she had either never had a PE or she was brighter than I and knew never to admit to having had a PE, she got to go back to her hotel room.
There were two twenty-something food service workers from one of the resorts at the base of one of the ski slopes of the Northeast where teen and twenty-something skiers had been falling off cliffs. The two did not appear to have fallen off a cliff. One wore a costume looking like a cartoon Turkish Janissary, only not quite as believable. He accompanied another who wore gray pants, the uniform top of a sous-chef, and a dozen feet of gauze wound round his hand.
From my vantage point I could see the station where doctors, nurses, and PAs examined x-rays and CT scans. I discovered that, just as every snowflake on the ski slopes of the Northeast is unique, every collarbone that slid across those one-of-a-kind snowflakes and over a cliff is unique. Some appear to resemble collarbones. Some appear to resemble something like collarbones gnawed on by a Yeti. Some resembled something resembling collarbones with an unrecognizable bony structure sticking out where least expected. The rarest of collarbones resembled a delicate curvy collage of not quite recognizable bony structures.
At some point during this compulsory observation of my surroundings, I fell asleep. Only a fellow asthmatic can appreciate what it takes to put someone to sleep after a fistful of Prednisone and a nebulizer treatment, and while sitting in a cushionless wheelchair in a double room of a noisy, busy ER.
Finally, around the seven hour mark, it was time for my CT scan. I was rolled into the room where a technician armed with two saline syringes greeted me. After several hours waiting in the wings it was time for my very special IV shunt to strut its stuff and prove itself worthy to carry contrast dye.
The IV failed.
The technicians made a few phone calls to find out what to do next. The first was to the IV nurse. They were told that the IV nurses had given up on me. The next was to my doctor, and I was told he would meet with me back in the room to "discuss other options."
After another hour of waiting (as every teen and twenty something skier in the midwest fell off a cliff, was evaluated at a midwestern hospital, and was diverted to the ER in which I sat), a PA arrived to give me my option, which had lost its plural during my wait: they were going to check my legs for a DVT with ultrasound, and if it was clear, they'd send me home. I proposed a alternate option, that I just go home, and they insisted, reminding me that PEs can be very lethal things and that I'm an at risk patient. They said I was next in the queue and it would not be very long.
More time passed. A lot more time. In the bed next to me they brought in a seventeen year old skier from Madrid, Spain. I panicked, thinking that every teen and twenty-something skier from the slopes of Europe had fallen off a cliff and were being transported to the ER in which I sat. I was relieved to discover it was merely an exchange student who had fallen off a cliff in New York State, and had been transported to the ER in which I sat from a small New York hospital which wasn't a regional level one trauma center like the ER in which I sat.
Finally I couldn't take it anymore. My bottom was sore from sitting for hours in a cushionless wheelchair. My legs (which have lymphedema) had been pointed down for far longer than was recommended. I had missed not one, but two of my medication times, and was rapidly creeping up on the third. And I was wearing a Depends in dire need of a change. I am not a big fan of skin ulcers, and there is a point after which trying to rule out the unlikely invites the inevitable. I hit the help button, and waited, as teen and twenty-something skiers on slopes in the Rocky Mountain States fell off a cliff, rearranged their tibia, collarbones, arms, and hands, and were transported to the ER in which I sat.
After another six or seven hours, or maybe forty five minutes, of waiting a nurse arrived. "I want to get my Prednisone prescription and go home". Skiers in the Pacific Northwest began to plunge off cliffs, break body parts, and be transported to the ER in which I sat. Time swirled around me and consumed my thoughts like an army of Dementors. Alien water skiers on Europa ran into icebergs and entered UFOs in preparation for their journey to the Fletcher Allen Health Care ER in which I sat.
The PA arrived to try to talk me out of leaving. In the middle of our argument the ultrasound tech and a portable ultrasound arrived. I agreed to submit to the test, and climbed onto the torture rack they call a cot (I have an orthopedic condition that makes it painful to impossible for me to lay flat), removing my shoes as I did. The test was negative. I could go home.
I searched around for my shoes. I could find only one. I began to pace outside the room in frustration, when I looked up and spotted my other shoe on a high shelf in the nurses station area. Properly shod, I waited another century or millenia or eon or half-hour for my paperwork, checked out, waited an hour for the wheelchair cab, and, wrapped in a thin hospital blanket, rode the few minutes home in a vehicle which could have been used for flash freezing.
Finally, after midnight on the fifteenth, I prepared dinner for myself and my Valentine, who had patiently waited for me: my pet parrot, sick himself with a respiratory infection. We shared a plate of pasta, ate the strawberry shortcake I had purchased specially for the holiday, and crawled into bed.
Happy effin Valentine's Day.
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