Friday, March 19, 2010

10 days in the hospital

"Don't worry; be happy."

(Later I realized it was 11 days) Sunday morning I was showering, thinking about Sunday school and having deep thoughts like wondering if we would sing Happy Birthday to our teacher who just celebrated his 84th birthday. I began having some abdominal pain and when I finished showering, told Leslie I was going to skip church – which was okay, because I’d been in Houston the previous four days and spending the morning with Leslie sounded good. The pain continued to worsen and in a few minutes I told her I thought what I really I needed to do was go to the ER. So we saddled up and headed to Baylor. I checked myself in while Leslie parked and shortly we were headed into the labyrinth. The pain was considerable and much of what happened from here on is a daze and blur of disconnected events and memories:

  • Abdominal exams that I don’t think were positive for rebound tenderness.

  • Several times people asking the fateful question of does the pain go into your back?

  • Gagging on the NG tube insertion and indicating that sure, I’d rather have the stiffer tube, for which I paid a price down the road.

  • The surgery resident saying that she thought they needed to go ahead to operate and me saying, no, Dr. L would decide on that and the resident arguing with me, saying that Dr. L. only did colorectal surgery and me saying, we’ll let him decide what to do. Now I wonder how it was that Dr. L agreed to take care of me as he really is a colorectal, not general surgeon. Regardless, I’m enormously grateful.

  • I kept thinking that I was going to end up diagnosed with cancer and have an ileostomy. But why was this all so acute? And wondering why no nausea and vomiting? Why no rebound? Thinking I knew enough to know that I didn’t know what was going on except it was bad – amazing pain with little relief from morphine. There was no doubt that I would end up in surgery.

  • I remember saying to Leslie that I was glad she and I are current – no love unexpressed, no secrets, nothing undone.

  • It would be a mistake to think that the main thing happening was fear of dying or cancer. Which is not to say I’m unafraid to die. I don’t know, but we’ll see. Mostly I was thinking about Leslie and me; I was thinking about David and the joys and difficult things we’ve shared; wondering about the etiology of what was going on; wondering how much impact all this would have on the rest of our life together; glad that Leslie is retiring in a few weeks; being grateful that we’ve lived as hard and well as we have.

  • CT scan and the tech saying “Try to lie still.” “Uh-huh.”

At some point – probably Monday evening – Dr. L was standing by the bed saying that he needed to operate that evening. I was ready.

I know this is out of order and there are probably other mistakes and certainly there are omissions, but this not about the order of battle; it’s about the battle – two different things.

In recovery and critical care I was in a lot of pain, which the nurses and physicians managed very well. In fact, everything went well. I especially remember R, who had high levels of clinical excellence, confidence, and kindness. I felt very connected to her. I remember telling her something I learned in hospice – what a great thing it is when you can entrust your body (or that of a loved one) to someone with high levels of qualities like these.

The diagnosis as I understand it now (better Dx in a few days) was obstruction caused by a torsion of my intestine. Why it happened in the absence of adhesions or tumor is not known.

I went from the unit to the GI floor and again the care was good except maybe the first night (not sure on this – I could be thinking of my 2nd night in the hospital) when I couldn’t get the nurse to just bleeding tell me what she was doing/giving, even after I’d asked her to tell me. Every time I had to ask how much of what she was giving. I viewed it as controlling and marginalizing – “Your pain medicine” doesn’t cut it. But overall ...

  • L was as competent and kind as R. She also quickly established the sort of collaborative relationship that R in the unit did. Her focus was always on how I was doing and what was best for me.

  • M was always right there, always patient, always ready to explain and to offer encouragement – a good man to see coming in the door late in the night when I’m freaking out on Ambien, seeing malevolent colors and falling asleep now and then only to have truly bad dreams like walking into a dark room where I knew there were black mambos and having to keep on going or dream waking to realize there’s a lion in the bed with me, realizing it can rip my guts out with no effort at all. Calling for help and spending the rest of the night with lights on.

  • M (the tech) who took stellar care of me, was kind and gentle, and who was always ready to seek opportunities to serve and learn – not exactly universal qualities.
And what can I say about Dr. L? He is a well-known surgeon (Chief of Colon-Rectal Surgery) with a reputation of brilliance. At some point I used the word competent, which is a compliment, but still, sorry, man. I’ve been around for awhile now and have some thoughts on surgeons. In many cases, all they can do is the surgery. I mean, it’s a Big Deal to cut another person’s belly or chest open and fix whatever is wrong in there. So competence or even excellence (as in an even higher level of skill or advancing the science) in that is often what you’ll get and it’s enough. A higher level is that plus skill in managing or preventing symptoms related to the surgery, because, you know, it hurts. A still higher level is all that plus the patience and kindness to support and explain and take precious minutes from finite time to do it some more. In this work there is never enough time, never enough resources, never enough anything. So, for your excellence, skill, and time, brother, thank you. And I want you to know that I too work hard to get it right and to be kind and patient. Hahaha – at one point he says exactly what every Cambodian tuk-tuk driver says, “Don’t worry; be happy.”

Leslie, my wife, the center of my life, my rock, my partner - always there, a true hard-charger.

I called Jeff, croaking around the NG tube, telling him what was going on, including waiting on pathology re esophageal lesion. He drove on down from Tulsa area “to see your face.” I don’t remember whether it was on the phone or when he was in the room, when he said, “Well, hell, the worst that can happen is you’re gonna die (and you have to that anyway).” Oh, good one man. I cannot imagine a more comforting thing to hear. “… know the truth and the truth will make you free” John 8:32. He stayed about 2 hours; it was a wonderful visit.

The pain was well managed, thanks to dilaudid via PCA and other meds via the nurse. I recall so clearly long ago several hospice patients who got great relief and some euphoria from dilaudid. I thought then I’d like to try it some day. It wasn’t that great for me, though. Maybe if I’d been despairing I’d have gotten more than analgesia. Larger doses via the central line in my neck (!) always gave me a jolt of nausea, but I learned that that passed in minutes, so quit asking for Zofran. Photo: CK looking good with on day of discharge

John came in for a few minutes. It was pretty emotional as he’s one of the ones who thinks I’m bullet-proof, not to mention the love and his own struggles.

A day or two post op they took out the catheter. Having it in wasn’t bad, but having it out was better. It was also good in that I was forced out of bed to stand swaying beside the bed urinating into the urinal. I was so loaded up on fluids that I was peeing every 15 minutes, literally, which got old after just a few hours. It was around this time that they gave me Ambien, to which I had the previously described bad reaction. Small wonder; other factors in the bad reaction included no food for days, poor sleep, surgery, anesthetics, dilaudid, the bleeding NG tube, just the whole hospital scene.

Ice ax up and across a steep snow field and finally standing alone on a high col (~12,000 feet) in the Wind Rivers, two days since I’d gone off trail or seen another person (and three days since I’d seen a tree) and nobody ahead of me for the next few days, glaciers all around, knowing then it was epic and now in this hospital room, thinking I may never be in a place like that again and grateful that I got to that col.

Finally, while Bruce B was in the room (“He can stay, he’s used to this stuff” - or not) the NG tube was taken out – unnghhh! Immediately I was feeling better, though my throat hurt for days (and still does). That evening I had a very good visit with Tom – thanks for coming by, man.

Nora and Anthony and Julio came to see me. Anthony and Julio were pretty subdued and later, while the nurse was taking out yet another tube I was telling Leslie about that. She told me then that Dr. B had died a few days before and maybe the boys were thinking the same might happen to me. My first response was to smile and feel glad about his life. What a man. 80 years old, motoring around the clinic all bent over like he was, going up the ladder in the pharmacy, taking care of patients almost every Saturday, focused, tough. Later I cried several times – the first time when I was listening to Oh God Our Help in Ages Past on the iPod. Though we were not close (I’m not a Saturday guy), Dr. B was always an inspiration to me. I know Bobbie will miss him deeply.

Finally all the tubes are gone and they’re wheeling me out to meet Leslie at the patient discharge place. Spring came while I was in the hospital, and though I didn’t really enjoy the ride, still it was pretty and green. Home! Photo: the view from bedroom window (cedar waxwings and robin redbreast)

Wednesday, 10 days later I awoke at home next to Leslie and listening to a mockingbird’s sweet song – followed by a cardinal's and in a flash of red, Mr. C landing on the feeder. I doddered outside to put the seeds on the feeder at our bedroom window.


Alison said...

Hope you're all recovered and doing okay now.
Best wishes to you :)

CK said...

Hi Alison, As you can see, all is well. No cancer, home, Leslie retiring. Best to all.

Mandela said...

Welcome back! Must have been quite an ordeal you went through - but it sounds like you're taking it all in stride. I hope writing helps you to heal.

CK said...

Mandela, Thank you. I'm stronger every day. I hope you're well.

Anonymous said...

Charles, you and Leslie will always be inspiration for me to really LIVE. All the best to you during your healing at home. Love to Leslie too. - ali

Anonymous said...

woah!!CK, best wishes from me and the kids. Phil

CK said...

Thank you guys. A message from "Oriental Sweet Lips" sounds pretty hot - until you see it's signed Phil and then understand that Oriental Sweet Lips is a type of fish. Oh well.

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