The seizure

The Thinker by Rodin

Sorry Razor fans for being a bit remote this week. Life has taken me places I didn’t want to go, like Bay 18 at Fairfax Hospital’s emergency room and subsequently room T275 Bed 2. The only good part of this story is that it wasn’t me in that hospital bed. It was my wife Terri. Last Saturday around 3:30 p.m. she had a seizure.

I was down in the basement putting a second coat of paint on the walls of our rec room. I was subliminally aware of my wife upstairs from her humming and the sound of her pushing one of those Swiffer cleaner mops across our kitchen floor. Then abruptly I heard the loud sound of a bellowing seal, or so it sounded. “Whoop, whoop, whoop,” was the only way to describe it, sounds of a body parts hitting solid walls, then a huge thunk as she hit the floor. I dashed upstairs to find the door barred by her body. With considerable force I pushed her body out of the way and wedged myself between the door and the wall. I found her face down on the floor, twitching, something like bile coming out of her mouth and incontinent. She was bleeding from a cut above her left eye, and the swelling was rapidly turning her forehead into a grapefruit. If I hadn’t been on heart medicines, I might have joined her on the floor myself from the shock.

I remembered some advice to take deep breaths, then quickly reached for the phone and dialed 911. Did she have a heart attack? She was breathing, sort of, through a small opening in her mouth obstructed by her tongue. Her face was turning gray. The operator had me turn her on her back, not an easy maneuver in so small a space. To facilitate her breathing, I found I had to wedge some fingers into her mouth. She was getting grayer and her forehead was growing larger.

Amazingly, within five minutes two ambulances and a fire truck were at our door and a squad of EMTs was in the house. They asked questions about her medical history (no previous history of seizures), medications she was on (I babbled some of the few I remembered, but she is on about a dozen), her conditions (quite a few there too) while they stuck things into her arms, put an oxygen mask over her face and tried fruitlessly to bring her to consciousness.

“Take her to Fair Oaks Hospital and I’ll follow,” I said knowing she preferred it to Reston Hospital. She stabilized a bit. I gathered her stuff, failed to find her list of prescriptions, grabbed my cell phone and began a comedy of errors. I followed the wrong ambulance down the parkway, which abruptly turned around. Ohmigod, I thought, they must be taking her to Reston Hospital because they can better treat something that had just developed. I did a U turn with the ambulance which cleared all the lights while I waited at them. At Reston Hospital’s emergency room, I found an ambulance parked outside but they had no record of her. I ran back to my car and drove as fast as I could back down the parkway to Fair Oaks Hospital’s Emergency Room. No, she hadn’t come in there but since it was in the Inova network they checked Inova’s other hospitals. The ambulance had delivered her to Fairfax Hospital fifteen miles away, Bay 18. The EMTs could not reach me because neither of us had thought to provide my cell phone number. Despite the heart medicines my heart was racing, but the traffic wasn’t. I was stuck in stop and go traffic on I-66, finally showing up at Fairfax Hospital’s emergency room around 5 PM, three emergency rooms and ninety minutes or so after the incident. Some pissed off looking employee at the emergency room desk finally gave me a sticker to go into the emergency room, perhaps because I knew her room number.

She was groggy but conscious and tethered to the usual medical equipment. What the hell had happened? There were no obvious answers. She just remembers waking up in the ambulance and had no memory of the incident itself. The important thing was that she was alive and seemingly stable for the moment. The nurses were working on other cases, but I did meet the EMT who explained why they took her to Fairfax Hospital (better heart care). Nurse Kelly came in occasionally, and eventually we met the emergency room physician. The doctor agreed with my diagnosis (she had a seizure) but we had no idea what caused it or if it might recur.

Six hours in the emergency bay eventually landed her in a bed in a hospital room on the second floor of the main hospital, where other people with swollen eyes seem to congregate. The swollen eye was a red flag to the emergency room personnel: had I been beating her up? She was asked this repeatedly. (“It’s okay to tell us. You will be safe.”) They even asked her again while I was in the room. It must happen so often that is it unusual to come in with a black eye from a simple fall.

Two nights in the hospital, lots of expensive tests, scans and blood draws. No concussion, no blood on the brain. That was good. Concerned phone calls and emails to and from family, including our daughter in Richmond who came up Monday after getting a pass from her professors. Getting lost in hospital corridors and in the parking garage and getting dinner from a vending machine. Arriving home around midnight to a freaked out cat, but at least one who had been fed. Our friend Mary came over, cleaned up the mess and put things away. The force of my wife’s impact on the floor dislodged a light globe in the basement. Sunday involved trips to and from the hospital, phone calls and emails, and eventually flowers and cards. My iPad let her communicate with far-flung family and friends.

She was released Monday afternoon and since then it has been mostly a round of doctor visits and more tests. She was told not to drive, feels reasonably weak but otherwise seems normal, just with a face that looks like Elphaba Thropp from Wicked plus a black eye that would make a prizefighter proud. And so it will go for most of next week or two. She did make it to work for a few hours on Thursday only to discover that she really wasn’t well enough to be very productive at work.

There are no answers so far, and there may never be any. We are not sure when or if she can drive a car again, or if her life will be fundamentally changed from now on.

I am grateful to have my daughter home for a bit. She ferried my wife around to most of her appointments, which let me get to work and try to keep up on my busy agenda there.

Life feels more fragile, more ephemeral, more due to the whimsy of an unseen god that is toying with us. This is an incident we hope will work itself out in time and normal life may then resume again. Or not.

No answers. Just ambiguity.

Mind games with myself

The Thinker by Rodin

It was just over three weeks ago that I was hospitalized and here I was in a hospital again. The emergency room had changed. Last time it was Fair Oaks Hospital, this time it was the smaller E. R. at the Reston Hospital Center. At least this time I did not black out and break my nose. This time I was in physical therapy when I felt dizzy and asked to be laid flat. Donna, my physical therapist immediately started taking my blood pressure and felt my clammy skin. Within a few minutes, she had called the paramedics. Within half an hour I was in the Reston Hospital Center’s Emergency Room, my vitals being constantly monitored, the compulsory bag of saline already dripping through a tube into my arm.

This time though I was getting oxygen right away. My number was 85 when it should be close to a 100. My blood pressure trended toward the lower side. I could stand up briefly for some X-rays but most of the time I wanted to be horizontal on a gurney. I kept wanting things to improve, but it seemed no matter how much pure oxygen I was breathing my oxygen levels only rose modestly and my blood pressure stayed low.

Earlier that morning I met my cardiologist. She detected an abnormal heart rhythm that hadn’t been there three months earlier. She took my blood pressure lying down, sitting and standing. She ordered a Doppler ultrasound of my carotid arteries. And she sent me home with a heart monitor and a journal where I had to describe my minute-by-minute activities for twenty-four hours.

Why I felt dizzy while in physical therapy is something of a mystery, but it may have had something to do with simply explaining to Donna what had happened earlier that day with the cardiologist. It was weird to be there doing stretches with probes all over my chest and box hanging off my belt. In any event, some mental wire tripped in my brain and told my heart to slow down when it needed to speed up and that triggered the dizziness.

Yesterday’s afternoon and evening events had a surreal feeling to them. I was being ferried in an ambulance and trying to talk through an oxygen mask with a helpful female EMT. Most surreal of all was lying on my back in an emergency room again constantly moving between lucidness and feelings of being faint.

My wife eventually showed up, having first checked for me at the Fair Oaks Emergency Room. “Breathe deep,” she is telling me and I try. Bring in the full rush of pure oxygen and exhale but it seems to be of limited use in elevating my oxygen levels and pushing up by blood pressure. By now three weeks ago, I was nearly back to normal. Today I was still wondering if I would just pass out. If so, would I go into cardiac arrest? Would I simply die there in the Emergency Room? It seemed unlikely but holding on to consciousness seemed a challenging willful act. Breathe in. Breathe out. Don’t panic.

I learned a few things from the experience. At some point, worrying about what is going on becomes impossible. You have more immediate things to do, like stay in the present, breathe in, and breathe out. When I lapsed into moments where my oxygen levels hovered close to normal then I could worry about things. Was I skipping heartbeats? It rather seemed that way but in actuality, every third beat was not so much skipped as double-repeated. Had I developed heart disease? Was there some sort of medicine they could give me to make me feel normal? Curiously, no one wanted to administer any medicine. My cardiologist instead wanted to finish the complete twenty-four hour test, which left me lying there with oxygen gently hissing up my nostrils, mostly feeling lightheaded and more than a little helpless.

Hospitals, like the Army, runs on its own time. Hours pass in E.R. More hours pass in a staging area where for an hour or so I feel better and I eat a Wendy’s Grilled Chicken sandwich that my wife had fetched for me. Finally sometime after nine o’clock I am wheeled upstairs to a private room where many people of color are looking into my eyes, adjusting saline drips, carting me downstairs for a CT scan of my chest, and helping me to the bathroom.

A hospital night passes uncomfortably. I asked them to come in as infrequently as possible so I could sleep. One might was well ask the tide not to come in. A battery monitoring my vitals fails and must be replaced. Despite measuring my blood pressure and oxygen levels constantly via telemetry, every few hours they feel the need to wake me and take these reading manually. I awkwardly try to sit on the bed and pee into a urinal bottle. This alarms them and they rush in because my heart rate spikes to 140. Sleep is sporadic and fleeting. In the morning, I still feel weak and dizzy perhaps in part due to lack of sleep. My bag of saline is nearly empty. A walk down the hall with a nurse has me feeling wobbly-kneed.

Back in my room, I sit in a chair and try to breathe without the aid of oxygen. I still feel weak and lightheaded, but I really want to go home today. Suddenly, the cardiologist on call arrives. He has good news, of a sort. Your abnormal heartbeat is actually not dangerous and is not related to your symptoms. I do not have heart disease. Basically, I am fine. I was just having vasovagal symptoms again. My brain was telling my heart to slow down when it should not. The good news is that most episodes can be controlled through awareness and proactive strategies. My salt level is low. Eat more salt. Drink a lot more fluids. If you feel faint, get horizontal quickly. Ask for water. Train yourself not to panic. It will pass. If episodes recur frequently enough, a beta-blocker might help.

Maybe he is right. I ask the nurse for a jug of water and keep drinking glass after glass. I do start to feel better at last. I take a walk down the corridor and feel okay, but a little lightheaded. Finally, I am discharged.

Was my hospitalization necessary? It is hard to say. My physical therapist did what she thought was prudent, and I cannot say I could have made a better judgment. I did ask to lie down. I did not know I was sodium deficient and at the time, I did not feel dehydrated.

Still, the episode was undeniably scary and in retrospect probably closest I have come to meeting my maker prematurely. There were times in the E.R. when I felt certain I would lose consciousness but at least my wife was around. What if she had not been there? The E.R. people seemed to have more important patients than me. A baby two-doors down cried with a piercing sound that left no ambiguity about how he felt. My wife reported a man in another room who is passed out. He appears to be dying.

Later today after being discharged, I drove my car home from the physical therapists where it had sat overnight. I still felt a need to breathe somewhat deeply. I got it home okay but some part of me wondered if I might feel faint on the way home. I also wonder if I can convince the limbic portion of my brain to stop sending false signals to my heart. A crisis eases. Yet, an ambiguity hangs over my life now that was not there before along with feeling my mortality more sharply than ever. I wonder if my life will ever be the same again.

Hospitalized

The Thinker by Rodin

It was more than ironic that less than twelve hours after writing my last post on violence related to recently enacted health care legislation, I would be putting our health care system to the test. After posting Wednesday night I readied myself for bed. On my way to the bathroom, my right toe grazed the side of the door frame. It hurt but I have broken this toe before. I hoped it wasn’t broken and shuffled off to bed.

The alarm woke me at 6:30 AM. I optimistically assumed I was good enough to go to work, so I shuffled to the bathroom to shave. It sure hurt walking. I realized I had injured my toe more than I thought. I figured a couple of Ibuprofens would take care of the pain. Since I injured the smallest toe, I knew there was nothing a health care provider could really do. Sometimes they are wrapped to the adjacent toe for support, but aside from elevating, icing and trying not to use the foot while it is painful nothing else is done.

What I did not expect was the incident of vasovagal syncope I was about to experience. Since it hurt to put pressure on the right foot, I put it on the left foot instead but the right foot still throbbed painfully. I tried to shave but started sweating and felt dizzy. Feeling I might fall, I sat myself on the toilet then blacked out. My forehead and my nose made a sharp contact with the side of our bathtub. Blood poured out of my nose, into the tub and over the floor. When I regained some semblance of consciousness, I whimpered to my wife, still asleep in bed.

Both the bathroom and I were a bloody mess. She wanted to call an ambulance but a few minutes later I was capable of staggering outside to our car on crutches. I was sweating and shaking on and off. I often felt short of breath. Kleenexes were stuffed up my nostrils. She made the short drive to Inova Fair Oaks Hospital’s Emergency Room which fortunately at 7 AM had a completely empty waiting room. I staggered in on crutches, collapsed into a wheelchair and within a few minutes I was wheeled into a triage room. Ten minutes later we were in Emergency Room 7. An emergency room physician was shining lights in my eyes while I stumbled through the various procedures in a shivering and cold haze.

I was still short of breath and still feeling somewhat nauseous. A saline drip with anti-nausea medication soon went into me through my arm. X-rays of my foot and abdomen were ordered, and were followed by a CT scan of my head, which fortunately did not show a concussion. However, it did show a broken nose to complement my broken toe. My face and forehead were swollen. No amount of tissues seemed to stop the blood from trickling out of my nose.

It took a few hours to feel better and to understand what had happened. If I had ever fainted before, it was as a child because I have no memories of previous episodes. Vasovagal syncopes though are fairly frequent occurrences. They are often a result of combining dehydration and acute pain, and I had both of them. They result in a sudden loss of blood pressure, which naturally caused the fainting. Some particularly squeamish people can get them from watching other people in pain. For example, some husbands have episodes while watching their wives giving birth.

After spending the usual restless night in the hospital, this morning I am expecting to be discharged. I am in the hospital out of what is probably an abundance of caution. Since Marfan’s syndrome runs in the family, and I already have an enlarged aortic artery, there is some concern that there may be a relationship. Some twenty years ago I had a brother pass out from Marfan’s symptoms right in the middle of taking a bath. It may be that as I age my Marfanoid symptoms are expressing themselves. To find out, I am tethered to an mess of sensors on my chest which are wirelessly transmitting signals to some nearby collection machine. Except for when I walk on the foot, I now feel fine. I would prefer to be home.

So what is the state of hospital care today? For those of us who are insured, and even many of those who are not, it’s pretty darn good, at least here at Inova Fair Oaks Hospital. My emergency room physician was on the mark. His diagnosis was confirmed by a visiting primary care physician later in the day. I got lucky in that I did not have to wait long for emergency care or tests. I fell around 6:45 AM and by noon I was wheeled into room in the Telemetry section in the north wing.

I may feel less charitable toward the hospital when I get the hospital bills. My insurance company will pick up the bulk of them, but of course pretty much every physician who sees me will bill me, and I will probably pay 25% or so of their bills as deductibles. They will dribble in over the next few months. I hope I have enough in savings to cover them. It is likely they will amount to a couple of thousand dollars out of pocket.

My roommate is both less lucky and luckier. He is lucky because his girlfriend telephoned him on Wednesday and realized he wasn’t making sense. She called the paramedics, who had to get the super to let them into his apartment. They found him tethered to an empty oxygen canister. His oxygen levels were dangerously low. He would be resting in a morgue tonight instead of in a hospital bed had it not been for his girlfriend. I don’t know all of what is going on with him but for a guy my age he is a mess. From over the thin hospital curtains I hear details of his life: his daily trips to the methadone clinic and his constant companion: the oxygen tank. While here at Inova, he is constantly being probed and wheeled out of his room for more tests. From his disheveled look, I doubt he has a steady job. He is likely among the uninsured or marginally insured. A good portion of my hospital care is probably subsidizing his care.

He spends most of the day and night asleep or groggily repeating his name when they come to measure his blood pressure or draw blood. He will awake to find the movie that he has had on is mostly over which he then restarts it again. I am already sick of the movie Duplicity and have even memorized some of the lines. As for me, they periodically come by to take my blood pressure and temperature, which are always in the normal range.

Despite the frequent nighttime annoyances, this hospital stay could have been much more unpleasant. For the chronically ill, at some point these constant interruptions in sleep patterns must feel like torture, because they are never allowed to sleep for a sustained period. For me one night in a hospital is just an annoyance. Inova Fair Oaks Hospital is all high tech these days. I can have movies on demand but more importantly they offer free wireless. By mid afternoon yesterday I was united with my laptop and spreading my news electronically. This episode will mean that I will miss spending a week in Denver next week on business travel.

The staff has been as caring and considerate as possible considering they have to periodically abuse your body. The hospital food has been surprisingly good but the portions have been small. You place your order over the phone from a menu that is provided. The food arrives about forty-five minutes later, usually lukewarm. The rooms are clean, the beds reasonably comfortable and my devoted wife is a frequent companion at my side. No spouse could have been more helpful in my time of need.

While all these creature comforts are nice, some part of me wonders if they are all worth paying for. It seems to me if we are going to get serious about controlling medical costs, movies on demand are easily expendable. My major concern is whether I will pick up an infection. I have been wary of hospitals all these years because of the high level of infections. A few hospitals are good at managing infections. Most are not. I have no idea how this hospital compares with others. Fortunately, I have no gaping wounds.

I look forward to reuniting with my house and my feline later today. I hope that unlike after my last surgery I will be back to normal within a few days. I count myself fortunate to be among America’s well insured. As a federal employee (as well as members of Congress), I cannot be dropped for any preexisting conditions, so I do not have that albatross around my neck. Within a few years, all Americans will have this privilege as well. Thirty million more will also be insured. It’s about time.

In the ICU

The Thinker by Rodin

It is not a trivial exercise to get into the Intensive Care Unit at Holy Cross Hospital in Silver Spring, Maryland. To begin with visiting hours are very restricted. Evening hours opened at 8 p.m. and ended at 10 p.m. I decided to leave at 7:15 p.m. and hoped for fair traffic. The traffic gods were kind to me. I had only brief delays trying to get on the beltway and navigating around paving crews.

The ICU is on the sixth floor. It is quite a walk from the parking garage to the ICU. Once on the sixth floor there was more stumbling around trying to actually locate the ward. The unit is isolated behind locked doors. To get in the ICU you have to use a telephone in the lobby and hope they will open the door for you. After a couple minutes of dickering on the phone they let me in. I found my 84-year-old mother in Bed #10 and arguing with a male nurse.

My heart skipped a beat. I hate hospitals. I have too many bad memories of visiting people I love in hospitals. The last time I visited my mother in the hospital (when she still lived in Michigan) had been rough. But I had thus far escaped an ICU visit. I expected multiple tubes running in and out of her, lots of machines that went “bing” and my mother in a fog or passed out. Instead it looked pretty much like any other hospital room except there was no phone. I could see her blood pressure and heart rate on the monitor. Her stats looked good.

“Everyone thinks I am crazy!” my mother began and told me over and over again, as if expecting me to validate the hypothesis. “I must have pressed this buzzer a hundred times and no one answered. They are ignoring me! I know I am not myself. But I am not crazy! Do you think I am crazy?”

“No Mom, you are not crazy,” I said. “But I think you may be confused sometimes.” I tell her about her low sodium levels and how that caused mental confusion. I think she heard me but I got the sense it didn’t penetrate. “I am not crazy,” she keeps repeating. But she seems to keep confusing names and times and places. My sister Mary and my sister Teri visited her today she says. But actually it was my father and her granddaughter Cheryl. Teri lives in Florida.

We talk but mostly she complains. She has every reason to complain. She looks lost because she is lost. She is very confused. She can’t read. She can’t focus. She is not interested in TV. There are lights on that she doesn’t want on. The hospital is full of noises that she doesn’t want to hear. She lives in the moment. Despite the tender care given to her by the nurses she is controlled and she does not want to be controlled. She wants to be free and moving around but she can’t; she can’t really walk at the moment.

Since there is no phone in the room and she wants to talk to my Dad I put him on the cell phone. I don’t know how my Dad stays so philosophical. Maybe it’s from spending way more time in hospitals with her than I have. Despite all her anguish he has managed to enjoy his day. He went into DC to see the grave of his grandparents. He enjoyed a spaghetti dinner at one of Riderwood’s fine dining facilities. In many ways having his wife in the hospital is a benefit: he is relieved for a while of his orderly duties. I know he loves her and cares deeply for her but he accepts this is something out of his hands. He says he will visit Mom around noon tomorrow but don’t tell her because knowing his timing will make her anxious.

Ministers talk about the importance of presence at times of great turmoil. I know my being there for my Mom meant a lot to her. I held her hand. I listened to her. I kissed her on the forehead. I fed her the occasional ice chip. And yet I mourn. It tears me up to see her in a hospital bed with tubes coming in and out of her. I want to see her as she was, happy and cooking a meal in her kitchen. I doubt she will be able to lift a pot again. I’m not sure she will even be able to use her walker again. I’m thinking there will be a whole lot more of this is in what remains of her future. She needs a nursing home. Yet what she needs is also the same thing that will kill her spiritually. Her spirit is flagging and that is not a good sign.

I play the good son. I smile. I talk nicely. I stroke her forehead. I hold her hand. I tell her I love her. And eventually I say goodbye. In my car driving back to Northern Virginia I am a mix of emotions. But I cannot express them now. There is too much going on in my life. I feel like I want to cry but life has other plans for me at the moment. So I put my feelings in a tight little box knowing that they will pop out unexpectedly some day like a Jack in the Box. But right now I am tired. At home I have a wife who has lost her job and needs support. I have a daughter beginning her sophomore year in High School and who has a birthday party that needs planning. I have a class to teach Saturday morning and I must be prepared.

The handle to our screen door comes off when I enter the house a bit after 10 p.m. I will deal with it … later.