Mind games with myself

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.


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.