Out of body experience…
THIS WAS NOT
The Hospital is central in the delivery of healthcare to any given community and the public in general. As such it is pivotal in the direct saving of lives, cure or reverse the progress of disease and offer state-of-the -art diagnostic or surgical procedures; to function in this role it is necessarily made up of diverse complex moving parts, and these moving parts, challenging as the task maybe, must be almost seamlessly synchronized if it is to achieve the optimum delivery of health care to the community it is entrusted to help. No doubt saving lives is its noblest goal, and the hospital is the place that does it best. There is no other institution that competes in this goal. However, not uncommonly acknowledged in the trade the hospital may also be in specific instances a dangerous place to be; the nosocomial infections that can be contracted is such an example. Mistakes of omission or commission by health care givers themselves not always published is another.
I decided to write this experience because I believe there are layers of lessons that could be gleaned from it, as I did, including taking a more circumspect view on what is life; consequently the appreciation of my own life was greatly enhanced and enriched. Life is a line it has a start point, and one can draw the line as long as her/his heart desires but it always has an end point. Often it is not straight, it may undulate, it may go through peaks and troughs, or even detours but it will always arrive at an end point.
On July 10, 2013 I had a partial knee replacement of the medial compartment of my right knee. This was a carefully scheduled surgery, it was meant to be a three-day hospital stay but it ended up an as an eight-day stay. On the first night, from 8:30 PM on I was in the recovery area till early the next morning when I was transferred to the Intensive Care Unit (ICU) because no regular bed was available. Needless to say, it was a restless night, I was tethered to a dripping IV fluids, a calibrated pump to be self administered to control post-surgical pain, various monitoring devices for vital signs, EKG leads over the chest, at least two or three ready to-be-used catheterized open veins, was catheterized to relieve bladder fullness, (350 cc ) but was thankful and gratified nonetheless when I was able to move all my toes freely, following spinal anesthesia particularly when the surgery lasted longer than planned, because of some computer glitch. Lower limb paralysis is a very rare complication of spinal anesthesia.
It should be noted that the surgery was performed at the 17th Street Hospital Campus, where all orthopedic special procedures of the teaching institution were done, but managed by the main teaching hospital on 36th Street, albeit the medical and administering staff like nurses and assistants are separate and not necessarily shared. Despite my immediate post-surgical pain by choice, the record showed that the analgesic pump (Dilaudid) was used sparingly. The following day I refused the narcotic pump or opiate-related medications for fear these may raise intraocular pressure and so I became fully reliant on Tylenol as my form of analgesia. To my surprise, and I never knew this before, Tylenol was now available as IV drips (400 mg.) and it had worked for me like a charm, equal if not more effective than Dilaudid. (Parenthetically I was told that the IV form is very expensive, why this should be so, only Big Pharma knows)
My first morning at the (ICU) a breakfast tray was waiting for me. After breakfast a small framed gentleman introduced himself as my physical therapist during my stay. He walked me through his plan and what to expect. I was impressed that he guided me right away to get out of bed despite pain and all, with my full weight resting on his right shoulder, he ably supported me; I managed to take a few slowly measured baby steps to a waiting chair, where he left me to move and dangle my feet and to expect him the next morning with a walker. Now I noticed how my right knee despite the bandage had swelled up to the size of a baby’s large head making the whole leg not easy to lift. The swelling was attributed to the soft tissue trauma of surgery and subcutaneous blood thinner I was on.
THE EVENTFUL SECOND DAY
I must have just touched my breakfast when the physical therapist came back the second day earlier than expected to begin my walker exercise as planned. I asked him to return after I was done with my first sponge wash scheduled with the Patient Nurse Technician (prior titled as Nurse Aide) that morning. This matter of fact move to delay the physical therapy exercise proved to be a very fateful decision.
The internist who cleared me for surgery days before in his office and who just made the rounds was not quite out of the ICU when he rushed back aghast to a commotion triggered by a code call. Unbeknownst to me and now bewildered, I was the focus of this commotion, (I was it,) I initiated the code; the monitors to which I was hooked up lit up and alarms sounded off as if a casino slot machine just hit the jackpot and a winner was goaded by cheers and applause from a crowd of well wishers and the curious; only in this case there was no winner, nor were there cheers or shouts of celebration. The only shouts were orders, from the point person to the code team members who hovered over me. He was the same physician I conversed with a few minutes earlier during his rounds. The stat orders were for multiple tubes of blood chemistries and baseline CBCs, hook up of a 500 cc of normal saline solution, a continuous running hard copy of my EKG, IV administration of potassium chloride, and magnesium sulfate, and continual monitor of electrolytes, and lastly 250 mg of amiodarone, executed in orderly sequences; while many eyes were affixed on me and the different monitors, mine roamed at the panorama of somber faces of the code team members working furiously.
PRESENT AND IMMINENT DANGER
At least twice I glanced back to my left and peeked at my EKG monitor and definitely did not like what I saw, but I was alert, fully conscious of the unfolding drama, never lost consciousness and responded to repeated queries that I did not experience chest pain, nor was I having one, the only pain was in my right knee. I knew I was in grave trouble, but for some reason the feel of fear was not there, I stayed calm, accepted the situation and observed the on-going activities, including the ever so familiar cardiac electric gadget at arm’s reach which was ready for use if needed.
Amidst this urgent dilemma or because of it, the brain, with its billions of neurons and synapses must and was able to process, thoughts, events and images, past and present almost instantaneously and concurrently. The continuous stream of myriads of images, thoughts and events, sometimes interleaved and interweaved with and against each other but at the same time came through fresh, crisp and clear. My life was flashing in a deck of video cards. The mind amazingly was able to multitask, shift through and process diverse thoughts. Images and events some long past. My own first and only priority was I prayed fervently and assured myself, I had reconciled my entire life with my Maker and Faith thanked him for loaning it to me and humbly accepted whatever was to be all according to His will. At any moment now I expected to be transported to another dimension or zone where time did not matter and was a measure of nothing. Or maybe an alternate path was to experience a sense of an on-going struggle between leaving or staying, between here and there, and feel weightlessness and sense nothing physical nor surrounded by anything material, but something ephemeral, with perhaps a rhapsody of eternal music of the purest sound and fascinating lights never heard or seen before; feel an ecstasy never experienced then eventually return to my temporal body, wakeup and narrate this to others, as others had. There was to be none of this penultimate ecstasy as described by those who had experienced it. This was not an out of body experience. I was still in reality. Here I was, observing and being observed, monitoring and being monitored by the code blue team.
Thoughts remained fleeting, changing, and asynchronous, of my family, my childhood, my friends, my paintings, the museums, the many places visited with my wife, names like San Fernando, Cordillera, Porac, Taft Avenue popped in and out. I even recalled some lines of William Cullen Bryant who at 17 wrote Thanatopsis and how on target the subject of his poem was. The thoughts, images and videos that kept playing and resurfacing in my mind however were those of my two beautiful grandsons, Finn and Beck.
The dominant images of these two adorable, lovable angels persisted and were so real that I can almost kiss, hug and cuddle them; there they were, happy, smiling, playful, the younger always trying to catch up with the older, who he idolized, and apes whatever he does. Images of two adorable, innocent faces; I had absorbed so much joy by just looking at them, being with them, and playing with Finn and Beck (yes, the dynamic duo, the adorables, the cutest, the incomparables, and as a grandparent I felt licensed to shower them with silly superlatives, and I had), their smiling happy faces just lingered on and on, as their images in videos occupied the full canvas of my mind; Lord, I must have whispered, see these two absolutely innocent, gorgeous kids, they are so young, Finn will be five in about two weeks,(and I may not be there) he will start kindergarten in less than two months,(and I may not be there) smart as he is, he still has no clear concept of weeks or months or time or sudden departures, how will my dearly beloved daughter, his Mom explain this to him, and Beck, my little toddler, who wears the sweetest of smiles and has the softest of high fives he happily dispenses, understands commands well but does not even talk yet. What of him, then pleadingly, I must have whispered again, I would like to spend more time with them, see and watch them grow and develop, enjoy them some more if I may. In the end still it is truly Thy will Lord, Thy call and I have accepted that too. I felt my eyes welled at this point which may have been noticeable. Actually it did not matter, nothing mattered anymore now. It was obvious that everyone still wore a somber look but stayed fully focused in their work; I stared blearily at the lead internist and distinctly heard him yell to me “STAY WITH ME! STAY WITH ME! (A phrase I was too familiar from watching TV crime drama re-runs like NCIS or LAW AND ORDER: SVU, when a good guy was downed by a bullet and in a precarious condition, the partner agonizingly utters to the victim those same lines.) I sent a mental message by staring directly at the lead physician, “please no intracardiac adrenaline, it was much too soon, too early.” (No one who received intracardiac adrenaline in the code blues I had participated had ever survived.)I took another gaze at my monitors and concluded that this was the moment when everything changes and in nanoseconds it will be over and time no longer tracks anything. This was my exit, my final curtain call and reiterated to myself “Thy will be done on earth as it is in Heaven.” Lord if you are ready for me, I too am, it is Thy Call, Thy Will which will be done.”
THIS SHOULD NOT HAVE HAPPENED
Ventricular tachycardia (V-Tach) is a very serious medical emergency, which can morph quickly in seconds into ventricular fibrillation, and/or ventricular fibrillation-flutter then the final flat line. Hence it was imperative that the V-Tach be reverted to sinus rhythm by appropriate drugs, including if necessary with the use of cardiac electric shock. The second time I gazed back at the monitor I was having V-tach, and (which I later learned lasted for 3.5 minutes which was unusual but lucky for me) I was fully aware of what was happening but was resigned to what was to be, not that I thought I had other options. In the midst of all the activities, one distinct order I heard was IV amiodarone 250 mg, IV, (which turned out to be the final drug I received,) followed by a pause, a silence, a silence which seemed so looooong. Then the incredible happened, there was a sudden burst of applause, smiles, jubilation among the staff, and others who had milled around; the monitor showed the V-tach did in fact reverted to normal sinus rhythm. I must have I applauded too with weak claps but was too numbed to even yell out a thank you to all who worked so efficiently and cohesively, but kinesically I felt I relayed my ultimate feeling of gratitude for an excellent job well done and for which I was forever beholden.
Amiodarone, was new to me, is a most potent drug in the pharmacological armamentarium. It was not available when I was in training, so I researched it. Khellin, the base molecule was discovered in Cairo, by Gleb von Anrep,a Lebanese, and Dr. Bramah Singh, from India in his doctorate at Oxford wrote about it, and Labaz a pharmaceutical sold it in Europe and based on the clinical experienced Dr. Mauricio Rosenbaum from Argentina it was used as a new Class III antiarrythmic drugs. It was approved by the FDA only in 1985 because of initial controversies and never went through a double-blind study. I would be hard put to make a call had I had the chance, now knowing the warnings and controversies that surrounded its use; but I was more than glatified and thankful someone in the code team had the intestinal fortitude to make the call.
I learned that my serum K level dropped precipitously from a prior 3.9 to 2.9 Meq, magnesium down to well below 2 mg, Na down to 132 Meq and it was this abrupted electrolyte imbalance which initiated the atrial fibrillation and multiple narrowly spaced premature ventricular contractions (PVCs) which deteriorated rapidly into ventricular tachycardia and in turn triggered the code blue call. This was totally preventable and should not have happened because it was purely iatrogenic. The abrupt electrolytes imbalance was the culprit for the V-Tach.
Much to my dismay and disgust I learned that somehow, someone decided to cut into half the normal daily KCl dose (40 Meq) which I took religiously for the last 30-35 years. This dose to the inexperienced may seem to be an unusually high, hence I underscored this many times when I went through my history and current medications to all interviewers. The unilateral 50% cut of a critical medication with no explanation I found inexplicable and appalling. At this writing I was still not clear as to who, why or how this happened, although, I started to have some inkling.
Moreover, I detailed the rationale for my oral K daily maintenance, presumably was duly recorded in the computer since one of the day nurses assigned to me read something about it in my hospital records. The segment of my renal tubules which reabsorbed about 90 % of normal extraneous K intake from food are faulty and consequently the the K was not reabsorbed and excreted. To compensate, daily supplemental of oral K (Klor-Con, K-Dur) was prescribed. This failure to reabsorb K in my case is associated with osteomalacia. A brilliant nephrologist made this diagnosis 30-35 years and placed me on supplemental K maintenance since then. Excess K was not an issue because normal kidneys handle this efficiently. It is doubtful had the error in catastrophe, the actual cause may not been clearly evident forensically. To compound this blunder the hospital discharge papers I received included instruction to stop taking the 20 Meq of potassium, which presumably was a mistake carried over from the physician’s original written order. Who was actually responsible, I want to know.
As soon as the code blue commotion petered out, and the dust settled I requested the nurse assigned to me that it was imperative, she got hold of my private cardiologist/internist, who I impeccably trust, but unbeknownst to me he was already conferring by phone with the attending physician and discussed my transfer as soon as possible to the Cardiac ICU at the main campus.
Word filtered down to me that other causes for the V-Tach had to be excluded (in my case it was clearly abrupt electrolytes imbalance that threw my sinus rhythm out of whack) which meant a cardiac catheterization, to rule out coronary artery block, a spiral CT to rule out pulmonary emboli. The former is invasive (it involves an arterial approach) and the latter entails inordinate exposure to radiation. Both procedures were already scheduled. In fact prior to my transfer via ambulance, escorted by my daughter, an Orthopedics resident and the Nurse Director of ICU. I was detoured to the Radiology department for spiral CT of the lungs which as presumed was negative for pulmonary emboli. The cardiac cath was performed the next afternoon, and venue of entry was the right radial artery in lieu of the femoral artery; my right thigh was not used because of the knee surgery. The anticipation was more fearful than the procedure, any way the coronary arteries were clean. And the interventionist was heard to have said “why the procedure was even ordered.”(Hooray! A touchdown for all the red wines quaffed daily.)
DELAY IN DISCHARGE, FEVER OF UNKNOWN ORIGIN ON FIRST ADMISSION
The plan was to be home three days after the knee surgery, but instead I was discharged on the ninth day because of persistent fever of undetermined source. It was not uncommon to run low grade fever for one one or two day after a major surgery, but five days was a concern and puzzling. Puzzling because the successive blood cultures, urine cultures, absence of any productive cough, and four daily portable chest x-rays yielded negative readings. Since I had arrythmias that resulted in code blue the RHYTHYM Team, cleverly named, and I think there was some humor tucked into that, was consulted by The Team. Cardizem, an antihypertensive drug with additional use in arrhytmia was ordered,by the Rhythm Team. I refused to take it pending a check with my internist cardiologist. When I saw him on rounds that evening he agreed, and said the cause of arrhytmia was identified and since the code blue incident the sinus rhythm was perfectly stable. He gave another reason not to take it.
I suggested to my private physician additionally that perhaps the source of fever maybe the localized inflamed swelling and pain in the dorsum of my hands and the left forearm which were the inserted plastic catheters sites since admission. He checked, agreed and consulted the infectious disease specialist who examined me thoroughly, specifically excluding the surgical site as a source of the fever. The three open veins with plastic catheter caused non-bacterial inflammation resulting in segmental phlebitis, swelling and pain. It was almost another 24 hours before these catheters were removed because The Team apparently wrote the discontinue order somewhat belatedly but less than 24 hours after their removal, the fever abated overnight and I was discharged the next morning. This minor episode was a major learning experience for me.
The consultants, namely the gastroenterologist and the abdominal surgeon discussed ERCP vs MRCP. The former favored ERCP perhaps because that was the procedure they do but was more invasive and involved inordinate radiation exposure; while the surgeon stated that there was to be no “stone fishing”, he prevailed and I concurred fully. MRCP had no ionizing radiation exposure but manifestly more difficult to order because four MRI magnets were ruined by Sandy and only one makeshift magnet was in used.
READMITTED FOR SEPTICEMIA SECOND ADMISSION
I was upbeat because I was home and the physical therapy, despite the pain and limited leg mobility, was aggressively progressing; but this changed on the fourth day, after I experienced diffuse severe epigastric pain which radiated along the upper and lower spine, identical to an episode in May, when I was rushed into the Emergency Room (before Sandy) and stayed till 2:30 AM because the focus then was rule out dissecting aortic aneurysm. The full body CT scan excluded this but multiple gall stones with sludge were detected but were not connected to the symptoms. This time the colic attack happened near midnight, and came with same severe intensity that caused me to have cold clammy sweats; the symptoms receded with antacids, analgesics and application of warm abdominal compress. The night was relatively restful, the next day however the nurse from the Visiting Nurse of New York detoured back to see me because I developed chills and high fevers, (103.3 F); after he conferred with my internist and with my daughter I agreed to go back by ambulance (I sent the first one back) to the Urgent Care Center, a makeshift ER after Sandy. Liver enzymes and lipase were twice or thrice above the normal range, WBCs markedly elevated, but to the puzzlement of the physicians my abdomen was supple and the examiners did not elicit pain even with deep abdominal palpation. My K was 3.7, just to be on the safe side, I prevailed over the attending physician to order stat 40 Meq of KCl orally after he was clued in, on the blue code episode. Blood cultures were drawn simultaneously from two separate sites and repeated daily, and even every 12 hrs. initially. (Blood for culture cannot be drawn through the open IVs.)
Two types of antibiotics IV to cover a spectrum of aerobic and anaerobic bacteria were started. IV NSS was ordered because I was on NPO ultrasound of the biliary tree and HIDA test, routine chest x-rays, repeat blood works were ordered. Ultrasound, a totally benign imaging procedure but as a physician one imagines the worst could happen, what if the gall bladder burst or provoke more stones to pass, from the excessive repeated probe over the area of interest, which the technologist did. The ultrasound re-confirmed the multiple stones and sludge seen in a dilated gall bladder and the HIDA test also showed a non-functioning gallbladder but the common bile duct was patent in both studies. The findings initiated more consults arranged by members of The Team, the gastroentorology and the abdominal surgeon groups were called in. The original Infectious Disease specialist was also notified and was surprised to see me back so soon albeit for a different issue. It became clear that I must have passed a gallstone (reason for the painful episode), and subsequently developed acute ascending cholangitis. In retrospect I must have passed a stone also in May but without infection since I was afebrile. My orthopedist came that morning to be assured that my large swollen warm knee was not the cause of fever. The site of surgery was a usual rule out suspect. He used a large size needle that looked more like a trocar to draw a fair amount of sero-sanguinous fluid from the right knee joint, which he allocated into three separate vials for various tests. All yielded negative results except for a few WBCs in one were expected. This was a big relief, imagine had the surgical site been the source of the fever I dread to think the subsequent scenario. It was even a bigger relief when the initial blood cultures all yielded Escherichia coli, now the antibiotics could be fine tuned. The official diagnosis was acute ascending cholangitis. After the fevers abated and the blood cultures turned negative and the liver enzymes and the WBC returned to normal levels, I was discharged home with a week supply of two oral antibiotics. I was upbeat again despite my markedly swollen ecchymotic right knee that was still bandaged. I was even concerned about about acute renal shut down because while I had the urge, I was putting out only tiny amounts of urine.
Two medical residents of The Team I met for the first time gave me written instructions to follow and the female resident proudly stated that they were members of The Team that managed my case behind the scene. I sensed there was an emphasis on “behind the scene,” The tone of how she said it, intrigued me, it sounded like they belonged to a secret or mysterious society of do gooders and were delighted to now be unmasked. I further learned The Team may possibly, hopefully rarely, override orders of attending physicians; if the Team consensus I guess felt it was the way to go. This empowerment had a genesis. Apparently, (pending further verification,) if any of the residents filed a complaint that if the attendings encroach on their ability to manage a case independently, this would be a major code violation of a pre-requisite of the American Board of Internal Medicine Residency Program and may cause that teaching institution its residency accreditation; this in turn may result in the loss of funding of the program and also places the institution at a different level of reimbursement among third party payers for patient days of hospital stay. While the preceding may be so, and depends further verification, in the finite point of responsibility, especially where human lives maybe at stake, there must be some ultimate accountability from a more senior staff member, whoever that individual maybe. No team or committee of 6 to 8 resident staff, still wanting in experience, even if their years were added cumulatively can equal the tested experience of a physician who had been in the trenches of medical practice for scores of years.
The visiting nurse, the physical therapist and the aide from the NY Visiting Nurses resumed their respective services when I came home. The nurse monitored me clinically and cared for the three inch by .3 inch denuded wound, parallel to but away by mere 0.2 inch from the surgical incision; which resulted from removal of the original dressing (which stayed longer than needed.) A periodic image of the wound was emailed to the orthopedist, who initially entertained a small skin flap might be necessary (another trip to the hospital, I thought) but thank G-D the wound started to dry up and a thick eschar formed, including the cratered part by just cleansing with H2O2 and Silverdene ointment application. In the meantime I tolerated the pain from the manipulation and stretching of my right lower limb as part of the physical therapy.
SECOND COLIC ATTACK THIRD TRIP TO URGENT CENTER
Afternoon of August 2nd, was déjà vu, a second gall bladder attack, same symptoms, epigastric pain, 101.3 F fever, same scenario, my dear daughter happened to be visiting (my grandson was to celebrate his 5th birthday with a swim party the next day at our building), the same nurse was attending to me and consulted my internist, and was advised that I had to be readmitted; an ambulance was dispatched to take me back to the UrgentCenter. Even the staff in our building were now empathetically curious by all the ambulance runs.
I hesitated, because I knew what was in store, the waiting, the endless rehashed of questions and history, the needles, blood cultures and chemistries, the IVs for antibiotics and antipyretics (the latter I actually welcomed because I felt I could use it), just for good measure I took an extra pill of KCl, which I told the physicians who interviewed me. The big production included bagging my CPAP machine, the five different eye drops which I was still on and the weekly tray of medications I regularly take. I learned from the past, it was easier to bring these medications should one encounter some red tape. I politely rejected the CT scan of the abdomen ordered because of the level of cumulative radiation dose I already received, besides there was 2.5 hour wait for the procedure. We settled for a repeat ultrasound of the biliary tree, since I already had a baseline study, which once again showed the gallstones, a patent common bile duct, and moderately elevated liver enzymes but were not as out of whack as they were during the first attack. There was a long discussion whether to admit or not and to which service medicine or surgery among the attendings of the three departments; finally it was felt there was no surgical urgency after the IV antibiotics and the 400mg Tylenol IV, 500 cc of Normal Saline (since I was on NPO) were administered.
Besides, a patient readmitted within days of discharge with the same diagnosis can cost the hospital a reimbursement denial by Medicare or secondary party carriers. I did not think this was a variable, but that I was already clinically stable and in no state of medical urgency, hence I was sent home. At about 2:00 AM, my daughter, very distressed and disappointed took me home with the appropriate medications. The consolation for the emergency visit was I did receive by IV a full 24-hr antibiotics coverage and antipyretics. My poor dear daughter was beside herself, in tears and totally confused by the decision. I explained to her things will work out. She honestly felt had to be admitted she was going to stay with me and was prepared to miss my grandson’s birthday party which was in preparation for several weeks. I stayed afebrile and thanked G-D, ably moved around slowly on the day of the party, did my chore of dissecting the roasted piglet my friend picked up earlier that morning. I fully resisted even taking a bite of the crispy skin of the piglet while preparing it as a center piece, but encouraged my friend who was with me in the kitchen, to keep eating vicariously as I kept feeding him samplers. This was a second big consolation, my daughter and I were at the party. I was happy to meet each of my grandson’s 12 little guests and an accompanying parent and in short I had a party without actually eating anything except for bagel and honey. The non-admission after all turned out, to be the right call. In the midst of all this my internist, and a close friend, called to find out how the night went. I told him fine and I was at a party. (He was likely puzzled.)
AUGUST 19 GB LAPAROSCOPIC SURGERY 4th ADMISSION
I received subtle and not so subtle hints that the gall bladder had to come out (to which I agreed) before my discharge because of the risk of another acute colic attack. Since the MRCP, done just before I was last discharge re- confirmed categorically that the common bile and pancreatic ducts were patent and harbored no stones, I felt no urgency in rushing to surgery because I was physically, mentally and emotionally drained despite knowing that the gall bladder sac was not thickened implying it was not inflamed, and the laparoscopic surgery had no added risk; hence opted to go home first and schedule myself for the laparoscopic cholecystectomy later. The last message I received from the surgeon through his resident, who was present at my discharge, was to schedule sooner rather than later. I agreed. August 19 was the earliest I could book the surgery but asked that I be the first patient for that day. I had to be at the hospital at 6:00 AM and procedure will be done at 8:00 AM. I waited for with angst, since I was the one who opted to go home and now I developed a phobia of another colic attack. I restricted all my meals from the day of discharge to the day of surgery to bagels, honey, non-citrus fruits and water.
Prior to the procedure the surgeon and the anesthesiologist spoke to me separately. The surgeon walked me again through the procedure, there were to be four small incisions, one including the insertion of a tiny camera through the navel which will serve as his GPS (italics mine) during the one hour procedure, and I will be at the recovery room for about an hour and as soon as I am fully aware and able, I will go home. In the meantime he will have spoken to my wife, daughter and friends who were always with me in my travails of this medical odyssey, in the waiting room. From the recovery room, after getting into my street clothes, I was served a biscuit and a cup of decaffeinated black coffee and as soon as I showed a little urine, albeit with difficulty I was discharged and went home via the SUV of my friend who was always there at all the critical junctures of all these episodes.
DISCHARGE AFTER FOUR HOURS: 5TH ADMISSION
The unthinkable happened, four hours after my discharge on the day of surgery, I was chilling and my muscles, mostly the thigh muscles actually quivered and I ran a fever of 103.3 F. Called the surgeon and back to the UrgentCenter, but this time in the surgical service. The surgeon who operated on me, was actually at the Urgent Care waiting when I arrived; he was incredulous but asked what I ate at home. I ate nothing except what I was served at the hospital after the surgery, a biscuit and the decaffeinated coffee. I went through the routine blood workups, EKG, and open IVs but with one addition, a CT scan with contrast was added. I asked if I could have an MRI instead, but per their current setup, this was not possible because there was only one magnet, the four that the Hospital owned were ruined by Sandy. Since there were no signs of peritonitis and it was too early for it to occur, someone raised the question of a possible nick of the duodenum or small intestine and this had to be excluded. The surgeon said he will quit surgery if this in fact was the cause of the fever and chills. While extremely, isolated cases had been reported. That was all I had to hear, and my mind, given the strings of setbacks I already had, my physician mind went berserk. That’s all I needed, an emergency abdominal exploration. Throughout this stream of painful medical journey, this one scared me most because it came like a bolt of lightning. To be a physician and a patient, amplified problems, worsened them until you think they are real in one’s mind. And for some reason when things go wrong, they usually happen to physicians or members of their families, maybe because I usually heard news about physicians who had complications or problems of some sort or another during their hospitalizations.
The taste of the contrast, Gastrografin was not the problem. It was the volume, one full liter had to be sipped in less than an hour to prepare for the abdominal CT. When I reached the CT unit I had to drink another glass of the same before getting into the gantry and the tech from the Philippines always made it easier and reassured me. Including giving me extra blankets for the uncontrolled flow of urine because of all the liquids imbibed. Incidentally the gastrografin was supposed to cause diarrhea, in my case it worked the opposite. This seemed to follow another Murphy’s Law, if one thing goes wrong, everything goes wrong.
I was out of for the CT scan for about an hour, when I returned my Urgent Care cubicle, was relinquished by my nurse (who I thought was a per diem employee) to another patient and had to wait on the stretcher in the hallway. The nurse who commandeered my slot apologized profusely and indicated that the patient who was ushered my cubicle had to be interviewed behind drapes privately. I asked for her name (never intended to file a complaint) and I politely told her I don’t buy what she said, and was very unhappy because in my last visit and I gave her the date, three staff interviewed me separately in the hallway within everyone’s earshot. This hastened my getting back the draped cubicle. Anyway I was anxious to get the abdominal CT results which became available before I was admitted to the regular surgical floor. Before the report, which was normal came, I theorized that if I had a duodenal nick I would have had experienced severe abdominal pain from all that Gastrografin.
Before medications were dispensed or IVs started the nurses scan the patient’s ID wrist band and enter it in the computer. My assigned nurse scanned the band three times but it would not register. I said try the right one, and surprise, surprise it registered. She initially scanned the morning ID wrist band which no longer worked but was never removed. I thought to avoid future confusion I asked her if she can cut the first band with a scissor to which she answered there were no scissors at the nurse station. A friend of mine who witnessed this just came over and ripped off the band with her fingers. Luckily I did not have to deal with her much further because I was transferred to the regular surgery floor.
The infectious disease specialist who attended to me, in earlier admissions saw me again in consultation for the third time in mid- afternoon and his only explanation that the 24 hour fever may have stirred a nidus of something (?bacteria) during the procedure and since I was now afebrile, the enzymes have come down and WBC only borderline high, that I could leave the hospital. I called my wife and the new assistant homemaker to come and pick me up. We left by cab at about 6 PM. The official diagnosis was the fever and chills were unexplained, but “all is well that ends well.”
THE FIRST THREE WEEKS HOME
The same-day laparoscopy with the four small abdominal small incisions collectively gave me another source of pain, which superimposed itself to the existing pain from the knee surgery. The sites of pain occasionally competed in intensity and whichever site was more intense masked the other and won. I initially felt bloated because CO2 gas was pumped into the abdominal cavity to get a better access and view of site of interest, from the surgery itself, and the anesthesia probably including the one I swallowed. The abdominal binder I used did not help, especially when I sneezed or coughed. It was also difficult to get out of a chair or bed because the abdominal muscles were weak and the anesthesia may also have contributed to this. Externally that was the picture, but internally depending on one’s tolerance, to pain and discomfort the problem was equal to or worse than the pain. Prior to the actual laparoscopy, I had to bite on two gauzes soaked with purple colored lidocaine to anesthetize my mouth, its buccal mucosa and pharyngeal area for intubation, but was made to swallow the liquid after I bit on the gauze and squeeze it out. I did. Hind sight told me that I should have spat it out, although this would have been messy. If the lidocaine numbed the pharyngeal mucosa, it can also deaden the esophagus and the entire GI tract plus the urinary bladder, although this alone did not explain all the physiological problems I felt for several days as they related to the urinary and gastrointestinal tracts. I had felt findings and symptoms of urinary tract and colon obstruction on top of the pain experienced.
When I went home minus a gallbladder, I was prepared to enjoy the usual food I enjoyed to eat and the drinks I enjoyed to imbibe. I immediately realized I had another problem, my taste buds were dysfunctional and totally distorted either because of the many types and amounts of antibiotics I had taken continually and or the anesthesia administered. This taste bud dysfunction lasted for about 16 days and I monitored this initially with a good bottle of red wine that my daughter had left open initially and followed up with bottles I was familiar with. Finally after this self-imposed alcohol celibacy (since July 8,)I dared have my first Belvedere martini on the 19th day, and suddenly the taste buds opened, blossomed and were receptive to various taste. It was a new day for culinary consumption and imbibitions. Not to be trivialized, I shed 10 pounds during the curse. Which was a welcomed collateral.
PROLOGUE: MY SUMMER MEDICAL ODYSSEY
When I returned to Manhattan from Vegas I had two carefully planned surgery for the summer, one, pachoemulsification or cataract surgery scheduled on May 14, 2013 and two, right knee replacement scheduled on July 10, 2013. I was focused on these two priorities and was totally oblivious of any social functions no matter how significant or otherwise they seemed to have been, and I was pretty public about this. The gallbladder surgery that came on top or in the middle of all these was a complete surprise. It complicated an already complex endurance situation and in fact had interfered with the rehab plans for the knee surgery.
So, in short I had a back-to-back-to-back surgeries this summer. Of the three, the cataract surgery probably caused me the most trepidation because of an earlier botched up surgery I experienced for the other eye five years ago performed by an ophthalmologist who advertised himself as having done 40,000 of these operations (on his phone voice messages, it may now be 50,000) but probably failed 101 intraocular pressure monitor. Obviously I changed to another ophthalmologist who had followed my eye care for the last five years. I wrestled with the moment of truth that I needed the second surgery done because my vision reached a point of borderline function. On our way back home after the second surgery, I was horrified while in my friend’s SUV. Because I could not read any signs or street names. the buildings, the stores that were so familiar I could not recognized and when I reached home, I felt even worse, the TV became a mere radio. My paintings were shadowy frames with no pictures, I could not read the prints in a newspaper and worse I cannot access my computer. I had five different types of eye drop medications that were immediately started and a close friend volunteered to sleep over and help my wife in the dispensing of the tightly scheduled eye drops. That night it took me a while to fall sleep, and when morning came, I was afraid to open my eyes. I was extremely ecstatic and thanked G-D for allowing me to see faces and moving figures on TV, my frames now showed my paintings, access to my computer was with some struggle initially. I told no one of what was happening except to my daughter who stayed late with me and googled the immediate side effects after cataract removal. I was relieved when she told me that in most instances the return of vision was restored immediately, (my younger had this experience a month earlier) but reassured me was that in a few instances it may take longer, and in some extremes it may take as long as a couple of weeks. Had my vision not been restored, it was doubtful if I would undergone the knee surgery. So that was my 2013 summer of medical, actually surgical odyssey and am fully grateful to G-D, my family,(the dynamic duo) extended relatives, and close friends who were there all the way with me. If I am duly inspired and find the time I will type an addendum on many small incidents and some general observations during the different times that I was admitted in the hospital. After all, exclusive of the cataract surgery I was inside a hospital five different times in six weeks. If you had reached this sentence it means that you probably read the whole journey or jumped forward to this line.