I should have known better 

 

 April 23, 2008.

This is a very personal story.

I was in the hospital recently.  And I wasn't visiting someone.  It was about me.  And I was there twice.  First it was a trip to the Emergency Room.  Then, a few days later, I was "admitted" into the hospital for treatment.  I stayed for 3 days that second time.  The earlier ER visit was about 6 hours long.

So what happened?  The simple answer is that had a Gastro-Intestinal (GI) bleed.  I lost between 4 and 5 pints of blood over a period of around 5 to 6 days.  Details in a moment.

Looking back, I recognize I made a couple mistakes and I now realize how lucky I am.

On that pervious Saturday morning I awoke very early.  It was around 4:30 AM.  My stomach hurt.  This was nothing new.  There's been a lot of stress and worry about job stability and financial outlook.  The company had been bought and there was a lot of open discussion about outsourcing all the IT staff; with rumors of layoffs of perhaps as many as 80% coming some this year.  So the pain was understandable and familiar.  I had been treated for stomach ulcers around 30 years ago, so I knew what they felt like.

I wandered into the kitchen, grabbed the bottle of chilled Mylanta from the refridgerator and swallowed a few gulps.  I stayed up for around an hour, surfing the web and reading news sites.

Melissa, my wife, was up by around 5:30 AM that morning.  That's our usual time, even on Saturdays.  I still didn't feel comfortable and decided maybe I'd feel better if I spent a few minutes in the bathroom.  I told her I wasn't feeling too good.

So there I was in the bathroom just sitting patiently.  That was when it happened.  Just before I stood up, I noticed my skin was clamy.  When I stood up I nearly fainted.  The room was spinning around and I was feeling very weak.

So I walked carefully, but quickly, over to the bed and laid down.  By this time my wife came back into the bedroom to see how I was feeling.  My breathing was really odd, I seemed to have short breaths.  And I was drenched in perspiration.

We have nicknames for each other.  I call her "Wif", she calls me "Hubster".

I remember saying, "Wif, something's wrong."  Now this is very unusual.  I'm generally the healthy one.  Sure I get colds and the flu, but never anything serious.  And for me to tell her that something was wrong was also a sign of something serious since I never did that sort of thing.

Melissa, remembering how her father had died from a heart-attack 12 years ago, was concerned that I might be having a heart attack.  My symptoms were not exactly like a heart attack, but something was not right.  She immediately called the doctor's emergency line and spoke to him about my symptoms.  They agreed I should be checked at the Emergency Room in the hospital.

So she drove me over.

The hospital was efficient.  They took my vitals and put me on an EKG machine.

Truth is I don't remember a lot about that morning because of my overall feeling of tiredness.  

They also took a blood sample.  I think they do this as an additional check to see if you had a heart attack.

My blood pressure was a lot lower than normal for me.  But it was within normal range.  And the tests showed I did not have a heart attack.

The hospital also did chest x-rays as part of their standard procedure.

The diagnosis was "Vasovagal Episode".  Here's a summary of the information they provided which describes the symptoms.

There was a fall in blood pressure due to an interaction of the nervous system and the circulatory system.  This results in an abnormally slow pulse, faintness, low blood pressure and other abnormal sensations.  Vasovagal symptoms are brought on by emotional distress, pain, dehydration, bleeding or medication.

They did not find any serious problem.  That's reasonable since there were no other symptoms to go on.  And the possible pain contribution should also not be ignored.  I'd been diagnosed with Adhesive Capsulitis (Frozen Shoulder) a few weeks earlier.  This had been causing me a lot of pain and made sleeping soundly difficult.  My right shoulder/arm constantly ached and if I rolled over and put pressure on it I could feel a lot more pain.  And I'd just come off of a week of doing on-call Production support for my work, carrying a pager.  It had been a fairly quiet week with only a one early morning (2:30) pages to deal with.  But it's easy to see how this all fell into place.  I was stressed, not rested, dehydrated and dealing with continual shoulder pain.

So they sent me home after lots of test and about 6 hours time in total.  I was instructed to drink a lot of water and to rest.

Getting rest later that weekend was easy.  I was really tired.  And Melissa and I were both relieved that my heart seemed to be in fine shape.

I slept most of the day.  That evening I had to go to the bathroom again.  This part is a "poop story," so sorry if that's offensive.  There were two problems I experienced.

The stools were very dark and soft, almost sticky.  Like tar and black like coal.  And the water had blood in it.  Dark plum-red blood, and what seemed like a lot of it.  I looked and became alarmed.  I really got scared.  You're not supposed to see blood and certainly not that much.

And I made two dumb choices.  I did one of those "guy things" and decided to go to bed and hoped it would go away.  I worried, but I ignored it.

I also didn't want to go back to the Emergency Room, so I didn't tell my wife.  That was the second dumb choice.

I woke up again that evening around 12:30 AM and Melissa was still awake.  She asked me how I was feeling.  She could tell I didn't feel right and was understandably concerned from earlier that day.  I couldn't bring myself to tell her about the blood in my stool water.  It was embarrassing and I also didn't want to alarm her and make her worry even more.

But I was concerned enough that we agreed we would set the alarm for 2:30 AM to wake me and check how I was feeling.  When the time came I was still feeling exhausted but not worse.  So we went back to sleep for the night.

On the following Sunday morning I had another episode where my stools were tar-like and I was still discharging a lot of blood.  Again, I didn't share the part about those symptoms.  However, we did agree that I would call-in sick for work Monday and that I would call the doctor's office and get in as soon as possible that day for a follow-up visit from the Emergency Room activity that Saturday.

That morning, around 11:00 AM I was able to get an appointment with my doctor.  He reviewed my verbal account of what happened on Saturday and also reviewed the report from the hospital with me.

I told him about the blood in the stool.  He asked about the color of the stool and blood.  Since it was a very black stool, he said that meant I probably had a stomach ulcer.  So he prescribed Previcid and ordered a blood test.

I went back home and went to bed.  I told Melissa about the blood.  She was very upset with me for keeping this a secret from her.  She was right.  We talked about it a bit and I promised, and meant it, that I would never do that again.

The following Tuesday morning I called-in sick again because I was still feeling really exhausted.  We were also hoping to get the lab results from the blood test on Monday, even as soon as that Monday evening.  But had to wait till Tuesday morning.

We had another appointment with the doctor at around 1:30 that afternoon.  We reviewed the blood test and learned that my hemoglobin count was way down.  He said it was likely that my ulcer had gotten close to an artery and was dumping blood into my stomach.

After some discussion over our options, with the advice of the doctor, we agreed I would check-in to a hospital that afternoon.  The goal was to get an Endoscopy procedure performed quickly to ascertain where I was bleeding and how it should be addressed.

The Endoscopy procedure, in addition to allowing the doctors to see carefully all around my upper-GI, also has the ability to heat, or cauterize, any open wounds.

I was admitted to the hospital within the hour.

 

Melissa likes to tell the story about how I was in such denial about needing hospital care.  Now, I don't have as clear a memory of all this since I was by this time feeling both exhausted and very distracted.

The room was actually very nice.  It had a private bed, shower room, and a sleeper-couch for a guest.  Apparently, upon arriving in my hospital room, I decided to stay seated, still dressed in my street clothes, on the couch.  I wouldn't put on the hospital gown nor sit on the bed.  That status hadn't changed until the nurse came in and asked me to get dressed and get into the bed.

After changing clothes and getting into the hospital bed, according to my wife, I went into "geek mode".  I started rambling endlessly about how the hospital bed must have a strain-guage in it so they could easily measure my weight while lying in bed.  And apparently I rambled on and on about how strain-guages work (I used to be a mechanical engineer about 30 years ago).  And then I rambled about my observations about the sensors and other equipment that was visually evident from the hospital bed.

According to her, I was behaving as if in complete denial that I had been checked into a hospital.  I could not mentally accept that I was in serious trouble.

The nurses started an IV on me right away to get my fluids level up and to give me some nutrients.  I was not permitted to eat real food for several hours in preparation for the endoscopy procedure that was scheduled to happen that evening.

Little did I realize that my encounter with needles had only just begun.

After I was checked-in, Melissa had to take off to put other things in order while we would both be at the hospital.  She intended to stay in the room with me as much as possible.  We had already agreed that she would spend the night in the room on the pull-out-bed of the couch.

She had already arranged to have Nicholas, our son, stay with a friend for the next few days and so she went home to transport him over.  She also brought our Macintosh laptop computers so we could both have things to do besides watch television.  I'm happy to report I never turned the television on.  The hospital provides Wireless Internet access, and that was cool.

She also wanted to go home and pack up some clothes for the evening and eat her dinner too.

When Melissa returned later that evening, she found a way to make her arrival dramatic.  By accident.

Now, she's not mechanically inclined.  And from what I could see from my hospital bed, it looked like pulling the sleeper-bed out from the couch would take a little care.  Within moments of her arrival, since it was past 10:00 PM, she started to pull out the bed.

Now if you can imagine it, the mechanism was like an elaborate scissors with many moving parts.  And you had to do it only a certain way.  Well she started to pull it up and out and the major section of it was sitting high in the air, like a triangle.  It didn't look right to me.  I remember saying, "Wif, that doesn't look right."  And she got kinda stuck mid-way in motion.  Something got jammed up or out of order.

And then the entire assembly dropped down hard to the floor.  It made a very loud crashing sound.  A heavy thud.

Two nurses came running in the door, panic written on their faces.  They dashed over to where she was, lying on the floor, with the pull-out bed in a somewhat proper shape.

After everyone realized that no one was hurt, we all took a moment to laugh.  I'm sure it was also embarrassing for Melissa.

The funny part was that the next day, when the nurses came into the room after she had left.  They instructed me to please have a nurse come into the room and setup the spare bed next time she arrives.  I guess they didn't want a repeat performance.

The worst part about the whole hospital experience was needles.  Actually, there were several worst parts.  But right now, the needles experience stands out.

From the moment I arrived in the Emergency Room on that Saturday, I was getting jabbed with needles.  They needed a blood sample.  So they sent in a technician who did it.  Now I've been stuck by needles enough times now that I know what to expect.  But that guy.  He was quick but man, did it hurt.  I yelled "Ow!" when he did it.  It's supposed to pinch.  Not hurt.

By the time I was back on Tuesday and admitted to my hospital room, they put me on an IV right away.  And of course that required inserting a tiny tube into a vein.  That wasn't as bad.  The nurse who did it was skilled.

But there were lots of other times.  For example, they needed to draw blood samples on a regular basis because they were monitoring my hemoglobin levels.  This was more than once a day.  And it was getting harder and harder for them to get a sample because my overall blood volume was so low.  The poked around my arms inside the elbow, on both arms.  The poked around the fore-arms.  And the hands too.  There's a lot of potential vein sites on the top of the hand.  The problem was that sometimes they would get a tube in there but then the flow would collapse and have to start anew.  Or one time I remember when they were giving me the 2 blood transfusions, the original site had blocked up and could no longer be used so they switched arms.  The nurse had a heck of a time locating a vein that worked for her.  I remember I was sweating from the pain she was causing while moving the needle around trying to get a line started.  She tried three times before asking another nurse to come in and try.

There were 2 very nice needle punctures that happened.  One, which happened at 4:00 AM one morning, was done by a nurse with a Russian accent.  I don't know if I knew her name.  She went into my left hand.  It was so gentle I didn't even notice.  I thanked her for that.

Another one was when a technician came in to draw a blood sample and I was telling him how good a job the nurse from early that morning had been.  He commented, "Well, we can't have a woman doing a better job than me." and proceeded to do an excellent and gentle pinch.

Some of the time the problem was because my body was not co-operating.  Sometimes I think it was the skill of the person.

I was on Morphine for pain for a few times on one of the days, and during that time I don't remember needle pokes.  I also slept a lot.  Although I'm pretty sure I was awakened for every blood drawing.  One thing for sure, you don't really get much rest in a hospital.  It seemed like I was awakened about every four hours for something they needed to check or do.

Before the 2 units of whole blood were given to me, I had apparently been showing real signs of anemia.  My wife said I looked gray as death.  She told me days later how scared she was when looking at me.  I admit when I looked at my feet they looked a kind of green-gray color.  One of the doctors explained easy ways you can check color is by looking at the hands and eyes.

On the hand, if you look at your palms, you can see all those lines that are sometimes used by fortune tellers and such.  The lines should have a slight pink color to them.  On my hands they were blanched.

The other easy one, which you cannot do yourself without a mirror, is to look under your eyelid.  The doctor showed my wife if you pulled back the lower eye lid flap and looked underneath you should see red.  They told me mine were parchment white.

I also learned that the hemoglobin count tests could yield inaccurate numbers because of the drop in my overall blood volume.  The lowest test score we got was 8.3, which is pretty low.  I should be around 14 to 15.  But we also know that when the blood volume was low the count was actually probably lower than the test indicated.  This was one of the contributing factors to why they decided to give me 2 whole units in a blood transfusion.  From what a doctor explained to me, they avoid this step if at all possible.

It was explained that there's always risk with donated blood.  You just don't know about the donator's life-style nor what diseases they may be carrying.  It was explained to me that even though blood is carefully screened today, some of the tests we run now we're not known about only 10 years ago and who knows what we don't know to test for today?

But the blood transfusions were wonderful in results.  By the time the second one completed I had most of my color back.  And a lot of my mental energy was back.  I still got winded if I went for a walk, and I got tired if I worked on anything mental for more than an hour, but I was a lot better.  I was told it would take about 6 weeks for me to feel right again.

After the last blood transfusion, which each took 3 hours, I had a final meal at the hospital.  The food there is pretty good.  And I was hungry.

I was also fortunate that my friends Blaine and his wife Michelle dropped by to visit.  They hung out with us while I finished my meal and when the nurses came in to disconnect me from all the equipment.

I had to be pushed in a wheel chair to meet the car when leaving but I was so grateful to be going home.

When I was home and back in my own bed I began to reflect on what had happened.  This led me to a train of thought about an experience from when I was in my early 20's.

Back then, I was working as a Mechanical Draftsman in an Engineering Department.  My mentor was a person also named Steve.  He had a kidney disease and was required to undergo dialysis twice a week.  Well, the time had come where he was due to have a kidney replacement.  Now as I understood it, they had to give him some kind of medication during the procedure that would thin his blood.  The problem was he also had a bleeding stomach ulcer.  So he had to go into the hospital to have the ulcer repaired first.

He died during the procedure on his ulcer.  Now this was 30 years ago.  I don't really know a lot about what his conditions were but I truly believe this:  The medicines and medical practices today have improved so much.  I'm thankful that I didn't turn out like he did.

After spending 4 days at home I was ready to attempt re-entry into the work place.  Truth is I get really anxious without having something mental to do.  So I went back for 2 half days.

The first half day was exciting.  I was so thrilled to be back at work.  And many people were glad to see me back.  But by the end of the second half-day I and was so exhausted I slept for 15 hours.  I ended up staying home the next day and sleeping except for getting up to eat meals.

I went back to work again but promised to only do a half-day again and then rest up for the weekend since that was a Friday.

When I started again the following Monday I did whole days of work.  Now I've been working 3 full days straight.  And today was the first day I drove myself to and from work.  Prior to this, Melissa had been driving me.

The work experience has been interesting.  I found myself telling people that they were talking too fast for me to follow what they were saying.  Anyone who has ever worked with me will see the humor and irony in that.  And I seemed to get "winded" easily when I walked around. I also notice that my comprehension skills drop off by mid-afternoon.  I avoid trying to understand or code anything requiring deep concentration during that time. 

I'm drinking a lot of water every day.  I'm doing about 3.5 liters of water a day.  And I'm taking Iron pills twice a day and taking medication to heal my stomach.

Because of the need for me to build up red blood cells, I'm eating a lot of spinach salads and broccoli. And I'm having steak for dinner most nights.  That's a neat perk.

So what did I learn?

One thing is that I promised my wife to never withhold medical related information again.  I should not have done that and understand better why.

Another is that I'm grateful to be alive and recovering.

I also learned that I need to pay attention to what my body is telling me.  When my stomach first started to bother me weeks before all this happened, I should have taken that seriously and seen the doctor right away.

I also have a renewed respect for modern pharmacology and the practice of medicine today.

Posted: Wednesday - April 23, 2008 at 07:23 PM           |