Map of life expectancy at birth from Global Education Project.

Wednesday, August 25, 2010

Oh yeah, my time of strife and woe . . .

I know I'm supposed to tell the rest of this story so I'll get on with it.

When you have your intestines cut apart, they shut down for a while. The anesthesia and the morphine also contribute, so getting off the morphine is helpful, but it still takes at least three of four days for things to get going again. That's why I had the nasogastric tube sucking my stomach dry all the time, and that's why I couldn't eat or drink anything. Hence the IV hydration. You don't want the stomach trying to send anything on for further processing and causing a backup. The way you can tell the guts are starting to operate again is pretty simple -- you fart. So passing gas, as the nurses more delicately put it, became my principle goal in life.

So, Saturday morning, taking my early walk, I farted, just a little puff. What a joy! I felt fine, except that I was thirsty, I still had some pain from the incision and from gas, and I was tired beyond words of being in the hospital. The Chief Resident told me that perhaps I could try some liquids the next day and, if all went well, go home on Monday. He pulled off the dressing, ripping out a good chunk of pubic hair in the process. The incision, it turned out, ran from directly below my navel to just over the point of my right hip. It was closed with big steel staples, like railroad ties.

Then the Chief of Service came and told me I could start eating immediately. He put me on what is called a Full Liquid diet. He gave me his card. "After you're discharged, I'll want to see you in a couple of weeks. In the meantime, if you have any problems or questions, just call." The card read: "Beth Israel Hospital, a major teaching hospital of Harvard University. Andover G. Knozall, Instructor in Surgery." Leah, my wondrous primary nurse, was off that day. Nurse Chris Huang, who I did not know well, gave me a lunch menu. Mirabile dictu! I could order tomato soup, vanilla pudding, cream of wheat. I lustfully circled my choices. Then Chris told me I could get juice from a referigerator across the hall.

It turned out the juice came in a little container that looked like a urine sample. I drank some apple juice, trying to be cautious, but it was gone in a minute. I will not try to describe this experience; I'm sure you can imagine what it meant after nearly a week with nothing getting past my front teeth except a wet sponge on a stick.

I waited a half hour or so and still felt okay, so I went for a urine-sample container of orange juice. I was on my way out of there! I got a little anxious, though, the next time I got up to walk and discovered that my abdomen had blown up into a hard, geometric hemisphere. When my lunch came, I was too bloated to eat.

I had begun to feel surges of pain in my abdomen, always in the same place directly below my navel. As each one subsided, my diaphragm would spasm and acid would burn through my chest and into my throat.

My friend Peter, who is a psychiatrist, came to visit with his eight-year-old son. JJ had brought me his electronic baseball game, to help me pass the time.
In the end, that people care for you is the meaning of life. But pain, in its time, is the whole universe. The cramps now came every minute, stronger every time. They would start in a tight focus just below my navel. Then pain would swirl through my belly and explode into my groin and up through my chest and neck like a cluster bomb, trailing acid fire into my throat. After every attack, I violently gulped the air I would need to make it through the next one. My memory of this whole episode is a blur of agony, but my nurse knew that I was in serious distress before Peter and JJ came. She paged the intern on duty on my team right away, but he didn't come for more than three hours. By the end of that time I thought the spasms would break me in half.

Peter did everything he could to help. Even though he is a doctor, it was not his place to intervene. He tried to talk me through a meditation exercise to conquer the pain, but I could not concentrate. I was not simply in pain: I was possessed. My body was no longer my own. I wanted JJ to leave, afraid he would be hurt and disturbed by what he was seeing, but I didn't want to send him away either because I wanted him to know that I liked having him care about me. It was up to Peter, anyway, and Peter let him stay.

Peter urged nurse Huang to page the intern, again and again. She argued with him, defending her own conduct although it was the system Peter was resisting, not her. Finally he threatened to call Andover Knozall at home. Five minutes later, the intern came. His name was Dr. Huang. No relation? I don't know.

"Ileus", he said to Peter, who agreed with him. That's a fancy word for paralysis of the bowels. Peter had explained to me that the cramps came from the bowels starting to work, but without coordination. One section might start a wave of contraction that met up against another section that was locked up tight. The problem came, ultimately, from the apple juice I had drunk that morning. My stomach was trying to send it on down to intestines that just weren't ready.

Dr. Huang said he was going to pump out my stomach. Peter and JJ left the room. Dr. Huang had a little roll of thin orange tubing. He cut off a piece and dipped one sharp looking end in some vaseline. Then he stuck it up one of my nostrils. It felt exactly as though he had stuck a burning match up there. "Don't do that don't do that don't do that" I yelled. I couldn't yank my head back because it lay against the mattress. I couldn't struggle with him because I was paralyzed by the cramps. The match burned back through my skull. "Where is it?" Dr. Huang asked.
"My throat my throat my stomach my stomach take it out take it out." Then I gagged and vomited onto Dr. Huang's shirtfront. I vomited again, and a third time. By then, he had a bowl under my chin. The tube came up with the brown glop in my stomach, and I pulled it out of my nose. The cramps eased.

Peter came back in and he helped Dr. Huang change my smock. "Actually," Dr. Huang said, "I'm more concerned about his fever. It should be going down by now. It's still 102." I was lying back exhausted. Peter and Dr. Huang left. I still had cramps, but they stayed in that tight little focus under my navel, no longer exploding through my vitals. Every minute, a little surge of pain. But no more cluster bombs, no more back arching and throat burning.

Nurse Huang came in. "I did everything correctly from the standpoint of nursing. Your friend was wrong to say he was going to call the attending." She leaned over to lecture me. How could she would berate me in my present condition? But I found the strength to answer. "My friend wasn't criticizing you. He said so. He was surprised that you took what he said so personally. He was just upset with the system," I told her. But she wasn't satisfied. "I did nothing wrong within the responsibilities of nursing," she insisted.

There are a couple of lessons here. The first concerns the hubris of the surgeon. Even though the residents and nurses knew that I wasn't going to be ready to eat anything for another day or so, he is such a great surgical genius that his patients get better a day earlier than they are supposed to. Actually I later learned that he should have put a stethoscope on my abdomen to determine if the bowels were working, but he didn't even bother.

The second lesson is that it was impossible for me to get any help because I had the bad fortune of already being inside the hospital. If I had been out on the sidewalk and somebody called for an ambulance, I would have had help in three minutes. But inside the hospital a guy with ileus and abdominal cramps is way down the list of things to worry about. Presumably it was only going to torture me, not kill me, so nobody gave a shit. Not only that, they were angry at me for causing such inconvenience. I'm pretty sure they are more attentive in your typical veterinary hospital.

Sorry, but 19 years later, I'm still pissed off about it.


robin andrea said...

What a terrible experience, on top of the already terrible experience you were having there. It's amazing how wrong they were, even about when it was time to start adding liquids and food. It's also pretty wild that the nurse took up her personal complaint with you. I think that's completely inappropriate.

I have a photo of Roger's surgeon listening with his stethoscope quite intently to Roger's intestines, the day after surgery. He came in to check on Roger and listened everyday. When the surgeon was unavailable over the weekend, a different surgeon came in and changed a few of the orders, especially about when Roger could start taking in slightly more solid food. He thought it could happen sooner than Roger's surgeon had written. I have to admit, it made me a little nervous.

kathy a. said...

oy. and you had a doctor friend right there! oy.

i think the world of nurses; they so often have better sense in the moment than whichever doctor is flying by. but i also had a similar experience being berated by a nurse -- although thankfully i was not also recovering from major surgery.

i'd gone into early labor with my daughter, been in the hospital nearly a week, on meds to stop labor. and almost as soon as they stopped those meds, some idiot doctor decided to do a pitocin stress test, to see how my baby would react. i objected -- which in any normal place would have stopped it, but i was a military dependent overseas, in a military hospital, and i wasn't willing to yank the IV. after i complained to a visitor, the head nurse lectured me -- the doctor was the HEAD ob/gyn, and i shouldn't say that.

well, the stupid test put me right back into labor, and the next doctor in line refused to believe i was in labor -- despite hours in the labor room, on oxygen -- until it was too late for pain medication. he almost didn't make it to the delivery. then he told me not to push, and i told him he was out of luck, because i had no choice at the moment.

kathy a. said...

which is a pretty petty whine compared to getting crappy post-surgical advice creating major pain and problems.

roger said...

you are so restrained and tactful. i might have had a few words for the nurse. and the "chief of service." at least you got to barf on the doc.

how is jj now? robin wants to know too.