#109 my hospital adventure

 

June 23, 2024

              For those of you who've gone through surgery, some of this may bring back memories. For those who have not, here's a glimpse of what portends if the physician tells you that you're going under the knife.

              This narrative is more, far more, than anyone wants to know about my recent hospital stay. But I like telling stories and perhaps it will engage and amuse you for a few minutes.

* * *

              I got hit by a train, so to speak.

              It was a routine evening at home last Friday (June 14): cocktails, dinner, Kathy off to crochet and watch a movie, Gary off to read. In the middle of the evening my stomach began to hurt; it felt like a gas bubble, something most of us get from time to time.

A trick I was taught when young was to lie carefully down on the floor, on your stomach, and the gas bubble will go away. It didn't do so this time, nor did anything else I tried to alleviate the pain. After an uncomfortable night with little sleep, Kathy took me to the ER early Saturday morning.

The excellent ER physician did two things first. One, since by this time my pain level was reaching an agonizing level, she got me a pain medicine almost immediately, which I implored her to do as soon as I met her. Two, she ordered a CT scan, which happened very quickly.

We waited a short while for the scan results. The ER physician returned with another physician in tow. The new one, a surgeon, spoke. She said something to the effect that "you need surgery and you need surgery today." My small intestine was twisted and wrapped around the major blood vessel supplying blood to the intestines; without fixing the problem, parts of the intestine would die. Oh. Well. Not much to say. OK. I had no idea what was coming.

Perhaps four hours later I awoke in a hospital room with tremendous pain in my abdomen. The next five days were hospital hell: constant pain from the multiple incisions, a continuing backache from being in bed so long, four tubes coming out of me (two from the nose), and just plain discomfort.

My stomach, as Kathy commented, looked like I was five months along; I was bloated and the skin pulled very tight. One of the tubes went from my bloated stomach out through my nose to a suction machine and served to drain the accumulated liquid and gas, the NG tube.

The hours go very slowly when you don't want to--can't--read, watch TV, do email, anything, because you are utterly incapacitated and doing nothing but turning over in bed trying to get comfortable. Looking at the clock at 6:00 a.m. and realizing it will be a long day with considerable agony does not make one a happy camper. That wasn't the situation all the time I was awake but it was the majority.

My only redemption during this period was dilaudid, a powerful narcotic pain killer, which the docs and nurses dispensed as needed. But I couldn't be on it all the time, so dilaudid was my sleeping med. None of the other pain killers worked, confirming my long-standing opinion that Tylenol is largely worthless, at least for me. I have never used any kind of narcotic, but this experience gave me a glimpse of why people might: When I was in pain, and the nurse injected the dilaudid in the IV affixed to my arm, the relief was instant. It went directly into my bloodstream and caused relief, even bliss.

 I thought things were going well by last Wednesday, and I felt better. Then Thursday everything went to hell and I thought I'd be there until next week. I was despondent. The worst part of this long miserable experience was having the NG tube reinserted. The first time was no problem: it was inserted during surgery when I was under general anesthesia. When everything seemed to be going well, my nurse had removed the NG tube (just a quick pull and it was out—piece of cake). When the situation turned around on Thursday, when the bloating returned, they had to reinsert it. Two of the nurses held me tight while one of them inserted it; they knew that the insertion provokes an involuntary violent reaction. It did. I jerked. It was painful and nauseating.

The situation flipped 180 degrees on Friday. The food processing systems all decided to begin functioning normally again; whatever blockage had existed had dissolved or gone away or who knows what. But the NG tube had done its draining job. I felt great and had no pain anywhere. I no longer looked like I was five months pregnant. I wanted desperately to go home—I made that abundantly clear!—but the docs wanted to be on the safe side, sure I could digest food, and Kathy agreed, darn her. So there I was, dammit, for the seventh night in a hospital bed.

I know of someone who had to have the NG tube procedure, or something like it, as a part of treatment during terminal cancer. If the path to dying because of cancer (or any other terminal illness) includes a tube up my nose, I will decline the tube and accept an earlier exit.

It occurred to me that doctors and nurses deal with patients on two levels. One, they face fellow human beings with a medical problem of some kind, often in pain, and they are in the profession to help. But two, they are treating an organism with an affliction and are on a quest to treat it successfully—and can be brutal in seeking a positive outcome. We as patients are treated as kindly as possible and at the same time with ruthless devotion to effective treatment, which can involve lengthy and painful procedures. None of us can voice much objection, of course, because we must trust they are using the best available procedures and we have to suffer through the treatment in order to continue to live.

I made it a habit to chat with the nurses (heaven knows that the one person on the planet you want to be your friend is your attending nurse) as well as joke about whatever it is they were doing to me at the time. We had a few laughs. I'd inquire where they went to school, how long they'd been a nurse, where they were from, and so on. In a couple of cases, I asked them if they thought they were fairly compensated. Both said yes but added that they were not in the job for the money; they loved caring for patients. Other nurses made that same comment. That commitment was certainly reflected in the care that I received.

              Anyone who has been in a hospital knows that a patient gets poked and prodded and tested repeatedly. The surgery post-op ward added a new element: heparin every six hours. A lovely shot: it stings. Not as much as lidocaine but worse than a routine vaccine. My arms are now dotted with red spots from morning blood draws and heparin shots four times per day. When I questioned the heparin, I was told that blood clotting is a significant concern following abdominal surgery (maybe all surgery), so we get a blood thinner.

I was reminded once again that hospital lingo for time is different from that used in the outside world. "I'll be right back" can mean anywhere from 30-90 minutes. "It will be pretty quick" means an hour or two. "Pretty soon" suggests two hours or more—or maybe not at all.

I was also reminded that in a hospital, one has neither dignity nor privacy. Not to go into too many details, at one point I had a young Black woman nurse student intern cleaning my groin area after a procedure. I joked with the nurse and the intern that some of the routine actions in a hospital would either be subject to criminal prosecution in another setting or would reflect some really weird sexual practices.

A few months back I read in a couple of different sources that the medical profession was abandoning the 0-10 pain scale. You've all seen it, I'm sure. This is the one that was in my room.

If anyone in the profession is suggesting moving to some other scale, Fairview Southdale didn't get the memo. I was asked perhaps 200 times what number on the scale described where I was at that moment. Many of my answers were 7-8. I must have said a dozen times to the nurses that coughing was my enemy: for the first days after the surgery, if I had to cough, I'd be 10 on the pain scale at the site of the incision.

Why did this happen to my small intestine? Docs do not know, the resident who discharged me said when I asked. The surgeon had earlier commented that it was just "bad luck" and the resident agreed. It most definitely was not our fitness routine; he said he couldn't even figure out the amount or kind of external force it would take to rearrange one's intestines. The closest he could imagine would be on one of those amusement park rides that spins you around really fast if you rode it for quite awhile—and even that would be unlikely to cause bowel misalignment. So the etiology remains a mystery.

Meantime, poor Kathy was going back and forth between home and the hospital. It was nice to have her nearby even if we had little conversation beyond my medical status from day to day. I wasn't in the mood to chat, needless to say. Hospital rooms, at least where I was, are all single, fairly spacious, and include upholstered furniture for visitors. One piece was a recliner, so Kathy could crochet and listen to an audio book while I was napping—or she could take a nap herself, which she did a couple of times.

I don't know about the rest of you who've had a hospital stay, but I turned down all requests to visit. A number of you were kind enough to volunteer to come, but I said no. Most of the time I was too distressed and the rest of the time I just wanted to sleep. Besides, *I* don't like visiting people in the hospital because the conversations are often stilted and limited; why would I want to put any of my friends in that position?

What I found remarkable is that I had no food—NO FOOD OF ANY KIND—from dinner on Friday, before I went to the hospital on Saturday morning, and Tuesday. The only substance entering my system, besides a multitude of drugs, was saline solution through the IV affixed to my wrist. From Tuesday through Saturday morning, I had only a liquid diet (e.g., chicken broth, orange gelatin, apple juice, tea, etc., a much-sought-after cuisine). So no solid food from Friday dinner to mid-morning the Saturday eight days later.

              I didn't realize one can go so long without sustenance and not lose some kind of function somewhere. Moreover, even more remarkable, at least to me, is that I wasn't at all hungry during that period nor did I feel particularly weak (other than overall from the surgery itself). I couldn't even finish the liquid diet servings that I ordered—and if I tried, the liquid only exacerbated the bloating in my stomach (thus leading to my relapse).

              My first solid food on Saturday morning, the eight days after Friday dinner, was scrambled eggs and toast. They were my "get out of jail" card: If I could eat them and not throw up within two hours afterward, I would be released. I was already feeling great, peeved that I'd spent Friday night in the hospital. When the resident gave me that challenge, I promptly ordered the food and equally promptly ate it when it arrived. Once finished, I walked down the hallway and found my nurse and told her that I wanted it noted in the record that I finished my meal at 10:26. She laughed and said she'd contact the resident at 12:26. She did; he showed up about 12:35. He signed the release order and the wonderful nurse had me discharged in less than 15 minutes.

              One question that a friend asked was whether I was worried about the outcome. I said no, apart from general worry anyone has about being in a hospital. This surgery was very different from, say, cancer surgery, where your life can hang in the balance. In the minds of the physicians and nurses, there was no mention of long-term risk or an outcome to be feared; it was just an obnoxious process that I had to go through.

The hospital staff was fabulous, as I mentioned earlier about the nurses. They repeatedly assured me I'll be fine and this will just be a bad memory. I hope they're right on the first score and I know they're wrong on the second: it won't be a bad memory, it will come back to me as a nightmare. This was the worst experience of my life.

              For the locals who drive in the area, the next time you drive on Hwy 62 near France Avenue, and you see those huge E M E R G E N C Y letters on the front of Fairview Southdale hospital, you can remember that your friend Gary had the best time of his life in one of the rooms overlooking 62 about 50 feet to the right of the Y.

              On to regular life again, albeit slowly.

              Gary

 

 

#110 Finding fitness

June 6, 2024

            Good morning.

            Many of you have incorporated some kind of exercise routine in your lives for many years or you pursue athletic or quasi-athletic activities or you may do both. Those of my friends who know me well and have known me a long time know that I have been allergic to anything even faintly athletic my entire adult life. (Does bocce ball count as athletic? I suspect not.) The last time I was "in shape" was probably in 9^th grade, when we had to take physical education. I have long understood, and read frequently, that one important way to stay healthy and mobile (and mentally fit) as one ages is to engage in physical activity. The thought makes me tired. I have always admired Hunter Thompson's point of view:

Life should not be a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out, and loudly proclaiming "Wow! What a Ride!" ― Hunter S. Thompson, The Proud Highway: Saga of a Desperate Southern Gentleman, 1955-1967

I know darn well, of course, that without maintaining a reasonable level of physical activity one will arrive at the grave too early and perhaps after a long period of physical disability of some kind.

            After repeated but friendly badgering from my son Elliott, and after Kathy observed that we have a free membership to Life Time Fitness with our health insurance (the "Silver Sneakers" program), we decided that we'd join. (If I catch all the stoplights right, there is a Life Time club three minutes from our townhouse, so I can't even use inconvenience as an excuse not to go.) I must thus reluctantly set aside my affinity for Thompson and accede to the demands of an aging body. (Elliott has taught himself much about physical fitness and read widely and exercises regularly and he's been on my case for years to do something.)

            So we scheduled a time for a tour and introduction. I assume we were randomly assigned one of the staff trainers, whoever was available. We were assigned to Mena Youssef, a lively young woman of 26 (I learned that later).

            As we walked around, we realized that we had no idea how to use all the equipment we were seeing, we had no idea what kinds of activities or exercise we should do, and little idea of what we expected to accomplish. So we decided we better engage the services of a trainer, and since we liked Mena, we signed up right then and there: once per week for 12 weeks. (Sure, the Life Time membership is free; a trainer is decidedly not.)

            As we talked, I asked Mena if she was from the area. She told us that no, she was not, originally; she was born and raised in Egypt and came, with her mother and siblings, to Eden Prairie in 2006 when she was 8 years old. I was astonished. What I found amazing is that she sounds like she grew up in Eden Prairie. I asked her what language she spoke growing up; she said Arabic (naturally) and British English. I know that if one learns a new language young, it comes easily, and American English is not exactly a "new" language for someone who speaks British English, but I was nonetheless startled at her utter lack of an accent. (I'm no linguist but over the years I've discovered I do have an amateur's ear for languages and accents. When we first visited Life Time and were waiting for our tour and introduction, I told one of the young women working at the front desk that she had a Scottish brogue; Kathy agreed. The young woman was startled; she had no idea.)

            We have now had seven sessions with Mena and could not be more pleased. I guess we're pleased. I come home after our 9:00 a.m. hour-long sessions and I can feel it. We get a workout. I guess that's how this is supposed to work. Mena told us that if we follow the exercise regimens she prescribes, and do them 3-5 times per week, we'll gain one pound of muscle mass every five weeks. I am so excited by that prospect. No, not really. Excited or not, Kathy and I go in four times per week. I enjoy the three mornings per week when we don't go in. (Elliott says he enjoys his workouts on their equipment at home. Good for him.)

            As is often the case for me, the technology associated with exercising was a surprise. Mena prescribes a set of exercises—different each day—that we follow on the three days per week that we do not see her. I learned quickly why all these people at Life Time are walking around with their cell phones in hand, looking intently at the screen. I'm doing it as well, since the exercises are on the Life Time app on my phone. Of course the app also keeps track of what I've done and what weights I've achieved on each machine.

            Another way the technology surprised me is in the seemingly infinite variety of exercise machines that are made. There are dozens and dozens! Sometimes Mena assigns an exercise on a machine she hasn't shown us how to use. Some are easy to figure out; some I can't even find and have to ask one of the trainers where it is, and some I can't figure out how I should use it even when I do find it.

            Since I've never belonged to a fitness club before, I don't know what the difference is between a high-end and not-so-high-end club. This place seems higher-end to me: lots of machines and weights and classes, a pleasant and large training/exercise room, huge and well-appointed locker rooms, generally a classy place. Is Life Time high end? What's lower-end? What's even more high-end?

            I have been impressed with Mena's knowledge of exercise physiology. She told us that after graduating from Eden Prairie High School, she went to the University of Minnesota and earned a degree in Kinesiology. She learned her stuff; for example, she points out the muscles that we're working on with each exercise. Because I have a shoulder that's a little painful sometimes, she tested my range of motion and then told me to go to an orthopedic physician. I have an appointment in the next couple of weeks.

            When we started this program of exercises, Mena told us to be sure we eat enough protein because muscles need protein. When I informed Elliott about this Life Time venture, one of the first things he said was to be sure we eat enough protein. Apart from occasional curious glances at dietary information on almost every food item one purchases these days, I've never paid much attention to it. Now I have to check for protein content.

            I find interesting the social interactions at Life Time: there aren't any. No one talks to anyone else (except on the rare occasions when it's apparent that two guys or two women know each other outside the club setting). I would have thought that there might be some chatter, talk about the equipment, what exercises one is doing, whatever. Nope.

            I suppose that now I have to buy some spiffy gym clothes so I look good while I'm working out. Or maybe not.

            I grudgingly concede that the four hours per week are probably doing me good, although I can't tell it (yet), other than by stiff arms and legs from time to time.

            If you're of a certain vintage (i.e., old enough to be retired), I'd be curious to learn what you do to keep fit and what your experiences have been at places like Life Time Fitness.

            I hope your life is going well. Please stay in touch.

            Gary