A Wee Pioneer

I had a fun new adventure! Yesterday morning, I woke up at 2:00 because of pain.. sort of generalized back pain and sciatic nerve pain down both legs. Too hazy with sleep to recognize exactly what I was feeling. I went to the bathroom, trying to decide if it was really back or abdominal pain. The two can be confusing in the middle of the night... or I'm pain-impaired. I went back to bed but couldn't sleep. At 2:30, I gave up, took some ibuprofen, and sat down at the computer to play a game.

My back/stomach started feeling better! But by then I was wide awake. I kept playing on the computer.

Around 4:00, the pain came back, as well as strong urges to use the bathroom. Oh brother. I had already taken 600 mg of ibuprofen. Whatever, I took 400 more. Ran a bath.. Lay flat on my back.. Tried sitting.. Walking.. I was not a happy camper. And then, around 4:30, someone stuck me in the back with a knife.

I mean, I couldn't see the knife, but it was definitely there, in the right side of my back. It surprised me. I tried the bath thing and kept running to the bathroom without much luck. I just assume everything is a bowel problem, because for me, it usually is.

The pain got better. It had been an 8 but went down to maybe a 5. About half an hour later, it hit again, this time worse. Tears sprang to my eyes. I emailed my home teacher (it wasn't even 5:30 am, so I didn't want to call) to ask for a blessing on his way to work.

The pain started coming in ever-more-frequent waves, going down to a 7 and up to a 9. For me, gallbladder pain is a 10, and it wasn't quite there. But it was bad!

Laynie woke up around 6:20 to find me cowering on the bathroom floor. She told me to CALL our home teacher. I texted him as I took more ibuprofen. He got back to me pretty quickly, and I got my blessing before 8:00. Ugh, it wasn't what I wanted. I fully expected to be healed, but no: "slowly subside," "due time," "trust medical system." Doctors? Not my cup of tea.

There are about a million hospitals within half an hour of here, and my home teacher said he liked GBMC when his wife gave birth there. I had a not-so-enjoyable experience at Johns Hopkins (waiting five hours in excruciating gallbladder pain before a doctor even laid eyes on me, leaving the next day without answers), so I didn't think I wanted to go there. Northwest, 10 minutes away? I wouldn't leave my car in the parking lot--probably come back to no radio or tires. I decided to give GBMC a try.

I got right in! Score! I went straight to triage, right back to the actual ER, and saw a doctor within 20 minutes. Oh, yeah. I was loving it, although the waves of pain (still 9 at worst, 7 at best) were coming every 10 minutes. But I thought the end was in sight. The doctor immediately ordered dilaudid and something for nausea. The nurse tried to get blood but I was too dehydrated--managed to start an IV at least. I really didn't care what they did, as long as I got pain medicine SOON. They ended up giving me two doses of dilaudid, because the first one didn't do anything.

The dilaudid helped for a little while, but it seemed to wear off within an hour. Then my pain was ranging 8-10. Yup, 10. It was actually worse than gallbladder pain, although it didn't have quite the staying power. At least it was coming in waves and not being continually excruciating.

They gave me more dilaudid. I guess it helped. I had a CT scan of my abdomen and chest. Abdomen for obvious reasons (the pain was in the right side of my back, sort of near my waist), chest because I had pain when the doctor pushed on the right side of it--different pain than the other one. And some test was elevated that could mean a pulmonary embolism. Again, I didn't really care what they did, as long as they made the pain go away, so I said fine, scan my whole body if you want. Radiation shmadiation.

After I got back from CT, my pain was back up at 10. Laynie flagged down the nurse, and she stopped at the door to say, "I'm obviously in the middle of something; you're going to have to wait." Aaaah! I was in agony. I answered email and gave instructions for an IEP meeting I was missing--tried to distract myself. Mostly I held Laynie's arm and cried. The nurse came back in a while with a percocet pill.

Later (by now it was after noon) the doctor came in to say that I had a kidney stone in my right ureter. Great. I sort of thought that was what it was. Despite not having a family history of it, I knew there was a wee pioneer blazing trails through my unsuspecting innards. What else is going to cause single-sided pain in that area? On with it, make the pain go away. I was thinking that they should just put you under general anesthesia to pass kidney stones...

The doctor ordered toradol (anti-inflammatory and pain med) and flomax (old men with prostate problems medicine--relaxes the urinary system or something, less spasming as the stone goes through). And more nausea medicine, because I was pukey by that time. Still had pain fluctuating between 8 and 10.

Well, something started to work.. or maybe it was the combination of everything: dilaudid, percocet, toradol, and flomax. Suddenly my pain was fluctuating between 6 and 7. Beautiful. They kicked me out. Gave me some funnel sieves to pee in and sent me on my way.

Around 2:30, Laynie drove me home. She hit the cement base of a pole trying to navigate the tight ER circle. Poor Laynie. I screamed when the impact happened and freaked her out. I couldn't really be mad though--I cracked her front bumper when her car was pretty new, failing to a short sign in the little road around UVSC. And sadly this impact was not the first damage to my less-than-9-month-old car. The roofers dropped a canister and dinged the hood. The bumper was abraded, but I don't care, because it's plastic and won't rust. Poor little Bug, though.

On the way home, I got this weird feeling. It's hard to describe. Definitely psychotic. My heart raced, heat rushed through my limbs, and I had the uncontrollable urge to hit myself in the face. So I did. I slapped the sides of my face, and I kept saying (signing), "Something is wrong, something is wrong." I didn't want to slap my face, so I wrung my hands, bumped my knuckles, finally clapped my hands. That was good--closer to normal. I just had to keep the rhythm. Bad trip? The feeling subsided within 15 minutes and didn't happen again.

That's why you don't do drugs, kids.

Well, my pain didn't go past maybe 8 the rest of the day. The worst was over. Well, not really--the worst was controlled by drugs. Laynie went out and got my percocet and flomax prescriptions filled. I was dizzy, getting nauseated every time I picked up my head. I tried to sleep but kept getting woken up by small noises. I passed the rest of the afternoon in a haze. I ate chicken soup broth and saltines for dinner. I traded emails with friends. I texted with my sister. I texted with my dad, who is a PA. I think he specializes in urology. He said it would stop hurting when the stone got to the bladder. The doctor had said that could take hours or days. One thing dad had said made me feel better: it wouldn't hurt coming out. I could now pee with confidence.

I fell asleep at 8:30, knocked out by the percs. I got up a few times during the night and took medicine, but I slept a lot. I woke up feeling better but hating the drug side effects more. Dizziness to the point of vertigo, which caused nausea. But there was no way I was taking a chance that the crazy pain would come back.

Around 11:00, I started passing sand flecked with dark stuff that I thought was blood. Now I don't think so. I think it was bits sheared off the stone, which passed around 12:30. Hooray! It was dark red, looked like little spheres stuck together. Dad was right: it did not hurt coming out. It was only 3 mm.

So now I have the little devil in a specimen cup, ready for my urology appointment on Tuesday. They will analyze it and let me know what kind of stone it is and what kinds of foods to avoid or vitamins to take or whatever.

If you are thinking about my previous blog post and scratching your head, yes, I passed the stone at 12:30 and got to work by 2:30 for a 3:00 meeting. Because I rock. And I'm crazy: I was soooo dizzy. Of course Laynie was my chauffeur.

My little inquisitive guy asked why he didn't have speech today. It's Thursday, after all, and Thursday is speech day! So life goes on.

Surgery

I finally took the plunge. Surgery. Here I am at about 6:15 am, ready to go back. My girls Katie and Laynie were with me, and they forgot their cameras... good thing for phone cameras! I wasn't nervous yet. It didn't hit me until I walked into the OR.

Hazel, an anesthesia nurse, had started my IV. She signed and dated the tape. It HURT! Worst IV yet for me. She also took some blood from the crook of my elbow. That didn't really hurt. Too bad she didn't know to do that before she had my IV all taped up. The blood was for Dr. M-the-GI-guy's research study.

Let's get this party started!

I'll go ahead and apologize for a long post now. I've got nothing else to do today, and this is like my journal entry.

They wheeled me on my bed to the OR, and stopped outside. They had me get up and walk in. That was when the emotions hit. I realized it was really going to happen. I felt the tears welling up. The anesthesiologists were getting the table ready for me to get up on it, and I looked around the room. A little. I avoided looking near the table, because I didn't want to see any instruments. But I saw the radio in the corner. The room was big, and the table was small. I told the anesthesiologist (the REAL one, not his resident, who was more nervous than I was) that I was kind of scared. He was very reassuring and had me get up on the table and stretch out my arms onto the arm boards. Somebody put a pillow under my knees. I could see the strap they were going to use to keep my legs on the table, but she didn't put it on yet. The anesthesiologist said he was going to give me something to relax me. I do not remember a thing after that. I suppose that he didn't actually put me out yet, because the surgeon wasn't even in the room, but I don't know.

Dr. M-the-surgeon removed my gallbladder, which turned out to be badly diseased. It was contracted. He also removed my appendix, which was totally fine. I guess he figured as long as he was in there... Well, I had known that he probably would do that, because he put three procedures on the informed consent form: laparoscopic cholecystectomy, EGD (meaning upper endoscopy), and possible appendectomy. I signed it without looking. I was signing a lot of papers. Later (this is going back to before the surgery, obviously), a nurse brought it to me to verify my signature and read off the procedures. I was like huh? Whatever.

Dr. M-the-GI-guy was right: I did have actual reflux (the surgeon thought I was confusing heartburn with gallbladder pain), and it was a separate problem. I knew I liked that guy. He was smart. Dr. M-the-surgeon saw reflux during the endoscopy, even though I had taken Prilosec the night before and that morning. He did not see evidence of Barrett's esophagus, but he took biopsies. He also took biopsies from my stomach, and did something that will test for H. pylori. He found that I have a small hiatal hernia. I also have a grade II lax GEJ sphincter (that's the lower esophageal sphincter on the hiatal hernia picture). I wonder how many grades of laxity there are. Anyway.. that explains the reflux.

I had a tough time waking up from the anesthesia. Of course I was really groggy, and my eyes didn't want to open. The first thing I registered was pain--on my face! My cheeks and lips were burning. Darn Accutane has made my skin so sensitive. I think I've written before my Aquaphor addiction. As I woke up, the oxygen mask was only making my cheeks hurt worse, and I began to cry. The nurse (my best nurse out of the four I had) came over to see what was wrong, and I tried to sign pain and thirsty, and she didn't get it. Actually, I didn't even mean that I was thirsty. I meant dry, but somehow I signed thirsty. My brain was a little addled. The nurse seemed to think I was randomly moving my hand, and she kept asking me what was wrong. I finally realized that I was signing and of course she is not going to understand, so I whispered, "Vaseline. Dry." That's right, my first word upon waking up was not Mom, Dad, Katie, or Laynie... It was Vaseline. The nurse noticed the rash all over my face and got worried. She smeared Vaseline on my lips (sweet relief!) and had the post-anesthesia doctor, Dr. S, look at my face. They were getting kind of worked up about it, so I must have looked awful. I kept trying to say Accutane, and finally they got it. They put bacitracin on it and I felt much better. Except that my stomach hurt and itched. I asked what time it was: 11:30. I had gone into the OR at 7:15. Later I found out that I came out at 10:58. I guess I was under the knife for three and a half hours.

The surgeon came by to see me, and he told me that he removed my gallbladder, which was quite inflamed, and my appendix, which was healthy. Prophyaxis, you know. The more I think about it, the happier I am that he did that. That was all he said. A few minutes later, the anesthesiologist came by to see how I was doing. After he left, I was not doing too badly, and they were going to get Katie or Laynie to see me. The nurse came back to say that they weren't there. I figured they were still at audiology, because Laynie had a mapping appointment. I didn't care anyway. I didn't have a desire to see them. It wasn't that I actively didn't want to see them, I just didn't care. Then I felt like there was junk in my throat, and I had to cough. I had trouble coughing it all up, and I ended up making it worse for a while, and I couldn't breathe. The monitor was blaring its warning, and the nurse helped me sit up to cough it out. Finally I did, and I laid back down. My throat was so dry. It hurt to breathe! Every breath felt like little knives stabbing the back of my throat. I started to cry, and the nurse wasn't able to help me feel better, so she went to get Dr. S. I wanted to stop her, because I knew the doctor couldn't do anything about it. But I couldn't exactly yell after her. I could barely whisper.

While the nurse was gone, my throat began to settle down, and I wasn't feeling too horrible. But then I started crying uncontrollably. It hurt to cry, but I couldn't stop. Dr. S came, and I told her that I was fine, but I just couldn't stop crying. She and the nurse went out to the other side of the curtain to talk. I could hear them just fine. Dr. S said that the medicine (from the anesthesia?) was making me cry, that it would probably continue for a while, and just to reassure me. I opened my eyes and smiled at the nurse to let her know that I heard everything (still crying, ha). She came over and told me to get some rest. A few minutes later, the creepy crawlies started.

I felt like something was crawling under my skin, all over my whole body. I loved the pressure from the leg massager things, which were on my lower legs. I wished I had those all over. I kneaded my hands into the bed to try and get some pressure, wondering if this was how sensory disorders feel. This is going to sound crazy, but I reeeeeeeeeally wanted to beat my head, like just hit it with my hand, because I thought that would make the feeling go away. I didn't, because I figured the nurse would flip out. It was hard to contain that impulse, though. Finally, I fell asleep, or at least into a haze. I could hear the conversations around me. The guy in the curtain area next to mine had had some malignant tumors removed from his lungs. His family was loud. I wanted them to be quiet so I could sleep. I think I finally did sleep.

At around 1:30, I woke up doing a little better. The creepy crawly feeling was gone, whew. After a while, the nurse asked if I wanted to see my family, and I said OK, but my voice didn't work. She understood my mouth movements, though. Katie came to see me, and I still couldn't talk. I just couldn't get my voice going! I decided to sign. Poor Katie. I didn't have great motor control yet, and I was signing with only one hand. That conversation was basically one big miscommunication. She told me that the surgeon had spoken with them, that he removed my gallbladder and appendix, which I knew. She also told me about the hiatal hernia, which was news to me. She said that hiatal means small, and I tried to tell her no, hiatal is referring to the location of the hernia, as opposed to an inguinal hernia, etc. But I had more language inside than I could really express. Katie didn't understand me. I'm sure my fingerspelling was horrible. I tried to ask if I needed surgery to fix the hernia (thinking about my friend Deb from work, who had a hernia repaired last year), but Katie thought I was talking about pooping. If you know ASL, you will understand why confusing surgery with poop is a perfectly reasonable misunderstanding. I started getting my voice and the nurse came over. She was confused, to say the least! Katie left, and the nurse said, "I talk and you respond.. I talk and she responds.." Haha, I told her that we are both hearing, but we were just signing. Come to think of it, I don't know why Katie was signing back. My ears worked just fine. Putting out what she was taking in, I guess. I think Katie left pretty frustrated.

A little while later, Laynie came back to see me. I don't really remember much, except that we communicated fine. Laynie just reminded me that she was the one who told me that I only had two holes: an umbilical incision and a shorter incision (punture?) under my right ribs. I was surprised and didn't quite believe her, because Dr. M had said he would make three punctures and an incision. The nurse said, "Yeah, I think there are only two--I was looking for them before." Eh? When I was out? Haha. So she looked again and still only saw the two spots. Wow.

I've said a few times that my mouth was dry--this is something I struggled with all day. The nurse swabbed my mouth with water every now and then, but I was breathing through my mouth (guess I didn't need the cannula on my nose), so it kept drying out. I wasn't able to eat or drink yet. One thing I noticed was that I was aspirating the bits of water that would run down into my throat. I was hoping that a larger bolus (bigger swallow) would help, and I didn't worry too much about it.

Katie and Laynie took turns visiting me all afternoon and evening. Laynie took this picture of Katie in the waiting area. Little techie girl.

Of course, they wanted to get me up and eating, drinking, going to the bathroom. All of a sudden, I really needed to pee. Laynie was with me at that point. I wanted to try and get up to use the bathroom. When the nurse sat my bed up, the room spun. It spun more when I tried to sit on the edge of the bed. I wasn't able to sit up straight, and I wanted to lie back down. I just wanted them to leave me alone. All of a sudden I did not have to pee. The nurse got a wheelchair and was locking the wheels when the room spun again and a wave of nausea washed over me. I leaned against Laynie and began to cry. I told the nurse that I was nauseated, and she laid me back down and went to get medicine for that. First she had me use a bedpan. Weird. Then she got the medicine ready, warning me that it was going to make me sleep for a few hours, but I would feel much better when I woke up. It was called fenerdyl or fenerfen or something like that. The nausea subsided as soon as I laid down, but I wasn't thinking clearly enough to connect the nausea with the room spinning, so I didn't stop her from injecting the medication into my IV line. Within 10 minutes I was in a stupor, but it took a long time for me to fall asleep. I kept hearing conversations around me and machines beeping.

I woke up around 5:00, and Laynie was there again. I had to pee again, and they tried to get me up again. Same thing: the room spun and my stomach spun with it. All of a sudden I had a word for it: vertigo. I told the nurse that I was feeling nauseated and couldn't get up to use the bathroom, but I didn't think I needed nausea medication. I tried to explain the vertigo. She gave me nausea medication anyway, but a different one, which would not make me drowsy. I was fine with that. But I still wasn't able to get up, and I had to use a bedpan again. Then the nurse kicked Laynie out. That nurse kept kicking them out.

I wanted to get up, and of course everyone wanted me to. I was learning that if I fixed my eyes on something directly in front of me, the room would not spin, or at least not much. So I sat up in bed for a while, practicing that, and then I asked the nurse to help me to a chair. Oh, man, did my stomach hurt when I stood up! And it hurt sitting in the chair. The nurse offered to put my legs up, which helped tons! Dr. S came by to discuss pain, and I told her that I was having quite a bit of pain, maybe a 7/10. But I did not want something that would make me dizzy or lightheaded. I agreed to take IV Tylenol. I think it was called Toridol. It didn't really help, but I have a decent pain tolerance, and pain wasn't my main concern at that point. Pain wasn't what was keeping me from going home; vertigo was.

The nurse wanted to get me eating and drinking, and I was definitely down with this plan. It was about 5:30 by this time. She offered Pepsi or Sierra Mist, and I chose Sierra Mist. I would never drink caffeine. She was gone for a while, and Katie was there by that time. The nurse said, "OK, here are your crackers, and here's your Pepsi." Apparently they were out of Sierra Mist. And I had to drink something carbonated to try and get some of the air out (they pumped me full of air for the laparoscopic procedure), so water was out. Oh boy. There was no way I was drinking Pepsi. I knew it would all work out. Of course, Katie offered to buy Sierra Mist from the vending machines in the waiting room, and the nurse thanked her. Katie was gone for a while, reappearing with fruit punch. As in, non-carbonated fruit punch. The machine with Sierra Mist wasn't working or something. The nurse rejected the fruit punch and was ready to give me Pepsi. This was a different nurse, actually, the only one whose name I got. Earl. Big guy. At first I wasn't too sure about him, but I ended up liking him. I explained to him that I could not drink caffeine, and he was fine with that. Katie texted Laynie to get something carbonated for me. About 10 minutes later, Laynie texted back that someone needed to watch the bags if she was going to go looking for more vending machines. That whole time we had thought Laynie was off getting my drink, but I guess the texts took a while to be received. So I sent Katie out to the waiting room. It felt like forever before Laynie showed up with Sprite. She had had to go all the way to the cafeteria, which is two buildings away! I really appreciated that.

I got to drinking, and just as I had feared, I aspirated with every sip. Small bolus... large bolus.. it didn't matter. Chin tucks didn't help. "Hard and fast" swallows didn't help. I wasn't aspirating the entire bolus, but a little bit with each swallow. I was able to cough it back up every time, though (although I would often reaspirate it when I tried to swallow it again). I told Earl that I was aspirating, and he asked me what I thought was happening. He knew I was a speech pathologist, and swallowing is within my scope of practice. I paid closer attention. I thought it was a problem with the pharyngeal phase. When I put my hand on my throat during the swallow, I could feel my larynx elevating. But was it enough? Or maybe I wasn't adequately clearing the laryngeal vestibule--what most people would think of as the back of the throat. I could feel liquid still there after a swallow. Maybe the upper esophageal sphincter was snapping shut too quickly, before the entire bolus was in the esophagus? Maybe I the problem was really with the oral phase of the swallow, that I wasn't pushing the entire bolus back. What I wouldn't give for a barium swallow or FEES, just to satisfy my curiosity. Well, it's not worth it just for curiosity's sake.. but you know. I'm nerdy, what can I say?

It wasn't just the liquids either: I aspirated some crackers, as well. I had to laugh when I coughed after swallowing crackers and chewed up cracker hit the back of my hand HARD. It was like in the movies when a person is choking and someone does the Heimlich. I figured all of this was due to the anesthesia or maybe the intubation. Earl told Dr. S, who came over and was concerned. She checked my chart and noticed that I was an easy intubation. She considered keeping me NPO (which would have meant that I would have to stay in the hospital, I think), but she ended up letting me keep trying to eat. She said it was because I was an SLP and she trusted my judgment. Hm. I kept trying to eat, and I kept coughing after each swallow. The more I coughed the more my stomach hurt. My regular nurse (Earl was filling in for her because she was busy) came over to check on me. I told her that I was aspirating, and she said, "Oh, I'm sure you're not really aspirating. You're sitting up, so I know the food is going the right way." She was exactly the kind of nurse that drove me crazy during my hospital internship, because they send people home who are at risk for aspiration pneumonia! Nurses have to refer when patients are aspirating, so that the SLP can at least to a bedside swallowing evaluation. I explained to her that you can aspirate sitting up, and I am. She went off to find the doctor, still think she was right. She came back a little more contrite.

My surgeon walked snappily by at one point and asked how I was doing. I told him I was fine except that I was aspirating. He said, "You're dysphagic?" and laughed. He asked Earl to get me a spirometer, reminding me that I should know what to do with this, being an SLP and all. He wants me to use it to monitor my lung capacity and to work out my lungs. He said he would trust me to call if I needed to see an SLP. He was giving me a hard time about being an SLP with dysphagia.

After my adventures in aspiration, I wanted to use the bathroom. I asked Earl to help me. He went and made sure the bathroom was empty (smart), then came back to help me up. I still had vertigo, but I was getting better at finding a spot to focus on, which kept the room from spinning. Much. I crept very slowly to the bathroom, holding onto Earl. I noticed that he had placed a seat cover on the toilet for me. Thoughtful. I went a little faster on the way back--maybe a turtle's pace instead of a snail's pace. Turns were tough, but spotting helped. I finished my crackers and most of my Sprite (coughing all the time), and then it was time to discuss my release. Yes!!!

Earl was so sweet as he wheeled me down to where Laynie and Katie were waiting with the car. He warned me which way he was going to turn, so that I could find a spot to focus on. It worked, and the world didn't spin much.

Hooray, home! My vertigo was a little better. I was able to move my head about 30 degrees without things spinning, as long as I kept it level. Looking down was the worst. No, looking diagonally downward was the worst. We left the hospital at 8:00, and I was in bed by 9:30.

I got up about every two hours to use the bathroom. The pain was getting worse all the time. I had only taken Tylenol or ibuprofen since 6:00 pm. Dr. S said that the oxycodone that I got would help with incision site pain, but that Tylenol or ibuprofen would be best for crampy, internal pain. I occasionally felt a breathtaking stab of pain at my incision site, but mostly bad crampy pain. It was worst when I was standing. My whole stomach felt to tight. Still does, actually.

I got up at 5:45 and ended up taking oxycodone around 7:30. I'm not sure it helped. I think just sitting still helped. I have a low dose of oxycodone anyway, just 5 mg. I had a bad reaction to codeine in the past (it made me puke), so the doctors were playing it safe. I have 90 pills (89 now), but I doubt I will take more. At least it didn't make me puke.

Now I'm in a weird position. My brain is active, since I'm not on narcotics. I feel fairly decent, except for abdominal pain. But I can hardly walk. So I can't do anything! I think I will be tearing my hair out this week. I have never experienced anything like this. Normally if I am sick, I feel tired (which I am, but not too badly--just one nap today), light-headed, dizzy. You know. So I don't want to do anything. But now I want to do stuff but can't because I can't move well and I have all this pain! It's just weird.

So that's what happened. Wow, it has taken over two hours to type this blog post! My butt is asleep. Time to go.

Oh Darn

Weird day yesterday. It started out fairly decently, and I wasn't having a whole lot of pain. I should mention that I was in pretty much constant pain last Thursday-Saturday, a little better on Sunday. I had another pain attack Sunday night and had great days Monday and Tuesday, with very little pain. Yesterday it started up again a little, and I was having processing problems (SO annoying). I did wake up with pain and reflux today. But that's not why I am saying, "Oh, darn."

Yesterday I was working (of course), and I happened to check my phone messages at 1:45. I had three voicemails: one from my dentist (broke another temporary crown on Tuesday, so he's trying to get me in to replace it--he needs to trim gum tissue before he can do a permanent crown, just waiting for my medical issues to be resolved first), and two from the surgeon's office. This would be Dr. M-the-surgeon, not Dr. P. I didn't like Dr. P very much. I was not supposed to see Dr. M-the-surgeon for at least a week, but I guess Dr. M-the-GI was bugging him to get me in. Dr. M-the-surgeon had something open up for this Friday and wanted to meet me first. As in, surgery this Friday.

It was odd to get the message, call them, and have the secretary say, "Can you be here now? Like in half an hour?" Yeah, OK, Woodstock to Johns Hopkins in half an hour. In the rain. Not that I have a problem driving in rain, but 695 is always backed up when it rains. Anyway, I headed straight there. I don't know why I hurried, because it was over an hour before I even saw the PA. Two hours until I saw the surgeon. Only the cleaning crew was there when I was leaving--the doors were locked where patients normally leave! I didn't even think about it until I got on 83 (right near the hospital) and it was basically stopped traffic. Baltimore at 5:30! Doh!

The surgeon is going to do the endoscopy and cholecystectomy (removing my gallbladder). Actually, lap chole. He's confident that he will not need to open me up, that it can be done laparoscopically. Hope so! For the endoscopy, he will check out my esophagus, stomach, and duodenum, and he'll take some biopsies. I'm pretty glad that will happen while I'm completely out rather than under heavy sedation. I know I wouldn't remember anything while under heavy sedation, but it was really freaking me out.

I'm nervous to have surgery, and I know I will be really nervous tomorrow morning. But I do feel it's the right way to go. It was not a hard decision to make.

Today I have to go in for a presurgical workup. I will be annoyed if they take more blood, because I think they can use the bloodwork I had last Wednesday. I think they did the tests that are usually done preoperatively. Well, we'll see. The have to do an EKG anyway (although I had one in October), so I know I can't get out of it.

Ugh, have I ever said that I hate reflux? Yup, hate it. And the feeling of someone poking me in the ribs. I can't wait until this is all done. The surgeon said 85% of people have their pain resolved with this procedure. Hopefully I will be in that 85%. The PA didn't really help when he said (before the doctor showed up) that he had had pain just like mine, had his gallbladder removed, and it ended up not being the problem. What does that mean?? Anyway, the surgeon recommended asking for a month off work, just in case. He has got to be kidding. I can't take a month off. I have three sick days!

Better get ready for work. Um, or the dentist.

Do I Have a Tale for You...

I had the privilege of spending the night in the ER at Johns Hopkins. What an experience!

During my four hours in the waiting room (while in excruciating pain, mind you) and my eight hours in and out of Bed 28, I saw and heard some exceptional things. Actually, I think they are not exceptional but typical, which is sad. Let me present you with a series of vignettes.

A woman starts an argument with another woman in the waiting area. They move to the lobby, where things become physical. Right in front of the main security guard's desk.

A man in a wheelchair (NOT unusual--probably a quarter of the people waiting went out and got wheelchairs for themselves) "gets loud" with a woman in the waiting area. A female security guard tells him to cut it out, and he blames the woman for making him yell at her. The security guard tells him, "You a grown up man and you sayin' she made you? Can't nobody make you. You a grown up man." A valid point, to which said man replies, "Now you mad at me? I didn't do nothing, you tell her she gotta quit makin' me mad." The guard assures him that she is not mad at him. Wheeling him out, she continues, "I just disappointed that you say somebody made you, when you a grown up man and you supposed to know how to behave. Now, you know you can't stay here when you loud."

Sylvia Squires wanders through the waiting area aimlessly. She sits in various chairs, finally parking it at one of the registration windows, wanting to have a chat. The woman at that window seems to know her, and she ignores her. After a moment, the woman leaves Sylvia alone. Sylvia (I know her name because she said it so often) initiates a conversation with herself. Although I was actively trying to ignore her, I could not help but hear some of what she said, because she was three feet away from me. Sylvia is 51 years old, with two grown daughters. Their fathers were not Mexican. Her current boyfriend, however, is. He is a mean drunk who cannot hold his liquor, and he smacks her around all the time. He tried to throw her through a window. Sylvia, on the other hand, can drink all day and all night, without any deleterious effects. She hates Mexicans, because they have too many kids, like leeches. Sylvia is a sociable person, loudly inviting everyone in the waiting area to go out for drinks rather than wait any longer. As the night wears on, Sylvia becomes increasingly belligerent. Each time a nurse calls a patient's name, she yells, "Squires?? Do you have Squires?" They firmly tell her no, and she lets them know that they are smart mouths, and that she has been here since 6:00/4:00/5:30 (fill in a random time). Sylvia runs into an acquaintance, who is at the security desk, complaining that she has waited too long and would like her IV out. After 15 minutes, a nurse is available to do this for her. The friend looks back into the waiting area and notices Sylvia slumped over in a chair; she calls out, "Sylvia, are you OK?" No answer. Sylvia has fallen asleep. When I leave the hospital, eight hours later, Sylvia has not moved.

A young couple comes in, the girl obviously having abdominal pain and feeling poorly. She sits next to me and leans against her boyfriend, who stands in front of her, murmuring in Korean and stroking her head.

A man does laps in the waiting area in his wheelchair. He bumps into things and blocks people's path. 

A man comes out of triage reeking of urine. His dirty clothing and unkempt appearance bespeak a life different than mine. He encounters a "brother" in the waiting area, who is similarly attired and sports a black eye. Pee Man stands near the security desk, chatting with his brother, while the security people gag. The same female security guard who escorted loud man out of the building takes it upon herself to grab a can of air freshener and spray it directly at Pee Man's back for at least 10 seconds. This does not even touch the funk in the air, and it does not phase Pee Man. She goes through a set of double doors; five minutes later, she emerges with a set of scrubs and a plastic bag. She informs Pee Man that she cannot handle his stink, that he must change. He is understandably worried that someone might steal his blue jeans, and she reassures him, instructing him to carry them in the plastic bag. Pee Man reluctantly enters the men's bathroom and reappears in bulky scrubs, without the plastic bag. He leaves shortly, but for the next several hours, every person who walks through the ER waiting area (the elevators to the peds ER are at the back of the adult ER waiting area, so parents dragged children through the room from time to time) comments on the smell. An hour later, a triage orderly travels throughout the room, spritzing liberally with a fruity spray, smiling like Miss America. Her journey was more welcome than any beauty queen's.

In a monitored bed in the ER, a diabetic woman is there because she stopped taking all of her meds. Although she doesn't have any family and really doesn't care, she accepts the central line that must be placed in her neck. She asks for food and is told that she can eat a bunch of bananas, or she can have orange juice. She weakly accepts the juice.

Later, in that same bed, a man with a thick Baltimore accent has difficulty answering questions from the nurse and doctor. He provides tangential information with each answer, but I will spare you that. Has anyone ever discussed diabetes with you? No. So, when you were in the hospital a month ago, did they tell you that your blood sugar was high? Um, yeah, they gave me a shot for it. Oh, they did. And did they give you medicine to take home? No. Did you follow up with your primary care doctor? No. They didn't tell you to follow up with your primary care doctor? Well, I've been taking the medicine my doctor gave me. Medicine for what? Diabetes. Which doctor gave it to you? My regular doctor. So your regular doctor is treating you for diabetes? Well, yeah. Did you take your medicine today? Of course. Later: Does this hurt? Yes. Where does it hurt? On my leg. Where on your leg: the front or the back? What? Where exactly does it hurt? Where does what hurt? Your leg. When I push here, does it hurt on the front or the back? The back? OK, this is the front, and this is the back. Does it hurt on the front or the back? Oh, the front.

A woman lies snoring in a monitored bed in the ER. She was brought in because she was searching a manhole for a cat. There was no cat.