Tuesday, September 29, 2009

Tales of the ER, Part II

So "ask me about my day," will ya?
The day started out normally, nay, well. I had on a good outfit, the drive in was fine, the papers were moderately full of stories. I was motivated to work and get things done.
This all came to a screeching halt around 9:00.
As I was clipping the Dayton DAily News, I started to fell...odd. Massive amounts of sudden-onset chest pain, along with shortness of breath.
Now, I had a doctor's appointment yesterday, and we thought I might have a virus. But I had never felt this way before, and I didn't think viruses did things like that.
I tried to take a few deep breaths and calm myself. Getting upset would only make whatever this was worse. So I continued cutting, continued deep breathing, drank some water.
Stabbing pain invaded my chest.
I finished Dayton, moved onto Cincinnati. Still pain. Deep breathing getting a bit difficult now.
As I was working on Cleveland, I knew this wasn't something I could just write off. I had never felt this way before, and I knew that shortness of breath + chest pain was not a recipe for good things. So I went up to my boss's office and told her I was going to the ER to get checked out.
She shooed me out the door and I drove to The Resort.

The ER was really quiet, so I went to wait at the admit desk. As soon as I said "transplant patient", "chest pain" and "shortness of breath", a nurse brought out a wheelchair and took me back to triage. My vitals were all OK. We ran through my med list, and the nurse asked how much I weighed.
The charge nurse, who was inputting all my info, then asked my least favorite question in the world-- "are you nervous about anything?", thereby inferring that I was having some sort of mental things that were manifesting themselves physically.
I shook my head. "No." I had, in fact, been feeling fine.
"Well your vitals are OK. Are you having chest pain?"
I nodded. She asked me to rate it. "Nine," I said. (The scale goes to 10)
She sort of sighed a bit and took me back to the ER proper, into the "critical care" rooms, where ambulance patients go. I'd been back here once--this is where they send you when they want to run a  bunch of tests, quickly, and hook you up to fun things.
At this point, my suit jacket was off, so I was in my heels, camisole, and skirt. Once I reached the room, I met two docs and three nurses--one of whom was also a paramedic.
A pulse oximeter was attached to my right index finger. Leads were put on my chest to monitor heart rate, respiration, and to prepare for an EKG. A nasal cannula went under my nostrils. One nurse removed my camisole  (the male doc stepped out), which became tangled with the blood pressure cuff. Another nurse unzipped my skirt and helped me scoot out of it. A gown was thrown over me, and my arms threaded through it.
"Do you have a port?"
I nodded. "1 inch needle," I said. That nurse, Janelle, went to get supplies. The other two watched my vitals, as the blood pressure cuff took measurements every five minutes.
The doctors came back in, asking all sorts of questions, including another lits of what meds I was taking. (I was thinking, We just did this).
The docs were conferring in hushed tones, but I head one say, "her vitals are fine." I rolled my eyes as I breathed in the cool oxygen.
Janelle ran an EKG--everything looked OK. One of the doctors--the one I now labeled the 'nice' one--asked me about pain, and told me we were going to get blood, give me pain meds, and run a CXR.
Janelle got the port up and running, and blood was drawn. I was starting to wonder if I was going to have any blood left, since we had done a blood draw yesterday.
After the blood was gone, the nurses pushed morphine, which dulled the pain a bit. I went from a 9 to about a 5, then to an 8 after about 20 minutes.
Janelle left, and Wendy came on. Wendy and Paul, another new nurse, who was also a paramedic, had the unenviable job of trying to get a peripheral IV line in me for the contrast CT. Nice Doctor had said that they were thinking blood clot, which couldn't be ruled out after the lab work and the CXR.
Even though I have a port, contrast cannot go through the port. So we have to do this peripherally, and I have no peripheral veins. I just don't.
So Wendy and Paul began to look, very carefully. They found a few that might work, and took out a 22 gauge needle. We have to use baby needles on my veins, because they are so tiny.
The first site was in the crook of my right arm--Paul tried it. No luck. Wendy tried next, on my left arm. No luck. As Paul looked for another site, Wendy was on the phone with CT.
"We need to use a 20 gauge," she told us after she hung up.
I gaped at her. "20?" 20s were bigger. My veins were NOT 20 gauge needle size.
"IT has to be 20?" Paul asked. Wendy nodded.
We sighed. He kept looking. He found another site on my right arm, above the crook, on the side. It blew again. Every time we tried to advance the tubing, it collapsed.
Wendy tried again, finding a spot in my left wrist. The wrist is one of the least pleasant places to get an IV, but we thought it might work because, since it's a rather painful spot, it wouldn't be too scarred over. Paul held my hand and I gripped it tight as Wendy tried my wrist. Again, no luck.
By this time I was crying pretty good. We were going into sensitive areas, and really digging around to try to get the veins to cooperate.
Another paramedic came in. He began poking around on both arms. My arms were held out, away from my sides, almost cruciform, as Paul and Max looked for veins. Max looked at my left wrist again, scrubbing it with alcohol, reopening the wound. I cried out.
As Max perused my arms, Wendy talked to me about theater, trying to distract me.
At this point, as all my mascara was running and my nose was dripping, and we were all stressed form the lack of vein cooperation, Not Nice Doc made an appearance.
"Can I ask you something?" He said as Max prepared to try a site on my left arm.
"Um, can you wait a minute?" I said, as Max inserted the needle. I gasped and began to cry again. Wendy squeezed my hand, murmuring "Deep breaths" in my ear.
When the vein blew and Max withdrew, I turned my face to the doctor (still crying) and said, "OK, we can talk now."
He looked a bit uncomfortable. The gurney was strewn with discarded medical paraphernalia, bloodied tissues, gauze, and used alcohol swabs.
"I was just talking to the transplant team, and they said you have a history of anxiety attacks--" (my kill radar started circling at this point)--"And I was wondering if this felt like that?"
"Well, given that I've never had any anxiety attack, I can't tell you," I said tartly. One of the nurses gave him an "are you crazy?" look.
He backed away slightly. "OK." He left the room very quickly.
"I hate it when they do that," I hissed after he left.
As soon as he left, Wendy said, "I'm going to call the IV team."
"Oh, they love me."
The IV team is sort of the Navy SEALS of IV insertion. IT's sort of an "If they can't do it, no one can!" thing. Now I like the IV team, but sometimes even they don't get my veins. I am that tricky.
(This is not a distinction in which I take pleasure.)
So while we waited for the IV team, Paul and I talked a bit. I was never left alone in the Critical Care room, which was OK with me.
Suzy from the IV team came in, wearing the bright pink smock they all wear, and carrying her tackle box of IV insertion goodies. She began to look, noting where we'd already tried.
She flipped off the lights in the room and applied the vein light--a bright red light that shows where veins might be hiding. She applied a warm pack to my upper right arm, and tried there first. No luck.
On my left hand, she found a vein that looked good. She swabbed it, then sprayed it with a topical anesthetic. She uncapped the 20 gauge needle and slid it in.
This time, it worked. The blood ran back, and she and Paul tapped it into place. Wendy, Paul and I went down to CT, where Elsa, one of my favorite radiologists, was working.
The entire CT scan takes about 5 minutes. It had taken us an hour to get the peripheral line in.
The contrast, very warm and fast spreading, was injected. The picture was taken, and I was taken back to the ER, where I was moved into a 'normal' room, without all the fun equipment.
I saw Dr. K talking with nurses at the station as I was wheeled back, so I knew he'd be coming in. After I was re-attached to everything, Dr. K came in.
He asked me to recap what had happened, pulling the rocking chair up next to the bed.  I recounted. And even though I love Dr. K, I still felt like he was sitting there thinking "She's nuts."
So after I recounted, I said, "I'm not trying to be difficult, and I'm not crazy."
He looked at me. "What?"
"I'm really not trying to be difficult! And I'm not crazy."
"You are not difficult--you're a great patient--and you're not crazy. Really."
I felt somewhat better. I mean, when you think that your docs think you're crazy, then things get out of whack. You don't know what to do, or what to tell them. You're always thinking that maybe you ARE crazy, and that is it all in your head. Sigh.
But anyway, today it didn't look like I was crazy.
About an hour after Dr. K left, I was discharged. There wasn't a blood clot, but, like Dr. K said, it was looking like a virus. So I was to lay low and just...hang.
So after picking up some food, I came home and am going to sleeeeeeep and hang out. So maybe me body will like me better.

1 comment:

Jane said...

Ug! I'm hanging out at the resort right now. :( Hope you feel better soon!