Tuesday, September 1, 2009

The Boy Who Lived

This is to update any of my fans who hadn't already heard the story of my summer adventures in health care.
On Saturday, July 18, Beth and I met some friends at an outdoor concert in the park in Bryn Mawr (Tom Chapin, whose CDs I highly recommend for kids.). We had a picnic dinner (hoagies, deviled eggs, etc.), and had a good time. A few hours after we got home, I started feeling incredibly full, as if I'd eaten two or three Thanksgiving dinners. Then I started getting pains in my belly and couldn't find a comfortable position to sit or lie down in. Then I got cold sweats and started vomiting. Around midnight, I told Beth I thought we needed to go to the emergency room. Fortunately, Bryn Mawr hospital, right across from the park where we'd been to the concert is less than 10 minutes away.
They put me on anti-nausea meds and morphine for the pain, then took me for an ultrasound. Believe me, I quickly tired of hearing, "Take a deep breath and hold it" while the tech was jamming the ultrasound wand into the parts of my belly that hurt the most. Eventually, the doctor told me I'd had a gall bladder attack. She said my gall bladder was inflamed, but didn't seem to be infected, and I didn't have a gallstone, but I had "sludge", which is a precursor to gallstones. She said I'd probably have to have the gall bladder removed at some point, but, for the moment, since I was now pain-free, and it was early Sunday morning, they'd send me home with a prescription for anti-nausea drugs and for Percocet for pain. If the pain returned, though, I should come back to the ER.
When I woke up Sunday morning, I was still pain-free, and continued so for the rest of the day, so I didn't fill the Percocet prescription. Early Monday morning, around 1 AM, I awoke with the same kind of pain, although not as strong, as the night before, so we headed back to the ER, where they repeated the ultrasound with the same results as the night before. They decided, as a precaution, they would admit me and put me on Monday's surgery list as an add-on, to remove the gall bladder laparoscopically. Later, they decided instead to do a procedure called an ERCP, in which they would insert a scope down my throat to see if there was something in the bile duct they'd missed in the ultrasounds. (It turned out they had, indeed, missed something.)
I spent the rest of the night in a hospital room while Beth went home to get a little sleep. She came back later Monday morning to see how I was doing. I felt okay, and we didn't know, at that point, when they'd do the surgery, so I told her to go into work and I'd call her when I knew the schedule.
A little while after she left, around noon, I fell asleep. I woke up a short time later shivering like mad. I've never felt so cold in my life. It was as if I were naked in Antarctica. I rang for a nurse, and an aide came in and wrapped me in two blankets, and I soon fell asleep again. The rest of the afternoon is still unclear to me, and most of what I know is based on what people have told me. I recall waking several times to the ringing of the telephone in my room, and, each time I answered it, there was a dial tone. Beth was trying to call me to check on me and the surgery schedule, but the phone was malfunctioning and she couldn't get through. I remember waking up feverish and sweating and falling back asleep several times. I think I was also hallucinating at times, because some of the things that seemed quite real couldn't possibly have been happening.
Since she couldn't get through on the phone, Beth left work and came to the hospital to find out what was going on. When she arrived, the nurse was taking my temperature and it was 104.8 degrees. I don't recall that, but I remember her saying, "We're taking you down to prep you now." and, at the time, I just figured I had been put onto the schedule and everything was normal. I didn't know how bad it was until much later, when every doctor seemed to make it a point to tell me, "You were a very sick man." and "You almost died!"
Beth, at this point, was beside herself with worry, as you might imagine, and decided she should call my brother and sisters. My two younger sisters, who live just across the Schuylkill River in Philadelphia, came out to the hospital. I didn't know any of this at the time.
The next thing I knew, I was hazily coming out of the anesthesia fog, when someone asked me for Beth's cell phone number, which I recited, then promptly lapsed into unconsciousness again. Apparently, she had stepped outside to call my sister and the staff didn't know where she was to let her know I was in recovery. As I awakened again, I saw Beth, trailed by my youngest sister. When Beth saw me, she started crying in relief. Again, I knew none of what had gone on, so I just saw her crying when she saw me and thought, "What the Hell did they do? Cut off my legs by mistake?"
Apparently, when they did the ERCP, they found a gallstone blocking the bile duct (First thing they missed in the ER), and when they removed it, they unleashed a flood of pus (Missed that infection, too, in the ER), indicating sepsis, which was the cause of the nearly-fatal fever. The good thing here is that I hadn't filled that Percocet prescription. If I had, it would have masked the pain and I'd never have returned to the ER, and might have died at home.
I spent the night in ICU, where they take very good care of you, but give you no rest at all. The next morning, I was moved back to a regular room, with IV antibiotics to attack the blood infection before they could go back and remove the gall bladder. I spent the next week on IV antibiotics, and most of that week I was NPO (Nil Per Os, "nothing through the mouth"), so I could have nothing to eat or drink, not even water. I could also only wash up by taking "soldier baths". At one point during that week, they also did a second ERCP, to see if there was any more blockage in the bile duct. When they brought me down for that procedure, I was conscious, and I was like a rock star. The OR staff was the same staff that had been there for the first procedure. When they saw me being wheeled in, they greeted me with, "Hey, it's good to see you again! You look a lot better than the last time you were here! You know, you almost died!" "Hey, thanks for reminding me. I was in the hospital! What else was I supposed to do?!"
Finally, the Monday a week after I'd been originally admitted, they removed the gall bladder laparoscopically. Apparently I surprised the nursing staff by being on my feet later that afternoon, trying to go to the bathroom without assistance (apparently a big No-No). During the week I'd been there, I amused some of the staff by walking in place in my room, to give myself some exercise and activity to keep from going stir-crazy.
While I was in the hospital, I'd also exhibited some jaundice due to a high bilirubin count. At one point my eyes looked like Lt. Commander Data's from Star Trek: The Next Generation.
The day after the surgery, they let me come home. I was bloated like the Michelin Man from a week of IV fluids, and my stamina was pretty low from the hospitalization, surgery and inactivity, but I was thrilled to come home. It took me a day to walk off the fluid build up, and, by the end of a week, I was back up to walking two and a half hours (total) per day. I'd come home on a Tuesday afternoon, and on Saturday, we had a visit from our grand-nephew, Nicky, which lifted my spirits considerably.

By Saturday evening, we went to a Billy Joel/Elton John concert at the ballpark with some of my high school buddies and their wives. On Sunday, we hosted dinner for some of the friends I used to teach with. Fortunately, by Friday morning, I was allowed to shower, so neither Beth nor our friends had to deal with "soldier bath Dave". If I live to be a hundred, I hope I never fail to appreciate the glorious luxury of a shower.
Two weeks after the surgery, I had a follow-up visit with Dr. Denne, the surgeon, and she seemed very pleased with my progress. She said it would probably take a while before I felt physically up to normal, and when I mentioned that I was walking two and a half hours a day, and had been for about a week, her eyebrows shot up. I must confess, I'm not 100%, even now, but, in addition to the walking, I am riding my bike an hour a day now.
The only remaining concern is my bilirubin count. The jaundice is gone, but the bilirubin count was, last week, at 2.4 mg/dL. Dr. Denne told me that "normal" is around 1, but I was down considerably from my in-hospital level of around 7. She didn't seem overly concerned, and said, as sick as I'd been, it will probably take longer for me to return to normal. I thought this was a much sublter and more sensitive way of phrasing it than, "Dude, you nearly died!" She's scheduled me for another blood test in October, by which time she expects the level will be normal. If not, I may need to have a liver biopsy to see if there's a problem there. Let's hope not.
About a week ago, I got my Blue Cross statement for my hospitalization. The hospital billed $114,368.00; Blue Cross paid $30,879.36 (interesingly enough, exactly 27%), which the hospital accepted as payment in full, so I owe nothing. I'm happy about that, but it says something about the health insurance system, I think.

Finally, on Saturday, Beth and I went to a friend's house for, we thought, a barbecue and swimming with a few people. It turned out to be a surprise "Dave Didn't Die!" party. It took a while to understand that it was a party for us, but it was a fun evening.