You Had A Bad Day

For all the days I'm here in which there's nothing to report, Tuesday was a doozy.

It started simply enough. I usually sleep on and off as the nursing staff, students, and residents buzz around taking care of business. In the midst of all this, my nurse tells me "they" are increasing my inotrophics. These are two meds (dopamine and dobutamine) on a drip that are administered the whole time I'm here. In fact, they are the main reason I'm here so often - UNOS (the transplant big shots) require that a transplant candidate spend a certain amount of time admitted to the hospital on inotrophic/IV drugs. So as long as I'm here, and as long as I'm receiving this treatment, I am gaining what's called "IA time" which in turn helps me to move up the transplant waiting list.

Ever present on Dr. Doodaa's hat, they look perfectly innocent but as I learned
Tuesday, can cause a world of hurt if you don't keep an eye on them.

I always want to know why something is being changed in my standing orders. I've had too many close-calls with the Grim Reaper in emergency rooms and hospitals not to. I advocate for myself so aggressively that it's probably offensive at times but not doing so is a quick way to get dead. And that involves a lot of paperwork, so I figure I'm helping everybody in the end.

The nurse didn't know why, but the doc was next door and would be stopping in on rounds to discuss it. Now my suspicion was that he himself didn't order it, but rather one of his residents - my usual doctor is out this week, so one of his colleagues is running the show here in the heart unit. He and I already have this understanding that I want to know what is happening at all times. The doc who's here this week apparently gives his students more free rein with patients. It's a teaching hospital, I get that. But I ran into a problem on Monday when a resident tried to stop my Heparin (blood thinner) drip in favor of Levanox - administered by shots in the stomach a few times a day. Um, no thank you Monty, I'm going to stay with whatever is behind Door #1. Sometimes doctors change orders without talking to or even looking at the patient, as was the case here. I don't tolerate it because it's dangerous and they know it's dangerous. Turns out, the resident ordered this change without talking to anyone. And since the Heparin drip isn't really necessary to being with, why change the blood thinner med to shot form? I get enough needles as is.

Re-enactment of my "Yo, residents be crazy" face upon learning that some moron
wanted to stab me in the stomach every eight hours. 

I suspected the inotrophic increase was a similar situation. Before I could ponder this further, I was overcome with a headache, cold sweats, and gut-wrenching nausea that left me dry-heaving about a dozen times into a bucket. I have a much milder but similar reaction when they start the drips the first time, but it passes quickly. The doctors explained that since the inotrophs were helping my heart function, giving me a bit more might help the diuretic to work more effectively, thus helping to shed some of the fluid I'm retaining in my abdomen. The nausea subsided, but within about thirty minutes it had returned with a vengeance. Horrible stomach cramps made it feel like fireworks were exploding in my kidneys. More dry heaving. The nurse was incredulous because it was such a small increase.

Actual bucket into which I dry heaved. E-bay listing to follow.

Thus began what I call the "Let's Fix That" cycle, in which you are administered a drug you don't need, spawning bizarre and painful side-effects, that must now be treated with further medications, causing side effects which must be treated with further medications, and so on. It seems to me doctors, especially younger ones, sometimes lose sight of how this cycle began, and become hellbent on seeing the "Let's Fix That" cycle through to the bitter end. And so the doctors began to surmise that the reason for my sudden onset of pain and misery was due to lack of bowel movement, too much sodium, too little this, too much that, no enough of the other, the pull of the moon on the tide, the changing weather, my astrological sign, etc. It takes quite a while sometimes to force them to admit that the only thing that has changed is the thing they just did to you.

In the meantime I couldn't sit or stand without excruciating pain in my lower back and abdomen. I was given Phenergan to relieve the stomach pain. If you've ever had this drug before, you know that it is most likely what the guys in Pink Floyd were passing around when they wrote "The Wall." My dreams consisted of marrying Etta James to conquering an evil corporation run by Will Smith (with my sidekick, a talking toaster oven. Who else?) all to a really terrible dubstep soundtrack. Trippy stuff and lots of it.

I slept from 1:30pm to 5pm only to awake and find that the pain was still there. I had to have a nurse help me from the bed to the chair because I was afraid I might fall. This is how the "Let's Fix That" cycle works. Now I was not only STILL in pain from the med increase, but hungover from the attempt to fix the side-effects from the med increase. A nurse finally convinced the doctor to decrease the med again.

By the time Christie and the boys arrived, I was feeling a bit better and as soon as the meds were put back to the original dose, surprise! Most of the pain went away. I'm such a lightweight when it comes to pain meds, so after a delicious meal of chicken enchiladas and a short visit, I went back to bed. Slept from 7pm to 1am, took some pain meds for my neck (it was stiff from sleeping so much) then slept again to 5:30am. I've been up for half an hour, sore in my abdomen, and shaky from the hangover. But breakfast, provided by my lovely wife, is restoring my strength a bit. If you called, texted or email Tuesday after about 11, it's unlikely I saw it or remembered it, so I'll try to catch up today. Nothing personal, I was just busy at a rave with Bert and Ernie after our water-skiing adventure.

Honeyed yogurt with blueberries and strawberries. Tons of potassium going down here. Yum!

What a day. This morning I have to discuss this whole goose chase with my doctor, who will be here). The students will probably leave convinced that poo-poo or the temperature in the room were to blame for the whole thing. Either way, I know for next time to refuse an increase unless I absolutely need it.

Christie met with the oncology surgeon today to find out more about her gallbladder issue. I was able to listen in on speakerphone and the doctor didn't seem to have any concerns about her long-term prognosis. The "polyph" actually turns out to be a thickening of the gallbladder wall, consistent with stones and cholesterol.  I'll update here if we get any new information. Thanks for reading and for all the encouraging comments, both here and on Facebook.