"The Next Step"
I was in and out of consciousness those first few hours in ICU and as far as I could tell, there was quite a lot of activity in and out of my room. Doctors, family, friends, nurses, and assorted other medical staff. It wasn’t until later in the evening that I was able to stay awake long enough to ask some better questions. The next shift of staffers was now taking over and did what they could to provide me with answers to those questions. The intensive care unit isn’t the place for long term diagnosis and the information I was getting had more to do with the immediate issues and making sure I was around to have a long term to diagnosis.
The staff explained each procedure and medication as it was performed and administered, but rarely did they have time to tell me how this happened or what was next. This section of the hospital is for acute issues only. Get the patient stable and move them on, if possible. The next stage and round of tests were tasked with determining the reason I had found myself in this situation; what we were going to do about any future I might have; and frankly, how long that future was going to last. It took a day and a half before I was moved to the next section. Either my health was stabilizing or it was just too expensive to house someone without insurance for another day.
Each time I took a step in the process of my care there was a common element that felt overwhelming. The steps were mostly forward but it didn’t aid the feeling that occurred with each of these moves. I was given the details of the proposed path with probabilities - but rarely options. The likelihood of skipping a step was near zero but each time I made a move a black cloud of fear and anxiety crept in and lingered.
“Are you sure I am ready to move out of ICU? Can I be left alone in a room with just a button to push for help?" It’s not that I didn’t want to get on with the “fixing”, but the comfort of being stable added an additional weight when it was time to go forward. Maybe this is a normal psychological pattern or maybe I didn’t want to return to my old life, at least not at that moment.
Whatever the issue, it popped up with each step and presented a new set of fears every time. In addition, each day more of my new reality was being presented and more absorbed, just not at the same rate. Big changes were coming regardless of when I decided to except there appearance and necessity. The first change was moving out of the ICU.
In that first evening in intensive care a nurse came in my room to start her shift. As she walked in I saw her eyes avert to the my right shoulder. It wasn’t a look of shock but rather of disgust. Like walking into a kitchen with a pile of dishes and a delivery dropped in the corner waiting to be put away after a lunch rush (for those of you in the restaurant world).
I couldn’t see what was causing this look on her face, but she soon let me in on the culprit. I was a bloody mess. My right side was red with dried blood and that mess had violated the gown that was draped over me and the bedding underneath. Apparently while I was taking one of my ‘naps” the doctors found it necessary to place a catheter in my chest leading directly into my right internal jugular vein (RIJ). This is a common placement for chronic and acute kidney issues. Sticking out my my RIJ was a port with two tubes. One tube for blood flow out of the body, and one for returning the blood. The machine on the side of the bed was there to clean my blood as my kidneys were not holding up their end of a system that keeps us alive.
The nurse wasn’t phased by seeing the tubes protruding from my jugular vein but rather that no one had bothered to clean me and change the linens stained by my toxic blood. When I finally saw the mess that I was lying in it made the fear and shock of my guests more understandable. Not only was I hooked up to plenty of machines with several tubes coming out my body but I was lying in a blood soaked ICU bed. Any comfort I may have experienced from waking up (versus the alternative) was slowly being challenged as I was absorbing all that was being done to correct my body’s revolution to it’s past life.
A room opened up in the hospital the following day and in the late afternoon I was moved to my new accommodations. I remember vividly being rolled down that hallway and the sight of the nurse who stood outside my new room. That imprinted memory was based on the next several minutes. The staff that rolled me down to the new floor told the nurse they needed the bed and gurney to take back. My new nurse sternly suggested otherwise. Each side started digging in on their position, including long and serious stares with forced wide eyes and little blinking. The two side assumed battle posture while I lay on a bed in a hallway, tubes dangling from each side. Great! A turf war for a gurney. This wasn’t a brief encounter. The nurse for the room told the ICU team that they were not moving me out that bed, period. They returned fire with issues of need of the special bed in ICU and hospital rules that didn’t allow for this bed to be on this floor.
“That bed won’t even fit through the door.” I heard one of them scream. “Don’t you worry about my room, I’ll take care of it”, was the response from my new nurse. This was getting to be too much for my mediator personality. “I can get up and walk to the bed, really, it will be fine.” This didn’t go over well with my new nurse. He wasn’t interested in my position on the subject or my help.
The confrontation ended with a one sided victory for my new nurse. Frankly I was surprised as it was two against one. I think home field advantage had something to do with the victory. Adding insult to the loss, the ICU people had to partake in moving the bed currently in the room, into the hallway before returning sans gurney. I would like to point out that this is the same nurse who brought me tea every night, even when he wasn’t working my section. I think you have to respect someone who takes a strong position and holds to it, right or wrong.
The issues with that bed didn’t end that evening. The next day I headed to a treatment room a few floors down and had to be rolled there in the bed from the room. That meant getting the bed out of the room again and back in after the four hours of dialysis. A bed was required in the hospital’s dialysis unit and every person that came in had there own. This was also part of the acute treatment of my now ongoing ailment.
Although there was still some doubt about my long term prognosis, the short term plan was becoming clear. I was going to receive daily treatments in the hospital’s dialysis center to do the work my kidneys were failing to do. The rest of the day was filled with monitoring of my sky high blood pressure and other testing. The plan was to determine what turned off my kidneys and why, and hoping they would start doing their job again.
This went on for several days. The large amounts of medications being sent into my system were also sending me to distant places. LaLa land, Narnia, Alice’s wonderland. Most were pleasant but not all. I was able to remember many of the steady flow of visitors that came to check on my well being, but the notes I found after one of my journeys indicated that I missed more that a few. Let me add that the number of people willing to come and visit me in the hospital was surprising. Family, friends, customers - it’s part of recovery that isn’t recognized at the moment but in hindsight there was a mental boost with each new and returning face. Some brought books, some brought food, and others just sat with me for a hour dancing around as many personal questions as they could while monitoring how far they might venture into the subject. There was plenty of uncertainty but I did the best I could with every visitor.
By far the worst part of each day was going to the dialysis room. This is where the reality hit hardest. Laying in that bed with 4 to 6 other patients in the same room, none of us looking like we were going to make it out of our current situation. There was a T.V. at each station and I naively brought books with me. Everything about the place was horribly uncomfortable, except of course for the “extending my life” part. For some reason there was no getting comfortable in that room.
Since I had to be wheeled down to the treatment area part of my day included waiting for a “ride” from one of the hospital staff. Once in the dialysis center I was weighed and then hooked up to the machine. No small process with all the precautions taken to stave off potential infections. Those tubes were dangerously close to my heart and infections move fast.
Those were also the longest hours of each day. As I entered that room I felt the looming presence of something that added to the general discomfort. Although I can firmly state my position on spiritual matters is undecided, there was strong feeling I was being visited by my mortality as I rolled into that room. Sitting beside my bed fidgeting, he served as a reminder to the severity of a situation I was still not accepting. He waited impatiently for the results of each treatment, checking his imaginary watch that measured eternity.
When the machine had cleansed the toxins out of my blood there was another waiting game to suffer. Anxiously wanting to return to my room, I had to wait for my “ride” to fetch me from this spiraling inferno and take me away from the demon sitting by my side.
Any excitement of finishing the process was tainted while waiting to be removed from that room. I could see the same fear in the other patients. The desire to get out of that place and away from an uninvited and impatient companion quickly inflated when those tubes were disconnected from the machine. As I rolled towards the door of the room I could feel him following me to the edge. He stopped at the entrance and watched with disappointment as I rolled away. The daily scene reminded me of the baseball players in the movie “Field of Dreams” as they approached the edge of the diamond. He gave me a look that said “I will be waiting for you when you return.”
Fortunately he was not my only visitor while in that room. Included in the list of real visitors was a friend named David. He developed a habit of stopping in to see me several times a week and he invariable came while I was in that room. Even though my schedule changed each day, oddly his did not. He almost always visited while I was in that room. Guests were allowed in the dialysis section of the hospital but you wouldn't have known as other patients rarely had them. I was quite surprised when he came wandering in for the first time. He stayed about 15 minutes, checked on my status and caught me up of what was going on with our mutual friends. There was never any sign of discomfort in his appearance, with me or any of the other near death patients in the room.
He made attempts at cheering me up as I lay there in my vulnerable position. Even if he had limited success, there was a long term effect that was hard to quantify. The hospital is a tough place to visit in general but this room elevated that discomfort 10 fold. How and why he first wandered in there has always amazed me. Every time he came back it amazed me more.
It was uncomfortable at first to have visitors as I was usually in some state of undress both physically and mentally. But I looked forward to seeing David. He stopped in during his work day which meant he was in a suit or at least a sport coat. He and I share an ethnic background that in no way can be disguised. He also looks like he can handle himself in any situation, alone or otherwise. I’m fairly certain that this is more than just appearance. The comforting nature about his visits extended beyond the mere caring and concern of a friend. There was a balancing effect to my unwelcome counterpart that sat beside me, unseen to others. Just like the battle in the hallway between the staff over that bed, I could feel the tension between these two forces.
David’s presence several times a week felt like a signal to that rude and impatient visitor that he was going to have some competition. David represented the away team of an army of friends that helped me get through the most difficult and vulnerable part of the recovery. Somehow my suited friend showed up to remind my mortality of the existence of that armed group - a group ready to fight him for possession
I had no way of knowing how much my friends were stockpiling for any necessary confrontation nor how much of it would be needed. Most of my 23 days in that hospital were focused on surviving each day and slowly accepting the changes ahead. In hindsight I can see how the efforts and persistence of that army carried me a long way through the battle at hand and the one they foresaw coming.
This was the beginning of what became a collection of individual and group efforts over several years. I don’t recall asking for much help verbally but they must have seen it in me. The road ahead wasn’t to be forged alone and I rarely confronted a challenge without at least one of them at hand. David represented those efforts as he stood there in that difficult room without hesitation or concern for the forces interested in opposing their efforts. Thanks David. Goliath never stood a chance.