Pedestrian Prose

The roommate
The moment I was brought to my semi-private recovery room—though I was still a little confused and uncomfortable from the drugs and tubes—I noticed that I would not be alone for my stay at the hospital. For both of my previous stays at UAMS I managed to have a private room, and I didn’t really know then how valuable privacy is for me, especially in terms of recovery.

The room was small—a problem considering that I had brought a big bag of stuff to do and wanted to be able to see groups of friends at a time. Here there was a necessary two-guest maximum.

They wheeled me in and transferred me to my bed in a three-count whompf. I was glad to have the window side of the room, though for the most part I kept the blinds down.

My roommate was an older black man, Mr. Charles Cane, who I later learned had a seizure, broke his neck, and was more or less paralyzed. He could raise his legs a bit, but had very limited use of his arms or hands. Most importantly, he could not push the call button.

This single fact—though I was never convinced that he couldn’t find a way to hit that button with something if his life depended on it—was a big point of contention for our relationship.

We rarely talked, mainly because he talked all the time. I never knew if he was talking to himself, to the staff, or to me. Generally he would complain about his immediate situation, condition, or position. He did so in a general mumble that could barely be heard outside the room (due to the trache).

Cane: “Help, help, help! I need some help. Could somebody help me please? I need to move this foot. I need some damn help. Will nobody help me? I’m paralyzed. Ain’t nobody gonna give me some help. Oh Lord! What am I gonna do?! What. Am. I. Gonna. Do?”

Now don’t get me wrong—the first few times he cried “Emergency!” and no one came, I pushed my button and politely said “Mr. Cane needs some assistance.” Until I noticed the frequency and trivial nature of his complaints, the total lack of respect he held toward the staff, and the terrible attitude he held toward his own recovery.

The next day, I started ignoring him altogether and noticed that he was never satisfied.

Cane: “Help, help, help! Somebody help me! I wanna sit up!”
Nurse: “O.k. sir, I’ll call the lift team.”
5 minutes later
Cane: “Help, help, help! I need some damn help! Put me in this chair!”
Nurse: “Mr. Cane, the lift team is on its way.”
5 minutes later
Cane: “Help, help, help! Oh Lord. What have I done? What have I done to deserve this? Why won’t somebody give me some help?”

It went on like this every day. One time while lifting him back into bed something shifted and made his neck uncomfortable. He proceeded to cuss out the entire staff. Certain staff members would be very apologetic, others would not take it.

This total disregard for nurses and other hospital staff really got to me. My mother has been a nurse ever since I can remember. Now she teaches nursing and is getting her PhD in nursing. Believe me, there is a reason they do every single thing that they do. They are for the most part over worked and under staffed.

The staff
The hospital staff that I interacted with daily consisted of nurses and PCTs (patient care technicians). I enjoyed nearly everyone who in some way participated in my recovery; and I thanked them at each encounter. I’ve found that when you are an active participant in your own care, you recover faster. And when you are gentle with the staff, they are gentle right back.

My first two RNs (day and night shifts) were both men. This was cool because I had never had a male nurse before, and knew all about how nursing as a profession seeks out gender diversity. I found the care to be no different—they were both excellent and professional. One of them talked like Tim Gunn [http://www.bravotv.com/Project_Runway/tims_take] from Project Runway, which cracked me up from time to time. I kept wait for him to just leave me with the medical supplies saying “Make it work!” but he never did.

My favorite nurse came during the weekend. Her name was Virginia. She was a float nurse meaning she would be assigned to a unit that was short staffed, but before moving to the float pool, this unit was where she worked. She had a very pleasant British accent and we got along great.

She was the nurse that removed the NG tube and oversaw the removal of the epidural. She also witnessed my first steps with my mom to the waiting room and back. On a later day she authorized me mom to wheel me outside for some fresh air. When it was time for me to go she stayed past her normal quitting time to give me discharge instructions and wish me well.

Emotional recovery
Saturday night I was about have my first good night’s rest. The previous night I got no sleep what so ever. The night shift was pretty good about coming at regular intervals: midnight for a shot, vitals check shortly after, and blood draw at 2 a.m. If I went to sleep at 8 or 9 p.m., I’d get a good nap in. Saturday night was going to be different because I was less two tubes. And without the epidural, I got oral narcotics (yea!) which were going to put me out like a light.

I had just finished talking to my sister on the phone. The conversation ended with me remarking on how touching it was to realize how many people cared for me and were thinking of me. That thought continued as I adjusted the bed for sleep, and I even said a sort-of prayer of thanksgiving for all the positive healing energy that I could almost feel coming my way from an innumerable amount of people. Maybe it was just a happy Percocet thought, but I felt it nonetheless.

Then I thought about my roommate, Mr Cane. I had been thinking about him and our strange relationship all day—thinking about what I could do to establish or improve communication between him and the staff, and to talk about how he could take control over his own recovery. I was feeling very pastoral—I wanted to comfort the afflicted and afflict the comfortable. Mr. Cane needed a little of both in my opinion. It was my first positive feeling toward him, and the last.

That night, around 1 a.m. Mr. Cane coded and died. Our room was swarmed with people, and I heard the entire process go down—my first code experience. In the middle of it all, I decided that even though I wasn’t in the way, I wanted to leave the room. My nurse happily agreed to unhook my IV and I was led to an empty, private room down the hall.

Finally. Privacy. Wasn’t this what I wanted the whole time—to be alone? I stayed up late that night. When Mr. Cane passed, they said they would help me get my things and bring them to the other room. I crept in and saw the plain white sheet lay over his body. The nurses and techs helped me move my ever growing pile of reading material, techno gadgets, plants, flowers, and balloons to the new room. I certainly wouldn’t be alone with all this stuff.

Certain words had new meaning now: trauma, shock, alone, privacy…recovery.

Again I was thankful. I was thankful that my last thoughts of Mr. Cane were positive. I was thankful that my new room did little to remind me of the old space, and my physical recovery surged ahead (I was released the next day). I was thankful that, through my help, Mr. Cane’s son visited him that evening and they got to see each other one last time. And again I was thankful for my own life, health, and most of all, family and friends.

Crohn’s Disease
I first knew I had an Inflammatory Bowel Disease in 2000. Then-diagnosed as Ulcerative Colitis, I was treated as such and got better. My friend Ashlee used to call it “Super-Sonic Spontaneous Colon Blow-itis” because she lived under my apartment and could hear me running to the bathroom.

In 2003 many of my symptoms returned. I just got hired at UALR, so when my benefits kicked-in I started going to the UAMS Gastroenterology Clinic. My diagnosis was switched to Crohn’s Disease after my first Small-Bowel Follow-Through, a sort-of x-ray test where you swallow Barium contrast and a radiologist follows it (and takes pictures) as it makes its way through the small bowel to the colon.

My Crohn’s is kept quiet (in remission) by two medications: an anti-inflammatory, Pentasa®, and an immunosuppressant, azathioprine. When a flair-up occurs, I usually have to take a corticosteroid, Predisone, at a high dose which gets tapered-down to near nothing over the course of several weeks.

The gastroenterologists have been telling me for a while now that surgery is only a matter of time with the kind of Crohn’s that I have—the kind that creates strictures or narrowings in my small bowel. Over the last three Small-Bowel Follow-Through’s, we had identified two significant strictures: one in my jejunum (middle) and one near the ileum (end).

Prep
Prior to the main event, I had to be empty. Anyone who has ever gone through any kind of prep (and if you haven’t yet, rest assured that one day you will) knows that this process is quite possibly the most uncomfortable part of the whole ordeal.

For me, the prep was nothing new. Most every procedure I have ever done regarding Crohn’s Disease involves one form of prep or another. This particular prep was about three times as bad as the others, however, because it essentially involved three different kinds of prep: phospho-soda, laxative, and enema. Empty doesn’t even begin to describe how you feel after you’ve performed Fleet’s magic on your body over the course of 24 hours.

Surgery
I was among the lucky first surgeries of the morning on Wednesday. My parents and I arrived at UAMS at 5:30 a.m. and I would go in sometime after 7. As soon as I got the gown on I had to finish my prep with the enema. The nurse showed me the restroom and left me to it.

After that ordeal I returned to a swarm of techs, nurses, interns, and doctors. A tech shaved my stomach and we chatted about various things including the fact that David Prior was nearby, preparing for his heart surgery. Dr. Robertson, my surgeon, came by to say hello and say a few words. I asked him to visit my concerned parents in the waiting room and he gladly obliged.

No one really wanted me to have this surgery—especially my parents and Dr. Robertson. I figured they should meet. For typical Crohn’s patients, surgery is a last resort and never the cure. The disease is very likely to return exactly where it was cut out in a few years, so the medical community (whom my mother is a member) is always hesitant to operate.

After he left I met with the anesthesiologist. She explained a lot about the order of events, when I would get which drugs, when I would go under, and when I would come back. She also organized the “pain team” and the placement of my epidural for the relief (or blocking) of pain during recovery.

At the same time the pain team were placing the epidural, the surgery attending and a large mixture of interns and residents also showed up to introduce themselves. I also met the nurse team that would be working with Dr. Robertson. I told them I felt like I was on “Grey’s Anatomy,” and they assured me that none of them were sleeping with Dr. Robertson.

By now it was getting close to time, so they gave me something to make me more relaxed. Ahhh. Off to the operating room. Once inside I was carefully positioned on the table, and they began giving me the big sleep medicine. “Here I go!” I said.

Initial Recovery
Moments later they were trying to wake me up, saying my name. Confusion doesn’t even begin to describe how I felt, mainly because “confusion” doesn’t imply a tube in your nose that goes down your throat to your stomach. That had to go—I didn’t like that at all.

Julia, the recovery nurse had a sweet, polite tone-of-voice which quickly changed to a much more stern one as she saved me from myself and explained that even though I was indeed choking on the NG tube, it had to stay for a few days.

I felt drugged and hung-over. I was both soar and numb. I was connected to a myriad of tubes in many places. Besides the NG tube which was by far the worst of them all, I had a Foley Catheter, IV access in both arms, and an epidural in my back.

It took a couple of hours before I was ready to be delivered to my room for the rest of my hospital stay, and even when I was ready, it took another while before the delivery people could get me there.

My parents were waiting for me there and they stayed a while. My pain was under control, thanks to the epidural, but my comfort was nowhere near acceptable. I had tubes everywhere; I couldn’t get comfortable in the hospital bed. Again, the NG tube was the worst. It’s placement from my stomach, through my throat and nose, to the vacuum on the wall made it both necessary (due to the increased mucous) and painful for me to swallow or even talk.

The NG tube’s job is important and shouldn’t be overlooked. It keeps my intestines free from stomach acid and bile (plus anything else that has made its way down there). The vacuum port on the wall essentially sucked it out intermittently. The settings were a bit tricky, however, because too much suction too often starts to irritate the stomach, making it bloody. Too little suction doesn’t catch enough of the stomach acid goo before it reaches the intestines which at this point needed a little break.

Next Steps
As my recovery progressed, it became clear to me that the people involved were a much bigger part than the mechanics of surgery, pre-op. and post-op. My next blog will be about those that I encountered, befriended, and even lost.