Waiting

This is the final in a series of four posts. Please see the previous posts for context.

Honestly, there is not much more to tell. I was healed. As the GI consult team cleaned up from their procedure they decided I didn’t need the NG tube any longer; I wasn’t going to argue. What a relief to have it removed! All that was left was to wait and make sure that I stayed healed, to ensure that food would flow through my GI tract properly, and test whether or not I could use the restroom and walk around without passing out.

Saturday night was exhausting. While I can see God’s hand clearly in retrospect, in the midst of the ordeal -- drugged, exhausted, and weak as I was -- all I could do was cling to God’s nearness rather than appreciate the work He’d accomplished. Poor Larisa only had about an hour and a half of sleep, and as Sunday dawned we were facing a very long day.

A funny thing happened during rounds Sunday morning. As the doctors huddled up outside my door, my nurse insinuated herself into their conversation and invited Larisa to join them as well. As the night staff presented my case and history to the newly arrived day shift, there was some question as to the nature of my procedure on Friday. Larisa interjected at this point to tell them that the doctor who performed the procedure said he had “used a knife to cut out” the scar tissue in my stricture. This answer was soundly dismissed by the team: lasered out or burned out, sure, but scar tissue isn’t “cut out with knives” during a sigmoidoscopy. They then consulted the medical report from my procedure and were collectively stumped with the notation “performed NKSt”. What is a NKSt they wondered? Nobody knew, so they consulted…wait for it…Google. For real. The sight of five medical doctors clicking away on Google was actually both amusing and refreshing to me; my line of work is at the very fringe of medicine, and I fully appreciate that there is no way for any doctor to know everything there is to know. The fact that they could freely acknowledge this and look it up was reassuring to me. As it turns out, Google failed them initially, coming up with the Universal Reformed Christian Church in Nigeria, much to their chagrin. Finally, one of the residents piped up with “Needle Knife Stricturotomy!” Sure enough, tiny little knives used to cut out a stricture. Just like the patient’s wife had said.

The only hiccup in the rest of my stay was most likely caused by diet. For those of you unfamiliar with hospital diets, they range from Clear Liquids on through Full Liquids, GI Soft, and up to Unrestricted. Sunday morning I was on Clear Liquids and the fellow in charge of my case zoomed me all the way out to an Unrestricted diet. I should have known better than to tackle the chicken fingers, but I hadn’t eaten a decent meal since lunch on Thursday and dug right in. Just as I was getting ready to transfer out of ICU and down to a regular floor, I had a tiny bit of blood in my stool -- the only blood, in fact, all day Sunday or Monday. I could see the disappointment in my nurse’s eyes as she stared into the commode and told me this would almost certainly keep me in the ICU another night. She was right.

That’s about it. Thank you to our dear friends who drove our car home Sunday night so Larisa wouldn’t have to drive. My wife was such a comfort to me, and I’m grateful for good and Godly friends to watch out for her when I cannot. My nurse on Monday was a true blessing. A “praying man” by his own admission and a real treat to interact with. In fact, the entire nursing staff in the ICU was, by far, the best nursing team I’ve ever experienced. Competent, compassionate, and collaborative. One of them joined our family in prayer, and another compared Bible study notes with me.

On Monday morning, I had a visit from the ICU physical therapist, who walked me around the unit while holding onto a thick black belt that was buckled around my waist, while my wife followed us with a recliner, just in case. This little exercise proved that I was, in fact, able to move about on my own without fainting, and I was given the all clear to get out of my bed without the assistance of the staff.

Early Monday afternoon I was discharged directly from the ICU, a very uncommon occurrence as I understand it. So uncommon in fact, that my nurse had never done a discharge before. He had just received his RN in December and the only other patients who had left his care had been transferred to somewhere else in the hospital.

It’s good to learn from hard experiences, and here are a few of my lessons:

• Don’t have procedures done on Friday. If anything goes wrong, you’re much better off heading back into the hospital on a weekday than a weekend.
• Don’t leave the ER until you’ve stopped bleeding or have at least had a consult with specialists in the parts that are bleeding.
• Doctors would much rather talk about the implications of the color and volume of your stool than actually inspect it for themselves. While understandable, make them look. The penalty for not doing so is to have a small pipe shoved up your nose.
• Don’t skip steps in the diet progression from soft to hard
• Pull the nurse cord in the bathroom!

That concludes my story. Larisa says I can’t post pictures. So sorry to disappoint.

Thank you to everyone who prayed for, cared for, and loved on us during this episode. It is such a blessing to have a family, friends, and church family who can be counted on any time day and night. I’ve been home three days now and am back to work and feeling stronger each day. Other than a cancelled business trip this week and two little boys who are more clingy than usual, life is back to normal. I have so much for which to be grateful.

A Miracle

This post is third in a series of four. Please see the preceding posts for context.

I vaguely remember three members of the ER team lifting me into the bed. Clarity came back quickly as I laid flat. What had just happened? I remember watching our nurse comfort Larisa, who was pretty shaken. I can remember being thankful that this happened; I knew I was sick, and I was glad the ER staff was able to observe both the bleeding and the fainting. As people scurried about the room, the resident realized that my IV fluids had not been hung yet and had a few choice words for the nursing staff.

Shortly after the falling incident, the attending physician came in. He ordered more blood work and assured me that he was working to get me admitted to the hospital. In fact, the GI doctor who had performed my procedure was in charge of one of the wards for February; the exact ward I’d be going to. This was great news to me: even given the trouble I was having, I trust this doctor implicitly. Also, it’s just one less variable having the original doctor also be the attending physician of the ward you’re in.

As we waited, Larisa started to receive texts from people who were praying for us. On the way to the ER, we’d alerted our families and a few close friends to my situation. Also, Thursday night we’d let our Bible study know of my procedure, and as they checked in, we let them know what was going on. The saints were praying.

About twenty minutes later, I needed potty break #5. There was no way the nurse was letting me down the hall, and she asked if I could wait for a bedside commode. While my need was urgent, I could wait a few minutes, and the commode was quickly placed directly beside the bed. I slowly got out of bed, sat on the commode, and commenced…you get the picture. Almost immediately the room started to swim, my ears started to ring, and I gasped out “Oh no” before passing out completely.

I understand from Larisa that she grabbed the nurse, who was leaving the room, as I slumped on the commode. The nurse asked if Larisa could hold me up while she ran to get help. She was only out of the room a short time, but during that time my eyes rolled back in my head, and I started to have seizure-like behavior. The nurse returned with the attending, resident, medical student, and at least two paramedics.

I remember coming to sitting on the commode. It was bizarre: exactly like one of those scenes we’ve probably all seen where the focus is fuzzy, the background is black, and someone is leaning over the camera saying “Can you hear me?” In fact, for a moment, my brain registered that I was watching a medical show…I couldn’t process what was going on. I think I regained vision, but couldn’t really think at all. The staff of six moved me back to my bed and, again, as I lay flat, my mental faculties quickly returned. The room was a beehive of activity as my shaking, terrified wife backed into a corner.

Then my lab results came back and everything went crazy.

The day before in the ER, my hemoglobin had been at 14.7. Roughly 24 hours later, my first draw in the ER had been 11.7: not good, but still well within the normal range. However, only about 90 minutes later my hemoglobin was down around 8, and that was drawn before potty break number #5. The attending asked how much blood was in the commode, and my nurse responded “about a cup and a half." If you chart the hemoglobin over time based on those three points you get a parabolic decay. While not mathematically precise, the picture was clear enough. As I understand it, organs can start shutting down at a level of about 5. Given the time since the blood draw and the content of the commode, it was not unreasonable to think we were getting close. (I’ve put this together after the fact… I wasn’t charting any parabolic decay just moments after fainting… although I did remember my nurse’s name which convinced her I was, in fact, lucid again.)

Apparently the attending physician was creating this chart in his head, because he barked out “Change everything! Order two units of emergency release blood stat, get his blood type immediately and order two more units of cross-matched blood, and send him down to the -- [[insert proper term for the serious end of the ER]]”. Larisa fielded questions about whether there were any reasons why I would refuse transfusions, was told the risks involved, and signed off on everything.

A paramedic appeared to start a second IV on my other arm, and in very short order, I was whisked down to another area of the ER that was literally buzzing with activity. A new doctor appeared to tell me that she had authorized the emergency release blood, that my blood pressure and heart rate looked better, and that I was to “hang in there”. This was actually consoling. Larisa and I had known for a while that things weren’t right, and now apparently, so did the ER docs. This end of the ER hummed with calm efficiency. There was a comforting reassurance in the measured, rapid pace of the staff. I was simultaneously being prepped for two units of blood and for transfer to the ICU.

As it turns out, my stress response is to turn into a chatty-Kathy. I was asking everyone their names, about their families, making lame jokes… generally making their job more fulfilling no doubt. Poor Larisa, though, felt like she was watching her husband die. I can’t even imagine how I’d feel if our roles had been reversed.

We only had about half an hour in the busy ER, but it was actually a very precious time. I asked Larisa to come over and read to me the scripture from Acts 13 that I’d read in the morning and as she did, we wept together. She looked down and asked “Are you afraid?” I knew what she meant: Was I afraid of dying? Was I afraid of death? Did all the precepts that we both hold so dear hold up in the busy ER? As I searched my heart, I found God’s Word: He always fulfilled His promises. He always loved His Children. His servant David brought Him pleasure. Unimaginably, inexpressibly, my heavenly Father had prepared my heart only that morning for the answer to this, the only, question in life. I was not afraid. There was no room in my heart for fear because in this moment of crisis, my heart was completely occupied by the love of the Father: Jesus. I held up my fingers, put them together and said “Not even this much”. We wept together at the sheer presence of a God who sees us, loves us, and meets us in our need.

Immediately after our impromptu worship service, the two units of blood arrived. They told me the blood would be cold and that it would be administered as fast as possible. They were right on both counts. They started with my right arm, and within seconds my forearm got that ache you get when you play in the snow without gloves; almost like brain-freeze of the arm. I could follow the sensation up my arm and it died out somewhere around my shoulder as my body warmed the blood. Then they started the IV on my other arm. I remember asking the nursing student -- who had been a civil engineer before deciding to switch jobs -- how much energy it would take to raise two units of blood from freezer temp to body temp. Seriously, these were the silly things pouring out of my mouth as a response to my stress…

As the blood flowed into me, hospital transport arrived, and we set out for the ICU. The journey was uneventful, and upon admission a medical resident reviewed my case and ordered a consultation with the GI staff on-call.  When the GI fellow arrived, it turned out she remembered me from my call earlier in the day. We agreed that I’d made the proper decision to come into the ER rather than wait this out.

What happened next was truly bizarre, because the first several hours in the ICU were defined, if you can believe it, by the color of my bowel movements. Was it bright red? Maroon? Black? Some medical terms that I don’t think actually equate to color? If I’d know this was going to happen I’d have had the ER folks just save the mess in the hat and send it up with us.

It turns out that because I claimed my stool was black (sorry folks… you can stop reading now) there was some concern that the bleeding was higher in my GI. My prize for sticking to my story was to get an NG tube inserted to check for blood in my stomach. I should have gone with really dark maroon…

If you’re not familiar with an NG tube, the N stand for Nasal and the G stands for Gastro. It’s a tube that runs from your nose to your stomach… but don’t let the “tube” part fool you. Small pipe is more like it. Think of those big, fat straws they give you with a thick milk shake. Now think of them sticking it far enough up your nose to reach your stomach. The best part of the process was they used a lidocaine gel on the tip of the NG tube. This was nominally used to numb the area where the tube went. Whether or not it worked is hard to tell, but when my nose started to bleed some of the lidocaine ran down and numbed a bizarre section of lip. So there is that.

This was actually the most miserable part of the day for me. My parents had arrived and had taken Larisa downstairs to get some supper, because she hadn’t eaten anything all day, and there was no way she was going to watch them shove a pipe up my nose and down my throat. Every breath. Every swallow. Every word elicited a gag reflex that needed to be forced down. Once the tube was in place, my nurse pushed 120 ccs of water down to my stomach and then suctioned it back out. No blood. Woot! This meant that the trouble was all down near the other end, just as we expected. I should have gone with maroon.

With the NG test complete, the GI fellow started to set up a mobile endoscopy station. As best I can tell, an endoscope is something like a very expensive Wii. The physician uses tiny controls to navigate a machine through a maze, attack bad guys, try not to blow up the sensitive parts… all while watching on a big-screen TV. Knives: check. Flame gun: check. Water gun: check. I could be persuaded that these procedures are actually performed by a cub scout troop in Boise, sitting on beanbags and munching Doritos.

Meanwhile, an hour south, my church family was gathered for a Chili supper. Although I didn’t know it at the time, they announced that I was in the ICU and called for prayer. Larisa continued to get texts from friends and family. Keep that in mind as I describe what comes next.

Once the mobile endoscopy unit was ready, the GI consult team arrived. Because my blood pressure was fairly low, they were only able to give me two thirds the medication they had administered for the same procedure the day before. As a result, I was able to, more-or-less, watch the big screen as they set out to find what had caused me to lose nearly half my blood in previous 36 hours.

And here’s the miracle: they found nothing. No gaping wound, no seeping incision. No fresh bleeding. Nothing. Only old, dried up blood. Whatever had been causing me to lose about a cup and a half of blood every hour or so had suddenly, inexplicably, stopped.

Later, my nurse explained that she’s seen this before: the change in blood pressure and the drop in temperature from the new blood caused the wounds to coagulate as they should have after the procedure. Possibly. But given the blood loss in the ER, it seems a stretch to assume that such a wound would completely, immediately stop. What seems more real to me (and more likely by far) was that our God heard the prayers of His children. Besides, as Nicole C. Mullins says: “I know my Redeemer lives. I spoke with Him this morning!”

Decisions: one bad, one good

This post is second in a series of four. Please see the preceding post for context.

Immediately following my procedure, Larisa and I hiked through the hospital (think several city blocks…for real) to visit a friend who was recovering from surgery. My first solid recollection after my procedure is sitting in the room sharing the success stories of our respective experiences. I have no memory of getting to her room. After this visit, Larisa and I headed down for some lunch.

The doctor who performed my procedure said to expect some bleeding the next couple times I used the restroom, but that things should clear up shortly. Having no colon, I am pretty regular, and I had to use the toilet immediately following my procedure and once again, an hour later, right before lunch. This is when the trouble started.

As I exited the restroom and headed to the restaurant (still in the hospital), I started to feel weird; similar to the sensation you get sometimes when you’re sitting or lying down and stand up too quickly. As I grabbed a tray and started doling out soup, things got progressively worse: ladling was more complicated than usual. There was a restaurant employee cleaning up beside the soup tureens, and I had a hard time figuring out if I should stop and move. Then I started to feel weak, and I handed my tray to Larisa so I could go take a seat. Unfortunately, I only made it about three steps until I slumped back against a counter as my head swam. The last thing I remember is my vision narrowing, and Larisa standing in front of me asking what she should do.

I came to sitting in a chair in the restaurant, weak, sweating, and totally muzzy headed. After the fact, Larisa told me that she had been forced to put down our tray, put her arms around me, and help me walk from the food area to the seating area; probably over 60 feet. There we sat, panicked as to what to do next. I tried to call my doctor, but through the fuzzy-headed fog was unable to navigate the phone hurdles set in place. Larisa asked a doctor sitting close by what to do and he said to call 911. She did, and was informed that since we were actually in the hospital, they could not respond. Fortunately, the doctor who Larisa spoke with saw my state and called the Hospital’s emergency and cardiac response teams, who were on the scene in about 3 minutes.

When the response team was able to ascertain that I wasn’t having a cardiac episode, they turned me over to the paramedics who had just arrived. The paramedics got me onto a gurney, wheeled me to an ambulance, started an IV, and drove me several blocks around to the ER.

In the ER, they immediately drew blood work and did an EKG. Not surprisingly, I was very dehydrated as a result of prepping for my procedure and the ER doc order IV fluids. We explained our situation and our concern that my intestine had been perforated as a result of my procedure; pretty quickly, I was sent for X-rays to see if anything was leaking on the inside.

As we waited for the test results, I continued to need to use the bathroom every 30-90 minutes, all with the same bloody result. As the test results rolled in, the news was all good: blood counts were very healthy, nothing on the X-ray, and as a result of the IV fluid all my vitals were back in line. The ER declared victory, writing the episode off as a result of dehydration and sending me home. We discussed several times doing a GI consult, but I don’t think that ever happened.

In retrospect, I should have either demanded a GI consult or refused to leave until the bleeding stopped. Although the ER folks asked if I was still bleeding, they neither checked the results in the bowl or had me go into a container for inspection. I should have forced this issue. Neither Larisa or I was comfortable with the discharge, but home we went.  Going home from the ER was a very bad decision.

Friday night was rough. I maintained my bloody pattern with no relief. Larisa and I kept asking what exactly a “couple” bloody movements meant. While I slept OK, Larisa was gripped by fear and had a very hard time sleeping.

Saturday morning we resolved to call the GI fellow on-call if things hadn’t improved by noon. About 8, things started to improve a little. During the course of the morning we took a long walk and I noticed that I was more winded than I should be for a leisurely stroll up and down the street. It’s not as if I’m a 26.2 guy, but I do walk/jog 3-5 times per week and push myself fairly hard for 20 minutes. Strolling for half an hour should be no problem.

During devotions, I took a long time praying and asking for two things: first, that God would speak to me. Chastisement, direction, comfort  or encouragement…I just needed to hear from my Father. Second, I prayed that He would help me to make a good decision. Paying another $250 ER visit co-pay wasn’t high on my list, but neither was getting critically ill. I opened the Bible to Acts 13 where Paul is addressing the synagogue in Antioch of Pisidia. As Paul recounted God’s faithfulness to His children and his delight in His servant David, an inexpressible peace flowed through me: it was going to be OK. I was going to be OK. (For the record, I realize that I am not David, king of Israel. However, I suspect that most of us with Biblical names take special note when we pray to God for guidance and then see our names in the passage we read).

Shortly after 11, I passed a lot of blood once again and called the GI fellow. The doctor responded immediately, was very sweet, was able to access my records, but after about 10 minutes indicated that my only options were to wait it out or go to the ER (she also indicated that the pictures I took wouldn’t be helpful…yeah, yeah I did). Larisa immediately made me pack an overnight bag, but I thought we should still wait. About noon I noticed some dizziness when standing up or using the bathroom, and that was the final straw. We called my parents to watch the boys and, after praying with my boys and playing one last game with them, Larisa and I headed back to the ER.

It turns out that there are two areas in the ER: the “this guy ain’t so bad and we’re gonna send him home” area and the “uh-oh, this is serious” area. On Friday I had been to the former area and after clearing intake on Saturday I was once again channeled to the “give him some IV fluids and send him home” side of the house. While waiting for the doc to see me, a paramedic came in and started an IV. Gentlemen, let me just say that you never want a male to start an IV or draw blood; they always turn it into some sort of macho-pain competition. Guys: pick the female phlebotomist. Every. Single. Time.

I headed off to potty break #1 in the ER, and my nurse had the wherewithal to put a hat down. This keen little device looks like, well, an upside down hat, and it sits inside the lip of the toilet bowl to collect…stuff. Upon completion of my duty, the hat contained ample evidence that I was, in fact, passing a lot of blood. Back in the room, a resident and med student came to see me. Interesting aside for the folks at work -- the resident was a Podiatrist. Anyway, they studiously avoided the full hat in the corner and ordered some IV fluids.

Next up: nurse shift change and potty break #2. Larisa and I sat. And sat. While nobody was actually coming into the room, Larisa was shamelessly eavesdropping on the conversation at the nurses’ station. Apparently my hemoglobin had dropped from 14.7 the day before to 11.7 when I was admitted to the ER on Saturday; this, finally, caught the attending physician’s eye.

Things started getting really exciting as I headed off to potty break #3&4 (I was only planning on one as I headed out). The frequency of my potty breaks, as well as the amount of blood that I was losing, had picked up markedly since I got to the ER. #3 was a mess and as I rose to wash my hands, I felt a little woozy and contemplated pulling the nurse string in the bathroom. However, before I could finish washing my hands, #4 announced it’s presence with a great deal of urgency, and I sat back down. You’d think that the 90 second interim would lessen the amount I was passing, but not so (note here, this is not exactly uncommon for folks with no colon and strictures… things don’t always play nice).

Standing at the door to the bathroom after washing up, definitely feeling light-headed, I had a decision to make: pull the cord for the nurse or walk the 25 feet past the nursing station and back to my room. I did what all self-respecting males would do and staggered down the hall. I even had another chance to make the right choice at the nursing station immediately across from my room. However, rather than just asking for help I bolted toward my bed.

I only made it as far as the door. As I slumped against the door-frame, I called Larisa’s name in desperation as the blackness swam up to meet me (this is real folks.) Just like in the restaurant the day before, the last thing I could see was my wife, panicked, coming to my side. However, unlike in the restaurant, my legs didn’t hold out. We made it five steps when I went completely out, slammed against the bed, and hit the floor.

In answer to my prayer earlier in the morning, we had made the right choice by going into the ER. Any earlier and we’d probably have been sent home after receiving IV fluids. I shudder to think about what would have happened if we had tried to wait this out. We were in the ER. We even had everyone’s attention. Finally.

Crohn's In Remission

Warning: This is David. If you are looking for cute quotes from the boys and don’t want to hear an update on my medical condition, then you may want to skip the next few posts…

As many of you know, I’ve been battling Crohn’s disease for nearly two decades. This disease manifests itself in the GI tract and varies in severity from causing minor diarrhea to destroying the large and small intestines, leading to death. My particular brand is on the more aggressive side, as it has already destroyed my large intestine which I’ve had to have surgically removed.

As a result of my surgeries, I now have portions of my bowel surgically reconnected, and these areas tend to form scar tissue and become narrower, a condition called a stricture. As part of my ongoing treatment, I need to have these strictures widened periodically, using endoscopic procedures. Last Friday, 2/19/2016, I went in for sigmoidoscopy (lower-end… we’ll leave it there) to dilate my stricture and to see how my Crohn’s was coming along.

During the procedure, I was administered a heavy pain killer and a narcotic and, consequently, I have no recollection of the follow-up consult with the physician -- I only have vague recollections of some nurse aid calling me “Big D” (which is better than dinky diddums… I guess.) However, when I finally “came to,” Larisa shared two things with me: first, there is a new procedure available, and instead of dilating my stricture with a balloon, the doctor had widened it by using “needle knives” to cut out the scar tissue and, second, the beautiful news that there was no sign of active Crohn’s disease. The doctor said we could consider the Crohn’s to be in remission.

Praise God for this good news! I would gladly repeat the last several days if doing so would ensure such a good report.

However, as I will share in future posts, we were not able to savor the moment for long, especially since the narcotics didn’t wear off for about an hour after the procedure. Following is an executive summary of the events following my procedure:

• I experienced heavy bleeding
• I passed out three times
• I went to the ER twice
• I received three units of blood
• I ended up in the ICU two nights
• I experienced a miracle

To be continued....