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!”