Hearts in Hawai'i
The Fickle Pancreas
1/5/2015
We had just settled in on Sunday night, December 14, to re-watch an “old favorite” movie of ours–it was to be a nice mellow end to another weekend.
The first sign of trouble wasn’t much of a sign, just a slight discomfort in my stomach bringing back memories of old ulcer pains which I used to endure during the late 1980's and early 1990's. Patty offered me a couple Tums, which I chewed up and turned my attention back to the movie.
The Tums did nothing, and the discomfort soon became outright pain, probably a 5 on a 0-10 scale. Those of us who have had any hospital experience understand the “pain scale” very well, considering nurses and doctors are constantly asking us this question; “on a scale of 0-10, how would you rate your pain?” It’s a very subjective question, as what would qualify as a “3" for one person might be a “7" for another. It’s relative to what our past experience has been, I would suppose. In my case, the benchmark was the heart attack I suffered in 2011. At that time, I rated the pain as a “7" as I was being taken by ambulance to a local hospital. What I was feeling now wasn’t quite as bad, so rating it a “5" seemed accurate.
Nausea set in after a couple hours. Once I was able to vomit, I felt slightly better, but it was a temporary relief. Now I was hungry, so I had a toasted peanut butter sandwich.
In hindsight, that was a mistake, although I had no way of knowing it at the time. The “5" turned into “6" and then “7". At 1:30 a.m., I woke Patty and told her I had to go to the emergency room.
The drive to downtown Duluth was torture. Every single bump on the freeway felt like a punch to the stomach. Once at the hospital, I was able to walk unassisted to the check-in desk, where they took my pertinent information and asked me to wait.
The wait seemed interminable. Aren’t they always that way in any hospital? Tonight’s wait seemed worse. Eventually, they came and got me, asked some questions, and decided I was to be admitted overnight so they could “check things out”. From that point (when they inserted the first IV in my hand and gave me pain medication) through the next week, my memory consisted of a series of disjointed observations. I went from one room to another room and then to ICU for a four or five day stay. And that was just the beginning.
It seemed like every day I was there, at least for the first week, they were wheeling me downstairs to the labs to run some kind of tests. Be it an MRI, and Ultrasound, a CT scan. What the hell were they looking for? They weren’t exactly clear most of the time–by the second day, they knew I had pancreatitis from the first CT scan and from lab work done which showed an extremely high level of lipase in my blood. Other than that, I wasn’t sure why they kept testing me.
The diagnosis meant a couple things–first, I was going to be there for a while, a few days to a few weeks depending on how bad the pancreatitis was, how soon the pain would subside and how quickly I could resume eating. The main treatment for this affliction involves not eating, since food stimulates the pancreas. The pancreas needs quiet when it’s inflamed!
My memory of those first four or five days was spotty. They had me on some seriously butt-kicking pain-killers–much of what I am recounting here is courtesy of my wife’s, brother’s and sister’s recollection. I remember the first full night, and how I had trouble sleeping because of my roommate’s snoring. I remember being wheeled downstairs on Thursday, when I was transferred to ICU. I wasn’t making any progress and in fact, was getting worse. They considered putting me on a breathing machine. It wasn’t until I was discharged to home and researched this illness that I discovered that acute pancreatitis has a 10% mortality rate. Suffice to say that I was, as a nurse told Patty, “very sick”.
Transferred to ICU, this place would be my “home” for the next four days of my hospitalization. The first thing they did was insert a catheter. This would help in the respect that I didn’t have to constantly fill those damn little plastic “portable urinals”. No need to worry about having an accident in my drug-induced haze.
The other change was the insertion of a feeding tube through my sinuses, and down past my stomach to the start of my intestinal track. This was needed because my pancreas needed time to rest and begin the healing process. Any introduction of food into my stomach triggered the pancreas and would prevent the necessary healing. At this point, they thought my gall bladder would have to be removed. There was also the issue of a bowel obstruction, and to top it off, I was suffering from hepatitis (although they never told me this, I found out by reading my online patient summary after I got home!).
With the feeding tube in place, I could now take nourishment, also vital to the healing process and to minimize potential weight loss. This would prove inconsequential in preventing weight loss, as the next two weeks would graphically prove.
ICU is nice in one respect. You have your own room! But rest was difficult to find and the nights dragged on forever. I’m not someone who can sleep well on his back, and there was too much pain trying to sleep on my side. This made for a long series of restless nights, and the painkillers didn’t help this much. I was mostly alone with my drug-addled thoughts, watching the hours tick slowly by, waiting for daytime and whatever visitors I would “entertain” that day. That 5 a.m. phone call I would place to Patty on work days because perhaps the most anticipated daily event as each night slowly slogged by.
And I was anything but entertaining. The medications, plus being this sick, caused me to conk out from time to time. I had some major hallucinations during the week. At one point, I was convinced that one of my co-workers was in the “office” and they had converted where I was staying to governmental offices! I remember the hippie-type RN who took care of me for the most part, William. And the sponge baths--I lived for those!
I was starting to slowly improve so they sent me back to the main area of the hospital on Day 8. Still, no food, no beverages other than the ice chips they let me suck on.
A room on the ninth floor was where I would spend the next week. I had the window bed featuring great views to the west, downtown Duluth and the hillside. By now I had improved to the point where I could appreciate having these views, and was well enough to care that there was a television in my room. I was better to where I could appreciate and carry on semi-lucid conversations with visitors such as Dale & Jyll, my sponsor, Mikey and John from the Friday night meeting, Shar & Steve—in addition to my family who was there almost every day.
During this week, three roommates came and went. Most of the roommates I would have during my stay in the hospital would stay one, two, three days, and then they’d leave, staff would clean their side of the room out, and a new patient would be moved in. And I stayed on. And on. And on. When would the improvement happen? When could I eat something? Nobody had any answers other than “Well, you’re pretty sick, and the recovery is going to take some time”. This was not exactly what an impatient person wanted to hear.
My world during this time was very simple, and I had few needs. My table was set up so i could reach everything I needed without getting out of bed; my cell phone, a glass filled with ice chips, my portable urinal. The catheter had been removed, and I had to urinate frequently, usually every hour or two. This contributed to the ongoing sleepless nights I was dealing with. By now my interest in television had returned, and they had a reasonably good channel lineup in this hospital. But because of the ongoing pain medications I needed, I’d fall asleep watching most shows.
I was now able to get out of bed on occasion and go for short walks, with a lot of help from nursing staff, of course. One nurse would make sure I didn’t fall; one would wheel the oxygen tank behind me along with my IV cart. It was amazing how quickly I had lost almost all my strength. Two weeks ago I had rode 100 miles on my Kinetic! And now it took all my effort to slowly walk with the assistance of a walker. How the hell did this happen?
One primary issue for the doctors was my lack of bowel activity. It was simple; bowel movements are concrete evidence that there was improvement, and I’d be able to take nourishment by mouth once again. When it happened on Christmas Eve, it took me very much by surprise, and I got to learn about the “dark side” of nursing; cleaning up a patient after a major accident! While she was at work changing the bedding and I was completing evacuating my bowels into the portable commode they had brought into my room (albeit late), I asked her “How can you folks do this? How do you put up with this crap? (pun intended)”. Her reply was simple; “we don’t think about it, we just do it”. It left me with an appreciation for how underpaid these people are.
Obviously there was no Christmas Eve potluck as our family always did. There was a gathering in my room, the exchange of gifts, while I tried not to drift off to sleep. I was on self-administered pain medication by now. You’re limited to one very small dose every ten minutes, administered by pressing a button at the end of a cord attached to the medication. It helped just enough for me to focus my thoughts on something other than the pain.
Did I mention how appreciative I was of the nursing staff? It wasn’t universal. There was one who had a tendency of pulling the tube going into my nose on occasion. It was accidental, to be sure, but still careless and it possibly contributed to an incident on my 15th day in the hospital which would lead me back to Intensive Care. Another one got on Patty’s (and by extension, my) bad side by stating that I would probably have to go to a nursing home after I was discharged, that I wouldn’t be able to care for myself. She actually did me a favor by what I saw as a “challenge”. If you want to make me want to do something, tell me I can’t do it!
Progress was occurring but it was slow. By now I was able to take in some clear liquids. Beef broth, chicken broth–both tasted terrible as my sense of taste was totally repulsed by anything salty. I was craving sweets! Orange juice, apple juice, popsicles, Mountain Dew Live Wire and Code Red. These had no real nourishment. They just tasted good. The bowel obstruction appeared to be cleared up. I was able to do some walking aided by my walker, but they wanted me to walk much more than I was willing to. Several times I buzzed the nurse’s station to ask if one of them could take me for a walk, but by the time they arrived, I had fallen asleep, or simple no longer wanted to walk. But overall, there was light at the end of the tunnel, and I was hopeful I could be released by New Year’s.
There was little indication of what was to happen as I began my third week in the hospital. On Monday morning, I developed a loose cough. As the day progressed it became a very productive, wet cough. Karen, Patty and Bruce had stopped by in the late afternoon, and I wasn’t feeling very good. No big deal–I didn’t expect every day to be better than the last day, so I saw this as a natural thing.
It was anything but natural. In the early evening, when I sat up to pee into that little plastic jug, I became short of breath. Then my blood oxygen level started dropping. Eventually I was having trouble breathing even while lying down, and I rang the nurses’ station, telling them something was seriously wrong. What was wrong, I had no idea, but my heart was pounding and I was starting to worry if I was on the verge of another heart attack.
Things were happening quickly, and I was suddenly drawing a lot of attention. They turned off the liquid food being delivered via the feeding tube and put a special mask over my face. I fought it, because it felt uncomfortable, but they told me I needed this. Every few seconds it would deliver a burst of oxygen. I didn’t like this but they told me to try to relax and not to fight the oxygen. Eventually I was able to relax just enough for the oxygen to start helping. They brought me back to Intensive Care, and there was talk about my feeding tube having become dislodged and causing the liquid to start going into my lungs!
The fever (103 degrees) I developed during the day dissipated quickly, and that wet hack from my lungs being flooded with whatever the fuck they were being flooded with, likewise cleared up. I only spent two nights in ICU this time before I was released back to general care. They understood my concern about being returned to the unit I had been in, so I was sent to a different floor. There would be three new roommates in the course of my final week at Essentia.
From this point, improvement came quickly. Nutritionally, I went from a Clear Liquid Diet (which is as it says, only clear liquids, water, broth, etc.) to Liquid, to a Mechanical Soft Diet (soft foods which have been pureed or ground), and finally to a Regular Diet. The Regular Diet allowed me to eat basically whatever I wanted (if it was on the menu sheet they gave me each morning). I still had a serious craving for sweets, so I ate a lot of cereal (Cheerios and Rice Chex), chocolate malts (yum!); an attempt to eat a chicken sandwich on the second day before I was released didn’t work so well (still had difficulty stomaching anything not sweet).
I was walking more, and on New Year’s Day managed to take my first steps without aide of my walker. Three days later I was handling stairs and being put through a series of exercises such as side stepping, etc. My oxygen level was still poor when I wasn’t on oxygen assistance. They were asking me questions one morning about my home environment. Did I have a walk-in shower? Did I have a walker at home? Stairs I needed to negotiate? Had I been on oxygen before? Basically asking me what kind of an invalid I was before my pancreatitis. Finally I lost my cool…slightly. “Hey, the week before I was admitted, I rode 100 miles on my Kinetic trainer!!” This ended the string of what I felt were pointless questions.
The feeding tube came out two nights before my release; I worked with an occupational therapist and physical therapist over the course of the final two days. I had one final night of what promised to be good sleep which was rudely interrupted by a brain dead roommate who thought it necessary to blare his TV at 5:00 on my final morning. I wanted to walk over and punch him in what used to be his gall bladder, the stupid ass Cheesehead.
But finally, it was over. Patty picked up a few medications I would be needing–Prilosec, anti-biotics (I had developed a mild case of strep during my final week) and Oxycodone for the residual pain I was still affected by. I was tired from the ordeal and not having a comfortable bed to sleep in. The doctor discharging me said I couldn’t return to work for two weeks (this was later extended to four weeks), and then they wheeled me to the Fourth Street exit where Patty’s car was waiting.
I was finally home! And 32 pounds lighter than when I was admitted three weeks ago. And cold.
Kimo didn’t recognize me at first when I walked into the house–he backed up against the rear of his case and looked at me with his head down, sizing up this stranger who he hadn’t seen or smelled in 21 days. Once I was safely on the couch, Patty opened his cage door and I called out to him. Recognizing my voice, he ran over and jumped right up on my stomach. Ouch, what a welcome!
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