About me

Saturday, August 31, 2013

And so that's how it ends

The doctors released me from the cardiac ward Wednesday morning, and I went directly home for my first real bath since Sunday morning. With all the crap they had stuck to me for cardiac telemetry, I could only splash around in the sink, much like a sparrow in a summer puddle, but with far less exhilaration. I followed the shower with a huge fruit smoothie. The hospital food was adequate, except at breakfast when it was loathsome, but someone should tell them that low sodium does not have to mean tasteless. 

There are these things called spices that I'd encourage the hospital chefs to investigate.

No longer stinking and tum no longer growling, I headed out, first to drop off my new prescriptions at Kerr Drug, and then to noodle on over to see the massage therapist. If I've ever needed some time under his watchful care, it was now.

Two hours later, I'm headed back home. My earlier resolve to let The Rocket cook my dinner had faded, and now all I want is some PB&J and my pillow. By 8, I'm dead to the world.

Thursday is a full day of meetings at work. You can imagine my joy, but DaMan often pays me to sit around and talk to people, and it certainly beats picking cotton, so that's what I did all day. That evening, I stepped out for a five mile run toward dusk. It was uneventful. The calorie burn was half the usual it was with the afib. I even felt good at the end, not the usual run over by a truck feeling.

Maybe the doc was right.

Friday is PTO. That's paid time off, not power take off. Still, I went to the office at noon to pull five miles with the crew. They run a little faster than my usual, but that's a good thing because it pushes me to do more, and I thought I'd croak coming up the last hill. Yet we all survived. I crashed the rest of the afternoon except for a brief while to go grocery shopping. My blood pressure was cruising at 90/50, and I was feeling excessively nappy. This feeling was unexpected, but I'd had a rough week, so maybe I'm in recovery. Sleep came easily that night.

I slept 12 hours, awaking at 9:30 Saturday morning. Knocked around the apartment eating and doing laundry until 2 when I stepped out for another run. I really wasn't feeling it, but I know that feeling well, and my intention was to push through it. It didn't work out that way. 100 yards into the run, downhill, I knew this would not end well, and I turned around to go back home.

At this point, I suspect I wasted a lot of time and money at Wake Med. Obviously, the procedure ended the atrial fibrillation. Just as obviously, there's a side effect that causes excessive exercise intolerance, and I don't see that I'm any better off, just different and with an expensive maintenance drug to go with it.

The hospital gave me seven days worth while the drug store ordered what I need. (I'm number two in their world with this prescription.) It won't be in until next week. At this rate, I'm not sure I'll continue with the drug. In fact, if I had to make the decision right now, the answer would be a big negatory.

So here's the score. We have multiple strikes against Wake Med. The only thing that place has going for it is the Marine night nurse. Cary Cardiology is at least four strikes down, but they're damned fine at applying decision trees without much consideration regarding the rest of the systems interacting with the one, albeit very important, cardio system. All the while, Jim is substantially worse for the wear, and a damned sight poorer.

My patience with medical systems is about exhausted, and I cut off the treacherous drug with the last dose Saturday morning.


Updating...

And there's more. Sunday I slept 20 hours, rising enough to eat and do one load of laundry. I have no idea where that amount of tired came from, but I did enjoy the dreams.

Monday, I wondered if I'd do anything, but I found myself sufficiently motivated to get out to the park and try a run. I chose my usual 5-mile circuit. The first two miles had me thinking I should have stayed home, but them something happened, and I suddenly started feeling alive again. I suppose the drug from the hospital finally worked it's way out of my system. I almost added a few additional miles to the run, but I knew I was headed downtown for the nOg run at 6, and so I stuck to the original plan.

That left me with 9.44 miles for the day, and hardly more than that for the long weekend, but at least, maybe, this chapter is over. I sure as hell hope so. 

Tuesday, August 27, 2013

I told them so

When all this mess started, I pointed out that my sitting around pulse should be in the low 50s, not 70ish, and certainly not 100 as it initially was. The nurse practitioner at the regular doc's accepted that statement, and worked from it. She is smart. Every-freakin-where else, the docs went on to the next question, dismissing without comment my statement. How could a 60 year-old old fart have a sitting around heart rate in the low 50s? You could hear that question echo in the silence. 

So here we go with the condition in abeyance. 52. Fifty-fuckin-two, bitches. Just like I said. Well, guess what? This morning's conversation was about sleeping heart rates, mine in particular. It's normally about 35ish depending on the hot dude in my dreams. (I didn't mention the hot dude part this morning.) And so they had to recalibrate the dosage, what with wanting me to be more likely to wake up and all. 

You might think that'd teach the fuckers to listen once in a while. Don't count on it.


Note: When I finally checked out of the hell hole, my heart rate was 45. I don't know if that's conditioning or drugs, but I'll take it.

My Marine night nurse was good for his word

My Marine night nurse was good for his word. After they left at 11, nothing happened until 7. I arose at 5:30 so as to not be all groggy when the action started. Do know the guys were lined up ready to go at 7. I was very popular. Even the real doctor got the message about closing the door when he came in at 8.

The doc and I had a frank discussion regarding this situation. He was a bit taken aback when I told him that it’d be a very long time before I agreed to step into this Wake Med facility again, and that I would not be repeating this procedure ever. Never. Again. (And saying that leaves me expecting to be back here next week doing it again. Note: I also said that about my PhD qualifying examination.) 

The doc and I also discussed treatments and options for chronic conditions. His perspective is necessarily limited because he’s a specialist. That’s good in that he knows his stuff. That’s bad because he doesn’t much think of wholeness and the care thereof. That the drug he’s using interacts lots with other exotic drugs such as aspirin and Fleet enema doesn’t bother him much. It bothers me a great deal, and this is why I doubt any long term success will arise from this expensive encounter.

Now, back to the night nurse. As he was leaving, the night nurse came by to check on me. I stood to shake his hand. We discussed how organizations often have tight and complex rule structures, and these rules exist for many reasons, most of which are idiotic and positioned to reduce the effectiveness, if not efficiency, of the organization. However, the successful employee, or at least the smart one, will seek to both understand the rule structure and all the paths over, under, around, and through that let us accomplish our jobs and fill our roles without having to worry about going to jail.


He is a smart man. His attitude reminds me of my own #1 Son in many ways. Wake Med was lucky to get him and smart to hire him. I wonder if the organization will be smart enough to keep him.

Monday, August 26, 2013

Needs an alligator

Behold! A sign on my door. I love this night nurse. Almost. I'll decide that tomorrow toward 7. Wake Med finally sends me someone who might look out for me. Of course, I believe I said something like that earlier today, and it was all a big lie, but this guy's a Marine. Maybe he means it.




Finally! A bed!

I love my new night nurse. He brought me a better bed. Old school. No rumbling motors. No air bladders to roll me around until I puke. I told him I still would not forgive him for coming back at 11 to torture me, but that I would love him for bringing me something I can sleep in. Sometimes we get lucky.


So they lied. I knew they would.

And so much for believing what anyone says. The fuckers have lied. They just told me they’re coming in at 11 to do stuff. So much for going to sleep early.

I doubt I ever agree to enter the shit hole known as Wake Med as a patient again. Well, maybe if they drag me in unconscious. This place is the antithesis of health.



It's getting better

Since all the excitement of this morning, things have been much better. I suspect the nurse practitioner had a lot to do with that. So what has made it better? They bring me food. They bring me pills. They have done only one or two EKGs. They’ve taken my blood pressure only twice. They have not stabbed me once. The lead nurse knocks quietly on the door and asks if I need anything, which is probably her code for checking if I still exist. (She does not know about my plan to rappel down the building. I think.)

And they all CLOSE THE FREAKING DOOR WHEN THEY LEAVE. How fucking hard is that to do, and why did they feel the need to leave this old, highly strung, bitter, introverted queen out on public display anyway?  

I have long held that the nurse practitioners often define excellent caregiving, and the example I met this morning upheld my observation, even if she didn’t like my language. Her colleague, however, who rolled through here a bit later in the afternoon, could use some instruction. He knocked rapidly and sharply, flapped open the door, strode in like a ranger in Lord of the Rings, and proceeded to compliment me on my ability to sit up. I shit ye not. My ability to sit up. 

He also wanted me to walk the halls for exercise. Of course, he was too busy talking to hear that I’m resting a foot from running 27 miles the other day, and that I haven’t been in the same chair for more than an hour since I arrived.

Am I so old to these young eyes? Evidently, I am. When he left, he left the door open. He and I will not be doing much business together.


So we’ll see how the evening goes. The nurse practitioner said she left orders to leave me alone from 9 to 7. We’ll see if the ever efficient staff can meet those requirements. Of course, I’ll probably code tonight, and they’ll remember the orders then. 

Conversions-R-Us


Well, that’s not the conversion you might think, and I have no plans to reenter the Baptist church. Ever. I’m talking about normal sinus rhythm. Toward late morning, I felt a change, and the EKG confirmed it. I have returned to normal sinus rhythm.

Maybe I should blow up more often.

There should be much rejoicing, but I take this with a large grain of salt. The last time lasted all of eight days, just long enough to remind me of how I’m supposed to feel, and then wham! Back down again.

The doc is stepping in tomorrow, probably for a disciplinary visit. Be that as it may, we get a frank talk regarding expectations, and there is no literature for the question I have to ask, at least nothing that shows up in any form of online search, and I find that very hard to believe. Pharma research is often more about getting to market to make a buck, not so much about answering a question.


And so I’m feeling very calm, and I feel inclined to enjoy the moment even if I’m going to do so by pre-writing an even calmer report. There is no indication of how long this will go, and I’d like to take this dance for as long as the music lasts. 

Oh, what a goose I am

So I packed to leave, and they sent in reinforcements. Two nurses and one aide. The three left quickly. Apparently, Grandpa can still project anger. Moments later, the PA goes off. Yet. A. Freaking. Gain. They're summoning my regular doc. I like this doc a lot, and I'd really love to see him as he's generally a straight shooter with me, but I’m also pretty sure he has a full agenda already that does not include talking me off a ledge.

No Dr. Craig for me. Bummer. I wonder if they did that just to get my attention.

So I pack my grip, and then it strikes me that I’m beyond hungry. I pull a Clif bar from the bottom of my bag, grab a glass of water, and settle in with my Kindle. After a few swallows, the bar is gone, the water is gone, and I’m putting away the Kindle.

Here comes a rapping, tapping on the door. One of the nurse practitioners from the cardio joint is here to speak with me. Mr. Penny? This title shit drives me crazy, and if it weren't for the fact that Mr. Jefferson found the title sufficient, I'd be correcting these peeps by the dozens.

She wants to talk to me. What she wants is to get me to stay. I didn't stand as she entered the room. She offered her hand to shake. I took it. Her active listening from an Agape class was apparent. I didn't point out that I took the same damned class. She also didn't appreciate some of my language, and I toned it down to a degree, but not completely. She didn't think swearing was necessary. I didn't remind her that swearing provides a relief known not even to prayer. She's not up on her Twain anyway.

The upshot is that if I leave, and yes I do know how to detach the electrodes and IV, I get to pay it all as the insurance company will dance over the non-compliance. If I stay, whether I stick with the drug or not, the insurance company pays. So here I sit, compounding a poor decision with an even poorer decision based on money, which I know is invariable a wrong decision, all the while being removed from any semblance of the support structure I've managed to cobble together for myself.

I was born to suffer. Much as the nurse practitioner did as she endured my toned-down language.


So here I'll sit, maybe, through Wednesday, while I take their god-forsaken chemical abuse and write on a report so dry that it's probably a Class II Incendiary, illegal in seven states.

My form fitting bed

I will give them credit for one thing. The bed molded to perfectly fit the shape of my ever-expansive derriere. That dip in which the TV remote is sliding would hold two of the larger watermelons Wilson McGee ever raised, and still have room for a few cantaloupes. 



I wonder what agent of the Spanish Inquisition designed all this mess.

Oh, what a night!

You might think that a place designed to restore, if not promote, health would set the stage for a reasonable night's sleep. If so, you'd be wrong. Very wrong.

Towards 10:30 last night, they brought me this little pill, a capsule actually, the thing that is supposed to make me well. The nurse turned out the lights, left on the night light, and wished me a good night. The bed continued to growl, bump, grind, inflate, and rotate. The chimes and beepers outside continued to chime and beep. The announcements rolled in. People walked by chatting. I turned the lights back on.

At 1 or so, the ECG dude appears, announces his chore, and then expresses surprise that I’m awake. When he left, the nurse came in and unplugged the bed, though she told me she would have to plug it back in later in the morning. Probably, they have rules about running the beds and precluding sleep to drum up business. I still don't get how I’m a bed sore risk, especially since I’m not much in the damned thing.

At 3 or so, it's time for blood pressure, oxygen saturation, and temperature. Surprise. Surprise. The tech expected to find me asleep. I’m awake. Imagine that. And guess what? My blood pressure is elevated. Now, what in the world is that about? Maybe it had something to do with the advertisements for the (straight) sex telephone lines that appeared on Comedy Central about that time.

Then 4 or so, it's time to bleed. Again. Three vials. Third poke. Same arm. Same vein. Slightly different hole. The tech is matter of fact. I’m not sure I spoke. She left, and I grabbed a bite from the food I brought.


As best I can tell, they'll expect to do this for the next two nights and three days. I wonder if these people ever get to be patients here? I can only wish.


PS: Another tech came in at 6 for BP, O2, and temp. I finally lost it as she left the room, feeling much like Mark Twain that Sunday morning when he couldn't find a shirt with all it's buttons.

Sunday, August 25, 2013

I hate this bed

I will need a mental hospital if I have to sleep in this freaking cardiac hospital bed tonight. Apparently, someone is afraid I'll develop bed sores, and to assuage that fear, the bed inflates, tips, grinds, growls, and otherwise produces motion sickness the likes of which I've not known in a bed room since that evening ages ago when I dipped snuff thinking I'd be cool.

I keep looking for a damned switch to cut the thing off, and I might be reduced to pulling the power cord.

There are many reasons it's a good thing I never went to Vietnam, and I've long wondered why I never relocated to Canada at the time. Nonetheless, had I gone to that war, and the Viet Cong had captured me, I'd have been their bitch within minutes of entering a tiger cage.


Maybe Wake Med is an arm of the North Vietnamese. They did win that war, you know, and I'm pretty sure I'm not going to win this one. 

My life in hell

Here we go again

This one is different. I’m substantially pissed while sitting in a hospital receiving treatment that I’m pretty sure is a waste of time. Oh well.

Yes, it's been a while, and that's for good cause. Atrial fibrillation. The persistent kind. Being out of breath while speaking. Or taking out the trash. Nothing to kill me directly, but enough to make the consortium of damned fools far harder to tolerate, and it's not like I had any patience for them in the first place.

Some four months ago. At Krav Maga. Kicking a bag a little too hard. Think the sound of burlap ripping, but coming from your left inner thigh. Ripped adductors and lots of language. Followed by Vicodin. Just days before Rugged Maniac.

So that hurt like 30 hell, probably much like the feelings of the nurse who was just now on the receiving end of my summary judgment. But that's a story for later down the page.

So I went to the doctor. Several times. And my company changed insurance carriers in mid-treatment. And then I fired a physical therapist, not because I didn't like her but because the office staff was a about the biggest assemblage of dumbasses I've ever met.

The only caregiver worth a shit was the crew in the family practice office, especially the nurse practitioners, and while I was there, I mentioned that my resting heart rate had advanced from it's usually low 50s to nearly 90. One ECG later, and I’m making an appointment with a cardiologist regarding the documented atrial fibrillation.

I picked a hell of a season to stop drinking.

So I let the cardio dude do his cardioversion even if his office staff and voice mail system conspire to make me hang up more often than leave a message. Think CLEAR! It worked for eight whole days during which I was actually able to run, and then BOOM! On the eighth day, the afib returned worse than ever, or it at least seemed that way. That could have been the result me me having forgotten what it's like to feel good. Who knows? So instead of running five miles as I had the day before, I limped back home and drove to DC to work.

Yummy stuff. Imagine sitting around with your heart rate at about 110 or higher constantly. When sleeping, you drop back to maybe 90. You're living in a vortex of virtual angst and despair, and you will fall in it. There's nothing you can do to stop it. It is, however, a sure fire way to loose weight. And friends. Rapidly. And to wake up starving in the middle of the night.

Another trip to the nurse practitioner, who is apparently smarter than a cardiologist. A few prescriptions later and a few more runs to figure out dosing, and life is tolerable mostly. Maybe I should become a couch potato. The new health insurance certainly acts like it'd prefer that.

Of course, running is the issue, and maybe I shouldn't complain that my pace is 12 minutes per mile, not the 9:30 it was the week before this mess all began. And my heart rate is still hitting 200 bpm when running the hill I refuse to walk up. And I’m certainly not doing the weekly 10-milers of last winter anymore.

Now, try telling this to a cardio dude. All you'll hear is that you must not be all that bad off. This led me to see another cardio dude, and I fired him directly after the visit, which resembled more a scene from Absolutely Fabulous than it did a doctor's office. Well, I did take one of his pills, but the ensuing rubber legs cured me of that.

These guys really need you to fit in their little decision trees.

So now I’m at it again. My third attempt to receive pharmalogic cardioversion. The previous two trys were aborted for technical reasons. Okay, the first because the doc had not prescribed a blood thinner. The second because the hospital expected me to pay for it all. Yes, it took the insurance company a few weeks to finish an expedited review for pre-authorization in which the final word was that pre-authorization was not required.

But now I’m in a room with a needle in a vein. Sitting. Waiting. Listening to Ding! Bing! Boing! Aperiodic overhead announcements. I see a sleepless night ahead, especially with all my regular chemicals off line for the duration lest there be some interaction. I should have run before I arrived so I'd be tired. And de-stressed. To compensate, the nurse suggested I walk the hall a few times.

Then there's the staff talking to me like a first grade teacher speaks to a class. This pisses me off more than I expected, and one nurse has already suffered an F-bomb as I reacted to the news the Pharm-D relayed through her. Well, come on! The fuckers should use more than short words in declarative sentences. And not freak when someone asks a probing question.

This all leaves me thinking I've made a mistake. They plan to titrate a drug that has substantial interactions with about everything else while I lie in a hospital for a few days. Then, I’m supposed to return to a normal world and expect everything to be all right? Well, maybe it will be, and I certainly hope so, but I’m not holding high hopes.

A big part of me wants to channel Hub from Second Hand Lions. That certainly makes for a nice fantasy, and an even better movie scene, but it's not likely to play well in Club Wake Med. I'll endure this bullshit, and try to keep security at arm's length. Maybe I won't be any worse off than when I started. Next week, is another week for another decision.


Do you suppose I could rappel down the building using this IV line?