Friday, July 28, 2006

Hospital Hell

An update following what I thought to be my son's healthy recovering from his laparscopic surgery. This did so not happen! This is an extremely long entry but I know my journal readership at this point is extremely low. This is more for a record for me and as anyone who likes to write knows, there is nothing like the catharsis of writing when one's head and heart are too full. All that stuff swirling around inside me has to go somewhere and so I have poured it out onto this page.

Tough love usually means taking a firm stand on your child's (or any loved one's) very bad behavioral problems and not giving in an inch until they are resolved or a major attempt at resolution is made. Many days ago I experienced another variation on this theme. The five to six days following my son's surgery were good. He seemed to be doing well, eating okay and feeling fine. As we approached the weekend his nausea/vomiting problem returned and, subsequently, the increasing inability to keep any food or liquid down. This was the weekend of July 15/16.

By Monday evening, we had a young man who couldn't even keep a 1/4 cup of water down. My husband and I had gone to work, hoping for the best that he'd come around and start feeling better. I called him on my lunch break and learned he'd eaten one piece of toast for breakfast and one small 4 oz. container of applesauce for lunch. By the time I got home around 5 PM he told me he managed to eat a small piece of a flour tortilla. Desperately trying to think of something that might appeal to him and that he could tolerate, I bought some nice Dryers Strawberry fruit bars. I gave him one. He ate it and not even ten minutes later, up it came. The result was not red as one would expect; it was dark yellow-bilious green nasty looking stuff. Since the onset of this entire nightmare, green vomit has been the red light to signify immediate action. A few quick phone calls later, we were in the car heading back to San Francisco to the Emergency Room of a different hospital from where we'd been before but an affiliate of the same group.

We got to the city in record time and worked through the inevitable ER waiting room maze in good time. This was about 10 PM. Before long, my son was lead to a guerney and the attending nurse proceeded to start him on fluids, intravenously of course. As the nurse was hanging up the plastic bag of solution, my son told her that it looked refreshing to him and since the poor guy was drooping like a wilted plant and extremely dehydrated, this didn't seem surprising. The decision was made to admit him and we followed him up to a room and proceeded to move ourselves in for the night. Fortunately, this room was set up for two beds but only had one in it. Our son was in line for more tests and since we weren't sure when these would take place we wanted to stick around. A very helpful nurse brought a futon, pillows, sheets and a blanket in for us to sleep (sleep??) on and there was a recliner to sprawl out on, albeit not a very comfy one.

The vomiting continued and then a nurse arrived with the worst news of all. Remember that ghastly nasogastric tube? One was going to be inserted once more to suck the crap out of his stomach. The sheer panic and horror on his face was heart-wrenching and just about did me in. This tube was the worst part of the entire first surgical experience and he was sedated when they put it in that time. That was not to be the case now. The nurse gave him some Ativan, a med for anxiety, and told him she'd return in about 20 minutes. Now my son is feeling wretched, nauseated, still retching and lying there like a sitting duck just waiting for the door to open again, knowing what's in store for him and filled with dread. My husband and I left the room when the nurse returned to insert the tube. There are definitely times when it's better to leave and let the medical staff do what must be done. We walked to the far end of the hall and could still hear the process going on. He gagged and retched through the entire procedure.

By the time we returned to the room, it must've been around midnight. We were exhausted, all three of us. My husband and I had been up since 5 AM since we'd both gone to work that day. My husband threw himself down on the futon and tried to get a little sleep. I think he fell asleep for a few hours. I was past the point of sleep and listened to my son throwing up all through the rest of the night. The N.G. tube was pumping out some very nasty looking stuff; it looked like what I always imagined the Le Brea Tar Pits to look like. He went on like this until almost noon the next day. I mentioned tough love. When he could muster enough strength to talk, mostly what my son said was, "get this tube out". "I can't stand it". "This is going to kill me"! I was practicing "tough love" each time I had to tell him his doctor was emphatic about keeping this thing in. Finally, thetime came somewhere close to midday the following day when a male nurse came in to tell my son he was there to remove the tube. My son looked up at him and said "I love you". It could've been anyone telling him this; male or female, beautiful or plain and he would have said the same thing. I know that he meant it with all his heart and soul.

The day progressed and the patient was feeling better by the moment. Gradually, a little solid food was brought in to try. It was a small bowl of mashed potatoes. Very plain, institutional mashed potatoes. I didn't see a trace of seasoning or margarine/butter mixed in and there probably wasn't any. My son ate this and seemed to tolerate it well. Time went by and it stayed down and he continued to feel better. The surgeon came in to talk to us and said he'd done all he could, there was no blockage in my son's system and perhaps we just had to give the procedure (and resultant shock to the intestinal system) time and all would be resolved. We were given a guide to follow for a bland diet; foods to encourage, foods to stay away from. This sounded encouraging and by around 5:30 PM, he was once more discharged and we headed back home. Back to an incredible heat wave that had northern California (and a great deal of the country) in a melting grip for a very long time. It was now Wednesday night and we were back home in the sweltering heat but we were home! Two days went by and all seemed well. We followed the diet and though he wasn't eating much at all, at least what he did consume stayed down. Saturday, July 22nd arrived. I had to go to work and my husband was home for the weekend as usual. Our son had been vomiting again during the night and several times upon waking in the morning. My husband telephoned me at work to tell me that he had been in touch with the local doctor and that he was taking our son to the ER at a hospital in the area. They got there around noon and I met up with them in the emergency room when I got off from work at 4 PM. After waiting for hours in the ER, once again the decision was made to admit our son and by 7:30 PM he was settled into a three-bed room, once more hooked up to a drip bag of water plus whatever flowing into an I.V. in his arm. Hmmm, three admits to a hospital in as many weeks this month.

Today is Wednesday, July 26th. He's still there. More tests, more observation. Fine when he's hooked up to bag-o-water and receiving anti-nausea meds. Begins to feel sick when he ventures to eat something as simple as a few grapes and a small container of jello. Now he's afraid to try to eat anything. He was scheduled to have an endoscopic procedure late this afternoon around 5 PM and we're awaiting the results. Basically, this test is a camera which will be put down his throat to take a good look around the inside of his stomach. Thankfully, blessfully he will be sedated for this test because guess what? That wonderful tube will be shoved down his nose and into his stomach one more time.

Friday, July 28th. Test has been completed; still no answers. Biopsy done of stomach lining; came out benign. Well, thank God for that! A possible theory has been tossed around that the lower section of his stomach does not contract the way it should to break down food sufficiently in order for it to get passed on down the intestinal line. If it can't go down, it's going to come back up. At present, my husband and I are sitting by the phone awaiting a call from the hospital to tell us that a bed is free and an ambulance is taking our son back down to San Francisco to the hospital where he had his laparascopic procedure. We'll be right back at square one. However, this time around he'll be seen by different people who specialize in gastrointestinal problems. Interesting to note: I'm sure the ambulance transporting the patient won't be rushing to the city at light speed with sirens wailing. Evidently one of "the rules" is that transfer from one acute hospital to another must be done via ambulance.

Nothing more to report at this time but I'll return when I have more information and time and opportunity to write.

Friday, July 14, 2006

A San Francisco Recollection

Over the years from time to time, I've remarked to my husband about how long it's been since we've spent any length of time in San Francisco. It's been almost 30 years since we lived there. Our visits over the past years have been limited to streamlining through the city en route to the airport and in more recent years, several visits to the zoo with my daughter's family.

Because the dictates of health insurance can be crazy at times, inconvenient and sometimes absurd we were directed to a hospital and surgeon in San Francisco to fix our son's woes. The first trek into the city was back on June 26th for a consultation with the surgeon who ultimately performed his operation in July. The appointment was 10:30 AM so we were at the tail end of the morning commute into the city and things were in full swing by the time we rolled into San Francisco around 9:15 AM. Cars, taxis, busses and pedestrians were out in full force. There were so many of them and they were all over the place. I had forgotten what driving in the city was like. Your eyes really have to be everywhere at once. I found it hard to believe that I used to drive around in this city. True, it took me a long time to gain enough confidence to even attempt it at first but I soon got in the groove.

My daughter is my San Francisco child and my son is local home grown from where we currently reside. Throughout his life, he's heard stories and reminiscent tales about our several years living in one of the most beautiful, interesting cities in the world. It really is! Since we were already in San Francisco, my husband got a bee in his bonnet to check out the old neighborhood and show our son the flat where we lived and how everything looked in general these days. This is exactly what we did once our appointment was over.

For those of you who know and read me, you know where and what type of neighborhood this was. For those who don't, check out this link: wherein I regale my public with some interesting facets of my life.

Up and over Divisidero we drove and down the hill to cross Market Street onto Castro. The Castro. A neighborhood unto itself! There was the glorious, regal Castro Theater in all its glory. It looked the same and one glance at the marquee assured me it was still showing those wonderful older films from yesteryear when movies were....well, better! But that's just this woman's opinion. The sidewalks were full of life and seemed more congested than I remembered. It was difficult to recall that for almost four years, my husband and I were among that throng. It was even harder to believe that I walked around this neighborhood pregnant and later, pushed a baby in a stroller or (more often than not) hauled her around in a Gerry Carrier frame on my back. But I did these things and they seemed to be part of another lifetime. This baby is now 28 and has her own little girl of six so indeed it was another lifetime.

There were a lot of changes. There seemed to be more stores and everything seemed to be shoved together more tightly than I remembered. We turned a corner onto 18th Street and headed for Diamond. Sweet Diamond Street. A quick left turn and several hundred yards later, there was the building housing four flats looking very much the same as when we moved. The little spindly trees in front had grown quite a bit, the color of the building was different but it looked the same. The Catholic Church was still next door and the school and large playground (where The Sisters of Divine Indulgence used to cheer on softball games between San Francisco's finest and the Gay Pride Union) were still across the street. When we moved in the late summer/ early fall of 1980 we were paying $350 a month rent for a San Francisco flat. This gave us three huge rooms, a long hallway (along which cloth diapers were hung to dry on a clothesline strung from one end to the other during the wet, cold months), one small room (the nursery, of course), one bathroom, a very small kitchen and back stairs leading down to a funky garage with parking privileges for one vehicle per flat.   A clothesline was strung out from the side of the porch to the corner of the garage, the kind on a circular loop where one hangs the laundry from one spot and feeds the line out. I wondered what the current renter is forking out now each month.  $1,500? $2,000?

We didn't stop, we didn't spend any more time than driving by slowly and saying, "there it is" but for me, this little side trip spoke volumes. I had many a happy time in this place but I was very happy to drive away and head for the Golden Gate Bridge in a northerly direction to my own little house in my own little town. The sheer force of traffic and humanity was overwhelming. I was very young when I lived in the city and it was my first and last experience in a large city. What a lucky woman I am. One city to have lived in thus far in my life of almost 53 years and that city was San Francisco. Sweet! It was so good to return home and I've had quite enough of the big city for some time to come. At heart I am the epitome of the country mouse and that's perfectly fine with me.

Wednesday, July 12, 2006

A Surgical Story Part Two: The Fateful Fart

One of the hardest times of being a parent is killing time, sitting in a waiting room lobby while your child is undergoing surgery several floors above you. Just as we had been assured would happen, the surgeon came to see us once our son was in the recovery room and explained what he did and that everything went well. We were very impressed with this gentlemen when we met him for the first time at our consultation. This man knows his business and travels the world to educate and help others to perfect this particular surgery. My son liked him right from the start and felt quite comfortable. Yes, yes. This was the one he wanted to take care of his problem.

Our arrival up to his hospital room coincided with our son being wheeled down the hall from recovery en route to the room. I had forgotten how people look fresh out of recovery and after taking once glance at him I felt like bursting into tears of relief, joy, empathy and shock at his appearance because I'm a menopausal, sentimental old fool and one can only hold things in for so long. However, I pulled myself together rapidly to present a brave face as we accompanied him through the door. My recollection is a very pale young man on oxygen lying supine on a bed, a nasogastric tube down one side of his nose and a Foley catheter hanging from the side of the bed. The oxygen and catheter were taken away immediately after settling him in his room. My husband does not concur with this memory and only agrees with the N.G. tube. Perhaps I was hallucinating. After all, I'd only been up since 4 AM that morning and it was now going on 3 PM.

As he began to come around a little more, it was that tube that was causing him the most distress. I've only seen N.G. tubes carrying nourishment into the stomach of individuals not able to swallow. Evidently it works in the opposite direction as well because this was drawing some nasty looking stuff out of his stomach. The presence and discomfort of this tube seemed to be worse for him than any incisions lower down. That tube had to go and thankfully before too much more time went by, one of the nurses got the orders to pull it out. The next chief complaint was a sore shoulder and neck. God knows what position they had him in during surgery but whatever it was left its mark after almost three hours of surgery. Some nice, friendly morphine took care of these problems and the ever increasing pain at the surgical site. As he drifted into a mildly drug-induced state, we drifted out of the room knowing he was in good hands and there was nothing more we could do for the time being. An eighteen year old doesn't really want Mom hovering about but takes great comfort in knowing that she's going to be only a phone call away.

When we returned the next morning, our son was up and sitting on the edge of the bed looking a whole lot more like himself. As usual with such surgeries, he was started on a liquid diet and one look at the breakfast tray on his side table told me he hadn't taken in a thing. He was still hooked up to a saline drip bag and at this point had eaten about one spoonful of putrid looking green Jello and some ice chips. He had no appetite at all, not surprisingly, and the chicken broth, apple juice, hot tea, and the ubiquitous Jello (multi-colored this time) did nothing to spur things on.

The nurses impressed upon him he needed to at least drink water. By this time, he'd had enough of the "hospital experience" and just wanted to go home. On a regular basis, the nurse appeared to check vital signs, listen for bowel sounds and inquire about his level of pain. Apparently it was bearable because he never asked for any additional pain reliever after receiving the last infusion of morphine which had worn off long since. We were assured his gut was making good bowel sounds but what they were really waiting for was evidence of, ah...flatulence. That's right, one good fart and you're out of here, kid! Then everyone's sure things are moving along and all systems are, if you excuse the pun, go. As you can imagine it's hard to get things going when there's nothing in your stomach to get. A nurse offered him a choice of some cereal or a piece of bread and peanut butter. He chose the latter. It was the creamy variety too. What luck, his favorite. It took him more than 30 minutes to get that slice of bread down.

He'd been in and out of the restroom a lot throughout the day because that bag of slightly salted water somehow created gallons of liquid. The hours were ticking by and finally through the closed door following yet another trip to the john, our son announced that the much anticipated event had occurred. Houston...we have lift off. Honestly, the balance of our private little planet was hanging on this one little phffft. It took about another two hours after this before we were officially discharged and on our way home. We live several counties away but for insurance purposes, this entire process had to been done in San Francisco. I knew the ride home was going to be long and hard on the patient. No matter how hard you try, it's impossible to avoid all the bumps, twists and turns on the road and traveling along at a good clip to keep up with traffic. The weather had been very hot the short time we were away and once we finally walked through our front door around 7 PM Saturday night, the house was hot and stuffy My son flopped down onto the sofa. Within five minutes he was back up and in the bathroom...vomiting. Hell, I thought, we're right back where we started. We set the patient up on the sofa bed in the living room, got some Gatorade into him and pointed a box fan in his direction. It was all uphill from that moment on. The ride and the heat and a great deal of pent-up anxiety were to blame for this backward slide.

It's Tuesday afternoon now and I'm pleased to say he's doing just fine. His appetite's back, his discomfort seems to be minimal, if not non existent, and aside from taking two Tylenol Sunday evening for a headache (once again, from the hot weather), he has taken nothing else post surgery. All systems are working well and now he's better than new. Literally!

Tuesday, July 11, 2006

A Surgical Story Part One: The Modus Operandi

All hail the marvels of modern medical technology. Four short days ago, my son was wheeled into a hospital room from the recovery room looking quite green around the gills and looking like it would be some time before he would be up and around. By the time Sunday night came around (and he'd been home a mere 24 hours), he said his stomach felt like it does after completing the last of 100 sit-ups. By Monday morning, this number was reduced to 25. Not bad for gastrointestinal surgery; not bad at all. Frankly, I'm amazed.

Last Friday, July 7, my son underwent laparoscopic surgery to have repaired whatever it was that was making him vomit on a regular basis two to three times a week. This was occurring at the same time, early morning, and once he was finished he felt fine and life went on normally until the next bout. If this had been my teenaged daughter, I would've been certain the girl was pregnant. After much second guessing and being told what the problem wasn't, an upper GI series test provided the answer to his problem. A diagnosis of malrotation of the bowel was confirmed and surprisingly, this is a congenital defect that is generally discovered in infants and very young children--not young men on the verge of turning 18. Who knew? Who suspected? This symptom began to manifest just several months ago, was quite sporadic at first and then began to occur more and more frequently.

I won't go into a long song and dance about what this condition entails exactly (anyone that interested can look it up easily enough on the Internet). The surgeon with whom we met for an initial consultation regarding surgery told us that until he was able to look around inside, he wouldn't be sure exactly what would be needed to be done to "fix" the problem. Therefore, my son was going to wake up with either four very small incisions or a more traditional long incision across his belly when he came to in the recovery room. Happily, everything went extremely well and he ended up with only three small, very neat (and I don't mean "cool") incisions. The surgeon removed a great deal of scar tissue which had been developing over time across the Duodenum which is a narrow tube at the end of the stomach which leads into the large intestine. Enough scar tissue had developed there to form the pressure of a very firm handshake and if left undiscovered would, in time, close things up completely, cut off the blood supply and the rest I'll leave to your imagination. Trust me, it wouldn't be good and quite likely fatal. Yikes!