Doctors and nurses

doctors and nurses


I have not since my birth overnighted in a hospital, until this last November. Then my white-cell count crashed and I became neutropenic (no dirty jokes, thank you), and I had to spend seven nights in a nice local hospital.

It really wasn’t so bad. I was often sedated, naturally. The noises at night can be a little unearthly, all kinds of hoots and hollers and cries, but if you think of it as an indoor camping trip, you won’t be too far from the mark.

I learned a lot. I learned that morphine makes me see handwriting on the wall where there is none, and faces where there are none. I learned that only a qualified medical professional can tie and untie a hospital johnny from the back.
Most interestingly, I learned a lot about the difference between doctors and nurses.
If you want to continue the camping metaphor, you might think of the nurses as the flowers on the forest floor, and the doctors as the trees. Nurses are far more colorful; they can and do wear whatever colors they like. Doctors are monochrome – usually white. Nurses are everywhere; doctors sprout up only here and there. Nurses tend to be bright and cheerful (with a few exceptions); doctors are a little on the stiff-and-somber side.
Nurses fall silent when doctors enter the room. We all of us, patients and nurses and guests, wait for the eighty-five-dollar-a-word advice to fall, pearl by limpid pearl, from those doctors’ lips. Nurses try their best not to impede the grave to-and-fro passage of the doctors from ward to ward, floor to floor, room to room. (Questions are met by: “I know they’ve begun rounds. I’m sure they’ll be here shortly.” The nurses try very hard not to get your hopes up; they can do just about everything, but they can’t say the magic words that will pronounce you cured and get you into a speeding wheelchair headed for the exit.)

 
I was lucky, in that about every single one of my nurses and doctors was wonderful (with a few tiny aberrations, which you generally have to chalk up to being human). I did see one doctor come close to telling off a nurse for something – I think for using an alternate drug protocol; to be fair, I knew the nurse and know that she would never do anything to endanger the life of a patient, and the doctor looked young and sniffy and full of inferiority complex, so we will leave it at that. I know who I was rooting for.
At any rate, during my week in the hospital, I learned enough about medicine to pass some kind of premed exam.
Too bad I can’t stand the sight of blood ‘n guts. Otherwise I’d be a whiz of a medical professional.


 

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Update, Dec 1 2013

ljw120113


I started my treatments (simultaneous chemotherapy and radiation) in mid-October; I get chemo every Monday (it takes about 3 hours) and radiation five mornings a week (each session is about ten minutes long). The standard protocol for this kind of cancer is seven weeks’ therapy, which brings us to early/mid December.

 

 

Weeks One and Two were easy. I was able to work almost a full schedule, and felt almost no side effects at all. (I did notice that Thursdays were bad days for tiredness, malaise, etc.).

 

 

Week Three began to get interesting. One evening I discovered that my beard hairs were falling out by the dozens, so I shaved the whole thing off.  My sense of taste went wonky – almost everything tasted awful, like cigarette ashes and cardboard. Acidic and spicy foods were literally painful. Ice cream was okay for a while, and marshmallows, but I was eating less and less because the flavors and sensations were so unpleasant.

 

 

Week Four: now I was feeling it. I got very dehydrated (my own fault for not getting enough water). My old friend the kidney stone decided he wanted some attention too, so now I was taking pain medication both for my throat and my kidney. Swallowing was now becoming very painful too; I was reduced to eating soup and crackers, and I knew I was losing weight. Still going to work most days, but seldom for more than a few hours; I was generally very tired most of the time.

 

 

Weeks Five and Six: finally decided to stay home full-time and rest. Using my feeding tube now – frankly, much easier and efficient than I thought it would be. My daily menu is six cans of Ensure Plus, two each for breakfast, lunch, and dinner, plus lots of water.

 

 

On Friday of Week Five, I got very listless and warm; Partner took me to Miriam Hospital, where they determined that my white blood cell count had crashed over a period of a few days, and I had an opportunistic infection (probably thrush). I spent seven days there, absorbing intravenous antibiotics and waiting for my blood count to get back to normal. (The number in question, my Absolute Neutrophil Count, was around 300 when they checked me in; 1500+ is normal, and anything under 500 is dangerous.)

 

 

Anyway, so seven days in the hospital. I was perfectly comfortable, and all of the nurses and doctors were wonderful.  Partner spent time with me mornings and evenings. My voice is terrible – sometimes I can’t speak at all – which made communication with the nurses and nurses’ aides and doctors very interesting sometimes. (I ended up using a “conversation book” – if I wanted to say something more profound than “yes” or “no,” I wrote in my little red notebook and handed it to the person I was talking to.)

 

 

I was released on Friday, Nov 29 (ANC count 1000+), and am glad to be home. I’ve already resumed treatments; I have only eight radiation sessions to go, and one (or possibly two) chemo sessions. The completion date is still around December 11.

 

 

Good news: everyone agrees that the tumor and the accompanying lymph nodes are shrinking very rapidly. My neck is reddish and looks sunburnt, but everyone thinks the area looks very good. My throat’s painful, of course, and I generate mucus like an opened fire hydrant, but things could be worse. (The header picture was taken this morning a little after 3am. Notice that I have ditched the hospital pajamas. I think I look like Gale Gordon as Mister Mooney, getting ready to reprimand Mrs. Carmichael for something.)

 

 

Thanks to all for your kind thoughts and comments.

High-tech medicine

high tech medicine


My father’s radiation therapy in the mid-1970s was really brutal. It scorched his entire torso, and it did no good anyway, as his cancer was far too advanced.

My mother’s 1990s chemotherapy in the 1990s was much milder. She was only nauseous a few times. Taxol made her hair fall out, which really stunned her; I think it was the worst thing about the treatment for her. But the chemo extended her life considerably, without much affecting her quality of life.

And now it’s twenty years later, and I’m doing a tandem combination of radiation and chemotherapy. The radiation is directed straight at my left tonsil; after the first few treatments, I haven’t noticed many ill effects, apart from a little neck soreness/stiffness. The first few chemo treatments were similarly mild (apart from a little nausea and fatigue).

When I go in for radiation, I lie on the table and let the nurses fasten on my Radiation Mask:

 

Radiation-mask

 

They also give me a plastic hoop to grip with both hands, so I don’t flail my arms too much. The treatment is about ten minutes long; the machine makes all kinds of space-age humming and beeping noises. Then the attendant comes in and unbuckles me.

My mind wanders during the treatment. Early on, I found myself thinking about the plastic hoop. It’s ridged, and slightly flexible –

When the attendant came in to unbuckle me, I handed her the hoop and said: “This is a dog toy, isn’t it?”

She chuckled. “Yep. The medical version costs a hundred and fifty dollars. I bought that one at Petco for seven ninety-five.”

File this one under “health care costs,” and “high-tech medicine,” and probably under “human ingenuity.”

Pity the poor dog going without his toy. But it’s in the name of medicine, after all.

Woof woof!


It only hurts when I laugh

it only hurts when i laugh


It was a shock when, a few weeks ago, my radiologist told me that I needed to have a feeding tube installed. “You may or may not need it during your treatment,” he said, “but we prefer that you have it put in now, because you’ll be very weak later.”

 

 

So, terrific, hooray for the protocol. Feeding tube installed, 4 October 2013, approximately 9am.

 

 

Jesus, it’s big. I was expecting something small, like the nozzle on a can of WD-40. Instead, I now have something like a garden hose implanted two inches above my belly button.

 

 

Getting a hole punched in your belly hurts for a few days. I suppose that’s a silly thing to say, but (for whatever reason) I wasn’t really expecting it. I spent the weekend aching and cradling my belly, walking with a hunch, wondering how long this was going to go on, and assuming (of course) that it would be the rest of my life.

 

 

Over the last few days, the incision has mostly healed. I am now able to walk upright and almost normally. But some movements that involve the abdominal muscles – especially getting up from a seated or lying-down position – still give me a twinge.

 

 

Also: I can now burp without pain! Also, I can cough!

 

 

Sneezing is still a little painful, however.

 

 

Also laughing.

 

 

Oh this is the last straw. I can’t laugh? Whom do I need to talk to about this?

 

 

As James Thurber said when his blindness prevented him from seeing a beautiful girl embracing him: “Dear God, this goes just a little bit beyond a joke.”


 

Why I can never be a medical professional

learnbing to be a med professional


A few days ago, I was lying on a gurney, lightly anesthetized, waiting to be taken into an operating room to have a feeding tube implanted. They’d parked me in a hallway; I was like a plane idling waiting to take off at an airport. (To be honest, I wasn’t so much idling as eavesdropping on doctors’ telephone conversations and studying the pattern of the ceiling panels.)

The receiving nurse, Rose, introduced herself and patted me on the shoulder (to reassure me, I think, and also to reassure herself that I wasn’t going to be difficult.) Then she busied herself with the ten thousand other things that seem to be going on in her department.

Then two new characters appeared: a fortyish woman, very pert and charming, and a tall younger woman, trying very hard to look bright and eager. They presented themselves to Nurse Rose. “Hi,” the older woman said. “I’m Professor Dunbar from the nursing school, and this is Katie, our nurse trainee.” She giggled briefly. “We want Katie to have an endoscopy day.”

“That’s fine,” Rose said. “The nursing staff is okay with it, and you don’t even have to ask the docs, because they’re okay with it too. All you have to do is ask the patients if it’s okay.”

She and Professor Dunbar slowly turned to face me, with sweet smiles. Katie didn’t know right away what to do, but caught on quickly. “Hi,” she said to me brightly. “Is it okay if I observe – ?”

“Of course,” I said.

As they wheeled me into the operating area, I heard Rose tell Katie: “This isn’t the usual thing – not an endoscopy or a colonoscopy. This is the implanting of a feeding tube. You won’t be seeing many of these.”

I lay in the operating area for about fifteen minutes, listening to the nurses chatting around me. They’d faced me toward the clock, and all of them were behind me, so I had a hard time connecting names and faces; there were at least four of them, I think, including Trainee Katie. Rose showed Katie the various kinds of equipment they’d be using, and now and then a new nurse would introduce herself to me and ask my name and birthdate. My blood pressure was through the roof, and I kept having to reassure them that, yes, I’d taken my medication that morning, and that my through-the-roof reading (190/90) was unusual for me; before my diagnosis, I was usually more like 135/85.

Then my gastroenterologist came into the room. I find him cute: he’s short and stocky and has a sharp expressive face. He kept leaning with one elbow on my gurney as he talked to me. I could tell that this was just a routine procedure to him, and I was very comforted by that, and by his casualness, and by the way he insisted on shaking my hand, even though I was draped with all kinds of tubes and sensors.

It was over in an hour or less. A little after that, I was revived in the post-op area and given cranberry juice.

Also, I had a huge plastic tube sticking out of my midsection.

I keep thinking about Katie, the nurse trainee. No doubt she learned something that morning, watching my feeding tube being implanted (it’s a quick process, but a very involved one). How did she feel about it? Did she wince when they made the incision into my belly?

I’m fascinated by medicine, but I know I could never be a practicing doctor or nurse.

The things they see! The things they have to do!


Glaucoma and marijuana

glaucoma pic


I’ve told you recently that I have been getting loads of genetic information from 23andme.com. Among other things, I have learned that I have a significantly enhanced chance of developing something called “exfoliative glaucoma.”

 

 

I have read several descriptions of this interesting condition. As I understand it, little particles of dead tissues (often described as “dandruff-like”) begin to accumulate within the eyeball. (Actually they accumulate within the “trabecular network,” but let’s not get too technical.) At any rate, your eyeballs turn into miniature snowflake paperweights, full of inert whitish material. This increases the fluid pressure within your eyeballs, and – presto! – glaucoma.

 

 

The average chance for developing this charming disease is 0.7 percent. Mine is 2.2 percent. Not huge, but more than triple the average.

 

 

This is interesting. There’s no glaucoma in my family that I know of, but we seem to be capable of generating nasty little mutations of our own, so I’m sure the folks at 23andMe.com are not making this stuff up.

 

 

So what’s to be done?

 

 

Glaucoma is treatable. There are eyedrops, and laser surgery, and other things.

 

 

Also there is always medical marijuana.

 

 

One of the first uses of medical marijuana was to reduce the fluid pressure in the eyeballs of glaucoma patients. It’s not the most highly-recommended treatment – damn medical research! – but it’s still used in many cases.

 

 

And medical marijuana gives you the nicest giggly feeling, and the most tremendous appetite.

 

 

Ah well. There are much worse things than glaucoma.


 

Floating kidney

floating kidney


Gather round, children! Mama has another self-diagnosed illness!

 

 

So you know all about my kidney stones, blah blah blah. I was told a month or two ago that little can be done for them; they’re small, and they dissolve quickly, and there’s no medication to prevent them. The pain and discomfort I suffer is mild, and usually ibuprofen is enough to make me feel better.

 

 

But hm.

 

 

I took some very interesting Human Biology courses in college. My instructor was a remarkable woman who was a church organist, and city councilperson, and chief anesthesiologist at a local hospital, as well as teaching courses at Gonzaga. She was funny and energetic, and an excellent instructor. I remember a lot of what she taught me.

 

 

And suddenly, from back the mid-1970s, I remembered her saying something like this: “The kidneys are cushioned on layers of tissue. In some people – often when there’s weight loss – the kidney can move around. This can cause discomfort. It’s called floating kidney.”

 

 

No kidding.

 

 

I checked. Kidney stones normally don’t feel worse when you move around, but a floating kidney certainly does. Kidney stones aren’t normally relieved by lying down; my pain goes away when I lie down.

 

 

A lot of the other symptoms are the same: colic, upset stomach, etc.

 

 

So wait’ll I see my timid little doctor.

 

 

Do I have a few things to tell him.


 

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