Friday, August 6, 2010

Prep the Patient with Alcohol




What do you do when a scabby fist lodges itself behind your sternum?  When the fingers of that fist begin to lengthen and swell even when there's no space, none, but those fingers - with claws for nails; coarse and cracked - when those spreading fingers with rough nails keep expanding when there's no margin for expansion, when the sternum, usually so hard, so protective, when the sternum is going to splinter, then burst, when you can't breathe because there's no room for air in your lungs, when that fist is going to open, no matter what--

Stay seated on the couch with your three-year-old.  Your daughter who should be asleep but who's up, happy for a little extra Mommy-time without the distracting competitions of her older sister.  Sit there and look down at her sleepy face, so peaceful, until she looks at you and screws up her little three-year-old features, looks up at you and says, "What's the matter, Daddy?  What's wrong?"

Then isn't the time to disregard the voice of your wife as she offers any number of solutions.  "We can call the Andersons," she says. Or:  "Cassandra is traveling, but Natasha's home - she could get Harry to sleep on the couch while we drove to the hospital.  I'm sure of that."  Or:  "No, you can't go to Alameda Hospital.  Your insurance just switched over on the first, August first, right?  Kaiser's it.  Let me figure out where we need to go."

Then isn't the time to decide that you really should shower before hitting the E.R.  And brush your teeth.  Shave.  Krissy, though, she shaved her legs when she went into labor with Matthew, right?  It would make perfect sense to do these things, to attend to these ablutions, if it wasn't for that fucking fist that was so close to punching through the wall of your chest.

So instead you look at Kristina, at her beautiful little face.  She never snuggles like this, not when Mom is so close.

There are things to do, so many things.  Karen, she was a bit unobservant there at the beginning, but she's on it now.  You're not going to poke fun of her in the years ahead - you've got years ahead, Kristina needs you to have years ahead; Elizabeth too, Elizabeth asleep, upstairs, she's not even going to get a goodbye hug - so you won't poke fun of Karen like you've done for twenty years, twenty years ago now when she wouldn't immediately hop out of bed and drive you to the hospital.

That was a bad summer that started so good. You'd just gotten married, but then the tumor in your esophagus, necessitating an ugly surgery, a lateral thoracotomy, and then weeks of recovery after they cut you in half.  That's what "lateral thoracotomy" means.  It's Latin for "they cut you in half and use the Jaws of Life on your ribcage and then staple you back together after they finish messing about."

And as far as being a patient?  You suck, just suck.  Hadn't Karen done everything?  Stayed with you at the hospital - for how many days?  Often past midnight, then you calling before six in the morning.  "My comb," you'd say, "I need it."  And:  "When are you coming back?"  So stop the jokes about her not jumping up that second and driving you to the hospital.  The second time that summer.  Not a tumor this go around.  This time, your gallbladder shut down.  Yeah it hurt.  Big deal.  You were a sissy about it then, don't be a sissy now.

It didn't hurt like this, though.  Not like that fist was about to explode like a grenade from the inside.  You thought the gallbladder hurt - but this?  This is what hurt feels like.


The nurse looks at me funny when I tell her I drove myself.  I don't tell her about Karen and all her solutions, my urge to shower.  I'm focused on the second occasion of the "incident."  She calls it that first, this blonde nurse in blue scrubs, but they'll all call it that in the next twenty hours there at Kaiser.

The Incident.

The Incident was three, all wrapped in one.  First there on the couch, at about 9 p.m.  Then about an hour later, that time with Kristina next to me.  The pins and needles in my left hand.  That was the Incident that made me forget about taking a shower, and got me into my car alone.  Then the third, after the blonde in blue told me to take a seat, and I did, sat there by the entrance, by the metal detector I had to go through because this is Oakland - the detector that alarmed even after I set out my keys and my sterling cigarette holder-cum-wallet and the random change from my pockets, set all that in the plastic tub by the gate - I alarmed the detector even then because my belt buckle is metal, and large enough, and so the game warden there at the entrance, she had to wand me, find the buckle and only that buckle before she waved me through.

So that third time I sat there by the alarming gate and I got quiet, and tried to breathe, and closed my eyes because the fist was back, larger and hotter than before, so I closed my eyes and breathed all shallow, breathebreathebreathe, and that's when the blonde took notice - took notice of my closed eyes, my short breaths, breathebreathebreathe - took notice and grabbed my arm and led me to the back, to the doctors, through some swinging doors to the doctors.

Bridget's beautiful.  She's the nurse taking care of me.  I don't get a really good look at her.  I feel like there's a lot of blue in the ER.  Nurse scrubs and walls and gurneys.  What I remember of Bridget are the crazypretty silver earrings swinging from her ears, the silver shiny against her coffeeblack skin.  She's talking to Marcos, this tatted dude who might be a paramedic.  They're chatting about needles and what gauge they're going to stick me with - 20, 18, or 16.  "The funny thing about needle gauges," he's talking to me, "is that they're the exact same for stereo speakers.  So now you know that," he says.

Beautiful Bridget straightens my arm, "Wow, look at that vein.  We could do a 16 in there.  You want to do a 16?"  "I'll do a 16," Marcos says.  "That's good bragging rights."  But it doesn't work out that way.  He tells me there's going to be a stick, and there is, but then he's digging around inside my arm with his 16 gauge, and I'm thinking the smaller the number the bigger the needle, and then he's saying, "I blew that vein out.  Just blew it."  So Bridget takes over, starts swabbing the back of my hand with alcohol, says she's going to do it, nothing fancy, just a 20 gauge to get it in, stick me just a little.

She does stick me, and my blood squirts, I get her shirt pretty good, and it's wet on my hand, my hand's wet with blood and Bridget's apologizing, getting it clamped off down there, and then they're moving me to Room 12.

Outside of 12 there's a print by Ansel Adams, big and black-and-white, of a tree covered in snow, three main branches coming off the trunk, all listing to the left, blanketed in white, and I think it's there to warn you how cold the room's going to be.  The blanket they gave me came out of an oven, that's what it feels like, warm, almost hot, but the blanket will keep that warmth for just a few minutes inside the room.  I'm looking down at my feet, my feet in blue socks sticking out from under the white blanket.

The room's got a plexi holder on the wall inside the door, lots of slots for lots of forms:  Surgical Checklist, Valuables Checklist, Tetanus Consent Form, Lab Slips, Surgical Consent Form.  They don't worry much about those for me, just wheel me on the gurney tightly through the small room, past the big red biohazard wastebasket and the blue gloves in another plexi holder on the wall.

Bridget slicks back a beige curtain and Marcos parks me against the wall and all I can do is focus on the mismatched acoustical tiles in the ceiling as Bridget tosses two plastic sacks onto the counter, one holding my shoes and pants, the other holding my rolled-up blazer.

This is home for the next 19 hours.

As soon as I'm parked, this dude pushing around a mobile x-ray machine stops and looks in.  "Why dint you tell me you needed a chest done?" he says to Bridget.  "I called out," she says.  "You gotta use my name," he says back.  "I said 'Hey,'" she says.  "'Hey' ain't gonna do it," he says back to her.  "You gots to use my name."  Bridget laughs.  "I am going to get you later," she says.  "I want you to get me later," he says back, "so I'm gonna run slow."

And this time they both laugh.

The dude maneuvers the machine into 12.  "You had an Incident, huh?" he says, and then he shoots my chest and leaves.  A lot of nurses and techs come into 12 and then leave.  Like the nurse that slaps a Nitroglycerin patch onto my chest.  Then the other one who has me dry-swallow two tabs of some children's aspirin because the nitro can give you a bitch of a headache.  Or Marcos again trying to get me hooked up for an EKG.

It doesn't help that I have a hairy chest.  I'm Greek, ok?  Five of the connections work, but not the sixth.  He rips that one off, taking a mat of black hair with the connection, unsuccessfully sticks another one on me with Bridget watching.  Just watching.

Until Bridget tells him she'll do it, kind of like she took over with the needle, and so she asks if she can shave my chest a little to get down to skin.  I tell her I'm not going to be on any calendars anytime soon, so shave away.

I need another blood test and a stress test on a treadmill and my temperature needs taking and my lungs listened to and I should focus, but now focus is hard.

Karen calls at 12:06 a.m.  Gets an update, wonders if I'll be able to sleep.  As she says that, the blood pressure cuff tightens hard on my arm.  The cuff goes off every 15 minutes.  I have to wait six hours before they can take more blood.  So that means the cuff will go off, loud and hard, 24 times between now and 6:15.

I'm thinking no sleep.

But I've got clean oxygen pumping into my nose, nitro on my chest, the cuff on my bicep, something attached to my flip-you-off finger, a 20 gauge needle stuck into the back of my other hand in case they need to pump fluids into me before they use it to draw more blood - more blood in approximately 24 blood pressure checks from now.

I tell Karen my phone's about dead, so I'll be incommunicado.  Bye and I love you.

A nurse kills the lights.  And the little doohickey clamped to my flip-finger glows red, and that red matches the sign out in the hallway next to Ansel Adams, the red a circle and slash - the slash through a lit cigarette, the sign announcing, "No Smoking Oxygen in Use."  So I breathe some of that O2, no sense letting it go to waste.

Another nurse around 2:30 a.m. and I'm complaining about the nitro-headache I've got drumming, and she asks if I'd like her to remove the patch, and I'm not lucid enough to think "more aspirin please," I'm just thinking Billy Joel, right?  And I'd rather deal with a headache than a heart attack-ackackackackack.

Sometime after 3 a.m. and an alarm goes off in 12.  A nurse rushes in, she looks like a rockstar.  Maybe in the light of day the nurses wouldn't look like rockstars, not all of them, but in the middle of the night?  When you think you're dying and they rush in to attend to an alarm in 12?  They could all be on General Hospital.  No problem.  She tells me the alarm indicates that I'm not breathing.  Then she smiles a rockstar smile and says, "But I can see you are."  She kills the alarm and goes off for her closeup.

4:30 a.m. and another alarm.  A different rockstar comes in and I ask if the machine says I'm not breathing again.  Rockstar smile and she says, "It does.  But you are."  And a laugh.  "This unit," she says, "it's not very sensitive."  And all I can think is, this unit?  This unit that's monitoring my breathing?  Wow.

There's no Stress Test for me in the morning.  The test is still needed, but the treadmill isn't available until four in the afternoon.  There's Karen in the morning, though.  Happy with her coffee, and a present for me - the charger for my phone.  I can rest with Karen there.  I feel stupid that she's blowing off work, but I can rest.  It helps that a nurse changed the setting on the blood pressure cuff - it'll only go off on the hour.

Rest.

So I do that, I rest, a lot, with Karen basically holding my hand in between the calls she has to take and the emails she responds to.  But lots of that is done while I sleep.

Then the afternoon finally comes, late afternoon, and my treadmill awaits.  I get wheeled up to the second floor, and another nurse is going to prep me there.  She has me remove my tshirt - I'm glad I kept it on when I first put my gown on last night; it was some comfort against the cold.

She stares at my Greek chest, with the connections from last nights EKG buried in my stupid Mediterranean hair.  "Why would they do that?" she asks.  "We have to remove those," she says.  "We?" I say.  "No, not 'we,'" she says.  "Would you do it?" she says.  "I couldn't.  It's going to hurt."

Thanks, I didn't know that.  So I proceed to rip, and she winces and turns her head, and as I rip I read a sign on the wall in front of me.  What lovely words:

Prep the Patient with Alcohol

That's the ticket.  Why haven't I been Prepped with Alcohol?  I'm thinking about the bottle of Pappy Van Winkle's Family Reserve that I have waiting at home.  I splurged.  It's a lovely 20-Year-Old Straight Bourbon Whiskey that I've been saving.  I thought when I finally finished a draft, when my Groop gathered to discuss the Great American Novel - we'd crack open that fine bottle of Pappy.  But now I'm thinking, what in the world am I saving it for?  My dad died and left behind a lot of bottles of the best that Metaxa has to offer.  Not the Seven Star, but the Very Old.  Why'd he save it?  So we would have something good to pour for those who came visiting that week after he died?

Why save it?

But of course the lovely words don't mean ply the patient with alcohol, I know what they mean as I riiiiippppp off the last of last night's electrodes.  They mean rub my skin with it, the same way Bridget rubbed alcohol on the back of my hand before she stuck me with the 20.  And my nurse will do that, after she shaves six patches from my chest, leaving me looking like a mangy Hellenic dog.  And then I read the words underneath Prep the Patient with Alcohol, and those words say:

Use Sandpaper on the Skin

Sandpaper my skin?  "Why do you do that?" I ask.  The nurse tells me it's to ensure that the electrodes don't slip off.  She's giving them a rough surface to stick onto.  She's wrong.  I'd find out that the sandpaper removes dead skin, and that by removing it, you're allowing the electricity that the heart produces to more easily travel to the electrodes.  I'd also learn that Prep the Patient with Alcohol was a pretty way to say Defat the Skin.  Defatting the Skin removes oil, and it's this process that ensures the adhesive base of the electrode properly adheres to the skin.  The sandpaper has nothing to do with that.

I mean, if you're going to do it day after day, why not know what you're doing?

We do the test.  Or, I do the test.  They monitor.  And although this doctor doesn't look like a rockstar, she's saying all the right things.  "Oh, you're a young guy."  Or:  "My goodness, there are candidates for the Police Academy who can't get the heart going like you are.  They have to, or they're out.  And many are left out, but look at you!"

I wish I had received Harry's text before I started.  "Don't try to prove anything on that treadmill," he wrote.  But I was trying to prove something.  It was only six minutes, the doctor said, the doctor wearing her non-rockstar sandals that showed her pedicured nails.  Two minute increments, each getting harder, and uphill.  I'd never done one before, it couldn't be that hard, especially with the frumpy doc telling me how young a guy I was, how I was putting the Police Academy applicants to shame.

Pant.  Pant.  Aren't we trying to figure out if I had had a heart attack, not induce one?

"Okay," the doc said, "you've done the six minutes" [praise Jay-sis!] "but can you give me one more?  To really test out your ticker?  C'mon, another one?"  And she turns to explain to the doctor in training, a doctor new to Kaiser, that she likes to stress the heart if she can.  She can read the results better that way.  She knows that's not how they teach it, but she's found it works.

So I pass.  And they discharge me.

No heart attack, they ruled that out - Kristina and Elizabeth, you're stuck with me, at least until an out-of-control bus does what my heart didn't do - but they didn't rule-in anything.  Couldn't give me a definitive reason for the Incident.  Stress?  Maybe.  I should be happy for stress, I guess.

*  *  *

It's late.  The kids and Karen, they sleep.  Next to me is the bottle of Pappy.  I've got a crystal glass chilling with ice right next to it.  I've had the bottle for about a year - Bernie scored it for me at Beltramo's down in Menlo Park.  I'd told him to look for Pappy in his travels, and he was in Beltramo's but didn't see it.  He thought he'd ask, why the heck not?  And the clerk smiled.  They did indeed have Pappy, the 20 Year.  You just had to ask for it.  So Bernie asked and called me at the store, all excited, and after getting my ok he got me a bottle, and when Scott heard about Pappy, he asked for a bottle, too.  But Scott was more a gentleman that I, because he brought a shotglass of Pappy into the warehouse for Bernie to try, a shotglass covered in Saran Wrap, wedged tight in a little box.  So Bernie tasted it before me, because I was saving mine.

Why was I saving the booze?  The better the booze, the better the reason to drink it, to share it with your friends.  Saving it.  For what?  For what would I be saving it?  So I'm going to stop here, stop trying to get down what happened over the past few days.  I'll stop, and pour Pappy.  I'll look at it - quiet there inside Waterford crystal - and admire its whiskey hue.  I'll sniff, savor the aroma.  Then I'll toast my dad.  Dad - I'm not saving the good stuff.  Is that ok?  I think it's ok, Dad.  I think it's ok.

Ah, dad.  I wish you could join me.  Why didn't we drink the Metaxa Very Old - why didn't we drink it together when we had the chance?

2 comments:

  1. Dude, that sounds just awful. Really glad that it was NOT a heart attack! But have you had follow-ups? Any idea what happened?

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  2. That was an intense story. I'm glad you're okay, Nick!

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