Random Thoughts

Thoughts from a hospital

... seventeen days in stir

by John Averell

If there is one thing that all seniors have in common, it is health problems. Well, maybe there are those few centenarians who go through life with no sicknesses, but the rest of us have stories to tell.

My latest bout with cellulitis in my right leg started on June 15, and my treatment continued in some form until August 13. Over the last months I've made family and friends aware of the condition. In turn I've been astounded to hear back dozens of tales of illnesses, some similar to mine and some much worse. So whatever thoughts I have about my experience, almost everyone has his own as well.

Just a quick summary of the timeline for context. Twelve days in the hospital, Brigham and Women's, taking powerful intravenous and lots of pills. Released for a week taking oral penicillin (which proved to be worthless.) Infection recurs in leg. Then back into the hospital for five days taking intravenous Vancomycin again. Released with a PICC port in my arm for home IV. Then fifteen days of self-administered IV twice a day, with oral cephalexin. Then fifteen more days without IV, but still the pills. Now an ongoing fight to reduce edema in the right ankle and leg.

MEMORIES

I'll summarize my memories of things that happened and people I encountered. Many of you will have your own memories from hospitals.

EMERGENCY ROOM

I was admitted twice. First was by ambulance straight in. Second was walking in, so I had to wait an hour to finally be ushered in. Controlled chaos. I was hooked up to EKG and heart monitor, and the rest of the apparatus. Lots of questions. What was causing the infection? Was the atrial fibrillation I was admitted with an artifact of the infection, or a chronic condition?

I was in fact admitted to inpatient before the cellulitis presented in the leg in a visible form. That diagnosis came the next morning. The afib only showed up once during the night, then never again to this day. So that is ongoing question.

ROUTINE

VITAL SIGNS HELPER. At least four times a day, temperature (under the tongue), blood pressure, percent oxygen, pulse rate. Not bad, just frequent.

SUGAR HELPER. Finger prick for sugar level. Smarts!

MEDS, morning and night for me. Lots of pills. The worst is the anti-clotting shot in the belly. Leaves bruise marks. Every med is given only after reading my arm ID bracelet with a laser. This is fed remotely to a laptop to verify that I really should have that med. Even Tylenol! I felt some security with that step.

BLOOD TESTS. Once a day usually. Poke a vein again, draw several vials. The worst is for lab culture. That is taken separately with a bigger bottle.

INTRAVENOUS. THE WORST. Penicillin six times a day, vancomycin twice a day. Have to be proactive with nurses to make sure they give simultaneous dilution with saline in the vancomycin to reduce the vein corrosion.

CATHETER for intravenous. THE VERY WORST. About every other day has to be taken out and new one put in the other arm. The vancomycin is so strong it corrodes the vein. A major annoyance when I showered every day. Had to protect it with plastic wrapped around my arm and taped.

FOOD. THE BEST. Not restricted for me after first day. Could order anything from menu. Too much to eat with no exercise.

TV. Good setup, moderate channel choice. Except when my roommate kept his on until 2 A.M. Red Sox games every night.

HEART MONITOR. About eight stickers all over my chest with wires connected to a monitor in my pocket that reported heart signals continuously. Not much of a problem after I got used to it, but a real annoyance when I showered every day. Had to take it off then. When I finally was released and the stickers were pulled off, the adhesive marks stayed on for weeks.

ROOMMATE. I had three different roommates during my two stays. We shared a bathroom and sink, but that seemed to go smoothly. One roommate took food and drink through a tube in his throat. I could only feel bad at how difficult life must be for him. All food had to be pureed. They wouldn't let him eat a lot of things that he wanted.

STAFF

NURSES. Quite good, with one or two minor exceptions. They give meds and IV, and generally are responsible for 95% of what goes on. These are the important people that you don't want to p*ss off, because they can make life either smooth or miserable.

HELPERS. Take vital signs, change bed linens, clean floors, empty urinals, etc, etc. I got to enjoy chatting with some, whom I saw during the whole 17 days in the two rooms. One rather older woman was from China. She had her own ideas about alternative treatment, and offered some different ideas to me on what I should be doing. I'm pretty sure this is not part of standard training.

DOCTORS. Confusing. I was never sure who "my" doctor was.

One, the attending physician, I saw initially. He diagnosed the cellulitis (not an easy task at the beginning.) He, and his successor (she), seemed to be in the role of super-consultants. Kind of important bosses. They have to give OK to release.

Then there were staff doctors. These were in-house residents who came every day, sometimes twice, made up med schedule, and in general seemed to be more personally connected to me. He or she reported to a daily group who followed every patient's progress. They didn't always agree with the attending physician.

Interns came in somewhat at random. They were learning, but always seemed to ask questions (the same, over and over.) I couldn't figure out if they were really doing anything.

Experts. Toward the end, when it was apparent that I wouldn't be "cured" by just a few more days, the Infectious Disease team came in, headed by a physician who was clearly a highly regarded expert. All the accompanying physicians hung on every word. He gave the findings that were eventually carried out. Just keep taking Vancomycin, for at least two weeks after release.

VISITORS

In general it is great to have visitors, even if they are for a roommate. Fortunately my wife Shirley, who understandably will not drive in Boston, found an excellent route in by public transportation. With a senior Charlie card, the total one-way cost is 60 cents, which includes a bus and two subway transfers. She faithfully came in almost every day, bringing newspaper, books and clean underwear. It was a real lift to have her with me to light up the room.

OVERALL FEELING

Boredom. Despite the fact that I was treated well, ate well, and appreciated all that everyone was doing, I could imagine what prisoners feel like. The living space was limited -- a hospital bed with table on one side and IV equipment on the other. I could walk around pretty much at will, but most of the time I stayed in bed and watched TV. This is not the way I want to spend my last years if I am not healthy, although the alternative is probably less fun.


September 7, 2007


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