I thought I was going to die. And for once, I didn’t want to.
You see, I have placed myself in plenty of death-provoking circumstances before, not really caring whether I lived or died. Those many times when I coyly seduced death, taunting and teasing it in a rather catty way – giving it my most smoldering “come hither” look as I peered down my outstretched arm, palm up, slowly curling my finger toward me. “Come on … that’s it … just a little further …” As if I were a dancer in some sort of twisted burlesque show. “Touch me, Death … I dare you! Betcha’ can’t …” as I raised an inviting eyebrow. Then I would suddenly plop to the floor like a rag doll. “And I don’t really care if you do,” I’d sneer, rationalizing the self-centered delusion that I deserved it anyway – death, that is.
But not this time. This time I cared. This time, for once, I was clean and sober. It had been nearly a year since my last provocative, drug-induced dance with Death. This time, however, it wasn’t about me.
The pain began one Saturday night in January. It was “movie night” with my husband. We had planned on going to a local theater to see the latest indie film – nothing much, really. I couldn’t tell you what the name of the movie was today.
I was taking a shower in preparation of our evening out when the cramping began in my lower abdomen. It felt like menstrual cramps (sorry, guys), but the pain didn’t really wax and wane like it did with cramps. It began as a slow, constant, gripping, slightly-piercing pain. It wasn’t extremely painful then, but it definitely got my attention. “Shall we dance?” asked Death.
I quickly looked down. “Whew! No blood,” I sighed. That had to be good, right? Every time that I’d had those kind of cramps before, there had been blood. Blood was bad. So, no blood must be okay – right? Yet a twinge of panic hovered that I couldn’t dismiss. And there was the pain. It wouldn’t stop.
I abruptly ended my shower before I had a chance to wash my hair. I knew that I had to lay down – now. Yes, I thought, the right thing to do with abdominal pain is lay down. I quickly toweled myself off and lie down on my bed. The pain persisted, and it was ever-so-slowly getting worse.
While I was lying on the bed, I accepted the fact that the pain wasn’t abating, and so I called out to my husband, “Hon! Can you come here for a minute, please?”
He rounded our open bedroom door and upon seeing me lying on the bed, wrapped in a towel and curled into a semi-fetal position, his eyebrows raised and he said, “What’s going on?”
“I have cramps – bad cramps. They feel more just lower abdominal than just uterine,” I said as I motioned over my stomach slowly with one hand. We were both nurses and we dropped medical jargon around freely.
Behind his glasses, his eyes narrowed in concern.
“No bleeding, though,” I said and managed a smile.
“Hmm …,” he muttered. “Something you ate, maybe?”
I shrugged, “Maybe.” I winced and shifted my position – slowly – but couldn’t quite find the right spot that would ease the discomfort. We had eaten pizza earlier that evening. Perhaps, I thought, it was just some bad gas …? But the pain wouldn’t go away and it began to worry me. I said, “I don’t think I’ll be able to make it to the movie tonight, hon – I’m sorry. You can go without me if you want. I’ll be okay.” I mean, I am a nurse, right? I should be fine. Lord knows, I’d experienced plenty of torturous stomachaches in the past when I was hungover and somehow got through it.
My husband chose to stay home with me. He went to the corner video store and rented, “The Mask of Zorro.” We hadn’t seen it in the theater the year before, but we both wanted to watch it. As it turned out, the pain chained me to the bed so I didn’t watch it that night. Well, I should say that the pain and the slight nausea that had begun kept me in bed. I could hear the movie playing in the living room, where the TV was located. A feeling of tightness began to accompany the pain and nausea in my belly.
Somewhere along the line, I had managed to carefully pull on a sweatshirt and sweatpants by myself, but even that was exhausting – it must have taken me about 5 minutes (or more – I can’t quite remember now) to do it. Moving each limb into its appropriate sleeve or pant leg was laborious due to the pain, and I had to rest between movements. The pain was spreading upwards from my lower mid-abdominal area. I didn’t realize it at the time, but I began to hold my breath when I moved, so as to guard against any further unintentional abdominal movement and its subsequent pain. Suddenly, I was overtaken with the urge to have a bowel movement.
As I slowly made my way out of bed and crawled along the walls of the bedroom to the nearby bathroom, I clutched onto the doorframes for support. It was beginning to be difficult to stand fully straight up. I tiptoed my way into the bathroom, I looked down for traces of blood on the grainy wood floor underneath me. Whew! I didn’t see any blood. I sighed. No blood. That was good.
Without going into detail, suffice it to say that I was overtaken with a case of diarrhea. But still – no blood. It had to be something I ate, I vowed to myself. It couldn’t be another miscarriage. No, no, NO! There was no blood! Sure, lots of unrelenting, painful cramping – but no blood. Yes, I thought, that was it! Something that I had eaten gave me an acute case of gastrointestinal distress.
I apologize in advance here, for I’m going to get a bit graphic. Well, sort of graphic. But it’s part of the story so … I’m sorry. I suddenly realized that I could not properly use the toilet paper. I had taken a nice bunch of toilet tissue, but upon reaching around, behind me, pain seized me mid-motion. It was a searing, hot, “you-are-not-moving-that-way again” pain across my abdomen.
I took a slow breath and tried again. ZAP! Nope. I couldn’t do it. A few tears formed in my eyes. This was unbelievable. The pain had exhausted and restricted me to the point where I couldn’t clean myself. I took another slow breath.
“Hon? Could you come in the bathroom, please?” I said as loud as I could, but not shouting – it hurt to shout.
My husband immediately appeared and saw my … uhh … predicament.
I cast my pride aside and asked, “I’m so sorry … I can’t … I have diarrhea, but the pain is so bad I can’t … wipe myself. Would you … help me?” I slowly turned to the side, bent over, and braced myself against the wall.
My husband looked at me incredulously at first and said, “You can’t? Really?!” But he quickly saw my distress and took the wadded tissue from my hand and cleaned me up. I would have been terribly humiliated had I not been in so much pain that I absolutely could not do it myself. I’m usually a pretty stubbornly independent woman. And at times, we nurses almost feverishly delight in denying help when they are ill or incapacitated.
The rest of the evening was a blur. Just pain and more pain, punctuated by bouts of nausea and diarrhea. I paged my Ob/Gyn doctor at Kaiser – twice. No response. Eventually night fell, the movie ended, and my husband came to bed.
I will never forget that night. I didn’t sleep at all. I tried but couldn’t find some reprieve from that damn implacable pain! Lying on my side ultimately seemed to be my best position. Then Death showed his dance card.
As I moved certain ways, a flash of scalding electricity ripped up my back, to the shoulder opposite of the limb I was moving. Ipsilateral, referred shoulder pain? No! It couldn’t be. No way. It was just really bad gas. Really, really bad gas. Probably food poisoning.
A little gnat-like voice buzzed in my ear, “This is bad, Susan. You know it. Radiating shoulder pain is bad. It means ...” I shut my eyes tight and tried to shoo away that voice with some intermittent soft moaning. No! I was not going to lose another baby! No! You see here? Still no blood!
Sunday morning finally rolled around. Time to get ready for church! I knew immediately that I wasn’t going to make it and told my husband so. He hesitantly went to church without me, as I tried to downplay my pain the best I could. Hell, I had done better acting as if I was okay when I was embroiled in my addiction! Why, I could’ve won an Oscar or two for the acting and manipulating that I did when I desperately wanted everyone to believe that I was just “fine” as I slowly drifted further into that hellish abyss of chemical dependency. Alcoholics and addicts know how to choreograph those particular kind of theatrics. And here I was once again, putting on an act for the wrong reason.
Death was leading me, unwillingly, to the dance floor while as I tried to delude myself that I wasn’t that sick. While my husband attended church, I somehow – God knows how – made it to the kitchen and living room. I knew that I needed to rehydrate and refuel after the diarrhea, yet I had little thirst and no appetite. The nausea was still present, but not as strong as the night before. The diffuse abdominal pain, rather than the nausea, had the majority of my attention now. I did, however, manage to scrounge up a few crackers and some water in the kitchen, force them down, and inched my way toward the living room couch.
I teetered and tottered about slowly, hunched over because standing up straight caused excruciating pain in my belly and back. I got winded easily, too, for some reason … Not good signs for an otherwise healthy 33 year-old woman. But I had stubbornly entrenched myself in denial about Death’s dance call. I sincerely did not want to die this time! So … I tried to brush off His advances by ignoring Him.
While lying on the couch that morning, watching TV and trying to force down a few more crackers, I dropped the TV remote on my stomach. Death then tried to shove His hand in mine to dance.
The pain was excruciating – like nothing I’d felt before (and I’ve had a number of surgeries in the past). My vision went pitch black except for some bolts of bright white, blue, green, and blue light which flashed before my narrowly-opened eyes. A four-letter word suddenly made its way to the back of my throat, but never materialized because I just as rapidly inhaled it back in at that moment. All went black.
Milliseconds (which felt like minutes) later, my living room slowly reappeared like a “fade-in” to a movie. What the hell was that?!? I thought. That annoying little gnatty voice grew a little louder, “This is bad, Sue. Very bad.” Okay – I got the hint. Time to get back to bed. All the way back to my bedroom, I tried to convince myself and that drat little voice that it really was just bad gas, or GI distress, or something …
It took me nearly 10 minutes to get back to my bed. I inched across the wall, slowly, hunched over like a 95 year-old lady whose head you can’t see as you walk behind her because her upper back was so contorted. One hand guarded my abdomen and the other hand alternately grasped at the wall, then the furniture, back to the wall, then the door frame, as I finally made my way back to the bedroom.
Some time had passed and I hoped that my husband would be home soon. Did I think to call him and tell him what happened to me on the couch? Or how winded and pain-wracked I was becoming? Oh, no. Of course not! It was just bad gas, after all. It couldn’t be … that. No way. You see? Still, there is no blood!
On one of my trips to the bathroom that morning, I lost my balance. I was getting out of bed and didn’t have my foot squarely underneath me. I remember slowly tipping backward, desperately trying to find my balance, but it was of no use – I went down.
The whole incident felt like it took hours, but surely it was a manner of seconds. It seems like reality tends to slow down when death is near. I don’t remember hitting the floor. All I recall was opening my eyes and wondering why on earth I was lying on the floor! I wasn’t drunk or high at the time. Nope – I’d been clean and sober for a solid 10 months by then. I was randomly drug-tested an average of twice per month in the recovery program I was in to prove it. So how on God’s earth did I end up on the floor?
That damn little gritty voice wasn’t so little now. “This is serious, Sue! You do not faint!” And that blasted little voice was right. I had never, ever fainted before. In the past, I’ve had my fair share of moments of “passing out” in some rather unflattering ways while under the influence, but I’d never truly fainted. I had seen some extremely gory things in the operating room in the past, but I’d never fainted. But strangely, at that moment I remember a fleeting sense of relief – the relief that came when I let my heavily-armored ego lay down her weapon. I finally acknowledged that I was in some serious trouble.
Shortly thereafter, I heard my husband bounce in from church, still high on the fellowship there. He looked dapper in his button-down, long-sleeve shirt and colorful tie. His face fell as he walked into the bedroom.
I confessed what had happened. I told him that I had fainted twice from abdominal pain while he was gone. In so doing, I relinquished my façade about the severity of the pain. I quietly but urgently said, “I need to go to the hospital now.”
My husband quickly picked up the bedside telephone and called the Ob/Gyn department at Kaiser hospital. I heard him talk, but didn’t hear what he said. After he hung up, I pleaded with him, “What?” I wanted to know what they said. I was in some serious trouble, dammit!
He looked at me briefly and hurriedly said, “They told me to call the Emergency Department.”
More dialing, more talking. I couldn’t make out either side of the conversation. Again, I pleaded, “What!?!”
He hung up the phone and said, “They want me to bring you to the ER at Kaiser.”
I put my pride aside and truthfully said, “I can’t walk to the car, hon. I need a chair or something. The rolling chair from the office …?” It was the next best thing to a wheelchair, I figured.
He rolled the chair from our office into our bedroom and set it at the foot of our bed. He left it at the footboard because there wasn’t enough room for the chair to get between the wall and the bed – the arms on the chair were too wide.
I saw that I was going to have to crawl to the end of the bed in order to get to the chair, so I began moving slowly toward the end of the bed when …all went black.
“Susan? Susan!” I heard an urgent voice – my husband’s – fading in. Everything was still black. At the same time that I heard my name, I felt my tongue maneuvering in my mouth, as if trying to spit something out … Blechhhhh!
The grainy bedroom floor faded into view. A small white trash can had been thrust in my face. I was lying on my side … on the wood floor.
“Susan?!”
I heard my husband’s voice again, more sternly this time. “Susan!!” he said with authority.
My eyes widened. I spit out a piece of … what? Chewed up cracker? … into the white trash can. Blechhhh!
There was his voice again. “Susan!! Can you hear me?” He had been holding the trash can in front of my face as I lay on the floor.
I whispered a reply as I did not have enough air to talk, “Call 911.” I didn’t know if he heard me.
The trash can was pulled away, and there was a washcloth dabbing at my mouth. Then I saw my husband’s hand and face. It all came into view as if I was in some surreal state. “Oh, shit!” I thought. This is bad! Help me! Somebody … help me! I cried silently and tearlessly.
Next I heard my husband’s voice – he was talking on the phone again. His voice held a tension that I had never heard before. “Call 911!” I cried out silently as I drifted in and out of consciousness. At that moment, I felt a strange yet comforting sense of release. The pain was still excruciating beyond description – it felt like my innards were being ripped out of me while I was still conscious. I felt Death’s determination to have its last dance with me.
But there was that peculiar sense of release in it all. That release in giving up the fight. Letting go of my obstinate, perverse desire for control. I closed my eyes.
My husband suddenly appeared at my feet, standing over me, holding the telephone.
“Who did you call?” I whispered.
He told me that he’d called the ER department at Kaiser and reported what had happened. “They told me to call 911,” he said as he began dialing.
“Yes! Yes!” I thought as I tried to stay in reality. “How come I’m down here?” I whispered to my husband. The last thing I remembered doing was crawling on my bed toward the office chair at the foot.
My husband said, “You passed out. As soon as you sat in the chair, you passed out and vomited. I got you to the floor.” There was that odd tension again in his voice.
“Oh …” I said. Actually, I don’t know if I actually uttered any sound – I didn’t seem to have a lot of energy to talk. At best, I could whisper.
The paramedics arrived faster than I thought. Within 5 minutes, I wagered. I heard that all-too-familiar wail coming up our street, then abruptly stop in front of my house. I lived a block and a half from the local university hospital and my street was one of the only direct paths to it, so the screaming of sirens at all hours was common. Normally, I would’ve been embarrassed if they had stopped in front of my house. But not today. Today, I had a new gratitude for that siren’s normally obnoxious blare.
Next, I heard clomping of heavy shoes on my wood floor. No one could sneak around in my house with its squeaky 1920’s wood flooring. Clomp, clomp, clomp.
Suddenly, my small bedroom was very busy. I heard several voices – a male and a female – perhaps 2 males and a female. I wasn’t sure because I never saw any distinct faces – I only heard terse exchanges of words. At their request, my husband recited the basic information: age, weight, height, etc. Pause. “Is she pregnant?” an unfamiliar voice asked.
“Yes”, my husband replied. “About 7 or 8 weeks … something like that.”
I wanted to yell, “Seven weeks, you idiot! How could you not know?” but no words materialized. He truly didn’t know exactly. He didn’t want a baby like I did. He hadn’t been the one obsessing about their temperature every day and using ovulation prediction kits in order to time sex during my most fertile time of the month. And he wasn’t the one who had an early miscarriage a few months prior …
Busyness and commotion permeated the air, but I couldn’t make anything out clearly. It was as if someone had glopped Vaseline in my eyes – no matter how I tried to focus, my world was translucent, at best. But I could hear and I could feel.
What felt like a plastic bear-nosed clear mask was hastily placed over my nose and mouth and soon the familiar “fssssss!” sound of oxygen filled my ears. Now knew what my patients felt when I strapped that blasted thing on them and why they immediately reached up to take it off. It seems instinctual to want to remove something covering one’s nose and mouth – even if that “thing” is providing critical oxygen. Through my foggy brain I also remembered my training: applying oxygen is standard procedure for someone in any form of respiratory or cardiac distress. I didn’t perceive myself as having either one of those two predicaments, but I wasn’t able to be objective in this situation. I wasn’t the one managing the airway this time. Fortunately, my human instinct to remove the mask was precluded by my physical inability to do so – I was simply too weak to move or to care.
Little round cold sticky things were being stuck to my chest and instantly I heard another familiar sound: the “beep-beep-beep-beep” of my pulse on the portable ECG machine that the paramedics had.
Shit! I thought. It was my pulse that was beeping! “Beep-beep-beep-beep …” Wait a minute. This is bad. This is very bad. The rate sounded very fast – too fast. The heavy weight of reality was piercing its way through my foggy, surreal world.
I vaguely remember looking at the ECG monitor on the floor near me. Yes – my heart was racing. It must have been … what? 120 (beats per minute)? 150? My blurry eyes couldn’t make it out. Holy crap! I was in shock. Every nursing textbook I’d ever read and 20 years of nursing experience shouted at me: That’s not normal – a normal, healthy adult does not have a resting heart rate of 150 while lying immobile on the floor!
While all this was going on, I vaguely recall the blood pressure cuff being applied to my left arm and squeezing tightly, then slowly releasing … then tightening again and releasing … then tightening again … Why was it doing that? Couldn’t they get a blood pressure? Good God. More voices …
Next I felt another kind of tightness on my right arm – the familiar rubber elastic band that was used when starting I.V.’s – and the needle poke that followed. Thank God I had saved them some good veins, I thought. What ex-addict type thinking! I was actually proud that I had reserved my larger antecubital veins in case someone might need I.V. access. Sad, isn’t it?
During my active addiction, I recall hypocritically priding myself when working in the operating room with indigent I.V. drug addicts. I’d think, “Geez, did they save me any veins to start an I.V. or is this going to be like looking for a needle in a haystack” (pun intended)? As I lay on my bedroom floor while the paramedics tried to start an I.V., I thought how pathetic my thinking was – that I was actually proud that I’d saved them a few good veins. People focus on the damndest trivial things when under extreme stress, don’t they? Like focusing on whether one’s underwear was clean while being extricated from their mangled car by the Jaws of Life.
I felt the cool surge of I.V. fluid rushing up my arm as the paramedics prepared me for transport. I heard an EMT ask, “Does she have any health insurance?”
“Yes,” my husband replied. “We have Kaiser.”
There was a distinct, brief pause. The EMT continued, “That’s good but … she’s going to UCSD.” The implication being, of course, that I was too medically unstable to transport across town to the main Kaiser hospital. UCSD was a block and a half away – they could practically coast there from my house.
The trip down my driveway on the gurney felt like I was on a rickety airplane runway. Black and white flashes appeared before my eyes with each tiny bump. The jarring caused indescribable, searing pain, yet I barely had the energy to moan.
As the EMT’s loaded me into the waiting ambulance, an ache in my right arm became more and more apparent. I managed to whisper loudly, “It’s hurting … the I.V. …” and I motioned my head toward my right arm.
“What?” a male voice said.
“The I.V. It hurts!” I repeated, trying to talk over the “fssssss!” of the oxygen and other noisy contraptions in the ambulance. I used what little energy I could muster to raise my right arm slightly. Yowch! I thought. Yep – it’s infiltrated. In my head I shouted, “Dammit, people! The I.V. has infiltrated. Change it!” yet no words ever left my lips.
“The I.V.?” the male voice asked. “Something’s wrong with the I.V.?”
I nodded and whispered as loud as I could, “Yes! It hurts!” Then a thick fog covered my eyes and I slipped into some semi-conscious state – neither unconscious nor fully aware. A very bizarre, surreal state.
Searing pain from the movement of the stretcher wrenched me back into reality. I was being taken out of the ambulance and wheeled up a ramp through doors with a large label: “EMERGENCY DEPARTMENT” in unmistakably huge, bright red letters.
I was thrust into a room of bright lights and commotion. Every movement of the stretcher brought excruciating pain – yet I had no breath to cry out. They wouldn’t have heard me anyway with that darn mask noisily blasting oxygen in my face. I felt all of the paramedic’s monitoring equipment being exchanged for those in the ED and I heard a brief report being given by the EMT.
Amidst the poking and prodding, I felt the sharp coldness of ultrasound gel being applied to my abdomen. Then intense pressure as the probe was moved around my belly. Black, white, blue, and orange flashes of light raced before my eyes against a dark background. The piercing pain overcame my inability to vocalize and I let out an audible moan. The pressure let up a few seconds later, and I settled into my familiar Vaseline-smeared fog.
Then I heard what confirmed what that pesky little voice had been trying to tell me all along and which I had been deliriously trying to deny: “Free fluid in the abdomen,” a male voice pronounced above all the clatter. A small tear trickled down the side of my face. More needle poking ensued as the ED staff attempted to start another I.V.
In a strange sort of paradox, the more I felt Death’s slowly-tightening squeeze, just that much more I let go. The onion-like layers of denial and pride and stubborn independence peeled away much easier now … I was surrendering the fight.
Suddenly, a man’s face was thrust into my view. I don’t recall what he looked like as I was unable to focus – that thick film still obscured my vision. He delivered the final blow that shattered any remaining shards of denial I held. “Susan, we think you have a ruptured tubal pregnancy. We need to get some fluids in you quickly, so I’m going to put a big I.V. line in right … here,” the man said as I felt the pressure of a gloved finger just below my right collarbone.
Of course you are, I thought. A central line (an I.V. catheter whose tip lies just outside the entry into the heart). It is standard procedure in a case like this. That’s just great, I thought as I closed my eyes in passive consent.
I felt the cold alcohol and betadine swabs hurriedly swirling below my right collarbone as they cleansed the site, then the distinct stickiness of the sterile drapes being pressed to my skin. No offense to anyone, but I prayed that the hands that were doing the procedure were skilled ones. Having been in the medical profession for over 10 years (four of those years in a university hospital setting ), I feared that a medical student or 1st-year resident might be attached to the hands about to thrust a catheter in or near my heart. “Please …” I prayed. “Please get right the first time!”
I heard a voice call out, “What’s her crit?” The hematocrit (or “crit” for short) measures how much space in the blood is occupied by red blood cells (ml of red blood cells per 100 ml of blood). This number varies slightly, based on age and gender. For an otherwise healthy adult woman, a normal hematocrit would range from about 35 – 45 %.
“Her crit is 18 (%)!” was the answer. I thought I hadn’t heard it correctly – it couldn’t be that low.
Then the initial voice called out, “What’s her blood type? Anyone know?”
My attention was instantly brought back to the cold area where they had just swabbed and draped as I felt a little poke and a sharp sting (Lidocaine, probably, to numb the area), then pressure just below my right collarbone. Then more pressure. “Please get it in the right spot …” I prayed. I knew that getting it in the wrong spot meant that my bad situation could quickly become worse, perhaps fatal. I was already circling the drain as it was …
The pressure on my collarbone released, some tape was applied to my skin, off came the drapes, and I could turn my attention back to the blood type issue.
I heard my husband’s voice – thank God! He was there! – answer, “I - I’m not sure what her blood type is.”
Inside I was screaming, “A+! A+!” I knew my blood type, but the words never left my lips – I just didn’t have the energy. “I know my blood type, dammit! It’s A+!” I thought.
“Two units of O-neg,” that now-familiar voice said – clearly, he was the physician who I had heard asking the questions and giving the orders.
“Crap!” I thought. “I know my blood type!” Ugh. Still, no energy to give sound to my words.
Another blurry male face was thrust into my view. “Susan, you have a lot of fluid in your abdomen. We need to take you to surgery now to find out the cause of it, okay?” My gurney began to rattle and move. “Do you agree to the surgery?”
“Huh,” I thought. Informed consent. Nice going, doc. I’m barely conscious, don’t even have the energy to talk – hell, I’m barely alive – and this guy appears alongside my moving gurney, and blurts out, “Do you agree to surgery?” I know the legalities of medicine, and why he had to ask. They already had probably already asked my husband if he would consent to surgery for me, as he was the only relative available at the time. It seemed rather comical that this doctor would ask a barely-alive person whether they wanted potentially-life-saving surgery or not, but … that’s the medical-legal system today for you. I should know – I have asked thousands of patients myself whether they would consent to their anesthesia before I provided it because of this system. I knew it was required. It just seemed rather amusing (okay, a bit ridiculous and questionably legal) to me, given the circumstances, now that the shoe was on the other foot.
“Geezus!” I thought. “Like I have a real choice in the matter? It’s the definitive and ethical course of action. Duh.” Besides, let’s not forget that ruptured ectopic pregnancies of this severity are rather uncommon these days. Plus, I was in a teaching hospital – what a fabulous educational opportunity for all those students and residents!
My husband appeared out of nowhere, alongside my gurney. I didn’t know he had been tagging along for the ride. “Everything is going to be okay,” he said in his best forcibly positive voice. “I’ll be here …” his voice trailed off as I left him at the open double-doors to the O.R. Only staff were allowed beyond the double-doors.
My stubborn ego managed to attempt one final triumphant feat. As soon as I left my husband and entered those double-doors, my pride took one desperate last stand before surrendering her weapon. What the heck was my ego guarding, anyway?
My head began to swim with worries about who was going to be on the surgical team, and most importantly, my anesthesia provider. You see, a nurse’s worst nightmare (okay, one of this nurse’s worst nightmares) is to be a patient at the hospital in which they work. I feared that my dark, dirty chemical dependency history would surface. I also worried that they would deduce how my prideful, rebellious resistance to reality (i.e., denial of the obvious) nearly cost me my life; how stupidly arrogant I was to abstain from getting much-needed help earlier.
The shame over those issues was mercifully shattered by a new self-centered fear. It was Sunday. On Sundays in the O.R. where I worked, attending or chief physicians were scarce – surgery was frequently provided by … residents! I winced.
I had been a nurse anesthetist in that hospital up until 10 months before this incident (they used nurse anesthetists as well as residents and chief physicians as providers at this facility). I had worked with many of the nurses, surgical technicians, residents, and attending doctors for 3 years. After a while, one gets to know which residents have a bit more skill than others. My biggest fear, interestingly, was not who were going to be my surgeons, but who were going to be my resident and attending anesthesiologists! The skills of the anesthesia provider were crucial in a case like mine. “Shit! It’s Sunday!” I thought again.
As voices continued to swirl about me, I struggled to stay conscious until I could ascertain who my anesthesia provider was going to be. And my pompous ego was surprised that no one seemed to recognize me. Of course, I was vertical at the time, in a gurney, covered in a white sheet, which in turn was covered with transport monitoring equipment, wires, and I.V. and oxygen tubing. I’m sure that my normally fair skin was probably becoming ashen and/or had taken on an alluring tinge of blue due to my low hemoglobin and oxygen levels. And just to make matters more confusing, the admission information apparently had my last name and birthdate incorrect – two vital pieces of identification of someone. No wonder they didn’t recognize me.
I tried to gather enough energy to ask who my anesthetist was, but the best I could do was whisper. The continued loud “fssssss!” of the oxygen, as well as that darn mask, obscured any visual or audible sounds I may have made. At that point, I had little energy to even become frustrated by the situation.
A few bleary, indistinguishable faces appeared over me, upside down. I heard the voices of a man and a woman. They briefly stated their names, but it was difficult to discern their words over the other people chattering nearby, as well as the beeping of the nearby monitors. And there was that intrusive oxygen still fiercely blasting in my face, too … “fssssss!” Ugh. I just wanted to go to sleep and be relieved of the pain. I had no struggle left in me anymore.
“We’re going to do your anesthesia,” I heard one of them say.
Eureka! I knew one of those voices! It was a resident whom I had worked with in the past. “Oh, thank God it’s him!” I cried internally. I couldn’t recall his name, but that was okay. I knew that he was a senior resident and that allowed me a small sigh of relief. Someone with a little experience. Halleluiah!
Out of the corner of my eye, I saw another face –fleetingly – of one of the staff anesthesiologists. He usually worked at the VA hospital – he must have drawn the lucky card and been the on-call attending anesthesiologist for the university hospital that day. It took a second or two for me to put a name to the face, but I finally recalled who it was. He was old, but he was experienced. Another halleluiah moment!
I finally breathed a small sigh of relief. “Oh, thank God,” was all I could think at the time. “I hope that this doc stays with these guys,” I thought, referring to the attending anesthesiologist and his resident and … whoever the woman was (a nurse anesthetist, I sincerely hoped). I wanted to make sure that he accompanied these two into the O.R. and helped manage my case. I feared being left at the discretion of this male resident and no-name woman. I was in big trouble and really didn’t want to be the teaching moment du jour (i.e., guinea pig) for some inexperienced medical folks to tinker with. I sensed Death trotting alongside my gurney as I entered the operating room suite.
I braced myself for what was next: the transfer to the operating room table. The pain would be horrific. And it was. I heard the countdown, “Ready? 1 … 2 … 3!” and as the O.R. staff yanked the sheet underneath me, I instantly felt bolts of scalding pain ripping through my abdomen and back as everything in my line of sight went black except for flashes of bright white, blue, and orange light. The intensity of the brightness of those flashes is indescribable; it was like nothing I’d witnessed before in “real life”, save perhaps staring directly at the sun.
Monitors were changed over from the transport machines to the O.R. equipment. I.V. bags and tubing were removed from the gurney poles and hung on the I.V. stands in the O.R. Then came the familiar placement of my arms on the padded armboards, with the raspy, fabric-pulling Velcro sound as the wrist restraints were applied. The oxygen mask was removed and replaced with the bulkier plastic, padded mask that the anesthesia provider uses with their machine. It was being firmly held to my face by a rubber-gloved hand.
The ““fssssss!” noise of the oxygen became louder than before. I was being “pre-oxygenated” prior to induction of anesthesia. Part of the problem of being a patient in the environment in which you work is that you know everything that is going on … and panic if a step is missed or not done to your liking. Another hypocritical moment: analyzing and critiquing the movements of those around me – especially my anesthetist – while I was hemorrgaging to death internally. Unbelievable. My tenacious ego was alive and kicking, even though the rest of me was half-dead!
The blood pressure cuff squeezed as I heard the ECG electrodes being snapped onto my chest with their familiar “click!” An oxygen monitor was quickly clipped to a finger. Suddenly, my gown was being lifted. Or was it a gown at all? Perhaps only a sheet covered me. At that point, I really didn’t care. I couldn’t care. I couldn’t move. I could barely breathe …
“We’re putting you to sleep now,” a voice said. I wasn’t even sure if it was a male or a female voice – the cacophony of noises in the operating room obscured my ability to distinguish any particular voice. I felt a gloved finger or two slightly press down on my throat, right about where the Adam’s apple would be. I resisted my critical brain’s urge to want to know what medications they were using to induce anesthesia and instead let go in anticipation of release from the pain. “Sleep … finally … thank God …” I thought. Sounds, lights, and reality quickly faded away and for a split second before a black shroud of unconsciousness enveloped me, there was no pain. No pain! Everything finally felt “okay”. Then suddenly and voraciously … the velvety darkness of unconsciousness.
I awoke in the recovery room a few hours later, knowing that I had (reluctantly) taken the first dance step with Death that day. I had held its colder-than-ice hand and looked into the eyes of the great abyss. I felt a surge of overwhelming gratitude that I had not finished the waltz.
Reality then jolted me through the remaining wisps of anesthesia fog.
I suddenly knew a new kind of pain. It wasn’t from just having had my abdomen sliced open and inner organs manipulated. It wasn’t from the loss of my right Fallopian tube, or even the loss of the potential baby that the tube had so preciously tried to hold.
No, this was a new kind of pain entirely. It was coming from an intangible, yet vital, part of my life. It was the loss of hope. It was then that I scoured the horizon for Death, but He had cunningly slipped away. He had silently left me amidst the ether, holding His dance card.

Impressum

Tag der Veröffentlichung: 24.01.2010

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