I am lying in a bed in the dialysis ward at Hennepin General Hospital in April 1974 and I have terrible pain in my back. It started out as a slight ache a few minutes after I started dialyzing, but it just keeps getting worse. Eventually I'm thrashing around and groaning; the nurses are trying to calm me down. When they stop the dialysis abruptly, I know something is seriously wrong. I understood that any time dialysis is stopped without rinsing the artificial kidney you lose all the blood in it. I had been told this could happen if there was a power failure or if the dialysis membrane ruptured. I was very anemic, as were most dialysis patients were back then before EPO (another story for another time), so any substantial blood loss was a bad thing.
The Samurai Sword
A nurse tells me "All that thrashing around is going to make the bleeding worse." "What bleeding?" I ask, and she tells me they think I am bleeding from site of the kidney biopsy. Then I remember Dr Bergseth about a week before saying as I laid on my stomach and he poked around on my back, "the important thing is to hold your breath and breathe only when I tell you to". Then he said "Hold your breath now" as he stabbed me with what felt like a Samurai sword. After what seemed like half an hour I heard him say something that I thought sounded like "breathe" and I took a breath. He immediately shouted "don't breathe." So later I'm apologizing and he's saying it's OK, but I could tell he was concerned about something. Later I would find out what he was really concerned about, but that's another story for another time. As I lay in the dialysis unit in pain, I'm thinking it's all my fault because I breathed at the wrong time.A Blood Pressure of Nothing Over Nothing
When the doctor they have been talking to on the phone arrives, he wants to know my blood pressure. The nurse who has been taking my blood pressure over and over whispers, thinking I can't hear, "I can't get any blood pressure." The doctor comes and takes one himself, then says "Order two units of O-negative stat and type and cross 4 units to hold. As another doctor is coming over they are moving my bed closer to the door, and the first doctor is listening with a stethoscope on my belly. Doctor two: "bowel sounds? Doctor one: "not much." As each doctor or nurse comes near I ask for something for the pain that is getting progressively worse. The answer is always the same, "Not right now." Finally someone tells me that any pain medication that would do any good would also cause my blood pressure to go even lower. By now I no longer care if I live or die, I just want the pain to go away. There are so many doctors swarming around my bed I can't tell which is which anymore. Bonnie calls the unit, as she usually did while I was dialyzing; I can hear the nurse tell her "He's having some pain right now. Yes that would be a good idea." The nurse says to me "your wife is coming." I asked one of the doctors, a nephrology resident, if I was dying. He said "No, we're not going to let you die." I could tell he was trying to be reassuring, but he didn't seem all that confident. The reality was, I was in deep shock and if it could not be reversed, death was not unlikely.The shock was caused by a combination of blood loss and severe pain. The blood loss came when the anticoagulants used with hemodialysis allowed my necrotic recently biopsied kidney to hemorrhage; the internal bleeding was causing severe pain and together the result was severe shock. I would later learn that the kidney was so necrotic (rotten) that it would have 'blown out' sooner or later, and I was lucky it happened there and then.
A Catholic priest and a protestant minister walk into a ....
A Catholic chaplain appeared by my bed and held my hand as he talked to me. I told him through gritted teeth that I was in terrible pain. He asked me if I would like to receive the Last Rites, just as a precaution. I told him I was not Catholic but it couldn't hurt, so go ahead. He said he would page the protestant chaplain, then quickly left. Soon after another chaplain was standing there reading the Twenty-third Psalm.
Dr Comty is Weeping
Bonnie arrived, but was only allowed to talk to me for a few minutes. She tells me days later that as she waited in the waiting area, Dr. Comty, one of my dialysis nephrologists walked out of the unit crying. Dr. Christina Comty passed away in 2007, so I don't feel bad about telling her real name. She strongly believed that for ESRD (end stage renal disease) the superior treatment was dialysis not transplant, but that's another story for another time.
The Gravity Suit
One of the doctors who was called is saying something about "gravity suit" and everyone agrees that might work; "I know they have one at University", "maybe they have one upstairs" and "see how fast they can get it here." What seemed like hours later, but probably was fifteen or thirty minutes, they are wrapping a rubbery sheet air mattress around me from my armpits to my ankles. Then they are pumping air into the 'gravity suit' and it is squeezing my body. Evidently one of the ways to treat low blood pressure is to squeeze you like a tube of toothpaste with the cap still on. I was kind of surprised that it didn't make the pain worse, and that I kind of started to feel better. But the pain was still there.When Demerol Wasn't Enough
Every few minutes they are taking my blood pressure and finally one of the doctors says "Ok, I think we can start some Demerol. The Demerol is in a locked box on the wall by the nurse's station and only one nurse has the key. They start the Demerol and I wait for it to kick in, but the pain continues and I wait and the pain goes on. After a while the doctor asks me if the pain is any better, I say "worse". He tells the nurse "MS" and the nurse goes back to the lock box. I ask "MS?" and someone says "morphine sulphate". They start the morphine. Almost instantly I can feel the difference. My body is saying "Ahhhhh, that's it, that's so much better." The pain is still there, but somehow it doesn't hurt so much. From the start of the small pain in my back to when the morphine kicked in was probably two or three hours but it seemed like an eternity. I don't think Demerol is used much anymore, replaced by drugs with fewer complications; but I knew then and it may still be true. If you're bearing the unbearable pain, morphine is a really good thing.Off to the ICU
The doctor tells me I am stable enough to be moved to the ICU and I'm thinking "ICU, isn't that where they take people because they're not stable enough to begin with." But I was no longer in severe pain and no longer feeling like I was about to die, so I was happy to be alive as I was wheeled off to the ICU for a night filled with many more adventures. But that's another story, for another time.
What it Feels Like to Die
Lacking any first hand witnesses none of us will actually know for sure until it happens. I do know what it feels like to be in severe shock and close to death. Besides the pain, I was feeling tingling, pins and needles, and a buzzing in my head, the voices of people talking to me seemed far off or in a tunnel, Those are the feelings I can describe. But the worst, that can't be adequately described, was the feeling of impending doom, it felt something like slipping off the edge of a precipice.Evolutionary biologists say shock is an adaptation for surviving severe injury. If you're sliced up by a saber-toothed tiger who then decides he's not hungry enough to eat a foul smelling human, shock's low blood pressure can prevent you from bleeding out while allowing time for clots to form in your wounds. This is probably what saved Hugh Glass after he was attacked by a grizzly.
When I think about it now, I'm thinking like the dying part maybe isn't so bad, but the getting there part sometimes is.
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