Monday, June 11, 2012

Blow Out Part II - The Wind Beneath My..


Part Two

This is part two of a two part story about a hemorrhaging kidney,
but like a lot of stories it has a lot of interconnections to other stories. The adventure began in the acute dialysis unit at the old Hennepin General Hospital in Minneapolis, in April of 1974. It was late night or early morning when I arrived at the ICU. It's hard to keep track of the time when you are in these hospital wards with no windows or visible clocks, but I'm sure it was late. It was a busy night with not much sleep despite a lot of morphine.

Stomach pump

It's called nasogastric intubation and it's a way to access the stomach and pump it out. The tube being 'intubed' is called an NG tube. My digestive system had stopped working from the shock; with nowhere to go, whatever was in my stomach had to be pumped out or it was going to be coming up on its own. So they come with a bunch of apparatus and what looks like a couple hundred feet of plastic tubing. Once in, the tube is taped down to my nose from there it goes to a jar connected to a vacuum pump that murmurs constantly day and night. The jar is emptied once or twice a day; each time it is emptied they make an entry in the input-output chart. I now know how it feels to be an elephant with an 8 foot trunk hanging down where a nose should be. Of course I am NPO (nothing by mouth); no food, no water, no ice chips (ice chips are another story for another time), no nothing, forever or until the NG tube comes out, whichever comes first.

Peritoneal Dialysis

Next was a procedure to insert a deep cannula for peritoneal dialysis. I needed dialysis, but they couldn't do hemodialysis because of the bleeding. They hang a bag of dialysis fluid, something like two liters, on the IV pole and connect to the cannula next to my 'belly button'. Unlike a drip IV, the fluid runs in pretty quickly.  It feels very gurgley and sloshy once it's all in my abdominal cavity; it stays for awhile and then they put the bag on a hook below the bed and let it run back into the bag. So all night it was a murmuring vacuum pump under the bed to pump my stomach out, blood and sugar water dripping in my arm, peritoneal dialysis fluid into the 'tummy'; then after a while dialysis fluid out of the tummy, as well as the usual vital signs every few minutes.

In and Out, Nephrectomy #1

I already expected to have to have both kidneys taken out eventually. The transplant nephrologist said my kidneys were causing me to have antibodies which would destroy a new kidney. A surgeon appears beside my bed.
Surgeon: "So, we're going to take that kidney out in the morning." Me: "Oh? OK. Take them both please." Surgeon: "Can't do that, it would take too long. This will need to be done as quickly as possible." Me: Are you sure you can't take them both out at the same time." Surgeon: "We need to get in there quick, remove bleeding kidney, and get out while you're still alive." Bonnie signed the consent, I wasn't considered competent due to the morphine.

Off to the OR

It must be morning because I am on my way. They clamped off my elephant nose, connected my blood and IV fluid to the OR gurney. A little while later I am in the OR and someone is saying, "You're going to start to feel groggy now."
The next thing I feel is somebody poking me as she says "Wake up Mister Nelson, you're in recovery." I wake briefly, but I don't want to be awake, then back to sleep.
I wake in the post-op ICU this time hearing, "Cough Mister Nelson."
Inside I'm screaming, "Let me go back to sleep." But I make a weak cough, "oof, oof." Each weak "oof" brings a sharp pain to my right side.
"That's not coughing Mister Nelson. You're just clearing your throat. If you don't cough I will have to suction you."
I'm thinking, "Go ahead and suction. It couldn't hurt any worse than coughing."
Oh, but it does, I'm hearing "gurgle, crackle, slurp" in my head and I'm coughing violently while a searing pain hits my right side. Done with the suction torture for now, as I drift in and out of sleep I'm having a dream about a huge booger, the biggest booger in the world, and it's stuck to my nose and I'm trying to pry it loose and get it out.
Someone is shouting at me: "Mister Nelson, why did you pull out your NG tube, Now I will just have to put a new one in?"
Then I am awake trying to apologize and explain about the dream, but she is too busy getting the supplies for my new NG tube. I get a new tube with enough tape on my nose to stabilize a fire hose. I finally drift off to sleep again. This time when I wake up and try to move my hands, I can't. My wrists are secured to the side rails with a gauze restraints. I can't believe it; restraints are for the deranged, demented, or criminally insane. Then and there I am determined to prove that I am not a babbling idiot. I am carrying on lucid conversations with nurses and doctors; coughing earnestly when I am told, finally saying "C'mon," as I gesture with my head toward a tied hand, "If I promise not to escape or rob any more banks?"
Nurse, showing big smile, "Okay, I guess." She is pulling a bandage scissors out of her pocket.
I can't remember for sure, but I think I was in the post-op ICU for about 24 hours, and then it was back to Annex 8.

Dr. Comty: The Answer is Blowing in the Wind

Back on Annex 8, not exactly the kind of place you would want to come home to, but Annex 8 is another story for another time; all I want to know is when do I get this tube out of my nose. The nurses say "The doctor will tell you when you're ready."
The next one I see is Dr. Christina Comty. She was a prim and proper English lady doctor. Very straight-laced and assertive in posture and demeanor, her British accent was much like the Meryl Streep version of Margaret Thatcher. I liked her because she was kind and caring with me; I was sorry to see that she passed away in 2007Whenever she came on the floor, the nurses and staff scrambled. Dr. Comty puts a stethoscope on my abdomen and listens for about a minute. "Not yet." she says.
The surgeon came and talked about the surgery. He said it went well, that my heart was strong through it all. The kidney had bled about two liters into its capsule. He looked at my incision, pulled on the drain tube coming out of it and then put a stethoscope on my abdomen and listened for about a minute. "Not yet." he said.
Finally, one day after what seemed like months, but was probably four or five days, maybe a week, the look on her face indicates she had heard some bowel sounds. "Did you have wind?" asks Dr. Comty.
I say, "I don't know." But I was thinking, "Wind? What the hell is that?" Not wanting to appear stupid, I don't ask what she meant by "wind." Later I ask a nurse who explains that having bowel sounds is just the first indication that the digestive system is starting to work. Once you are passing gas a few times they will consider removing the NG tube. So I'm thinking "All I have to do is rip one a couple times and I can get this damned tube out of my nose." All day and night I am trying and trying to make a little 'wind', but I get nothing. The next morning after doing a sponge bath and trying to brush my teeth with that damned tube dangling from my nose, I get a little "poof". Then later there a couple bigger "poofs."
When Dr. Comty comes that morning I want to jump up and shout, "I have wind! I have wind!" But I don't, this is Dr. Comty after all. I wait until she asks, then I smile and say "Yes, lots."
There would be many more adventures for many months to follow; but right then I was happy that even if not all my innards were functioning normally, at least my digestive innards were getting back to normal and that damned tube in my nose was going to come out.

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