5 de mayo, 2006

On the 4th of May, 2006, I had a routine doctor visit with my Seattle primary care doc. She has a great assistant who always asked me the same questions. One of the questions, always except on 4th of May 2006, was "has anything changed since you last visit?"

I had been saving up my answer to that question because something had changed. Every now and then, for no reason I understood, I could not breath. This inability to breath could last about a minute. It was scary when it was happening. Since I resumed breathing, however, I downplayed its significance.

I was really only looking forward the the question 'what's different since last visit' so I'd have something to say.

The assistant did not ask.

So my doc came in. Martha. She did her doc thing.

Sidebar:  when did docs stop listening to patients breath, esp, as I am now, a heart patient?  My new primary did not use her stethoscope when I saw her yesterday.

Martha listened to me breath, asked some questions and she was done. As she gathered up her stethoscope to leave my exam room, I said, believing myself to be joking, "Your nurse forgot to ask if anything has changed. Something has changed."  I believed myself to be kidding, seriously not serious.  I was mostly joking around, 'catching' the nursing assistant in a small mistake:  she did not ask.

Martha, however, closed the door, which she had already opened and begun to exit through it, stepped back over to me and said "What's difference?"

So I told her about my very occasional inability to breath for a tiny bit.

She asked lots of questions, listened to my heart and breathing. And ordered me to get some lab tests on my way out, to get them asap. There was a lab in her building so it was easy.

The next day, I was out all day, at some meeting. I was the lead organizer for a large, complex conference that would start about two weeks after that office visit. I was probably out at meetings for that.  This was pre-cell for me. Cell phones existed but I didn't have one.

When I finally came home, around 3 p.m. I listened to multiple phone messages from Martha. It was unusual for the actual doc to call. Each of her messages had a slightly more anxious tone. "Call me as soon as you get this."  "Call me immediately, I have instructed my staff to put me on the phone when you call even if I am with a patient."

So, yeah, I called her. And, by golly, the actual doc came to the phone. She told me she had gotten my blood test results and it indicated I had, at least, deep vein thrombosis and, given my breathing issues, probably pulmonary emboli. "I want you to take a cab to the a lab next to the hospital and if you tell me you can't afford a taxi, I will pay for your taxi. Don't go on the bus."

I lied to her and promised to take the cab. I was thinking "If I am very seriously in threat, maybe this is my chance to die."  So I resolved to take the bus. She had told me to go to a lab what would test for DVT and PE, but it was adjacent to the hospital closest to where I live. It wasn't even a hospital in her system, she had chosen one closest because she was so worried.

She also said she had consulted two different specialists about my lab results because she was a bit surprised that I seemed to have DVT and PE and both of those docs has said my blood tests indicated significant clotting issues.

On the map, the hospital was closest to my apartment but it was not on a bus line. I had to transfer three times, with long waits between each bus. And, piece de resistance, the walk from my last bus stop to the hospital was almost two miles. It took me hella long to walk those two miles because I had to stop to catch my breath constantly.

When I got to the lab where my legs would be evaluated for deep vein thrombosis and then for lung clots, the receptinist squealed. Then she said "where have you been? Your doctor said you'd be here an hour ago and she keeps calling and lots of people have been worried that you died on your way here."  The rechnician rushed out and rushed me to her testing room. She shared that she had once had a DVT in a leg and it hurt like hell and asked if I was in a lot of pain.

It wasn't until that moment that I had realized my lower left leg was often in a lot of pain. I have had arthritis all my life. I am accustomed to feeling lots of pain.

So. She did the tests. I knew right away that something was wrong because on my not-clot leg, the machine made one kind of sound but when she put it on my DVT leg, the one with a mass of clots, the machine made very different noices.

After that, I was not allowed to walk. She rolled me over to the ER. I had not eaten lunch or dinner that day because I had planned to go out for Mexican on Cinco de Mayo. I was starving. The ER receptionists lied to me, said I'd be seen too soon for me to find the cafeteria to eat. Later I learned the health care team didn't want me to eat. But I was not seen soon and I was so hungry so I got up to get to the cafeteria. It involved going outside, it was a bit confusing so I asked for directions.

Whoosh. Someone rolled up with a wheelchair and I would be seen right then!  And I think they did that to keep me from eating.

I spent that whole evening, until around midnight, in the ER. I went for tests intermittently.  A doc was involved, ordering the tests, but I never saw a doc in the ER until the guy's shift ended. He came in, he did not tell me -- and no one had thus far -- what was wrong or going on with me. He patted me on an arm, said my condition (what condition?) was serious and the staff would do their best. But he didn't tell me what health issues were going on.

Finally, I met my hospitalist. I don't remember her name but I liked her.  She explained taht I had deep vein thrombosis and multiple pulmonary emboli. I had had a test to look at my lungs so I had seen the images of my lungs. I had dozens of clots in my lungs.  More later. . . I have an appointment. Fascinating stuff, eh?

Later. . .

That first ER doc was such a jerk. He never talked to me, just looked at my chart and gave orders. I wsa in that ER from around 6 p.m. to 1 a.m. and until the nightshift hospitalist came on duty, NO ONE told me what was going on, what was wrong. Just test test test.

The hospitalist came in, shook my hand, introduced herelf to me. Then she told me I had a large cluster of clots in my lower left leg, a mass of clotting. She explained that some of those clots had broken away and traveled to my lungs. Lots of them in my lungs, which I knew because I had seen the image of my lungs. When I remember that image of my lungs full of clots, I usually visualize a chinese checkerboard, with little holes for all the marbles. The marbles represent my huge amount of pulmonary clots.

It was kinda a miracle I could breathe.

They had me on oxygen.

The hospitalist explained taht sometimes she would recommend surgical removal of lung cluts but I had so many that such surgery was not feasbile. She said I'd likely die before a surgeon could get all the clots! She was recommending, like I had a choice, that I be administered a serious drug by intravenous means that would, the theory went (said the doc) would gradually melt my clots. This drug was a very serious drug and I would be very vulnerable while receiving it. So, she went on, I needed to be in intensive care.