HERE....THERE....NOWHERE....

Singing like a caged bird

Monday, January 26, 2004

Here....


Thoughts On Passing By a Cardiac Bypass
Prelude...cold and dark out at 4:00a.m.... winter in upstate New York....a few snow flakes falling..very quiet...little wind...hardly anyone else up and about on Martin Luther King Day...only gas station attendants locked in behind their glass. Thinking of seeing the sun another day! Having read and reread the easy to follow directions to the "Emergency Entrance" my brain locks in on the word emergency and sends a boding of fear. Since the directions were so simple and clear, I do not have them with me...typical male. Easy to read directions, not so easy to follow.

Go to window for emergencies...oh ok... an emergency man behind his glass tries to help..."now turn around and go back and take a right and right again" Saunter past the "Information man" in his natty uniform, in such a sedate state that he could pass for one of Walt Disney's automatons in a 60's theme park. Everything is dark down by the second hallway...no one in sight. Backtracking again, the information man , behind his glass encasement, springs to life when asked a question...must have voice recognition software. "Go back down the hallway to the doorway on the right not the hallway on the right." Sure enough there is a doorway...to a darkened room..."go through that room... into the room behind". Slowly directions are being parsed. The lit room in back reveals a hospital clerk, with a smile, and a greeting. Of course, the accent gives it away, but the service would have in a moment, an immigrant....glad to be here, have a steady job, helping people in a hospital. No automaton here...quickly rechecking the printed info...all correct...now for the next part of the journey...no directions, but rather a personal escort through some more dimly lit corridors filled with signs...Wing A, Main Elevators, EXIT, Stairway, Emergency Hose. Imagine if you are some illiterate or spoke anything other than English. Escort ends at elevator...return to direction exchanges...."go to 2nd floor... turn left... go past visitors room...go to nurses station." Ok so far into visitors room...opps, dead end, u-turn... spy corridor with counter like a nurses station....with no nurses. There behind the column, some movement...a nurse.

"Name, date of birth, social security number"....shown to a room....."undress, put all belongings in bag, dressing gown opens in the back, socks on" ..."Name, date of birth, social security number"....More explanations.. "Read the Info?"...consents to sign..."time to draw blood..oh you have good vessels (then I don't need bypass?)...a little stick now". Shave time! Chin to ankle! Gives new meaning to twin blade shave...a tag team match and one was the evil twin. In a race to remove everything as if she was being paid "piecework", Evil was a NASCAR wannabee; the other twin was slow, methodical, gentle...no pulling, no scraping, no jabbing. I am turning into a pink little piggy, but only on one side. Evil must be singing "Lady in Red" to herself and thinking of some bad date as I was turning crimson on the other side. Weigh-In time....197.6 lbs...quickly converted to 89.3 kilos...right science uses the metrics. Into the shower room, given bottle of "special soap". Christ it was enough to wash 5 times. But it does not suds up, must be one of those Madison avenue hypes..."rich, luxurious lather". What we need is dead germs, not lather that forms peaks and covers lovely models bodies...Second set of dressing gown, second set of socks with rubberized treads...Back to the room...."wait will be 1/2 to 1 hour"...please do not let me wait here for another hour...yes mercy, only 20 mins in the Garden of Gethsemane....

"Name, date of birth, social security number"....with an added "for a coronary bypass?" The attendant is in full scrubs and in a cheery mood...happy that his first two patients are on time and he is now ahead of schedule, starting a good day for him. He is a strange looking fellow...dark complexion with the outline of sunglasses or more likely protective goggles from some kind of ultraviolet treatment on his face. Reminds me of the McDonald's Hamburgular in a reverse negative. Hurry up and wait...parked parallel in another staging area of consents and questions....I have a companion patient. We give each other sideways glances..."I'm Harold, glad to meet ya...Bert, nice to meet ya." Harold is a jovial fella, trying to make everyone feel good. More about Harold later....but for the moment I give Harold the resolute quiet treatment while thinking ...Harold, SHUT THE FUCK UP!

Next staff in full scrubs..."Name, date of birth, social security number,for a coronary bypass?" and an added "where you from?", "oh, Saratoga...I was up there buying a bicycle last week end....you cyclist...should look at Sirotta frames...got one...an expensive toy...but now need a touring bike...No more questions? see ya later." That must have been the take the mind off with disconnected talk technique. In waltzes a very tall, handsome man, nicely dressed in tweed coat and starched shirt...french cuffs, smells nice, nice handshake, exudes professionalism...he is the gas passer. Flips through his notebook..."mmmm, uh huh, good", sliding his finger down row after row of data...an initial here and there...more internal grunts of communication. "Everything looks good"...."Name, date of birth, social security number"... "for a coronary bypass?" with an added "Sign consents for anesthesia here"! "Thank you, see you in the OR shortly".

Soon the Reverse Hamburgular returns for another stage of this stage stop journey. Harold says "good bye, good luck, you'll do ok!" I manage a feeble "you too, see ya later". Twists and turns down the corridors wheels my hospital stretcher...as we near the operating room...a whispered, "this is against policy" results in a stop at the operating room door. What's up? Doc is not in the house yet! Apparently patients are not to be wheeled into an OR until the Doc is in the hospital. Quickly resolved...cell phone to the rescue....doc is in the parking lot...everything to proceed.

The OR is a beehive of activity...human and high tech...."Name, date of birth, social security number"... "for a coronary bypass?" Operating table height adjusted. Begin instructions on how to make the transfer onto the operating table.......but after 3 angioplasts, 5 angiograms, a lithotripsy and an appendectomy...I just do it...to the compliments of the OR staff....what a worthwhile skill. The table is rather comfy, form fitting, snuggly warm in a rather chilly atmosphere.

Activity is increasing...must be the Ace of Aces chest cutter does not want to waste any time once he arrives. Tape flying...on forehead, arms, neck...oxygen mask over face..."that won't work over the beard", off comes the mask, stripped of its elastic bands.....taped onto the face and beard.

In walks the gas passer, in scrubs now...."NO,NO,NO...the other arm...he's left handed". The equipment is switched around. He quietly explains that the radial artery in my right wrist is to be "harvested". I think that is a creepy word. I notice that classical music is playing in the background...rather soothing...don't recognize it, but like it. Tell that to the gas passer, who seems pleased and mentions, "good, better than clanging instruments" Don't know if he meant the musical variety or surgical variety. The high brow gas passer continues..."I am going to insert an IV now" as he reveals a 4 inch long needle...really. "Just a little pinch (Docs say pinch, nurses say stick) and a little burn"...he was truthful, they were little....this guy is good, real good.

Suddenly I am aware of the all the shiny objects in the room, the music is dreamy, and those lights, so bright and pretty and big, circular prismatic lights.....they enthrall me...time becomes meaningless...the nether world of modern pharmacy.

ARRRGGHHHH!!!!!!!! My throat......pain, pain, pain!!!!!!!!! Plastic shoved down my throat, strapped to the bed....a red hot poker must have been inserted into my chest...biting on the intubator. "You will feel much better when we remove the breathing tube from your throat". "Hang on for awhile." "Mmr fugng shhhh" I scream in an agonized muffled whisper. In and out of consciousness. "We are going to remove the intabator now, you will feel much better." Yippeee...can hardly wait...ecstasy at last......oh, you didn't mention you would rip out my tonsils and vocal cords with it. Going from very extreme pain to extreme pain is not what I would describe as "feeling better". Stripping away the throat pain lets me concentrate on the hot poker in my chest. "No pain killers for one full hour".....I am counting in nanoseconds.

Thank god for a new mantra...too late now to check who I am....Now it is..."On a scale of 1 to 10, 10 being highest, please rate your pain". TEN, did you really have to ask? They don't ask this while you are intubated as the muffled sound would come out, "mrgng mrfty, mrthrmgr".

Worries begin as rationality returns, not a hot poker...I am having a heart attack, must be, why aren't they responding.....oh right, JUST a sternum cracked in two, ribs mechanically spread, freshly harvested vessels sewn in (wonder how Martha Stewart would decorate her heart...oh, right she doesn't have one)pieced together with thread and wire, and three tubes extruding from a huge bandage. Right arm, "harvest site" is furrowed and aching under another bandage oozing crimson from wrist to elbow....."On a scale of 1 to 10, 10 being highest, please rate your pain". Ok, ok 10 already, give me the morphine. Nodding out and in. It hurts......."On a scale of 1 to 10, 10 being highest, please rate your pain". 10, nodding out, 8, 7 thru the night. No not night yet, its only been one day.

Why do I need instructions on "how to move,sit up, sit down" and what is this heart shaped pillow? A feel good toy from the Reverse Hamburgular? I quickly learn the answer as the non-existent ice pick is inserted between my ribs. The scale returns to 8. The pillow I learn to love and hug tightly...when I do my breathing exercises and mandatory coughing torture.

Sticks, probes, prods, questions! "Bones" from Star Trek would feel right at home with the digital displays, the plasma screens, color graphs, touch selection, onboard computing, PDF's....oh and yeah....the clip board with pen and paper.

Morphine time is over. Handled it correctly...stretched out the morphine use to maximum advantage. Now onto percacette...just learned it is mixture of Oxycodone and Acetaminophen. Opium deriviative. Gives you a wallop for 3 to 4 hours...wiping out pain 8 and below. I cannot imagine the kick the abusers get from this. Apparently they crush the tabs and snort them. I guess Rush Limbaugh is more of an addict than I realized. Does he still use the term "moral weakling"? Is the term hype? Or is he in denial? Or is he a hypocrite...making him a moral weakling of a different stripe? Sometimes Biblical sayings are so right...."Let thee who has not sinned cast the first stone!"

Oh no, Harold has been transferred down to the progression unit. That is the good direction out of ICU. The once annoying buffoon has become a real spirit lifter.....telling all within earshot the story of his caper. Laughter is indeed good medicine. Harold has apparently been in the hospital for several days not healthy enough for his bypass. The staff, recognizing the value of positive thinking and humor, have enlisted Harold as a temporary court jester. Just in time for payback to the staff prankster. Harold played the perfect fool. The intended victim was left alone with Harold. "ma'am, I am a little confused". "Yes, can I help you"? "I run the county trash transfer station." "That's nice". "But I am confused, I don't know why I am here?" "You do look confused." "I really don't know why I am on the cardiac unit. I just came in for a vasectomy." "Oh, I will check with the charge nurse and get this straightened out." Althought his part in the skit was over, Harold loved to tell the punch line....over and over...with varying degrees of effectiveness. The nurse turns around to handle the situation and in the doorway there is a collective "gotcha" from assembled staff. Smiles and guffaws all around.

Harold gets to go to the progression unit a day earlier than I since he had only 2 tubes to my 3. His are already out. Later, I am told that the real reason is not the number of tubes, nor a shortage of rooms, but rather a lack of nurses in that unit. Can't we get some more immigrants, please?

Finally day 3, time to remove the tubes. The tubes run through slits between the ribs which are loaded with nerves, thus the pain. Especially when sitting up, but sitting up is what is needed to prevent pneumonia. An endless tantra of "on a scale....". "Take a deep breath, now make a face like this"....the nurse demonstrates a perfect Ellen DeGeneris , Nemo like fish face. Ok, lets rehearsh.....breathe deep, make the face...good...showtime (I am quick study)....ready, breathe deep, make f.......ooooowwwww! Another trick by the staff, who know what they are doing. Ok, it does feel a little better, but no more auditions for me.

Thursday is boring....endless vitals....temp, BP, pulse, oxygen level, blood sugar levels. Pills, for pain still can get the percocets every 3 hours, other stuff to make you pee, poop, adjust BP, bring blood sugar back to normal. "How do you feel? Are you doing the breathing exercises, coughing? Bringing anything up? What color?" Let me consult my Martha Stewart color palette. Burnt umbra! The nurse aides don't get it. Except the competent one from.....yep you guessed it, Bosnia. I have noticed that the further you get from the ICU the lower the appreciation of bad wit.

Friday, parole hearing with the Ace of Aces...don't get your hopes up. Ok, thinks I am another of his good statistics. Now the worst part...paper work...that's hyperbole. Just very impatient. In the middle of removing the last IV, nurse is called to insert one on somebody else. 2 hours later she returns. Long list of do's and don'ts, nutrition, follow-up appointments....can tell this is designed by the attorney's. They do not know anything about teaching and learning....and little knowledge is imparted. Sprung at last, the sun is beaming in the atrium. Whack...single digit air hits the lungs. That is worth a deep breath and a couple of coughs.

Home at last.....some privacy....my own bed....not too comfy yet. Very tired and weak. No mantras. Good to be home. And alive.

There....


Thoughts About A Cardiac Bypass Bypassed

Thirty years ago my father had a bypass operation. I say father as at that point in my life he was merely a biological fact...not a Dad. I was not there for his suffering.....in fact I did not even know that he was scheduled. It was for the best.

My father was not a good candidate....decades of tobacco, non-exercise, family history, decades of alcohol abuse......and PTSD from his war years. Part of the reason he was not really there for my childhood. But now that I have learned of his war horrors, I can call him Dad. And forgive him for my traumatic youth.

30 years is a long list of improvements in cardiac surgery. Just think of the technology. They didn't even know what a pc or an apple IIe was.

When my dad came out of the OR into ICU, he couldn't write a blog. Although he always loved to write. They had tried writing therapy in the VA hospital psychiatric unit, and had been part of the Veterans Writing Project. It is horrifying to think of his fear....as he had been transported back in his mind to WWII. And had been captured by the Germans, who were experimenting on him. Can you imagine the fear seared onto a mind when you think you will be killed and your buddies around you have been mangled ...day after day. It never goes away. And in the stress of the bypass...the fear takes over. But my Dad made it out of the hospital, and lasted for three more weeks, until peace was finally brought to him. And my mom too was finally released from her purgatory. There is an excellent description of this fear in the closing, going home chapters of the book by O'Donnell, Beyond Valor.

Think of this fear when you hear about the boys coming home from Iraq, and the terms "Mission Accomplished" are used as a political gimmick.

Nowhere....



The plans for the technology transformation of the Hudson-Mohawk Valley revolve around the development of the nanotech industry. Nanotechnology is about small, very small. Albany has been renamed Smalbany. Of course, the NYC folks have been saying that for years. But it has been hard to imagine something so small. All the definitions don't quite put it into proper perspective. Until the other day......I heard the greatest explanation.....think of building a Cell phone for an ant.....and the ant can use it. My mind went wild.....all I could think of is Dervala's sister and her flying thumbs...and then a horde of 6 legged social animals that collectively weigh more than human kind...doing a sextet of messaging.....locating recent spills on the kitchen counter, text your friends and family o come on over for a barbeque drink-up, yeah it is the Jack Daniels brand, but i am sure we can find some soda pop laying around.....lost in a jungle of a suburban lawn? Get text directions home before the lawn maintenance guys arrive....report live via text about the flooding of the new underground mall....Ant News & Entertainment Network....

And then if cell phones, why not PC's? Before you know it there will be a marketing scheme for Ant MeetUps I can see it now:

--Carpenter Ant Meetups to exchange woodworking techniques
--Vegan Leafcutter Ant Mold fest
--12 step meetups for Ant sugar addicts
--Ants with pet Aphids
--Flying Ants, how to use GPS while swarming(ant version of mobbing?)
--Fire Ants, Burning Man plans, igniting of nano-effigy of 10 y.o. bully with magnifying glass
--Gourmet Picnic Meetup with Martha Stewart and other felons.
--Film classic meetup, "The Naked Jungle" Teach your kids so Leiningen's butchery can never happen again.

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