what a whacked coupla days

I’ve been out of commission for a couple of days. Wednesday evening, because of feeling a pain in my chest, which went away, and lots of pressure on my chest and weird sensations etc. that I’ve never felt before and that didn’t go away, I asked Stanley to take me to Norwalk Hospital to get it checked out. That’s how bad it scared me—that I would ask to go to the hospital. I thought they’d check me out, tell me it was all in my head, and send me home and then I’d bitch about having to pay for it all and that would be that. We had plans to go see Candy and Dirk on Friday and were really looking forward to it.

Nope. EKG, CAT scan, admission. I spent the night in the ER because they didn’t have a bed in telemetry. The ER nurses switched the cot for a real bed, but it didn’t help much. I told Stanley to go home at some point—there was no reason for him to be there because nothing was going to happen and he was so tired. I was heading into migraine territory fast, and I didn’t want to have to think about anything let alone worrying about my husband being too tired to drive home. I know we spoke with an admitting doctor, a nice woman with an accent like Luka’s on ER, but I barely remember it. And I remember being examined by a PA named Lee something and the ER doc, whom I liked, name of Dr. Strichman.

The migraine grabbed hold and didn’t really go away until I got out of bed on Saturday (at least, that’s when I noticed it was gone) to let the dog out. The migraine was the direct result of nitroglycerin, which they gave me in an attempt to ease the pressure I felt on my chest (for a long time, it felt like the cat was on my chest. It slowly subsided.) Strichman allowed me to have some aspirin when I told them that Tylenol does not work for me, and that took the edge off. It took hours and hours for them to get my blood pressure back down toward anything resembling normal. I’d never had a problem with high blood pressure before, so this worried me more than anything else. At one point it was something like 192/95—yikes.

Thursday, around 11 or so, I was moved up to telemetry, to a room on the ninth floor with a wonderful view. I was on the wrong side of the building to be able to see the Sound or our house, but it was a great view nonetheless.

While in the ER, I was visited by, I think, Dr. Chi, a cardiologist, and two student doctors from Chicago Medical School. Dr. Chi said he was setting me up to get a stress test, told me I would have to be in a couple of days because there were no open slots for the pharmacological stress test. I told him I’d do the other kind, the treadmill one, because I didn’t want to be in there. One of the student docs gave me an exam and asked me lots of questions. He was nervous about not forgetting anything. It reminded me of my student teaching days, so I was nice to him. Despite my migraine. Dr. Chi wouldn’t let me have any aspirin, insisted that I try Tylenol. Asshole—I’m old enough to know what does and doesn’t work on my headaches.

Anyway, once I was up in my room, I gleaned that the reason I was being admitted was so I could have the pharma stress test and an echo-cardiogram. Mark Kulaga, an associate of my doctor, Nina Karol, from Internal Medicine Associates, was the doctor I gathered took over my case. I like him too. I think the reason I really like the practice at Internal Medicine Associates (in Westport)—Stanley’s doctor, Jay Horn, is there too—is because they are down to earth and not pompous jerks by any stretch. They lay it out, they treat us like we’re adults.

On Thursday afternoon, I got an echo-cardiogram. The guy came to my room and did it—I didn’t get stuck being transported to the bowels of the hospital and forgotten, which is what happened more than once to Stanley when he was at Bridgeport Hospital. It was interesting to watch my heart—for about five minutes. I was so very tired I just wanted to sleep—I hadn’t slept more than ten minutes or so in the ER. You know, how sometimes you can lay there with your eyes closed and be sort of asleep, but still aware of everything that’s going on. It was so noisy in the ER—I wouldn’t have been bothered if the noise were constant, like having the TV on, but it wasn’t. I start drifting off, and somebody would laugh or moan or just make a comment and it would be like being yanked back to the surface again.

Dr. Kulaga came to fill me in on what was going on, said the cardiologist, Dr. Moskowitz, would be in to talk to me about a plan soon. Moskowitcz is in the Cardiology Associates of Fairfield County practice, which is the same on that Stanley’s cardiologist, David Lomnitz, is in. So I was pretty happy that they were on the case. Never did see Moskowitcz, but that was ok since Dr. Kulaga came in to fill me in. Told me that I was scheduled for a pharmacological stress test on Friday morning—guess CAFC has enough pull to get me in (I heard the techs talking about how I was a last-minute appointment the next day). Stanley had made it by then—I said he should just work on Thursday rather than waste all his time sitting around—it wasn’t like I’d just had open heart surgery and needed an advocate in a crappy hospital like he did at Bridgeport. Anyway, I told Dr. Kulaga that I needed more than Tylenol for the headache and he said he’d write an order for percocet since I couldn’t have aspiring with all the heparin they were pumping into me.

Oh, I forgot. I was on a heparin drip, in order to prevent any blood clots from forming or, if there was a clot somewhere, from it getting any bigger. And nitroglycerin, to, I don’t really know why, to dilate the blood vessels and ease the pressure on my chest. The nitro is horrible. It’s what caused my migraine—it felt like my right eye had a stake in it that was slowly being twisted. It made me so nauseous I could barely eat. And I kept feeling so hot, sweating profusely, I thought I was going to float out of bed (just a thin sheet over a plastic mattress cover). I just assumed the hot flashes mean that menopause has finally started—I’m at the right age for it. It wasn’t until I looked it up today that I find nitro causes flushing and a feeling of warmth. So I think I may be getting hot flashes, but the nitro made them much, much worse.

The percocet helped take enough of the edge off the migraine that I was able to actually get some sleep.

About 5:30 a.m., the nurse woke me and said she has to put in another pict line for the stress test. They’d been having all kinds of trouble with my veins, one blowing (whatever than means), complaining that I have fragile veins. I don’t know what that means, either. The nurse said rather than torturing me with her repeated attempts, she’d get a nurse who was better at it to do it. So an ICU nurse did it. It was a very bloody process and hurt like crazy, but it was in.

Later, Dr. Kulaga came in and said I could be off the heparin drip AND the nitro patch—I was so glad. It took a while, but the nurse finally got a chance to come in and removed the IV needle (blood was flowing back into it, anyway, and it hurt a lot) and the patch.

A word about the nurses: I liked all of my nurses quite a bit. I could ask them questions about stuff, like what the results of my lipid panel were, and they’d go look at the chart and come back and tell us. This was really important to me and made me feel much more secure about being in the hospital, that nurses are considered part of the team and not just automatons directed to dispense medicine and change ivs and nothing more. That’s how they were treated at Bridgeport Hospital, and it made me crazy to see so many smart people cut off at the knees. Worse than anything, at Bridgeport, the nurses couldn’t do what they do best, which is really care for the patient and the family—I was so scared there all the time when I didn’t have to be if Dr. Robinson would’ve just let the nurses do their job and explain to me and Stanley what the tests were showing and what was going to happen and why they were doing what they were doing.

Anyway, around 11:30, I went down for the test. First, I was injected with some stuff, I have no idea what although I’m sure the tech told me, and had to wait an hour before being placed under this huge machine, which would take a film of my heart for 15 minutes. Fortunately, I fell asleep, and in no time I was being taken in for filming. I had to lay flat on my back for the entire 15 minutes, without moving, which doesn’t sound too bad unless your lower back screams when you lie flat, like mine does. But I managed.

The worst part about this test was the tech, who seemed pleasant enough but tried to engage me in a conversation about how the country is going to hell because of all these foreign people ... something I definitely do not believe, but who’s going to argue with the guy aiming a nuclear camera at your chest? I just said “whatever” and cut it off.

Next up, the stress part of the test. The tech injects a chemical that pushes your heart rate up as though you’ve been exercising. But only after hooking you up to and EKG machine and blood pressure cuff and making sure the cardiologist is standing by. Then you start feeling as though your heart is going to blow through your chest, your eyeballs pop out, and your lungs have collapsed. This lasts for ten minutes or so, until the cardiologist injects you with the antidote (and that’s exactly what she called it). As the antidote is injected with this huge turkey baster, and things start to return to normal, the cardiologist becomes your god. Giver of Life and all that.

Then, after a short rest or long rest, depending on the line ahead of you, you go back under the machine for another 15 minutes of scanning. This time I only had to listen to a diatribe about the evils of uncaring emergency room personnel. I tried to switch the conversation to find out what DVD the tech was watching. I was so relieved when the woman who transports me was waiting to take me back up to my room. I was so exhausted from the whole test I just wanted to go home and go to bed. After petting my dog and kissing my husband (in that order).

After a while, one of the doctors assigned to my case, a woman who is, I think, a resident (Dr. K…? I suck with names, I’m such a dimwit) came in to tell me that the films were back and though all of the other tests indicated there is nothing wrong with my heart, the nuclear stress test indicated that there was some ischemia going on, which is a failure of oxygen to get to some of my heart muscle. She said a very small section, and that it could be a false positive. And yes, the symptoms I came in with would result from that problem. And that the cardiologist would be in to explain it all to me. She felt bad when I started crying—I desperately wanted Stanley there but know he wouldn’t get there for a while (he’d been by earlier, but I was being injected with poison at the time ... )

So I just watched People’s Court and Judge Judy waiting for the cardiologist to come in. I was hoping Stanley would make it in time to hear what he had to say, but getting around Norwalk on a Friday afternoon is a time consuming prospect at best.

The cardiologist, Martin Krauthamer, also a doctor from CAFC, came in. I’d never met him, but you know how sometimes you just feel everything is going to be ok when you meet someone? He’s got that kind of vibe, just a calm, reassuring presence. What a good bedside manner for a doctor. Anyway, he started explaining what the test showed, and again, all the other tests didn’t show any damage or problems, and it might be a false positive. And asked me a bunch of questions and listened to my heart, etc. Said he’d be back in five minutes to lay out my options.  I called Stanley to ask him to hurry up—he was already on his way but like I said, traffic is a bitch around here on Friday afternoon. So he didn’t make it in time.

Anyway, Dr. Krauthamer came back in with Dr. Kulaga and the other doctor, the woman. Dr. Krauthamer said there were some options—he could ignore that findings since it was only one test out of many, he could take the findings seriously and do further testing. He could go right to an angiogram, which is invasive and not without risks although risks are minimal, or first do a barium echo-cardiogram and see if that showed there was a need for further testing or if everything is ok. And, he could either keep me in the hospital until I had the additional tests, or let me go home and have me come back next week for the test (or tests). During the conversation it came out that Dr. Lomnitz looked at the films and conferred with Dr. Krauthamer, and they concluded that it would be ok for me to go home and come back next week since I wasn’t in any imminent danger (remember, all the other tests were good).

When I heard that Lomnitz was also involved, I felt a lot better—he is Stanley’s cardiologist and I think he is really smart and competent—here were two top-notch cardiologists telling me that I don’t have to worry much and should just go home and follow up—well, which course do you think I chose? I asked Dr. Krauthamer what he recommended, and he said go home and come back and get the barium echo-cardiogram first, since if that is ok I probably won’t need the angiogram. That the stress test might just be a false positive. That it was ok for me to resume my normal life for now. Dr. Kulaga said they’d send me home with a prescription for metoprolol (a beta blocker, for hypertension)

Dr. Krauthamer then had me do an exercise. He had me breathe very deep and very fast for two minutes. Then he said, “How do you feel? Is it anything like the symptoms you came in with Wednesday night?” It was damned close—the almost tingling in my hands, the wooziness in my head. Very close. No “cat on my chest” feeling, and the pain was in my back, but very close. He explained that what he did was induce me to hyperventilate, explained how it worked. I wouldn’t have known what it was because I’ve never hyperventilated in my life (until then, if that’s what it was), and what to do if I got those symptoms again (slow my breathing, breathe into a paper bag if it didn’t go away, or go to the ER if the symptoms STILL didn’t go away). He said one possible explanation is that when I got the pain in my left chest (which felt like a stitch), even though it went away it might have made me nervous enough that unconsciously I was doing a slow hyperventilation, until the CO2 balance kicked over enough so that I got symptomatic.

I sincerely hope his theory is correct. If the echo shows no problem, I am going to accept that explanation as probable and be very grateful about it. I am hoping. Stanley is hoping. Which doesn’t mean I’m going to stop trying to lose weight—so far, it’s been a wake-up call, a smack in the head: lose the weight. If nothing else, my knees will feel better!

This was my first real hospital stay, other than detoxing in 1992 (which I don’t remember much about other than lots of pain and nightmares and nasty staff—also at Norwalk Hospital). I can only compare it with Bridgeport Hospital, where Stanley had his valve replacement and bypass done and then, the following month, his operation-induced infection and pericarditis fixed). Of the two, I think Norwalk is the better hospital—by magnitudes. The staff at Norwalk works as a team, including the nurses and the patient care technicians. Transport was very efficient. I could ask questions and get answers without having to wait for the doctors to give the ok to a PA to give the ok to a nurse to give me an answer. PAs didn’t seem to be running the unit, like they seem to be at Bridgeport Hospital. I was able to tell the nurse that I would not be using the potty chair—that she needed to find me an IV unit pole so I could use the bathroom—and she did! That wouldn’t have happened at Bridgeport.

Then there were just patient/family comfort things. We could use the telephone at all hours—we weren’t shut down before 8:00 by the switchboard, as they do at Bridgeport. This was really, really important—it made me a lot less frightened about being left alone, knowing that I could call Stanley, and he could call me, whenever we wanted to. Norwalk also provided an internet connection—which was great. It meant that I could read the news, pay bills, take care of stuff, send email, without having to worry about these things. If I’d been in longer than two days, this would have been very important. At Bridgeport, they wouldn’t even allow you to use your cellphone, let alone provide you with a wireless internet connection. And, I didn’t have to pay $4 per day to use the TV. Granted, it was a tiny TV, and I couldn’t get MSNBC, but it was free and important to me to be able to at least listen to it—it is so lonely lying there in a hospital bed.

The food was a lot healthier at Norwalk. Eating it didn’t make me feel like they were trying to get repeat business by using too much salt and fat. There were even tasty items, like muffins and pancakes and pasta with meat sauce. And the ceasar salad was terrific.

The bad things about Norwalk Hospital? Well, it took them a long time to straighten out where the meals were to go, and even when they did, there were a lot of missing things like milk. But they apologized for that and things were much better afterwards. But the worst thing was the fact that my roommate was a bedpan patient—not in and of itself bad, but the techs taking care of her left the shitty bedpan on top of the toilet I had to use, and there was shit on the bathroom floor which was still there when I was discharged. I had to stand in the hall and yell to get it cleaned up so I could pee—and the tech who left the mess was nasty to me. If I’d had to stay, I would’ve called the nursing administrator or someone up the chain to get that straightened out right away. But I was more focused on getting the hell out of there. Oh, and the ER nurse didn’t send my Newsweek up with me—I noticed it because there was an article I hadn’t read yet and was really looking forward to (the one about Annie Leibovitz). And most of all, not having a hospital gown to fit fat people. That’s a pretty basic thing—while I was in the ER, not one overweight person had a gown that covered him or her completely. Seems like with the demographic trends going the way they are, that’s something that should be addressed. But these were my only complaints (other than the asshole doctor who wouldn’t give me anything but Tylenol for a migraine.)

The difference between Norwalk Hospital and Bridgeport Hospital, I think, is that at Norwalk, I felt I was being cared for, while Bridgeport left me the feeling that Stanley was just being tended to. There’s a world of difference there. I know that if I need to be hospitalized again for more procedures than Norwalk can handle (they weren’t able to get certification as a cardiac center—why, I don’t know, but they should have been), it sure as hell won’t be at Bridgeport. Yale isn’t that much further up the road.

I’m starting to feel less tired—it’s shocking how much stress you go through with the tests and just being in the hospital, I never really thought about it before until I realized just how exhausted I was. And it was really hard to allow myself not to give a shit about anything but myself—I started worrying a lot about Stanley and realized how ridiculous that was. And the strangest thing of all to me was how blown away I was when I was told I couldn’t go home yet, or even at the prospect of having to stay in past Friday. It wasn’t the money or anything like that—we do have a ceiling on how much all this will cost us (we do have insurance)—or the not getting work done that’s been piling up. Nope. I missed my dog and I missed my cat and I really missed just being with my husband. But I was worried most about my dog.

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