Sunday, June 28, 2009

Recent Misadventures, Part III

I generally start out procedure days with the Ramones.

Anyone who knows me knows it is no secret that I really, really, really like narcotics. Given a different life, I would be a junkie. In a different era, I would have been one of those ladies taking Laudenum. Morphine and its relatives have a wonderful, pleasant, velveteen mist that descends from the crown of my head and warmly envelopes all of my senses in sunshine. It's a sure-fire way to get that same feeling of utter well being that otherwise takes a perfect day floating on a river, or a just-right bed and the world's best pillow, or the most amazing delicate chocolate torte. You get the picture.

So anyway, when I know that I am going to get fentanyl, I am generally more than okay with the idea. I have had it myriad times over the last ten years or so -- there was a period of about 2 1/2 years during which I was having endoscopic exams every 6 weeks. I have a bit of a tolerance for the stuff. Fentanyl (or demarrol, for those who can take it) is frequently administered with Versed, which is an amnestic. It renders one conscious but completely oblivious.

Put bluntly: fentanyl controls pain, versed enables you to be controlled.

There's a ton of opinion out there about versed, and people who really, really, really hate it. They don't like the idea of not being able to control the situation, not knowing what is going on, not having input on their medical care, etc. I understand the point of view, but I guess it's never bothered me. In fact, it generally results in some really funny stories -- whenever I've had it I've been well in the care of family or friends, so they keep me out of too much trouble... I am very very lucid while on the cocktail, but I don't remember the entire day. It's kind of a nice little holiday from reality in an otherwise straight-laced life.

So when I showed up for my angiogram on May 28 I wasn't worried. I figured I'd be sedated for one or two hours, be out of the outpatient wing by night time, and able to join friends for dinner and games the next night. The clinic was running late, so I made it back an hour late, and spent another hour in prep, hooked up to an iv, and without anything to read and with no iPod to listen to. The prep area is a series of cubbies with curtains, so it's not at all private. I suppose Sarah could have been with me, but I was alone. The family across was waiting for radiology on tumors in the one gentleman's lungs. I gathered from their conversation that the woman's sister (the wife of the other man) had died of cancer. They all were or had been smokers. They were funny and joking in the way of really stressed-out people. There was also a man who was having some sort of procedure to relieve back pain - installation of a pump to deliver painkillers directly, maybe? I shouldn't have been listening... but what else do you do. There were two "codes" while I waited, and one woman who had an allergic reaction to the CT contrast fluid...

So anyway, it's easy to see why they get behind schedule.

The nurse anesthetist came to speak with me about the sedation, and told me what the procedure room would be like (like an operating room... ha ha like I'd ever paid attention inside one of those).

What I didn't expect was so many people. I think there were 5 actual personnel plus maybe 4 more students/interns. The room was big with a glassed off partition with more people and instruments. The angiogram takes place atop an x-ray machine, so everyone in there is operating in lead aprons (I think of their poor knees), which allowed them to guide the catheter to the right place.

I was out cold by the time Dr. V came in. I vaguely recall the soundtrack this day was classic rock, which is cool. (I once had an MRI that was about 1400 years long and it ruined James Taylor for me forever.) There was lots of activity.

Since I wasn't completely unconscious, there are things I do remember from the next -- oh yes -- four hours. Asking for more pain meds at least three times, and then descending back into a pale blue fog.

The only thing I remember about waking up the first time was being told that the procedure had taken about 3 times longer than expected, and they had had to "poke me" an absurd amount of times, each with progressively smaller catheters, because they could not work their way into the portal vein in order to expand the little balloon-type device to expand the vein. I found out not much later that, once there, the vein was blocked nearly 100%.

I also know that I hurt like hell. Not the baseball-sized bruise between my third and fourth ribs, but my entire right torso. I felt like I had been kicked repeatedly by horses, and then flipped around three or four times in a car filled with cannonballs. On the pain scale (1-10) I was fully at an 8. (I hesitate to ever tell that I'm at a 9 or a 10, because I am sure there is always something worse than whatever I might be experiencing at the time.) For me, a really bad charley horse is a 5, and some headaches can get to a 6. Post surgery I hovered in the 4-6 range depending on what I was trying to do.

What was even more pleasant than the pain was that every time I sat up above, say, 45 degrees (let alone walk), I would throw up. Now, considering that I hadn't eaten for - at this point - twenty hours, it was a pretty hideous experience. Not only for me, but for Sarah and Martin, who were hanging out with me. Obviously not going home on Thursday.

Friday rolled around and I hadn't slept and I still hurt terribly. We played "let's give Shirley drugs" all day. Different muscle relaxants, different pain killers (the oxys, atavan, codein, etc.) and still, every time I breathed the pain was excruciating. I think I had another ultrasound that day. I think I remember the nurses were nice. I think Martin was there most of the day, working. I think I was able to eat some clear foods.

The clinic were trying to get someone to admit me to the hospital. I wasn't allowed back to the transplant floor, and there weren't any beds on the correct floor for hepatology. They were also trying to get authorization for a self-administered pain pump for me. Until that time, I was just to wait in the ambulatory out-patient ward. I think Kathy and Gary came to visit and have dinner with Martin.

Saturday morning came. My parents were there with Marcie. I refused the pain pump and just begged them to let me go home.

The weird thing was that the dr. that was responsible for me (Dr. V) was at another hospital doing procedures all day, so getting discharge authorization took some work. The hitch was that if I needed pain meds he couldn't prescribe them since a real signature was necessary. I explained in what I thought were very polite tones, given the situation, that I had a whole bottle of painkillers at home so please couldn't they let me leave!

And I was out by 1. Thank the gods. With a new prescription for Plavix (yum) and still at a pain level 7. I could. Not. Breathe.


  1. I am one of those people with very strong feelings about versed. Someday I'll tell you about it. The transplant machine is full of both happy and unhappy surprises. I'm sorry that you have had some of the later recently.

  2. I like the term "transplant machine." I haven't even gone *there* yet.