The Lung Con

Oh great, another illness post…

Although we had planned to spend Presidents Day weekend at DunDraCon, I was concerned about a cold that was leaving me severely short of breath and occasionally dizzy last week. I saw my general practitioner because I had been told to watch out for symptoms like shortness of breath. She gave me antibiotics to avoid the cold turning into bronchopneumonia. But although the cough rapidly got better, the breathing and dizziness didn’t — I was panting from merely getting up and walking to another room. So on Friday morning when my doctor called to check back, she said I should go directly to the Emergency Room.

A proof-of-life photo for my friends.
A proof-of-life photo for my The friends.

A few hours later I had had an electrocardiogram, a CAT scan, an echocardiogram, ultrasound of the legs, and multiple examinations, as well as being hooked up with an intravenous heparin drip for blood thinning, electrodes to monitor my heart, a pulse oxymeter, three catheters in my arms, a sphygnomanometer cuff for frequent blood pressure monitoring, and a nasal cannula for oxygen.

Doctors said the CAT scan showed “multiple, extensive” pulmonary embolisms, and the echocardiogram indicated that my heart was enlarged on the right side from overwork to pump blood through the obstructed alveoli. On the plus side, my physical strength, blood pressure, heart rate, respiration rate, and even oxygenation were generally good, no clots were found in my legs, and I had no chest pains at any point.

pulmonary_embolismI was at one of these tipping points when the benefits and risks of two different treatments seem to exactly even out.

  • In a moderate case, the treatment would consist of administering heparin to prevent further clots, then allow the clots to dissolve gradually, transitioning me to another blood thinner like warfarin for long-term maintenance. The risks in this are primarily associated with clots starting to move before they’re small enough and causing cardiac problems.
  • In a severe case (i.e., when things are dire and you can’t really f– them up much more), the treatment would be the administration of a tissue plasminogen activator (tPA), often referred to as a clot-buster. The risk then is to cause catastrophic internal bleeding, particularly in the brain — such as a stroke.

In the end the primary doctor, a pulmonologist, was very cautious. She sent me to the Intensive Care Unit instead of a regular room because clot-buster treatment can only be administered in the ICU due to the risks. I was monitored at all times with a heparin drip, but the tBA treatment was not immediately administered. It was crazy busy in the ICU with some acute cases (fortunately, I was in the quieter wing) so it was only in the evening that the doctor was able to come back and talk to me. Since my vital signs were strong and I had even eaten dinner (I was SO hungry by then, having left home without even breakfast), she decided to keep me on heparin but supervised in the ICU for the moment.

In ICU with my pussy hat for warmth.
In ICU with my pussy hat for warmth.

Thus ended Friday night, with me sleeping in the ICU, nurses watching me and blood samples being drawn every few hours. Despite the severity of the case, I was by far the “healthiest” looking patient in ICU. Two things that made the nurses chuckle: I asked for a sleeping mask, and I was the only one well enough to eat an actual breakfast on Saturday morning. By Saturday afternoon I was allowed to get up, take a few steps around the room, sit up in a chair for a couple of hours. I spoke to the doctor a few times throughout the day. In the evening I was well enough that she transferred me to the Transitional Care Unit (TCU); she just wasn’t willing to risk a stroke if she gave me the tBA.

So I got to TCU in time for the night shift. Because the ratio of nurse to patients is much lower there, the doctor told me with some insistence that I was not to wait at all if I needed even the slightest help, but immediately use the call button to summon a nurse. So I did. In fact, I try to be the most obedient and courteous patient around, but when I need help, I ask firmly. I had to, because there were a lot of distractions during my stay in TCU!

When I was wheeled there, the room across the corridor from mine was already the site of a commotion. The patient there was a woman who appeared to be suffering from dementia, along with whatever other problems were being treated. She was having hallucinations at times, she would not comply with the personnel’s instructions, she would not let them take her stool-stained garments, she yelled, etc. Several nurses and aides were tied up with her case at all times. Their patience and gentleness was truly amazing, but they were clearly very tired.

In addition to the noisy neighbour, other rooms had multiple visitors, and I could hear everyone’s televisions. Possibly because of the number of elderly patients, the wing was kept much warmer than the ICU so I was sweating like a pig. Nevertheless, I was grateful that the nurses told me they would trust me to call for any help I needed and allowed me to keep the door to my room closed for the night. And yes, I could hear the agitated patient and her cohort of personnel throughout the entire night. I was grateful I had my iPhone and earbuds to have some soothing sounds covering most of this. After my 3AM blood draw, instead of going back to sleep immediately, I spent a couple of hours making a music mix on Spotify!

No cannula anymore!
No cannula anymore!

I finally slept again for a few hours, until I was awakened on Sunday morning for more monitoring, sampling, and the sounds of Jesus TV coming from neighbours’ rooms (soon to be replaced by super-violent-movie sounds!) But happily, once the lab results came back I was switched from the heparin drip to Lovenox injections every 12 hours and warfarin tablets in the evenings, much less cumbersome. I was also allowed to do without the oxygen cannula for most of the day, so I had fewer pieces of equipment interfering with comfort.

Edmund was actually with me for much of the time, unexciting as it is to sit in a hospital chair. Since we live only a few minutes away, he was able to come and go for meals, errands, and checking on the cats. He brought me dark chocolate-covered pretzels and raisins, fresh blueberries, and flowers. Throughout the weekend he kept up this shtick with live reports from the “game convention” which made me laugh.

Since I could hear everyone’s televisions, I played music and sang along when I was alone — as confirmed by the pulse oxymeter readings, this actually helped me get nice, long, regular breaths. The nurses chuckled again and encouraged me to continue (I told you they’re dedicated!)

On Sunday afternoon I was allowed to take a couple of closely supervised walks up and down the corridor; it was nice to stretch my legs. I spent a second night in TCU, a little quieter noise-wise though the agitated patient started again on Monday morning.

But after breakfast and a couple more walks, the doctor came to talk to me. Because I had someone at home with me and because I showed good comprehension of, and compliance with, medical instructions, she said she would let me go home but sternly admonished me to treat this as if I was still in the hospital: bed rest or sitting quiet, no activity until my blood prothrombin time (coagulation rate) is in the right range and the clots are dissolved. And by early afternoon on Monday, I was home. Hurray!

Valentine and me, minutes after I got home.
Valentine and me, minutes after I got home.

It was so nice to be home, without wires and catheters, and buried instead under a pile of purring cats! Valentine, in particular, has been keeping a close eye on me. It’s been a luxury to sleep in my own bed and be able to take a shower at last!

I’m in contact with the anti-coagulation clinic pharmacist for dosage adjustments. I must report any unusual symptoms, of course, and come in to the lab for blood sampling every couple of days. The best guess right now is that the tamoxifen I started taking in late January to prevent cancer recurrence is what precipitated the problem (pun intended). I have follow-up appointments scheduled with my general practitioner and my oncologist.

I want to say thank you to all my friends for their encouragements and kindness. I know some of you wanted to come visit me in the hospital, but I just wanted to rest most of the time. The care I received was stellar, but I still wouldn’t call it a fun place to hang out at! And thank you to all the ER, ICU, and TCU nurses and doctors, who were so kind, respectful, and competent (and in some cases, funny!)

Advertisements