Here We Go Again
“He’s taching into the 150s. His pressure is in the 60s. Adam, are you with us?” 24 hours ago I got my new pancreas. This morning my blood sugar was 101 and I haven’t wavered more than 3 points from that number through the day. I’ve never felt better from a diabetes standpoint; the only problem now is that I’m dying. Alarms blare and my ICU room is flooded with people — busy, noisy people. Again I hear, “Adam, are you with us?” and I open my eyes. Voices, initially distant, suddenly come into focus as I realize the gravity of my situation.
“I think he’s in a SVT (supraventricular tachycardia). Let’s try adenosine”, one person says. This guy thinks my fast heart rate is caused by an electrical “short wire”. This is causing my heart to beat two to three times faster than normal. This fast rate is not allowing my heart to fill and subsequently lowers my blood pressure. The medication he’s about to try will stop my heart for about six seconds. He’s hopes when my heart kicks back on, it will return to a normal sinus rhythm. He doesn’t explain his rationale because the team is made of Advanced Cardiac Life Support (ACLS) providers; they are all on the same page of their playbook. Unfortunately, they don’t know two things:
- I’m an ACLS provider also and I’m scared out of my mind realizing what’s about to happen.
- The rationale is wrong, dead wrong
The adenosine hits, my heart stops briefly then goes right back into its rapid rate. My blood pressure remains in the crapper.
Shock, of any variety, is always a bad thing; it yields grim sequela for the post-transplant patient. In shock states, a compensatory mechanism kicks in and directs the brain
to divert blood to the most vital organs — the brain, the heart and the lungs. All other organs get the shaft – “No oxygen for you!” In my case, this includes my new pancreas. Each minute in shock causes damage at a cellular level that accumulates to whole organ failure. It leaves many with altered quality of life and is a leading cause of ICU deaths.
A new voice enters the room: “His hemoglobin is down three grams, his lactate is six.” His face comes into view and I recognize him as a surgeon. He takes command issuing succinct orders:
“Stop that Heparin drip!”
“Get blood, uncrossmatched if you have to”
“Pack him, we’re going to the O.R..”
I feel a single tear roll over my gaunt cheek. My nurse sees this and says softly, “You’re going to be alright.” I reply, “No I’m not. I’m a nurse.” She doesn’t reply but picks up the pace in mobilizing me to the O.R.. Amy appears at my bedside as I roll out of my room. The look on her face is one of sheer panic. My mind is so cloudy that I cannot speak. She gives me a kiss and they start pushing me down the hall. I remember nothing of the 36 hours that follow.
There’s beeping over my head. Steady, normal, regular beeping – I’m alive! My vital signs are stable, I’m breathing on my own and I feel a “normal” pain along my incision. One of the first thing I’m told is my blood sugars are perfect! I’m brought up to date by the SICU team during rounds. Nearly a liter of blood leaked into my abdomen at the site where the transplanted pancreas was tied into my vascular system. The heparin infusion I was on prevented me from forming a clot in the blood vessels of my new pancreas (like my previous transplant). It also nearly caused me to bleed to death. Their quandary now — I still need the heparin. They restarted it at half my previous dose last night with plans to cautiously increase it to therapeutic goal. I’m not out of the woods yet so I’ll remain in the safe confines of the SICU.
The days that follow include shutting down my immune system, constant lab monitoring and managing my pain. My suffering pales in comparison to how great I feel with over a week of normoglycemia in the books. I was seven years old the last time I experienced this. I’m now cleared for transfer to the floor and I’m one step closer to going home. My central IV catheter needs to be removed prior to transfer so my IV heparin is off (I don’t need another bleeding problem!). New IVs are placed in my arms. They’ll restart the heparin after I’m downstairs.
A New Man
It feels so good to be out of intensive care! No more wires, no big catheter in my neck and a real bathroom, where I find myself right now. I barely recognize the guy in the mirror. I’m 25 pounds heavier putting me at a normal weight/height ratio for the first time in my life. Even more delightful, I now possess pecs! I show these off to Amy and she gives me a very tired smile. She’s exhausted by the events I’ve put her through and is in desperate need of sleep. I tell her this and she agrees. She heads out the door to her hotel. I go to sleep feeling more than a little guilty for all the things she’s endured through this ordeal.
I cannot stay asleep because I’m having pain. They discontinued my fentanyl PCA and transitioned me to analgesia by mouth. I hit my nurse call button and she eventually responds. “I’m having a lot of pain. Can I get some medicine?”, I ask her. She informs me that it’s two hours before I’m due for more. I accept the answer because I don’t want to appear to be drug-seeking. The next two hours are torture. The pain intensifies along my incision and now goes straight through to my back. I have a horrible premonition flashing back to last year when my pancreas failed. I hit the call bell then wait what seems an eternity for my nurse to arrive. I express my concerns to her and ask her to check my blood glucose. It’s 105 (!) which settles me. I take the two Percocets she gives me and go back to sleep within the hour.
It’s 6 am and I’m in agony. My enemy, left shoulder pain is back but an older more ominous foe is also present — thirst, fatigue, blurry vision. I notice the bag attached to my urinary catheter is almost full. This means only one thing to me – hyperglycemia. I hit the call bell and now IT IS an eternity before my nurse comes! I instruct (demand) her to check my blood sugar NOW! She’s visibly irritated with me so I add a “Please”. She makes an about face and returns with a glucose meter. The result: 301 disastrous milligrams per decaliter of glucose. Crying, I ask her to call the doctor covering me. She quickly returns with a resident. I see stars when he presses my belly. He can’t hide the concern on his face. He orders labs, an ultrasound and fentanyl. The ultrasound confirms what I already know – a clot blocks the blood vessels to my transplanted pancreas. “I’m on heparin. This wasn’t supposed to happen!”, I state in exasperation. The nurse responds, “You’re not on heparin.” “I’m supposed to be!” I say, glaring at the resident. He’s awkwardly silent then says, “I’m waiting for the rest of the team to get here.” His exit is hasty.
Amy and my mother arrive just as I’m being wheeled out to the O.R.; it’s another tearful goodbye. I awake in the SICU. My pancreas is gone, just like my hopes of a life free of diabetes. Amy and my mom spend part of my time in surgery at a place called Pickles Pub. In a slur I ask, “Did you get pickled?” which gets the three of us laughing until we’re hysterically crying. It’s cathartic and births my resolve to get better, never return to this place.
Just When You Thought You Could Breathe
A week’s now passed and I’m discharged in the evening. Amy, my mom and I (along with the twins) decide to stay the night in the hotel where they’ve been living for nearly a month. The plush hotel bed invites me in and I succumb to its luxury. The twins are sleeping in their stroller and Amy takes the opportunity to take a bath. My mom heads out the door to wrangle us some dinner. I’m not asleep fifteen minutes when someone stops the elevator right outside our door. The alarm rings incessantly. I crawl out of bed with plans to rip someone a new one. I throw open the door and get hit by a hazy, acrid smoke. We are on the 11th floor and it’s on fire!
I slam the door shut. Amy is standing behind me in only a towel (her hotness is not lost on me despite the situation). My mother enters the room in a plume of smoke, her arms are laden with take-out. She jolts us into action. Looking at the map on our door, we see the fire escape stairwell is right next to our room. Amy throws on clothes then grabs Zoe; my mom scoops up Freddie. We exit quickly and get to the stairwell. I tell Amy and my mom to move it. Fatigued, anemic and in pain, I can only descend the 10 stories of stairs one step at a time. A college football team staying a floor above us soon overtake me. These Good Samaritans offer me assistance. I explain my situation and a linebacker makes a move to lift me over his shoulder. I lift my shirt and show him my staple-clad abdomen. This leads him to Plan B. He and a teammate sandwich me between them and under hook both my arms. I lose consciousness about halfway down.
Back to the Pokey
I come to in the back of a city ambulance. They’re taking me back to the prison I just escaped. My mother is by my side. Amy, she and the twins made it safely down. I roll into the ED and get slid into a hallway spot. The guy next to me is handcuffed to his stretcher with two policemen guarding him. A hacking, disheveled, malodorous patient stops at my bedside. He gets pushed into a negative-pressure room by a burly nurse. Ironically, the nurse is wearing a mask to protect himself from tuberculosis, the patient is not. My nurse is friendly and tries her best to move me through the process. We commiserate over Friday nights in urban ERs. My labwork comes back and is unchanged from earlier today. I just need Transplant to stop by to give me the green light to go. Amy calls as we’re waiting and we learn the fire was more bark than bite . Someone left a pizza cooking in an efficiency room with an oven and forgot about it. Amy is now back in a room and waiting for us. The Transplant intern arrives to clear me; it’s the same guy who forgot to order my heparin. He remains awkward, maybe guilt-ridden, but quickly clears me for discharge.
A Dose of the Best Medicine
My mother hails a cab and I hobble out of the ER waiting room lobby to it. Our cabbie is of Eastern European descent and is quite curious about the frail, young corpse that he just made a fare. My mother gives him all the details as he pelts her with questions; she couldn’t stop herself. Normally, this would bug me but tonight, it gets me laughing. My laughter is contagious and my mom joins me. She makes a snort, then a guffaw failing to stifle the hysteria. The cabbie hears it and thinks he’s the one being taken for a ride. My mother apologizes as we pull up to the hotel. Then, to clear her good name, she offers my abdomen for his viewing pleasure like she’s hawking a peep show on the Vegas strip. The cabbie pops on the dome light and rustles through newspapers and long finished fast-food wrappers. He finds the reading glasses he is searching for then extends himself over the seat peering through the lenses at the tip of his nose. Resignedly, I lift my shirt to show him my 50 staples running from my xiphoid to my suprapubic region. He shakes his head, crosses himself and gives a “God bless you”. I exit the cab, closing the door and the chapter to this part of my life.
It’s been a pleasure bringing Spare Parts to you. I’ll conclude with one last post on lessons learned through my patient experience. I’d love to hear your thoughts and answer any questions. Please post them in comments section. Thanks for reading and following! Adam