The Misadventures of Rex Libris

One Year Later

2009-04-04T14:49:00.006-04:00

I don't know if anyone is still reading this blog. Perhaps some of you are using a RSS reader, and you'll be notified that there's a new post. In any case, I felt it was time to revisit this moribund blog and commemorate the passing of the one-year mark since the Big Accident.

It's hard to put into words everything that's transpired since March 20th, 2008. Now that life has returned to a state of normalcy comparable to what I enjoyed before the event, it's a little jarring to look back and recall the month spent in a hospital cot, struggling at first to survive, and later, to remain engaged and look forward to a life outside of a hospital. It's a trope of medical reminiscences to mention how all of life's 'petty cares' were swept away by the tidal force of a life-changing event, like a serious neck wound, but I think there's no shame in returning to the same cares you carried even after you survive. These days, I worry about my job, my goals in life, the state of my 401k and my relationship with my girlfriend. Those are the things that shape the quality of my life on a daily basis, not the half-remembered hours spent in a specialist's ward. This blog has been a travelogue of my own physical recovery, but I'm happy to say that I'm studying and writing about issues that surround all of us, and not confining my attentions to my internal world. The accident seemed important at the time, but I've been more profoundly interested by the last presidential election and the vagaries of the economy.

That said, I won't dwell too long on medical issues. I haven't spoken with Dr. Smith since my final followup appointment in June of last year, and I'm kicking myself weekly for having forgotten to send him a Christmas card. I will be sending him a card on my birthday in recognition of the anniversary, and to thank him for saving my life. I might schedule a followup appointment, just to see what his professional outlook is after all of these months.

Page and I are still together. We laugh nervously about the accident. She bore the stress of it well during my hospital stay, although in later months we were both on edge and inexplicably angry. I wish I hadn't put her through the kind of experience that she had during that first week. I've promised to ring in my 31st birthday with a nice dinner instead of a hospital trip, so perhaps I can make up for last year. Her craft business is succesful and thriving, economic downturn nonwithstanding.

Gentle Fluffy, who cried himself to sleep nightly whilst I was away, is now fatter and happier than before. As the winter months give way to spring in Washington, the temperature steadily rises and Fluffy seems to rejoice in shedding great tufts of fur that waft throughout the house and aggravate already-aggrieved sinuses. It's good to have my little buddy back.

I haven't attempted to swallow a sword, juggle knives, eat fire or any other stunt since last year. After I got back on my feet, Page and I resumed our weekly visits to the Palace, where I briefly enjoyed a kind of celebrity as a spectacular failure, but most importantly, a spectacle. Later in the year, our attendance slowed, and I haven't been back in weeks. We have new venues to socialize in, as the lustre of the carnival life has dimmed somewhat.

I'm spending more time on the road and in the office than at home, and in some ways that's a good thing. During the runup to the Christmas holidays, one of my coworkers staged a 'team building' activity. Each of the staff members was asked to submit a fun fact about themselves, and the rest of the team would have to guess who submitted the fact during a luncheon. My fact was 'This team member used to perform on stage as part of a carnival show.' To my surprise, no one guessed correctly when my fact came up. After the activity, several people asked what my act was, and I replied blithely that I had been a sword-swallower. It took most of the group a few seconds to make the connection and cast hurried glances to my neck, still bearing a livid scar, to my face, and back again to the neck as the realization set it. Most people were curious. My boss admitted that there had been suspicions that I'd been involved in some kind of elaborate suicide attempt, but he was relieved to learn I had simply been collossaly foolish. Since that day, no one asks about my scar, and the accident was ignored in my year-end review.

I'm in pretty good shape, physically. The scar will probably never fade, but that's fine. My throat feels mostly normal - no problems eating or drinking. When I left the hospital, I was at a frightening 179 pounds. I've since ballooned up to 190, but I attribute that to approaching every meal since I left the hospital as if it were my last.

To be continued tomorrow - life is interrupting!

Benefit Show in DC Tonight

2008-05-15T11:11:00.002-04:00

For readers in the DC/NoVA area, please consider coming out to the Palace of Wonders tonight to support Charon and Johnny Henning, two friends of mine for whom a benefit show is being held this evening. Charon is a fellow performer who suffered an injury very similar to mine, and in addition to the medical costs of that misfortune, is now struggling to meet the expenses of treating her husband Johnny. Johnny was seriously injured by another driver in a motorcycle accident last year, and has endured a number of very expensive surgeries and procedures in an ongoing struggle to repair a shattered leg.

A number of very talented magicians and other variety performers will be on stage tonight to raise funds for Johnny's care. Page and I will be in attendance; in fact, Page will be mixing with the crowd tonight as the official donation collector for the show. The cover is only $10 for several hours of entertainment, so please consider coming out, having a good time, and meeting some very unique member of DC's performing arts scene.

The Palace of Wonders is located at 1210 H St., NE. Ample streetside parking is available nearby. The show starts at 9, but consider arriving early to secure a good view of the stage.

Intermission

2008-05-13T23:28:00.003-04:00

Sorry, I've been busy with work since my last post. No new adventures to report, although the roses continue to thrive. These days, I'm struggling with more prosaic challenges, like finding the cheapest gas in DC and rearranging my apartment for a change of pace.

More to come eventually. Thanks for stopping by!

Surplus, or: Fun Ways to Repurpose Medical Waste

2008-05-07T18:48:00.025-04:00

One of the things I'm left with after this ordeal, besides a funny-looking neck and some substantial medical bills, is a collection of medical surplus. After my 'jailbreak' from the hospital nearly a month ago, I've received weekly deliveries of medical supplies to my house to assist me with my TPN and antibiotics applications. From what you've read, you might suppose the packing manifest for that sort of thing to be pretty straightforward. "OK, big bags of goopy sugar water, one week's supply. Check. A bunch of antibiotics packets. Check. What else is there?" Well, quite a lot, actually.

When I was in the hospital, 95% of my social interaction was with nurses. Every hour or two at first, and then every few hours, a nurse would come in, check my vital signs, inject me with painkillers or something to clear my IV line, and check my various support devices and bring me buckets of ice cubes. I rapidly developed a serious sense of respect for these men and women who, for very low pay, tended to my every need, no matter how basic, and managed to keep up a cheery outlook and remain supportive, no matter if I acted petulant, or if it was three o'clock in the morning and I was still up watching late night wrestling whilst in a stupor and demanding extra ice, another blanket and possibly a fresh pillow. They were very patient with me.

Naturally, I started asking questions about their jobs, what they liked most about the experience, and eventually started wondering if I had what it took to be a nurse myself. I didn't feel any particular inclination towards the job, although I liked the selflessly helping others angle, but I'm a curious person and like to know what makes others tick. Most of the nurses were happy to talk, and so I got the gist of the role from most of them. The best part was helping others, especially when the patients got better; the worst part was seeing a patient not recover, followed by the frustration of dealing with excessively demanding patients or doctors.

By the end of my stay, I considered what I'd learned, and decided that nursing would not be the profession for me. Not because I lacked in patience or empathy (some of you who know me can stop laughing now, thank you), or because I was especially squeamish around gross physicality. Rather, there was one fundamental reason why I'd not last in the profession very long, and this is it:

I'm a big slob.

Well, I'm not as big of a slob as I was in college, or immediately thereafter. These days, I have a cleaning service so I don't have to worry about the issue at all - it's like being able to hire a substitute mom to come by and pick up your clothes and dust off the mantle. Actually, I'm reasonably tidy for a bachelor living in a cheap apartment in a squalid section of DC, but I think I'd need at least a day, possibly a whole weekend, to clean up my place if I were expecting reputable company. I don't have a particular aversion to leaving a couple empty soda cans out on my desk if I've been busy, and my cat has been known to strew socks and cat toys and bits of yesterday's newspaper all over the floor, and I have been known to not bother to pick any of that up until several weeks has passed and I'm starting to notice that I no longer have room for a new soda can on my desktop, but nonetheless I don't think I'm embarrassingly lax about my housekeeping tendencies.

The point of this whole conversational roundabout is that I was thoroughly unprepared for the actual responsibilities involved in taking care of myself after my excuse from the hospital. "I can't wait to get out of this sterile environment," I moaned to myself. In retrospect, that should have been a worrying sentiment, considering that I was about to take my medical care into my own hands. "This'll be simple," my line of thinking continued, as I lay in bed hours before my release. "They just come in and change a bag of medicine every couple hours, I have all the lines in me already, I'll just plug in the antibiotics and other stuff and it'll be a cinch. I can't wait to get out and see all of my friends and go to the movies and do everything I'd normally do, and I'm sure everything I need will fit in a small backpack."

Well, of course it turned out to be much more involved than that. My first delivery of medical supplies came in a box that would have housed a modest refrigerator. Surprised, I lugged the box up two flights of stairs (my first mistake that weekend), and opened it up to see exactly why they'd used such a huge box for a couple of packs of TPN fluid and saline solution.

"Well, this is interesting...", I thought. I pulled out a yellow sheet - the delivery manifest. On it was written line items like this:

TPN fluid, one day's supply - x7
Ampicillin/Sulbactam (Unacyn) - x30
Dosi-Flo IV tubing - x7
TPN tubing - x7
Alcohol wipes - x200
Saline flush injectors - x50
Heparin injectors - x50
Multivitamin additive - x7
Syringes & needles - x10
End tubes - x10
Sterile gauze bandages - x30
C cell batteries (for the TPN pumps) - x20
Rubber gloves - x500

...and so forth. The list went on, and I started rummaging around in the box, matching objects to list items. Although we'd reviewed the procedure for changing out the IV lines and using the TPN pumps at the outpatient facility on the day I departed the hospital, I was sure that there were at least a few items in this box I'd never seen before and no one had told me about. "IV prep kit? What, am I going to have to put another one of these lines inside myself", I wondered querulously as I stared at the evil-looking needle and gauze, and sanitary wipes, all neatly packaged in a small plastic kit. The effect was a little overwhelming.

As days passed, I realized that the answer was probably pretty simple: the pharmacy had simply been a little lazy. Instead of counting out exact amounts of everything I'd need, plus perhaps one or two spares of each item to account for the chance of accident, I'd been given bales of prepackaged items that met or exceeded my actual requirements. A good third of the items I'd been sent served no apparent purpose. I didn't need heparin, nor had it ever been prescribed; I was genuinely doubtful I needed ten sterile wipes just to change an IV line (I bathe daily, that should serve), and I really had to wonder why I'd been given the equivalent of do-it-yourself IV insertion kits, when I was already chock-full of needles and rubber hosing. By the end of the first week, I'd only used about two-thirds of the supplies I'd been sent. I amused myself by squirting saline solution from spare syringes at my cat when he'd attack my IV lines.

The second week, TWO giant boxes appeared. I suspected that there was a plot afoot to help me rebuild my lost muscle mass by forcing me to lift ever-increasing amounts of useless medical supplies up to my third-floor apartment, in addition to my ever-present TPN sack. As before, I had been granted a total excess of everything. My room was starting to get a little treacherous - in addition to having to navigate all of my usual junk, I had to sidestep bins full of medical supplies whilst trailing IV lines and TPN supplies, and hope my cat wouldn't elect to pounce on a vulnerable tube and cause me trip and fall over an economy-sized pack of sterile wipes.

After the second delivery, I mentioned the plenitude of supplies to my outpatient nurse, Jean. I was happy that I wasn't being shortchanged, but even though I'm not exactly known for being thrifty, I was a little concerned at the excess. She assured me that she'd mention it to the pharmacy.

Later that week, I got a call from the pharmacy. I explained the situation, and we went line-by-line over the manifest. I identified each item in turn, and stated when I felt I'd stockpiled enough to last me through the following week. The pharmacist agreed, although she expressed doubt that I really didn't need all of the sterile wipes they'd provided, and I ended the conversation with the understanding that the next delivery would only contain what I needed.

Well, that was the case. The next delivery came in a small box, and only held antibiotics and a few bags of TPN fluid (as I was going off the IV feeding regimen mid-week.) I felt a little forlorn, actually. In a way, I'd looked forward to my weekly deliveries; it was like getting the craziest collection of Christmas presents ever. Who knows what I'd receive? Wasteful as it was, I liked searching each box for the odd medical accessory that had absolutely nothing to do with my situation, and had contemplated building a mighty fort out of the manifold cardboard boxes that were now lining the wall of my apartment. I could have held the whole thing together with spare IV tubing and paste made out of powdered antibiotics and saline fluid.

Unfortunately, it looked like the mad pharmacist in charge of my case had finally managed to restrain his or herself, and I was only receiving the bare essentials of my case. I got over it, of course; I was happy to not have to move my bookshelf to accommodate another two boxes, and the week passed as I medicated and rested.

Unfortunately, the brief interlude of sanity appeared to be a passing phase. The following Wednesday, I returned home to find TWO more boxes of supplies. I wasn't even on TPN anymore, so how much could I need? Inside, the contents were all too familiar: boxes of sterile wipes and saline flushes, and packet after packet of antibiotics.

A few days later, as I recounted in my last post, I had my PICC line removed, and I was officially off the IV lines and done with my therapy. Via the outpatient clinic, I learned that the pharmacy would be discontinuing my deliveries. "Good," I thought. "I can start working on my fort now and not have to move my exercise bike to accommodate an extra wing." Returning home after my last appointment, I took stock of the leftovers.

At this point, I am left with (perhaps) 20 packets of IV antibiotics, several hundred sterile wipes, at least fifty or so saline flushes, bales of heparin (I don't even know what heparin *is*), two boxes of 500 rubber gloves apiece, a bunch of miscellaneous caps and tube fittings, at least two my-first-IV-line kits, and assorted IV tubes and flow controls. In addition, I ended up with four useless sacks of TPN fluid, which have just been sitting in the downstairs fridge aggravating my roommates who would at least prefer that if I decided to hog an entire shelf of the fridge with my food, it could be food that they could mooch and eat normally, instead of inject via a little pump and IV line.

I called the pharmacy up and asked what exactly was I supposed to do with all of this stuff. "Give it to a veterinarian or a walk in clinic," they suggested. I was taken aback. A vet, I could understand. I'm not surprised quality controls are looser for animals than they are for people. But a walk-in clinic? I've *been* to those, when I couldn't schedule an appointment with my regular doctor. Did they really take donations of antibiotics and other supplies off the streets? I recoiled at the thought. Didn't the FDA, or AMA or somebody regulate this kind of thing?

I'm still left with all of this stuff. Since the IV lines are out, I don't have cause to annoy my cat with the saline flushes. I guess I'll take everything to a local clinic, and hope that no one has a seizure because of my off-the-back-of-a-truck heparin doses.

I was particularly reluctant to dispose of the leftover TPN fluid. I sensed that it might have potency beyond sustaining human life; a lot of thought and care went into concocting this special blend of substances that was calculated to provided the maximal amount of nutrition and support that a liter-sack of fluid could provide. If I could no longer benefit from it, what could?

Well. What if I fed it to my roses?

I mean, it's sugar, water, fat, and vitamins. What living thing doesn't thrive on those things? (Note: I was a solid C student in biology in high school. Don't mock me if I'm totally off the mark on that assumption.) I was reluctant to feed it to my cat, since he's already, ahem, plush enough without concentrated doses of fat juice, and *I* wasn't interested in eating it, since I now had dumplings and sushi and peanut butter milkshakes to content myself with. It seemed a waste to put it down the sink, since a nurse had told me each daily dose cost *$200* to prepare. $200!! I had to do something with it.

There is a giant rose bush in my neglected front yard. Every month, the landlord comes by, mows the grass, picks up some trimmings, and that's the extent of our lawn care routine. Every so often, one of us gets it into his head that he's going to remake the lawn, turn it into a shining example of horticulture and beauty in an otherwise despoiled neighborhood, and the impulse lasts for exactly one weekend before we decide that it's really too hot to muck about in the dirt outside, and it would really be a lot more satisfying to go play XBox until night falls and the temperature is something bearable again.

The rose bush is always late in blooming. I can't say we've done much to help it along. Nonetheless, it struggles, and each summer a few blossoms appear, shockingly vivid against the lawn's expanse of patchy green and the brown bricks of our shared home. I don't feel like we really deserve it's beauty, but we've never done anything to prevent it from thriving, either. Except this time.

Armed with several sacks and a pair of scissors, I decided to perform an experiment upon the unsuspecting rose bush. My hypothesis: that fed a potent mixture of water, fat, sugar, multivitamins, and sunlight, my giant rose bush would thrive and bear blossoms early. This was a totally unscientific experiment, of course; there was no control group, no repetitions of the study (I only had one rose bush and a few TPN sacks), and my recollection of previous years' rose performance was the closest I had to historical data. I was pretty sure that no matter what, the rose wouldn't *die*, exactly. At worst, I guess I might choke it a little; I had no idea how plants tolerated a fatty diet. Do plants even get fat? Again, this is why I was a journalism, not a biology, major.

I spent fifteen minutes spraying white TPN fluid all over the rose bush. Neighborhood children sidled past, staring as I heaved giant clots of fat and sugar all over the lawn. I was thorough, and had several liters of material to work with; the rose bush was thoroughly coated in a slime of nutritional mix that, although it had been calibrated to my precise requirements, might also benefit a shrubbery. I do not care to brood on the implications of that statement, should my hypothesis be correct.

Two days passed. And then, one day on the way out the door to work...

"A-HAAAA!", I chortled. Two days prior, there had only been barren leaves, with a few limp buds, but now full roses blossoms were visible. Excitedly, I decided to be late for work (traffic was bad anyhow), and I stooped to examine the Frankensteinien results of my mad experiment:

"IT'S ALIVE!", I exclaimed. More than alive, in actuality; full, vibrant, saturated with color and clearly better off than the average weed or dandelion in my neglected garden. All over the rose bush, blossoms existed where none had 48 hours earlier.

I cackled as I examined all sides of the plant. The distribution of healthy roses seemed approximately even. Surprisingly, I found one rose unlike all of the others:

I don't remember having an *orange* rose. Maybe it's a mutant? Perhaps it's part Rex, part Rose, a weird hybrid saturated with enough fat and nutrients to become an exemplar of its species and something else besides. Well, before I get too far ahead of myself, it's probably just a rose. But it looks pretty good, odd color regardless.

So, my experiment appears to have been a resounding success. The rose bush bloomed early, and our lawn looks much better for it. Unfortunately, I really doubt there's anything else out there that would benefit from my medical leftovers; I don't think saline fluid, heparin, or powdered Unacyn is going to replace Miracle-Gro anytime soon.

If anyone here is a doctor or knows one, please let me know what I should do with this stuff. If it's OK to give it to a clinic, I will do that, but I am a little uncertain, particularly with regards to the prescription stuff like the antibiotics.

Well, it's time to find something to eat - preferably less fatty than what the roses had. Thanks again for reading - RL

Is It Over?

2008-05-05T18:50:00.008-04:00

After a week of silence, I hope you're still here. Last week, I talked about mobility; traveling to New York City, buying a camera and traipsing around the city taking shots. Well, that describes the interim. I've been trekking across DC, rediscovering the fact that I haven't got a lick of compositional sense, but I haven't let that deter me from taking hundreds of photographs since then. I'll post a few as soon as I decide a few aren't too amateurish to display.

I had three appointments last week. One, the typical Monday appointment with the Homecare facility. Homecare provides me with nurses who change my IV line dressings and manage my pharmacy deliveries - the Monday appointment never holds any surprises. I get a new bandage, gossip with the nurses for half an hour, and then I'm off after some bloodwork.

Tuesday's meeting was unusual. For the first time, I met with - we'll call her Dr. Garcia - Dr. Garcia, who consults on my case at the hospital. She's an infectious diseases specialist, and was responsible for prescribing the various antibiotics and other anti-infection medicines that I've been receiving daily via an IV since my accident. As my last post suggests, I feel a great debt to her, since I think she managed to treat more than just the infections and illnesses arising from my primary wound site. Anyhow, the purpose of this visit was to review my condition, and to decide if any changes were needed in my treatment.

Dr. Garcia is a pleasant doctor. Her bedside manner is better than that of Dr. Smith, whose candor is sometimes indistinguishable from mere bluntness. My bloodwork is excellent - I'm tolerating the drugs well, and seem to be in excellent health otherwise. The only item of concern at this point is my recurring stomach aches, which Dr. Garcia seems to be convinced are caused by a specific infectious agent empowered by the die-off of bacteria in my gut precipitated by the weeks of antibiotic megadoses. I disagree; I think it's merely the consequence of having had 'Thai-hot' crispy fried duck for lunch the previous day. In any case, Dr. Garcia pledges once again to test me for the presence of c. difficile, the suspected bacillus.

Dr. Garcia seems optimistic about my case. Upon hearing that I've been tolerating drink and solid food without major complication over the past week or two, she's willing to move to oral antibiotics instead of an IV regimen. I'm silently thrilled; I'm tired, literally, of getting up every six hours to tie myself to an IV line. Eight hours of uninterrupted sleep would make my day.

With that, I'm dismissed. Dr. Garcia feels this is the last time we will meet, since I am so close to recovery, or at least a state so approximately close to normalcy that further treatment would be unwarranted. I thank her warmly - I have a soft spot for doctors who don't belittle their patients, and can smile when the situation warrants it.

The following day, I have a fluoroscopy scan scheduled, as well as an appointment with Dr. Smith. The scan will be the first in two weeks; I think it will be my sixth overall. I'm on a first name basis with the radiology staff, and have figured out how the interface to the CT machine works. I can evaluate the results as fast as the technicians, and this is good since the doctors are spared some of the awkwardness when they need to tell me that my esophagus is still mildly disfigured. I see it for myself before a word is said. We did things a little differently today, rotating my body more to gain a fuller view of my throat. I can see small divots lined with glowing gastrograffin, the thick fluid that provides the contrast for the scan. It's a fascinating few seconds, watching the scan replay itself and I see how my throat has handled a gulp of liquid since I was able to swallow.

I had an hour to kill before meeting with Dr. Smith. I bought a newspaper and breakfast, and tried to make the best of a plate of hash browns and bacon. My throat was hardly acclimated to solid food, despite the past week. Some things, like soups, or liquids, passed without incident. Other foods - not all - seemed to lodge firmly in the center of my throat, causing me to cough and carry an uncomfortable sense of fullness behind my Adam's apple for the next 15 minutes until the sensation passes. I can't tell - is the feeling that of an angry injury site, rough with scar tissue and confused about how to interpret these new sensations, or have I truly injured myself, and the food is lodging somewhere in the hollows of my reshaped throat? I can't tell. Everything feels new, even more than it did when I took my first few hesitant nibbles of food and sips of water.

I meet with Dr. Smith, who invites me back into his office and begins his examination. My neck is dimpled and textured with livid suture points and tube sites, but Dr. Smith nods approvingly, noting that the wounds were healing after my improvised self-surgery a few days earlier. I assure him that I'm in no pain, but eating is a strange affair, since half the time I feel fine, and the other half I feel like the food won't go past the injury site. He nods, and then we take a look at the printouts of today's scan.

Most of what we review is obvious. I have a slight 'dent' in the back of my throat, less than a centimeter or so long and much less deep, from where I stabbed myself with a blunt sword a month earlier. I continue to be a mystery, since typically the tension of the bands of esophageal muscle would push the tissue back into shape, closing the injury and recreating a smooth passage. It's this curious condition that kept me in the hospital for as long as I was there; it was difficult to tell from the scans that I had actually healed, despite the odd healing progression.

Dr. Smith has some surprising news that I believe explains the previous mystery. "Well," he begins, "we changed the scan around and looked at more of your throat than we did before. And the type of injury you're left with - a diverticulum, an outcropping into the muscle of your throat - is usually harmless, but you're unusual in that it's not the first one you've had." I blink. "You have a dip in the back of your throat. It's not leaking, you won't get an infection, and you've shown you can eat and drink. I'd call it a diverticulum, at this point, since there's a naturally occurring condition just like what you have. In fact, you seem to have had one already." Pointing at one of the printouts, I realize something I'd missed in the radiologic lab - this is an image of a dent in my throat, a small hole progressing into the muscle wall, but it's not in the same place as my injury.

Dr. Smith continues. "Usually we see these in men later in life, around 50 or so. It's not medically significant unless it's symptomatic; sometimes people have trouble eating or swallowing, since food can get lodged in that space. If that's the case, we can fix it with surgery." I ask the obvious question: What do you do with people in their 30s with this kind of condition? Do you sew them up to? Dr. Smith smiles and replies, "There's still a good chance your primary injury site will close up, just in more time than we expected. If it doesn't cause you problems in the long run, we can consider it sufficiently healed. Otherwise, we can do surgery - we'll have to make another incision through your throat, and you'll have to come back to the hospital." I'm a little shocked, as I stare at the scans below me. Two injuries, nearly identical! One I caused, and one that happened spontaneously. I thought back over the past few years. Had I had trouble swallowing or eating? In truth, I had started coughing a little after big meals - I remember mentioning to page months earlier. It hadn't been a problem, though - merely a memorable anomaly I filed away in the back of my mind. The two 'pockets' in my throat were at the same level; one in the very back - the injury - and the older one on the left.

I had a funny feeling, then, as I started to wonder. The 'naturally-occurring' diverticulum had been caused by a weakness in the band of muscle at that level of the esophagus. Perhaps that prior weakness explained why my new injury hadn't healed normally? If I'd injured myself any higher or lower, would the wound have resolved in a week, the tissue pushed back into place by stronger tissue? I wondered, and kept my hypothesis to myself. It seemed to make sense.

In the short term - what could I do? Dr. Smith, as he had been when we first met, was reluctant to perform any surgery he could avoid if I had a reasonable chance of recovering on my own. We agreed to the following: Regular scans, followed by a final decision at the end of the year. I would return in June - six weeks away - for another scan. I'd return again later in the fall for a second scan. If the injury site failed to continue to shrink, and if I was experiencing consistent dysphagia - that's fancy talk for difficulty swallowing - we could revisit surgery. It'd be a much more dramatic procedure than the one I endured in the hospital, since I'd have to have my neck cut open and the 'divots' sewn up - but I'd be able to repair both diverticula at once. I wasn't anxious to return to the hospital, though, and I would have about a week of recovery time afterwards.

In the meantime, I wait. I experiment with different foods. Pizza aggravates my throat and makes me feel like I'm choking, whereas sushi is a dream to consume - I enjoy it as much as I did before. I thank God profusely for the simple fact that I can eat Chinese dumplings without hesitation - but a mouthful of rice seems to come to rest at the bottom of my throat and refuses to pass without a glass of water. Trial and error seems to help identify problem foods, but as the week goes on, I'm doing better. I'm not sure whether I'll have a chronic or long-term problem at all, especially as every day I feel a bit more normal, more adjusted to the notion of being a typical person without functional limitations. I am terribly glad for two things, though. One - my injury is now in the same category as other very well understood, naturally-occurring conditions. Two - if I should tire of all of this, if I don't recover satisfactorily on my own - there is the surgical option. I can fix it all, and in fact be better than I was before, if I am willing to accept the cost and risk. Much like anything in life, really.

In the meantime, I continue to shed the apparatus of my medical misadventure. Today, I had the PICC line in my arm removed - a foot and a half of white rubber tubing running from my right mid-arm to the arteries of my heart. I expected it to hurt, but the procedure was painless and took moments. As is commonplace these days, I had a totally new and unexpected emotion - the satisfaction of knowing I was whole again, simply myself and not augmented with weird additions that felt parasitical, despite providing a valuable medical function. I was happy to be untethered and unconnectable, with not one valve or drain to hook up to a machine or injector or other device. In short, I was on my own again, and independent in a way I hadn't been since early March.

While at the outpatient facility, we received a call from Dr. Garcia, letting us know that the PICC line was unnecessary, and that any additional medication I needed could be provided by a local pharmacy. So, my involvement with the outpatient facility was at an end. My exit was actually a little emotional, since I'd been so well attended to by the two nurses who staffed the office, and I'd enjoyed talking with them about their interests as well as the interesting details of nursing and my own care. I'll miss our Monday appointments - they were educational.

At this point - I'm done, for now! I'm on my own. No more medicines, no opiates, no appointments, calls, or deliveries. I have about three boxes of surplus medical supplies to deal with - I need to find a local clinic to donate them too. I still have two TPN pumps to return to the pharmacy - I want them off my hands, since they're ridiculously valuable. The IV stand has been folded up and retired to the closet. My cat is a little disappointed, since I'm no longer trailing fun cables for him to capture. I can move about, and don't have a fixed schedule to attend to for my own care.

I can't believe this whole experience lasted only six weeks.

I'm left with a few unresolved emotions about the whole experience. Firstly, and perhaps most importantly, I have a sense of empathy for individuals who are dependent on long-term medical care every day for their continued comfort and survival. I saw a few people like that in wards next to me in the hospital, and Dr. Smith never failed to mention how he had patients who were committed to a lifetime of the treatment that I could expect to forget in a month or so. Being young and whole, I can walk unassisted in society, head outdoors, take photographs and indulge my interests as I see fit in my healthy, although reconfigured, body. However, I suspect there's a 'shadow' class of people, young and old, enduring conditions worse than anything I've encountered who will never have the certainty of recovery I was given, and might not be able to manage their own care outside of a hospital setting. What was their lot? I was thrown back into a familiar life, full of typical middle-class cares and all the comforts I could afford. I feel like I'm looking over my shoulder more now. There's a world of unpleasant possibilities out there - I'm not sure what I should do with the constant awareness that there are quite a few people who haven't been able to walk away from their health problems as quickly as I did, besides try to stay appreciative. I feel a little guilty for being better, and not having done anything in recognition of it, especially since I practically asked for the injury I received. We'll see.

That's all for now. I'll update this post later with scans from my fluoroscopy printouts, so you can see the conditions I'm describing. In the meantime, I'll be on a 'normal' schedule again, going to work, coming home, and seeing my friends. That's what I wanted to come home to - right?

One Month, One Week, and Two Days Later

2008-04-29T18:07:00.004-04:00

It's hard to believe that it's been five weeks and change since the accident - life before the injury sometimes seems like the distant, foggy past, only partly remembered and not entirely authentic. I don't mean that in a miserable, pitying way - actually, a lot of things have changed for the better since the accident.

As you know, I've been on MASSIVE antibiotics since late March. At first, I was on all sorts of anti-bacterial and anti-fungal medications, but I've been on Unacyn since I left the hospital. Unacyn is a combination of Ampicillin, a general anti-bacterial antibiotic much like Amoxicillin, and Sulbactam, which is an additive that protects the Ampicillin from certain bacteria that can destroy it.

The interesting thing, which I haven't blogged about yet since I've been waiting to make sure I wasn't imagining it since I exited the hospital, is that I feel much better overall for having been on a variety of medications. I had a few health problems before my accident. The chief one was some kind of occult sinus pain, which has haunted me since my mid-20s - literally, I've had a case of sinusitis for over half a decade. I've tried everything from oral antibiotics to steroids to inhalers to air purifiers to home remedies to... well, you get the idea - and almost none of it made any difference. I took prescription Sudafed on a daily basis for about a year before my accident, and it was the only thing that granted me any relief. I have no idea why, really, especially when so much else failed. The entire situation was particularly galling as x-rays and CT scans revealed only the mildest of abnormalities, suggesting only slight inflammation that was hardly proportionate to the discomfort and headaches I lived with on a constant basis.

Since I left the hospital, things have been markedly better. Not fixed - I still have an achy face - but not nearly the kind of pain that I would have expected before the accident. I guess some combination of medicines got whatever it was that was causing my discomfort, and killed enough of it to make a big difference in my comfort level. It's really nice walking around and having a headache all the time to distract me. I think also I might have exacerbated the problem by clenching my teeth, which I do at night, and a month of forced relaxation may have helped with that. I'll have to talk it over with my PCP and see what he thinks.

I'm also breathing better. When I was younger, and more foolish (yes, I realize that's an amusing statement given my 'adult' hobbies like eating swords), I was a heavy smoker. For about five years, i.e., throughout college and off and on for a year or so afterwards, I smoked a lot of cigarettes. If some people have a genetic predisposition towards alcohol consumption, then I must have had a parallel susceptibility to nicotine addiction. Anyhow, during that time, my girlfriend and I smoked two packs a day or so. It was no wonder I never had any money. Eventually, I came down with a horrible case of bronchitis or pneumonia - I forget which - but I had to stop smoking for a month because it hurt too much otherwise. When the course of medications ended and I was back to normal, I'd found that circumstance had accomplished what I couldn't do of my own free will - force me to withstand withdrawal and experience life without the crutch of having cigarettes to set the pace for my daily routine. After that, I might have a cigarette or three when out with friends who hadn't quit, and even backslid into daily use for about six months at one point, but in the long term, the spell was broken.

Unfortunately, just because one is finished with a bad habit, the consequences of said habit may be late in arriving. Since that time, I was always aware of the fact that I'd likely permanently compromised my health through five or six years of constant abuse. Although I could look forward to vastly improved health over the coming years as my lungs repaired themselves, I'd still never be at par with those who'd forgone smoking entirely. Indeed, I spent most of my twenties with breathing capacity that wasn't as great as others my age, and my weight skyrocketed and stayed excessive as I ate more to compensate for the lack of a pleasant vice and the elimination of the appetite suppression that cigarettes produce. In addition, I'd probably set the stage for my later sinus problems by allowing myself to live in an indoor environment where smoking was permitted, and by associating with others who smoked as well.

Cut forward several years to the twilight of my twenties, just before my accident. I felt fine. However, after a month of antibiotics and other treatments, I'm breathing better. Something was fixed, subtly - I realize now that there had been a mild, persistent discomfort in my chest that vanished sometime during my stay, and now I could breathe easier and deeper. I have a friend whom I've known since I started college, and we were both heavy smokers - he much longer than I. He quit several years ago as well, but just a few months ago had to go through intense antibiotic treatment for some kind of persistent bronchitis that had endured in his ravaged chest well past his actual smoking days. I suppose I might have been in a similar situation - perhaps my lungs had never quite cleared themselves out entirely, and I was enduring a mild infection or irritation that, without treatment, I would carry for years. After a month of professional care, I was feeling better in a way that simple abstention from cigarettes hadn't been able to produce.

Other health benefits include the obvious weight loss that came with a liquid diet, although that benefit is rapidly vanishing as I stuff myself full of everything that looks appealing and is within reach. Page and I split a giant box of donut holes this weekend, and today I had a foot-long Italian sub. Oh well - I can put on a few pounds, but I hope I can retain my newly-chiseled features for a while.

I'm finally in the home stretch of my recovery, I think. Food and drink aren't a problem, although I can feel them 'sticking' a little in the back of my throat. I think that's just because of some scar tissue. The drainage valves in my neck are gone! They've been gradually removed by Dr. Smith at the hospital, but I think they must have been shorter than we recalled, since one managed to work it's way entirely out overnight this weekend. It was a little gross, but it was a relief since my neck was sore and stinging, especially whenever the drains were disturbed. Having one out meant the wound could heal and I could be less careful with my collar positioning.

The second one popped out today. I called Dr. Smith, since I now had two bits of medical detritus safety-pinned to my neck. After a quick discussion, I dug out a trusty pair of surgical scissors - I was given a collection of tools when I was discharged, in case I needed to perform self-surgery of this kind - and carefully removed both. I'm now suture free, and I'm hoping my neck will look a lot smoother and less angry in a week when the wounds start to close up.

Now, all that's left is the PICC line in my arm. I'm only using one of two lines, since I discontinued TPN. I met with my infectious diseases specialist today, who is managing my antibiotics treatment and stomach issues. Since I'm tolerating food and water, she may recommend that I switch to oral antibiotics at the end of this week, which would mean I'd off the six-hour IV schedule for good, and could take out the IV line. I am very hopeful that this will be the case, since I'd like to not have to keep waking up once or twice a night to set up the IV line.

One sort of holistic benefit of all of these improvements is that I'm much more mobile. I feel strong enough to get around and be active, even though I have to pause every six hours to apply some medicine. Page and I decided to have some much-needed fun and adventure by driving from DC to Brooklyn, NYC this past weekend.

If traffic's light, the DC-NYC trip takes about four hours each way. We set out in the morning, and hit enough traffic that the first leg of our trip took over five hours. We took turns driving, which worked well, and we improvised an IV stand by hooking my antibiotics pack to the ceiling hook of the passenger side of my car. The IV drip took a VERY long time to complete, since it's dependent on gravity and the pack was barely elevated above me, but it was a five hour drive.

We spent the afternoon shopping at outdoor flea markets and indoor craft shows. Page is a crafter by profession - she makes handmade purses for a living - so I was constantly being introduced to artists and other business people. I didn't buy much - a key chain and a belt buckle - but we had a great time browsing and being in an unfamiliar city.

The drive back was a bit of a challenge. It turned out that the hospital had robbed me of my night-time driving ability, in addition to the other deficits it inflicted. I can usually drive for hours, nonstop, in daylight or at night without problem. After a busy day on our feet, I was exhausted, and couldn't manage more than two hours on the road at a time before fatigue kicked in. Well, that's one more thing to work on - it'll be a while before I take any major roadtrips, I think.

This week involves more medical activity - I have another scan and a meeting with Dr. Smith on Thursday - and getting caught up at work. Things had been quiet during my absence, but now that I'm back, we're back to schedule on our various projects. I won't have a free minute through Friday, I think.

That's all for now - thanks again for reading. I know there are ongoing issues with the comments, so if you'd like to get in touch with me, I set up an email account for just that purpose if you don't already have contact info for me. You can write me at rex.libris.blog@gmail.com. I'm also on Instant Messenger as rexlibris2008, in case you're bored and would like to say hello.

Brief Update

2008-04-28T23:10:00.003-04:00

Hello everyone - I haven't posted in a few days, as you know. It turned out to be a busy weekend. Unfortunately, I've had very little sleep in the past 72 hours because of an apparent stomach ailment, so my posts are going to be a little terse until that clears up. Nonetheless, thank you for continuing to check in, and I promise a more substantial update in the next 24 hours. The brief summary so far is that I'm perhaps 90% of the way to physical normalcy; Page and I took a daylong tour of Brooklyn, NYC Sunday on a whim, and I've been busy getting back to work while bouncing between doctor's appointments (as usual).

Thanks to everyone for the kind emails.

Back to Work

2008-04-24T19:18:00.003-04:00

As much as I've enjoyed this impromptu summer vacation, whiling away the hours in bed watching television and corresponding with all of my lovely readers, I was eventually forced to admit that if I wanted to continue receiving paychecks whilst in absentia from my dimly-remembered day job, I would have to clean myself up, put on a collared shirt, and trek an hour or two out to Ashburn and reconnect with my employer. I was a little wary of returning to the office for a few reasons:

I'd probably have to actually do work again. As rotten as my hospital experience had been at times, I was never pestered to meet any of my job obligations - a huge credit to my boss.
I'd have to resume commuting five days a week. Without going into a lot of discussion about it, my drive to and from work requires about 2.5 hours a day. You think swords are dangerous? Try risking your life on the DC -> Ashburn 66/Dulles Toll Road corridor every day.
There would be Questions. I wasn't sure how or if I'd explain what really caused my absence. Did I want to be known as Rex Libris around the water cooler?

All of these issues were pushed roughly to the back of my mind as I set out Wednesday to brave the hazards of DC's traffic thoroughfares. 35 minutes into it, and I'd just left DC. "This drive is longer than I remember...", I recall thinking. Eventually, the colossus of my employer's main campus swung into view, and I relaxed as I settled back into the start of a very familiar daily routine.

Once inside, I was greeted warmly, and (predictably) peppered with questions. I'll credit my coworkers; they were polite, friendly, apparently only concerned with my immediate wellbeing, and unabashedly curious about the swaths of gauze and tape I'd hurriedly affixed to my surgery site that morning. Unfortunately, I'd been a little too quick; the bandages were poorly taped, and I later realized the ugly valves and angry red wounds had been peeking through the whole morning.

I was given the morning to get settled, and I was left to myself as I checked email, reoriented myself in my cube, and set up IV stands and my TPN sack. Some of my closer colleagues asked questions about my hospital experience and the purpose of my medical accessories. I was happy to talk about the superficial details of my situation, but by mid-day, I could observe a change in the expressions of some of my coworkers. "So," I thought..."do I tell them?" I decided to be honest; if anyone asked me to tell them exactly what happened, I'd reward their boldness and tell them. Otherwise, I'd simply had an accident. A bad cutlery accident. I doubted it was very convincing, but what did I owe anyone? The specifics of my case were mine to share only at will, and anyone who knew me well enough would know of this blog already.

In the end, no one did ask. There was a little confusion, but I think most people gathered that I'd slipped and cut myself badly with a kitchen knife. I feel a little bad for not being as honest with them as I have with almost everyone else in my life, but I couldn't honestly invent a reason why any of my coworkers - almost all of which are virtual strangers, no matter how blandly friendly - needed to know the whole strange story. I think it would have confused them, and possibly done more harm in the long run to my reputation. It's a very conservative work environment.

In hindsight, my only troubling thought is that a coworker might suspect I'd attempted to take my own life. I truly hope no one suspects that, but I doubt I'll ever have a chance to set the record straight unless confronted on the issue.

Overall, it was an easier return than I thought it might be. Life went on without me, but there's still a place for me, and I have enough work to jump back in and stay occupied for a very long time. I am a bit of a strange sight, with my IV stand and collection of medical tchotchkes littering my desk, but there's a simple comfort in having a task to perform. Paradoxically, work can be relaxing after a long, troubled rest.

More Good News

2008-04-22T12:43:00.002-04:00

Met with Dr. Smith today. Highlights of the visit:

The lower drainage tube was removed completely.
The other two tubes were partially removed, and now only about an inch and half remain inside. These are draining anything around the main suture site.
The sutures were removed from the lengthwise incision, so now I just have a ruddy scar.
I can eat solid food! Dr. Smith cautioned me to start with soft foods, like pasta, and avoid anything crunchy and seeds until we're sure solid food doesn't irritate my throat.
I can stop using the TPN later this week when I feel comfortable with food. I'm going to call Dr. Smith on Friday, let him know how I'm doing, and probably stop TPN use that day.
I am officially a medical anomaly, on account of the weird way that my throat has healed. I hope to see myself written up in the New England Journal of Medicine in a few months.

Anyhow, I am very grateful to have had such a speedy recovery, and to basically be in as good shape as I was a month ago, despite having such an rare injury. I will be even more grateful when I have my next meal. Tonight, Page and I are going out for dinner - there's a little Italian place down the street that we like, and it has great tiramisu to boot. In the meantime, though - I might order some lunch. There's a good sushi takeaway place down the street...

Regarding Comments

2008-04-22T08:44:00.003-04:00

I checked the blog settings and it looked like you had to be a registered Google user to leave a comment. I changed that, and now I think anyone can comment without registering. Please let me know if you have any problems.

Thanks! - Rex

The Week in Recap

2008-04-21T18:16:00.015-04:00

I'm back! Sorry, I've been too busy gorging myself on ice water and soup to post lately. I do have a lot to relate, though.

First, an administrative note. I received a few emails from folks who were a little freaked out by the animated sword-swallowing image, as well as some of the medical content. I don't want to make anyone sick while reading this blog, so from now on, if I have content that might be considered graphic (particularly medical stuff), I'll post a link to it so you can click through if you're feeling brave. I will not post anything that I'd consider in poor taste, nor anything especially graphic, but I will try to keep the blog free of unpleasant visual surprises.

That said, here's the update on my condition. I survived Soup Weekend 2008, and after several liters of tomato soup and chicken broth, plus uncounted cups of water and lemonade, I am happy to report that my esophagus is apparently not a porous material, as nothing leaked out of me. In fact, after the first bowl of warm soup, my throat feels almost entirely normal. There was a slight stiff spot in the back of my throat where the injury had been, but by today (Monday), that sensation has vanished.

As you might imagine, I was filled with trepidation when I had that first glass of water. I didn't try it alone; I actually drove to Page's apartment, invited up a friend, and the two of them watched me while I drank. The fear, of course, was that I'd swallow a gulp of water and a moment later it'd pour out of the side of my neck as I started gurgling horribly, and then I'd have to be driven to the hospital and the whole hospital affair would repeat. Fortunately, that wasn't the case. My throat was as tight and stiff as you'd expect after a month of disuse, but everything worked out.

About that administrative note: If you're curious, I posted a picture of the drains and valves that I keep mentioning on a separate site. The picture is a little gross, so fair warning.

I feel very good, overall. I am still a little weak from inaction, but I've been able to lug my supplies around without problem, and can drive without limitation. Not all is perfect, though. I have a slightly sore throat, which I'll ask Dr. Smith about tomorrow, and the valves and drains on the side of my neck continue to be a source of discomfort. They stick out about an inch from my body, and although usually hidden and protected by gauze padding, they tend to ache a great deal. This is because they are being gradually removed by Dr. Smith, as he pulls a little more tubing out of me and replaces the valves each time we meet, and because I tend to roll over and sleep on my sutured side. I don't know how I manage the latter, since the area around the valves is sore to the touch.

Jumping backwards - prior to Friday's announcement, the big highlight was my return to the Palace of Wonders. The Palace, of course, was the scene of my injury.

Page and I had kept up with our friends from the bar and DC performance scene during my hospitalization, and it worked out that the April Weirdo Show - again, the monthly variety event at which I was slated to perform in March - was being hosted this past Thursday, just a few days after my release. The Show always attracts a good crowd, and since the lineup tends to be packed, half the crowd is comprised of that night's performers, or friends of a performer. I knew Professor Sprocket, the MC who had visited me in the hospital, would be there along with other friends, and the chances were good that I'd know the bartenders that night as well. Unfortunately, I still couldn't drink, so I'd have to pass the time with a glass of ice instead of a soda or a beer, but that was fine.

I was nervous to return for a few reasons. Firstly, because I'd suffered trauam there, and the embarrassment of having to withdraw from a show. I felt my gut tighten as I stood in Page's apartment before we left. How would I feel when I saw that stage again? Secondly, there was not just the issue of the place, but the people. Seeing friends was the important thing, but how would they see me?

Before my accident, I'd heard stories of what happened to performers who'd incurred serious injury on the job. Those who recovered returned to hugs and well-wishes from fans and fellow performers alike, but a few faced a kind of chill from spooked colleagues and fans. All of us are daredevils, to varying extents: the appeal and challenge of most of our acts lies in the potential for physical harm, no matter how remote or overstated the actual risk might be. Swords can cut, fire can consume, nails can pierce. Although a little nick or scrape here and there can be an advantage, since we're working hard to convince the audience that it's not witnessing an illusion, neither I nor anyone else in our unusual brand of show business wants to be really harmed. Unfortunately, we're not exempt from the same rules of chance or fate that govern everyone's lives, and occasionally - as in my case - an accident does occur that doesn't resolve in a few minutes, or with the speedy application of a Band-Aid. My accident was easy for me to deal with, since I was too preoccupied with surviving and staying comfortable to brood on the larger implications, but my friends and family didn't have that luxury. Sometimes watching is the hardest task, since you may be required to consider that despite one's best precautions, chance, or fate, or God if you prefer, may intervene to alter your life forever - or end it sooner than you planned.

I don't mean to sound maudlin, since I'm not. I'm supremely glad to be alive, and give credit where it's due to my friends and family, and the superior medical staff of my hospital. Others might not be so philosophical, though, and just as some people recoil from graphic photos of medical injuries, how would people react to me? I was a walking reminder of mortality, if one thought it through, and the last thing I wanted was to dull people's enjoyment and appreciation of my peculiar craft by showing up torn and thin, alive but visibly scarred.

It was appropriate, then, that the first two people I should meet upon walking back through the doors of the Palace for the first time in a month were the two other performers in the area who'd suffered the same injury as I. Charon (pronounced like Karen) Henning and Alexander Kensington were the first sword-swallowers I ever met. Indeed, Charon inspired me to take up this mad pastime; she's the performer who rebuffed my first inquiries about the craft, as I described in my earlier entry, 'The Palace.' Charon had endured the same slashed esophagus I had, although her injury occurred during a taping for a radio segment; she didn't even have an audience to witness her near-death experience! Alex had a similar injury and suffered massive internal bleeding, but lived to see another day. We all have the same scars, long slashes down the front of our throats. As I stood in the entranceway, sunlight streaming down upon my neck as I saw friendly faces push towards me from the back of the bar, it felt like the best company I could be in.

It was great to be back. Charon and Alex had spent most of the past months on tour, so I rarely saw them under any circumstances. We traded tales of our struggles, and Charon mentioned she'd passed my name along to Dan Meyer, president of the Sword Swallowers Association International (SSAI). Sword swallowers are rare, and individuals with esophageal perforations doubly so, so I may be in touch with him to discuss my experience and add to the shared knowledge about explaining these types of injuries to triage personnel and strategies for dealing with the recovery process. I may still join the SSAI, as I'd hoped to do after the Palace show. I've paid my dues, after all.

After meeting with Charon and Alex, I greeted Professor Sprocket, the MC and my supporter in the hospital, and Karen Mitchell, Sprocket's partner in producing the Weirdo Show and a great email correspondent of mine. It was fantastic to see them again and support their show. Other friends present included Malibu and Silver Raven, two fantastic fire performers who appear regularly at the Palace, and dancer Bambi Galore, who works for Page on occasion and produces her own line of headwear for performers.

The rest of the evening was simply fun. I was a conspicuous sight, with my bandaged neck and wrapped arm dangling with IV plugs. Page and I met up with a crowd of gawkers who showed up hoping to see sword-swallowers. They would be disappointed if they expected to catch an act, but I enjoyed a few minutes of minor celebrity as I regaled the bar with tales of my horrific injury and struggle to survive. Sprocket greeted me from the stage mid-show, which validated me, both to myself and to the audience. One of the audience members asked for my number; she's a photographer and wants to shoot some pictures of me in costume with my scars. I could use some publicity shots.

The rest of the week held other highlights after the joyous return to a normal social life. I spent days sipping drinks and tasting soups, happy to have an alternative to the feed bag for nutrition. Page and I made peanut-butter cup milkshakes last night, which was heavenly. I'll have to make more of those... I don't care if I put all that lost weight back on!

The last bit of big news is that I finally procured my late birthday gift to myself. I usually buy myself something nice for my birthday, and since I hadn't spent any money in the hospital, I had a little extra to spend this year. I've decided to take a little hiatus from performing, or skydiving, or wrestling bears or anything else remotely dangerous (besides the usual risk of living in Washington, DC), so I chose something relatively innocuous:

That is a picture of my new Nikon D40 digital SLR camera. I have a little point-and-shoot digital camera which is fine for basic shots outdoors and for recording VHS-quality video, but I wanted something with more control and better overall image quality. This camera came well-recommended by some photo enthusiasts I know, and I got a great deal on it from Photocraft. If you're in the Northern Virginia area and need photo equipment, I recommend them based on their prices and very friendly and knowledgeable staff. I bought the Nikon body and a Tamron 18-250 lens, which I think will be a great everyday lens that will serve me well until I need something more specialized.

Unfortunately, it's been raining every day since I bought the camera, so I haven't had a chance to get outside yet and take pictures with my new toy. All of my indoor shots are of cats, predictably, which I won't bore you with. Hopefully, I'll be able to visit the Arboretum soon and shoot the bonsai for practice.

Well, that's it for tonight - I'll post more tomorrow after my big meeting with Dr. Smith. Hopefully my mouth will be full of food when I post next.

I'm Still Alive!

2008-04-21T12:40:00.003-04:00

Hi everyone - just a quick note to let you know that I'm still here and will continue to update the blog. I have a lot to post about the past weekend, and will have new entries up tonight and tomorrow. In the meantime, feel free to leave comments under posts you enjoyed!

Thanks, Rex :)

Oh Happy Day

2008-04-18T19:19:00.004-04:00

As I type this, I am eating a tasty bowl of chicken broth and sipping on a tall goblet of ice water. Mmmm, water...

Dr. Smith called this evening - after five, which was surprising - with some interesting news. He'd been in consultation all week with some other doctors about my case, and had come to a surprising conclusion. His review had been prompted by the fact that I was four weeks into recovery from an injury that should have been relatively healed in half that time.

Apparently, my throat wound is doing something that, in Dr. Smith's words, he'd never encountered during his medical career. Instead of healing from the outside-in - that is, from the outside of esophagus in towards the center - my wound had scarred over from the inner surface, and was healing in reverse. I was thus left with an injury that was basically encysting upon itself and shrinking slowly.

Then came the big news: "Well, Justin, I think you can start drinking again. Try some ice water, maybe avoid carbonated beverages, and call me if there are any problems or bad drainage. You can have soup, but just broth, no chicken." My heart stopped, and then leapt - it was a chaotic three seconds of emotion - and Dr. Smith continued: "You can skip next week's scan. Come in on Tuesday, and if everything went well this weekend, you can try solids. I know you're anxious to get off the TPN." Solid food!

What solid food means to me:

Chinese dumplings
Pizza
Salmon steaks
Tortellini with alfredo sauce
Quesadillas
Those little sausages wrapped in crispy dough
Steak tartare
Sushi... spicy tuna rolls... wasabi... octopus...
Bacon

I can't wait!

So, I had my first meal in a month tonight - pictures are forthcoming. I started simply - a glass of water and a bowl of soup. I didn't choke, or cough - there was no pain. Everything works normally, although my throat feels tight. I can feel a small spot in the back that must be the injury site, but it's hardly noticeable.

Tomorrow's plan: Stock up on soups! Soups and drink mixes - I might make lemonade for the hot weekend. Ah, it's like a new world. More to come.

Wednesday Update

2008-04-16T12:39:00.004-04:00

In brief - no apparent change. Still waiting to talk to Dr. Smith to get his opinion on things. So, we'll see what happens. Looks like I'll be back on Tuesday, though.

Good news is that TPN schedule is being moved from 24 to 16 hours on the feeding IV today, so I'll have a window where I'm untethered for a while. If 16 hours works out, I should be able to move to 12 pretty soon.

I was going through some papers this afternoon and found some printouts of my CT scans. These images were taken from the series of CT snapshots taken during my weekly fluoroscopy scan. For all of you who have borne with me during this long struggle, here is a picture of the problem that started it all, taken during the first week of my hospital stay:

You can discern the vertebrae on the right and the area where my chin meets my chest (my head was tipped forward) easily. The central white column is my esophagus - it's brighter because of the gastrograffin fluid that I swallow during the snapshot.

You can see a slight gouge, or dip, in the back of my esophagus. That's the wound. The perspective is off on this shot, because the injury is actually a little to my right, but you get the idea. It's a pretty small injury site, but it was problematic enough, obviously.

It's smaller now, and I presume is getting smaller every week. I'll be meeting with Dr. Smith in a few days (after my next scan, which will be a little earlier) and hopefully he can give me some perspective on how my recovery is coming along.

Cat Attack

2008-04-15T10:53:00.007-04:00

Not much to report at this time. I'm settling into a schedule of IV treatments, rest, and projects. The big news is that my cat, Fluffybear (not his real name) came home yesterday:

Above: Gaze into the eyes of innocence. Gentle Fluffy is home again.

I hadn't brought him home immediately since I had a lot of organization and cleaning to do, and I was concerned about interference while I was getting used to the IV routines. I was a little nervous yesterday... Fluffy can be a gentle creature, but he likes to roughhouse, and I was a little worried that our fun games of chase-the-wand would lead Fluffy to think that the various IV lines dripping off me were fair game for chewing. Worse, one of Page's cats found a spot on my shirt where a droplet of TPN fluid had falled, and had licked at it incessantly until I forced him away. If Fluffy knew that I was carrying around a bag of tasty sugar water, full of fat and protein, he might try to attack the bag!

We had a few rough patches where Fluffy's animal instincts got the better of him, and he would gnaw and slobber on my IV lines until pushed aside. On one occasion, his exuberance at being home nearly had tragic consequences. A typical evening at home involves Fluffy dragging one or more of his toys to my feet in an invitation to play. This is fine, of course, but Fluffy dragged over one of his wands, which is a stick attached to a length of string with a toy at the end. Fluffy managed to gallop around my feet and under my chair, wrapping the wand's string around my feet and the IV lines. He leapt with joy under my desk and to the window, and I nearly fell completely out of my chair yelling as my PICC line was pulled to the floor. It took about five minutes to untangle the crossed lines, and then I still had to play with the cat, who was doubly-excited now that he was trying to help me untangle the lines (by batting at them, of course.)

After an hour of testing on Fluffy's part and reprimands on mine, I think we reached a compromise: Fluffy was content if allowed to simply sit on the IV tubes. I suppose that was tantamount to 'capturing' the prey without actually destroying it. This arrangement has proved mutually beneficial as I can position Fluffy to pin the line down in specific places, thus preventing the line from lying in the path of my rolling chair (which can snag the line and crimp it.)

I'd had a busy weekend, so I decided to take it easy and retire early. I had to move the TPN backpack onto the bed with me and hide the cables under the sheet, but part of the line would be exposed so long as my arms were above the sheets. I was exhausted, and decided to wake up only long enough to set up the antibiotic IV infusion, and then return to sleep instead of waiting for it to complete. This meant that I would have an IV line running from a stand down to my arm all night, and a bag of refuse next to the bed where I would drop wrappers, spent saline syringes, etc. If there's an annoying activity Fluffy loves more than chewing on things and people, it's rooting through boxes and bags.

I was a little nervous after setting up the midnight IV. What if Fluffy pulled the whole stand down, shattering vials and spilling antibiotics everywhere? What if he chewed through a tube and infused himself with a megadose of Ampicillin? What if he nibbled through my TPN feed line and put himself into a sugar coma? All of these worries nagged at me, but I was too tired to do much. I fell asleep...

I awoke at 6 AM. I was amazed - all of the IV lines were undisturbed. Fluffy hadn't attacked the sack of refuse next to the bed. Instead, he was happily curled up atop the blue bag, back to my side. I don't know how he managed to resist so many temptations, but he was perfectly behaved. He even limited his usual nighttime prowling, seemingly so as not to disturb me any more than necessary. In fact, I realized that his perch atop the TPN backpack had an advantage for me: he was keeping my food warm.

As I type this, we are both still in bed. I am not getting up until my noon IV infusion - I can work on my computer in bed just as well as I can work at a desk - and neither is he. I have to wonder how he knew not to bother certain objects - I suppose he is a more resourceful and considerate cat than I'd thought. Welcome home, kitty!

Home Care

2008-04-14T08:07:00.010-04:00

Hi everyone - I haven't posted much in the past few days because of my busy schedule and need to rest. It's also a little harder to sit down and concentrate on projects like this - I didn't have a lot of distractions in the hospital.

Today, I'll try to describe the medical procedures and supplies that I will be responsible for until early May. As you know, I was released from the hospital on Friday, April 11, with an unhealed esophageal perforation. Well, not completely healed, but sufficiently so that I was deemed fit for home care.

The overarching concern for someone with my kind of injury is avoiding infection. This is achieved by:

Avoiding food and liquid intake by mouth ("NPO")
Administering IV antibiotics on a regular basis

Latin trivia: NPO stands for "Nil per os," meaning "Nothing through the mouth".

Because of this, I have three rules to observe while my wound is considered unclosed:

I am not to eat or drink anything, but I may munch on ice or rinse my mouth with water, provided the fluids are spat out afterwards.
I must administer TPN nutrition to myself every 24 hours, and keep the nutrition bag and pump on my person at all times.
I must administer IV antibiotics to myself for 30 minutes every six hours, without exception.

#1 is the hardest rule. During my stay in the hospital, I never yearned for food, but I desperately wanted a glass of ice water. I still do, and it's difficult being out in a world where everyone else thinks nothing of drinking whatever they want at any time.

#2 and #3 aren't hardships, but they are inconvenient. We'll start with the TPN.

TPN, or "Total Parenteral Nutrition", refers to the delivery of nutrients via intravenous catheter. It's used when someone has an injury or condition that prohibits normal food intake. In my case, my doctor has developed a mix of proteins, lipids, various vitamins and other healthy things into a bag of white slop that I consume daily. You can see my typical TPN bag below:

If you look closely, you can see things like the various ingredients of the TPN mix, the dosage and infusion rate, and other details. Each pack of TPN mix is dispensed over 24 hours, and must be kept refrigerated until 2 - 4 hours before use. It's important that the TPN bag be taken out of the refrigerator several hours before use, or I could put myself into shock by infusing icy liquid into my veins.

Before use, each TPN bag has to be injected with additional vitamins that my doctors feels I need. Once the TPN bag is ready, I connect it to a small, battery-powered pump that manages the rate of TPN infusion:

This pump attaches to special sensors on the line from the TPN bag, and alerts me if there is anything blocking the line, or when my dosage is complete. The pump is very easy to use, and comes preprogrammed from the pharmacy, so I don't have to worry about altering infusion rates or other settings.

Right now, I change the TPN bag around 6 PM, but that may change to better accommodate my schedule. I may also be able to have the infusion rate doubled, so that I will only be connected to the TPN pump for 12 hours a day instead of 24.

Preparing the TPN for use takes about 10 minutes. Without going into all of the steps, I have to flush my IV lines, add the vitamins to the TPN, attach special tubing to the TPN line and connect the tubing to the pump, change the pump batteries, sterilize everything, and connect the TPN line to my PICC line and start the pump. Afterwards, everything runs without interaction unless there's a problem.

Conveniently, the TPN bag and the battery-powered pump fit inside a special backpack, which gives me some mobility:

Above: My stylish blue backpack. Note the TPN line running out of the side.

Although I managed to lose about 15 pounds while in the hospital, I think the doctors decided to help me regain my muscle strength by saddling me with 12 - 15 pounds of TPN fluid and equipment to lug around each day. I feel like some tragic Greek character who is being punished by the gods by being forced to carry around a heavy weight all the time.

I also have antibiotics to apply every six hours. This has been the really life-altering thing, since the rotation that I've settled on requires me to get up at 6 AM every day. For those of you who know me, this is unheard of. Prior to the accident, I could barely get out of bed at 8:30 AM. The antibiotics infusion only takes about 30 - 45 minutes, but unless it's the weekend, I don't see much point in going back to bed, especially since I'll be working again soon.

The antibiotics come in an unrefrigerated pack that looks like this:

The antibiotics are a little simpler to set up than the TPN. The picture is dim in places, but you can see the main body of the pack, a glass vial, and a plastic reservoir with a spike at the top that runs into the main pack. I start by mixing the powder in the glass vial with the fluid in the main pack by breaking the tip at the top of the vial, and the squeezing the pack to mix the fluid and powder. This activates the antibiotics, since the active mix denatures if left unused. Once that's done, I connect the plastic reservoir by inserting a hollow 'spike' into the pack, and then connecting the IV line which runs from the base of the plastic reservoir to my IV. Of course, in between there is much sterilization, and the line has to be cleared of air first. The line is shown below:

On the right is my arm, covered in a sheath to help me manage the excess of PICC cables. Moving away from the arm, we see a white block; that's a clamp that can be used to prevent fluids from moving along the line. Next is the actual PICC line valve, which is connected to the valve for the IV line. Past the line 'joint' is a yellowish object. That is actually a dial that lets me manually control the flow rate along the line. I can shut the line or open it completely; or set it to one of several preset rates. Being able to shut or open the line is useful when pushing air out of the line or draining excess fluid once infusion is complete; otherwise, it is set to a specific rate while I am hooked up to it. Once set up, I don't have to do anything but wait for a little while.

There aren't any real side-effects to either of these treatments that I've noticed. Everything else seems to work pretty normally.

I'll post more later, once I'm done with my doctor's appointment.

So Tired

2008-04-12T22:48:00.003-04:00

This is going to be a brief post. After my first full day of being out in the world, I'm exhausted.

Today involved going through the routine of six-hour antibiotics applications, switching out TPN supplies, going to CVS and filling prescriptions and stocking up on household goods, moving most of my stuff from Page's place and the hospital back into my apartment (i.e., lugging it up three stories), getting started on cleaning up the house, starting laundry, organizing the medical supplies... etc., etc.

Those activities wouldn't be too draining if it weren't for the fact that my body is not exactly in the shape it was when I entered the hospital three weeks ago. When seated, I keep falling forward; apparently, my back muscles turned to mush during my many days reclined in a cot. My legs are burning after taking out bales of trash and moving suitcases and supplies around. Even though I may have lost 15 pounds recently, I gained them back in the form of a heavy TPN backpack that I have to carry everywhere.

Suffice to say, I'm going to sleep in little bit after setting up my final antibiotics IV of the night. I'll post more tomorrow - maybe when I get up at 6.

Day One in the Outside World

2008-04-12T12:17:00.002-04:00

As you noticed, "yesterday's" posting was being updated until 6 AM this morning. "Yesterday" and "Today" don't have a lot of meaning in my new medical schedule, where I'm getting up every six hours to infuse myself with antibiotics, and I'm constantly lugging around a backpack full of nutritious paste.

The good news is that I've had a relatively comfortable experience so far. The TPN feed is keeping me hydrated, despite the warm weather; I have much more variety in my choice of sleeping positions, now that the drainage tubes have been removed, and the cats haven't taken too much of an interest in my medical gear. I think they sense something is amiss.

Today (Saturday's) immediate challenges are to document the procedures for using the antibiotics and the TPN, and set up the 24-hour TPN change, which will happen around 4 PM. Once I'm confident about both procedures, then I need to tackle the mammoth task of cleaning up my room, which somehow grew messier during my three-week absence, do laundry, clean up my desk, and generally make sure I have a comfortable nest in which to rest during the remaining weeks of my recovery.

I have another goal, which I haven't really paid much attention to, although it's the whole point of leaving the hospital in the first place: figuring out what to work on now that I'm home. On Monday, I need to get in touch with work, explain that I can't drive yet, and work out a work-from-home plan for the short term. I also need to get back to reviewing for the PMP exam. I'll still have the same challenge I had in the hospital (and before I entered the hospital, really) - how to fill my waking hours when I'm not working. I had plenty of hobbies and time-wasters before I entered the hospital, but I'm not sure how many of them are important, now.

I have been thinking of taking up amateur photography again. I haven't done much with it since college, but I think it would encourage me to continue getting out of the house, and I could take advantage of the natural beauty of the local National Arboretum. Friends of mine recommend the Canon Digital Rebel XTi and a Canon 50mm 1.4/f lens. We'll see - photography is a great money sink. On the other hand, I haven't spent any 'spending money' in the past month since I've been in a hospital and haven't had shopping as a high item on my list of priorities.

I'll update this later. For now, I'm going to keep watching episodes of 'Lost' and enjoy the cooler temperatures brought by today's overcast weather.

Moving Out

2008-04-11T10:24:00.004-04:00

EDIT: 4/12/08 - 6:54 AM. Well, this is what my life is going to be like for a month: preparing and applying antibiotics IV drips every six hours. Set up is simpler than I thought it would be, and it takes about 35 minutes for the pack to run through.

I slept better than I thought I would. I was concerned that with the hot weather and the lack of AC, I'd be dehydrated (since I can't drink anything!) I woke up feeling fine and only a little dry-mouthed - the feed bag is keeping me hydrated after all. That'll be the next challenge - making sure we can prepare and set up the TPN mix correctly at 4. At least that's only a once-a-day event.

EDIT: 8:54 PM - What a day. Released at 1:30. Dr. Smith removed the JP drains, which was a good sign - he doesn't expect any additional drainage. I am left with 'valves' in my neck which will come out when the fluoroscopy / scan comes back positive.

Much of the day was spent either slogging in traffic or in training at the outpatient IV facility. Page and I spent three hours learning how to operate my TPN (feeding) pump and my antibiotic courses.

Because of an oversight at the nursing station, I'm currently on 24 hour TPN - I was supposed to be on TPN 12 hours a day, so as to make getting around during the day easier. I'll discuss that with Dr. Smith on Monday and see if we can get that changed to 12 as discussed.

Today's training was grueling and complicated, or at least it seemed that way. I have to basically perform all of the day-to-day actions my nurses were performing. That means fetching ice (and making it, and crushing it), changing my sheets, hooking up my feed bag and antibiotics in a safe, sterile fashion, and in the case of the antibiotics, doing it every six hours; administering my own medication, doing my laundry, taking out my trash, buying my toiletries, and other tasks I haven't thought of yet.

Now I'm home, sitting on a couch with a bunch of cats at my feet, watching my favorite television show (Battlestar Galactica!) with Page. The air conditioning isn't so good here, and I don't have a magic button to push when I want something. Still, I think it will be better than just lying in bed another week, looking forward to nothing but a routine of medication and sleep. I'm happy to be back.

EDIT: 4/11/08 - 10:51 AM - My last nurse came in to update me. Everything seems ready to go, but he is making sure that everyone is clear on the schedule and expectations. Additionally, my representative from the Home Care organization came by to introduce herself, and give me her contact information in case I have any questions. Things are moving swiftly...

Well, today is the day. The nurses have already been in to check on me and let me know that last minute preparations are underway to get out of here. To my understanding, I'm just waiting on Dr. Smith to show up, maybe perform some last minute suture adjustments, and then Page and I will walk out of here around 1:30 to get on the road to Rockville so we can get IV training and pick up my supplies.

I'm excited! I am trying to transition myself to feeling like a normal person who walks and talks and goes places. It's going to be an interesting challenge just getting out of the hospital, and then enduring the drive to and from Rockville.

Until Dr. Smith arrives, my only tasks are to keep gathering belongings, and decide when to shower and get dressed (in street clothes, of course). Even though I still have a lot of restrictions on my life, like being tethered to an IV, covered in tubes and not being able to eat or drink, I really do feel like I'm breaking free and rejoining civilization. Hopefully, this coming Tuesday (or the next) will mean I can remove the feed bag, tubes, and start enjoying some real food and drink.

Thank you to all of my readers so far, I have been amazed at the letters and calls I've received over the past few weeks. I've really enjoyed being able to write back and answer questions about my progress and what my hopes are day-to-day. It's meant a lot to me.

Watch this space! I'll update this entry over the course of the day.

Jailbreak Plans

2008-04-10T13:42:00.003-04:00

EDIT: 8:59 PM. I got the news earlier, but just thought to update my blog this evening. I'll be leaving the hospital around 1:30 PM on Friday and will be traveling to Rockville, MD with Page to pick up medical supplies and receive training on the IV machines. Then we'll head back to Page's, where I will probably crash for the evening, reunited with my cat. I'm going to take Friday as easy as possible, and then think about getting my own apartment set up.

It's confirmed: I'll be released from hospital tomorrow, April 11th. Technically, I could get out of here tonight, but I want to make sure the various participants in my release (the social workers, the nurses, etc.) know their roles and the doctor's orders are correct and match up with my expectations before I bolt.

Once I'm ready to leave, it appears that I won't need to do anything until I get home. Sometime after my arrival at home (but within the current day), I'll get a call from the outpatient nurse who is working with my case handler. The nurse will arrange for delivery of my IV equipment and supplies, and then she'll set up a time to come over and train me. Page should be there for the training as well, so I will have a backup. From that point on, I will be on my own with some exceptions:

A nurse will visit at least once a week to draw blood and check on me in general.
I'll return to the hospital on Tuesdays for my weekly esophageal scan.
I'll visit Dr. Smith on Thursdays to discuss my case.

Most of the weekend is going to be spent acclimating to life at home and without constant nursing care. I am a little frightened, since my worry is that there'll be an issue with the IV that I can't solve and I won't be able to summon a nurse to look at it. Additionally, I'll have to provide for myself - no one will bring me ice on demand, or take my temperature. I'll have to train my cat not to gnaw on IV lines.

On the plus side, I'll have true privacy again, and the comfort of an area that is really set up to meet my needs. My apartment is spacious enough to accommodate an IV machine.

I was also told last night that they wouldn't be able to send me home with IV pain medication. It wasn't clear at first what alternatives I might have, since oral medication was not an option as long as my wound exists - but today I got an answer: I'd be given patches. Presumably the dosage will gradually taper off so I'm not left in the uncomfortable position of having to quit anything cold turkey.

I'm going to try to go into the office on Monday. I have no idea what shape I'll be in, but I need to get back to work, explain my situation, and figure out how to ease back into a normal work experience. As much fun as I'm having working on this blog, it's not going to earn me a paycheck anytime soon.

I'll have to start packing soon - this place is as messy as my apartment. Unexpectedly, I think I'll miss this place, or at least the nurses who have worked so hard to keep me comfortable 24 hours a day since my arrival in March. I'll return here once I'm better to thank everyone. For now, it's time to get ready to leave.

Post-Birthday Wrapup

2008-04-10T10:40:00.005-04:00

Last night's celebration turned out to be fine one. Page came over late-afternoon, bearing balloons and a suitcase full of presents, and we kicked off the party with birthday hats and noisemakers. I hope we didn't aggravate any of the other patients too much, but how can you have a 30th birthday bash in silence?

After a few minutes of happy reunions and making noise, I settled down to the important business of opening presents. I started with cards from my parents and my grandmother. These were thoughtful, funny cards, and they're now decorating the walls of my room. From my parents, I got two fun gifts - a puzzle in the shape of a globe - it's really spherical - and a curious game based around a cylinder filled with beads and toys. I'll have to try the game out with my roommates when I get back. I look forward to working on the puzzle - it'll give something to do while I sit at home and watch my IV infuser slowly drip, drip, drip.

Next, I tore into Page's gift assortment. Page took all of the gifts home afterwards to keep the hospital room neat, so I can't post pictures at the moment, but I'll update this entry later once I have my camera and the objects handy. From Page, I got the following awesome gifts:

A pair of painted googles, in the style of vintage welding goggles. Hard to explain without pictures, but they are similar in style to the goggles shown below. I have a hard time explaining my fascination with old goggles, but I love the look of the oversized welding goggles, or the distinctive style of old aviator glasses (think Red Baron-style frames.)
A beautiful shirt, short-sleeved, similar in style to the Guayabera shirts I wear constantly in warmer months. This shirt is much more ornate, though, with beautiful stitching and a great collar.
An adorable hand-made, stuffed hedgehog. I'm fond of hedgehogs, and hope to have one as a pet someday. Until that time, Page buys me hedgehog memorabilia, which is almost as good. I also got a magnetic desk hedgehog to hold paperclips with.
A fun handbook on how to assemble a robot army to defend against invasion from outer space or other threats. I haven't had a chance to read much of the book, but I like the art style a lot. Amazon link.
The piece de resistance: A SNOOPY SNO-CONE MAKER!

I had one of these as a child, like so many others. I hadn't thought about it in years until this hospital stay, when all I've been permitted to eat is crushed ice. I'd joked to Page that it would be great to have a sno-cone machine, since I could mix in any flavor I wanted and still be within the prescribed limits of my doctor's orders to not put anything in my mouth besides crushed ice.

As I fielded phone calls from family members, Page set up the machine and started making the first round of sno-cones using crushed ice from the nurse's lounge. The machine worked perfectly! I sat back and enjoyed a sno-cone and some pleasant nostalgia at having one of my favorite childhood toys come back to me in my old age.

We were soon joined by several nurses who'd come by to perform routine tests, or simply wish me a happy birthday. We couldn't convince them to put on party hats, though - too bad. We had a surprise guest in the person of Dr. Smith, who smiled approvingly at the Snoopy Sno-Cone Machine and the ongoing festivities. Dr. Smith had some serious business to discuss - I confirmed that I did want to return home this coming weekend, and he explained that various nurses and social workers would be by on Thursday to coordinate my release and the delivery of my IV supplies and training. One issue that came up, and still hasn't been resolved, is how to handle my pain treatment after I leave (since they can't send me home with a hydropmorphone IV, nor can I ingest anything.) We resolved to sort those and other issues out on Thursday, since my party was in full swing and I was much more interested in wearing goggles and birthday hats than speculating over the details of my impending release.

We were joined shortly by two surprise guests: Professor Sprocket and Karen Mitchell. Sprocket is the MC and organizer of the Weirdo Show, the monthly variety revue at the Palace of Wonders. As you recall, Sprocket gave me my performance slot at the March show where I received the injury that put me in the hospital in the first place.

Since my injury, Sprocket and Karen have been ceaseless in sending me supportive, funny emails that have helped keep my spirits up and keep me in contact with the ongoing local scene. It was great to have both of the arrive unexpectedly - it gave me a chance to talk about the accident with Sprocket and make sure we were both 'on the same page' about things, and to catch up with news about the DC performing arts scene. Page and I are both looking forward to getting out of here and getting back out into the clubs and bars to see our friends perform again.

I'll post more later with additional birthday details, and plans for tomorrow's 'jailbreak' from the hospital. Stay tuned!

Birthday!

2008-04-09T12:03:00.002-04:00

It's my 30th birthday! I could never have anticipated spending it like this, recovering in a hospital cot from a sword injury. I'm not bitter about it, though. Most of my birthdays are pretty low-key affairs - I'm happy to go out for drinks or dinner with a few friends, because on my birthday, that's what I'm grateful for - having friends. I can buy my own presents :) Since my hospitalization, I've received a staggering amount of messages from family, friends, well-wishes, and church members, some of whom only know me via prayer requests. To anyone who's reading this and has sent me an email lately: Thank you. My birthday is going great, solely on account of the concern and attention I've received over the past few weeks.

Today started with some special events. For the first time in three weeks, I showered! That's not to say I haven't been bathing - you can do a lot with some non-rinse soap and a few hand towels - but there's nothing like standing in a shower under a hot spray for 30 minutes after weeks of patchwork cleaning. The sutures are sufficiently healed, so I can get them wet - only the PICC line site has to be kept totally dry.

Not only did I get to shower, I got to wash my hair. Laugh if you want, but my hair was in a bad way. If you'd reached out and scritched my head with your eyes closed, you might think you were petting a terrier. My hair was akimbo, flung in all directions. With a little (ok, a lot) of soap, I managed to get my hair clean, and then dried and brushed back. To complete my mission of normalcy, I tried shaving, especially around the sutures. This task was much easier to perform with the stomach pump out.

After about 30 minutes of work, here I am:

The rest of the afternoon will be spent answering emails and thinking about how to organize my return to 9-5 life. I'll update this blog later after Page comes by and I open presents.

Tuesday Morning Anxiety

2008-04-08T07:23:00.007-04:00

Tuesday mornings at the hospital feel a little like Christmas - there's a hum of excitement in the air, and you know something special is waiting for you just around the corner. In my case, I have another fluoroscopy scan of my throat this morning. The results of that scan will determine whether I can start drinking and eating this week, and whether I'll be released this week as well.

I've been disappointed on the past two Tuesdays, so I refuse to get too enthused about this. I've resolved to be stoic and to accept the possibility of success of failure without getting overly emotional. I would really like to get out of here, though.

Watch this space! I'll update it later with the outcome.

EDIT: 11 AM. Got back from the scan. I've become a familiar face in the radiology department. There's still a small injury, but no idea whether it's considered small and removed enough to be sent home. Curiously, just after I got back in my room, I received a call from the discharge desk. They were under the impression that I'd be released tomorrow, so they needed to complete some questionnaires over the phone and give me some information about the treatment facility that would be assisting me with my IV. So I have no idea what's going on.

EDIT: 1:49 PM. Still no update.

EDIT: 4:02 PM. Still no update. I'm going to grow old in this place.

EDIT: 6:45 PM. Dr. Doe arrives. The 'leak' (that is, the wound) is not healed, which the doctors apparently thought it would be. It is very tiny, though.

We're not sure what will happen now, since apparently Dr. Smith and Dr. Doe didn't have a Plan B. My suggestion, and Dr. Doe appears to agree, is to go ahead with the liquid and food test tomorrow, and that will determine whether I need the TPN feed bag when I leave. It looks like getting out of here tomorrow is still on the table. Sitting on my butt here for another week is out of the question, as there's no reason to remain here when the IV equipment is portable. Dr. Doe seems to think that Dr. Smith will need some convincing. I will probably speak with both of them tomorrow morning.

EDIT: 9:00 PM. Dr. Smith arrives. He flatly states that I need to stay another week, just as before, and wait until Tuesday for another scan. I'm not surprised, exactly, but I'm not going to just let it rest at that. Before I can get started with an argument, though, he does say he can do something to lift my spirits: he'll remove the stomach pump. Now. I'm a little surprised - I thought there'd be more ceremony to it - but there's nothing, you just gently pull it out. It was another novel, uncomfortable sensation, but those are becoming commonplace here in the thoracic ward.

Dr. Smith and I discuss possible causes for the slow healing of my neck injury. We both surmise that it may be because of the drainage tubes which have been causing constant, mild irritation for me since their installation, and are sharing space with the injury. The plan, then, is to gradually pull the tubes away from the injury site. Dr. Smith says he can do it now, if I like, although I haven't had my pain medication. Why not?, I think, and he walks off to get a suture kit.

While he's stepped out, I try not to let the disappointment flood out of me, but I can feel it seeping around the mental blocks I've erected in my mind. Stoicism only goes so far, but I'm having visions of a very dull birthday. I can feel the bitterness in my eyes, and I know it'll be visible on my face when Dr. Smith returns. When Dr. Smith returns, I am on my laptop writing a letter to my family that lets them know I'll be here another week.

I'm glad I didn't finish the letter by Dr. Smith's return, though. In an unusual reversal, he acknowledges the truth of the situation: there is no real reason why i should be confined to this hospital cot any longer. The IV is the important thing. So, he offers to let me go home in a few days, if I want. Caveats: I'll have to use the IV for food and medicine. In the hospital, I'm being fed 24 hours a day, but at home, we can double the infusion rate for the TPN feed. It'll make social planning a challenge, but if I work at home, I can run the feed IV during the day, and keep the night free so I can go out.

Naturally, I won't be able to eat or drink anything (except munch on ice), and I'll have to figure out a suction alternative. Yet still, the prospect of going home seems too good to pass up. I think it'd be therapeutic just to be back in a comfortable situation - so long as I can keep Fluffybear from gnawing on the IV lines!

The best part, of course, is that I have some good news to share tomorrow on my 30th birthday. I can't wait! I'm happy I survived this long - I'm definitely going to play it safer for the next decade, I think.

The Perils of Recuperating in a Teaching Hospital

2008-04-07T16:53:00.004-04:00

When I was first admitted to the hospital, I was told that this was a teaching hospital, and was I OK with that? I was, I said; I envisioned doctors being trailed by the occasional student, who would be asked technical questions about my case as an exercise, just as I'd seen on ER. That was the case, in fact; several very competent young doctors-in-training came in and offered their best guesses at some diagnoses and other issues, and invariably the doctor agreed with them. So the med students are off the hook. On the other hand, it didn't occur to me that I would be victimized by nursing students.

Apparently, nursing students are free to torment helpless patients without the direct supervision of a trained, licensed doctor. During the course of my stay, I encountered at least three student nurses. One of these was completely competent and gets nothing but praise from me. The other two, well...

My first sour encounter with a nursing student occurred at about 4:15 AM. Nurses, as a courtesy, will knock and wait momentarily before entering, but if they have a task to complete and you are just one of several patients they need to see before their shift is complete, then your sleep schedule be damned - they'll wake you up. So at 4:15 AM, I am doing my best to awaken. I am bleary eyed, slumped awkwardly in my cot, my throat aches because the stomach pump tube has resettled during the night, my mouth is dry and all of my ice cubes from last night have melted, the IV machine is beeped inanely, and I am trying to sit up and orient myself so you, the nurse, can check my blood pressure, oxygenation levels, and my temperature.

At 4:15, a new face entered. A young fellow. I struggle to be pleasant and mumble good morning - it sounds more like, "Grmf magging" - and start working on sitting up in bed. The nurse - we'll call him Mario - smiles, says hi, and walks over to my left. So far so good, but I do notice the "Montgomery College" patch on the left sleeve of his shirt. Are you a student, I ask. He replies yes, and I notice a bad sign - he's nervous. At least he's not drawing blood, I think. We chat a little as he struggles to wheel in his diagnostic machine. He nearly sends my laptop flying to the floor, but I manage to twist and save it, a phenomenal achievement for the time of morning and how long I've been awake. I start to think this is the first time he's done this.

Now, there is a pretty fluid ritual for getting these routine diagnostics done. I sit up, I roll up my sleeve, you apply pressure cuff and then oxygenation clip to one of my outstretched fingers. Then we deal with the thermometer. This should have been the procedure, but instead, the new nurse decides to add a new step in and adjusts my bed.

Now, I've described how I learned to operate IV machines and suction devices. Those were easy. The bed that I'm on is something else. It has no less than four control panels and two remote controls, each with some degree of overlapping features. There are no words on the bed, only a series of vague pictograms depicting the associated action produced by pushing a particular unmarked button. These buttons can raise or lower my bed, or tilt it, or raise or lower specific parts of the bed. The bed can lifted all the way to the ceiling!

Because my high-tech hospital bed is so fiendishly complicated, I don't want anyone to touch it but me unless they have a very good reason to. Unfortunately, my nurse - who is short - decides to press a button and raise my bed. I go shooting up a foot into the air, and he begins his process. Fine, I think. At least he didn't change any angles. We conclude the vitals-taking - it's 4:25 now - and he decides to try to put the bed back down again. Unfortunately, he doesn't know how to.

The nurse does the worst possible thing in a technological crisis, which is to press all of the buttons in hopes that one of the buttons will produce the desired result while undoing the effects of pressing all of the other wrong buttons. What the nurse managed to do was elevate my feet a good foot and a half about my head. Picture me, as I have described myself. Take into account the fact that I have an upset stomach, and a stomach pump which is ostensibly pumping things upwards. Blood and gastric juices are now sloshing their way towards my head, and I am gurgling furiously at the nurse to put me right back down this instant and go find the head nurse and tell her I want my pain medication stat! The nursing student does exactly what any freaked-out student in his position would do - he flees. "I will tell the nurse!", he chirps frantically, and bolts from the room.

Time passes. In about two minutes, I start hollering and hammering the Page Nurse button on the side of the bed. I can feel my head turning red with pressure, and my stomach losing its struggle with gravity. Finally, a real, certified nurse shows up, squawks in horror, and starts attempting to decipher the cryptic runes on the side of the bed. Apparently, no one has been in this position before.

With mere moments to spare, we figure out the mystery of the mechanical bed: Although there is an 'elevate feet' button, there is no button to produce the opposite effect. Instead, the solution is to raise the bed all the way to the ceiling, where it will gradually flatten itself, bringing head and feet level. Then one can press the 'lower all' button, and gradually bring the bed down to the floor.

A few minutes later, I had my pain medication injection, my stomach settled and I went back to sleep, only to be interrupted two hours later by another nurse interested in my vital signs.

Coda: I never saw Mario again. I hope he hasn't trapped anyone else in an upside-down arrangement. Two nights later, a second nursing student came in and did the exact same thing. Fortunately, I knew how to fix the problem, so the student left a little wiser after the experience.

The Long Interval

2008-04-07T12:06:00.012-04:00

With the shift to the private suite on the fourth floor, I entered the penultimate phase of my hospital experience (before my actual release.) Days started to blur into each other as I was left alone for hours at a time, free to read and write, or find other ways to pass the time between the all-important Tuesday scans.

For the most part, I was only dimly aware of what was going on outside of my room. The nurses occasionally told me about particularly unfortunate cases, or whether the day was especially busy or placid, but I never ventured far beyond my own door. This was due in major part to the fact that I looked like a monster. Without haircuts or shampoo, my hair had grown and blossomed without restraint into a massive red tuft. The sutures and pipe insertion points on my throat were red and bulging; I looked like I'd be stitched together from spare parts, like an Irish version of Frankenstein's monster.

Every night, Page would visit me for a few hours to watch a few episode of a television show. Although I rarely watch television on my own, Page and I have a long tradition of spending evenings in and watching (and commenting on) a few select shows. While hospitalized, Page and I have been working our way through Lost and Dexter. At her recommendation, I'm also watching Firefly, which is apparently a hybrid sci-fi/western series that only lasted a single season.

For my upcoming birthday, Page and I had two major events planned: a trip to San Francisco, and dinner at Minibar. Unfortunately, I've had to cancel both, as I've been unsure of when I'll be released, and when I'll be able to eat solid food again. As I type this, Page is in SF now, and I miss the company. It's a real pleasure to sit in comfortable silence in the dark and watch a compelling show, especially when you have all of the back episodes on DVD and don't need to wait week-to-week for the next installment.

I'm also getting some reading done. I expected to read more fiction, but I haven't been able to muster interest in anything beyond Stanislaw Lem's The Futurological Congress. Lem is one of my favorite authors, one whose work is praiseworthy for many more reasons than simply being well-crafted 'science fiction'. This particular book is a vicious satire of government and professional conferences; I've had to put it down, though, since its hallucinatory themes are a little too close to comfort, considering my medical situation.

My mother, who is working on a Master's degree in the sciences (I forget what field, specifically), shipped me several of her textbooks, all of which are nonfiction. I'm finding science topics more compelling than fiction, lately. I'm currently reading Plagues and People, by William H. McNeill. I haven't got very far in it, but so far it seems like a cogent attempt to explain aspects of civilization's development through the impact of diseases.

The hospital does not provide free wi-fi, so my heart goes out to anyone imprisoned in this place with a laptop and no source of an Internet connection. Fortunately, I have a cellular card for my laptop that gives me a wireless connection, so I can update this blog, check my email, and so forth. Unfortunately, it's not fast enough to listen to many Shoutcast internet radio stations, so I've had to download podcasts and listen to my existing stock of music if I want a soundtrack for my days besides the incessant clicking and wheezing of the IV machine. For Podcasts, I tend to listen to a lot of science-themed shows, as well as talk radio and a few music-themed shows. I tend to switch my lineup around weekly, listening to just about anything that touches on a topic of interest to me. My current lineup includes:

Since I have the room to myself, I can also afford to play the music I like at all hours. Like anyone, I'll tell you that I think I have broad tastes in music, but I've really only been listening to a lot of ambient and downtempo music since I got here. I haven't got the energy or mood for a lot of uptempo stuff. Some of what I've been listening to includes:

(Yes, I listen to a lot of Projekt Records alumni.) Because I'm a nice guy, I posted a collection of a few tracks I've been listening to lately. It's available here (note: you need to enter the requested text and wait a minute before the download starts.)

Once I moved to the fourth floor, I began to settle into a more predictable routine as my condition stabilized. I could look forward to a nurse taking my vital signs at 4AM and 7AM, just before shift change, and then every hour or two until about midnight. If the day wasn't too hectic, I'd try to talk to the nurses about their work, and how the other patients were doing, or ask them to explain how various pieces of medical technology worked. That last activity turned out to be supremely important.

When I first moved to the fourth floor, I had no understanding of how the IV machines or the stomach pump worked. All I knew is that I was tethered to a heavy machine on both sides of my body, and if I needed to get up for any reason, or if a machine should start beeping loudly in complaint, I'd have to the page the nurse's station and request assistance. Sometimes a nurse or tech would show up in five minutes, more often within half an hour - and on one or two occasions, never. So, over time, I learned to operate the machines. I could start, stop, reset and troubleshoot a finicky IV (and they were all temperamental machines), and disconnect it from the wall so I could amble about freely. I learned how to disconnect the stomach pump and seal off the tubes (verrrrry important) as well. Being able to complete these activities meant that for the first time in over a week, I could get out of bed of my own volition and use the restroom, or walk to the window to look at the world below.

After the second Tuesday scan, the decision was made to provide me with some kind of nutrition. There had been some faint hope that I'd be out within the first week, but after a week and half, it became clear that my stay would be an extended one. By the start of April, I had to receive the following substances intravenously:

Fluids
Various antibiotics (Vancomycin, Unasyn)
Total Parenteral Nutrition (my feed bag)
Dilaudid (a.k.a., Hydromorphone)

To accommodate each of these substances, it was decided that a PICC line should be installed. PICC lines have the advantage of reducing the likelihood of infection and trauma by providing a semi-permanent set of 'input' valves to my veins that can be used for injecting all of the above subtances.

The installation process took about 45 minutes. Essentially, the technician had to thread two IV lines through a series of veins until the tips of the lines arrive at the heart. One line is used exclusively for food delivery, and the other for everything else. Once that was installed, it became a much simpler process for the nurses to inject things, and it became easier for me since I didn't have to worry about a constantly changing IV site and having to receive needle injections for one-off applications of medicine.

Once the PICC line was installed, I got a new toy: a drip feed for the Dilaudid. Not only did I receive a constant trickle of pain medication, but I could summon more of it using a 'clicker' every 10 minutes. After the first week, I came to rely upon the Dilaudid to relieve the discomfort of having various tubes in my throat and chest, and an abraded, dry throat which I could only partly wet with the ice cubes I was permitted to chew on.

When I had the opportunity, I spoke with the nurses about their lives at the hospital. I wasn't interested in knowing details about other patients, nor would I think appropriate to ask, but I did hear stories about patients from other floors. Knowing that there was a young lady covered in stab wounds to her torso, or that there was someone my age suffering in the Oncology ward did a lot to quiet me if I was feeling frustrated about my situation. Mostly, though, I'd ask the nurses what they enjoyed about nursing, and how the job treated them. The responses were unanimous: Each nurse stayed with the job because of the satisfaction of being able to help someone in a direct, physical way, and because it made them happy to see a patient recover and leave the hospital. At the same time, the nurses all agreed that this particular hospital was an extremely challenging environment, perhaps too challenging.

I spent an afternoon reading about the nursing profession (since I had encountered some male nurses during my stay), and contemplating whether it would be something I would be interested in as a career change. I've set the idea aside for now, though - as Page pointed out, I've never tolerated human foibles very well. I'm not sure I completely agree with that assessment, but I don't know if I'm made of the stuff needed to be a patient, successful nurse.

The days pass in a homogeneous fashion as I settle into a rhythm of tolerance for the constant medical evaluations, questions, and the stretches of solitude. The days themselves are broken up by intervals of pain medication. For the most part, the only quality to distinguish one day from another is its relation in the calendar week to Tuesday. I've been at the nadir of my spirits Tuesday afternoons, as I found out the wound hadn't sufficiently healed and that I would need to remain an additional week. Gradually, an arc of anticipation builds up, until the next scan is performed the following Tuesday. And then the cycle repeats, and continues to repeat.

Trauma Center

2008-04-07T08:22:00.014-04:00

After my initial triage and surgery in the ER, I was given a place to rest in the Trauma Center on the third floor of the hospital. Normally, I would have been lodged in the Thoracic ward, where Dr. Smith presided, but they were too full to take me. I was moved into a shared room with another patient, and I began my recovery.

My new nurse, Jane, explained the facts of my case to me. There were several medical issues that the nurses and doctors were concerned with:

- The actual injury. Because of the reality of infection, the wound site had to be kept as clean as possible. A tube attached to a pump had been slid through my nose, down my throat, and into the pit of the stomach. This tube constantly pumped out the contents of my stomach, so as to minimize the likelihood of reflux or bile reaching up to the esophagus. I was also given Nexium to reduce the irritation to my throat caused by the tube.
In addition, I was forbidden from swallowing anything under any circumstances. This included saliva, water, or any other fluids. To help me achieve this, I was given a suction device that I could use whenever I needed to empty out my mouth. The suction device was basically a wand attached to a long hose.
- Infection. From the doctor's standpoint, infection was a certainty, not a possibility. Human saliva contains hundreds of different types of bacteria, some of which could cause serious problems if they infected a wound. I would be on constant IV antibiotics for the duration of my hospital stay (and probably longer.)
- Nutrition and hydration. To begin with, I was fed nothing, but was given basically sugar-water via IV line for the first week of my stay. I was also given additional fluids to make sure I stayed hydrated in spite of my inability to drink anything.
- Chest swelling. My injury had resulted in edema, where fluids such as blood and pus, as well as air, had penetrated into the interstitial spaces of my lungs and chest. I had very little breathing capacity after my accident, and breathing, coughing, or clearing my chest was excruciating. To alleviate this, a series of drainage tubes had been installed in my throat and chest.
- Pain. As you might imagine, I was in considerable discomfort at first, and would remain in pain for the duration of my hospitalization. The pain resulted from the injury, the chest and throat swelling, the surgery sites, and the rigid plastic hose that ran from my stomach to the pumps. To combat this, I was given shots of morphine every two hours.

My first room was about the size of a small hotel room. The room contained a sink, a small private bathroom, and was equipped to accommodate two patients. The room was divided down the center by a curtain. I was given the window view, which was nice.

My first roomate was a hysterical man who had apparently been struck by a car. I never saw him, separated as we were (as I was totally immobile). He spoke in a weird patois of Spanish and gibberish that rarely made sense. I didn't mind him - he never spoke to me.

My parents arrived on Sunday. I don't remember much about our initial conversations, except that they had a lot of questions for the doctors about my prognosis and what kind of tests would be performed. My father seemed unusually fixated on the results of my 'cultures'; he was interested in knowing what infections I was developing. My parents, to their credit, were nonjudgmental, simply curious and concerned. My father left on Tuesday, satisfied that I was in competent medical care. My mother stayed until Thursday.

Because I was getting so little sleep, I had to stagger social visits. Usually my parents would arrive in the morning, then Page would arrive in the afternoon with some overlap. It was simply too draining to try to carry on conversations with three people and a nurse for hours at a time.

I was not the best patient I could have been. I felt profoundly annoyed at the fact that I was in the hospital at all, and doubly so at the various impositions placed upon me. At least every two hours, a nurse or a technician was coming by to listen to my heart, take my temperature, blood pressure, and oxygen levels; check my urine output, give me a shot of morphine, administer fever reducers, or simply come by and check on me. The constant interruptions took a toll on me. By Tuesday, I was having waking dreams whenever I lost focus on someone or something. In my dreams, I'd stand up from my bed, get dressed, walk outside and resume my life. The visions were so authentic that I was jarred and saddened when I'd suddenly twitch and wake up, still bundled up in my cot.

I had a sort of breakdown Tuesday night. I remember it clearly, as my nurse Jane crashed into the room in her grand style, anxious to check my vital signs for the twelfth time that day. "Jane," I moaned, "I need sleep! I haven't slept more than two hours at a time since Thursday! You have to go away and let me sleep!". I was furious, and mad - between the pain medication and the lack of sleep, I couldn't tell what was real anymore. Patiently, Jane hovered above me and explained that for the time being, the interruptions had to continue. My temperature was swinging wildly and the fluid in my lungs was reducing my oxygen intake to 80-85% of what it should have been. They left me alone a little more that night, though - I got four hours of sleep.

Above: The author in his cot. Note the sutures where the drainage pipes were placed, the short drainage tube of yellow rubber which drains the area around the main drainage pipes, oxygen tube above my lip, stomach pump tube through my nose, and the pair of tubes extended from the top of my neck to Jackson-Pratt drains.

Jane, my nurse, was a memorable character. She was tireless and completely unmoved by my stated desire to be left alone to lie in bed. If Jane felt I needed to walk on shaky legs for 30 minutes a day, she'd force me. If I whined about the injustice of waking me every few hours for tests, she'd simply pull out the clipboard that contained my track record for vital signs, and point to instances where I'd had a temperate of 102, or my oxygen utilization had dipped below 86%. I credit her with saving my life, though. Her constant vigilance meant I had immediate care from a team of doctors when I flew into a sudden fever at 4 AM. She watched patiently while I painfully struggled with an inspirometer to regain lost lung function (I had about an eighth of my normal lung function immediately after the surgery.) Jane helped me wash up, held me by the arm and walked me up and down the hallways in aching exercises, and continued to check on me after I'd later passed into the care of other nurses.

In some ways, though, Jane seemed to be a product of her environment. As troubling as my injuries were, I belonged in an environment that provided specialized care. The trauma ward was synonymous with mayhem. Daily, I heard whispers about gunshot patients, or sad victims shuddering in the burn ward units next door. Jane was never relaxed, and she often seemed to ignore questions or misinterpret things that were said to her.

I spent the next few days shuttling from room to room as new patients moved in. Because I was at special risk for infection, I had to be kept away from patients with infectious diseases, such as MRSA (i.e., a Staph infection). I was briefly moved into a private room (the scene of my breakdown in front of Jane), and then back into a shared room. My next two roommates seemed no better adjusted than the first. One was a middle-aged man who'd suffered a gunshot wound to the side; he was attended at all times by an entourage of attractive young women. He was polite to me, but harangued the nursing staff constantly, and would call up acquaintances of his to demand to know where his money was at, or in one instance, to berate a member of his harem for spending his lucky $5 bill at the cafeteria. After he left, a sullen young man was admitted, who complained of headaches. He said nothing, but merely stared at the walls or anyone else who walked in the door. I was careful to keep the curtain drawn between our bunks - I didn't want to make eye contact with him if I could help it.

The first week continued to be stressful. On Tuesday, I had the first of several Tuesday CT scans of my chest. These scans, performed after ingesting a disgusting iodine milkshake, showed high-contrast images of the injury in my esophagus. For the first time, I could see the gouge I had made. I had hoped that the initial scan would have shown a smaller wound, but I had really done a number on myself. The CT scans would become the most significant event in my weekly schedule: I would be kept comfortable and alive, and each Tuesday, the scan would be repeated. I would be released when the scan revealed a wound that was small and had healed to the satisfaction of Dr. Smith.

My mother remained, and we had the first of several good conversations about my life and what I'd been up to. I had a chance to honestly and openly discuss my sword-swallowing act, and why I'd taken up the hobby at all. It was a great comfort to have her there and to be able to talk, person to person. After she left, I stayed in frequent contact with my family via phone and email, but those first few days of direct contact helped a lot.

Page continued to visit. The stress of the situation began to take its toll on her as well: we squabbled violently over what her role was in this situation, and how she could best help me. I hated to be selfish, but I was; all I knew was that I was lying in bed with a very serious injury, and that I was constantly teetering on the brink of a deadly fever. Eventually, we reached an accord as my routine settled, and she better understood what I needed and that she was entitled to go home and take breaks.

My situation also improved when Dr. Smith approved my request to be switched from morphine to dilaudid, the same miracle drug from the first hospital. The morphine had never done much to dull my pain; instead, it had made me sleepy and incredibly itchy, and had contributed to the bizarre waking dreams. The dilaudid, administered via a constant IV drip and on demand via a 'clicker', produced a huge improvement in the quality of my life.

At the end of the week, a great thing occurred: I was moved permanently to the Thoracic recovery ward on the fourth floor. The new room was practically the penthouse suite; it was nearly as large as my own apartment bedroom, and had a private shower and toilet. Excitingly, there was a large window that faced the landing pad for the airlift helicopters; I could see where I'd been brought in a week prior, and could watch when new patients were brought in. Best of all, it was a private suite. I'd be blissfully alone for the greater part of my stay.

Above: The cot in which I'd spend approximately 23 of 24 hours a day. It's surprisingly comfortable, and adjusts itself automatically and periodically to help avoid cramps and blood clots. The bed had several remote controls which could be used to adjust the elevation of parts or the whole of the bed.

Above: My work area. The little rolling table held my laptop, phone, headphones, tissues, books, DVDs, surgical tape and the remote controls for the radio, television, and the bed. To the right is a reclining chair which Page commandeered during her nightly visits.
In the back, there are three drainage reservoirs, attached to various tubes. The reservoir on the left received fluids that I could suction out of my mouth using the wand. The central reservoir held the contents of my stomach. Fun fact: Everything in your stomach turns yellow or green. The reservoir on the right is unused.

Above: One of the views from my room. The square, light-colored platform in the center of the picture is the helicopter platform which we used during my transport to the hospital.

I left Jane's care when I moved into the new room. Although I missed her fierce concern and around-the-clock vigilance (she never seemed to be off-shift), I was tired of the intensity of the trauma unit. In the new room, I'd be seen by a rotating staff of nurses. By the end of the first week, my condition was stabilizing: the infection was still present, but the fevers had been consistently suppressed. I was regaining strength in my legs, and could stand upright and move around unassisted for minutes at a time.

In many ways, the 'acute' phase of my hospital experience had passed. I had a routine now; scans on Tuesdays, to determine if the wound had healed sufficiently to let me go; established sleeping hours between midnight and 7 AM, only interrupted twice for vitals and pain medications; evening visits from Page, every day; and finally the great interstitial gulfs of boredom, during which I'd have to struggle to pass the hours spent in a single bed, with no end in sight to my ordeal.

Emergency Response

2008-04-06T12:26:00.007-04:00

My memories of those first tense hours in the hospital are a little hazy. I remember being wheeled into an ER room, where I lay gasping and choking, face screwed up in pain. The moment-to-moment pain was bad, but not excruciatingly so... it felt as if a bowling ball had lodged itself in my chest. The real agony began whenever I swallowed involuntarily - it was if a wave of pain rolled down my throat and into my stomach. I remember wincing and arching my back for seconds in the wake of each swallow. I will always remember those first waves of pain as being the only thing I've experienced in my adult life that made me mewl like a hurt kitten or a child.

Bedside x-rays were performed, and eventually the diagnoses came back: I had cut open my esophagus, the classic sword-swallower's fatal injury. I remember feeling a dull amazement that I had managed such a serious injury so early in my career. Throughout this time, Page remained by my side, holding my hand and talking to me, and shushing me gently when I talked too much in reply.

Nurses questioned me about my injury. To one confused medic, I struggled to explain that my injury was accidental, although placing the blade in my throat was intentional. She stared blankly at me, apparently convinced I had survived an elaborate suicide attempt.

Eventually, some nurse - I don't remember their names, now - some saint brought me pain medication. I was brought dilaudid (hydromorphone) by an anxious nurse who tried to explain that the first-time experience of using intravenous dilaudid was analogous to that of the first-time crack cocaine user. I was a skeptical, although excited, since at this point I was starting to wonder whether there was a chance I could be put into an induced coma to escape the buffeting agony in my chest. "You might hallucinate," the nurse said, and she murmured a few more warnings before the needle slid gracefully into a vein.

I sat, propped up in my cot, and waited. Moments passed, and then my eyes opened wide, and I blinked involuntarily. "This is real," the nurse kept repeating, and I started to feel vaguely annoyed that the nurse felt I couldn't discern reality despite the lovely gauzy sensation that was spreading throughout my head and body. Eventually, she quieted down, satisfied that I hadn't disappeared into some remote part of my psyche, and for the first time, the pain was muted to the same gripping discomfort I had felt the previous evening at the Palace. It was 4:30 in the morning on March 21st, and I was awake and waiting.

Throughout this time, Page waited, awake and alert. She chased down nurses when I had a question, kept my things together, and held my hand when I shivered in pain or didn't want to feel alone. We rested together until 5:30, when a doctor returned with some surprising news.

"We've decided to transfer you to a new hospital. Their trauma center is better equipped to handle your injury. A team will be here in a few minutes to transport you, and you'll be taken by helicopter." I was surprised. Cross-town traffic couldn't be that bad at this time of morning, and a helicopter ride - as thrilling as that would be, terrible injury or not - seemed excessive, like the sort of thing they reserve for people who might die unless they received immediate care. I didn't quite make the mental connection those thoughts implied, but Page did. Things were more serious than I thought.

The EMT team arrived and began 'packing me up' for the trip. I mean that literally; I was swaddled in padding and strapped to a gurney, completely immobilized from head to toe.

Page and I decided to rendezvous at the new hospital. I was hurriedly wheeled out of the ER and taken to the roof where we'd then venture to the helicopter pad.

The airlift to the hospital had a tinge of surreality to it. In my immobilized position, it was difficult to look anywhere but straight ahead, or down above my feet. I remember the doors to the roof being thrown open, and a gust of cool air hitting my face as I stared upwards at the stars, strangely visible through the smog-filled DC air. Somehow I was conscious of my height, as we were rolling across the hospital roof, and I felt a germ of terror as I realized I was being pulled against my will, with no way to defend myself if a medic should lose control and my gurney careened towards the roof's edge...

A moment later, the fear disappeared and was replaced with a new sense of confusion and amazement as I was slotted into the back of the medical copter. I understood now why a medic had asked if I was claustrophobic. I was surrounded on all sides by blinking orange lights and electronics panels; a readout suspended above my head flashed my vital signs. I could peer just past my feet and look out the rear window of the craft; I could see the receding rooftop of the hospital, then the tops of other buildings, and finally stars in the distance. I imagined that I could roll out of the helicopter, and plummet into the night air and be forgotten.

The trip took longer than I was told; eventually, we landed and the boarding process was executed in reverse as I was wheeled indoors and finally left in a waiting room. Nurses and doctors swarmed and asked questions; I answered as best I could. My neck was swollen and tender for some reason; I found it difficult to speak clearly, as my voice still had that alien, nasal quality to it. I explained that I was a sword-swallower; from nowhere, Page appeared, and offered to bring in the swords for examination.

After an hour or so of questioning - my sense of time was not very firm - a new doctor showed up, Dr. Smith (a pseudonym). It was explained that he would be the doctor in charge of my case. Dr. Smith was straightforward and very candid. After providing him with permission to speak with my parents and their contact information, he told me that I had indeed lacerated my esophagus and would require surgery to drain the wound site of air, pus, and blood. Furthermore, there was a chance that I would die of my injuries.

I should pause for a moment to say that I always understood that sword-swallowing was a potentially fatal activity. I was never under any illusion that inserting long, rigid objects down my throat and to the pit of my stomach was a fundamentally safe thing to do, and furthermore, every sword-swallower I'd known had incurred some kind of serious injury in their careers. It seemed like an accepted cost of the profession.

At that point, speaking with Dr. Smith, I had one of those uncomfortable moments where simply knowing something is possible doesn't adequately prepare you for when that thing occurs. Dr. Smith didn't mention it, but I knew from past research what the mortality rates were for the type of injury I'd received. For someone like me, who had sought medical care within the first 24 hours, I had the best chances - 75% survival rate. Every day one waited, the mortality rate shot upwards. If I'd gone home and tried to sleep the discomfort off instead of going to the hospital when I did, my chances might have slipped to an even 50-50.

Page took it badly, but she'd been been through a lot already. I felt a sort of wretched guilt for having put in her in a position of uncertainty and concern - no one should have to sit next to someone you care for, and have to honestly confront the possibility that they might not be there the next day to help carry on your shared lives. What was worse, I needed her to call my family and tell them what had happened, in the most oblique terms - I didn't want her to have to explain sword-swallowing.

In what was probably poor timing, considering our alarm at Dr. Smith's evaluation, the hospital chaplain arrived to provide spiritual comfort. The chaplain, a middle-aged black woman, smiled above me as I lay pinned in my cot. She offered to pray with me, and I accepted her offer. Page looked on in concern, and I listened silently as the chaplain prayed for my wellbeing and deliverance. The solemn mood was broken mid-prayer as the chaplain intoned, "Dear Lord, save this young man from whatever this thing is that he's done to himself," and continued with her prayer. I laughed internally; surely God had seen this sort of thing before? I knew I wasn't the first sword-swallower to confront his own mortality.

What else we discussed was hazy. As the sun came up, I was wheeled away to surgery. I remember answering the same questions, over and over - did I have any allergies, any pre-existing medical problems, and so on. I was finally placed in a room full of bright light, where strange music played in my ears - to mask the sounds of surgery? - and I was given a mask to breathe from. Moments passed, and all things faded.

I woke in a noisy room full of nurses and doctors. I was upright in a cot. Page was there. I felt better - the pressure was gone from my neck. In exchange, I had a series of tubes running from my neck to somewhere in my medical gown. An oxygen tank pumped air into my nostrils from a clear tube. I think they must have given me more drugs - the remainder of the day is unclear. I sent Page home to sleep and rest, to play with her kittens and think of other things for a while. I received news that my parents were en route from Florida - they wanted to see for themselves what I'd gotten myself into.

Finally, I was moved to my first residence outside of ER - the Trauma Center. For the first week, I would be living in the Burn Ward. I wasn't a burn patient, obviously, but there was no room in the inn, so to speak, in the thoracic recovery ward where I'd normally be placed.

The date was Saturday, March 22nd. It was the start of several weeks in the hospital.

The Big Night

2008-04-06T09:40:00.000-04:00

Thursday, March 20th. I don't recall much about the day at work; I probably spent most of it trying to concentrate on projects and failing. The drive to and from the office was spent reciting my lines, injecting as much expression and enthusiasm as one can while careering down the Dulles Toll Road during rush hour.

I met Page at her apartment where we gathered up stage materials, switched into costume, fed the cats and made sure we had everything I needed. We had to hustle - the show wasn't until 9, but the goal was to arrive at the Palace by 7 so I'd have time to switch into costume and do a dry run of the act on stage before any customers filtered in.

We arrived on time, and greeted Priscilla, the Palace bartender; Marie, sound person, and some other friends and significant others. The bar was desolate and quiet. Page and I retreated to the back stage area, a tiny dressing room that could accommodate perhaps four people at a time, if none minded sharing the lone mirror in the room.

The first issue was makeup. I was skeptical at first, but Page did a fantastic job of making me look younger than my age. With pride I looked upon myself; polished leather shoes, fitted black slacks, pressed white dress shirt and the sleek, velvet vest. My hair reached to the ceiling in an improbably pompadour. The look was perfect; handsome, not slovenly, but faintly ridiculous. I looked around the dressing room; almost every inch of the walls were covered with the signatures of past performers. In a few hours, after I'd performed, I knew I'd have the right to scrawl 'Rex Libris' upon the Palace walls as well.

The next task was to set up lighting and stage arrangements. Marie, the sound person, gave us some bad news: the control board for the lighting system was out for repairs. So we had only a few options for lighting: no lighting, one light on the front of the stage; two lights, one in front, one in back, or basically everything on at once. We chose the two-light option, since Page would be stationed to my left flank, and I would be front and center. With the lights up, I realized I had an advantage in the glare: I could barely see the crowd. The fewer eyes I had to make contact with, the easier my job would be.

I was entitled to a drink. I have a strict policy of not practicing or performing while intoxicated, but a single glass wouldn't hurt. Backstage, I sipped my gin and tonic, and waited. 7:30 arrived, and I knew I had to get out there and review. Setting my glass down, I gestured to Page, who began gathering up the swords and the stand. I strode up the short steps leading to the stage, took a deep breath and passed through the curtains. Outside, the MC fulfilled his part of the rehearsal, but I barely heard a word until the stagelights filled my eyes and I heard "and now, Rex Liiibrisssss..."

"Good evening, Palace of Wonders!
My name is Rex Libris, and this is my lovely sidekick, Page Terror!
Some of you may know Page from her burlesque performances, but tonight, she'll be assisting me with my own dangerous pursuits!"

I gesture to Page, who tears a cloth away from the sword stand, revealing the blades with a flourish. Smiling, she hands me the first sword - the Robin Hood blade.

"Tonight I will be swallowing swords for you. Sword swallowing is a dangerous art that dates back thousands of years; only a few living performers exist today. There is no trick; the swords you see in front of you are entirely real; they do not fold up into the handle, and they made of steel hard enough to pierce through my tender flesh. To prove to you that the swords you see in front of you are indeed sharp, Page will assist while I slice this firm banana in half with my sword. The banana, please, Page!"

Chuckling, Page extends an innocent banana and shields her eyes. With a quick chop, I hack the banana in half. Page gathers the banana bits as I turn my gaze back to the glare of the stage lights. I can dimly see smiling faces at the bar as the other performers watch.

"If you've never seen this act performed before, it's really very simple. All I have to do is pass two feet of solid steel down my throat, suppress the gag reflex, pass the blade through the esophagus and finally bring the point to the very pit of my stomach... Page, you did wash your hands, right?"

I give Page a skeptical look over my shoulder and she makes a noncommittal nod of assent. I look back at the crowd, and I hear Page spitefully cough on the next sword. I hear a chuckle from the audience; it's all scripted.

"One mistake, and this will be a very brief performance!"

I heft the sword in front of me, holding it aloft flat in front of my chest for the audience to see. Gingerly, I lick the blade, wetting so as to gather any errant dust and make the blade easier to pass down my throat. At this point, I'm wishing I'd had a second gin and tonic.

I orient the sword so that its tip rests upon my tongue, the blade in alignment with my body. I breathe deeply, then exhale slowly. Like an archer sure of the moment, I swing the blade up in one smooth motion, arcing my head back to face the top of the stage. The blade descends, muscles relax, and the sword slides gracefully to the pit of my stomach. Thrilled to have made it this far, I bow to the audience, bending down to one knee to grin wildly. I can only bear the presence of the sword in my throat for a few moments, so I quickly resume my posture and withdraw the sword, passing it back to Page.

Page retrieves the sword and steps forward with the sai. Together, we face the crowd.

"Next up, I have something a little exotic. Who here remembers the 80s? Do you remember the Teenage Mutant Ninja Turtles? One of the turtles had one of these - this is called a sai. For a special prize, who can name the turtle?"

Greggi Glitterati (not his real name) - the fellow who is doing a Christ impression - correctly calls out, "Raphael!".

"Congratulations, you've won a prize. Page, tell them what they've won!"

From behind me, Page calls out gleefully, "You've won... A BANANA!", and tosses the wreckage of the bisected banana to Greggi. Laughter.

"This is a little shorter than the sword I've just used, but it's dangerous in a different way. Sir, would you please inspect this blade?"

Page hands the sai to Greggi.

"It's quite heavy, isn't it? Thank you."

Page retrieves the sai and begins cleaning it.

"You've washed your hands too, right?"

Page hands the sai to me.

"Now, this is basically a thick steel spike. It weighs twice as much as the first sword you saw - I dropped this on my foot a month ago, and the bruise is still there, a month later. If I should lose control of this, I wouldn't be able to prevent it from punching through my throat." (Ed.'s note: A month and half later, and I *still* have the bruise. I think that darn thing broke something.)

I heft the sai, and like the previous sword, swallow it successfully. No bow this time, it's too chancy, the sai weighing as much as it does. By this point my throat is aching already; the sai didn't go down gently, I suppose. I'm halfway done.

I return the sai to Page in trade for the long sword. This is the easiest part of the act; the sword is thin and light, especially compared to the broad Robin Hood sword and the thick sai.

"This sword is a little longer; the blade itself is 24 inches long. It is also the longest sword I am physically capable of swallowing. This sword goes all the way down into my stomach and the tip will rest just above the entrance to my small intestines. I should tell you that this is my first time performing at the Palace of Wonders, and I've got butterflies in my stomach, I'm a little nervous! So you can help me out by being sure to clap and cheer wildly after I swallow this sword. I promise this'll be entertaining - and if something goes wrong, if I slip and don't survive - Page will rifle through my wallet after the show and distribute the contents.

Here we go - Look out, butterflies!"

I tip my head back, wet the blade and lift the sword aloft, just as I'd done with the Robin Hood sword. I rest the blade on the tip of my tongue, throw my head back and slide the blade down... and it stops.

The blade stops, midpoint behind my sternum. It goes no further. I am staring in confusion at the ceiling, and for the first time become away of a tight discomfort in my chest.

I remove the blade and apologize to the glare. Nerves, I say. I'm shaken, but still composed - I've done well so far. I try again, relaxing as much as possible.

It stops again. Confused, I say to no one in particular, "It just won't go down. Page looks at me with concern and, I suspect, growing embarrassment. "I'm taking five," I say, and chuckle, but mentally I am already racing backstage out of shame and confusion.

"I don't know what happened!", I cry, and pause, attempting to gather my wits. Page runs to get another gin and tonic - nerves, I keep thinking, just nerves. I decide to practice backstage a bit, starting with the simplest object - my practice coat hanger. No problem. The sai - no problem, but difficult. I'm noticing a growing tightness in my chest, though; a small ball of pain behind the sternum. It's nerves, more heartburn - nothing to worry about. I try the Robin Hood sword, and this time - it stops, in the same place as the long sword. For the first time, I worry - this has never happened before. The blade simply will not pass. I have the presence of mind not to force the blade, but I am confounded.

I try again with the long sword. Same outcome. By now, the doors are opening, other performers have arrived, and I no longer have access to the stage. I pace frantically, trying to calm down, drinking glasses of water and wincing at the tight pain in my breast. Page and I confer. If we can't do half the sword act, we'll have to improvise. Page, in a moment of total selflessness and ingenuity, offers to perform a burlesque act midway. I'll use the coathanger and the sai, and then defer to her while she performs for a few minutes before we bow and exit. It's a way to save the evening despite my rebelling body.

The show begins. I am a wreck backstage, but the show organizer, Sprocket, is understanding. Swords are a dangerous business, he opines, and reminds me to take it easy. Offhand, he asks me a troubling question: What's it like when I cough?

I head to the bathroom to find out. Facing the sink, I cough as mightily as I can, despite the growing tension in my chest. I spit, and a thick gobbet of blood lands below me, stark against the white porcelain of the sink. Blood. I'd bled before during practice, from slight scrapes I'd incurred, but nothing to worry about. This was different. I spat again, with the same effect. In misery, I admitted to myself that it was time to go.

The next hour passed in a whirlwind of confusion and growing pain. I begged off from Sprocket, who understood completely and encouraged me to get medical help. Page gathered some of the show supplies and headed out the front, making excuses for me as I darted out the back door, swords in hand. By now the pain was undeniable. Page and I argued for a moment, then headed home to drop things off and change before I went to the hospital.

30 minutes later, I was in a haze of agony in the passenger seat, barely able to speak as my chest seemed to swell with pain. We drove to the nearest hospital, Washington Adventist, and I hobbled to the ER admittance desk, stiff with discomfort. My voice had changed, too; I sounded nasal, as if something had inflated within me.

I felt dull panic when I first entered the ER; the waiting room was mobbed, with family members and lone patients slumped across chairs and tables, waiting to be seen. I explained my situation as best I could to the admitting nurse, and a moment later was called in for triage. As soon as I mentioned spitting blood, the nurse exclaimed, "We'll see you right now... no waiting for you."

That would be the last evening I would see the outside of a hospital for more than two weeks.

Performance

2008-04-05T22:35:00.001-04:00

By mid-February, I was committed to performing at the March 20th Weirdo Show at the Palace of Wonders:

As you can see, the lineup included a 'Scottish Cowboy', myself, a burlesque dancer, two fire performers, and someone impersonating Jesus Christ, doubtless in honor of the Easter weekend. The lineup was sent to myself and the other performers a day in advance of the actual show - too late to back out, if I'd wanted to!

But before the 20th arrived, I would spend several weeks in misery as I tried and tried to develop an act around my swords. My problem was that I was so enamored of the actual sword-swallowing, I'd given no thought to presentation. In my mind, it was amazing enough to see someone swallow sword after sword, upping the ante each time in terms of danger. But three weeks before the show, I had to come to grips with a few uncomfortable facts about myself:

1. I had absolutely no performing experience in my adult life.
2. Any public speaking I'd done had covered the dryest, most technical subjects, and I was used to writing for business audiences, not rowdy bar crowds.
3. I wasn't schlocky, I wasn't a huckster, and I had no interest in aping the other performers I'd seen. Unfortunately, I also didn't know how to interpret other acts as inspiration for my own material.

In desperation, I started pressing friends of mine with performance experience for tips. I bought drinks for friends and begged them to share everything they knew, and I wrote down every hint, suggestion, or observation they could offer.

Finally, I scripted a draft a week before the show. I ran through the act in front of Page and some friends. I stammered, I mumbled, I flailed my arms, stumbled and rambled, and managed to swallow some swords in between. The response was gentle, but withering, and I rewrote the act. Page offered to be my 'lovely sidekick' and pass swords back and forth as I spoke my act, and after a friend complimented us on some ad-hoc comedic bickering during a rehearsal, Page became part of the act. Together, we wrote comedy, slashed segments that fell flat, worked on a dramatic arc and finally pulled together a routine that worked. It was gently funny, played to the crowd and kept the action going. All I had to do was rehearse my lines and give Page her cues, and for the first time in months, I heard a voice in my head say, We can pull this off!

Above: The author swallowing the Robin Hood sword and kneeling for the camera. Note the expression of terror and amazement on Page's face!

Above: A stop-motion animation of the actual sword-swallowing act. The photos were taken the night before the performance.

I spent nearly every free moment rehearsing my lines and getting 'in character'. Rex Libris is basically me, just twice as loud and maniacal. I made a list of hints to help differentiate my 'act' from being a lukewarm script reading with a few sword-swallows thrown in. My suggestions:

1. Lift sentences at the end. I have a tendency to 'drop' my sentences. By raising my tone at the end, I could infuse each statement with more energy than I normally would.
2. Enunciate! My father would be proud of me for remember to enunciate, to project my voice powerfully and with clarity.
3. Stick to the script. I'm a terrible ad-libber when I'm nervous. Stick to what works and don't ramble.
4. Make broad gestures, not small ones. I'd have to remember to use the stage to 'embrace' the crowd, to draw them in and make them part of the performance. I have a tendency to make small, mincing gestures if I'm unsure of what I'm doing. I'd have to be bold, no matter what.
5. Don't pace! Like #3, I tend to stray nervously when in front of a crowd. Find a spot and plant yourself there.

We performed a final run-through to friends, and everything went smoothly. The act was coming together! Page had settled on a cute dress for her role as sexy sidekick. I'd decided to wear dark slacks, a white dress shirt, and an elegant black velvet vest. My hair would be brushed up in a giant chestnut-red pompadour. Page had found a wrought iron lawn decoration, shaped like a narrow pyramid, that would hold all of my swords. In a figurative sense, the stage was set - and the following evening, that would be the literal case. I was as ready as I could be, terrified and thrilled.

Practice

2008-04-05T09:29:00.001-04:00

After graduation, I returned to DC with a bound collection of lecture notes covering all of the acts we'd reviewed, and a knapsack full of tools and handmade supplies that I'd used for practice and performance. Unless you knew where I'd been, the contents of my 'sideshow bag' would have seemed awfully suspicious: a mousetrap, sterile wipes, several 40-penny nails, a wire coat hanger stretched into a narrow loop, mouthwash, several practice torches made from snips of coat hanger and cotton tshirts, a length of rubber tubing, scouring pads for smoothing metal edges, and a handkerchief that reeked of lamp oil and Coleman camping fuel.

When I got back, I had to make a decision about my priorities. Clearly, sword-swallowing was my main goal. I set the stretched coat hanger and mouthwash out since those would be my main practice tools. Fire performance was the second most appealing act, but I was faced with the lack of a good practice space. Even using the smallest torches constructed out of an 8" piece of metal and a swath of cotton could produce a flame that would blacken the ceiling of my apartment; indoor practice was out of the question, and I didn't know how my neighbors would react to the sight of me prancing about in the courtyard behind my apartment, spitting flame and waving torches.

I decided to concentrate almost solely on swords. I set up a practice area in my bathroom, and settled on a simple daily routine:

- Wash down practice 'sword' (the coat hanger) with non-flavored Listerine and rinse in hot water. The coat hanger had been scoured of any rough edges or paint, and had been pulled into a narrow diamond shape, approximating that of an actual blade.
- Assume the correct posture: legs firmly planted, back straight, head tilted nearly straight back, eyes fixed to ceiling, mouth wide open.
- Gently guide the coat hanger down along the tongue, past the uvula, and down until it encountered the epiglottis.
- Attempt to relax the epiglottis and let the coat hanger pass.
- (Optional) Gag horribly and vomit/cough violently/tear up/make loud retching sounds.
- Repeat the above seven times daily.

At Sideshow School, we'd been admonished to practice 'seven times daily, seven times a week'. It sounded a little numerological, but in practice one could probably practice that many times a day and not incur too sore a throat from the constant spasming and poking. I, of course, threw restraint to the wind and practiced one to two and half hours a day. Coworkers commented on my scratchy voice, and I constantly nursed an aching throat with tea, ice water, and anything else that could ensure I'd be able to practice again that evening.

A week after returning from Sideshow School, I managed to get the hanger down. The sensation was startling, and my body rejected the full length of the hanger for the first few times I managed to pass the epiglottis. I realized I'd made a crucial mistake - my mental image of how my GI tract was oriented in my body was out of alignment with the reality of how my body was constructed. By angling a little to what I felt was my left, I was actually placing the hanger in the correct position. After a day or so of thrilled practice, the hanger could be reliably inserted all the way down my esophagus and into my stomach.

I decided to try using a real sword. Page, my girlfriend, had spent years as a reseller for Cutco, a cutlery company. Like all sales organizations, there were plenty of competitions and recognition for top sellers, and Page had walked away after five years with an assortment of trophy swords, daggers, and other mementos in recognition of her achievement. Page had since moved on to a business of her own, and most of the swords lingered in disuse, gathering dust in closets or wedged between dressers.

Page offered me a perfect starter sword. The blade was 13" - shorter than the coat hanger - made of thin, flexible steel, with a flat, unornamented blade and a securely fixed handle. The only task was to smooth the edges and point - the tip was sharp enough to draw blood if you weren't cautious around.

I returned to my bathroom workshop and set about dulling the sword. I'd purchased steel wool of various grades, and a handheld steel file, and a respiratory mask to prevent the inhalation of steel shavings. After about an hour's work, I'd buffed away the sharp edges, and reduced the steel tip to a gently rounded nub. My technique for removing edges was amateurish, and it showed: the blade was scored around the tip, leaving an unsightly crosshatch of scratches that I'd have to dull out later. I inspected the sword, rubbing it with my fingers, tissue paper, and microfiber cloth to detect any nicks or rough areas I'd missed. After a few touchups, I considered the blade ready.

It took another week to be able to swallow my new sword. Although my body was accustomed by now to the rounded shape of the coat hanger, it was completely unfamiliar with the sword. The sword was also much thinner and more rigid; consequently, I had to be much more gentle with it, as it could still cut or hurt me despite the dulled tip. I think that week was the most painful of all, as my throat worked to accommodate this new object.

Finally, two weeks after walking out of Sideshow School, I had technically achieved my goal of being a sword-swallower. I could pass the blade down, bringing the cross-guard (the 'flanges' of the hilt extending to the sides) to rest atop my cheeks. I proudly demonstrated my new ability to a horrified girlfriend, who cheered and winced at the same time. I felt no fear, although I was acutely aware of the dangers involved.

I settled into a regimen of daily practice with both the coat hanger and the short sword. December had arrived, and I purchased my second sword: a 'Robin Hood' sword, with a 20" blade.

I can still vividly recall the day I received my first purchased sword. I tore open the long box, cast aside the receipts, catalog and bubble wrap, and withdrew the sword, sheather in a rigid leather scabbard. I pulled the sword out and laughed in fear; the blade was nearly an inch wide, and as I held the blade in front of myself in the mirror, I could see how deeply the tip would penetrate - much further than the practice 13" sword had gone.

Although the coat hanger and the Robin Hood sword were approximately the same 'blade' length, this was a real sword; steel, less flexible - capable of inflicting injury, even after I'd worked away the sharp tip and the nicked edges. I began prepping the sword, working away over hours to bring it to a uniform, smooth surface. Eventually, I began gingerly experimenting with the new sword; letting my throat and tongue explore its dimensions, and slowly working towards the same level of comfort I possessed with the coat hanger and short sword.

By early January, I had the long sword down, so to speak. I was growing in confidence, and the sore throats were becoming a thing of the past as I grew in ability to suppress the gag reflex and pass the swords as if it were perfectly natural. I worked on a few variations; I could lean forward with the blade lodged in place, and let a volunteer (i.e., Page, the only person I trusted to do this) remove the sword with their hands, as I'd seen other performers do. I could even manage a slight 'drop'; I could insert the sword part-way, and then allow the muscles of my throat to control and then release the blade, allowing gravity to complete the 'swallow'.

February saw the acquisition of three new weapons, one of which I couldn't use. I purchased a cavalry rapier which seemed grossly out of scale to the image on the website. I would have need an esophagus the size of a paper towel roll to accommodate it, so the sword went untouched into the closet, perhaps to serve as a home defense weapon if we should ever be assaulted by brigands. The next sword was a disappointment and a pleasure at the same time. Described as a 'Classic German Sword', the blade appeared to be ideal: slightly longer than the Robin Hood sword at 23", the new sword would test the limits of my physical ability to swallow a sword. Furthermore, it was lighter and thinner: performing a drop would be easier, and having a smaller sword would open the possibility of swallowing two swords at once.

Unfortunately, at no point did the seller (Budk.com) make any mention of the crudely-embossed swastikas all over the hilt of the sword. I was furious upon opening the box; the sword lay like a snake on my bed, spiteful and untrustworthy. I had a dilemna. On one hand, the sword was perfect for my needs; the dimensions and weight were just right, and the sword was dull to begin with, lessening the amount of time I'd need to get it into a usable state. On the other hand, the hilt was desecrated with ersatz Nazi icons; it looked like a rebellious middle-schooler's school-notebook sketch of what he might imagined an SS officer's dress sword might look like.

I don't think of myself as a superstitious person; I'd call myself an enthusiastic skeptic, if anything. But it was hard to look at that cheap sword, crudely illustrated by some lunkhead with a fetish for Nazi imagery, and think of it as something I wanted to risk my life with. If anything, my revulsion at the thought of having a swastika poised an inch from my mouth in a very intimate pose could be dangerous; I needed to maintain my concentration and relaxation, two things which would be threatened if I were constantly distracted by an image I felt uncomfortable around.

It was then that I recalled a similar sword I'd seen at Sideshow School. Someone at Coney Island had fallen into the same trap and ordered a sword only to discover it was embossed with swastikas. The solution had been to wrap the sword in black electrical tape; since the handle was black, the overall effect was to produce a nondescript appearance that prevented the audience (or the performer) from seeing the hateful symbol at the base of the blade. I decided to use the same compromise - I wrapped the hilt in black tape, tamping it down to match the contours of the handle. In the end, I was satisfied. The blade didn't look great, but it didn't look evil, either.

The next weapon - not a sword, per se - was much more exotic. I'd never seen one used before, but an instructor at Sideshow School had spoken of the sai as the one sword he could never manage to swallow successfully. Intrigued, I'd ordered a pair - they didn't come singly, it seemed. I knew nothing about sais, save that they were some kind of martial arts weapon, and a member of the Teenage Mutant Ninja Turtles had wielded one.

I strongly suspect that what I'd purchased was a parody of the authentic martial arts weapon. The sais that I received were basically two-pound octagonal steel spikes with a tip that tapered off into a blunt end, with decorative curved flanges ("tsuba") on the side. What these weapons lacked in grace, they made up for in menace; for all the world, they looked like ornamental tire irons.

The sais were trickier to prepare for use. Although no part of the sai was sharp, the ends terminated in a blunt tip where the end had clearly been sheared away. It took hours to wear the edge down into a rounded end approximately 1/8" in diameter.

In the long run, I never really got comfortable with the sais. I could swallow them, and they looked great, especially when bowing to the audience as you looked positively demonic with the flanges spread back across your cheeks. Still, their odd shape and heft made them hard to work with; a drop of any kind was out of the question, and even bowing was hard because of the additional weight placed on the throat. Still, the sais became part of my repertoire, which was now focused on the Robin Hood sword, the long masked sword, and the sais. The short sword had been relegated to practice-only.

Throughout early 2008, I was performing for friends and parties, practicing daily alone or in front of anyone who would watch. My routine followed a basic progression: the Robin Hood sword, with a bow to the audience with the sword in situ, the sais, optionally with a bow if I felt I could manage it, the long thin sword, with a drop at the end, and finally two swords simultaneously. Swallowing two swords involved pressing the Robin Hood and long sword blades flat against each other in alignment, and then swallowing them like any other. Weirdly, this was actually easier for me than swallowing one sword, but vastly more dangerous. If I failed to maintain posture, lost my balance or became jarred, the blades could scissor inside of me, cutting away at tissue, or - worse - perforating dual sides of my esophagus or stomach. This portion of the act always received the most extreme care from me. If you've ever seen me swallow two swords, the look of trepidation on my face was absolutely genuine.

Throughout all this, you've probably noticed that my focus was entirely on the technical aspects of sword-swallowing. Presentation was absolutely secondary. This became a problem in February, when I was offered a slot in the March Weirdo Show at the Palace of Wonders. The Weirdo Show is kind of like open-mic night, with a little more structure. The performers aren't pulled off the street, but you're never quite sure what you'll get, and it's a great opportunity to try out new acts or show the Palace crowd acts that wouldn't normally be included in the typical sideshow or burlesque event. Suddenly, I was faced with a new challenge: Sure, I could swallow a sword. How could I make an act out of that?

Sideshow School

2008-04-04T19:15:00.000-04:00

In a previous post, I talked about performers at the Palace celebrating 'sideshow' or a carnival theme. The history of traveling carnivals and the exotic array of amusements they offered are well documented elsewhere, so I'll confine my comments to the so-called 'working acts' that were on display at the Palace. 'Working acts' included taught arts such as sword-swallowing, feats of apparent endurance, fire eating, and so forth that were usually present in the 'sideshow' accompanying a carnival.

Once I'd decided that I wanted to learn sword-swallowing, the immediate difficulty lay in finding a competent and available teacher. Professional sword-swallowers are vanishingly rare, and those that were local were either unwilling or unavailable to teach. As suggested, my best bet was to attend Sideshow School, a series of classes hosted over the course of a week in Coney Island, New York. I'd never been to Coney Island and only knew of it by reputation as a fading icon of American culture, well past its heyday.

Sideshow School had several compelling advantages: It was hosted by Todd Robbins, the same man whom I witnessed eat a crushed light bulb in front of a shocked, impromptu audience at the Palace of Wonders a year earlier. Besides sword-swallowing, the advertisements for the School promised "fire eating, the human blockhead, glass walking, magic and other famous sideshow acts." The cost for the course was $600: expensive enough to weed out absolute dilletantes, but affordable considering the scope of the acts to be covered.

In November 2007, I drove to Coney Island to attend two weekend sessions, each three days apiece. Unfortunately, Todd Robbins wasn't available to teach, but stand-in guest teachers Adam Rinn and Donny Vomit were fantastic substitutes. I was clearly a bit out of my element; I hadn't even considered the performance angle, which turned out to be the hardest challenge I encountered throughout the courses.

The structure of Sideshow School was simple enough: Adam or Donny would demonstrate an act, explain the principles behind it, and then hand us the necessary tools and have us try it out. By 'us', I mean myself and the other two students for the weekend sessions - we were a small class.

It was some of the most fun I've had in my adult life! There was a profound sense of being part of a little-understood tradition of weird entertainment, and a thrill in seeing skilled performers gamely pitch acts such as the human blockhead (thrusting long nails, spikes and even live drill bits into the nose), the Elektra routine (incorporating high-voltage lightning tricks into a stage performance with audience members), walking on broken glass (relatively) unscathed, lying atop a bed of nails and enduring the weight of other people, 'eating' fire, and even handling enormous serpents. Unfortunately, the one act that I was determined to learn was the most difficult, most impassable (literally).

We practiced daily by attempting to swallow a bent coat hanger. It seemed impossible at first; the most any of us accomplished during our time at School was to develop a constant sore throat and gag horribly as we tried to coax our epiglottis into allowing the foreign twist of copper to pass smoothly beyond the pharynx. I was proud of other achievements, though: I left knowing I could tolerate fire in my mouth and on my skin, and for a final recital, I had a blockhead routine that was funny and a little gross, and had been the hardest act to write for, since I felt it was the silliest.

Above: The author being crushed atop a bed of nails. What endurance!

I left Coney Island with a sense of accomplishment, but also a sense of dread. I'd known instinctively but hadn't really considered the implication of my completion of Sideshow School. Why had I gone, if I hadn't wanted to perform? Even if I could have swallowed a sword then, I would have only overcome one small challenge, since what point was there in keeping a performance art to myself? I'd have to start thinking about how I wanted to show off my new talents to the world. There was one intermediate challenge, though, before I even considered my performance style: I had to actually swallow a sword.

The Palace

2008-04-04T10:42:00.000-04:00

I saw my first sword-swallower at the opening of The Palace of Wonders, a carnival-themed bar in DC. The Palace opened in July 2006 in the H Street area of Northeast DC. I'd lived near the area for a few years already, but H Street had a reputation for being something of a no-man's land: fraught with crime, violence, and immune to the gentrification that was spreading slowly through the fringes of the established Capitol Hill neighborhoods. Page and I had visited the area during the evenings on a few occasions to dine at the Argonaut, a nautical-themed bar not far from my apartment, but until the Palace opened, there was little motivation to explore past the H Street/Maryland intersection.

Later, I learned that H Street had suffered terrible riots in the wake of Dr. Martin Luther King's assassination, and hadn't really recovered economically since the violence of 1968. The following AP photo illustrates the degree of damage H Street suffered through the riots, and the extent to which the same block has been reclaimed today:

Page and I were accustomed to trekking out to U Street or NoVA for drinks with friends; the prospect of having a 15-minute drive to a new watering hole was big news. We'd seen an announcement on DCist about a new carnival-themed bar a few blocks from Argonaut, and decided to head over on opening night to see what a carnival-themed bar really had to offer.

It was an astounding experience. I don't actually remember much about the opening night, except a feeling of amazement at seeing a sharply-dressed, middle-aged man stun an unsuspecting crowd by smashing and consuming a light bulb taken from a bar light fixture, and then a host of other acts I later came to recognize as part of the 'sideshow' or carnival repertoire of 'working acts'. More on those later. After that first wild night, Page and I pledged to return almost daily to see more shows - we were hooked on the weirdness of the acts and the strange ambiance of the bar. I'd never been to a carnival in my life, and to a circus only once - and just long enough to develop a lifelong terror of clowns - but I could see the gaudy appeal of tattooed burlesque dancers, fearless men and women sustaining improbable weights upon their bodies while lying supine upon a bed of nails, or unflinching performers swallow steel blades that came to rest at the very basin of the bowels. It was this last act that captured my imagination the most. All of the acts, if any danger was involved, were sure to include a spiel that defined (and perhaps slightly embellished) the risk to the performer, but it was the sword-swallowers who really seemed to court disaster in their act. Night after night, we returned to the Palace to witness daredevils swallow two-foot long steel blades, thin neon tubes, enormous broadswords and almost anything else that could possibly be accomodated by the esophagus.

After many months, I finally worked up the nerve to ask the resident sword swallower how she'd learned the craft. I was rebuffed at first; I was told sternly that the danger was real, and it wasn't a performance art for flippant, drunk bargoers looking for a party trick. To prove the risk of injury, the performer showed me a scar upon her neck. During a performance, one like any other, she had managed to injure herself seriously. After hospitalization and surgery, she'd been unable to swallow swords for weeks, but eventually decided to return to performing.

I didn't care, of course; I was sure of my sincerity, and felt intuitively that this was a stunt I could perform, with time and training. Finally, I was told to go Sideshow School, located in Coney Island in New York City. I'd never been to Coney Island - all I knew was that it had some kind of fair there - and I wasn't sure what kind of person signed up for this kind of class. My decision was made, though, and in late 2007, I enrolled in the fall session for Sideshow School.

A Little Background Information

2008-04-03T14:03:00.000-04:00

I realize most of the people who will visit this blog will know in advance who I am, and how I ended up in my current position. However, there are probably a few of you who found this page by accident, or know me but aren't acquainted with my activities for the past six months or so. I'll start with the basics.

I'm 29 years old, but I'll turn 30 on April 9th - next week! I've lived in metro DC since 1996, including four years at American University where I studied journalism. I've lived all over the city, but currently reside on Capitol Hill, right next to RFK Stadium. I am not a sports fan, though, and have never seen a game despite living next to the stadium for almost four years.

By day, I work for a large telecommunications company you're surely familiar with if you live in DC, and suffer a 2 1/2 hour commute daily to Ashburn. If you think that's crazy, you're right; I used to work for a smaller company that got bought out by aforementioned telco giant, and my daily drive went from manageable to maddening.

When not slogging through traffic along the 66/Dulles Toll Road corridor, I'm usually at home, reading or tinkering on a computer or electronics projects, and spending quiet evenings with my cat, who, for sake of his privacy and anonymity, will be referred to throughout this blog as Fluffybear. I know that sounds ridiculous, and it is, but I dote on him constantly and no longer feel shame in thinking of him as basically the teddy bear of my adulthood. Here's a picture of him:

Many of those quiet evenings aren't spent at home. My girlfriend, Page - again, a nom du net for the sake of her privacy - lives in neighboring Prince George's County with her three cats. I'll frequently head over after work, cat carrier slung over my shoulder, for an evening of television and a nice bottle of wine. We're big fans of sprawling adventure series such as Battlestar Galactica, Lost, and recently Dexter, and she's managed to get me hooked on America's Next Top Model and Project Runway.

Anyhow, sounds like a pretty mild lifestyle, huh? Well, it was, until the Palace of Wonders opened up. More on that in the next blog post, when we finally get to swords and to the series of events that led to my current incapacitation.

Hello, and How This Got Started

2008-04-03T12:12:00.001-04:00

Hi there! This blog is, for the moment, an activity to help stave off boredom while I spend 23 out of 24 hours a day in a hospital cot.

Two weeks ago, I was admitted to the emergency room at a local hospital in Washington, DC with excruciating chest pain and an insistent, bloody cough. After about 10 hours of examination, intensive pain medication, and transfer via helicopter to a larger facility, my suspicion was confirmed: I'd managed to tear open my esophagus the previous evening, causing an influx of blood and air into the surrounding tissue. I'd accomplished this injury during rehearsal for my first stage performance as Rex Libris, sword-swallower extraordinaire. Just a few hours after taking the stage for the first time in my adult life, I was a helpless trauma patient, strapped to a gurney and prepped for surgery to drain the contents of my swollen chest. I didn't realize it at the time, but this would be the start of a long, painful, tedious recovery process that would take away my ability to eat, drink, or move for days or months at a time.

Because I'm starting this blog two weeks into the ordeal, I'll have to jump around a bit, first by returning to the events leading up to my injury, and then describing the long intermediate period between my first trip to the ER and my current lodgings in the thoracic recovery ward. In any case, I hope you, whoever you are, find this to be an interesting read.