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.
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