Is It Over?

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?