Monday, February 22, 2010

Mile 15 of My Cancer Marathon: Carmen and the Terrible, Horrible, No Good, Very Bad Day

I have always been able to tell within the first 100 meters of a race whether it was going to be a good one or a gut-buster. Perhaps it’s a self fulfilling prophecy, or a little bit of clairvoyance, or just that I’m really self aware. Whatever the reason, I am almost always right.

I woke up on Thursday, February 18 with the same kind of premonition I get at the start of a race. It knew it was going to be, paraphrasing the titles of one of Dominic’s favorite books, a Terrible, Horrible, No Good, Very Bad Day.

First, Porter decided to wake up at 1AM and party into the wee hours of morning. I finally got him, and me, to bed around 4:30AM. One half hour later, the alarm went off to prompt Vince out of bed and onto an early morning flight for a business trip. Starting the day off with a major sleep deficient always sucks.

I had my 6 month post-cancer checkup that day and needed to be downtown at the hospital by 7:45AM. I had a whole string of appointments scheduled (bloodwork, CT, X-rays, visit with oncologist and a visit with the orthopedist) and running late to one would throw the whole day off schedule.
To make that happen meant I had to scramble to get the kids ready by myself, hustle to daycare, and hope for a incident free drive in order to have adequate time to drive downtown. It was a tight timeline but it could be done.

But alas, the kids were dragging their feet getting ready (thanks in part to Porter’s late night antics). This put me in full-on crazy-ass screaming mommy mode. Admittedly not my best side and definitely not a great tone to set for the day.

Just as we were walking out the door I couldn’t find my cell phone. I wasted 20 minutes frantically searching the house and car for it only to realize it was sitting on the counter all along.

I finally got the kids, cellphone and myself out of the house and successfully executed a quick daycare dropoff. If I pushed the speed limit, I could make it to my first appointment at a reasonable 10 minutes tardy. But as was my luck that day, there was an accident on the freeway and I spent a good 30 minutes sitting in traffic. Eventually I got through the mess, and made it to the hospital a not so reasonable 40 minutes late.

I had been right – I was having a bad day. I just didn’t know yet how bad it was going to be.
My first appointment was to get my bloodwork done. It went off without a hitch (the only thing that day that did actually).

My next stop was to get my CT scan. I had had one CT scan before and knew the routine. You lay down on a table, get injected with a tracer solution, and then they move you in and out of a cylindrical machine, take a couple images and call it a day. It’s pretty routine stuff and they do millions of these a day without incident.

My only other CT scan was pretty unmemorable other than that the tracer solution upset my stomach for a few hours. So I was hoping for a quick in and out procedure in order to get regain some of the time I lost earlier.

The CT area consists of one large room where the scanner is and a small control room off to the side where the technician sits.

The technician injected me with the tracer solution, laid me down on the scanning table and returned to the control room to start the imaging.

Almost as soon as he started taking images I started sneezing uncontrollably. He came over the intercom and asked that I hold my sneezes as it was distorting images.

“I can’t.”

“Were you sneezing before you came in here?”

“No”

“I’m going to go get the doctor.”

Despite all the Xrays and CT scans and PET scans I’ve had, I’ve never met a bona fide radiologist. Radiologists sit in their little dark offices and look at images on a computer all day long. They never, ever speak to patients. That’s what the nurses and radiation techs are for. So I felt it I was pretty darn special to witness a rare spotting of a radiologist outside their natural habitat.

The doctor came into the room and introduced himself. He asked me about my symptoms and I let him know that in addition to the sneezing my head now felt extremely congested, like a bad head cold.
“You’re having a mild reaction to the tracer. No big deal. This happens all the time. We’ll give you some Benadryl and you’ll be fine. Next time, we’ll pre-medicate you and you should have no problem.”

As they were getting the Benadryl from the supply cabinet I started itching all over. I resembled a flea ridden dog they way I was frantically trying to scratching myself all over. Trying to find the origin of my itchiness, I moved my gown aside and saw that I was covered in big red hives. They quickly gave me the drugs and the itching started to lessen and my head cleared up.

Satisfied that the Benedryl had worked, the doctor began to leave the room. Before he left though, he said, “That was just a minor reaction. We get worried when breathing gets involved. So if you start feeling worse, you must let us know immediately.”

No sooner than he had grabbed the door handle, my toes began to tingle and my head began to throb with a migrane like headache. And then I couldn’t breathe.

“Doctor, I’m not feeling so good”

He darted to my side and called for the nurse. The next moments were full of frantic but controlled activity as the nurse, CT technician and doctor completed the tasks of putting an oxygen mask on me, starting an IV and digging through the medical chest for the epinephrine.

My medical knowledge is pretty minimal but I’ve watched enough “ER” and “Grey’s Anatomy” to know that epinephrine was the life saving drug administered to people experiencing serious allergic reactions. Without it, you’re a goner. But with just one shot of that stuff, you’re golden.

I got my shot and instantly felt better. My head cleared up, my breathing was back to normal and the tingle was gone in my toes. I felt astonishingly well. Everyone in the room breathed a collective sigh of relief. I laid down to rest a little and the medical team began to clean up the room and fill out paperwork.

But only a minute or two later, my toes began to tingle again. In a flash my head started to pound and my lungs seized up again. I eeked out an “I’m not feeling so good” which caused the doctor to whip around and rush to my side once again. I was having another attack. The first dose of epinephrine hadn’t worked.

They gave me another dose which momentarily made the symptoms subside. But a moment or two later my stomach lurched and I began to vomit. Per protocol, I had fasted for the CT scan so there was nothing coming up but some stomach bile and a few remnants of dinner the day before. Totally gross.

I could feel the anxiety in the room accelerating. Per their training, they were controlled and focused but I could see concern in their eyes and hear nervousness in their voices.

At some point another doctor joined the fray. He came in and introduced himself. Dr. Einstein. For real.

Despite my miserable state of body and mind, I totally latched onto the humor of that situation. I couldn’t help myself and made a bad joke about his surname. He didn’t respond to my feeble attempt at humor – I’m not sure if it was because he was focused on the emergency situation on hand or because I was I pretty much indecipherable through my oxygen mask. More than likely, he has probably just heard way too many poor jokes at his expense throughout his lifetime. Whatever the case, Dr. Einstein came in and took control of the situation, in total genius fashion.

Things got fuzzy after Dr. Einstein’s entry. I know I continued to have attacks and they continued to feed my epinephrine. I’m not sure how many times this happened but I was later told I had received a “considerable” amount of drugs.

At some point, the doctors made the decision to transfer me to the Emergency Room. They had pumped a lot of medicine through me and I had yet to stabilize. The limited resources of the CT scan room weren’t going to cut it. The ER would have more extensive facilities and a specialized team for my condition.

The Cleveland Clinic is a sprawling facility made up of numerous buildings. I was in the Cancer Center and the Emergency Room was in another building about a block away. So due to the distance and brutal Cleveland weather, the only way to get there was via ambulance.

The paramedics showed up, transferred me to a stretcher and wheeled me out through the waiting room of the CT office. The CT office is just your typical doctor’s office waiting room complete with outdated magazines and talk shows blaring on the tv. At this particular location, pretty much all the patients were like me (or at least how I was a few short hours ago) – in remission and perfectly healthy. So I’m sure the sight of me being attached to an oxygen tank and IV drip being wheeled off on a gurney was pretty disconcerting. I wonder how many people bolted out of there that day without getting their scans.

This was my first ride in an ambulance. Unfortunately due the short distance and my foggy state I didn’t really get to soak in much of the experience. If they knew, my boys would surely be disappointed in me. Riding in an ambulance is pretty much the pinnacle of awesomeness to little boys.

After my two minute ambulance ride, they wheeled me into the acute care unit of the ER. This is where the most severe cases go. No bloody noses or surface cuts here – just the good stuff like heart attacks, gun shot wounds and apparently seriously bad allergic reactions to CT scan tracer solution.

As I arrived in my room, I experienced my worst attack yet. My whole body began to tingle followed by the worst headache of my entire life. I remember grabbing my head as hard as I could and a deep, hollow moan erupting from me. My heart was beating irregularly and my blood pressure had dropped dangerously low. And I couldn’t breathe - at all. My lips were blue from the lack of oxygen.

At this point I was considered in anaphylactic shock. Anaphylactic shock is when two or more of your body systems react adversely to the invading allergen. In my case four systems were in chaos – circulatory (my heart), digestive (puking), respiratory (difficulty breathing) and skin (hives).

At this point I knew things were pretty grave. I was scared. Really scared. Probably 100 times more scared than I ever was with cancer. With cancer, death was a possibility but not immediate. But at this moment I knew death was not just a possibility – it was imminent.

The thought of my children growing up without a mother raced through my mind. But I pushed it out of mind as quickly as I could. Cancer didn’t kill me and I wasn’t about to allow a freak allergic reaction do it either.

Things were starting to get really cloudy at this point, but one of the last memories I had was of the cranky old man being treated in the room next to me. From the location of his IV to the type of bandage, he was complaining about anything and everything and his poor nurse couldn’t seem to do anything right. The worst part of it was he seemed to have no will to live.

I was so absolutely disgusted with him. I wanted to live so badly and, unlike him, was ready and willing to do whatever it took.

First, I knew I had to fight like hell. It was do or die time, and I had dig deeper than I ever had before. Deeper than any marathon, deeper than childbirth, deeper even than cancer.

Second, I needed to put complete and total trust in the doctors and nurses caring for me. I didn’t care if they stuck the IV up my nose and covered my entire body with butterfly bandages. If it meant I was going to live another day they could do whatever the hell they wanted.

My last memory was of a half dozen doctors and nurses working frantically above me. I don’t remember what happened next but my will to live combined with my medical team’s knowledge must have done the trick. When I awoke the room was empty of people but full of my own awe at my beating heart and breathing lungs.

. . .

Both the radiologist and radiation tech came to visit me in the ER after I awoke. (Sadly, no Dr. Einstein. He was probably busy working on some quantum physics problems or something. Ok, bad joke)

They were still visibly shaken from the morning’s events. The radiation tech kept repeating “It’s just not supposed to happen like that”. The radiologist declared that I was “never, ever, ever to get a contrast injection again”. It was a once in a million event. Something they knew could happen, but never thought they would ever see. And it had rattled them as much as it had me.

. . .

There’s a risk of the anaphylactic attack recurring for up to 6 hours afterwards. So they transferred me to an observation unit for the duration. Even though I felt pretty decent, I was on edge the entire time. Each time I felt even the slightest of twinge I braced myself for another attack.

Thankfully, I made it through the 6 hour window without recurrence. However, my blood pressure was lower than they liked. For most of the day my systolic reading hovered around mid to high 70’s and they wanted me at 100-110. So I was put on a continual IV drip in hopes of pushing it up.

Around dinner time, they made the decision to keep me over night for further observation. They were concerned about me going home with my blood pressure still running low. As much as the thought of spending more time in the emergency room bummed me out, I was kind of relived by the decision.

I was still nervous about a recurrence and found reassurance that I would have an experienced medical team at arm’s length for a few more hours.

So I spent the night getting fluid pumped through me and trying to get some much needed rest. Mid way through the night my blood pressure creeped into the mid 80’s and my morning I topped out at 92.

I was still a good bit below their goal, but at this point they had stuffed so much fluid in me I looked like the Stay Puffed Marshmallow (Wo)Man. In fact, I had gained over 10 pounds in that 24 hour period.

(And it wasn’t from the hospital food, by the way. I learned during my stay that there are different grades of fare depending on your location.

My only experience with hospital food previously had been my two stays in the maternity ward for my boys. Both times were absolutely fabulous. I received a menu and was allowed to order whatever I wanted, whenever I wanted. A short time later a hot, delicious, made-to-order meal would arrive.

In the ER, not quite the same experience. All you get there is some nasty tv tray meal delivered on their schedule, not yours.

As I was complaining about the food, one of the doctors told me it totally depends on the department. For instance, the cardiology patients get delectable treats such as ice cream sandwiches.

So, if you are looking for a good meal, get admitted into a high profit margin part of the hospital. Definitely, definitely don’t go to the ER.)

They didn’t want to give my any more fluid and risk me bursting like a water balloon, so they gave up, called 92 acceptable and handed me my walking papers.

My dad took me home from the hospital. As I mentioned before, Vince had gone out of town for work. And he didn’t just go out of town, he was in the middle of freaking nowhere Alabama, several hours from the closest airport and basically a day’s trip away from Cleveland.

It’s just my luck that my husband would be a thousand miles away during an emergency. It would have been way too easy for fate to have had him working in Cleveland that day. But alas, we already know things were definitely not going my way. So thankfully my parents were able to make the drive from Columbus to assist.

I think my parents aged about 20 years that day. Not only were they called on to take care of two rambunctious little boys while their daughter was in the hospital, it just so happened that their only other child, my brother David, was scheduled for nasal surgery the next day.

It was just a routine outpatient surgery but after my not so routine appointment of the previous day, I know they were nervous and apprehensive. I don’t think they took a breath for two straight days - not until both their kids were home from the hospital, alive and ticking.

When I walked in the door and saw my own kids, it took all my strength to not start bawling. I had been given yet another chance to stay in their lives and be their mother.

When Vince made it home, it was if things were finally complete. Our family would be together yet another day.

. . .

Death has come to visit me twice now. He first came almost exactly a year ago, when I was diagnosed with cancer. And I took him down pretty easily. He tried a lot harder this time, but I was again victorious. He can keep trying but he should be forewarned that I intend to kick his ass each and every time. I’m not going anywhere with him anytime soon. I’ve got too much life yet to live.

1 comment:

DelhiBound said...

OH.MY.GOD.

You are one bad mambo jambo, lady. Kick death in the teeth, chick. Keep on kicking hard!!