Happy New Year!

What a year it’s been. I was just thinking the other day about how I declined to have surgery to put the trach back in. That was back in February (2023). If you missed that story you can read it here.

Hope everyone had a nice holiday. I’m sure 95% of you both spent and ate a little too much. I was just talking to someone (who shall remain nameless) who told me they recently got on a scale for the first time in a couple months. They described the situation as “pushing maximum density”. Yep. That’s the holidays. The day after Christmas I ate in entire tin of Hello Dolly bars (Clara helped a little.) I’m not proud of that; but it happened.

Anyway, I’ve dragged this on long enough. Should probably get this story wrapped-up.

You may recall it’s the morning of Day 7 in the hospital. I was admitted for a UTI which jumped into the bloodstream and started a nasty case of sepsis. There’s also the issues of the hard & distended abdomen, and a blood clot in the right leg. A series of x-rays showed that the situation in the belly was the makings of a bowel obstruction, and we just found out via a CT scan (with contrast) that I had a kidney stone lodged in my left ureter.

Are we all caught up now? Whew.

It was the infectious disease doctor who ordered the CT and came in Sunday morning with the results. Super nice guy (fabulous dresser), but always straight to the point. He had done his job. He wanted to identify the source of the lingering fever. And he did so. He was done. Out. The situation was going to be turned over to my primary care team and my urologist.

There are two doctors on my primary care team. Both are awesome. My PCP is exactly what you want in a doctor. Middle-aged, contemplative, careful with his words, and willing to change his mind when presented with new evidence. One of the partners in the PCP’s practice is my hospitalist. This guy is younger and talks faster. When I coughed up a blood clot this is the guy who said, “I think this is a piece of lung” and then had to walk it back. It’s a different style. I don’t judge. We spend as much time talking about TV shows and movies as we do my medical condition. He’s shown Suzie and I pictures of his kids at the pumpkin patch and on family vacations. Ya, he’s a little haphazard on the medical front. But he’s friendly and personable and doesn’t mind when Suzie or I call him out for his goofiness.

Maybe an hour after the infectious disease doctor gives me the news about the kidney stone, in walks the hospitalist.

We get past the how-do-you-do’s and he launches in with, “You ready to get out of here?” . . . Arrgh!

It’s early on a Sunday morning and I just spent a week in the hospital. So I’m sure I was not as diplomatic as I probably should have been. I think what came out was something like, “Dude, don’t you check the chart before you come in and see patients? I ain’t going home. I got a kidney stone lodged in a ureter.”

“What?!” he says pulling out his phone. (As if I was making this up.)

I relay the story of having the CT late Saturday night and having the infectious disease doctor tell me about the kidney stone that morning. His phone confirms my version of events. For a moment he’s quiet and thinking. Then comes, “Well now it all kind-of makes sense. That explains your pain, and the infection. And the kidney and the ureter are probably all inflamed and swollen and pushing down on the intestines which is causing your bowel obstruction. … We gotta get that thing out of there.”

It was with a good sense of alacrity that he rushed out of my room telling me that he needed to consult with my PCP and urologist.

That’s where we were Sunday morning. Now I realize it was a Sunday. Not much happens in hospital on a Sunday. There were no illusions of having anything done on a Sunday.

But I did assume something was going to get done on Monday. And I assumed wrong.

Absolutely nothing happened on Monday to deal with the issue. Doctors came and went. Nurses did their nursing. The kitchen kept calling my phone to see if I wanted to order lunch and dinner (the phone would just ring and ring.) And the kidney stone stayed lodged in the ureter.

Late Monday afternoon I get a second visit of the day from the hospitalist. (That’s what I call service.) I find out that doctors are more like lawyers than they wish to lead-on. Turns out they will argue about anything. While my primary care team was advocating for surgery to remove the stone, urology was of the opinion it would be better to just let it pass on its own. Never mind the fact that the stone was: (a) the source of the infection, (b) causing G.I. problems, and (c) that it had already been there for over a week!

The primary care team and I were in agreement. When it comes to surgery, there are always risks. However, we knew for 100% certainty that not removing the stone was going to continue to cause problems. The hospitalist tells me he’s going to “escalate” the situation.

Now let me tell you what was really going on here. And just to be clear, nobody “said” this. But if one is a careful listener, and can read between the lines, what was really happening is that urology didn’t think there was a rush to perform surgery on a quadriplegic who CAN’T FEEL THE PAIN ANYWAYS. A “normal” person with this condition would be in, more-or-less, constant excruciating pain. Because I did not require a morphine drip urology figured they could slow walk it.

What the urologist doesn’t know is that someone in my condition still suffers from autonomic dysreflexia. (We covered that in the first post. If you need to go back here’s the link.) The stone was the reason I continued to have high blood pressure, fevers, and generally felt like garbage even after six days on antibiotics.

That evening the urologist’s physician’s assistant comes in to see me. She explains that urology has seen the errors of their ways and that surgery to remove the stone would be scheduled for Tuesday. So that’s the good news. The bad news was they didn’t know what time because they weren’t sure when the doctor, a surgical suite, and an anesthesiologist would all be available. But the surgery was going to happen on Tuesday, therefore nothing to eat or drink after midnight.

So… You know where this is going right?

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“Hundred bucks and my left nut says this plane ain’t landing in Chicago.”
–– Del Griffith (John Candy) Planes, Trains & Automobiles, 1987

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I’m pretty sure I had something for dinner on Monday. I had been there a while, so I had kinda figured out what was edible and what was not. Any of the “daily specials” were to be avoided. But on the menu, available anytime, was a breakfast burrito. Now when I think of a breakfast burrito, I think of something about the size of a football filled with chorizo and eggs, shredded cheese, refried beans, sour cream, lettuce tomato etc. Let’s just say the hospital’s vision is a little different. Their version is a scrambled egg wrapped in a taco sized flour tortilla. The good news is, they let you get two.

Say what you will about hospital food service, but they have the portion control thing down. I’d ask for sour cream. They would send up one ketchup-packet sized tube of sour cream. You asked for cheese? You get exactly 0.25 oz of finely shredded cheese. You can ask, and they will provide, a couple of sausage links. But they can’t be assembled inside the burrito.

While I can’t say for certain, my recollection is that Monday evening’s dinner was two eggs and a couple of breakfast sausages.

Tuesday morning I get meds with a solid drink of water. That’s it. No food. Going to have surgery later.

Tuesday afternoon… nothing. No food. No water. Going to have surgery later.

About 6:00 the urologist walks in. He’s not in scrubs, but dressed in his “office” clothes. He starts babbling on about there not being any surgical suites or anesthesiologists or something. I gave him a little bit of the side-eye to let him know that my bullshit detector was admitting a steady tone. I wanted to make sure that he knew that I knew that he just got to the hospital from the office.

He mumbles his way through some excuse, and says he’s on his way to the OR so that we could get the surgery done that evening.

Tuesday evening… nothing. No food. No water. Going to have surgery later.

It’s about 10:30 when the urologist pops back into my room. This time he is in scrubs! I say something like, “Hey, I see you’re in scrubs.” But I can tell by the look on his face that something ain’t right. So I immediately follow it up with, “Don’t tell me you’re dressed for Halloween?” With that he laughs. I didn’t.

He proceeds to feed me all sorts of malarkey about the O.R., anesthesiologists, and all of the hospital’s logistical issues. The bottom line was that: it was late, and he was going home.

As we discussed scheduling the procedure for Wednesday, the good doctor explains that, “I have 32 patients in the office tomorrow. The surgery will have to be done in the evening sometime.”

Hungry… No that’s not right. Hangry, I snapped at the doctor about the delay and not eating or drinking all day and the complete lack of professionalism of the situation. He was very apologetic, said I could get something to eat, but the timing of the surgery was out of his hands.

Whereas the hospital’s kitchen is closed at 11:00 on a Tuesday night, my dad drove over to Wendy’s on Harlem Ave. I got the Dave’s Double with cheese & lettuce, tomato, and mayo. I washed it down with a large fries and Ensure protein shake.

Wednesday. Everything started out pretty normal actually. I took morning meds – with water – and I just kinda settled in. I knew nothing was going to happen during the day and the surgery would probably occur sometime in the evening after the urologist got done with his daytime appointments.

I feel the need to pop-in here with a sidebar. What are your thoughts about intermittent fasting? Never mind your thoughts. It’s awesome, and you should be doing it. It’s all about blood sugar and insulin levels. As humans, for thousands of years we have evolved in an environment where food was scarce. Today we live in a world of food abundance. (Thank you capitalism!) As such, we’ve gotten into the “three squares a day” mentality. Unfortunately our biology has not yet evolved to match our new environment. We are not “grazers” like cows; our nutritional biology is set up differently. We’re designed to: kill the elephant, feast like a king, and not eat again for a day or two. This is causing all sorts of health problems from obesity and diabetes to cancer and cardiovascular disease.

Since the accident I’ve discovered that I prefer to have all of my calories for the day in a narrow window. I was doing a little bit of this even before the accident, but I never really took it seriously. Now I (kinda) do. So my comment above about being “Hangry” is not really 100% accurate. I was angry; I rarely get hungry, but I do get thirsty. But “Hthirsty” is not a word (not even a good made-up word.) So for the sake of the story it became hangry.

Wednesday morning, hanging out in the hospital, it was not a big deal for me to skip breakfast. Instead, I took a nap.

Around noon I thought it would be good to get something to eat, if only just to have something to do. So I call the nurse and guess what?

No food. No water. Going to have surgery later.

I explained that the surgery was at least 8 hours away because I knew the doctor was seeing his “32 patients” during the day. But that didn’t matter because the note in the chart was “No food. No water. Going to have surgery later.” Arrrgh!

Not a big deal. At least now I knew. I was getting on the thirst (if you know what I mean) but other than that it truly wasn’t a big deal to go a day without eating. After all, I had just done so the day before. I just needed to chill-out and wait for the doctor. No problem. I got this.

I don’t know why – it had never been done before – but in the afternoon someone came in to check my blood sugar. It was, as expected for someone who hadn’t eaten in 17 hours, a perfect 77.

It was probably around 6:00 when the urologist popped-in. He was on his way to the O.R. and we were going to blast that stone. Alright. Now are getting somewhere.

7:00 – no surgery.

8:00 – no surgery.

10:00 – no surgery.

At this point I was tired, getting cold, and the back of my neck started sweating. My body was telling me that something was wrong. That stone had been lodged in the ureter for going on 2 weeks. My arms and back were stiff and everything hurt. I asked the nurse for a tramadol; I was denied.

No food. No water. Going to have surgery.

I explained that I would only take “a tiny sip” of water. Nope. No food. No water. Going to have surgery.

I offered to take the pills without water (which is actually something I can do.) Not. Gonna. Happen.

I explain that I need something for the pain. Nurse calls my doctor, explains the situation, and gets an order for morphine direct into the IV. Fine. Not what I wanted. But as I lay there tired, hungry, freezing under a pile of blankets and sweating, it should do the job.

Naturally, there was some sort of snafu in the pharmacy. I’m told the morphine comes in 3 mL ampoules. The doctor ordered 10 mL. So, you didn’t have to go to private high school to figure out that we needed three ampoules. The pharmacy sent one.

Naturally, this situation is easily resolved when dealing with controlled substances, there is a process. In the “normal” world, the pharmacy would just send up two more ampoules and the issue would be resolved. In our world, the original single ampule has to be returned to the pharmacy, the pharmacy supervisor has to check the inventory, the doctor’s order has to be reviewed, the original pharmacy order must be canceled, a training session must be scheduled with all employees, PowerPoint presentations created, and everyone has to move their cars from Lot D over to Lot F after they all first go home and make sure that the garage door closed.

Once all that was accomplished, the nurse showed up with my morphine. All proper procedures were followed. My hospital wristband had to be scanned along with each individual vial of drug. Then, after the computer approved, the vials could be opened and drawn into a syringe. The syringe connects to the IV line, and away we go. It only takes about 5-10 seconds and my face feels warm, flush, which is nice after feeling cold. The pain subsides. I can feel the body relax. I tell the nurse, “I need you to get a trashcan or something because I’m about to throw-up.”

It takes a few minutes, but the nausea goes away. Crisis averted. Nothing to do now but just relax and wait to get called for surgery.

12:00 – no surgery.

1:00AM! – no surgery.

It was a little after 2:00 when transport came to bring me down to surgery. The surgical nurse introduced himself as did the anesthesiologist. The procedure was explained and I got rolled into the O.R. Everything gets set up. Everyone is ready to go. The anesthesiologist puts a mask on my face and says, “I need you to take a deep breath.” So I do. I take *a* deep breath. Then we sit there and stare at each other for about 10 seconds before he figures out the problem and suggests, “You need to take *multiple* deep breaths.”

Surgery. Post-op. Transport. I was back in my room by 3:30. It took almost 4 days to complete a 20 minute medical procedure.

The surgery worked. A stent was placed in the ureter to hold it open in the event of inflammation. In the collection bag we could see busted up pieces of kidney stones and several of the big stone’s smaller cousins. Thursday was a day of recovery. I was discharged on Friday.

And that my friends is the story.

A quick epilogue: They send you home from the hospital when you no longer need to be in the hospital. That doesn’t mean you are healthy or well by any stretch of the imagination. Even though I was discharged, I was still quite sick. It took a month of recovery at home before I really began to feel like myself. My understanding is that this is completely normal after dealing with a sepsis infection. The stent has been removed and for the most part we have not had any issues. Once the stone was removed the bowel obstruction took care of itself. I was given 90 days of blood thinners to treat the clot.

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Super big thank you to everyone who has emailed, commented, called, visited, and prayed. Know that you are appreciated and I think of you daily.

As always, please feel free to share this post or the website.

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