Wednesday, December 28, 2011
The Femur Report - Part III
NOTE: This post is rated R for mild strong language and disturbing images.
This post finishes up the dark story of my broken femur. (Of course it’s still broken, and it’ll be a long road back, but this will be the last time I’ll write about it.) If you’ve stumbled on this post without reading my last two, click here and here to check out my first and second installments.
As I said of my last post, please note that though I’ve reported this episode as faithfully as I can, I cannot vouch for the accuracy of every detail. Especially where vast pain is involved, memory gets distorted. But I haven’t deliberately fictionalized anything and in fact have tried to be as straightforward as possible in the telling.
During my third day at the hospital (November 29), my pain only got worse. A nurse arrived unbidden at my bed and announced it was time for some pain killers. At first I was pleasantly surprised—this was the first time I hadn’t had to ask for them—but then I saw him popping two rather large white tablets out of a foil pack. “What are those?” I asked. He replied, “This is Tylenol.” I managed not only to keep from snorting but from saying something snide like, “Do you have any placebos I could use instead?” I kept quiet because I sensed I had little goodwill to spare with these nurses, but really the Tylenol was a joke.
The stretches between the real medication grew longer. I was now getting half the dose I had originally been given, and instead of every four hours it was every six. I overhead a nurse talking about a shortage. The pain had strange characteristics unlike anything I’d experienced before. Instead of the leg just aching and throbbing and giving stabs of sharp pain—though I did have all of these—I also had the sensation that my thigh was as big around as a barrel, and that the bandages running along my three incisions were a quarter-inch thick and made of plywood. My left wrist—uninjured in the crash—was also causing me a lot of pain; a nurse unwrapped the bandage from it to reveal that the whole wrist was a deep purple, with a stripe running along it of an even more saturated hue. Nobody could explain what that was about; perhaps it was a botched arterial line.
I was on the phone with a friend when a nurse came around to inspect me. She didn’t seem to need any input from me so I continued my conversation. Suddenly there was an intense, sharp pain in my male unit and I shrieked (into the phone, of course). All at once, the nurse had yanked out my urinary catheter! The pain was accompanied by a sensation of frightening wetness which I took at first to be blood, but which was actually just some leftover urine. My friend on the phone must have feared the worst and asked what happened. “A nurse just ripped my catheter out!” I told him. She looked at me sheepishly. “Sorry, I figured if I did it all at once it wouldn’t bother you so much,” she said. Sort of the ripping-off-the-Band-Aid strategy, I guess.
Later, another nurse expressed surprise that I’d filled my bedside urine receptacle. “A lot of patients find they’re unable to urinate the normal way after they’ve been catheterized,” she explained. I hadn’t known this and now I was greatly relieved. From this moment forward, successfully peeing into that thing felt like a triumph. In fact, whenever I did it I got Homer Simpson’s voice in my head yelling, “Yes! Yes! Ohhh, Yes!”
Presently the physical therapist arrived for my second session of the day. Again, this consisted of taking a short march, with my walker, from my curtained-off cubicle down the row of other cubicles and back. It was oddly exhausting but I guess I did well enough, for she announced that I’d have one more session the next morning, and if I could manage a short flight of stairs, she would sign me off as complete—meaning I could go home.
This great news was followed by another challenge: after two and a half days, I had to defecate. I steeled my resolve and figured that based on the success of my expeditions with the walker, I could handle the restroom. I’d need help, of course. I asked a nurse, and she responded as if I’d asked her to help me rob a bank. “I’m not allowed to assist you with that,” she said. “You have to get a physical therapist.” Of course I had no way to summon the physical therapist, so I asked for a bedpan. The nurse looked at me with disbelief, as if she’d thought bedpans were a best-kept-secret of the hospital. “A what?” she asked. Nice try. “A bedpan,” I persisted. She stalled for time. “What size?” she finally asked. What answer was she expecting? “Small”? “Never mind”? I told her Large, and a bit later she came back with what I suppose was the large size bedpan, though it didn’t seem very large to me. Not that I was an expert: it had been sixteen years since I’d last seen one, when my brother Geoff was in the hospital. And of course I’d never seen him actually use it, so I had no idea what to do. Not that I was about to ask for a tutorial at this point. I had to wing it.
When I’d done my damage—serious damage, I might add—I found I couldn’t get the nurse to come over. With great effort I held myself suspended over that foul, fouled bedpan for what seemed like a very long time. Finally the nurse came over and I asked for help getting rid of it. She said she’d have to come back. They always say that. I asked her to please hurry.
She didn’t. To make matters worse, a couple of friends had arrived to visit. I could hear them being denied access, based on me being “detained,” and I think I heard them chuckling. And yet the nurse still wouldn’t come back. Finally she showed up, her face awash in reluctance, and she gave an Oscar-worthy performance of having never in her entire career seen a patient actually use a bedpan. Where I was desperate, she was hesitant. The two of us grappled haplessly there, trying hard to keep the sheet from getting soiled during the disposal process. It was like Tweedledum and Tweedledee trying to clean up after a grisly murder. Thus was my last shred of dignity finally expunged.
As the patient across the curtain from me asked for some air freshener, my friends were finally admitted to my cubicle. They’d come straight from work, which reminded me that there was still a world out there in which people worked in office buildings. Not long after, four more friends arrived—all of these bike people—bearing Zachary’s pizza and (for themselves) wine. Needless to say my spirits were buoyed; actually, I think salvaged would be the better word. At first I didn’t think I’d be able to eat any pizza, as my appetite had been absolutely nonexistent since the previous morning. I had one slice, and then, to my own astonishment (but nobody else’s), had another. Looking back, those two slices and a third one the following morning were almost all I ate while at that hospital.
Of course we all had much to discuss, such as the events I related to you in Part I of this tale. Before long we had a full-fledged, rollicking dinner party going. All this was of course good distraction from my physical pain; when I think of the visit I don’t remember suffering during it. As a bonus, for the first time in two days I couldn’t hear that infernal TV across the curtain in the cubicle next to mine—we were drowning it out. By the end of the visit I was pretty exhausted but was sorry to see my friends go.
My worst night
The evening dragged on and on. There was a violent action movie playing on the TV, four feet from my head. My leg was killing me. My head felt vacuumed out, my mouth completely dry. My mind wasn’t calm enough to allow reading. I was tired of listening to music and didn’t want to ruin any more of my favorite tunes through future association with this bleak time.
Then there was a shrill alarm from a nearby cubicle. I knew what it was, from my brother’s hospital days: an I.V. drip had gone dry, or was on the verge of it. It’s an important alarm, because if an I.V. goes completely dry, the vein collapses and can no longer be used. But what else did this alarm suggest to me, with its absolute ear-splitting, incessant shriek? It took awhile but I figured it out: it was just as piercing and intolerable as a newborn baby crying. That well might have been the design intent of this alarm, just to make completely sure it would be impossible to ignore. And yet, astonishingly, the nurses—all four of them—were actually managing to ignore it. Where were these people? I pressed my call button. Eventually a nurse arrived, looking put-upon. “What is it?” she asked. “Well, are you ever going to do something about that alarm?” I asked. She looked startled, as if she simply hadn’t heard it until now. Unbelievable. (Why hadn’t the patient in that cubicle summoned her? I have no idea. Maybe he was dead, or maybe that cubicle was empty and it was just a malfunction.)
With the shrieking finally silenced all I had to contend with was the sound of people being shot, run over, and tortured to death. The TV movie didn’t bother with music or dialog or anything: just nonstop killing. My wife hadn’t called, and I was getting worried that the hour would come when I couldn’t take phone calls, or that my calls weren’t making it through. I had to tell my wife about the prospect of being released the next day, so she could find somebody to watch our kids while she picked me up. When a nurse happened by I asked her if I could please borrow her phone, just for a couple of minutes, to call my wife. (My own cell phone was with the police, along with my bike and other stuff gathered at the accident scene.) The nurse looked down at the cell phone clipped to her waist, as if it had betrayed her with its visibility. “Well, maybe a little later, when I come back,” she said. Translation: “No, and just to be sure, I’m never showing my face back here again.” (Obviously if she’d been willing to loan her phone to me, she’d have just said yes.)
Suddenly, an object came sailing at me from behind the curtain across the aisle. Amazingly, I managed to catch it. It was a cell phone. “Call your wife,” came a voice from behind the curtain. “Talk as long as you want.” I was filled with a sense of camaraderie with this unseen fellow inmate. I called Erin, made some quick arrangements for my Great Escape, and then asked the nurse very sweetly if she could possibly return the cell phone to its owner.
As I tried to fall asleep I start to feel really, really bad. My pain escalated and my heart was racing. I could hear my pulse pounding in my ears. Meanwhile, the wind was picking up outside and howling right through the leaky windows on my right, chilling me to the bone. I even started to feel delirious: I was having increasing difficulty convincing myself that the screams from the TV weren’t coming from actual people in the next cubicle, and that the wind through the window wasn’t going to spin me off into the night.
Somebody came by to take my vital signs. Every one of them was bad. I had a fever of 102; my blood pressure was crazy high; my pulse was 90 (compared to mid-40s normally). The person taking these readings looked a bit concerned and commented on my fever, but then left. She wasn’t one of the regular nurses. Another hour crept endlessly by, my pain continuing to increase. I was starting to feel frantic. I pressed my call button. A nurse came over. I explained that my pain was through the ceiling and all my vital signs were bad, and that I didn’t feel right. She said, “Well what do you want me to do?!” I said I wanted a doctor. She left.
I started to worry that I was actually going to die. Looking back, this wasn’t exactly rational, but then I was half out of my mind. I had a vision of a sensor moving through the room, beaming a red line that picked up everything and recorded it, and how quickly it would pass over me, how insignificant my form would be. It would register even less then the bed I was in. Moreover, my small existence was confined to the immediate present: the fact that I’ve walked the earth for forty-two years was immaterial, a flash in the pan, and the future was completely up for grabs. If I died right now, I thought, I would be erased so thoroughly I might as well have never existed. It was the closest I’ve ever come to believing in my own mortality.
I pushed my button again. A different nurse came. I repeated my complaints and again asked for a doctor. Instead I got the head nurse, but at least he was sympathetic. He also seemed as disgusted with the other nurses as I was. The first thing he did was give me more pain meds. “You’re allowed to ask for these,” he said. “The nurses have guidelines but they’re only guidelines. They act like they’re rules but they can always consult with the doctor and they know it.” Then he stripped off my bedding. It was all tangled and knotted up, doing me no good. Then he started pulling up and discarding the absorbent pads from beneath me. These pads are basically the same thing as what you get with store-bought chicken, that sit between the chicken and the Styrofoam tray, to absorb drippings. “Don’t let the nurses use these,” he said. “They’re disgusting and uncomfortable.” I couldn’t have agreed more. The guy put my bedding back in shape and gave me an extra blanket.
After that I felt much better—just to have been paid attention to was greatly comforting—but the pain was still awful. So I tucked my blankets in all around myself, thinking of how I used to swaddle my daughters when they were babies. In my delirium my cubicle had seemed to grow and grow, to where it was the size of a handball court, then ever larger, like I was Alice in some Wonderland scenario. I decided to try using these illusory sensations to my own benefit, and imagined I was a little Asian doll, wrapped tightly in a paper dress that was like origami. I held absolutely still in my bed and soon began to feel I was rising up out of my paper-doll body, looking down at it, tiny but perfect in its symmetry. I rode this perception as long as I could and the next thing I knew, it was hours later and I’d actually managed to sleep. My head and body had that vacuumed-out, dried-out sensation and the pain was awful, but morning was that much closer, and it was finally time for more pain meds. I even managed a couple more hours of sleep before dawn, and by morning the TV channel had switched to something merely asinine, rather than ultraviolent.
Late the next morning (November 30), the physical therapist returned for my “final exam.” She reiterated the plan: I would use the walker to leave the hospital room, go down a hallway, and stop at the stairs. Then I’d switch to crutches, go up a short flight and come back down, and then switch back to the walker and return to my bed. If I could do all this, I’d be a free man.
It took a great while, perhaps ten minutes, to make it to the stairs. Finally I got to the landing, but suddenly started to feel incredibly dizzy. I told this to the PT, who had me turn so my back faced the wall, and said to lean back a little bit to rest against the wall. She supported me at the waist. I felt dizzier and dizzier.
Suddenly I awoke. Holy shit, where was I? How long had I been out? Amazingly, I was still standing. My vision returned and I saw the PT looking up at me, her face a picture of great concern. There was also a nurse looking at me worriedly. The nurse had brought a chair. “Are you okay?” asked the PT. “Did you pass out?” Imagining another night in this hospital, I lied. “No, I didn’t pass out, I’m okay, just a bit dizzy,” I said. They sat me down in the chair and the nurse slapped a blood pressure cuff on my arm. “You are really pale,” she said. My blood pressure was extremely low. I was taken back to my bed in a wheelchair. Needless to say I’d totally flunked my final exam. But to my surprise and relief, the PT said she’d give me another chance later in the day.
Not long after she left, I got a phone call from an MD friend of mine. Hearing what had happened, he asked how long before my physical therapy I’d had pain meds. I said not long before. He advised that the pain meds can lower your blood pressure and lead to dizziness. Remarkably, another MD friend of mine called not long after, and gave the same advice. So I stopped asking for pain meds, and when the PT returned, a few hours later, I felt more confident. Hedging her own bet, she’d brought a wheelchair. “This time, I’m wheeling you to and from the stairs,” she announced. At the stairs, I got up on the crutches, and heeded the PT’s advice: “Up with the good, down with the bad.” That is, I planted my good foot on the higher step and brought the crutches and bad leg up to meet it, and then at the top turned around and came back down leading with my bad foot. It worked, and I passed.
From there, many hours passed in bureaucratic hassles. The nurse wasn’t allowed to give me pain meds within an hour of departure, and since my departure time got dragged out two hours, I was in great pain when it was finally time to leave. (I know: waah, waah, waah.) I was wheeled through the halls, into an elevator, down into the crowded lobby, and Erin went to get the car. She pulled up and I was wheeled out there. Getting into the car was really, really hard. I had to lower the parking brake handle and grab the steering wheel and slide myself almost into the driver’s seat to get my right leg—which wouldn’t bend—into the car. Erin got me all settled in and then, reflexively, gave me a little pat on the leg. I yelped in pain. Some homeless dude standing on the curb called out, “Man, you can pretend you’re embarrassed now, but when you get home you’re gonna want her to be pettin’ you!” This was amusing, but then the guy repeated his quip continuously while Erin loaded my walker and crutches in the car and we slowly rolled away. He wasn’t quite right, that guy.
Three friends had arranged to meet us at our house, mainly just for a visit but also to help moving me in from the car. It was tricky extricating myself, Erin carefully moving my leg like a piece of rotting lumber. It was like a contortionist’s act in reverse. It’s a good thing my friends were there, because I’d forgotten our street is on a slope that ran perpendicular to my trajectory with the walker. The walker is a spindly thing and surely would have buckled and collapsed like a crappy tin cheese grater had my friend not bolstered it from the side.
I made the ten or twelve feet to the porch steps in possibly less than two minutes. I switched to the crutches, and here I had intended to rest for a minute. But suddenly I felt really dizzy, just like during my ill-fated PT exercise, and I feared I would faint. So I pressed on, getting past the stairs and continuing, on my crutches, in a sort of slow-motion sprint to the door. Erin had it open already, and somehow I made the couch. I was so relieved. I had made it. I was actually home.
It’s been a month since the crash. I can get around the house pretty adroitly with the walker and on crutches now; I generally use the crutches because I feel they present a slightly less pathetic sight for my family. Sleeping is really difficult—I’ve never been good at sleeping on my back, and my leg still hurts—but it’s so nice and quiet here. The only sounds are conversation, my daughters playing, the clatter of dishes, and my daughters practicing their instruments. Fortunately my job allows me to work from home, so I’ve been back at that. My right leg can bend almost ninety degrees if I dangle it from the edge of the bed and push on it with my other foot. I have lost fifteen pounds and get chilled easily. I have a long recovery ahead of me but I’m on my way.
2014 update: it occurred to me to add links to all the chapters of this tale now that they're available. Here you go:
The Femur Report - Part I (posted Dec 11, 2011)
The Femur Report - Part II (posted Dec 19, 2011)
Physical Therapy (posted March 11, 2012)
Bike vs. Car - How I Broke My Femur (posted Nov 27, 2013)