I’ve spent much of my adult working life in hospitals. For forty years, I learned how to navigate the geography and sociology of these modern civic centers. Like train stations 60 or more years ago, everyone seems to pass through them, sometimes as a a visitor, sometimes as an inmate.
But for all my time scuttling in underground tunnels, waiting in cramped public or utilitarian service elevators, resting in the doctors’ “lounge”, scrubbing my hands at an OR sink, writing orders in a chart at the nurses’ station, for the thousands of hours I have lived within the monolith, I never really quite grasped the concept that these places exist not as a workplace for MDs, RNs, and all the other initials in health care, but as resting and restorative places for those who are so debilitated by illness, injury, or doctors’ ministrations, that they can’t take care of themselves. Yes, much as it pains me as a physician to realise this, the work of the hospital revolves around and exists solely for the care and return to society of those who are called “patients.”
My first five days were in the ICU at Madigan Army Medical Center. I was “ZuluTrauma”, so named because I was a civilian, and needed to be identified as such. Were I a service member or dependent, I would have had some sort of DoD number, but coming from the outside world, I was a square peg in a round hole, so ZuluTrauma it was.
I felt like the king of the world for a while there. Every morning, teams of fresh scrubbed young men and women would flow into my line of sight – morning rounds at this teaching hospital. General Surgery (the trauma guys), ENT, Neurosurgery, Orthopedics – they all had to troop in and explain my condition or ask me about it. One good thing about the Army – everyone has VERY neat hair. And they were all so young and fit.
My first conscious day, I had TWO RNs attending me, as well as visits by PT, and OT, and RT, and every other T you can imagine. At this point, I was assuming I could get out and get back into my training lifestyle with 2-4 weeks. Out with the trach, off with the C-collar, away with the crummy heavy cast they’d slapped on my wrist while I moaned inwardly “No, No, I NEED that hand – the OTHER one doesn’t work so well, guys!”
What I got was a series of earnest young women getting me out of bed and marching me to the door, then around the nursing station, then down the hall, all the while telling me how STRONG I looked ( to which I would respond by grinning and flexing my biceps). But what I really needed was someone to come in and sit down and say, “Look, you’re 61 years old and you’ve suffered severe trauma to your neck, throat, cervical spine, and spinal cord. In addition, you lost 30% of your blood and 8 teeth to a terrible mouth laceration, and oh yeah, you’ve got a broken wrist. So It doesn’t matter how good of shape you were in at 9:30 AM Sept 18th, or that you were the best Ironman athlete of your age in the country. Don’t expect to do anything for the next 6-12 weeks other than wait around for your old battered body to repair itself. You can’t will things to go any faster, and you can’t train it to get any better. ‘Rehab’ isn’t on the agenda until (a) you get that collar off, which may not be until November, (b) you can breathe without the trach and (c) you can start to eat on your own. Considering all the trauma and swelling in your throat, that may take until then as well. So get used to it, soldier, this is your life for a while.”
Luckily, though, they were used to dealing with “wounded warriors”, meaning Army guys from 20-40, who would heal quickly and who needed to get back in the game. They expected me to suck it up just like those guys, so they didn’t cut me any slack for my age, and they treated me like someone rapidly on the mend. For some reason, the culture at Madigan was to emphasize the positive, the fast track, and the bright future I had in front of me. That attitude, along with the young, friendly, and supportive staff, made that place seem like heaven.
But, my dear friends at Group Health, where I work and practice, needed to bring me back home, to stop paying the government for my care, and get me into St. Joseph hospital. So, almost without warning, I was transferred Wednesday evening to the PCU there in Tacoma. Into the funky scalloped shaped tower, with its pie-wedge rooms all facing towards the central noisy nursing station. The Franciscan Trauma team took me on, and lined up consults with Neuro, Ortho, ENT, and OT. I got poked, prodded, scoped, CT’d and MRI’d all within 24 hours.
Reality set in soon enough. I took stock of the tubes and wires I was connected to: Let’s see, IV, NG tube for food, tracheostomy for breathing, which had mist and oxygen flowing into it via another tube, pulse oximeter, EKG with a telemetry box, catheter to pee for me, and, while not strictly a tube or wire, there was the C-collar restricting the movement of my head relative to my neck and the humongous soft cast on my left wrist. Nine external connections in all. Just trying to move without entanglement was a major mental effort, and trying to get out of bed to go somewhere, say, for a walk or to X-Ray, was a major production. But down to X-Ray we did go the next day, to get another MRI and CT scan.
Yep, I’ve still got a broken neck and swelling in my spinal cord, says the MRI.
The orthopedist came by, smiled and said my wrist fracture was not a surgical problem, and I could lose the big cast and just wear a smallish splint for comfort. He cut the cast off right then and there, using a teeny pair of scissors on his Swiss Army knife. One down! If I could just lose one thing a day, I could be outta here in … nine days!
Next, the Neurosurgeon comes by, and says my neck doesn’t need surgery (duh; if it did, wouldn’t they have done that at Madigan?!) I complain about my hand numbness and pain and weakness, and he makes sure I get another OT visit. The Trauma team PA comes by, and I get one set of stitches, on my face, taken out. Each day, a new PA will come back and remove another set: finger, eye, mouth again.
We hear rumors that the ENT doc will show up and do a nasopharyngoscopy (basically, they numb a nostril and thread a flexible fiber optic scope down into area just above the larynx and the esophagus.) He is supposed to be checking on that laceration or abrasion I have in my pharynx, seeing if it’s healed enough to consider getting the trach out.
I had not really paid much attention to this “abrasion” in my pharynx – I mean, that’s just a little thing, like a scrapped knee, right? I assumed it was the throat equivalent of minor road rash, and would not be an obstacle to recovery.
So when the ENT doc shows up at 9:30 PM, scopes me, and then discusses the CT findings, I was thrown for a major loop. Apparently, while the abrasion was healing, there were several far more serious things going on in there which would probably delay the trach removal for “weeks”. (Nothing was mentioned about swallowing at this time – maybe he was trying to deflate my optimism slowly.) I had “more edema in there than I’ve ever seen in my thirty some years in practice.” In addition, there was a one inch ball of … something … maybe an abscess or a big blood clot gumming up the works. He’d came by so late because he had been reviewing the films and then discussing them with some of his colleagues up in Seattle. They agreed, watch for fever, and go SLOW with any trach removal.
Cheryl and I were devastated. We’d been thinking I would sail along, and that the trach was just a short term thing necessitated by the bleeding during my initial time in the ER. Instead, it turns out that the trouble they had trying to intubate me in the ER was due not to the blood gumming up the works, but the swelling already present by the time I got there. Imagine a big goose egg on one side of my upper wind pipe, blocking it from working properly.
Anyway, the trach and the constant attention it required suddenly became uppermost in our minds, and made us suspect I’d be floundering in the hospital for weeks, not days. The NG tube began to seem a bit more menacing as a result, as it was my lifeline to calories, and I was thin enough to start with when this all happened. Maybe I really was more beat up than I thought. I determined to start working on the things I could change, like peeing for myself, wiping my own bottom, and starting to walk with a bit more determination. And maybe convince the docs to switch the tube in my nose for one direct to my stomach.
Keep the faith brother.