This is Ridiculous

No one’s perfect.

We may go years in amongst the sick without  ever needing to ask for help.  We may feel as sturdy as tanks or as sprightly as pixies taking our imperviousness as a matter of course.  After all, who is going to have a more robust immune system than an ER Nurse?   Who is constantly exposed to everything that’s going around?  Who is coughed on, sneezed on, barfed on?  Who is dealing with urine, feces, blood and sores of a broad swath of humanity?   The idea of coming down with something just doesn’t enter my mind.  I don’t think it does my peers either.

This isn’t just swagger or machismo.  I am just a guy doing a job that among its benefits includes exercising my immunity daily.  So getting what everyone else has just doesn’t really concern me.  I do take reasonable precautions and use PPE (Personal Protective Equipment) to protect myself from imminent and likely exposures.  That said, there are times when we nurses break down, become susceptible and get injured or ill just like anyone else.  After all, we are anyone else.

I am overdue in terms of statistical probability.  By the age of two I had stitches in my forehead.  Three times.    At age ten I had a hernia that needed surgery.  I think it was brought on by the sit-up competition we had in my fourth grade class when I did 59 sit-ups in a minute.  (If I can do ten now I’ll be surprised).   I think I tore something.   I remember having surgery at the hospital where my grandmother, Ella Elizabeth Nelson Bateman Williams worked as a nurse.  I am the third generation nurse along that maternal lineage after my grandmother and my mother Bonnie Hudson.  Not until I was 26 did I break a bone, in a mountain bike crash.   It was an abrupt communion with an old Oak tree.  Another bike crash had me in the ER when I was 34.  Other than that I have been blessed with good health and freedom from injury.  This is probably when I should knock on wood or throw salt over my shoulder, but I don’t put stock in that.

One of my coworkers loves to travel.  Well, that’s inaccurate.  Many of my coworkers love to travel, but one of my coworkers has had the good fortune to have travelled all over the world.  On one of her trips she visited the Incan city of Machu Picchu.  That is a bucket list destination if ever there was one.  The journey to Machu Picchu is meant to be one of the salient memories in ones life travel log.  But for my friend Machu Picchu itself, although amazing, hasn’t turned out to be the biggest memory, or most interesting aspect of that trip.  Why?  Because when she was in that remote destination she noticed she was having abdominal pain.  No big deal.  Just walk it off, right?  Not this time.  I don’t know if she developed the Wretched Trinity of symptoms, Right Lower Quadrant Abdominal pain, Nausea and vomiting, Fever that are text book for the ailment, but if you guessed she had appendicitis, you are right.

Well Damn!  All the way up in the Andes!  Now what?  She had to find out where there was a medical facility she could trust to perform surgery to remove her appendix.  And she had to get there.  She took the train down to Cuzco.  The way she tells it, in her low key, good natured, laugh about things kind of way, it was no big deal.  She says she met the surgeon, he looked at her abdomen and commented, “Too much sushi”.   (Because of her fat stomach is how her friend translated it).   She is of Japanese descent.  Can you believe that?!  Then she says when he washed his hands in the OR he dried them on his haunches!  I’m not making this up.   Such casual behavior did nothing to inspire confidence or assuage her concerns about having invasive surgery in another part of the world more famous for it’s ancient roots than it’s modern medicine.   As it was, her choices were few.  She had an appendectomy in Cuzco, Peru.  She asked the surgeon if he would do the procedure Laparoscopically and was told, “Yes”, but the scar on her belly tells a different story.  And when my friend retells it, everyone enjoys a great big laugh.  I laughed so hard I cried.  She is a very good story teller and I thank her for permission to use her Andean misadventure here.

Sometimes, the idea that we could really be sick is so foreign to us that we’ll just keep on working, not wishing to be any bother to anyone, or feeling embarrassed to become vulnerable and in need of help, even from (or maybe especially from) our colleagues.  The prospect is rather unsavory to me and occasionally I have asked myself what I would do, where I would go if I needed medical attention.

Another of my world traveling friends from work returned from a trip and felt a little under the weather.  She knew what the problem was.  It’s common enough and we certainly see cases on a daily basis in the ER.  She had a UTI.  That’s a bladder infection.   Nothing major, but not anyone’s idea of a good time either.  She increased her intake of fluids orally to maximally flush the kidneys, ureters and bladder.  And she got a prescription for antibiotics.  Now the first agent often chosen is something called Keflex (Cephalexin).  It’s a broad spectrum antibiotic that’s effective against most of the common bacteria responsible for the majority of UTI’s.  The problem is she is allergic to Keflex.  Another antibiotic frequently used for bladder infections is something that is also generally effective and has the advantage of only needing a dose twice a day.  It is called Macrobid.  She started taking the Macrobid and had two days off work .  On the third day she was scheduled to return to work, but she started to feel short of breath and contemplated taking another day off work to rest, but being a trooper she decided to go in.  After all it’s just twelve hours in the ER.  Piece of cake!  That decision may have saved her life.  No really.

She started the day at work feeling run down and a little short of breath.  A short time into her shift she started to have pain in her chest.  Now that’s not so good.  She keeps herself in good shape, exercises, stays active.  She didn’t think she was having a heart attack, but after the recent travel the notion of a Pulmonary Embolism (Blood Clot that travels to and lodges in the lung) was not out of the question.  She thought maybe she could just sort of, you know, without being too much bother take a little break and get a quick look over by the doc and see what he thought.  But she was getting worse fast.  The people she was working with flipped her to the other side of the line in the nurse-patient relationship and it was found she was suffering a rare, but previously known and documented side effect of Macrobid, something called Flash Pulmonary Edema.  That means the lungs are suddenly and quickly swelling and secreting fluid as an inflammatory process.  If you guessed all that fluid in the lungs displaces the availability for O2:CO2 exchange in the lungs you can pat yourself on the back.

She was admitted to the hospital and spent a few days upstairs before going home to take some more time to recuperate.  This kind of experience changes the way you see yourself.  That nice image of invulnerability gets knocked out of its gilded frame and wrinkled up a bit.  Still she wasn’t ready to consign herself to the ranks of the merely mortal.

Six months later she was on another trip.  A SCUBA trip in the Channel Islands off the coast of Santa Barbara.  Her doctor had advised her against diving so soon after her Pulmonary Edema.  Her lungs were likely weakened and susceptible to problems related to the pressure stresses of SCUBA diving.  “Come On!”, thinks she.  I planned this trip and booked it a long time ago.  I’m not going to cancel now.  That’s ridiculous!  I’m experienced.  I know my limits.  I’m not going too deep.  I’ll just take it easy.

We got a call that she had been transported to a hyperbaric chamber.   She had gotten the bends while diving not too deep, or taking chances and while adhering to reasonable limits.  Well Shit!  That takes the fun out of things.  That was all last year, in 2017.

One of the ER Docs we work with carries on a tradition started many years ago by his parents.  He has a New Year’s party and at midnight everyone goes down to Cowell’s Beach and plunges into the ocean.  This year the plunge was significant for this nurse who had suffered these health crises. She had a lot to cleanse away from a year she viewed as a real Crap year.  It wasn’t just the health problems.  She has a Caribbean paradise she has been tending and building up into her modest but beautiful retirement destination.  I can almost not move my fingers to the keys and type the words…  A hurricane ripped through the island and wiped out her property.  The structure.  The vehicle she had been keeping there.  The landscaping she had been doing…Gone.  Erased.  Back to square one.  Back to Nature.  Thankfully, as a sliver of Sunlight, a Ray of Hope, her friends, companions who are native to the island were safe and after a time she was able to go there and, well, Be there.  With them. That much she still has.  But come midnight on New Year she was in that ocean.  Not just a quick in and out but a complete submersion and purification.  She had a lot to wash away and I hope this year will be better for her.

Some of my coworkers are big into exercise and fitness.  One nurse I have worked with for about fifteen years does ultra-marathon races.  These are foot races of more than 26.2 miles, the length of a Marathon. Some are 50 miles or a hundred miles or more.  I could say she  is fit, but that hardly begins to tell the story.  See where I’m going?

One day at work she started to have abdominal pain that started in a nagging sort of way but got gradually worse.  She started telling me her pains were becoming more than just a bother and was looking for guidance what to do.  Should she just keep working and see what happened?  Should she go home?  Should she check in as a patient to really find out what was going on?  I remember her saying, “This is ridiculous!”.  She was trying by force of will to tell her body, “This is not going to happen”. “I am going to continue with my day and this little problem will go away”.

It didn’t.

I was her Triage Nurse.  The experience was interesting for me and I became acutely aware of the intrusive and highly personal questions we ask our patients.  I learned more about her in a few minutes than I had in fifteen years of working together. The abdomen is home to many internal organs.  Women’s abdomens even more so than men’s.  She was having some tests, ultrasound, pain medicine.  There was no answer yet by the time I had to go home.

Later I got a text informing me she had a hemorrhagic cyst on her right ovary and an inflamed appendix.  She had been transferred to Stanford because she has a blood clotting abnormality and they wanted to keep a close eye on her in case her appendix got worse or ruptured, because she would be high risk if surgery was needed.  She was up there a few days and was abel to come home, but had to take things easy for quite a while.

She didn’t end up requiring surgery.  She is back to her ultra-marathons.   She looks full of vitality.  She has a partner she trains with and now her two boys are running with her too.  It almost seems like none of it ever happened.

But it did.

She was on that unfamiliar side of the line and I was where I have been for twenty years.  I got to know her better because of it.  Better than I probably would have if she hadn’t found herself in her ridiculous situation.  I feel closer to her too.  Vulnerability and trust can open doors like that and change the shape of the world.

Note:  These stories were generously shared with my by my coworkers and by me with you through their kind permission.

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