Life Threatening………….#274 – (2012)

Kaiser Permanente Hospital Modesto

Gary having spent a restless October night, the previous day having experienced increasing abdominal discomfort but attributing it to gas caused by something he may have eaten.  Raising in the morning, the pain continuing to increase finding no alleviation with over-the-counter antacids or gas relief tablets. The pain ever intensifying, Fran awaken showing concern, Gary contemplating driving to the hospital, but a new onslaught, he was having difficulty breathing.  The incessant abdominal pain now radiating to his back and  upwards to his chest and lungs, realizing he wouldn’t be able to drive.  Fran asking if she should call 911, Gary now uncertain of what was happening,  as an ex-EMT questioning himself about a possible heart attack although not experiencing any of the text-book symptoms.   Fran dialing 911 asking him what she should tell them, Gary starting to relate about the abdominal pain radiating up to his chest and the difficulty breathing but stopped, just tell them that you think I’m having a heart attack.

Gary watchful as the Modesto Fire Department and the American Medical Response ambulance arrived at the same time, the difficulty breathing and pain continuing, but deciding to step outside as the fire department responders approached with a questioning look.  After a brief explanation, assuring the AMR responders although unsteady and in pain he was capable of walking to the ambulance.  Once there he addressing the gurney, the paramedic beginning the same basic protocol Gary had performed on numerous occasions as an EMT.  The ambulance still stationary Gary questioning which hospital he was to be transported to, the paramedic responding Doctors Medical Center.  Gary vocally adamant that he didn’t want to go DMC, previous experiences leaving him with a detrimental impression of the facility.  Stating that he preferred  Kaiser Permanente, the paramedic relating that it was policy to transport suspected cardiac patients to DMC.  Switching tack a very shaky uncertain Gary reintegrated that his pain had started 24 hours earlier and that he didn’t believe he had a cardiac problem. The paramedic remained hesitant, then began placing EKG monitoring patches on his chest, a decision was in the making. The electrocardiogram taken in the ambulance showing no cardiac anomalies, Kaiser Permanente could be it’s destination.

Ambulance Portable EKG

Arrival, the paramedics transferring their charge to a Triage ER nurse who almost immediately provided pain medication and Gary’s physical world took on a soothing warm glow, the 10 mg. of morphine engulfing the intense pain.  Having spent 20 plus years working in a healthcare environment he was well aware that time to the seriously ill under medication day and night was irrelevant.  The time in the treatment room seemed like an eternity, the ER doctor having visited and when asked about a diagnosis volunteering that he was waiting on lab results.  Gary’s only visitor he was aware of  was when the ambulance paramedic who performed the EKG poked his head in the room mentioning that he was getting off work and just wanted to check on him, which Gary thought was somewhat unusual but later discovered that Fran had checked on him having arrived by Dial-a-ride.   Gary wasn’t sure of the gurney trips for scans, thinking there was three, probably a MRI and CT, but definitely remembers the Ultrasound, the lady technician asking if he had any past abdominal surgery because she discovered what appeared to be anchor pin.  Gary related that he had 27 inches of his colon removed years ago but that was first he had heard of having a pin inside, then she asked when, where and the name of the hospital.

It had to be late afternoon or early evening it was hard to tell with the intravenous morphine being administered every four hours, the ER doctor finally returned to inform him they were transferring him to the third floor.  Gary asking about the diagnosis, the doctor replying Acute Pancreatitis, then  Gary ask about the prognosis, the doctor responding as he left the room, “It could be life threatening”.  The third floor room was comparatively peaceful to the open door noticeable traffic of ER, Gary perceiving that every time he woke from dozing there was a nurse in his room.  Apparently it must have been morning as an elderly doctor looked in questioning how he felt and explaining the seriousness of his condition and like the ER doctor when questioned mentioned that it could be life threatening but not a word about treatment. Having never been acquainted with anyone who may have suffered from acute pancreatitis Gary was pretty much in the dark about the cause and effects with the exception of knowing that it provided the necessary enzymes for food digestion and insulin to regulate the blood sugar glucose.  Lying in bed with a vital monitor and IV he was still somewhat cognizant to what was going on,  giving weight to what had been said so far it didn’t sound very life threatening to him.

IV therapy

The pain never completely leaving but muted by 6 mg of morphine every 4 hours, Gary questioning a concerned nurse who looked in on him every hour asking her if she had any idea what was going on, when a doctor entered the room.  He introduced himself as gastroenterologist and in a matter of fact way proceeded to say the lab amylase and lipase results were at an acute level and the only way to correct this was literally is to give your pancreas a vacation.  We’re going to put you on total parenteral nutrition, you’re going to be NPO, not going to eat or drink anything for the next ten days, your nutrition will be intravenous.  No sooner had the doctor left, Fran entered relating that surprisingly a doctor had called to tell her that her husband was going to be there for a while.  The doctor wanted her to know the reason, stating that some of the test results had come back immeasurably  high and that basically severe pancreatitis of that significance would require intensive care because of possible complications including pulmonary and renal failure.  Gary thought it somewhat ironic the doctor telling Fran but not him, and as she was leaving asking if she should notify his family, Gary not hesitating, replying no, he would rather wait.

Fran’s visit informing him that he was considered an intensive care patient provided an answer to Gary’s question about the frequency of the nursing staff visits.  The ten-day journey beginning, the first thing he noticed was that without meals being delivered to ascertain the intervals of the day, time became totally irrelevant.  The pain starting to subside, the intravenous morphine reduced to 4 mg., the new discomfort prevailed,  the dryness of his mouth and the crusting of his lips, finally asking the doctor if he could at least have some ice chips,  the doctor giving him a look of disapproval but verbally agreeing.  He sot and received permission to use the restroom; given the ok but nursing refused to disconnect the bed alarm which required their summons, it was minor incidents that began to trouble him a sign that he must be getting well.

The doctor itinerary coming to fruition, on the evening of the 10th day a tray arrived the start of a clear liquid diet,  followed by a soft liquid, then a soft food diet.  The IV disconnected Gary elated that he was no longer leashed,  able to move about the room and slowly venture down the hall.  Mentally he was ready to go home, physically somewhat shaky, the bland soft food diet didn’t impress him, aware that his release couldn’t  be prodded, but also aware that he had the final word, but having visited with a representative of the Kaisers Medical Assistance Program, being told his name had been submitted, he didn’t want to jeopardize the possibility of their generosity as he could only assume that the placard amount of his two-week stay would be exorbitant.

On restriction

The day of reckoning,  Fran arriving in the morning riding out with neighbor Rob in the Accord now deposited in the parking lot, Lisa Rob’s wife having followed to provide him a ride home.  Gary was ready,  anxiously waiting on the doctor who for some reason was delayed, giving him time to thank and hug the day shift nurses who cared for him.  The doctor arriving, briefing Gary on  instructions of do’s and don’ts to prevent an occurrence, most of which he had already read in the literature provided, realizing  acute pancreatitis is somewhat of a life style changing event.  It was now a given, a zero tolerance for imbibing all alcohol beverages and its companion, his smoking on again off again habit for the past 55 years. The worse yet to come a restriction on trans and saturated fats and its residual nutritional culprit, butter, bacon and a host of processed foods.  Exiting the hospital thankful for the chauffeured wheelchair ride to the parking lot, Gary acknowledging his doubt about walking that distance and an acceptance that the past two weeks had changed his path in life.

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