An Epistaxis Retirement……#269 (2009)

Colony Park/Country Villa - Gary's Building for the past 9 years

Colony Park/Country Villa the 99 bed skilled nursing facility – Gary’s Building for the past 9 years

      It was a warm that late Friday March afternoon,  Gary participating in his routine of breaking down the empty cardboard boxes deposited by Rosa Guzman.  Rosa responsible for ordering and stocking the weekly  delivered palates of patient care supplies, Gary depositing the disregarded boxes in the 10 yard compactor.  The sun giving notice, the sweat on Gary’s brow bearing witness, a brief handkerchief swipe of the forehead and face remedying the accumulated moisture only the white kerchief came back baring the red stains of blood, Gary noticing  a runny nose, only it was blood.  Going inside the maintenance shop he followed the prescribed procedure from his EMT days, sitting, head slightly forward, pinching the cartilage on the nose but after several minutes, no results the blood flow continued.  With handkerchief in hand he decided to see who was at the nurses station, discovering that Carolyn Hauser the director of nursing and another nurse was in her office.  Entering, Carolyn immediately recognized his predicament, listening as he related how he had tried to stop the flow, Carolyn telling a passing  CNA to go to the kitchen and get some ice in a plastic bag as she reached for a blood pressure cuff.   Gary noticing Carolyn expression changed as she murmured “that can’t be right” retaking his blood pressure a second time.  Gary curious asking what the reading was,  Carolyn not immediately answering as she reached for her purse saying we need to go to the hospital,  she would drive, then adding your blood pressure is 210/121.

Carolyn Hauser Director of Nursing

Doctors Medical Center being only four blocks from Country Villa, in her haste Carolyn pulled into the employee parking instead of the ER, realizing her mistake but leading Gary and the other accompanying nurse through the main entrance asking an office employee how to get to ER from the business office side.  In ER his nose bleed remained but his blood pressure began to come down Gary telling Carolyn that he could take it from here but would appreciate it if she would call Fran and tell her he would be late getting home.  After what seemed like an eternity a physician entered the treatment room, the doctor swabbing the inside of his nose with silver nitrate stopping the flow.   He was about to leave when to his surprise Fran entered the treatment room having taken a cab to the hospital, it was a comfort,  the two walking back to Country Villa to retrieve the car.

  The 6:30 a.m. Monday morning ritual was normal, Gary was about to step out of the shower discovering his nose bleed from the previous Friday had returned, only this time flowing with vengeance.  He found it difficult to hold a towel over his nose with one hand and dry himself off with the other and get dressed,  then soon discovering that you can’t tie shoes with one hand.  Once dressed he placed a call to Country Villa to give noticed he wouldn’t be in and by chance Gary’s previous boss Brad happened to answer the phone,  Gary explaining the situation but after hanging up the situation turned for the worse, the blood not only was exiting thru his nose but now down his throat causing him to gag. His condition wasn’t life threatening, he didn’t need to call an ambulance, what he needed was a ride to the hospital deciding to call Brad back and see if he could come by, Brad answering,  he was on his way.  Gary finally waking Fran making her aware of the situation.

Doctors Medical Center

Doctors Medical Center

 Entering Doctors Medical Center ER,   Gary signing in, told to be seated, the blood continuing its flow, his towels almost totally soaked, enough was enough, he approached the reception counter area once more only this time removing the towel letting the blood drip all over the counter, getting the attention of the person behind the glass, it worked he was immediately taken to a treatment room.  For the second time in three days his nose bleed was stopped, the noon hour having arrived deciding to walk the four blocks to Country Villa to see about a ride home, but no sooner had he exited the building his nose bleed resumed.  Returning inside, the process of waiting for his name to be called returned, a second doctor repeating the same process as the first halting the bleeding, Gary being told to remain in the treatment room.  Time passed he  thought they had forgotten about him as the evening hour approached and as before the bleeding once again resumed, only this time requiring suction to prevent the blood from entering the throat.  A third doctor performing a brief examination informing him that he was going to be transferred by ambulance to the Kaiser Hospital in Fremont, a distance of 75 miles as Kaiser Permanente was his HMO.  Placed on a gurney and he was moved to the ambulance entrance, surprised to find Fran standing there having just arrived by cab after being notified of his impending transfer, looking very concerned..

Kaiser Permenente Fremont

Kaiser Permanente Fremont

   It became evident that the AMR ambulance crew hadn’t made very many trips to Fremont as Gary heard one of the EMT’s tell the other he was at the wrong hospital.   Apparently the driver pulled into Fremont’s 269 bed Washington Hospital instead of Kaiser, but was relieved that the hour and twenty-minute ride was over.  Placed In a treatment room introduced to a young lady doctor,  it was approaching midnight the nosebleed had subsided to a trickle but was beginning to feel the stress of his long day.  He questioned the doctor about the procedure relating that the previous two doctors had used silver nitrate to no avail.   She said she would be using something different this time, it was medicinal cocaine, that it had vasoconstriction properties, in essence, the cocaine puts a chemical tourniquet on the blood supply to the septum.  With the  procedure completed, the bleeding stopped, Gary relegated to a wheelchair, the hospital unseemly quiet at that time of the morning, thoughts about how and when he could return home beginning and just when he thought all was well, his nose once again gave forth another notice as the blood once again commenced.  He was beginning to have a concern that he might have to have surgery, the lady doctor returning,  informing him that there was another non-surgical procedure and that an ENT from the Bay Area was on his way to administer it.

     Once again relegated to waiting only this time in a semi-darken secluded area seated in a wheelchair,  a night shift nurse finally breaking the solitude wheeling him into a treatment room. The door opened, stepping into the room was a short elderly Chinese man wearing a traditional white lab coat introducing himself speaking gingerly about procedure that would halt the bleeding.  On the treatment table were two rolls of packing, the doctor unwinding rolls, producing two 24 inch long strips,  saying this might be somewhat painful as he proceeded to insert a 24 inch strip into each side of his nostrils forcing them up into his sinus cavities.  The procedure completed, Gary’s reaction from having tensed up from  the pressure and insertion of the packing leaving him somewhat exhausted,  plus the biting reality of the past 20 hours.  The doctor informing him that he would have to live with the packing in place for the next ten days,  but at that moment it was of little concern,  returning home was foremost on the patients mind.  He was relieved after being told that the hospital had notified his wife and that she was making arrangements.  Concluding that admittance was totally out of the question asking if there was some place he could possible lay down while waiting and to his surprise his request was answered, a nurse moving him into what appeared to be a darken unoccupied ward room, the bed a welcoming sight. The doctor was right when telling him of the extreme discomfort that would come with the sinus packing, sleep finally settled in.  He was aroused by nurse with a food tray informing him it was noon, surprised at the hour as well as the food tray as he wasn’t an admittance.   Gary surmising was correct, Fran had called his mother who in turn contacted his sister Katherine in Groveland, the two finally arriving that afternoon.   Awaiting at home was a concerned Val Galindo and his wife Kay from Country Villa,  apparently Gary’s two-day absence and word of Brad taking him to the hospital must have gotten around.

March 26th having arrived, the ten-day stay at home with the packing had elapsed, Gary having an afternoon appointment with Kaiser Dr. Vijay Bais M.D. ENT.   Still somewhat puzzled at the parade of events, a simple epistaxis, better known as a nose bleed requiring attempts by 5 doctors and two hospitals to halt the flow from a cartilaginous nasal septum.  On his way to the doctors deciding he would stop at work as quip so they could see his swollen facial disfiguration from the packing, evidence of what he endured for the past ten days.  The expression on the business office manager Joanie Peels face was priceless.  Dr. Bais a very congeal elderly man, removing the gaze and flushing the sinus cavity, Gary recognizing a familiar  odor as the packing was removed, mentioning to the doctor the smell reminded him of human decomposition, the doctor smiling,  nodding in agreement.

Joanie Peel – Office Business Manager

  Once again returning to work,  a renewed effort being made to retire,  an interview for a replacement was at hand , this time one with applicable experience.   Scott Hensley having worked at Manteca Nursing and Rehabilitation Center and  also possessed a state contractor license.  Gary took an immediate liking to his replacement but when questioned about the plant systems and appliances he enumerated the Manteca facility had contracted all the servicing out.   Six weeks having passed, Gary satisfied with Scott’s progress, it was time for the 68-year-old to approached Rashmi that his last day would be Friday, May 29, 2009.   That final day was much like most keeping busy,  approaching 4:30 he entered the business office to cede a farewell to Joanie Peel the business office manager.  After nine years, Joanie was almost like family, Gary having employed her son Michael and daughter Karen in the past.  Saying goodbye he was about to leave, Joanie stopping him,  imparting that he shouldn’t leave just yet,  grabbing him by the arm  leading him to the closed-door of the conference room.  Seated inside was Rashmi and all the department supervisors and many others, a large cake and refreshments adorning the long conference room table.   Gary was taken aback,  caught without words, the reception unexpected, but the real unexpected gift was not just their presence but their acknowledgement he would be missed.

One Response to “An Epistaxis Retirement……#269 (2009)”

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