Four Days at Hopkins

This is my first full day back home after spending Wednesday night through Sunday afternoon in Johns Hopkins Hospital.  I still don't feel quite "all there," but one more night of regular, unbroken sleep will probably do the trick.

The roots of this incident actually go back to April, when I began to take hydrochlorothiazide as a third blood pressure medication in an effort to get my still-too-high blood pressure closer to normal levels.  HCTZ is an extreme diuretic, and I was cautioned to drink even more water than I was already doing in order to replace the extra loss of fluids.  The point was brought home to me with extreme force on Easter morning when I keeled over at the 7:30 a.m. Mass at Sacred Heart.  Nicky and I were planning to eat a big breakfast after Mass, and so I took my morning meds with only a cup of yogurt and a glass of water to "make them go down," as the singing English nanny would put it.  We had also gone to an earlier Sunday Mass than normal in an effort to avoid the worst of the Easter crowds.  All the sitting, standing, and kneeling evidently took too much out of me as I collapsed while trying to leave the pew during the Eucharistic prayer.  Luckily, a number of medical personnel who had just come off the "graveyard shift" (a rather questionable euphemism to use for people whose work is saving lives, don't you think?) were sitting in the pews near us.  They got me outside and off my feet and gave me fluids to hold me over until the EMTs arrived.  On the way to Carroll Hospital Center, the paramedics pumped in an IV.  In an hour and a half, my blood pressure was back to normal and I was able to leave.

After I consulted with my PCP and nephrologist, it was determined that the HCTZ was the proverbial extra coin that had caved in the Money Bin.  I temporarily stopped using HCTZ... but only temporarily, as I was allowed to resume using it in May with the proviso that I ALWAYS make sure to eat substantial food and drink extra water when doing so.  And I did.  I especially drank PLENTY of extra water.  As in, "running-to-the-cooler-every-time-I-passed-through-the-kitchen" extra water.  No problem there.  Water is completely benevolent, right?

Cut to the weekend of the 18th-20th, when I started to feel a strange, semi-burning sensation in my gut.  It was as if I perpetually had to belch but couldn't do so.  I thought it was some sort of acid reflux deal, so I popped some Tums, took some additional antacid medication... and, of course, made sure to drink extra water any time I could.  The problem persisted through the weekend as Nicky and I did some heavy yard work (pulling out the azalea bushes in the front of the house, then ladling in some topsoil) and brought poor Harry to the emergency vet for what turned out to be his final illness.  The reason I didn't write more about Harry on that last blog post was because I simply felt too crappy at the time to go into any more detail.

On Monday and Tuesday, the problem refused to go away.  Now I was finding it hard to eat anything, and yet I didn't really feel sick to my stomach.  Nor was I having any diarrhea at the "other end."  In fact, what did exit stage rear seemed perfectly normal.  The burning sensation and concurrent abdominal tightness just seemed to get worse and worse.  I finally made an appointment for Thursday morning at my PCP's office (with another doctor; my PCP was "out," apparently recuperating from some sort of nasty "consultation" with his backyard mulcher).  In the meantime, I was encouraged to eat some Activia yogurt, just in case something was plugging up my digestive tract. On Tuesday night, I could get only an hour or two of sleep.

Once I took a spoonful or two of Activia on Wednesday morning, the dam broke and I vomited copiously, presumably emptying my stomach of everything that had been in there.  I tried a little "tea and toast" for lunch, but back up it came.  Throughout all of this, I was continuing to drink plenty of water.  I finally decided that enough was enough when I began vomiting up water and nothing else, and the pain in my midsection still wouldn't abate.  Nicky was home from work by this time, and we discussed going to the emergency room.  Northwest Hospital was closest, but Nicky wanted to be able to visit me easily (from her lab) if she had to, and I simply felt more confident in Hopkins... especially since the Adult Emergency Center at the recently opened Sheikh Zayed Center was brand new and, presumably, spanking (in a good way).

It was a tough drive down I-83 for me (Nicky was doing the driving, of course), as the pain in my gut was getting all but intolerable.  Furthermore, I knew that I hadn't retained any of the food I'd eaten during the day and might be at risk of fainting at any time.  We reached the ER at around 7:30 p.m. and sat down to wait for an available room.  Or, rather, I tried to sit down.  I couldn't keep my head up, and Nicky finally had to ask for a wheelchair.  I almost blacked out, seemed to briefly recover my equilibrium, and then prepared to abandon chair and hit the deck.  The ER personnel quickly made room for me and got me set up with an IV.  My BP bottomed out at about 80/40 before I finally stabilized and began to recover.  It was a legitimately close call; had I waited any longer to go to the hospital, I might have been in VERY serious trouble.

On Thursday morning at about 3 a.m., I was finally admitted into the Progressive Care Unit, aka the "step-down" unit, as in "one step down" from the ICU.  The ER attendants had given me an antiemetic that knocked me for a loop, and I was pretty much "out" during the transportation process.  Nicky stayed with me until I got settled in the PCU before going home to keep Shasta company and rest for a couple of hours.  She was back by 8 a.m. as I was recovering from the antiemetic.  I vaguely remember taking two trips to get a CT scan, one for my abdomen and the other for my head (I never got the scoop on the reason for the second trip).

On Thursday morning and afternoon, it didn't take very long for the pain to subside and for me to begin feeling at least a little bit more like myself.  The saline IV's turned out to be just what I had needed.  As the in-house "kidney boys" and PCU-affiliated physicians (throw a piece of charcoal in any direction at Hopkins, and at least half a dozen doctors will clutch madly at their white coats and try to dodge out of the line of fire) explained it to me and Nicky, the level of sodium in my blood had gotten dangerously low.  I was already on a low-salt diet to begin with, due to all of my blood-pressure issues, so the excess water that I had consumed (and I really had followed doc's orders almost TOO well in that regard) had brought my blood sodium level down into the danger zone.  Plus, it is likely that I had picked up some sort of gastrointestinal bug a week earlier, which had had the effect of dehydrating me, thus encouraging me to drink more water, thus reducing my sodium level.  It was the proverbial "domino effect."

I was finally able to eat again on Thursday night, getting some mashed potatoes and pudding to stay down.  The meals increased in substance on Friday morning and afternoon as I started to be able to have phone conversations with my family members.  BTW, these meals should not automatically be classed with your standard, and justifiably abhorred, "hospital food," of the type that only an indiscriminate consumer like Burger Beagle would admit to enjoying.  Hopkins' food service is of the "room service" variety and allows you to pick your menu from a large list of choices (within reason, of course; I was officially on the "cardiac" diet and thus couldn't have a number of the entrees).  I wouldn't say that the food was outstanding, but, at the very least, it was... not bad.  "Congratulations, you have not done a terrible job!"  But please try to make the coffee a little warmer next time.

Due to the fact that my sodium level had recovered to normal with surprising quickness, I was moved to a "normal" Med/Surg patient unit in another building on Friday afternoon.  In my lap on the wheelchair, I carried the containers of urine that represented the combined "outflow" from my ongoing 24-hour urine collection.  (And yes, they were pretty heavy, reflecting the large amount of IV fluid I had received.)  I had this room all to myself, at least until later that evening.  At the moment, it looked as if I was certain to be released by Saturday afternoon, at least such was the impression given to me by the doctors.  On Saturday morning, they told me that I would be out by 1 p.m., and I changed into my civvies (which Nicky had brought) in anticipation of my impending release.  Big mistake.

After a couple of hours of waiting, the word came down to do one more blood draw and check my creatinine level.  It came back distressingly high (even for me), and so I was assigned to get a final "shot" of IV.  This took a while to set up as, for some reason, an IV pole proved impossible to find.  (You would think that, at "America's Number 1 Hospital"... But, apparently, this is not an unusual occurrence.)  The nurse on duty ultimately had to improvise an IV setup.  (Nurses always deserve your respect; they literally have to be prepared to do anything at a moment's notice.)  The drip took a couple of hours.  By now, it was Saturday evening and I was royally cheesed off.  Nicky (who managed, with her standard combination of good humor, loving understanding, and New Yorker sarcasm, to talk me off the ledge a couple of times) can attest to how much I hate to wait for anything.  Nicky finally had to leave at the end of visiting hours, and, at about 10 p.m., I finally decided that there was no way I was getting out that night and called her to go ahead and come back on Sunday morning.  At 11:45 p.m., the results from my post-IV blood work came back, and the nurse told me that my creatinine had "made the cut" for release.  How nice to know.

But had I missed my one and only chance to turn in that proverbial "Get Out of Jail Free" card?  One final blood draw was done very early on Sunday morning...  and, you guessed it, my creatinine was back up in the red zone once again.  The doctors had finagled with my blood-pressure meds all during this process, and I had been told that I would need to limit my water intake in order to restabilize my sodium level.  By this time, I was trying to figure out some magical combination of liquid intake that would let me go home.  One final four-hour IV drip session was set up, postponing minimum time of EVA to late Sunday afternoon... and then, the docs abruptly decided to have mercy upon my poor, ravaged system and halted the drip in mid-flow.  I was finally released shortly after noon.

As of this evening, I'm still on the water restriction (around 100 oz. of fluids per day), and I've been cut back to a single blood-pressure medication.  The thinking apparently is that I need to get back to a "baseline" situation before subsequent steps are decided upon.  I have a lab appointment tomorrow morning and a followup appointment will be set up for Wednesday afternoon.

Nicky was right by my side throughout all of this.  We had to celebrate our 9th wedding anniversary in the PCU instead of at Woodberry Kitchen, as we had originally planned.  But it was still "special" for all that.  Folks, this is one WONDERFUL and SPECIAL life-partner with whom I've been blessed.