Thursday, May 22, 2008

Always, Always take someone with you to the Hospital ER!

Recently I had an interesting experience. I found myself going to the ER with an intense pain in my side and needing to have it checked immediately out of concern for a rupture that would lead to peritonitis. Granted if I had listened to my wife, I would have gone to my primary care physician more quickly, but I figure I pulled at least "a 1/2 guy, with some splash." While the triage could have been more effective once we arrived at the ER, I found myself playing good cop to my wife's bad cop - when we were trying to get my vitals taken. My wife was helpful in speaking up for me.

In this day of the health care field being under assault for rising costs and finding ways to make strategic cuts, modern ERs don't have the hustle and bustle that the NBC show, ER, tends to display. Duplicate equipment costs money, so they don't seem to have too many extra machines around - such as blood pressure machines. They aren't going to have as many staff on duty as once they might have - all in efforts to control costs I am sure. However, that means it is even more important that you have an advocate with you at the ER or hospital until you are lucid enough to watch and react for yourself.

My experience is telling of this. After we finally had my vitals checked, the ER found that I did have a strong need for immediate care. They put me on IV antibiotics, morphine for the pain, and otherwise started diagnosing and treating me. I found that the ER nurse would come in with the a machine to check my blood pressure, and then take it with her to check someone else in another room. I seemed to have been stabilized, was propped up on a gurney without a cuff or call button on me, and was waiting to allow the contrast to absorb in my digestive system for an hour before they could take the CT scan. No one was immediately around except my wife. After 40 minutes, I had been doing decently well when quickly I started feeling first more tired, then nauseous, then really nauseous, ... then the sense that my skin was on fire, started sweating profusely, and feeling far worse than I have EVER felt in a matter of moments. At the beginning of this, my wife ran to get the nurse quickly. This was all going on as they run back into the room.

When the nurse came in, her first concern was that I was having an allergic reaction to the antibiotic, which was not unreasonable given my medical history. They flattened me out on the gurney and put the blood pressure cuff on me; I was still feeling really bad. My wife, though, quickly suggested to further raise my feet even higher while they were cuffing me to check my blood pressure. Right before my feet were elevated, I had dropped from about 148/95 to 71/50 - which they called a "vagal." I quickly started feeling better once my feet were up. It was then that the nurse indicated the danger of such dramatically falling blood pressure - kidney failure, followed by other organ failures, and then death.

If my wife had not been there, I would not have had someone to run and get help quickly, and independently be assessing the situation. Given the position I was in - propped up in the gurney - if I had passed out without anyone there, I easily could have been found after 10-20 minutes or so - which could have been fatal. At a minimum, my wife probably saved my kidneys, and potentially my life by being there - getting help and assessing the situation as well. Part of connecting with people is making sure you know enough people to ask to go with you to the ER. For those with amble family nearby, they will serve. If you are someone without a lot of family nearby, then definitely start having those conversation with close friends and agree to be there for each other.

While I am sure the lawyers who read this will be assessing blame, it is MUCH easier to avoid the problems or deal with them quickly before the consequences occur - than judge people for years afterwards. For me, I am doing better after spending several days in the hospital. There luckily was no rupture and I am slowly on the mend.


At the time of this incident, as I reported above, the term the hospital used with me was "Vagal." Sometime after that, a friend who is a physician first used the phrase, "you might have been a little septic" when he heard the story. At the time, the term "sepsis" was not in my vocabulary and it went right past me.

However, several months later in January 2009, a Brazilian model died suddenly in an ER in Brazil when she presented with what they thought was simply a urinary tract infection that was severe. Within days, she went into "septic shock," lost consciousness and never regained it. In the days that followed, because of sepsis, she developed gangriene set in and they had to amputate her hands and feet to try to save her life. They did not and she died a few days later. I began to look into this incident since it had a lot of similarities on the front end to my experience, and made me very appreciative that my outcome was different.

The concern about sepsis, septic shock, and any other "true" shock became very real to me. I believe based upon my vitals I likely was on the beginning part of septic shock when I had a "vagal" and I was fortunate not to go into full blown sepsis. When these occur, a cascading organ failure can start that is difficult to stop - leading to hypotension, loss of consciousness, kidney and liver failure, brain damage and DIC, followed soon after by death. I was on IV antibiotics, fluids and morphine for 40 minutes at the time and I had pretty fast care when I went into shock, thus ensuring that I did not suffer oxygen deprivation to the brain or other organ failure.

If you do not fully understand the nature of "sepsis," and want to know what to look out for, please consider watching this video by the Sepsis Alliance, a non-profit educating people about this danger. If you go into an emergency room with the possibility of a severe infection, consider expressing "I am concerned about sepsis," and if they don't seem to know what that is, find someone there who does.

Similar concerns also exist for other true shock conditions, whether it originates as septic (vasogenic), anaphylactic, or hemorrhagic (cardiogenic, hypovolemic, or neurogenic) shock.
See also,

Saturday, May 10, 2008

"Sometimes you are the windshield, sometimes you are the bug!"

I like the above saying since it characterizes life well - that some days might be bad, but the next day might be a good one. The saying is as much about perserverance as anything else - about not to give up no matter how hard life seems to try to knock you down at times. Be smart, keep plugging away, and see that connecting is always a good move.

Have you ever been driving in the slow lane, you are in a hurry and the traffic all seems to be passing you up. Finally, after you get tired of being left behind, you change lanes, only to then see that your prior lane is now moving faster and ... once again you are in the slow lane. Some of those times, I even change back - only to find out - yes, I am in the slow lane AGAIN. AARG! Sometimes in the back of my head I start thinking, "why is the world against me on this!" Finally, I will try to just let go of the situation, and simply say to myself, "well, I will get here when I get there, I guess!"

The people who ultimately succeed are not the people who always succeed, but are people who can learn from failure or struggles, know when to hold them, know when to throw them, know when to walk away, and know when to run! Granted, an old line from Kenny Rogers, but still a good one.

Many of you might have seen the movie, Sliding Doors, with Gwyneth Paltrow. The thing I liked about the movie is how it went through the nearly parallel lives of one woman in two scenarios - what would happen if you hadn't caught that train and each event impacted the next. In one of the lives, Paltrow's character seems to always be getting the hard times, while the other geting the better ones, sometimes they shift. At the end, the character who seems to have had the best time - ends the worse.

Going back to that slow lane scenario, what if there is a cop ahead and ... if you had decided to speed in the "fast lane" and then you got a ticket! I have had times when I was getting slowed down and somewhat frustrated by it -- only to find out it was because ... yes, there was cop ahead. "Man, glad I didn't try to go into the fast lane that day!"

Maybe if you had ended up in the fast lane, you would have been in the middle of a huge accident. On one occasion on I-35 here in Austin I was going north in mid-afternoon pre-rush, when the cars are packed, but they are still hauling - and a 10 car pileup occurred literally seconds before I came along. I almost wasn't able to dodge through the scene since I was on it at 60 mph ... except the exit lane was right there and I was able to swing out to avoid hitting anything. As I went through, most cars involved where pretty badly crushed. The lane slower by seconds may have been in fact the lucky lane that day!

Part of connecting to the world is that you will put yourself into more situations where you can seem to fail or simply not connect well on particular days. It can be a day where everyone seems to be "against" you, and it can even shake the best people's confidence. Just tell yourself repeatedly, "sometimes you are the windshield, sometimes you are the bug!" Be smart, keep plugging away, trying to improve where you can, and don't give up on yourself or your opportunities - but learn wisely from them. Often life will have a way of turning things to your advantage, if it has not already been looking out for you by putting you momentarily in the slow lane!