You may have received notice that "Dreams" has been republished on the UPSTREAM IDAHO webpage. This edit was done because several readers were confused with my casual reference to two personal medical events. The first event was long ago and was life-threatening. At a low ebb, possibly in a dream, I gained the distinct impression that it was not my time. The more recent outpatient surgical events were not associated with dreams, despite the IV Fentanyl. I apologize to those who became confused.
Twenty years ago, MK had just been through a month of all the messiness that went with helping me recover from complicated repeat emergency surgical procedures. I was usually the doctor, but in this case, I had been the patient -- a sick one. It was in this weakened state that she convinced me to buy the cabin in Island Park. For a while, I thought it was an expensive mistake. Now I realize that was the best mistake I ever made.
Just before I knew I was really sick, I was in Hawaii. I did not know that I had a ruptured appendix at that time. I just thought that I had met too many Maui Tacos. I figured that I would get better if I could manage to pass some gas — nothing like being a gas passing expert and not being able to do so. I had a retrocecal appendix, a condition that often hides the classic signs of appendicitis. In fact, I worked for another week before I was the patient on the operating room table. Like many of my patients, I am from Idaho but live in the state of denial. Late Friday afternoon following four cancer cases earlier that day, JA, my medical assistant, found me lying on the floor of my office, gray and septic. She called MK, and between them, they dragged me over to the hospital. Soon I was admitted and cared for by JR, who has the finest hands in surgery that I have ever seen. He saved my life. It took two procedures two weeks apart. My sister, MP, who is matter-of-fact, thought it would comfort me to know that I was lucky to survive. She told me that my grandfather, Alexander Parley Hamilton, had died from the same illness, at the same age, at the same time of year, and in the same city. I never knew him, nor did my father who met my mother 15 years after my grandfather died. This was all sobering.
I was compliant, too sick to do anything else. Usually, I led the charge, fighting medical battles for others who were sick. This time, I was the one needing help. For over a month, the only patient I saw was the one in the mirror. On the second trip to the operating room, I asked JR to put in a subclavian central line for prolonged IV access. My peripheral veins were shot. I did not know whether or not I would return for more surgical procedures and suggested to JR that the central line wanted to go home with me, just in case I needed a third round of modern medical care.
Two weeks out, the insertion site began to itch and burn. I took the dressing off and discovered the ominous signs of early cellulitis and knew that this was trouble. The line needed to be removed, pronto. The other problem was that it was 11:00 p.m. on a Saturday evening and my lovely assistant was not medically attuned. I figured that JR was probably already sleeping next door and I really hated to disturb him. After all, he was the organist for church the next morning. For me, removing the IV was routine. Not for MK. Before including her in the plan, I gathered up some provisions -- gauze pads, antibiotic gel, and suture scissors. The smile and color left her face as I explained the plan and that there were two kinds of central lines -- one was short and would only be in the vena cava. If it was a long line, it would go down into the atrium.
In this picture, you see some of the elements of a central line kit. The central line is the tube with triple access ports. It is placed over a Teflon-coated wire that is inserted through the blue sheath into the subclavian vein after the pink insertion needle is removed, simple-dimple, easy-squeezy -- unless it gets complicated. I have seen both. This system was pioneered while I was a surgical resident and I had been one of the early users in St. Louis -- never thought I would need one.
MK was a shining star. She followed my directions perfectly. As she gently pulled the long, dripping catheter out, I told her that it looked like a long one and that she had probably just pulled it out of my heart. Quickly, she put the gauze pads with antibiotic gel over the insertion site and held pressure for a few minutes, before taping the dressing into place. She helped me get into bed and laid down beside me, holding pressure on the gauze. She began to sob. What for me had been routine, was, for her, a major medical event. She told me that she was afraid that I was going to die right in front of her. I told her that she had been a surprisingly excellent medical assistant and had saved her first patient. Then, without thinking, I said something oafish like, “And what would be better than dying in the arms of a loved one?” In silence, her brows wrinkled. I pondered my words and realized at that moment that the loved one who survives these events gets gypped and is left alone holding a cold, dead corpse. At that thought, we laughed and sobbed together. For the first time in over a month, we both slept really well.
Ever vigilant,
RT
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