Coma Dreams #1

Yeah, I know. Not everyone wants to know what it was like while I was in the coma.... so if you don't, now's the perfect time to hit your browser's back button.

Today as I was felled by this nasty head cold, something hit me from out of the blue. Not sure what triggered it. Within seconds though, I was reliving an odd aspect of one of my coma dreams.

As I was prepping for the first "swallow" test, they feed you applesauce mixed with a seriously blue food dye. Apparently the dye shows up as a leak if you are unable to swallow properly. Considering I had been ventilated for over a month and still had a trach-tube in... swallowing was rough.

The setting: I am sitting in my recliner, waiting for the speech pathologist to administer the test. Meanwhile: All around me I can hear voices, but something is amiss. The voices slowly become more sharp and distinct. I am definitely not hearing English. Not sure yet what though.

A nurse aid comes into the room and says something I can't quite make out. Then proceeds to tell me that I should expect some changes in hospital staffing. Then goes back to speaking Slavic.

Bewildered, I look around the room, obviously unable to get up or really move around. As I survey the equipment, all of the instructions are either in Spanish or in Russian. What on earth? So I asked the nuse aid: her response was that it was simply cheaper to provide care this way.

With the first couple gulps of the swallow test down, I knew I had to urinate. A lot. I was sure that it was all going to come out blue and leak everywhere. Mind you, I was actually sporting a catheter at the time, and was semi-conscious. Not enough though. Weird stuff happens on all the drugs they had me on.

I probed further. She replied that now that the hospital was incorperating with multinational corporations, they had to maximize profitability and the easiest way to do that was to start with folks who would work for less. She explained that she and her family lived near the hospital. For some of my care, she would be bringing me to her home. Apparently her mother was an RN and was moonlighting as well.

Moonlighting or bootlegging depending on how you look at it. What they would do is when a patient could be moved out of the ICU they would take them home instead of the post-operative care unit. There, family members would administer to the patient's needs. In addition, they would collect unused medical supplies that would otherwise be thrown away at the end of the shift. They repackaged them and sold them on the black market to folks who couldn't afford proper medical care.

So as I lived with this family, my mother and I got to know them pretty well. Apparently the husband of the family had injured his back severely in a firefighting accident. All of the kids were nearly finished with school and two of them were planning to work for the hospital. They all worked as "outreach" for the community. They provided care, medical supplies and serious help to folks who would never otherwise be able to afford a hospital stay.

The dream ends with me laying on the dinner table having their youngest sons who were still in high school, drawing blood for a workup. They kept telling me we needed to hurry because it was almost dinner time and they needed to set the table. But I shouldn't rush, because that would skew the results. Their care was impeccable. They were skilled and compassionate. It sort of made me wonder what it would be like to live in a world like this. I am sure this is common place in other parts of the world.

How to know you're HOT

It has been four weeks since I left the hospital. During my six week stay in the ICU, I ran pretty constant fevers. You know you're hot when the hospital staff has to search high and low to find a fan big enough to cool your body down. Apparently I was always so hot that the fan became MY fan. It went everywhere I went. When I was moved to the short-stay surgical ward after the ICU, the fan came along too. When they came to bring me down to the rehab unit, they brought my fan too. The funny thing though... I never needed it again after arriving on the rehab floor.




It is hard to explain how devastating it was for me to be in the ICU. I am not even sure now how much that time has affected my life. Being confined to four walls for a month will make anyone stir-crazy. Add to that the incessant bells and alarms going off all hours of the day and night, and you get what is affectionately known as ICU Syndrome. When I was taken outdoors one day in October, the sky was brilliant blue, nice breeze and the trees were aflame with color. Just feeling the sun on my face and the wind on my skin was like being re-born. I felt alive and safe for the first time in what seemed like forever.




I have to come to realize that I spend a great deal of time out-of-doors each day. Whether that time is spent walking, hiking, running errands, gardening, moving stuff from the house to the studio.... all of it adds up to lots of time observing my surroundings. The sounds of birds, the pine trees overhead creaking or even the cars driving down our road, all are part of my daily life. Being cut off from those sounds drove me crazy. Even now, if the house is too quiet I have to open a window or door so I can hear things outside. Fortunately, I am able to find a way to be outside everyday now. I walk around the yard, meander to the studio and occasionally drive into town. Each time I head out the door, I smile, knowing that this is right. This is home. I am safe and sound in our little house. It is good to be back.

Pass me the Passy-Muir!

Just kidding. I don't want to wear this thing ever again (if I can avoid it!). But in the ICU, I had to be intubated and placed on a respirator... fun fun fun. It took over a week of being in the ICU (with me trying, in my unconscious state, to tear out the tubes) before they finally gave me a tracheostomy. In other words, they cut a slot into my neck and slipped this device in. Nice... it allowed for air to get in without me having something in my mouth. It was stitched to my neck. On the inside of the device was a balloon, which was inflated so that it would effectively seal the trachea from that point down... ie, no mouth air. It also meant I couldn't speak. Then again, I was unconscious for over four weeks with not much to say. Once I began to waken from this chemically induced coma, my biggest frustration was being unable to speak.

How do you tell a nurse that you are overheating with piles of blankets on you when you can't speak? I couldn't even lift a hand to get someone's attention. There wasn't enough strength in my body to even press the nurse call-button.

On top of it all, I had pneumonia. Yeah, imagine hacking and coughing up loads of mucus, for days on end. Now imagine choking on a straw in your throat at the same time. Add to that, the inability to tell anyone that you're going out of your mind in fear of drowning in your own mucus.

Each night, Nancy or my mom would sit by my bed, siphoning the mucus clear of my trach-tube. None of us slept for three days and three nights. It was awful.

And then as the worst of the coughing began to subside one of the doctors decided it was safe enough to try out a Passy-Muir device on me. So what is this thing of which I speak? It is a cap, with a one-way valve that allows someone with a trach-tube to speak without having to put their hand (or in my case, someone else's hand) over the tube so air comes out your mouth.

With one small press of this cap onto my trach-tube, I could suddenly tell the world everything.
And my first sentence in over a month? "What do you want me to say?"
Yep. Oh, yeah. And we all cried.

From that point out nurses knew NOT to pile me with blankets, NOT to touch my toes (they had to stay uncovered or I would overheat!), and to make sure the fan stayed on ALL the time. I had a voice and I made it heard.

Here, in all it's glory, is my Passy-Muir. Invented by David A. Muir in 1990 who became ventilator dependent after becoming a quadriplegic. Thank you Mr. Muir. Your invention became a ray of hope for me. If I could communicate, I could start to change things. And things did change.

Now imagine how the nursing staff felt when in the rehab unit, I asked to keep my trach-tube and Passy-muir after it was taken out. It came out two days before Halloween. In PT we made jokes about blowing all this hot air out of a slot in my neck. We thought it might be fun to get some duck calls and tape them on to my neck so when I walked and breathed out it would quack. We never did it, but it was a funny image.

Now I have a trach-tube and passy-muir sitting on my kitchen table, waiting for me to do something with it. It is something between a trophy and an artifact. I fought mighty hard to be well enough to get it; I'm not ready to throw it away just yet.

Close to the Edge

My wife did an exemplary job of trying to keep everyone abreast of my condition while I was in the hospital ICU. Even after I regained conciousness after a month in a coma, she still continued to write about how things improved. For all intents and purposes, reading about one's self and having no memory of the events is like reading fiction. This week I began reading the medical reports from my ordeal. I made it twenty five pages into a 295 page document... and then I lost it. What little I know about medicine I learned from my family's medical chaos, from my time working as a videographer for the trauma unit in Miami, and from watching House M.D. Definitely doesn't qualify me to even play a doctor on tv. But I know, when reading, what bad looks like.

Allow me to give you a brief synopsis of what I read and why it hit me so strongly.

These things were all going on simultaneously:
1. Septic shock (BAD news!)
2. anastomotic leak with probable fecal spillage (my guts were leaking internally)
3. Lactic acidosis
4. Sinus tachycardia (sinus rhythm at a rate greater than 100 beats per minute )
5. Leukocytosis (an increase in the number of white blood cells in the circulating blood that occurs as in some infections)
6. coagulopathy (problem with blood coagulating)
7. hyperkalemia (the presence of an abnormally high concentration of potassium in the blood)
8. hyperbilirubinemia (the presence of an excess of bilirubin in the blood)
9. evolving renal insufficiency
10. urinary tract infection
11. fever

All of these spelled disaster. Two surgeries later, I would have experienced two lavages (where your organs are pulled away and washed -inside and out), and would remain unconcious and wired/hosed to every machine in the ICU for a month. Eventually pneumonia would keep me from getting the tracheostomy (surgical formation of an opening into the trachea through the neck especially to allow the passage of air). Every time I came close to conciousness I would try and pull out the tubes in my throat and nose. Not cool. All the while I ran wicked fevers; soaking through multiple changes of bedsheets everyday!

Somehow, Nancy kept fighting. Friends kept visiting. I was unconscious and unaware... but apparently my body knew. When my vital signs were really bad, Nancy would sing to me... and the vitals would normalize almost immediately.

Everyone keeps telling me that my fortitude and strength are what got me through this ordeal. I don't think so. I think I was very nearly gone. My bet is that the huge tug on this side of the universe kept pulling me back. Once I regained consciousness each day was measured by my time with Nancy, visits from family and friends .... and of course the beginnings of PT. I don't know if I will ever be able to thank folks like Lloyd (my PT) for all they did to give me hope. When you can't even begin to move your fingers or your hand... hope seems very far away. Take away the ability to talk and hope is an abyss.

But we did it. Somehow, I pulled through. Reading these medical records is hard emotionally. On some level, they happened to someone else. In as much as they happened to my body, I wasn't there. My recovery now is based on where I WANT to be, not on what they did to me. Each time I go out for my mile walk, I touch the stop sign at the end of our block... just to remind me that I am on this side... this is real! I can touch things again, I can move, I can walk. After two months of ICU syndrome, I no longer hear the nurses' call bells at night. Sleep is comforting, albeit still painful. Soon this pain will fade and pass. My hope is to then re-read this mountain of medical reports. It would be nice to be able to box this ordeal and know my life had moved past it.

March of the Tin Potter

Today marks yet another Indian Summer day; overcast, but warm and enjoyable. I'm still waiting for that fall misty rain that always seems to mark November's arrival. Then again, anything that curtails my walks outdoors would definitely hinder my recovery.

I have found over the past few days that walking out on the road has gotten easier and I can go incrementally further. There is always pain; due mostly to lack of muscle tone and flexibility. It's as though I have the physique of an infant trapped in a 200# body. Really hard on the joints!


Aurora is watching Dune tonight. Things she noticed: the Fremen soldiers using the "weirding module" look much like I did with my trach tube in place. The guild navigators had tubes running from the back of their heads to their nose which apparently much like the O2 monitor that I wore in the ICU. That O2 monitor left a groove in my forehead. Aurora and Nancy said that grants me entry into the Dent Head Club. Now we all have dents!