Tuesday, April 04, 2006
Essay: What I did this March, Part 1.
Today, I got the PICC line removed from my arm, which makes typing MUCH easier. So this seems like as good a time as any to fill in the details. As you'll recall from earlier entries, on March 2, I had surgery to try and implant the third lead from my device. When I originally got the device in 2003 (right when I started this blog!) the doctors in Austin had not been able to implant the third lead, the one that goes in the coronary sinus area to stimulate the other ventricle. As it turned out, several years of advances in technology and surgical procedures, and the reputation of Johns Hopkins here in Baltimore, still wasn't enough. After working on it for several hours, the doctors had to declare themselves defeated by a rather peculiar membrane which wasn't supposed to be there.
The longer a surgical site is open, the greater a chance for infection. When I went home on the 2nd, all seemed fine, and everything seemed to be healing up. But alas, that was deceptive. On March 11, we drove to Pittsburgh to visit some friends, and returned on Monday, March 13. That night I actually took a painkiller, which I hadn't done since the night right after the surgery, because my shoulder ached so much. I attributed this ache to overdoing it in Pittsburgh - which we certainly had done - Pittsburgh is a hilly city, and has nowhere near enough parking spaces, and I did more walking there than I usually do. Tuesday I awoke with a head full of cotton balls in place of a brain. Remind me NEVER to take oxycodone again - that sensation of brain numbness was far more distasteful than mere pain would have been. But anyway, somewhere in there, I began to have a fever and chills. By Wednesday, it was a full-blown flu-like illness; in fact, I assumed it was the flu. After a couple of days of sweating alternating with shivering fits, though, I noticed that the pacemaker area was inflamed and tender, and it also suddenly occured to me that no one had ever called me from the surgeon's office for the normal post-op follow-up appointment, which by then should have already occurred. So on Friday morning, I called the hospital. I talked to the surgeon's office, describing the problem and mentioning that I hadn't had a follow-up appointment yet. She said gee, you're right, wonder why that is? We've got a spot next Wednesday morning. So I wrote that in my pocket calendar, and went back to feeling miserable. An hour later, she called back, and said "I've talked to the EPs on call, and they think maybe someone should see you before next Wednesday; can you come in this afternoon and they will see you as soon as you get here?" Indeed. After managing to wash up (remember, I'm still feeling like I have a major case of the flu) and put on outdoor clothes, we drove over - a 20-minute drive turned into 30 minutes by the assorted lane closings and other hazards of urban streets.
As promised, within a minute of checking in at the desk, the EP on call saw me. He looked at the site, felt how it felt as though there was liquid in it, opined that it was almost surely infected and would definitely need exploratory surgery to find out for sure, and that if it was infected, the entire pacemaker would need to be removed. He then grabbed a senior guy who was in the area, to further take a look, which turned out to be Dr. Brinker. The two of them scheduled me for surgery first thing Monday morning, and discussed all the risks of removing the pacemaker with me. This is where this rambling personal essay gets interesting, because you all should know about this too.
→ Removing a pacemaker is harder than putting one in. Scar tissue has grown up around the device and the leads. Around the device, it's not too bad, especially in one that's only been in a few years, as mine was. Around the leads, however, since they are so thin, scar tissue is far more of an issue, usually thicker than the leads. The first thing doctors do to try and remove the leads is to fasten a teeny hook to the end and pull gently, hoping it will slide right out. This doesn't work often - I forget the exact percentage of the time, but I think they said around 10%. The rest of the time, the scar tissue is thick enough to block the lead from sliding. ● In those cases, what they have to do is use a "laser sheath" - a thin tube with a circular laser knife in it, which they then use to tunned through the scar tissue, around the lead, effectively creating a tunnel that the lead can slide through. This is where the risks come in. ● If the laser sheath cuts through anything besides scar tissue, the patient can be in serious trouble. ● The risk of death, although small, is still considerably larger than the risks of installing a pacemaker, or of any other surgery I've ever had done: 0.5%, or 5 in 1000. ● This is high enough that doctors are required to discuss it pretty seriously with the patient. ● Then there's another 1% chance of something getting nicked short of death but serious enough to require immediate heart surgery. ● The remaining 98.5% of the time, everything goes fine.
After being warned of this, and agreeing to the surgery nonetheless, we all shook hands and said our "See ya Monday morning!" farewells.
Warning: gross details ahead. Squeamish persons may want to skip this next few sentences. Friday night, pus began oozing out of the incision, which they had warned me might happen. Saturday, it got worse, and then, Saturday night, the incision
actually opened up a bit - visible holes a centimeter long - and pus began GUSHING out of it. At that point, I didn't think I could just sit around waiting for Monday morning. Once there are visible holes into the inside of my body, even I begin to worry. So, off to Hopkins' emergency room, arriving there around 1:00 Sunday morning.
Emergency rooms are no-one's favorite place. I didn't have to wait too long, though - only about an hour - in the waiting room, before someone could see me. There weren't even many people in worse shape ahead of me. Although Hopkins is in downtown Baltimore, it's not the emergency room that all the shootings and drug overdoses are generally brought to - there are other hospitals around the city that tend to get the majority of that sort of emergency trauma. So the waiting room was pretty quiet, and then the emergency "pod" I went to was quiet. The guy on duty for that pod was a very funny guy. As he was expressing all the rest of the liquid, and making notes, and ordering IV antibiotics and stuff like that, we were carrying on a fairly clear conversation. Of course, as an emergency room doctor, he sees plenty of stuff, including way more pus than I had, but he had to admit that it was certainly the most pus he had seen recently coming out of someone who was sitting upright and cheerfully talking to him. Later, when he was entering notes on the computer, we had a little word game going - was "copious" really adequate to describe that amount of liquid, or was it more than that? We came up with "voluminous" and even "oceanic."
While I was sitting there, with nurses doing blood draws in one arm, and setting up IV antibiotics into the other arm, and people trying to find an appropriate bed on an appropriate ward and a doctor on that ward who would officially admit me, other patients did come through. Someone with a migraine. A woman who had pulled a muscle in her groin, and was clearly angling for a doctor's note that said she couldn't work for the following week - which they refused to give her. And most interesting, a guy who had deliberately drunk a cup of ammonia cleaning fluid, for reasons only he knew. He was in handcuffs and accompanied by several of Baltimore City's finest. Turned out he had been living in a Federal halfway house, pre-release, and that's where he drank the fluid. The curtains between areas muffled most of the rest, but I did hear him say something about how they wouldn't give him any "medication" at the halfway house. When, at about 5 a.m., a doctor finally came to take me up to a bed in the cardiology ward, he was still in there, and cops were hanging around drinking ice water in the hallway.
To be continued!
Today, I got the PICC line removed from my arm, which makes typing MUCH easier. So this seems like as good a time as any to fill in the details. As you'll recall from earlier entries, on March 2, I had surgery to try and implant the third lead from my device. When I originally got the device in 2003 (right when I started this blog!) the doctors in Austin had not been able to implant the third lead, the one that goes in the coronary sinus area to stimulate the other ventricle. As it turned out, several years of advances in technology and surgical procedures, and the reputation of Johns Hopkins here in Baltimore, still wasn't enough. After working on it for several hours, the doctors had to declare themselves defeated by a rather peculiar membrane which wasn't supposed to be there.
The longer a surgical site is open, the greater a chance for infection. When I went home on the 2nd, all seemed fine, and everything seemed to be healing up. But alas, that was deceptive. On March 11, we drove to Pittsburgh to visit some friends, and returned on Monday, March 13. That night I actually took a painkiller, which I hadn't done since the night right after the surgery, because my shoulder ached so much. I attributed this ache to overdoing it in Pittsburgh - which we certainly had done - Pittsburgh is a hilly city, and has nowhere near enough parking spaces, and I did more walking there than I usually do. Tuesday I awoke with a head full of cotton balls in place of a brain. Remind me NEVER to take oxycodone again - that sensation of brain numbness was far more distasteful than mere pain would have been. But anyway, somewhere in there, I began to have a fever and chills. By Wednesday, it was a full-blown flu-like illness; in fact, I assumed it was the flu. After a couple of days of sweating alternating with shivering fits, though, I noticed that the pacemaker area was inflamed and tender, and it also suddenly occured to me that no one had ever called me from the surgeon's office for the normal post-op follow-up appointment, which by then should have already occurred. So on Friday morning, I called the hospital. I talked to the surgeon's office, describing the problem and mentioning that I hadn't had a follow-up appointment yet. She said gee, you're right, wonder why that is? We've got a spot next Wednesday morning. So I wrote that in my pocket calendar, and went back to feeling miserable. An hour later, she called back, and said "I've talked to the EPs on call, and they think maybe someone should see you before next Wednesday; can you come in this afternoon and they will see you as soon as you get here?" Indeed. After managing to wash up (remember, I'm still feeling like I have a major case of the flu) and put on outdoor clothes, we drove over - a 20-minute drive turned into 30 minutes by the assorted lane closings and other hazards of urban streets.
As promised, within a minute of checking in at the desk, the EP on call saw me. He looked at the site, felt how it felt as though there was liquid in it, opined that it was almost surely infected and would definitely need exploratory surgery to find out for sure, and that if it was infected, the entire pacemaker would need to be removed. He then grabbed a senior guy who was in the area, to further take a look, which turned out to be Dr. Brinker. The two of them scheduled me for surgery first thing Monday morning, and discussed all the risks of removing the pacemaker with me. This is where this rambling personal essay gets interesting, because you all should know about this too.
→ Removing a pacemaker is harder than putting one in. Scar tissue has grown up around the device and the leads. Around the device, it's not too bad, especially in one that's only been in a few years, as mine was. Around the leads, however, since they are so thin, scar tissue is far more of an issue, usually thicker than the leads. The first thing doctors do to try and remove the leads is to fasten a teeny hook to the end and pull gently, hoping it will slide right out. This doesn't work often - I forget the exact percentage of the time, but I think they said around 10%. The rest of the time, the scar tissue is thick enough to block the lead from sliding. ● In those cases, what they have to do is use a "laser sheath" - a thin tube with a circular laser knife in it, which they then use to tunned through the scar tissue, around the lead, effectively creating a tunnel that the lead can slide through. This is where the risks come in. ● If the laser sheath cuts through anything besides scar tissue, the patient can be in serious trouble. ● The risk of death, although small, is still considerably larger than the risks of installing a pacemaker, or of any other surgery I've ever had done: 0.5%, or 5 in 1000. ● This is high enough that doctors are required to discuss it pretty seriously with the patient. ● Then there's another 1% chance of something getting nicked short of death but serious enough to require immediate heart surgery. ● The remaining 98.5% of the time, everything goes fine.
After being warned of this, and agreeing to the surgery nonetheless, we all shook hands and said our "See ya Monday morning!" farewells.
Warning: gross details ahead. Squeamish persons may want to skip this next few sentences. Friday night, pus began oozing out of the incision, which they had warned me might happen. Saturday, it got worse, and then, Saturday night, the incision
actually opened up a bit - visible holes a centimeter long - and pus began GUSHING out of it. At that point, I didn't think I could just sit around waiting for Monday morning. Once there are visible holes into the inside of my body, even I begin to worry. So, off to Hopkins' emergency room, arriving there around 1:00 Sunday morning.
Emergency rooms are no-one's favorite place. I didn't have to wait too long, though - only about an hour - in the waiting room, before someone could see me. There weren't even many people in worse shape ahead of me. Although Hopkins is in downtown Baltimore, it's not the emergency room that all the shootings and drug overdoses are generally brought to - there are other hospitals around the city that tend to get the majority of that sort of emergency trauma. So the waiting room was pretty quiet, and then the emergency "pod" I went to was quiet. The guy on duty for that pod was a very funny guy. As he was expressing all the rest of the liquid, and making notes, and ordering IV antibiotics and stuff like that, we were carrying on a fairly clear conversation. Of course, as an emergency room doctor, he sees plenty of stuff, including way more pus than I had, but he had to admit that it was certainly the most pus he had seen recently coming out of someone who was sitting upright and cheerfully talking to him. Later, when he was entering notes on the computer, we had a little word game going - was "copious" really adequate to describe that amount of liquid, or was it more than that? We came up with "voluminous" and even "oceanic."
While I was sitting there, with nurses doing blood draws in one arm, and setting up IV antibiotics into the other arm, and people trying to find an appropriate bed on an appropriate ward and a doctor on that ward who would officially admit me, other patients did come through. Someone with a migraine. A woman who had pulled a muscle in her groin, and was clearly angling for a doctor's note that said she couldn't work for the following week - which they refused to give her. And most interesting, a guy who had deliberately drunk a cup of ammonia cleaning fluid, for reasons only he knew. He was in handcuffs and accompanied by several of Baltimore City's finest. Turned out he had been living in a Federal halfway house, pre-release, and that's where he drank the fluid. The curtains between areas muffled most of the rest, but I did hear him say something about how they wouldn't give him any "medication" at the halfway house. When, at about 5 a.m., a doctor finally came to take me up to a bed in the cardiology ward, he was still in there, and cops were hanging around drinking ice water in the hallway.
To be continued!
