Hospital Experiences

Spending several days in the hospital is always an interesting experience. I thought I would share some my experiences with modern medicine. Of course most hospital time is spent just laying in bed and waiting. But there were several times that something special or out of the ordinary happened. These are the things that I thought were interesting enough to write about.

The Saline Jungle
The first step that is usually included in every hospital stay is getting an IV put in your arm and getting a bag of saline dripping. This is to keep you hydrated while in the hospital. It is usually the last thing to be removed as well. This was true for me as well. But I also got something additional. I can't remember the name exactly, but it was called something like a "triple J-port." This was a special IV that had three different lines going in at different points along the tube inserted into my neck. Yep, thats right, my neck. It went into the jugular artery and was several inches above my heart. This was to put a particular immune-suppressing drug into my system that was too hard on the veins in the arm. It needed to be immediately dispersed through my body. But in addition to that they had a very large number of other saline bags attached to me, all daisy chained together to go through the triple J port. The strangest combination of fluids going in was a dextrose saline bag, essentially sugar water. But to make sure my sugar levels didn't get too high, there was also a bag containing insulin. This counteracts the sugar. I thought I would show you a picture of my "IV Tree" with all the bags of saline. In this picture, I count 8 different saline bags, each with their own pump, plus the monitor hookups. Needless to say, I had a lot of tubes and wires going all over the place.




The Respiratory Therapist
One visit I did not expect or know about was the respiratory therapist. I did know the hospital staff would bring the breathing device that everyone gets in the hospital to avoid pneumonia, where you have to breath in and watch two little devices rise up to the top. But the respiratory therapist was completely different. This man came in to room about 7pm and introduced himself. He said he was the respiratory therapist and had a treatment for me to do. I watched as he pulled a little tube out of his pocket and began to fill a small container with greenish fluid. Then he hooked it up to an oxygen line and connected the two together somehow, on one end it had a mouth piece and the other end a round hole. Finally he hooked up a large blue tube to the end of the bottle of green fluid through the round hole. He told me to put one end in my mouth and breathe normally. Then he turned on the oxygen and I began my first breathing treatment. As I breathed in a smoky mist would enter into my lungs and when I exhaled the smoky mist would shoot out the end of the blue tube. It really looking liked I was smoking some new fangled pipe. I laughed to myself as I tried to blow smoke rings out the blue tube while the respiratory therapist wasn't looking. I was unsuccessful. This treatment was supposed to happen every 4-5 hours, so I had a total of five treatments while in the ICU. I would say the 4am treatment was the most unpleasant. Here is a dark picture of me having a breathing treatment. I didn't turn on a light and didn't have a flash.




The Exercise Class
Anyone who has been in the hospital overnight knows that you never sleep very well because almost every hour the nurse comes in and has to do something. Draw blood, check vitals, change saline bags, or check on something. I had one really great ICU nurse named Stephanie. She was one of the best nurse experiences I had. I spent some time talking to her every time she came in the room. It was like clockwork. Every hour on the hour she would come in, I would usually be awake or wake up. I had a slew of questions to ask her about my condition and what was to happen next. I have been reading this book by Malcolm Gladwell called "Blink." It is all about the split second decisions that we make and how we can know if we will like a person in the first moments of meeting them. Stephanie was one that I knew instantly that I would like. She just had a presence about her that was comforting and made it feel that every thing was going to be okay. So I almost immediately trusted her. I had her take pictures of all the things I couldn't see, like the IV in my neck, my staples on my belly where the new kidney had been inserted, and then asked her about all of them. Once it started to get late, I didn't have as many questions and slept a little more. But since I had taken so many naps throughout the day, I did wake up at 2am when she came in the room and had trouble going back to sleep. After she left I just quietly sat in my room thinking about a lot of things. After awhile I heard a lot of giggling and laughing going on at the nurses' station outside my room. Some people think it is impolite that doctors and nurses laugh while at the hospital, but I love it and know that it is needed. They are around so many stressful situations involving life and death that laughter can be a great stress reducer. But this was not one of those times. As I lay in bed trying desperately to listen and look through my plaid curtain that was pulled shut, I could see a very faint outline of nurses in the hallways. In the ICU, there are sliding glass doors for every room so you can really see out. I could see nurses lined up, walking past my room, but they weren't walking they were doing power lunges and raising their hands in the air. I don't know how many nurses were out there power lunging together at 2:30am, but I figured it was about 6-8 of them. After the power lunges came stretching and other calisthenics. I thought that was great! I don't know if that is a regular occurrence or not but I thought it was probably a good use of time at 2:30 in the morning to keep alert and have a good time. I tried to take some pictures of the exercise class, but they don't show much. Here is one of the pictures I took at 2:30am. I know it is really hard to see anything in this photo, but you could see the movements with the fluorescent lights in the background.



Room number: North 376
After the ICU I was moved to the regular floor of the hospital. The day after my kidney transplant I was actually up and walking around the hospital at 11am. Then I walked from my room in the ICU to room North 376. Scripps green hospital is divided up into North, West and South. Actually I have only seen West and North now that I think about it. I guess Scripps Green East is the fountain and coffee cart out front. Well, actually I made a stop before I reached N376, I stopped in N377. The room next door to mine. Because in N377 was my donor recovering from his surgery, minus one kidney. He was in his room, me pushing a wheelchair, a nurse following me with my IV tree. We were stoked to see each other. It was awesome. We were both still on pretty heavy pain killers, in fact we each had our own PCA. PCA stands for Patient-controlled analgesia, which means we have a little button that when it turns green we can push it and morphine is injected into us. So you can control your own pain level. After you push the button you have to wait a predetermined amount of time before the light turns green again. I had to wait six minutes before I was given the green light. Studies have shown that a PCA actually makes the patient feel much better and they use considerably less pain medication then when administered by a nurse. So after I visited with my donor for a couple of minutes I went to my room right next door. It was great having a friend next door to me. He would walk over into my room sometimes and once we actually ate our liquid diet dinner in the same room. It made the hospital stay and pain recovery fun. We were both required to take walks to make the healing process faster and get us moving. When one of us was ready to go for a walk, the first place we stopped was the other's room to see if the other wanted to go with us. We almost always did. So we would walk around 3 North, a short loop that has nothing to look at. But talking was great.
"How is your pain?"
"Oh, dude it hurts so bad when I get up or sit down."
"What about you?"
"Same here."
"Oh dude your green light just came on."
"Sweet!"

Little conversations like that were regular. But we had many topics of recovery and working kidney production to discuss as well. We laughed, even though it hurt, about the little things that had happened to us, or the lack of sleep we got. It made the whole kidney transplant and donation something more special. I realized that my donor and I have a special bond that is like no other in life. We all experiences different bonds in our lives, family, siblings, marriage, friends. But this is a bond that few get to experience. One sacrificing part of themselves, to give life to another. It is so special to me and I know that my donor likes it too. I will never forget this time in my life, and I doubt my donor will either. Even as I write this I feel that words do not express the bond. It is only one that can be experienced. It is like trying to describe what being a father is like to someone with out children. You just have to experience it.

Thanks dude for your amazing gift. I will be forever changed.

An Amazing Day

Tuesday September 14th, 2010 will be a day I remember for the rest of my life.

It started at 4:00am when my alarm went off on my phone. The funny thing is I had actually put "kidney transplant" in my calendar on my iPhone and set an alarm to go off to remind me. I don't know what I was thinking when I put that in??? Like I needed a reminder. So I went back to sleep until 4:30am, when my actual alarm went off. In for a quick shower with special soap to really clean my skin.

My brother Jim wins the award for first contact. I got out of the shower to a text message letting me know he was praying already at 4:45am.

To the hospital. As I walked in, I met my donor and his wife walking in at the same time. We were both excited.

I checked in to the ICU, which is where I would be coming to after the surgery. Room 17, with a great view of Torrey Pines golf course and the ocean in the background. Scripps green has probably the best view from a hospital bed in the world.

After signing papers, changing into my back-less gown, and getting an IV. It was time....to wait. My wife Sarah was with me, which was great, along with my dad, aunt, and a friend Mary. We talked and the time went pretty quick.

My first dose of pills and injections. There were lots of them. A small price to pay. I was very used to taking lots of pills, but the injections I received in my stomach were a first. It amazingly didn't hurt, not as I had expected.

Of the 2 hours of sleep I managed to get the night before, all I dreamed about was the surgery being stopped or postponed. So I fell asleep in the hospital bed and replaced those dreams with much more positive ones.

The doctors and nurses steadily came in and introduced themselves. I was glad to meet them. They had originally told me I would be going down to the OR (Operating Room) at 7:30am, but that turned out to be the time for my donor to go down to the OR. I would go down to surgery an hour later.

It was time. I remember being very excited when the nurse came and wheeled me to the elevator. The anesthesiologist was walking and pushing me too. I noticed that when we got in the elevator he forgot to push the button to the first floor. So the 3 of us just sat in the elevator for awhile. Until the nurse realized we weren't going down, she pushed the button.

I was wheeled down to the surgery floor sporting a silver surgery hat on my head, it was like a filled Jiffy Pop, round and puffy. Everyone else had hats that were way cooler than mine. Camouflage, chargers bolts, duck patterns, stripes...but mine was chrome dome.

This is where things went fast. After going into the prep room, where I was given a "cocktail," which was really some injection to make me relax and start the anesthetizing process. The cocktail also made it so I didn't mind being shaved and washed with extra soap.

I was wheeled into the OR. And remember seeing the hallway that led to the other Operating Room where my donor was already in process. I wanted to call out his name and say something like "here we go," but I did not. In other operations and procedures I remember someone saying "you ready Mike?" or "here we go." But this time nothing. I was out like a light.

I woke up and remember trying my hardest to focus on the clock to see what time it was. How long had it been. I couldn't get my eyes to cooperate. I might have been cross eyed because there were two clocks, but even if I could get one clock, I still couldn't even make out numbers or hands on the clock. Later I figured out it was about 1:30pm.

Had it happened!? Yes!!!

I could feel soreness on my stomach. It felt like I had been doing 5,000 sit-ups all morning. My stomach was sore, but I was still very groggy. There was one more procedure for me to do, which involved inserting an IV into my neck. It actually went into the jugular artery and then went down close to my heart. This was necessary to give me certain injections that would immediately be passed throughout my body.

Then I was back out again. The next thing I remember was my wife Sarah walking in the room. It was about 3:30pm. I have no recollection of our conversation, but her sitting in the room with me was comforting and felt good.

When I woke up, I only could think of one thing, "is the new kidney working?" Well, the best way to tell is if I am producing urine. I know this is not the most pleasant of topics to talk about, but it is how you measure the production of the kidney. Well before the surgery I only produced about 150 mL per day. That translates into about 5 fluid ounces. After the surgery, on the first day alone, I was producing about 300mL per HOUR! Whoa! That is a lot of pee!

Every day after that I have been producing somewhere between 200mL - 300mL per hour and about 3,000mL per day. So yes, praise God the kidney works extremely well.

The end of dialysis in sight?

Wow, today is an interesting day. I went to the hospital yesterday (june 30th) and had some standard pre-operation appointments. Blood labs drawn, a chest x-ray and an EKG. I have done the preceding stuff so many times that it was no big deal. Then I met with my surgeon. He wanted to start me on my immuno-suppresive drugs today, so at 9am I took my first one. I began to read the warnings that come on the print out from the pharmacy. I was amazed that this is by far the most dangerous prescription I have every taken. But I know it is for the good.

Today it felt real. Today it felt like the surgery is actually happening soon. I am now wearing a bracelet that has a number on it to match with the blood bank, just in case. So I have one more appointment on Friday (july 2nd), and once that is completed I will be waiting for the 6th. I am starting to feel excited about this process. Before it always felt so far away, but now it feels close.

So as I realize that the surgery is coming closer, I have a lot of history to cover.

The last post I had written that a nurse named Kelly had introduced a new modality of dialysis to me. Home dialysis. I didn't know that I could do dialysis at home, but when she began to tell me about what it was like, I wanted to know more. Kelly told me that I would actually move from dialyzing 3 days a week to 6 days a week. But each session would be shorter, around 2-2.5 hours, which essentially came out to be the same amount of time as going 3 days a week for 4-5 hours. She also told me that we would have all the items shipped to our house and loaded by a delivery man and once a month we go into the clinic and meet with the dialysis team and doctor.

The main difference with home dialysis was that there were no nurses around to "do dialysis" for me. My wife and I would have to do everything. Draw our own labs, set up a machine, and what I was most worried about, sticking the needles in my arm. Sarah and I talked about it at home and decided to go to an informational meeting.

We drove over to Home Dialysis Therapies of San Diego (HDT), near Rancho Penasquitos. We met with the director, a very nice woman named Denise. She told us all about the home dialysis, the benefits, the potential issues that can arise, and showed up the machine.

We decided to go for it.

This was possibly the best dialysis decision I ever made. We had to start our training, which meant for 2 weeks going in at 8am and actually learning how to set up the machine, and learning about all the steps of dialysis, while I dialyzed. It makes sense really. I had to sit there for 2 hours on dialysis anyways, might as well learn about it.

I remember feeling like there were 100 steps to follow to set up the machine. But we had a book that laid out every step that we needed to follow and over the 2 weeks we got better and better. We finally graduated from the class. Which meant that we had to move the operation to our home. My brother came over to help set up everything and get us situated. We had to create a place to do dialysis that would keep our 1.5 year old Calvin away from the machine. The first day on our own, our training nurse, June, came over to help us with the first time. I remember feeling encouraged because she had trained us so well that when she came over to watch us set up, instead of watching our every move, she sat and enjoyed a cup of tea while we set up. She basically was saying, "you got it covered, good job."

The last year and a half has been such an improvement for me on dialysis. Because of the frequency of the dialysis, I got to take fewer meds, my diet changed drastically. When I once had to eat low phosphorus and potassium, I was actually once told my dietician Debbie that I needed to eat more potassium. Hallelujah!!! Finally I could eat the tasty stuff again. I remember wanting to eat any vegetable I could because it just tasted so good to have food with potassium in it again. And fruit, yes, the fruit was missed greatly. Today still I just want to eat fruit as my dessert. Goodbye cakes, ice cream, pies....I will take strawberries, blueberries, blackberries, kiwi, or whatever kind of fruit I can get.

Even though home dialysis was better for me and I felt much better, it was still dialysis. Six days a week for 2.5 hours I sit at home on the couch, setting up our machine after we have tucked the boys into bed. Sarah and I try to make the time worthwhile, often beginning the time with a couples devotional together, reading scripture, or praying for the boys and other friends and family. But I would eventually end up watching TV or falling asleep. Thankfully at the end of treatment I would be able to go to bed afterwards and sleep off any of the negative effects that might be caused from the dialysis.

I tried to not really ever think about all the things that I missed in the evenings because of dialysis. On one hand I may miss Padres games with friends, surfing the evening glass off in the summer time, having friends over at night to just talk and grow our friendship...etc, but on the other hand the dialysis is keeping me alive. I am thankful that I was born when I was. Forty-five years ago there was no dialysis and if your kidneys failed, your life was over. So I am thankful, very thankful.

The best long term solution for myself was not dialysis, but a kidney transplant. Science has come a long way in the field of transplants. So the first thing I was told to do was get on the list for kidney donations.

There are two types of transplants I could get. One is called a cadaveric donor, which only comes when a person has died and they are an organ donor. It is a great thing to have the pink sticker on your driver's license, but even so with so many people saying they are willing to donate organs, the wait in San Diego for a cadaveric kidney is 4-5 years. Amazingly, across the U.S. there are 82,000 people waiting for a kidney donation.

The other type of donation is a living donor. This is where someone who is alive decides to donate one of their kidneys. The human body is an amazing thing. Someone once told me that a person with two fully functioning kidneys have 240% of what their body needs in kidney function. So if a donor gives one kidney, they drop to 120% of their body's needs, which is still more than sufficient. My kidneys are at 6% function.

So a couple of months ago, a guy from our church heard my story and decided that he would get tested. I have had multiple people get tested to see if they are a compatible match but for one reason or another no one had been approved to donate. It might have been because of blood types or health reasons of their own, but as a result I never got too excited when someone would get tested in the beginning, because I had expected that they wouldn't be a match.

But that brings me to the present. This guy who was getting tested progressed through the tests relatively quickly. I kept getting reports from him and mutual friends that he had passed another test. It actually began to get exciting to hear about what had happened from the previous week. And now I am just a couple of days away from the actual transplant surgery.

At this point I am happy to have more tests done, and the donor and I actually joke about how many vials of blood we have drawn every time we go to the hospital.

"This time I only had seven." "Oh, that is nothing, yesterday I had fifteen!" We go back and forth and talk about the tests that we each have to do. "I got another EKG today followed by an ultrasound." "oh yeah, I had to go in and have ANOTHER physical, that is my third one." I am thankful for all the testing, it makes sure that the hospital is checking every possible angle, but it is comical at times too.

Well my timer just went off again. A second dose of immune-suppressing drugs coming in. I wonder what my body is really going through with this drug? Is it fighting the effects? Is it trying to stop this drug form doing its job? I bet if my body really knew what was going to happen on July 6th, it would be celebrate. I know I am celebrating.