According to my blog publication schedule, this post is supposed to share more information about Chiang Mai, Thailand. However, if you’re a Baby Boomer, you’ve inhabited this planet long enough to know that Woody Allen had it right when he said, “If you want to make God laugh, tell him about your plans.”
My latest trip was not planned. My husband, Steve, and I recently had our first dinner guests since arriving in Honolulu six weeks ago for his three month sabbatical at the University of Hawaii Cancer Center. I kept dinner
real simple uncomplicated — rotisserie chicken, salad (with mango as the surprise ingredient) and rice pilaf — courtesy of a box. (I don’t believe in re-inventing the wheel). For dessert — “adult” ice cream sundaes with local macadamia chocolate chip shortbread cookies.
We were having a very pleasant evening—appetizers on our lanai with ocean and Diamond Head views and then dinner. Conversation flowed and everyone was a member of the Clean Plate Club. As we were determining who might want coffee with dessert, I felt the first twinge of what I identified as an incipient GERD (gastro-intestinal reflux disease) attack — heartburn, in layman’s terms. I excused myself and took a dose of my go to GERD remedy — maalox. I was dining with 3 medical professionals. They felt badly I wasn’t feeling well, but no one, including I, was alarmed. The pain was bad enough for me to skip my favorite dessert. While the others enjoyed their ice cream with kahlua or amaretto, I settled for an over the counter acid reducer.
We bid our guests adieu and I retreated to our bedroom to wait for my symptoms to subside while Steve (a truly good guy) washed the dishes. My GERD had been under good control since leaving my more than full time lawyer job. Infrequent twinges were readily controlled with over the counter antacids. The symptoms didn’t subside. They intensified. Steve says I have a high pain tolerance — he has seen me endure kidney stones, child birth and severe GERD attacks without whimpering, even when my pulse rate and blood pressure reading confirmed my pain rating at 9 on a 10 point scale. (For me, 10 is childbirth). He was clear I was in serious pain when I told him I needed to go to an emergency room, the only place I knew I could get the “GI cocktail” of fast-acting medications that can stop the pain associated with a major GERD attack. He was particularly impressed when I said I couldn’t even walk to go outside and take a taxi to the hospital.
Honolulu Emergency Medical Services (EMS) showed up within five minutes. The two paramedics were extremely professional and thorough. They took us to Straub Hospital, suggesting that I’d likely be tended to more quickly there than at the large tertiary care hospital. I really appreciated that they dispensed with sirens and flashing lights once they determined I was unlikely to flat-line on their watch. They rolled me into the triage area while Steve was dispatched to tend to the paperwork. (Even in Paradise, someone has to pay the hospital bill). Within minutes, the charge nurse introduced himself and started taking my history. He looked like a marine. It turned out he had been a marine. He seemed immensely competent and in command. Steve and I both expressed our opinion that based on previous experience, this was a severe GERD attack that could be stopped in its tracks by a combination of an antacid, a topical pain killer and an antispasmodic. Nurse Marine was willing to entertain that hypothesis, but appropriately, he also wanted to rule out an acute cardiac event. Once I had a normal EKG and had blood drawn, I finally got the elixir I thought would take away my pain. Only it didn’t. Ruh roh.
Eleven Things I Learned after I Found Out I Wasn’t Having a GERD Attack:
1) Bedside ultrasound can be a valuable diagnostic tool in the ER. It told my attending physician that I did not have gall stones, but that I had something that warranted further investigation by a CT scan.
2) You can get an emergency CT scan in the middle of the night at Straub Medical Center in Honolulu. The CT scanner machine will even talk to you! While the Straub radiologist is at home fast asleep or whatever, your digital scan will be sent winging off into cyber space to be read by a radiologist on the mainland who will diagnose a partial small bowel obstruction —- a What? Why? How?
3) Once they know what’s wrong with you, you can have pain meds. Even if you’re allergic to morphine, they have other nice narcotics, like IV dilaudid. If you’re in severe pain, narcotics don’t make you feel high. They just relieve your pain. You are very thankful.
4) The initial treatment for a partial small bowel obstruction is a naso-gastric (NG) tube. The nurse will warn you that getting a plastic tube inserted through your nose, down your esophagus and into your stomach is really quite “unpleasant”. He will say this several times. He will be 100% correct — and then some. Your physician husband will decide he really doesn’t need to see this and will wisely decamp to the waiting room. You realize that freaking out will just prolong the agony and perhaps cause you to end up with a tube in your trachea instead of your esophagus, so you somehow suck it up (literally) and resolve to be a help, not a hindrance.
5) Once the NG tube is in place, you can be transported to your room. You will be very happy to learn that Straub Hospital has all private rooms. You’ll meet your very nice nurse who will explain that the plan of care for your small bowel obstruction is the NG tube, no eating or drinking and IV hydration.
6) It will now be 3:00 a.m. You are aware of all sorts of noises — suction, an IV pump and what you are convinced sounds like a cockroach walking across the pillow behind your head. You will ask your nurse if there are any cockroaches in the hospital. She’ll hesitate and tell you she saw a dead one once. Your husband will decide you’re appropriately psychotic from all you’ve been through and will patiently explain that he doubts very much that you are hearing a cockroach on your pillow. You will be very tired. Swallowing will be very painful. You will decide to let the cockroach thing go.
7) You will fall in love with your husband all over again when you look over and see he is planning to spend the rest of the night on the semi-reclining chair at the foot of your bed. You’re exhausted. You sleep fitfully in between very painful swallows.
8) You will decide that describing the events of the rest of the day would definitely be TMI (too much information). Let’s just say: It. Was. Not. A. Fun. Day.
9) You will send your husband home to get some sleep and spend a second fitful night, partly because you’re in the hospital and partly because your IV pump runs dry twice, emitting a suitably alarming alarm sound. You will learn there’s a shortage of “normal saline” IV solution, so the nurses have been ordered to use every drop.
10) You will find out that your diet (or rather, your lack of diet) has been advanced to clear liquids. You will actually enjoy some beef bullion and red jello for breakfast. When you tolerate this, they will advance you to a regular diet for lunch. A half an egg salad sandwich never tasted so good. When it appears this is on its way to being digested, you will be given the good news that you can go home as soon as transport brings up a wheel chair. You don’t need a wheel chair, but that’s hospital policy, so you cooperate and are deposited at the door in a wheelchair.
11) You will walk back out into the world, whereupon you will feel immensely grateful for modern medicine, that you are no longer in pain, that you married a
good great guy, that this didn’t happen when you were in Laos or Cambodia, and that so many people cared enough to wish you well. You will think about and endorse what your 89 year old mother always says, “Any day you can walk out your front door, is a good day.”