The man apologizes in his headline. After what he went through last week, the one thing he picks to top off the tale of his return here for his Sunday guest column is to say he’s sorry. Wait! There’s more to it than that. That’s our Paul Curran. Welcome back, good friend. Read on.
Welcome to the weekly coffee and tea garden. My name is Paul, I’ll be your barista today, and I’m happy to be here at Mark and Karen Bialczak’s Little Bitty in Syracuse, New York. With thanks to our hosts today’s post is long so I’ll get started right away. I owe all of my readers an apology for missing last week, so for that I am sorry. That said it is only the beginnings of the apologies, some of which you will see I have never in my 58 years ever heard before.
For those who are not aware I am a dialysis patient and dialyze three times per week at the hospital for 4 ¼ hours per session. For me access to my vascular system has been through a fistula, a sort of siding in a vein installed in my upper left arm that is installed for needling purposes. It is under the skin and is living tissue. It has had a small aneurysm since they installed it and this has grown over the last six years. It was becoming dangerous – about half the size of a fist – and had to be addressed. We have been making plans for this day surgery for about three weeks – including pre-admin testing, meetings with the surgeon and anesthesiologist, blood tests, imaging, and on and on. As a patient who had had cancer, the treatment of which had caused kidney failure (very rare) and a myriad of other serious conditions from treatments, I had been a regular in our medical system for about 12 years.
All the testing was fine and the final interview with the surgeon made it clear he had no idea how much vessel he would have to remove, the worst-case scenario was everything – in which case a catheter in my neck would be installed for access until our options became clearer. This was ho-hum routine for me and should have been a day surgery. I made all the arrangements for a pick up when done and on Thursday I presented myself at the surgery at 7:30 a.m. and found my appointment had been switched to 1 p.m. Being a world-class waiter by now, I had a nap for a bit and they took me in to get ready before lunch. Around 1 p.m. I was being wheeled into the operating room, having spoken with the surgeon, the head nurse, and the anesthesiologist in the hall. The gleaming new surgery room was hung with nests of huge stainless arms installed in the ceiling, and each arm had various smaller arms attached with every single thing a surgeon could ever want on tables and electronics cabinets all attached. The net impact was surreal – absolutely nothing but the staff actually rested on the gleaming one-piece floor. And every piece of equipment could be rotated into any position by manipulating the arms.
The staff was fully bedecked in operating clothes and only their eyes were visible behind eye shields. The surgeon introduced each one and they nodded as their name was said. There were about 15 people there, including another surgeon. All seemed well and in control as they slid me onto the operating room table and adjusted me on the narrow table that allowed surgeons to stand right against my sides. Arm supports were attached and they gave me the antiesthetic. Within seconds the world faded. I then remember a short conversation where they asked if they could shave off all my facial hair because the best option was to install a full face mask for transport – and then a nurse saying she had never been on a patient transport. Before I could wonder where we were going in the middle of an operation – for a coffee maybe? I’m in! – I awoke in the Intensive Care in the biggest hospital in Ottawa. I felt sluggish and a doctor was soon standing beside my bed. He introduced himself as the head of surgery for the General Hospital and informed me that it was Sunday morning. I had a nurse who was my ICU nurse and she was ignorant, refusing to give me what I wanted until I had been made to wait. Within a few minutes she was gone and a very kind and attentive nurse appeared.
My conversation with the doc continued and he asked how I felt. I told him it was like I had been run through an old-fashioned wringer that was used before hanging out clothes. He literally apologized (He said “I’m sorry …”) as he sat down and, in a quiet voice began to explain what had happened. In years of hospital visits I had never once heard a doctor apologize – even when they had made a serious mistake that affected me. He checked chest tubes’ output and the variant of dialysis machine used in ICU. He told me that the vascular surgery had been the worst-case scenario but had been successfully completed – removing all of the fistula and vein along with the aneurysm. At that point they had started installing the catheter in my neck for dialysis – a procedure I have had done a dozen times. For reasons not able to be known, while installing a wire into my heart for the catheter to align, the wire had punctured through the main vessel leading into my heart and had torn it so seriously that my blood was pumping into my chest cavity, causing my lungs to fail for lack of room for expansion. I died with a large part of my blood in my chest.
At that point I was totally overwhelmed by the story and it wasn’t over yet. He filled me in on the basics of what they had done to bring me back to life (emergency hybrid thoroscopic surgery) and he apologized again – something I would get used to over the coming days. I slipped from consciousness and awoke again a few hours later and about 10 docs were gathered around my bed. The head doc was there too and they took turns explaining their parts and what had happened and each who spoke apologized yet again. Not a single “I’m sorry” in 58 years and now more than I could count in one day. When asked how I felt now, I told them if I was an American I’d be a millionaire about now. I mentioned incompetence and the head doc jumped in and quietly agreed that could have been the case, but it could also have been an undetected flaw in the wire or an unusual curve in the vessel or any of a number of rare occurrences or combination thereof.
I knew imaging in the chest cavity was very difficult as the ribs form a cage around the soft tissue organs inside and as it is designed to protect from external damage, the rib cage also makes seeing what is inside problematic. I told the docs of my cousin who is a doc in the U.S. and she and I used to meet for coffee when she was training. They had a perfectly fine patient who just needed a chest tube drain and all precautions were taken. All procedures were followed and the tube was inserted perfectly into the cavity – and the heart was stuck to the chest cavity wall and was holed as well. That patient was dead in minutes. She cried when she told me and there were hearings that she had to attend and the finding was that everything humanly possible had been done to prevent the outcome. It was rare but it happened. The outcome was beyond human medical science to prevent.
That said the head doc asked how I felt emotionally and I told him that I watched a TV show called “Mayday” that reenacted the investigations of plane crashes. A number of the surrounding docs nodded. The outcome was very rarely the result of one action or occurrence and was often a combination of factors that had never before been encountered and could not have been predicted. I also said that in one episode the plane was an airliner in northern Canada and when it crashed only two people were left alive and they had only bruises and lacerations – nothing life-threatening. One was a young but very intelligent girl of about 10 years and the other was a woman geologist in her late twenties. As they sat side-by-side on the cold rocks quietly waiting for rescue after finding everyone else dead, the young girl turned to the woman and said: “I don’t know what to do now. This is my first plane crash.” And that is precisely how I felt.
Not long after that discussion I went to sleep and awoke on Monday in the Thoracic ICU. I was feeling much better but still empty. There were a couple of nurses who seemed to be taking care of me and they were very kind. I was wired for a wireless transmitter so I could move around and still be monitored. Still a few times a day a group of doctors would gather at my bedside and apologize and ask how I felt. The group grew from about 10 to about 20 as the work week started. Now this is a teaching hospital so any interesting patients being seen always have three or four trainees tagging along with the docs – groups of four or five total were not uncommon – I now had about 20 and I couldn’t tell which ones were real docs and which ones were trainees. I soon became suspicious there were more real ones when I started asking questions – each question was addressed promptly and fully by someone different in the group. I tried testing with marginal questions and sure enough another doc would pop up with an answer.
I grew stronger and by Monday evening I managed to get out of bed while supported by a walker or by using a wheelchair as a walker. One of the nurses told me that my clean-shaven face made me look young but my hair was too long. She said that she cut hair and asked if I wanted a trim. I laughed and agreed. They sent me, newly coiffed, down to dialysis for treatment. It was hairy because now we would be subjecting the newly repaired vessel to fluctuating pressures much different than it had yet had. My social worker dropped by as they were hooking up and when she asked how it was going I told her I wasn’t sure, that they were just trying dialysis for the first time and the vessel could burst and I could drop dead. Her eyes went really big and round and she backed away without further comment. I smiled. It went well. By Monday night I had snuck out for a smoke and no one complained, even though I told them where I was going. Very suspicious as “pulmonary exercise breaks” were highly discouraged. During the night Monday they removed the chest tubes and tracking devices and I was motoring around so well they moved me to a regular room on the ward.
By morning on Tuesday, I had stopped all pain killers and was wandering out for a smoke regularly. The docs – all 20 of them – came for their early-morning apology and were amazed to find me off pain killers, with all tubes removed and ambulatory. They asked a pile of questions and I apparently answered each to their satisfaction. The head doc told me that he had ever had a patient heal that fast before and that he would consider discharging me. He came back about an hour later by himself and asked a bunch more questions and then apologized for not having discharged me sooner – it was only about 8 a.m. By 10 a.m. I had been out for an hour and had a tet-a-tet with my nurse. He was very down to earth and had nursed for 27 years. He asked if he could get anything at all for me and I used my last trump card to get a free ride home with a taxi chit supplied by the hospital. He showered me with extra bandages and lectured me on wound care and even gave me some other supplies. The doc came back again apologizing for taking so long. He had my discharge papers and seemed as if he couldn’t believe that I was actually leaving after having died so recently. The nurse arrived with my taxi chit and the two saw me off as I left a free man. As I walked down the hall I met a Physiotherapy doc that had not been in the mix. He asked if I was Paul and when I nodded he apologized and said he was just coming to see me. I asked why a doc was sent for physio needs to a person in bed for four days. He just looked at the floor, apologized and said they wanted to make sure all my needs were covered. Umm, hmm. I was home by noon on Tuesday and spent most of the day napping or walking and eating.
Wednesday, I was following up on a thousand e-mails when the hospital called to do a check on me and to apologize. Ha! Anyway, the nurse and I chatted and I told her that my treatment was exemplary and we discussed various stages. She asked if I wanted to be on the patient advisory board that helped to make the hospital better and I agreed. She said that she would make sure that all involved were told of my satisfaction with the treatment.
I figure that if the accident that killed me was indeed a random concurrence of factors and would happen statistically to a very few patients that it was good that it happened to me as I healed fast and recovered fast and within a few days I was back blogging. It could very well have killed a weaker person. I also thank God for the strength to deal with this and for His contribution to my healing. Oh, I used no pictures as none were permitted where I was and none applicable are in the public commons because they are not permitted. Besides it is an intensely personal story and I chose to try to create the scenes with words – how did I do?
Please join me in thanking Mark, Karen and Ellie B for their invitation to tea on this weekend. We are all honored that you dropped by today to visit. I hope you’ve enjoyed this post and please look around at Mark’s other posts while you’re here. Oh and roughseasinthemed, your bottle of chilled Muscadet is on the table on ice. Have a great week all and I’m sorry I missed you all last Sunday …