Saturday 11/16/2019 – Monday 11/18/2019: Telemetry
Once I was well enough to leave ICU, the hospital transferred me to the “step-down unit”, also called Telemetry. (If you never heard of a unit called “Telemetry”, you’re not the only one.) I was moved by wheelchair on Saturday evening, schlepping most of my stuff—my blanket and pillow from home, the get well cards I had accumulated, the posters made by our friends’ daughter, pictures of the animals, and, of course, Substitute Charlee—on my lap. The rest of the stuff was transported in a bag by a courier, A.K.A. my wife.
In Telemetry I collected a new set of nurses and nurse’s aides, but because I was there for less than two full days—I was transferred out to the general population on Monday—I didn’t get to know them as well as my ICU nurses. Naturally, introductions needed to be made:
Telemtry Nurse #1 (seeing Substitute Charlee): “Who’s this little fella?”
Me: “This is Substitute Charlee.”
Telemetry Nurse #1: “Ah, okay. Does that mean there’s an Actual Charlee?”*
Me: “There is!” (points to picture on the wall) “She’s my cat.”
My wall decorations. Clockwise from top left: Actual Charlee, Lulu, Chaplin
The night shift nurse’s aide in Telemetry was a former Navy hospital corpsman. As he helped me settle in, he noted that he was only a few years older than me, and gave me a rousing little speech:
Telemetry Nurse’s Aide: “You gotta get better and get out of here and thirty years from now when we’re both in our 80s, you’ll bump into me on the street. I’ll still look exactly the same as I do now and you’ll say, hey, you look just like my nurse’s aide from Telemetry, are you his son? And I’ll say, No, man, it’s ME!“
I found this pep talk oddly inspiring.
I continued to take my physical therapy walks, and on one of them we bumped into the same nurse I had met earlier while walking around ICU—the one who had been there when I came in looking like death, not even warmed over. It turned out that she also takes shifts in Telemetry. We chatted again briefly:
Wandering ICU Nurse: “Have they said anything about changing your diet?”
Me: “Not really. There’s talk of cutting back on salty food.”
Wandering ICU Nurse: “Oh, I have such low blood pressure, my doctor said it wouldn’t be possible for me to eat too much salt.”
Me: “Oh, in that case, do I have a recipe for you.”
I happened to have my phone with me at this point (I had worked up to maybe three minutes of looking at the screen at one time) and proceeded to email her a recipe for Syracuse Salt Potatoes, a delicious treat involving small potatoes, butter, and salt. Lots and lots and lots of salt. No, more salt than that. Is there still salt in the box? Keep pouring. (Whether I will ever again be permitted to eat Syracuse Salt Potatoes remains to be seen.)
Telemetry was different from ICU in many ways, including its nurse-to-patient ratio and the double rooms, but the most obvious one was that while I was still being constantly monitored, it was done wirelessly, using a small gadget with various sensors attached to a wiring harness. These sensors were affixed to my body in all the usual places, while the unit itself was stuck into my pocket or just placed on the bed next to me. This was more conducive to movement than being hard-wired into a pole—not that I was actually allowed to get out of the bed; it had a pressure alarm to warn the nurses if they had a runner, and at least once I set it off just by shifting my weight around—but it did make it easier to go walkabout when the physical therapist came to get me. The gadget was a little unreliable, though; nurses had to come in periodically and disconnect/reconnect the sensor wiring harness or perform percussive maintenance on it.
Me: “Maybe we should try a different unit?”
Telemetry Nurse #2: “We can’t. It’s keyed to your bed.”
I guess by this point in my stay the doctors were pretty confident that I wasn’t going to suddenly flatline, or they wouldn’t have transferred me out of ICU, but still, this device did not inspire a grand amount of confidence in the technology.
The first day I was in Telemetry I got my usual visit from the trans-cranial doppler technician, but the second day they decided to mix things up a little and transported me down to trans-cranial doppler HQ for the procedure instead. (Substitute Charlee came with me, of course.) This meant I got to see the techs in their natural habitat. For the rest of my stay, that was how they did it. At first I was transported in a rolling bed, then I graduated to a wheelchair. In their lair, the techs were a little bit chattier than they were when on rounds. One of them had a question for me.
Trans-Cranial Doppler Tech: “So in school they didn’t really tell us about the patient experience, but I was wondering, does it hurt when we do this?”***
Me: “No. I mean, it hurt when they did the initial mapping because of how I had to keep moving my head, but the procedure itself doesn’t hurt at all.”
Being transported to my trans-cranial doppler procedures was the first time in weeks that I got to see anything besides my hospital room and (during physical therapy sessions) the immediate unit I was in. The route took me through the interior of the hospital, so I didn’t get to see outside, but at least it was a change of scenery. My room in Telemetry had a window, but I couldn’t really see out of it from my bed except for lines of sky through the blinds. I did manage to glance out it once or twice while being helped to or from the bathroom and only saw a section of hospital rooftop and a wall: Not much of a view.
Speaking of the bathroom, my adversarial relationship with it continued in Telemetry. While I was there, they tried again to remove my catheter, and once again I failed to be able to produce satisfactory results. This time they didn’t wait long** before putting it back in. (My stoic facade may have finally cracked a little bit at that point. Getting a catheter inserted is not particularly pleasant. It was a small thing, compared to everything else, but I had really been hoping it was gone permanently. It was a small thing on top of a lot of other things. Still, one endures what one must.)
The other thing about the bathroom in Telemetry is that there was no sink in it, or even particularly near it; the sink was in a counter against the wall in the middle of the room. Seemed like a long way to shuffle to wash one’s hands. I wasn’t sure what that was all about, but the entire unit seemed rather old and maybe not laid out as well as ICU.
Sunday evening, I learned that I was going to be transferred out into the general population on Monday, also known, apparently, as Med-Surg. When she heard the news, Telemetry Nurse #4 was sorry to see me go:
Telemetry Nurse #4: “Aw, I don’t want you to get transferred yet. I’m on duty again tomorrow!”
I think this was when my wife started referring to me as “everybody’s favorite patient”.
Monday 11/18/2019 – Wednesday 11/20/2019: Med-Surg (General Population)
By the time I got transferred to Med-Surg, there had been a lot of changes to my status. I was off the constant IV fluids, which had been helping to keep my blood pressure from going too low, off the Norco and the regular acetaminophen (now dispensed as needed), and off the Keppra (an anti-seizure medication). I was still on the nimodipine every four hours, still getting the neurological assessments, still getting the transcranial dopplers, still getting labs drawn from my subclavian picc line, and, of course, still catheterized. Despite all this, my time in the hospital was clearly winding down, and the “D” word (“Discharge”) had begun to be bandied about in my presence.
I was pretty happy to be in my new room in Med-Surg. It was another double, like Telemetry, but I didn’t have a roommate. What I did have was a big window, so I got my first view of the outside world in nearly two weeks. Shockingly enough it was still there. Look, trees! And hills! A horizon! I was indescribably grateful to be able to just turn my head and see such things. The room also had the nicest bathroom out of all of them, with an actual sink inside of it, and soap! Amenities, man.
As the Norco was getting out of my system and things started, uh, moving again, they cleared me to get up and use the bathroom on my own. Evidently the nurses in Med-Surg decided it was silly to keep me confined to bed when I was obviously capable of wandering the hallways and doing silly walks with the physical therapist. They had better things to do than come in to watch me get up and shuffle five feet to the bathroom and close the door, then get summoned again ten minutes later to watch me open the door and shuffle five feet back to bed.
While in Med-Surg, I tried again to watch television. This time I managed to watch about 10 minutes of Back to the Future Part II and, the next day, maybe 20 minutes of Sixteen Candles, although I spent some of that time with my eyes closed listening to the dialog. (Having already seen Sixteen Candles umpteen times, I didn’t really need to look at the picture to know what was going on.) The pillow speaker unit in this room, which controlled the bed lights as well as the television, was a little different from the ones in ICU and Telemetry. It looked like this one:
Take a closer look at the button in the bottom right hand corner and you’ll probably guess what I made of it.
Med-Surg Nurse #1: “How are you doing?”
Me: “Pretty good, except I keep pressing this “Call UFO”**** button and no flying saucer has come to beam me up and take me away.”
Med-Surg Nurse #1: “Well, keep trying. Maybe you’ll get lucky.”
On my second day in Med-Surg—Tuesday, 11/19/2019—the neurologists, hospitalist, and medical director all agreed that I was ready to be discharged. Preparations were made. The nurse took out my PICC line and showed it to me; it consisted of the port at the top, then an exceedingly long tube. I swear it was twice as long as a drinking straw (albeit thinner), although that could possibly be a product of my horrified imagination after seeing it for the first time.
Me: “Good Lord.”
They also replaced my large hanging Foley catheter bag with a smaller leg-mounted one (the catheter would be removed the following week by my regular doctor). I took to calling this the “hip flask”.
Med-Surg Nurse #1: “Hip flask. Wow, that’s descriptive. A nice little container of apple juice.” (beat) “Excuse me, I need to go throw up now.”
I needed to stay on the nimodipine for a while longer, so a prescription for that was called in to our local pharmacy. And thus was a roadblock to my being discharged encountered:
Wife: “You know what? I’m going to call the pharmacy and make sure they have this nimodipine stuff.”
Did the pharmacy have that nimodipine stuff? No, they did not. In fact, no pharmacy had it. Not even the hospital’s outpatient pharmacy had it.***** They could get it, mind you, but not until the next day. And since the doctor’s discharge orders said I had to continue to take it every four freaking hours, well, that meant I had to stay in the hospital another night. The preparations made for my discharge were reversed, mostly, except for the PICC line. No way was that thing getting put back in.
As my consolation prize for not being discharged, I did get to take a shower for the first time since November 7th; Med-Surge had a couple of showers and I was given permission to use one all by myself. I got to walk there on my own and everything. It wasn’t a particularly hot shower, and the water pressure sucked, but it was still glorious. I dropped the little bottle of shampoo they gave me but I decided to just leave it on the floor, lest I should fall while trying to retrieve it.
Med-Surg Nurse #2: “Yeah, don’t fall. If you fall, we keep you for an extra two weeks just to punish you.”
Naturally, because I was still in the hospital, they had to draw labs on me in the middle of the night again, which means that this time, I got stuck with a needle.
Me: “Of course I need labs after they take the PICC line out.”
(blood draw ensues)
Phlebotomist: “We’re done. Sorry about that.”
Me: “Oh that’s okay, it wasn’t so bad.”
On Wednesday, 11/20/2019, the pharmacy confirmed that they had the nimodipine, and I was finally discharged. It was pouring rain, but what’s a little water when you’re getting discharged from the hospital? At this point my parents were in town, having flown in from New York to help out for a few weeks, and I got a ride home from them. Soon I was back at the house, where my home care team of Dr. Lulu, Dr. Chaplin, and Dr. Actual Charlee were waiting:
Dr. Actual Charlee’s initial attempt at a post-hospitalization exam was thwarted by Dr. Lulu’s tail-powered force field, but she got to do one later.
And of course Dr. Wife, Dr. Mom, and Dr. Dad were there, too.
Although I was home, the recovery process was far from over. There would be doctor visits, physical therapy, more doctor visits, and a return trip to the ER for that infection I mentioned previously. All of that will be covered in the final installment, next week.
* “Actual Charlee” is in fact exactly how I had been thinking of Charlee ever since Substitute Charlee showed up.
** In ICU, the day after first time the catheter was removed, I spent the night waking up and summoning a nurse to help me to the bedside commode just about every hour. This despite the fact that their ultrasonic gadget for measuring the amount of urine in the bladder kept saying I opnly had 100mL or something like that. In the morning, when ICU Nurse #1 returned, she took a closer look at the gadget and discovered it had been miscalibrated and that I actually had something like 900mL of urine in there. So that explains that.
*** Apparently most of their patients aren’t really up to answering questions.
**** This button actually operates some of the lights around the bed.
***** The nimodipine prescription, without insurance, would have cost $4,000. The copay alone was well over $100. The pharmacy had to do some negotiating with our insurance just to get them to approve the prescription. My guess is that all this is because normally the people taking nimodipine after a subarachnoid hemorrhage are in the hospital for the entire course of their prescription, as ICU Nurse #1 had anticipated I would be, once again illustrating just how unusual my course of recovery was. Did I mention that I was the luckiest unlucky person in California that month?