Sunday, September 27, 2009

Someone To Watch Over Me

I had a pain somewhat like this earlier in the year. It took me a little over a week to get rid of after hitting it with Cipro and some other drugs. So, much like last time, I thought that this was another bad case of food poisoning. After dinner on September 11 (beef stew and rice), it started with a little tightness and indigestion and I thought it would pass.

Then came a pain like I had never felt before. I couldn't even stand straight, and after an hour of waiting for it to go away, I went to EMF (Emergency Medical Facility). Since it was after hours, they were gonna give me a GI Cocktail until they asked me what my allergies were and one of the active ingredients was one of them. They gave me some medicine for my stomach, and told me to come in at 1300 the next day, when they were open. I went back to the office and felt so bloated and sick but couldn't puke. Still thinking it was food poisoning, I stuck 2 fingers down my throat and made myself puke. No relief.

That night, the pain was so bad I couldn't sleep in any direction, not even sitting. I now understood what some people mean when they describe a pain that only death could take away. I was scared and anxious, and I think that exhausted me enough after a while that I fell asleep - - - sitting up in bed.

September 12, they gave me some antibiotics along with Prilosec and an anti-emetic and told me to check in for a follow-up the next day. I bought some Mylanta, had a protein drink, and tried to get some sleep. At night, my temperature was starting to creep up. In the middle of the night, I had the antibiotics and a protein drink and seconds later barely made it out the door before I projectile puked it all out. On the follow up, after a battery of tests and an ultrasound, they admitted me and put me on an IV drip and antibiotics, and started giving me morphine. Based on the ultrasound alone, they saw swelling in my gallbladder and had decided that it needed to go.

Now, I could sleep. The one thing about morphine is that it doesn't cure your pain but it effectively disassociates you from it. Seconds after injection, after the rush, I felt like the pain was somewhere else. I still needed Tylenol for the occasional headache, but the morphine took a large edge off the pain and I was still lucid.

Just one hitch. Several blood tests indicated a rising bilirubin count, and my eyes were starting to yellow . The surgeons were now telling me that there was the possibility of a stone elsewhere, maybe even near the small intestine or liver that was causing that. Now, there was the possibility that I would have to be medically evacuated, which would mean a military flight to Landstuhl Regional Medical Center in Germany (via Ramstein).

The one other thing I learned from all of this, from the doctor here at EMF, was that the last episode was probably my gallbladder acting up, too.  But since it went away quickly, I might  have had some function left and nothing much may have been thought of it.  Looking back at this and other incidents where I ate something bad, I think I know enough now that if my kid gets something like this, I know what to look for.

All this time, too, I couldn't eat or drink anything by mouth, which sucked. I was told that since I would be intubated for the surgery, that my stomach needed to be empty to reduce my risk of aspiration. When the surgery was delayed, they did give me some light clear liquids but still no solids.

On the 15th, my surgeon talked to me and told that that I would be medically evacuated to Ramstein. Djibouti had the technology to get the gallbladder out but that was it. After consulting with Ramstein, it was decided that they would go in laparascopically, look for the other stone, get it, clean up, then take the gallbladder on the way out. Nice and neat. I was looking at a 30 hour flight. I know: Germany is 7-8 hours away. This plane would make a few stops and get some other people, too.

That got better. The flight scheduling was not going to work. so they found a C12 (kind of like a Lear jet) that could get me there direct and would be leaving at 2:30PM on the 16th. So after preparing all the meds that the medical staff would need on the plane, and having me pack (1.5 weeks worth of clothes and my laptop bag), they wheeled me onto the plane and off I went. To all the staff at Djibouti EMF who took care of me and kept me safe and comfortable (and even smiley) during this time, thank you. And thanks to my own department (J4-JMC) for checking up on me daily.

My sister Magali, oldest brother Israel and his son Antonio were on their way from New Jersey to see me, too. For financial reasons, my wife and son stayed at home. My wife basically coordinated things with my sister and brother via email and phone. The fam made me smile, and my sister even had some skills in home nursing that she used to help me move around with no pain (she was even able to show some of the female nurses to the point where they made it look easy to move someone almost twice their weight.). Thanks, guys.

I had barely landed when they got me a room, got me on IV fluids, antibiotics, and a morphine pump with a button I could press to dose myself (to a point, it wasn't buffet style). Few hours later at around 6AM on the 17th, I got an MRI and an ultrasound with less than an hour break in between. Next day in the early afternoon on the 18th, a slot opened up (Note: Landstuhl receives patients from all war theatres across the world so there are people here from Afghanistan and Iraq, some with unimaginable injuries essentially making this place one of the biggest trauma centers in the world) and up I went. Nervously.

After a wait, the anaesthesist showed up. I asked him what it would be like to be unconscious. He told me how anesthetics kind of wind time back a bit, that I don't dream, then told me that this conversation would be the last thing I remember. Sure enough, I don't remember even getting anesthesia. Next thing I knew, I was awake getting ready to be wheeled back to my room.

Turns out, from what was explained to me, that they had to cut me open after all. I was intubated, of course, so that a machine could breathe for me (that went well, I didn't even awaken with a sore throat.). They puffed my abdomen up with CO2, to give the laparascope more room to maneuver (that left me sore after the anesthesia wore off, but not so much). When they got to my gallbladder, it had no function left and was now gangrenous: it could no longer be "sucked" out. So they cut a 4-5" incision, cut it out, took out whatever else they needed to (including some tissue for analysis), cleaned and sanitized the area, then sealed and stapled me (16 staples) up and attached a small plastic container to drain the region out.

The next thing I will write about is therapy. Let's just say, I won't be lifting for a while but that may be a good thing.

And to the nurses and medical staff at Landstuhl Regional Mediacal Center, thank you for fixing me up and taking care of me. It almost seems like clockwork, how they go about their business, even with what they deal with here on a regular basis. Or maybe, they are just as brave as we are!

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