On September 15, I was moved from ICU to the step-down unit. I was eating solid foods again and I had been sitting up for several days. Still no walking. While I’m on the subject of the ICU, I cannot say enough about the care that Anna Jaques provides. The nurses are spectacular. They’ve got everything down and there’s no messing around. Besides all that, they are a lot of fun. Because I’m at the hospital a lot with Beth to care for her various chronic illnesses, I never fail to visit the ICU and say hi to everyone there. I felt like they were my family when my family couldn’t be there.That was important to me. I’m not used to being sick and I’m resistant to being an invalid. They were great.

I had one unexpected visit before I left ICU. A doctor I hadn’t seen before walked in and introduced himself as Dr. Tarkan. He looked at my chart and IV and then said, “You’ll probably never have to see me again. My specialty is nephrology and they called me in on the case because your kidneys were close to failing. You were lucky.” I felt like saying, “No shit, Sherlock.” I decided at the last minute that I didn’t know him well enough to joke like that. Besides, he looked a little less loose than some of the other doctors that visited me. I mean, let’s face it. Nephrology? How exciting can it be?

On the road back

It wasn’t much different in the step-down unit. The care there was equally spectacular and Beth and I got friendly with a whole bunch of new nurses. The nurses and aides still came in at the same time at night, woke me up, took my vitals and gave me medicine. I still had the central and arterial lines. But I was going to the bathroom on my own. The best thing was that I was now going to get physical therapy and be allowed to walk again (with a heart monitor, of course). I’ve got to say that I cannot believe how much I lost while I was sick. I was just so weak. It took me forever to do anything, and the first day I was allowed to walk,  making it down the hall and back simply exhausted me. A lot of my meds were now in pill form, and I was on a ton of stuff. I was also getting shots in my stomach every day, but I cannot remember what it was for. My inhaler had been switched to Atrovent. (Later, my primary care doctor would add a long-acting inhaler as well, Flovent.)

During the week I was in the step-down unit, the kids came up for dinner several times. The food was great. The menu was like a restaurant menu.  One of the nurses we’d gotten friendly with came down from ICU on her break and ate dinner with us one night so that she could meet Thalia and Aaron. It was a fun time. Beth was great. She would get the kids to school and come up to the hospital for a visit. Thalia had a key and would let herself in, then get Aaron off the bus. Beth would go home and feed them, then come back with both in tow. My sisters and my niece cooked a bunch of food for Beth so she wouldn’t have to worry about that portion of the program.

I had received permission to use my laptop. The hospital had free wireless Internet, so I got back to my political blogging on Turn-Left. I also began to divide up Beth’s photos into categories so that I could begin her photo blog when I returned home. I had plenty of time to work on this stuff now. Jim, the guy who runs hypocrisy.com (which Turn-Left is a part of) called to say that he didn’t want returning to political blogging to be a detriment to my health. I told him it was adversely affecting my health to keep my mouth shut, so it was better to go back to blogging. By the middle of the week, I was working on the stairs with the physical therapist, and with the assistance of a cane. At the end of the week, I lost the heart monitor.

Dr. Pourati had come to see me before I moved to the step-down unit.  He told me that he would be on vacation the week I moved, and that I’d probably be getting out at the end of the week. He gave me a card with his cell phone number written on it, and told me to call him if I had any questions or if problems came up while he was away. Dr. Pourati also told me that someone would come in and set up the visiting nurse program with me. Before he left, he set up a follow-up echo for me on the 23rd of September, and a follow up appointment with him on September 26. I finally had to break down and choose a primary care doctor. I had scheduled an appointment with her in October. Dr. Pourati wasn’t happy with that timing, so he had taken the liberty of  calling and changing the appointment for me, making it much sooner.

Getting sprung!

On Monday morning, September 22, Dr. Harris came into my room and told me he was surprised to see me still here. My last chest x-ray was clear, and they were ready to send me home. He said he would take care of all the paperwork and I would be able to leave after lunch. Dr. Harris told me to order breakfast, and then went off to take care of the details. I had just ordered breakfast and hung up the phone when this tall skinny doctor with white hair walked into my room. He stuck out his hand, “Miss Della Piana, I’m sure you don’t remember me.” I shook back. “I don’t remember a lot of things,” I replied. He told me that it was probably just as well I didn’t.

He then proceeded to tell me that he had been a doctor for a long time and a handful of patients made the hair on the back of his neck stand up. I was now added to his list. He said it was a miracle that I was walking out of the hospital at all, let alone as quickly as I was. He also said he wanted to come in and wish me the best of luck. I was honestly trying to downplay this miracle crap. I’m not comfortable with that. I think it’s because I don’t want to believe I came that close and I essentially was taken completely by surprise; I couldn’t see it coming. That it could happen again is scary. But I don’t let it rule me. I did change some stuff. Now, as soon as I catch anything, I go to my primary care doctor whether or not I have a temperature or am coughing. All of the doctors got together and decided that would be the best bet since I had none of the outward symptoms of pneumonia. I’ll go along with that one.

We had one last thing left to do before I left, and that was to remove the central line. I’ll tell you what. After going through the removal of that small line, I was certainly glad that I’d been out of it for being put on and removed from the vent. The nurse bandaged the open wound on my neck and then came in and gave me instructions for showering because she was absolutely sure that was the first thing I was going to do when I got home. (She was right, of course. I had been there since September 6.)

I walked out of Anna Jaques at about 3:15 p.m. on Monday, September 22. It was warm and sunny out. We had to stop and get some prescriptions, and I was definitely exhausted when I got home, but I was happy to be out. I showered right off the top, then I hung out with the kids for a while. There were lots of naps thrown in there.

Getting back to normal…whatever that is

The very next day, I went to Pentucket Medical Center for my first follow-up echocardiogram. I had gotten a pep talk from Dr. Pourati before I left the hospital. He told me that he waited to give me the echo until after I left the hospital so that I would not become depressed that my heart had not made much of a gain. He repeated again that it would be a three-month process, but that he did expect to see improvement with this echo. Finally, it was my turn. The very first thing that happened was that I recognized the technician as a Starbucks Walkers Brook customer. She told me that I frequently made her grande extra-hot chai. She worked at Pentucket and also at the Lahey Clinic. That’s why she was in the Reading area.

After we talked for a bit, she started the examination. I was just laying there looking at the screen and, let me tell you, I had no freakin’ idea what I was looking at. After a few minutes, she said to me, “Did you actually have a heart problem?” I was kind of shocked at the question, so I told her what had happened. Then, it was her turn to be shocked, so I asked her why she was shocked. She told me that my heart looked great, perfectly normal, and that my ejection fraction was a perfectly normal 65%. No heart abnormalities. No thickness. Nothing. She said, “You’d never even know you were sick.” It was unusual for a tech to talk to somebody like that, so I had no intention of saying anything to the doctor about our conversation when I finally saw him at the end of the week. I did tell Beth. All she said to me was, “You crazy son of a bitch. Figures.”

I saw Dr. Pourati  on Friday, September 26 and he basically told me the same thing the tecnician did. He then told me that I could return to work without hesitation. When I asked him if I had to start at fewer hours, he said, “No. You can go back to what you were doing before.” The last thing he asked me to do was go downstairs on the way out and have my blood drawn. They had never checked my cholesterol or run a lipid panel while I was in the hospital. He was sure that my heart attack was related to the septicemia and not a result of heart disease, but he wanted to close the loop on the information. I thought that would be a great idea since I hadn’t had routine blood work in about fifteen years. (Hell, I still can’t tell you what my blood type is.) I was concerned that it wasn’t a fasting test, but he wasn’t. I had not yet had lunch. It was after noon, and I had breakfast really early. He thought it would be fine the way it was.

He asked if the visiting nurses had been coming and I assured them they were. I told him they told me not to take my blood pressure and heart pills together because my blood pressure was pretty low when I did. He asked me how I felt when I took them together. Did I get dizzy or disoriented? I didn’t. He told me to go back to taking them together. There was no problem with that. He also told me that he would keep the visiting nurses coming for one more week, then cancel them. I would not need to be monitored any further.

I wanted to get back on the schedule at work as soon as possible, so I called Joy — my boss — as soon as I got in the car. The schedule for the week of September 29 was already done, so she put me on the schedule for the following week. I worked for the first time on Friday, October 10, just a little over a month after the whole disaster took place. That was about two months earlier than anyone had predicted. I also began cardiac rehab, so I managed my schedule around that.

There are a few lasting effects surrounding my near-death experience. Like, oh, if Beth can’t hear me snoring in the middle of the night she shakes me awake to see if I’m still alive. You know, stuff like that. And Aaron finally said that he doesn’t want me to get too tired because when “you got sick before you really freaked me out.” He had never said anything like that until about a week ago. I’ve pretty much put it behind me. It’s not that it doesn’t creep into my mind every once in a while. I’d be a liar if I said it doesn’t. I have to say, however, that I’m handling this much better than I ever believed I could. Now I just have to get past September 6.

A few people have asked me to write this post now. I’ve been avoiding it, but I cannot avoid it forever. It’s still a relatively new event in my life, but I feel like I’ve gotten past it to be quite honest. That’s not to say that there aren’t times of anxiety. There certainly are. However, I choose not to have it rule my life.

The term “one step from the slab” was coined by my niece’s husband Sergei. We used to use the term when we were younger to describe the old people in our family who were having birthdays. I’d ask something like, “Hey, how old is he going to be Sergei?” And Sergei would say, “I don’t know but he’s like one step from the slab.” Of course, now that I’m in my fifties and now that Sergei is about to be fifty, we no longer talk like that. Last year, at almost this time, I was one step from the slab.

Let me tell you something about myself: I am an insurance company’s dream. I’ve been paying health insurance premiums for years and have cost the companies virtually nothing.  Up until last year, I’ve had a total of 11 prescriptions over an entire adult lifetime. In essence, I had no real medical history until last year. Sure. I have allergies. I’ve had them for a long time. Usually Benadryl does the trick, but I cannot use it when I drive. I swear it induces coma. When it really bothers me, I usually get Allegra. It works and it doesn’t make me sleepy. A couple of years ago, my primary care doctor thought my allergies were becoming more respiratory and I began using an inhaler. Other than that, nothing new on the health front. I get a cold a year and it’s usually gone in a few days. I haven’t had the flu for a long time, and I’m pretty resistant to the stuff my kids bring home. It’s just the way it is. So, I went from no medical history to the edge of the earth in what seems to me to be one night.

September 6, 2008

The anniversary is coming up. I was working on Saturday, September 6, 2008. I remember that I felt okay, but I had been using my inhaler (Albuterol) more often than usual in the course of a day. That was about it. I felt like I had a sinus infection or sinus headache the day before. That’s not unusual if I have a bit of a cold. That’s where I usually feel it. However, it had cleared up. I certainly didn’t feel as though there was anything seriously wrong with me while I was at work. I was closing at Starbucks in Reading that night. I was supposed to be out at 9:30 p.m., then I had to turn around and be back at 6:30 a.m. the next morning for an opening. As it turns out, it slowed down during the course of the evening and I had the opportunity to leave early. I was grateful for that because I had a long ride  to Amesbury (about 32 miles one way). I noticed when I got to the car that I was winded.  I didn’t think much of it. I used my inhaler and headed home. The ride home was pretty uneventful.

I knew for the first time that something was wrong when I got home. I had a short walk from the car to the house, and I was having difficulty breathing when I got in the door. I used the inhaler again. By now, I had used the inhaler far more often that the recommended two puffs every four hours. I remember sitting down at the table and turning to Beth. “Is it possible I’m having a panic attack? I’m having a real tough time breathing.” It was after this that all hell broke loose, and my memory is spotty from here through the 9th of September. I will relate what I can remember.

At one point, I felt like the inhaler was working. I decided to go upstairs to the bedroom and watch television with my son, Aaron. We were laying on the bed together when my breathing became a problem again. I remember saying to Aaron, “A, go down and get your other mom. Tell her I can’t breathe.” I could not lay down. I got up. I was gasping for air. I walked out onto the landing and looked over the railing. Beth was there and I remember saying, “Beth dial 911.” Now, anybody  who knows me knows I do not ask anyone to dial 911. Ever. Beth knows it. She called 911 immediately, then she came upstairs. When she got up to our bedroom, I was apparently standing in front of the air conditioner trying to suck in air. I do not remember that. Memories get even spottier here.

I remember hearing the ambulance. I do not remember the EMTs or how they treated me. I remember being carried down the stairs in a chair, and I remember seeing a policeman walk into my house. And, oddly, I remember thinking, “What the fuck is he doing in my house. Cops do not come in unless they are permitted.” That’s it. I do not remember the ride to Anna Jaques Hospital at all. I do not remember the emergency room at all. I only know what Beth has told me.

My oldest sister, Mamie, and her husband apparently arrived in record time from Medford, also more than thirty miles away. My sister Joanne had a shorter trip from Andover. I seriously do not remember the ER. I do not recall speaking to doctors. I do not recall doctors examining me. I don’t recall not being able to breathe, but apparently I asked to be put on a vent. Beth tells me that I threw her out of the ER repeatedly. I don’t doubt this. Beth tells me that she was in the middle of a panic attack and was apparenty vomiting in the other room. I know this vomit thing is a recurring phobia and we’ll get to that, but not tonight. Suffice it to say it doesn’t surprise me that I was tossing her out if she was in the yak mode.

I am also told that the two doctors taking care of me in the ER were promising Beth nothing. They told her they were literally taking it minute-by-minute, then hour-by-hour, and they’d go from there. They said I was very sick. They told her that, if I survived, I would probably be on the vent until at least Friday. So, what exactly did I have? Wouldn’t you like to know! (Just kidding.)

I apparently had pneumonia for a long period of time. However, I ran no fever and I was not coughing up anything. The only symptom I had was the need to use the inhaler more frequently over time. I didn’t make that connection. What really caused the problem was septicemia. I didn’t know much about this before it happened to me. There were two other things that happened as a result of the septicemia. I had a heart attack, and I now had stress cardiomyopathy. It was also determined that I have moderate to severe asthma. I was transferred to the ICU.

Pulling a Lazarus

When I woke up on Tuesday (yes, Tuesday) I had no idea where I was. I looked to the left and saw three pictures up on the wall. One was a picture of Medicine Buddha. On either side of him were pictures of Thalia and Aaron. There were two nurses there taking care of me.  I was no longer on the vent, but I still had an IV running with antibiotics being pumped in. I was not on solid foods and would not be for several days yet. I had a central catheter and an arterial catheter.

It was only then that I learned how close I had come. I didn’t even realize that it was Tuesday. I was being followed by two cardiologists (one was the ‘house’ cardiologist who worked with the actual cardiologist on my case), as well as a nephrologist and an infectious disease specialist. When I woke up, they told me that I had cardiomyopathy and that my ejection fraction was only 15%. However, Dr. Harris and Dr. Pourati believed that would remit over time. I do not remember them telling me that I had a heart attack. I found that out for the first time when I was released and went to the follow up appointment. I am sure they told me and I do not remember. It never came up in conversation between Beth and I, probably because she thought I knew. The prognosis was that I’d recover, but I would be out of work for at least three months. That was Dr. Pourati’s best estimate.

Beth called on Tuesday to ask if she could bring the kids up even though I was on a vent. They really wanted to visit. The nurse told her that she had a surprise, so she should bring the kids. She told Beth to call her from the waiting room and she’d meet them. When she walked in and saw me off the vent, she was ecstatic. We were talking and she pointed two things out to me. On the wall were two containers. One held a black liquid and it was three quarters full, the other a green liquid (there was significantly less here). She pointed to the green and told me that came out of my stomach. It was probably the remains of what I’d eaten that evening on my half. The other, the black liquid, had come from my lungs. Not only did I have pneumonia, but I had also harmed my lungs using the inhaler so much.

After Beth and the kids left, I couldn’t sleep. I had been out for so long there was no way I was sleeping right away. The nurse told me not to worry about that. I remember being up all night. I watched “The Omen.” Then came “Anaconda,” a movie I had never seen but one that was better than I ever thought it would be. After that, I was served a steady diet of WB 56 sitcoms until morning. Luckily, they had pretty good old movies on all day.

The one thing about ICU is that you never really sleep anyway. They were waking me up for medicine, then to check my vitals, and then to do chest x-rays. While I was in ICU, they brought the portable machine into my room. By the end of the week, I was sitting up for Beth’s visits. While I was up there, everything going on around me was very unnerving. I was stuck there, however, so there was no getting away from it. The woman in the very next room passed away. They could not save her. That was really difficult to watch. I caught glimpses of her family breaking down outside in the hall. I imagined what would have happened had I not been so lucky. By the time I moved to the step-down unit, three people had died in ICU.

I apologize for breaking here, but this definitely needs to be told in two parts.