Tuesday, December 15, 2009

Kidney Transplant 3

This is the third installment of the story of my hospital stays between January and May. If you're sensitive to medical stories, read it at your own gustatory peril. I eventually recovered. One of my body parts didn't.

I finally had a kidney transplant which worked fine. I had asked the doctor if I could have the same setup I had since I was three years old but he told me it was not feasible; I would be subject to infection since I was taking immunosuppressant medication to keep the kidney from being rejected.

I settled down to getting used to the new setup—a urinary pouch. It filled up pretty quickly and sometimes it was so full I thought it would burst. I emptied it in time though and continued to recover from the operation. At times I forgot to shut the pouch spigot off and I would find my gown wet, and also my own bathrobe. A nurse obligingly cleaned it for me—twice! This was something I had to get used to. When I was made aware that a lot of people have this setup, it made me more empathetic toward that lifestyle. You can get used to it and nobody notices. However, the pouches last only so long and every few days—maybe up to a week—it has to be changed. There was a wound nurse who changed it and I watched her so I could get the technique down pat.

But there was another problem that was presenting itself. I was getting a sore on my abdomen, about where the surgical procedure had been. It developed into a larger sore but I was sent home and in the care of Home Healthcare nurses. Lucy helped to change the pouch every few days.

The nurse would take blood samples to send to the lab for checking my condition every couple of days. It was difficult lying in bed so I sat on the armchair in the living room overnight. I still had a ways to go to feel comfortable.

Then one day I decided to go down in the basement to my computer. It was a mistake. When I went back up the stairs I was extremely out of breath and needed to sit down quickly. Something was definitely wrong. Lab tests showed I was low in hemoglobin so I was ordered back to the hospital—a 70 mile trek. They wanted to check if I had internal bleeding.

This was in February and there was snow on the ground—lots of it. We found an ambulance that would take patients more than to local hospitals. It got stuck in our lane. Fortunately, our neighbor on the other side of the street had a tractor with a snowplow and he graciously moved snow around to let them drive about 100 feet into the lane. The EMTs asked if I could step up onto the ambulance. I couldn't, so they put the gurney on the ground and I lay on it and they hoisted me in. It was a long ride to Columbus.

At the hospital again I was given blood transfusions and bed rest to recover. Meanwhile, the sore on my abdomen was getting more pronounced and when one of the residents came around I pointed it out to him. When a whole team of doctors and attendants came around again the resident pointed it out to the nephrologist in charge. The doctor said that it should be kept moist with ointment, and they left the room. I was sitting in a chair just then and I stood up and suddenly noticed a wet spot on my gown. I checked and the wound in question was leaking.

This is not a nice story to tell, and don't bother eating lunch while you read this, unless you not too sensitive about it. I was not happy about this new development. A nurse was still in the room and she called the team back and she was instructed to put on a pouch. That would be two pouches I would have to deal with. I was not happy. As she put it on I asked her if she saw a lot of this kind of wound. She said it was not too common but she did see quite a few of them in over 30 years of nursing. Arrangements would have to be made to deal with it. It was apparently a leak in the intestinal wall where they had taken a portion to create the diversion. It was fortunate that it leaked to the outside. A leak toward the inside would have been disastrous.

How they dealt with it was to put me on intravenous TPN, a protein fluid (it looked like milk) that would be my breakfast, lunch and dinner (breakfast, dinner and supper) for over two months. I was hooked to the IV machine for almost four months.

Meanwhile, I kept myself in pretty good spirits; especially when people came around—doctors, nurses, and nurses aides. They took my vital signs at all hours of the day and night. They wanted to make sure the kidney was functioning OK, and they could ascertain the condition by the numerous lab draws. I developed fits of coughing and a nurse would come in, mostly at night, and give me respiratory therapy. I felt I was gradually getting worse from something and I soon noticed that my urinary output was less and less.

I also developed dry heaves, gagging. The nurse would give me medicine for it but I often had these spells. Fortunately, that's all they were. I was the only one in the room, but sometimes at night I felt that there was someone else there, "No Never Alone". One time I did get into a depressed state and I cried like a baby, until I felt a hand on my shoulder. No one was there.

My legs started to swell. I had exercised every day by taking walks but then I suddenly couldn't walk. I lay in bed for weeks. They told me I had a huge blood clot, from my right leg to the liver, via the vena cava. The vena cava is a major vein to the heart. and that seemed to be the reason the kidney was not functioning as well. They took me to the OR and tried to put a filter in to keep blood clots from getting to the heart. They couldn't do it; it was clotted in that area. What would they do next?

One day, when the team made its daily rounds, the nephrologist explained everything to me. The whole room was full of his team and a couple of nurses. He went into detail about everything that was happening to me. He spoke with a foreign accent so I couldn't follow everything he said, but what he was saying became overwhelming and I started to get a little emotional, enough for the whole room to tense up but everyone was empathetic. After they left one of the nurses stayed behind and asked if I understood everything. She spent some time explaining everything he had said and I felt better for it. The doctor had said that I was one of his healthier patients.

Every day for a week they took me to the OR and systematically dissolved the blood clots. The mantra throughout the whole ordeal was "this is going to sting and burn." It would sting for a few seconds and I sort of got used to it by the seventh day. Maybe I was sedated a little—maybe—but I was awake through the whole process. Besides that pain, it was painful for me to be transferred to and from the operating table, which also lasted only a few seconds. I told them I would have to hold my leg while they transferred and it wouldn't be so painful. I had broken my left leg twice, in 2005 and 2007, and that was partly the reason. I also have a bad hip. Why me, Lord?! I had been walking with a crutch since the first break. Now I couldn't even walk. My legs were swelled up to huge proportions and I eventually noticed that there was very little urinary output. I knew I was in for the long haul.

I had to deal with the pouches. One day there were five pouch changes because of leaks, and when your digestive juices hit your skin, you can get a hellavu rash—witness diaper rash on babies butts; the same principle.

The doctor was sympathetic to my plight and he ordered that I could have juices to drink, to counter the monotony of eating nothing. Of course, it meant emptying the pouch oftener. I was not in a good situation, but I kept my spirits up and sought to learn all the facets of my medical anomalies and recovery. The nurses and aides liked me a lot.

I'll continue the story in the next writing. There's only so much you can remember about being four months in the hospital. That was in Ohio State University Medical Center in Columbus, Ohio in early 2009. What a way to start out the year!