Tag Archives: bedside manner

The Day My Appendix Died

I just read one of those clickbait articles on Facebook titled something like “I prosecuted serial killers all my life but never really understood until this one came for me!”  The story is about a very physically healthy prosecutor who almost died of a heart attack.  There was the bit about her feeling okay but her husband being worried when she vomited so took her to the ER, then all of a sudden she was swarmed by people ripping her clothes off, hooking her up to IVs, etc.  In the middle of all this the surgeon takes her hand and says, “I’m the boss of all these people. I’m going to look at your heart and do what I need to do to keep you safe and healthy.  I will treat you like my own family.”  That part made me cry, and I knew that – even though it’s late – I need to write this.  I wanted to share the article I read with you, but as usual… Facebook swallowed it whole and left no crumbs.  But if you see it, click the bait.  It’s not long.

So here is the story of the day my appendix died…

Exactly one week ago (11:30pm, 3/7/17) I was walking laps around the post-surgical unit at Good Samaritan Hospital at the instructions of my awesome Filipino nurse, Cef, who taught me that when there’s a kink in the hose gas will work its way UP your body until you think you have a pinched nerve that is numbing your neck and sending shooting pain down your arm. That’s right: the treatment for post-surgical neck pain was to walk and fart. He was right. Drinking lots of ginger ale quickly and belching loudly was also helpful.

I spent a lot of money on nursing school, and the better part of 9 months in 1997/1998 memorizing the tiny words and drawings in my very expensive and heavy Anatomy and Physiology book. I know what I’ve got going on inside me. For the past 6 months or so I’ve been having random expectant thoughts of appendicitis (God prepares me for important things because He gave me an awesome brain that just doesn’t handle surprises very well).

So when the indigestion I’d been having for a couple of days suddenly focused itself on a specific point deep inside my lower right belly last Monday evening, I knew exactly what it was.  I also had a plan.  I BARELY had symptoms. I was in no pain except little sharp bursts when I laughed, coughed, or pressed on that specific spot. No fever. No nausea. I was hungry. None of the things that happen when your gut is in trouble had happened yet. I called an advice nurse and my doctor’s On-Call doctor. I told my closest friend to keep her phone on in case I needed a ride to the ER. I updated my parents and told my coworkers I might be out on Tuesday. I cleaned the litter box and filled the cat’s food. Then I went to bed. I was not remotely afraid, but I knew I would be in surgery the next day.

The next morning I was at Urgent Care at 8:30, dressed for work just in case I was wrong.

I would like to take a moment to say how much I love absolutely everything about Palo Alto Medical Foundation.

Things moved faster than expected, but only because of efficiency.  In between the nurse and the doctor and the blood thief I was busy cancelling my morning sessions, communicating with my work team, prepping a list of what I would need my friend to bring to the hospital.  They made me do a urine test to prove I wasn’t pregnant.  I had a cat scan, which was kind of cool. Those machines talk to you! My IV tubing wasn’t connected quite right, and the whole thing exploded all over me and the machine when she did the trial with saline (before iodine). It was hilarious! That poor VERY pregnant tech with long curly hair was mopping me up and I just couldn’t stop laughing!

I told her the story of my very first day in nursing clinicals… my patient was an extremely obese woman (over 400#) who took up the full width of the bed. I managed to dump an entire tub of water (maybe 2 gallons) into her bed with her. It was like slow motion, watching that rose-colored rectangular tub tip over.  I will never forget. My instructor was right there. I was mortified, horrified, just… yeah. “Honey, I am one fat woman who can’t bathe myself. This isn’t the first time this has happened, and it won’t be the last!  Trust me, this is the most interesting thing that’s happened to me in awhile!” Then she just laughed and laughed while my instructor and I (and probably a 3rd person) struggled around her giant body and big naked bottom to try to get everything clean and dry. That woman taught me one of the most important lessons I’ll ever learn: I’m going to screw up. Laughter will make it much better!

So I laughed on Tuesday with the very pregnant tech who sprayed me out of my IV tubing. And surprisingly (because by this time my belly was getting pretty sensitive), I don’t remember that laughter hurting.

We got the IV fixed and within an hour I was congratulated on my very early-stage appendicitis.  I cancelled my life for the week, and started an email to a coworker who always steps up to help coordinate these sorts of things because in my office it takes 5 people just to make the phone calls in all the right languages.  The doctor at urgent care handed me a stack of paperwork and a CD and told to drive myself down the street to Good Samaritan Hospital, and hand these things to the surgeon waiting for me.

(Note: this is a graphic paragraph about surgery and body things.  You are warned.)  It’s a very surreal thing to drive yourself alone to a hospital for an operation.  Because I understand operating rooms, too.  I have explored them, studied them, watched incredible things happen in them.  I have seen babies and organs and bones and blood come out of human beings in them.  I have watched in awe as artists who have mastered the human body practice their craft, each focused on a specific part so that the mechanism can work smoothly and efficiently.  If I had been a nurse, I think I would have been an OR nurse.  But you can’t drive yourself to surgery without imagining yourself on the table.  I know I won’t feel or remember it, but I know I will have a tube down my throat.  They might give me a catheter.  If they cut me they will cauterize me.  I remember the smell of cauterizing flesh; it is the second most disgusting smell I’ve experienced.  Adipose tissue was the worst.  I have a lot of adipose tissue.  If my appendix bursts, how big will the incision be?  Will they put my intestines on my chest like in the bowel resection I observed?  I hope they get their gauze counts right.  I was not scared.  Not at all.  But I could see myself on the table.  I remember the patient’s perspective from the surgery on my leg.  Good Sam has free valet parking, which was awesome and super convenient and a relief that I wouldn’t have to try to tell Michelle where to find my car in the parking lot later.

So I showed up at registration with my stack of papers.  “Hi! I came to get my appendix out!”  I’m not walking quite so easily now, but the older Black gentleman behind the desk smiles back at me.  I wish I could remember his name; it was a grandpa sort of name, like Walter or Reginald.  He reminds me of William on “This is Us.”  He seems like the kind of guy who would get to know his mailman.  He looks at me oddly; apparently this is not usually how appendicitis patients show up for surgery at Good Samaritan Hospital.  So I sit for 15 minutes on the lovely couches with built in USB charging ports.  He figures stuff out and sends me down the hall and to the left to the surgery waiting room.  I go down the hall and to the left to the place that says “Surgery Waiting Room.”   There is only a volunteer there, no doctors or nurses.  There is coffee and tea there, and magazines that everyone is touching.  That doesn’t seem to match my expectations, but I’m starting to feel a little tired and fuzzy so I’m not quite sure why.  I tell the volunteer I’m here for surgery.  She looks at me oddly, too.  I don’t think volunteers process surgical patients.  Apparently this is the place where non-sick people wait around for sick people who are currently being mended.  She sits me down and bustles around trying to figure out what to do with me.  I am not emailing anymore.

Ten minutes later the volunteer and a nurse come rushing up to me.  “We’ve been looking for you everywhere!!”  She takes me another 20 feet down the hallway to the left.  Just around a little bend is another place.  It has a sign that says “Surgical Waiting Room.”  Subtle difference in name, significant difference in presentation.  There is no coffee or tea or magazines here.  People in this room are not dressed for outside.  Half of the people in this room are in beds behind little curtains, some have family members speaking quietly to them.  This looks more like it.

WHOOSH!!

We’re so glad you made it!  We’re getting all your authorizations.  The OR has been booked for you.  Just relax here.  Take off all your clothes and put this gown on.  Let me close this to give you some privacy.  Put this gown on.  Just relax.  I am alone in a space in a room full of people.  It doesn’t quite dawn on me that I’m changing into my surgical gown until it surprises me that it’s made of paper and the inside is lined with plastic and there are slits all over it and the plastic against my skin is actually some sort of tube thing.  It slowly dawns on me that they have clearly developed a more efficient body heating method since the days of separate tubing, and that the slits are placed strategically for examining and exposing various parts of the body while keeping the rest covered and warm.  “Bet this thing costs a fortune, but it’s really cool.  Wait.  I kinda feel like I just dressed myself for my funeral.  No, I’m not gonna die.  But strange things are gonna happen in this thing, special events completely focused on me, my body will be there, and I’m gonna miss it all.”  Okay, then.  I guess this is happening RIGHT now.

This is where things got interesting.  And funny. And really busy and fast.  And I was hungry and dehydrated and had appendicitis and no Ritalin.  So most likely this is not a direct account.  But it is as I remember it.

First they trickled in.

The nurse checked that I was changed and comfortable, then suddenly realized that I was never registered!  They put me in the bed so fast, before all the authorizations were done, and then made me get naked!  “Is there any chance you’re pregnant, honey?” No.

The anesthesiologist came in to introduce himself, make sure I understood all the things he was going to do to me and for me, get a history. I assured him I wasn’t pregnant.  I was reciting my medications to him when the surgeon came in.

Dr. Danagra Ikossi

When I broke my leg in college I got to take an ambulance ride.  I thought I could do it without pain meds.  Half a mile into the ride I swiftly and most robustly changed my mind.  That EMT put a morphine drip in my veinless arm without a tourniquet on the first try in a moving ambulance in less than 15 seconds.  His name was something normal like Matt or Chris, but I call him Toby.  I will swear to my dying day that a bright supernatural light shone over him inside that ambulance, reflecting off of his glorious blonde locks and making his crystal blue eyes sparkle like the stars over the Amazon rainforest.

Dr. Ikossi wasn’t quite like that.  Toby was magical.  She was sunny and bright and playful and calm, simultaneously curiously excited and in complete control.  Like a laparoscopic appendectomy was her version of a day in Half Moon Bay.  Dr. Ikossi is the doppleganger of my college friend, Mindie.  This is her, but her hair wasn’t all tight like that in real life.  She is funny, relaxed, natural, and made me feel in 2 minutes like she’d known me my whole life.  Like sucking an appendix out of a belly button is as normal and uneventful for her as pumping gas or putting her kid to bed.  In retrospect she probably wasn’t wearing jeans, but I remember her like that in my mind.  And she had this great black handbag over her arm.  I admire women who skip the shoulder strap.  It’s just classy, makes me think of the Roaring Twenties for some reason.  Women who can carry their bag on their forearm aren’t carrying around loads of extra stuff.  I’m a shoulder strap girl myself.

Dr. Ikossi checked first on whether or not we were on schedule, and was surprised the anesthesiologist beat her to me, and wondered why I wasn’t in the computer yet.  Then she kicked everyone out (or maybe they left, but we were definitely alone) and, after making sure I wasn’t in pain, asked me about my life.  She asked me where I work and what I do there and how long I’ve lived in San Jose and who I live with and where my family is and who my people are here and my cats’ names.  She spent what felt like a long time learning about everything except my appendix.  Then we talked about my appendix and my medicine and all the weird stuff going on in my body.  And how I’m definitely not pregnant.

Once we agree that surgery is the better option over antibiotics or denial, she leans toward me against the foot of the bed and says, “So here’s what I’ll do: little cuts here, here, and here.  I’m gonna blow your belly up like a balloon from here.  From your belly button I’m going to go in, scootch over your colon, tie off your appendix, cut it off and pull it out.  Risks: in the rare chance that something goes haywire, I will make an incision so I have more room to work and I’m going to make everything okay.  If everything goes to plan, you’ll be home tomorrow.  If not, it will be at least 4 days.”  I knew all of this already.  She didn’t smile, but she wasn’t stressed.  Not one bit.  That look of her leaning against the foot of my bed is frozen in my mind.  That was one confident woman.   I have only met one other person in my life who had this power to instantly absorb anxiety and replace it with peace just by being in a room.

I wasn’t anxious about the surgery at all, so it took me a few days to realize why she had such a calming affect on me.  I wasn’t alone in the hospital anymore.  There was someone else in that great big clean building full of experts who knew that I was a therapist who worked with refugees and lives alone with two cats and my family’s far away but my friend is close.  She said, “I could send you home today, but I think I’ll just keep you in so you’re not alone tonight.”  Magic words.

Then mayhem ensued.

Right now, before you go any further, create different voices for Nurse #1, Nurse #2, and IV Nurse.  You will need them.

IV Nurse: We need to put your IV in.  What’s your dominant hand?  I’m right-handed, but the only veins you’ll find are my right arm or left hand.  Okay, then let’s do your left arm.  Let me warm it up first.  Warm blanket on my arm. (huh?)  She walks away.

Nurse 1: We need to take your history.  Oh, you’re still not registered!  (I still have no wrist band or Medical Record # at this point.  I’m very glad my name is so unique.)  She goes to get the registration guy.

Registration Guy: Looks at me and realizes I’m naked under the gown.  Hmmm… let me just ask you some questions.  Asks questions.  Writes down answers.  Walks away.

Dr. Ikossi: I just tried to dictate my note, but she’s not in the computer yet.  I guess that will have to wait!  Laughs and leaves.  Calls back, “We need to hurry or we’re going to lose our time slot!”

I am frantically texting in the few seconds between all these people to make sure the people who need to know I’m about to go into surgery know I’m about to go into surgery.  The warm blanket has fallen off in this flagrant use of technology.

IV nurse looks at me like I’ve let her down terribly by not keeping the blanket on my arm.  She can’t find the vein in my left arm.  It’s clearly all my fault.  I guess we can try your right hand.

“Um, is there any chance I could use the bathroom before I get hooked up?”  She just stares at me as if we just drove out of the gas station 5 minutes ago.

Nurse #1: You need to take off your jewelry and hair clips.  Who’s taking your phone, do you have money or IDs?  You don’t have anyone here? (I’ve said this 5 times.) Then we need to call security to get your stuff.

IV nurse: Puts warm blanket on my right arm.  I do not understand this warm blanket business.

Registration guy: Brings me a tablet with a touch screen.  Okay, I need you to sign here, here, here, and here.  He explains briefly what they are.  I know what these documents say: I promise not to sue the hospital if I die.  I sign.  I never did get copies.  I always tell people to keep copies of these things.

Nurse #1 is on the computer on my left taking my medical history.  Nurse #2 is on the computer on my right getting whatever she needs for whatever she’s filling out.  IV nurse is stressing about the stupid warm blanket as she eyes the veins in my right hand; this is convenient, as Nurse #1 is now blocking her access to my left side.

In all fairness, hospitals can’t blow off OR time slots.  I cost us 15 minutes of precious prep time by getting lost, and everything was out of order.  No one was disrespectful to me or unkind, not in the slightest.  These nurses were awesome, and they did their job.  In surgical prep, their one job is to get all the information the surgical people need to know to keep you safe and alive.  But it got a little crazy for a bit.

In my imaginary replays, this is how it all plays out: I sit up tall in my bed, shake off the stupid warm blanket, and commandingly say, “Okay everybody, let’s all take a deep centering breath.  I know we’re in a hurry for the spot in the OR and I know all these questions are important.  Let’s pause for 40 seconds while you guys get organized and I pull up my list of medications.  I take a lot of pills in a day and that’s the only way I’ll get it all right.  Woman, for the love of mercy, you need a tourniquet, NOT A BLANKET, and the IV needs to go in my left hand or my right arm.  My left hand would be much more convenient. But before anything else happens, I am going to pee!”

Here’s what actually happened, in rapid succession.  I drew on every second of group home experience and greatly benefited from my ADHD to actually keep both of these conversations running separately and simultaneously.  I was rather impressed with myself.  And for the record, I take 3 vitamins because of specific deficiencies and several prescriptions.  Two of these prescription medications are most commonly used for seizure disorders and diabetes – I have neither.  Answering the medication questions is not a simple thing.

Nurse #1: What medications are you taking?

Nurse #2: So you told me what medicine you take, what did you take this morning?

Nurse #1: Did you take those today?

Nurse #2: What time did you take them?

Nurse #1: How long ago did you take them?

IV Nurse: Finally decides to use a tourniquet. On my right hand.

Nurse #1: Do you take the Lamictal for seizures?  No, for depression. What?  They use that for depression? Yes.

Registration Guy: Here’s your wrist band! He puts it on crooked because he has to reach over the IV nurse.  The adhesive messed with me the whole time I wore it.

Nurse #2: How long have you had diabetes?  I don’t.  The Metformin is for PCOS.

IV Nurse: Just a little stick!

Nurse #1: Is there any chance you could be pregnant? Not in the slightest.

Nurse #2: Do you take insulin? I don’t have diabetes.

The IV needle is digging into my bone.  There is no vein in my right hand.  Seriously, I promise you, God just drew a faint blue line with a magic marker.  I know this.  It has been proven multiple times by other IV people who like a challenge.  Right now, this hurts worse than my appendix.  Much worse.  I grunt and close my eyes.

Nurse #1: Have you ever had… she starts going down the list of every possible major illness.

Nurse #2: Do you think there is any way you might be pregnant?  (These women are literally 6 feet away from each other.)

I literally cannot speak.  I manage to grunt out “ooowwww.”

The IV nurse looks at me.  My eyes are welling.  “Maybe we should try your left hand.” Ya think?

“I would really like to use the bathroom before I get hooked up to a bunch of things.”

IV Nurse: Can she do that?

Me: (Looks left) No, I do not have any of those illnesses.  (Looks right) No, I am absolutely completely 100% NOT PREGNANT.  I’ve been on birth control for 3 years, don’t have anyone to make babies with, and the clinic sent you documents of the negative urine test they did this morning.  Not pregnant. NOT. not.

Nurse #1: Do you take insulin for your diabetes?  I’m not diabetic.  The metformin is for PCOS.  Oh gosh, you haven’t eaten today.  When was the last time you checked your blood sugar?  Calls out: Did anyone check her blood sugar??? Does she need glucose?! I’m NOT diabetic. Oh.  You’re sure?  I’m sure. (Again, these women are literally 6 feet away from each other.)

Security lady comes to collect my things.  She just stands calmly at the end of my bed.  Clearly, she has seen this mayhem before.  I start pulling out hair clips with my free hand.

IV Nurse: Hunched under Nurse #1’s elbow.  Just a little stick!

OR nurse arrives: Is she ready yet?  The OR’s prepped.

IV slides perfectly right into my left hand, like a miracle from Heaven.  Without a warm blanket.  IV nurse reaches for tubing and a bag of saline.

Me, pulling off my jewelry and dropping it into a zip-lock bag: I would really like to use the restroom before you hook me up to all that.

IV nurse looks at Nurse #1, who looks at Nurse #2, then all 3 look at the OR Nurse: Can she DO that?  I know they’re thinking I’ll be knocked out in 15 minutes and the OR nurse can just cath me.

OR Nurse: Yes, she should absolutely use the restroom.  Dr. Ikossi wants all of her patients to use the restroom before surgery if they can, it simplifies things later.  He winks at me.  I like this man.

Security guard is staring at me, looking at my phone.  I’m feeling pressured now to hand over my only link to the people who know more about me besides whether or not I’m pregnant or diabetic.

This time I do make everyone stop for 90 seconds while I call my mother to tell her I’m headed in and will have Michelle call her when I’m out.

Security guard lady, curiously: Is your necklace a snitch?  Where did you get that?

Me (quite proudly, because it’s actually really cool): I won it at my monthly Harry Potter Trivia Night meetup.

She smiles and I watch as she silently unbuttons and rolls her left sleeve up to her elbow.  Her forearm is tattooed with the word “Always.” We have connected on a much deeper level, sisters of an alternate universe in which this whole situation could probably have been avoided with a few drops of essence of murtlap, carefully chosen words, and a fancy stick.  The moment shatters as I hand her my phone and am brought back to this world of firing questions and increasingly firey belly.

Then they let me pee.  People, it was wonderful.  It had a door and no questions were involved.

Dr. Ikossi arrives in green surgical scrubs and a flowery cap, with her black handbag over her arm.  Big sunny smile on her face.  I have a sudden reverie to the world of Amelia Bedelia.  But I save it to enjoy later.  I’m honestly not quite sure when she got there, because I know she helped tape down my IV.  Something about some new kind of adhesive IV strips and shirt and pants parts of them.  The point is… I went to the bathroom, the IV went where it was supposed to go, my happy surgeon showed up, and people FINALLY stopped asking if I was pregnant.

IV nurse is hooking tubing and saline to my arm.  She puts the bag of saline on my pillow.  It rolls down under my neck.  I ask if it’s okay to use it as a pillow.  Her eyes get wide.  I think she might still be upset with me about my not buying in to her warm blanket system.

Dr. Ikossi: Is she ready yet?  We need to hurry.

And then we are off: Dr. Ikossi, the OR nurse, the anesthesiologist, and me, headed down the hallway to the operating room like Dorothy and her friends on their way to meet the wizard.

I really really did love my OR rotation.  I felt again the rush of cool sterile air as we went in, the sparkly stainless steel.  The trays of gadgets, the glass cabinet doors behind which is stored sterile versions of pretty much anything you might need if anything goes haywire.  Operating rooms are prepared for both the plan and the possibility.  A lot like me, how I structure myself within the context of ADHD.  Careful planning is the only way to have any sort of control over situations that can fall apart in an instant.

Falling asleep in an OR is a strange thing.  My mom told me that they had her count down from 100.  When my leg was repaired the anesthesiologist told me it was coming and watched me.  This time I was literally having a conversation with the anesthesiologist and Dr. Ikossi.  I don’t remember what about.  Normal non-appendix things.  The clock said it was right around 2pm.  I was talking…

And then I was in the recovery room, waking up very calmly from a remarkably restful nap.  Dr. Ikossi was there, watching me wake up.  She said things went perfect and I could go home tomorrow.  The anesthesiologist was watching over me, too, but disappeared pretty fast.  I hope I thanked him.  And there was a nurse.  And another nurse who called Michelle.  And really quickly I switched into a nicer hospital bed.  Next thing I knew they wheeled me into my room.  And it was done.

Dr. Ikossi stopped by the next day.  She checked my belly and everything.  But we talked about refugees and the executive orders and her kids being aware of these things even though they are young.  She said goodbye and I said thank you.  When I next saw my nurse she told me that Dr. Ikossi had told her I was a therapist who worked with refugees.

Dr. Ikossi never needed me to have a medical record number, and that meant the world to me.  I looked her up, there are lots of reviews online about her amazing bedside manner and how she treats all of her patients like people.  I loved one quote: “She is a beautiful tornado with a ferocious drive to make her patients whole again.”  Because I strive for the same thing in my own practice I know that this is not something she does for me, but for herself; she does it because that is what excellent practitioners do, it is how we maintain our integrity and keep ourselves out of the mental mire of red tape and politics and the power of expertise.  She will see me a total of 3 times and maybe never again, but she wrestles with her own methods every day.  Authentic caring is how helpers sleep at night certain that we have made the world a better place.  We do it because it is who we ARE, not just a skill we have learned.  But I also know that even though I was alone in the hospital and even though we were on a schedule, that afternoon she never let me feel alone.

So this processing exercise turned out a lot longer than I thought it would.  The whole recovery process has caused stirrings in my mind and these things are still settling into thoughts.  I have, however, learned that tiredness is not the same as weakness, and weakness really sucks.  I am overwhelmingly grateful for the help I received from friends, but also grateful that I only received the help I truly needed.  It was important for me to spend this time alone with my body, and in solitude.  Change happens deep within our souls when we are in a weakened state, much like my external weakness was only a reflection of all the microscopic work happening deep within my belly.  I hope I will write about these things later.  For now…

I am so very grateful that I took the time to listen to my body, and that I didn’t ignore that little pain.  Every doctor I saw last Tuesday was really surprised to learn that I caught this before I had any other symptoms.  Don’t trust google.  I googled my symptoms for kicks – she said I was fine.  Don’t trust what you know: knowledge is fallible.  Please, people, TRUST YOUR BODY.  If something feels funny or different, check it out.  In my case that was the difference between pain/nausea/fever/infection/invasive surgery and a simple procedure that was technically outpatient, the little healing cuts hurt more than the actual appendicitis, and me walking laps 5 hours later.

And I am so very grateful for a surgeon who knew exactly how to bring herself into her art form.  I never doubted her skill, but her humanity was what brought me peace more than anything else.  Please, people, BE YOU.  Yourself is what sets you apart from every other cookie cutter version of people who do what you do.  Do things expertly, your way, in your style.  Be memorable because you are authentic.

I realized yesterday… I totally forgot to tell them about my Vitamin B12.

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