Beneath the Gown

She Sat on Johnny Depp's Face

2009-06-23T23:30:00.000-07:00

(First, another NB: this blog appears in reverse-chronological order. For a more coherent experience, please read it chronologically, beginning with the oldest entries, which can be found to the left under "Blog Archive." Also, these recent posts--after my expulsion from the hospital--are decidedly less witty and interesting than those during my stay, and they should probably be avoided by all but the most blood-related.)

I went back to the hospital today for the first time since my discharge. Routine follow-up stress test and pacemaker check. As I began the test, which involves incrimental exercise on a treadmill, I noticed on the monitor a data field labeled "Bruce." Finding this a bit odd, I asked the technician what it was, and she said the test was named after "Bruce somebody." I love the thought of eponymous honors sticking to just first names.
Washington, D.C.'s famed John Center for the Performing Arts.

But alak, the Bruce treadmill protocol is named after Dr. Robert Bruce. Although, if there's any justice in the world, he named his son Bruce.

Very little of note to report, except in between appointments I went into Westwood to pick up a Philly cheesesteak for lunch. I went to college outside of Philadelphia, yet I'd never had a cheesesteak until last month, when a friend came to visit me in the hospital and brought one. It was one of my top-two meals the entire month in the hospital. So I had this weird, resentful nostalgic desire to have another. Also, it was tasty.

But I couldn't remember the name of the place and I didn't know where it was. I asked at the hospital information desk, but none of the four people stationed there knew. So I wandered down Gayley St. asking college-looking folks if they knew of a really good cheesesteak place in the area. Amazingly, nobody whom I asked knew; so I headed towards the Starbucks to ask a barista.

As I walked east on Wayburyn, I noticed droves of people lining the streets, politely if giddily gathered behind metal barriers. As I got to the Starbucks, I saw that these people had gathered for the premiere of "Public Enemies," Michael Mann's new movie. But on closer inspection, they revealed themselves to be no ordinary people, but full-blown weirdos. Autograph-seekers and aspiring stalkers. One woman had lots of Johnny Depp paraphernalia, and she was even sitting on a huge Johnny Depp beach blanket. I wouldn't have thought such things existed, either, but there she was, sitting atop her Johnny Depp beach blanket. (And, Dear Reader, even if one could argue for the functionality of a Johnny Depp beach blanket, why on earth did this woman feel compelled to bring all the other crap? Was she really worried there'd be any equivocation about her status as Johnny Depp's #1 fan? Wasn't her sitting on a sidewalk for hours and hours in the hopes of catching a glimpse of the man not proof enough? Trust me, lady, your title remains unchallenged.) The whole thing reminded me of the general bizarreness of Los Angeles, and of the further bizareness of UCLA--home of the Ronald Reagan Medical Center. Or, as I call it, the Star of "Bedtime for Bonzo" Medical Center.

Fortunately, the Starbucks barista knew the name of the cheesesteak shop (South Street) and its elusive location (across the street). I still felt a somehow criminal walking around Westwood: a vestige of my few elopements (See "AWOL" and "Cinco de Mayo Clinic!" below), I suppose, as well as some autonomic fight-or-flight reflex triggered by proximity to the hospital.

See, I warned you these recent entries are bo-ring. Forgive me. I blame the antibiotics...

Even though I've been off them for several days.

Stars, They're Just Like Us: They Go to the Hospital, Too!

2009-05-29T04:40:00.000-07:00

(First a NB: the posting "ID, Please" has somehow been corrupted, and a large chunk of it is missing. I cannot retrieve nor remember the lost text, but rest assured it was hilarious and poignant. I also can no longer even edit that post--so much for the power of the Internet. Thanks for nothing, Al Gore!

UPDATE June 2: I think I've reinserted all the text and pics, but I'm still having trouble with the formatting...with any luck the post will at least stay intact for now.)

Way back in my first post, I joked about celeb sightings at UCLA; then, in a subsequent post I had a legitimate A-list sighting and promised to post about it. (In looking back, I can't remember when--I think this might have been in the missing section of "ID, Please.")

John and I were sitting on the patio at noon with our iced coffees when we saw a young movie star emerge, looking professionally beautiful, and smoke several cigarettes before returning to the hospital. I stooped so low as to ask John to use his cell phone to take a picture of the celeb as he walked back in. (John couldn't figure out how to get it off his phone to e-mail me.)

I was blithely going to post some joke about how he was probably at UCLA for his weekly visit to the maternity ward (hint hint). I congratulated myself on my own boundless cleverness.

I then spent the evening with another visitor. It's scary, but I don't remember whom--it may have been my mom, but I feel like this incident preceded her arrival. Anyway, I went back to the elevators in the west wing (wow, how did this not occur to me until now?! All the amazing President Bartlett jokes I could've made! All the Josh-Donna-me fan-fiction porn I could've written!) to return to my floor, and who should emerge from the elevator but this selfsame celeb...

Holding a young child, and with a very normal-seeming, non-celeb woman. Was the child in fact his? Was the child sick? And who was this mystery woman? It was almost 9:00 pm by then. And it occurred to me that nobody spends eight hours in the hospital if things are okay.

And I was overcome with a sense of shame that I'd even considered revealing this huge movie star's identity, as though he somehow had a lesser right to privacy than anyone else. He was likely dealing with something significant and troubling, and I could not casually out him and discuss it, much less try to make light of it.

So, once more I apologize for being a celebrity tease. It's cold comfort, I know, but I will in good conscience out the celeb my mom and I saw at Katsu-ya the night before she left. (Not of course that Mom knows who this person is.) For some reason, dining at LA's best sushi restaurant does not seem as fraught as visiting a (your?) sick child in the hospital. And that celeb was...

Sam Rockwell, whose work I've enjoyed since "Lawn Dogs."

Mr. Rockwell, shown here in character as Albert Einstein, whom he'll be portraying in "It's All Relativity to Me!"

He was with a foxy blond woman whom I didn't recognize, but who the Internets suggest was Leslie Bibb--a fellow talented attractive celeb. And they were with one set of parents. Then, after dinner my mom and I headed to the adjacent pet store and saw them there, as well.

Parents...pets...sushi? Can wedding bells be far off for Sam Rockwell and Possibly Leslie Bibb? Stay tuned, Dear Readers, as the answer shall be revealed in my next post!

Gone...Home

2009-05-28T19:45:00.000-07:00

Forgive the long delay--and even more so please forgive any worry or concern I've caused anyone with my lengthy absence from the blog. I am fine. More importantly, I am finally home.

Not much to report from home, though, and certainly less fodder for humorous, wacky postings*, but I am home. Which feels good.

I've still got another month of IV Daptomycin (antibiotics), which I'm now administering to myself once a day, through the PICC line. And unfortunately it's making me tired and sluggish, and my red blood cell count is way down, but that's a tiny price to pay to be out of the hospital.

At some point I may have to post about my final night in the hospital: after the pacemaker-implantation surgery, I was in significant pain. (My past three pacemakers have been just below my clavicle; this one was inserted submuscularly, in the deltopectoral groove. Apparently this is a more difficult recovery.) I requested more Vicodin, but my nurse told me it was too soon....So she gave me Dilaudid. Check out the side effects here.

Suffice it to say, I immediately started sweating, became incredibly paranoid and agitated with my mother, and vomited repeatedly. Thank you, Nurse, for sending me off with a long, crazy trip. Next time, please just give me some mushrooms.

All right, that's it for now. I will post medical updates as warranted. Cheers.

*Unless you count my cats' daily shenanigans as humorous, wacky fodder. In which case, enjoy Bruce Wayne trying to walk across the clothes hanging in my closet.

Frat House Flower

2009-05-14T23:30:00.000-07:00

Yes, I did it! Today marked my third week at UCLA, and I still haven't been voted off the hospital!

Today was also my sister's birthday. Happy birthday, Jess! The cell phone reception in my room is poor, so Mom and I went out to the large hallway by the elevators to call Jess. I looked out the westward-facing floor-to-ceiling window and saw a vista so utopian I assumed it was merely an oasis. A mirage that my hospital-addled mind had forged in a desperate attempt to transport my spirit away from my body's septic incarceration.

Of course I can be speaking of only one thing: a fraternity house rooftop barbecue. This is what I saw by the elevators:
Believe me, I am aware of the symbolism of the bars. They symbolize a ladder to heaven?

Then, from the same window where I'd seen this panorama on Sunday, I saw this:
Click on the picture to enlarge it and behold a grander sense of Shangri-la. Yes, they are playing beer pong. Note the one dude sunbathing on the upper porch. Beer pong is fine for underclassmen, but this communications major prefers sun pong.

It wasn't an hallucination! Hallelujah! As you can see, it's a chapter of SAE. Better still, they've got their Paddy Murphy sign up. Who's Paddy Murphy, you ask?! Only some legendary bootlegger whom Elliot Ness shot and killed...before tragically discovering--via magical frat hand shake--that Murphy was a fellow SAE brother.

I went to a small Quaker college, so my knowledge of Greek life is limited to cultural artifacts.
Fraternities have a rich history of documenting their hazing rituals in ceramics. And yes, I'm aware of the symbolism. Ceramics are fragile, like heterosexual male friendship.

Oddly enough, SAE is the only fraternity I've ever heard of--because a childhood friend, who wound up in another fraternity himself, said that people refer to SAE as "same assholes everywhere."
My knowledge of assholes is also limited to cultural artifacts.

But in my brief Internet research about SAE, I was surprised to discover that William Faulkner and Terry Gilliam are brothers. Then again, so is sports super-agent Scott Boras.
"Barry Zito's mechanics are fine. Trust me!"

Either way, I want to reserve my judgment until I meet an SAE brother. Is President McKinley still alive?

As I lie here in bed now, I can hear the faint din of a large college party. Fortunately I was already woken up by a nurse who was unable to draw blood from my PICC line. The nurses all seem to think midlines can't draw blood, whereas the actual PICC technician swore up and down they could. This may turn into a real problem for me. And I'm feeling as though I may be coming down with a cold. Needless to say, part of me is worried the infection is back, which would also be a substantial bummer and would at least mean a new PICC line, if not a postponement of Monday's suregery.

Fortunately I am helping my own diagnosis by refusing phlebotomy in the middle of the night. Suffice it to say, the entire day I reminded my nurses, and my cardiologist, that no one had done cultures today. By the end of the day, my nurse said it was okay, that there was no order. So the fact that someone (anonymous CCU resident, thank you) ordered cultures at 11:00 and woke me up is too infuriating to countenance.

Mostly, though, I find it so strange that when I looked out the hallway window on Sunday afternoon and saw the foggy, spectral hills, I thought that that reality was about as distant from mine as I could imagine. Then today, looking out the same window at something so entirely different, I had the same feeling.

Fraternity parties and clouds are rocking my conceptions of the world around me, and my understanding of my place in it.

Home...Going

2009-05-12T14:06:00.001-07:00

For almost a week, I've been operating on the assumption that once I got my PICC line, I'd be able to go home. My cardiologist had assured me this would be okay--in fact, he pointed out that I was more likely to get an infection on the temporary pacemaker if I stayed in the hospital.

Late afternoon yesterday I wandered down to one of UCLA's older cafeterias to get an iced mocha. Simple pleasures attain great significance in demoralizing institutions.
In prison, cigarettes are worth their weight in tobacco, nicotine, paper, cellulose acetate, rayon, and tar.

The cafeteria iced mochas are not surprisingly not great. I walked back to my room through the new hospital's cafeteria (called the "Dining Commons") and noticed that it actually had a small Starbucks stand. How had I eaten there many, many times without noticing this little gem? I stared at the unsatisfying cafeteria mocha in my hand and decided that I was stuck in the hospital and deserved to treat myself to a real iced mocha. So I bought a Starbucks iced mocha latte as well. Venti, baby.

I loaded it up with half and half and sugar--only to discover to my chagrin that it, too, was somehow inadequate. Clearly I'd only thought I wanted iced coffee. Simple pleasures become less simple....So I bought some chocolate chip cookies and headed back to my room to watch the Mets game on ESPN.
Sick children in New York inevitably become Mets fans because of the team's infirm mascot, Mr. Met, a hydrocephalic. Despite his hideous hemicraniectomy scars, Mr. Met puts on a smile--and a show--for his beloved Metropolitans!

Mr. Met prays for a cure for his disfiguring disease. Note his ever-cheery disposition. What a trooper...

Oh, no! He must have been praying to the devil!

As I walked down the mean halls of 7 West, I looked out the window at the end of the corridor and saw this:
The large structure on the hilltop is the Getty Center, one of my favorite places in LA.

Needless to say, the picture doesn't do the view justice. Streaks of low-rolling, sun-streaked clouds caressed the hills. No doubt the light was moodily enhanced by the Santa Barbara brush fires. I couldn't help but feel hopeful on the eve of my release. The spectacular presence of Los Angeles endured; my confinement could not.

Later in the evening the surgeon who'd performed the extraction stopped by--in civilians and in a rush. As soon as I said that I'd been told I could leave the next day, he kind of flipped out. He stressed that if I went home and anything happened to the temporary pacemaker's lead, I could die. (Perhaps finally living up to his reputation of mentioning the chances of my death "five times a minute.")

This morning one of my cardiologists came in and seconded the surgeon. He said they really never let people go home with the temporary pacemakers, and he reiterated the catastrophic, if slight, risks. He also said, "What's five more days in the hospital?" I suppose he has a certain logic there. A Taoist sort of In-N-Out kind of Brahman-is-Atman McNugget.
The Taittiriya Upanishad says: "He who knows the Bliss of Brahman...does not distress himself with the thought, 'Why am I stuck in the hospital? What's another five days?' Whoever knows this (bliss) regards both of these as Atman."

So it looks like I'm stuck here at least another week or so. If I can go a few days past that, I'll make it a full month. As far as I know, Lewis and Clark got from St. Louis to the Pacific Ocean in less than a month.
Sacagawea readies to give Cpt. Willaim Clark the "Nyuck-nyuck" eye-poke. She learned from the best, Chief Why-ay-oughta.

But, I'm determined to try to use my tenure at UCLA productively. Perhaps I can even do some personal creative writing, now that I know I'm trapped here. As I've always said, "If life gives you lemons, get that fishy smell off your hands."

Who's Your God Now?

2009-05-10T02:00:00.000-07:00

Friday's successful surgery was a huge, wonderful relief, though it may slightly undermine the retrospective musings of this post....

Increasingly theology is creeping into my hospitalization. It started with a nurse/missionary's suggesting I pray (see "Even if You're Not a Christian" below). This prompted a similarly upsetting anecdote in the comments section. As the anesthesiologists and nurses prepped me on the OR table, they added small detachable arm rests, which reminded me of a crucifix (not that I've got a Christ complex), and made the operating table resemble a lethal-injection table.
As George W. Bush said, "If the death penalty is administered swiftly, justly, and fairly, it saves lives." Just imagine what medicine can do!

And today I saw a priest wandering the halls of the hospital. I wondered if he was part of UCLA's chaplaincy service. Or if he was just there to visit a friend. And then I wondered, can a priest ever visit someone in the hospital--just as a friend?
Can priests ever be "just friends?" Or must they be friends with benedictions?

Can a priest make a personal not pastoral call? What if a priest visits a Jewish friend? I know that sounds like the setup to a terrible joke, but the answer is as dead-serious as it is obvious: the Jewish patient takes the Eucharist with matzo bread and Manischewitz.
Surprisingly, all matzo bread contains apparitions of the Virgin Mary. Can you find her in this piece?! (Answer to be published in the next post.)

Indeed, religion is pervading my hospital stay. After all, Jeremiah 23:24 is not just a Jenny Craig slogan.
Kirstie Alley, star of "Look Who's Talking," "Look Who's Talking Too," and "Look Who's Talking Now," says, "Before I met Jenny, I'd wake up every morning and ask, 'Do I not fill heaven and earth?'"

"'Do I not fill heaven and earth?' said the Lord" is also often cited as scriptural evidence of God's omnipresence. Either way, it's time for me to welcome God to my illness. Unlike vampires, God doesn't need a technical invitation. And apparently I've got lots of people of lots of faiths praying for me. No, not for the redemption of my godless, foul-mouthed, porn-addicted soul. But for my medical treatment and recovery. And not only do I feel obligated to acknowledge these compassionate strangers, but maybe even to appreciate them.

I've got Episcopalians in New York praying for me. United Church of Christ-ers in Knoxville. Baptists in the Dominican Republic. I've got Jews in New York saying the Mi Sheberakh for me. Okay, maybe getting Jews in New York to pray is about as difficult as getting Kirstie Alley to the craft services table. So if that doesn't impress you, I also happen to have an Iranian Muslim in the holy city of Qom appealing to the daughter of an Infallible Imam for me. And he commissioned his relatives, on a pilgrimage in Karbala, Iraq, to pray for me by the tomb of Imam al-Husayn.
The Shrine of Imam al-Husayn. Some of these people may be praying for me.

This is not the first time I've been the object of intercessory prayer. When I was ten years old and at Boston Children's Hospital for my second open-heart surgery, an entire third-grade class from a Chirstian academy sent me get-well/I'm-praying-for-you cards. I didn't know any of these kids. One of them had shared a hospital room (in New York) with another boy whom I didn't know, whose mother knew my father.

Needless to say, countless studies have been conducted to gauge the efficacy of intercessory prayer, and they have yielded conflicting results. The most exhaustive study, however, was funded by Templeton Foundation, a mainline Christian organization that encourages a scientific quest for the spiritual. I'm probably not describing it well--or fairly, so perhaps it's better to let the Foundation speak for itself. I'll limit my editorial to saying that one of Sir John Templeton's stipulations was for his prize always to carry a richer purse than the Nobel Prize, and that past prizes have been awarded to Mother Teresa and Billy Graham. Here's a science writer's account of working with the Foundation.

The study cost 2.4 million dollars, spanned a decade, and included over 1,800 patients who underwent coronary bypass surgery. The patients were broken up into three groups: one group received intercessory prayer and was told so; another received intercessory prayer but was only told they might be prayed for; and the third received no intercessory prayer and did not even know they were part of the study. The group that received intercessory prayer and knew about it did the worst. According to the New York Times, "patients who knew they were being prayed for had a higher rate of post-operative complications."

My father, who told me about the study, said, "The 2.4 million dollars spent on the study could have provided a lot of medical care to kids who needed it." My mother said, of the countless strangers of varied faiths who are currently praying for me, "It means something to them. It's a special way of loving in their minds."

Maybe they're both right.

You Can't Spell "Extraction" without "Action"

2009-05-09T20:33:00.000-07:00

In fact, you could say that extraction is extra-action! You'd be mocked for your inane word play, but you could say it. And it might adequately describe my last few days. I should also note that my mother came to LA from New York last week, and she's been a saint and an incredible source of support. I could not have gotten through all this without her. And she brought my camera from home, which is how I'm able to pictorially document my most recent elopement and my procedures below.

As I mentioned at the end of "Cinco de Mayo Clinic!," my doctors altered their game plan slightly, and on Thursday they implanted the temporary, external pacemaker.
Thursday after the first procedure. Temporary pacemaker on my left neck, incision on my right, where they initially attempted to put it. I like the symmetry--it matches the hospital bracelet on each wrist. Note how the telly box sexily hangs in front of my genitals.

Yes, that's a pacemaker. Watch out John Connor, here I come.

Sometimes you just have to laugh at life. Unfortunately, this cartoon doesn't help at all.

But Thursday was really just a warm-up for Friday: the extraction of the old pacemaker and its three leads. I outlined the numerous serious risks of this surgery in "ID, Please," so I won't repeat them here. But I will say that I was incredibly anxious.

Thursday night, after the implantation of the temporary pacemaker, the surgeon who'd be performing the extraction came to my room to talk with my mother and me. I'd been warned he had a gruff bedside manner, and that he would mention the chances of my death "five times a minute." But he actually seemed quite pleasant, and didn't fixate too much on the odds of my demise. Instead he fixated on how delicate and complicated the extraction can be. He reiterated what my cardiologist had said: with open-heart surgery, you want to be as fast as possible to get the patient off bypass quickly. With lead extraction, you want to be as careful as possible. So, he said the extraction would take at least four hours, but could easily go ten. He added that he was performing a similar operation in the morning, and would likely not get to me until early afternoon.

My mother and I were left to contemplate all this in our own ways. Since I was NPO (from the Latin nil per os, "nothing by mouth") after midnight, my mom went to Westwood to pick up Italian food for dinner. I had about 4 lbs. of delicious pasta. I even had some beer. Then Mom and I retreated to my room and talked until 3:00 am. At 5:30 a care partner woke me up and declared she had to give me a sponge bath with antiseptic soap before my surgery. I tried to inform her that my surgery was not until early afternoon, at the earliest. This led to a series of nurses coming in and out of my room every few minutes to announce that my surgery was in fact scheduled for 9:00, and the OR wanted me there at 8:30. "Fine," I said, "and why do I have to have this bath at 6:00 am?" I convinced the nurses to wake me at 8:00, which they did. They taped up my various bandages and exposed bio-computers to keep them dry, and then I showered. The antiseptic soap was viscous and red, and I felt like I was bathing in blood, which was nice before surgery.
Sissy Spacek gets ready for her surgery.

I was all shiny and clean and ready to go by 8:25. Which was great, because they didn't come get me until 4:00 pm. But I have to thank the nurses (and whatever idiot they say they spoke to in the OR scheduling room) for giving Mom and me an entire day of constant anxiety. Each time there was a knock at the door, I thought, "Here they come. Now I'm going to surgery." I was able to nap intermitently, but my poor mother was too anxious, too focused on her mama-bear guard duty (a role she'd perfected by the time I was a toddler).

But of course, eventually I got taken down to the OR. I was surprised to see windows lining the hallways. Somehow it defied my expectations of cavelike sepulchral operating rooms. The anesthesiologist poked me several times trying to get his IV in. In fact, this is a fun little game I've established with nurses and phlebotomists, as well. My arms have more tracks than the 1, 2, 3 lines (little shout-out for my New York homies!), which is ironic given that I've got an IV into which I could easily shoot heroin. Shortly thereafter, I went under.

I returned to consciousness in the OR recovery room, and a few minutes later my mother joined me. I was drifting in and out.
In the recovery room. I actually felt worse than I looked.

But with a Wolverine-like healing factor, just moments later I was giving the thumbs-up with a look that said, "Join me for a cocktail, won't you?"

I soon got turfed back to my room, where my mom stayed by my side as I continued my crisscross journey through consciousness. I was lucid enough to speak with a few doctors who came to check up on me and inform me how well the procedure had gone. And I was lucid enough to speak to my father on the phone. But I wasn't lucid enough for the Rubik's Cube contest I'd foolishly entered for that evening. But if losing a Rubik's Cube contest was the worst thing that happened to me yesterday, then yesterday was a really good day.
Frighteningly, this is just the opening contest. The real contest starts when the giants come out and compete to solve the huge Rubik's Cubes that these nerds are using as tables. The victor then eats the puny nerds. Why on earth did I ever want to be a part of this thing in the first place?! My God, what was I thinking...

I was allowed only Oxycodone or morphine. Morphine's always made me feel dizzy and nauseated, so I chose the pill. Which made me feel dizzy and nauseated--and did nothing to address the considerable pain I was in. But I was able to eat most of a tuna sandwich, and a few of the cookies Mom had bought. She slept in my room for the second night in a row.

This morning wasn't great either, as the pain at the incision was pretty bad. Worse still, it's upsetting to discover blood stains in your underpants and realize they came from your penis (presumably from the catheter). Peeing was incredibly painful, too, but became much less so over the course of the day.

My mom and I ate lunch in the cafeteria, and I spoke with Katy, all of which helped me feel like I was recovering well. Now I play a waiting game and hope that my blood cultures come back negative, enabling a safer implantation of the new pacemaker, possibly within a week or two. There's a slim chance I could go home for part of that interim period, but I won't hold my breath. Hopefully, however, with yesterday's success, I'm at least out of the woods.

And I always like to end on a humorous note:
Ha ha ha ha ha!

Cinco de Mayo Clinic!

2009-05-06T23:21:00.000-07:00

There's no way I'm the first person to make that joke, but it's making me smile and I'm in the hospital, so for now I'm permitting myself to claim and bask in its authorship.

Well, I did it again. I eloped last night. This time with a lady. And another lady. My flights from the hospital now have me married to one man and two women. I wonder how Mormons feel about bisexual polygamy?
Joseph Smith has his first vision. Of two hunky "roommates" who play water polo and own a Jack Russell Terrier.

Ironically, my two lady liberators are both doctors. One, a friend of my girlfriend Katy's, is a plastic surgery resident (more reconstructive than cosmetic surgery), the other an ER resident. Worse still, perhaps, they're at crosstown rival USC.
The USC-UCLA feud is so intense that, during rivalry week, USC students duct tape their beloved Tommy Trojan statue to prevent vandalism.

And UCLA students duct tape their iconic Royce Hall to thwart biochemical attacks. Tragically, every year a freshman or two inevitably get stuck inside and suffocate. "We are the mighty Bruins, triumphant evermore..."

They had been celebrating Cinco de Mayo at el Cholo in Santa Monica and, remarkably, managed to sneak a margarita out of the bar and into the hospital for me. The margarita was just in a plastic Bud Lite cup; so Katy's friend's holding it upright in her purse the whole time was certainly quite a gesture. Now, before condemning the medical wisdom of a midnight margarita, it's important to note that Hippocrates believed wine was the best medicine.
Peter Paul Rubens, "Hippocrates, Doctor of Debauchery. And of Medicine." Oil on canvas, 1638-40. While riding around in tiger-drawn chariots, Hippocrates, the father of medicine, was often heard saying, "Come on, Baby, drink this. It'll make you feel fan-fucking-tastic! Trust me, I'm a doctor." Hippocrates was also famous for his bumper stickers that read, "Doctors Do It for 30 Hours!" and "My Other Chariot Is in the Zoo."

Controversial though it may be, I was drinking a medical margarita. The two doctors brought their white coats with them in case they had to sneak past security, but evidently security is lax enough at UCLA that they didn't need the officious ruse. I went downstairs with them, where they retrieved their car from the valet (yes, the Ronald Reagan Medical Center has valet parking), and we sped off into Westwood, whose streets were lined with drunken college kids. We cruised for a while.
This is what freedom looks like: Wilshire and Westwood Boulevards, just before midnight on May fifth. It looks dark, but I assure you it shone with the light of a thousand suns.

We parked and asked a few students if there was any place open late where we could hang out. They directed us to Jerry's Famous Deli, right across the street--an oasis of non-hospital normality and deli meats. Sadly, however, Jerry's was closing for the night. My escorts pleaded with the busboy mopping the floor, but to no avail.
Apparently the people at Jerry's Famous Deli didn't care that I was in the hospital, desperate for any taste of freedom. They're famous for their pastrami, and for their staggering indifference to the suffering of others.

So we left, and wound up following the roving herds of college kids drifting northwest towards Gayley Avenue. The pilgrimage was brief and easy, but the destined holy land well worth the journey.
The Church of In-N-Out Burger. While multidenominational, the Church's essential dialectic of in and out gives it an Eastern flair. "Are you in or out?" "Yes." Like a zen koan, but with an answer.

Unruly college students formed a line that extended out the door and onto the patio. As if I didn't have enough old-people problems (see "Old-People Problems," below), these youngsters appeared so alien to me. And so distant. Temporally, at least: the young woman on line behind me had her back to me as she talked to a group of her friends, and she kept slamming her butt against mine. No awareness of personal space whatsoever.
Aggressively young and stupid people queue up to press their butts against other people's butts. Thus is life in the twenty-first century, everybody.

It was awful, the constant co-ed butt-rubbing. "Take me back to the hospital!," I thought.

Katy's doctor friend proved herself to be some sort of sorceress, as she knew everything about In-N-Out's "secret menu." I got a cheeseburger, animal style, and a half-vanilla, half-chocolate shake. We dipped our fries into our shakes, and ate our animal-style burgers in the style of animals.
Dogs typically eat pasta separately from its sauce. That may be why their mouths are cleaner than humans'.

Momentarily, all was right in the world. But because of the stern talking-to I'd gotten after my last elopement, I soon worried about getting in trouble again. Strange to have curfew at a hospital.
None of these people is thinking, "Can I sneak back into my hospital room without waking up my surly care partner?" Wait, the chick on the far right is probably thinking that.

The residents asked me lots of questions about my condition, treatment, and hospitalization. And they dished on the intricate professional and personal politics inside a hospital. Though interesting, all of this reinforced just how weird it was to escape from my captors at UCLA only to hang out with other doctors. Crazily enough, they confirmed that junkies who don't have good veins really can capitalize on having a direct line with the hospital IV. Maybe my nurse was right to accuse me of shooting up (see "AWOL" below). And now I wish I actually had, since it's a real phenomenon and UCLA was practically expecting it.
The doctors inform me about all the routine hospital procedures, like IVs, that can be used to achieve a better high. The doctors were nice enough to bring me a margarita, but not nice enough to bring me any heroin. So I shot some milk shake into my IV. Dude, you think your brain freezes if you eat it too fast?!

Posing with one of my kidnappers, it's evident that Stockholm Syndrome can set in after even just a few hours.

Shortly before 2:00 am, In-N-Out's diminutive but in-your-face security guard started kicking people out, and my escape drew to a close. The doctors drove me back to UCLA, and as I walked by the nurses' station--well over two hours after I told them I was merely going down to the lobby--I passed my surly care partner, who didn't acknowledge that she even knew me, much less that I had just committed a serious transgression.

I was wired, tipsy, and covered in sauteed onions and fried mustard, so I didn't fall asleep until well after 3:00. Fortunately, the phlebotomists came at 4:00 to draw blood. And then, someone else came every 20 minutes thereafter to needlessly wake me up. By 7:00 it was time for a CT scan, before which I promptly got a migraine. They tried to prep a new IV for the iodine dye--this was loads of fun, because the nurse couldn't find the vein, but, showing her persisent spirit, spent several minutes with the needle in my arm, aimlessly poking around.
This was my view going into the CT scan.

And this was my view (of UCLA's famed ceiling) lying on the CT scan table.

I'd write more about this boring scan and my subsequent Vicodin, but I just found out today that they're shuffling things around once again, and adding a new procedure tomorrow: they're going to put the temporary pacemaker in; then Friday they'll extract the current infected one.

I will try to pound out another post soon, but the next two days bring two serious procedures, and possibly emergency surgery. Hopefully all will go well and I can at least retrospectively post about it early next week.

My surly care partner just lazily lumbered in and told me how she wanted the night to end quickly, because she'd been here four days (she meant four straight night shifts).

"I've been here two weeks." I said.

Another stellar moment for UCLA's medical support staff.

AWOL

2009-05-03T19:15:00.001-07:00

Yesterday my friend Mike visited and encouraged me to venture out of the hospital with him. My patio privileges extend only as far as the patio. But we walked into Westwood and got sushi. It felt so strange, after only 10 days, to be on the outside. Like I'd entered some lively alternate universe of co-eds and the homeless.
Otto Dix, "Downtown Westwood." Oil on canvas, 1927-28.

I'd been confined to my tiny room for so long that I'd apparently lost my ability to judge velocity, and I got struck by cars several times crossing the street. Fortunately, I am living in a hospital.

The sensation of freedom was disorienting. But still wonderful. The righteousness of breaking an unjust law swelled my heart with humanity. In barely over a week, the institution had crushed and enslaved my soul. And I had been complicit in my own bondage. But as Thomas Jefferson said, "Resistance to tyranny is obedience to God." "The Secret" is my god now (see "Even if You're Not a Christian" below), but tyranny is still my tyranny.
On liberty and the breaking of unjust laws, Jefferson wrote, "Fuck yeah!"

The excursion into Westwood felt like the fishing trip in "One Flew Over the Cuckoo's Nest." But with less vomiting.
"One Flew Over the Cuckoo's Nest" (1975). McMurphy and gang rejoice in their deliverance from the psychiatric hospital aboard a fishing boat. Yes, yes, they're not actually on a boat. Remember, they're crazy.

Mike played McMurphy to my cavalcade of character actors. An irrepressible rebel chipping away at my psychic constraints. And my literal constraints, the telly box.

I returned several hours later, and as I approached my room with a Starbucks iced white chocolate latte in my hand and a smile on my face, I met my Nurse Ratched.
Louise Fletcher as the oft-misunderstood Nurse Ratched.

While not an androgynous Southeast Asian, this nurse was Asian, and he was gay as the day is gay. He rolled his eyes, put his hand on his chest, and said, "You almost gave me a heart attack." Frankly, I'm not sure that's the most appropriate phrase for the cardiac floor. He probably should've said, "You almost gave me a myocardial infarction." Either way, he was none too happy with me.

He proceeded to lecture me about my absence, saying that I'm really only allowed to go to the patio for 15 minutes at a time. He asked where I'd gone, and I lied, claiming I'd simply been walking around the campus. Then he said, "You did two wrong things: you went away for too long; and you didn't bring me a coffee." I said he could only have one--either scolding me or getting a coffee.

Apparently they had been looking for me so they could set up a magnesium drip. The nurse warned me that the magnesium might burn, and I should call him if it did. "Or," he offered, "you could just bight a pillow." Then--completely innocently, I swear--I said, "Don't you have some leather I can bite?"

He smiled, "Ooh, you're a kinky one."

So now I was the incorrigible cad who flirts with male nurses. Great. And my quest for autonomy had been harshly suppressed. The whole thing was so devastating that, like Billy Bibbit in "Cuckoo's Nest," I promptly slit my throat.

But the revolution rages on, apparently. Today my friend John stopped by with his toddler, and we went to the patio (with the consent of the nurses' station). We sat at a picnic table and had a movie star sighting about which I may soon post. Within half an hour, though, I was accosted by the day nurse and her trainee in tow. She said I had to check back in at the nurses' station every half hour, or at least call her. I assented, and a short while later I did indeed call her and check in. So ridiculous, but I wanted her off my back.

John and I asked the person at the information desk if there was a children's playroom, and they directed us to the 5th floor. We innocently wandered into an enchanting little playroom with a floor-to-ceiling mural of Earth covering the walls and with toys and games and teeny little tables and chairs everywhere. John's daughter lit up, but a nurse in the room told us that everyone had to be out on the patio, so we walked out on the patio, which was replete with food and snacks and tables and chairs. And which was full of very sick kids and their parents.

I instantly felt ashamed to be there--as though I were stealing from the poor, crashing the sacred ceremony of a religion well beyond my grasp, spying on strangers' intrinsic truths I couldn't possibly behold. As though I had no right to complain about any of my maladies and medical misfortunes. As though mine were not maladies or misfortunes at all.

In my lifetime of dealing with serious health issues, I've witnessed a mindset in the healthy, a reflexive oppositional relief, that I call "the facile and unsophisticated gratitude of the non-handicapped." That term is pretty facile and unsophisticated itself, but it's an undeniable, instantly recognizable phenomenon that typically only presents as the subtlest of facial expressions when able-bodied people suffer upon the ill. "There but for the grace of God go I," and other such reassuring platitudes reverberate inside them. It's a weird mixture of genuine sympathy, utter horror, and the pitch unknowable.

This is exactly what I felt as I stepped out onto the balcony full of children who were far sicker than I'd ever been; children who wore their sicknesses externally, like calamitous Halloween costumes; children whose futures were not nearly as bright as mine. Children whose futures were doubtful, and no doubt full of pain.

I don't know how John felt. I didn't have time to find out, as a woman immediately approached us and asked if we were patients. I showed her my admission bracelet, though I somehow knew it was insufficent to grant safe passage through this dark kingdom. She said the event was only for pediatrics patients. Of course. She informed us that the playroom, too, was only for pediatrics patients. Of course. Wish the info desk lady had shared that little nugget. I unavoidably glanced at the pediatrics patients, their fiercely twisted baby bodies obliviously ambling along, smiles abounding.

So John and I spun right 'round on our heels and pushed the stroller off the patio and through the playroom. His poor daughter threw a fit at having been teased with all those wonderful toys, ignorant of the depth and acuteness of suffering so proximal to her. We returned to my floor, and as we approached my wing, the dynamic duo of nurse and trainee spotted me with jaundiced eyes.
Two nurses confront me. Under normal circumstances, outside the hospital setting, this is a welcome sight. Note their obsessive professionalism in always listening to each other's hearts. Note, too, that this has meanings beyond the merely medical.

The nurse said, "There he is." "You knew where I was. I called you." "Oh, that's right, you called me. Well, I don't smell any alcohol on your breath," she said. "Mouthwash," I said. "The problem with what you did yesterday," she went on, "is that no one knew where you were for a long time. Let me tell you what happened once when that happened. The hospital discharged the patient, and then they had to readmit him again. We don't want to do that to you, but we can't be responsible when we don't know where you are. We don't know what you're shooting in your IV."

That's right, she accused me of slamming junk into my IV.
Because after a shrimp tempura roll and an iced white chocolate latte, I always like to gravy me some Harry Jones!

"Why would I go outside to shoot up," I asked, "when I can do it in my room?"

(Update May 5: my girlfriend's friend is a surgical resident, and she says when patients go AWOL, doctors call it "eloping." I'm not sure how to break the news to Mike, though.)

Old-People Problems 2: 2 Old, 2 People

2009-05-02T23:43:00.000-07:00

Heartbreak alert:

My care partner (attendant) just came into my room do a routine blood pressure and temperature check. He asked how my night was going. I said, "Slowly." He said that his was busy, and I asked why.

He told me that he had several old patients who were very confused. Immediately I thought about my neighbor, though I hadn't heard any shouting. He told me that a male patient in his 90s was being visited by his wife, and apparently both are somewhat demented. The man's wife didn't want to leave, insisting that she was in their home. "But I am home," she said repeatedly.

The care partner had to call someone from the hospital to escort her out.

ID, Please...

2009-05-02T12:15:00.000-07:00

(NB: this posting has gotten corrupted and I've tried to salvage it a few times. Consequently the formatting is off. Hopefully, though, the wit and charm is on. Way on.)

The broad strokes of prognosis and intervention for an infected pacemaker are: extract the contaminated pacemaker and all its attendant wires; implant a temporary, external pacemaker while continuing to attack the infection with IV antibiotics; then within a week or two, and ideally with a completely sterile field, implant the new, permanent pacemaker. I don't know what the technical term for this series of procedures is, but when all goes smoothly, it looks like this:
The second jumper cable can actually be affixed anywhere on the body, but the nipple provides an extra tingling sensation. In some extreme cases, the cable is affixed to the genitals, earning the nickname "The Junk Buzzer."

This, of course, is assuming no complications. I refer back to the sage words of my favorite college history professor, Roger Lane. On the first day of Western Civ, he outlined his many Lane's Laws of History. Lane's First Law of History: Things Are Complicated. Indeed, Life is complicated. Let's talk about complications.
Pop philosopher Avril Lavigne has mused extensively on the nature of complications in her classic ballad "Sk8r Boi."

First are the predictable complications. Extracting pacemaker wires, or "leads," percutaneously (through an incision in the skin) can sometimes be difficult, depending on the degree of endothelization (how much scar tissue has grown over them). If possible, a laser lead extractionis performed, using an excimer sheath to burn the scar tissue off the leads.
Dr. Irving Cohen, Cleveland Clinic, performs a laser lead extraction.

Occasionally, however, the laser can't sever the scar tissue, and the leads must be removed surgically--with open-chest and potentially open-heart surgery. Or worse, extracting the leads, which sometimes requires violent pulling, can perforate a blood vessel or the heart itself, requiring emergent surgery.
Dr. Mola Ram, Pankot Palace Medical Center, performs his signature "Heart Burn" surgery.

These are certainly disquieting complications. But, as the old saying goes, "Complications love complany." An arguably more disconcerting complication is that there's some divergence of opinions between my cardiological team and my infectious disease (ID) team.
My cardiological and infectious disease teams discuss my treatment.

The TEE (see "Prologue: the Beginning" for an anecdotal account) revealed conclusively that there is an infection, or "vegetation," on one of the pacemaker leads, and possibly on thetricuspid valve, through which the infected lead passes. (Subsequent blood cultures came back positive for coagulase-negative staphylococcus epidermis.)

The ID team feels a tricuspid-valve replacement--open-heart surgery--is therefore inevitable. The cardiological team, however, thinks the vegetation on the valve is minimal and the valve's function is unimpaired, which does not indicate valve-repair or -replacement surgery. It's odd that the bacteria people want to operate on my heart, and the heart people want to use antibiotics.

An interesting semantic point emerged, which I hope will be easily verifiable at some point--not that that would alter the objective facts of my infection or course of its treatment. One cardiologist told me that the TEE report said there was "possible" thickening of the valve, which could suggest vegetation, but could also merely be the result of years of the valve's rubbing against the lead that runs through it. This morning an ID doctor told me that the report said there was a "probable" infection. Maybe this distinction is not very illuminating after all, and I certainly hope the cardiologist's recall of the report is better than the ID doctor's. Still, I wonder to what extent physicians inductively read reports and charts and tests to confirm their own initial diagnoses. Here's to the scientific method!

Presumably the doctors will hash this out and come to a consensus, if albeit a reluctant and divisive one. Hoping that we start with the primary goal of a successful laser lead extraction, I know that I will be prepped for the open-heart contingency, and the procedure will be done in an OR with a full surgical team present and with me under general anesthesia. It's strange to think that it can go either way; that, whenever the extraction finally happens, one team will be proven right--while I'm unconscious and unable to either gloat or castigate.

Further complicating things is that my blood cultures are still coming back positive. This confounds my cardiologist a bit: he pointed out that, for almost a year now, my body has effectively and repeatedly fought this infection on its own. Certainly it should be able to do so in conjunction with powerful IV antibiotics. I'm not sure exactly what it will mean should my blood persist in testing positive. I suppose just that the pacemaker's still got to come out, and then the lingering infection, if any, still has to be blasted with antibiotics. Whatever else it means, it's already pushed the extraction back by a week--though I wouldn't be surprised to see this date continue to recede. It also guarantees me at least another 2 to 3 weeks in the hospital. A bit of a bummer, indeed.

Proponents of intelligent design (ID) argue that many bio-organisms are so complex, wondrous, and beautiful, that they could only have been engineered by a powerful sentient being. Like spiders,

The strength and structure of spiders' webs have long been seen as signs of divine design.

Or Hugh Jackman,

Hugh Jackman's Aussie hunkaliciousness isn't the only clue that he was smartly architected--he's also a devoted husband and father. Take that, evolution!

Or the blind naked mole rat,

No, this is not a potato sculpture. Intelligent Designer, meet your handiwork, the blind naked mole rat. Note, not a photo of the author.

Some people like intelligent design.

Supporters of ID believe an intelligent, sentient being created humans in the act of performing a conga line.

Some people don't like intelligent design.

Atheists futilely throw their utensils at Dr. Manhattan--one prevalent theory for the personification of the intelligent designer. Too bad he didn't design himself some briefs. Jeez

But what happens when the complexity, wonder, and beauty of Life are corrupted or defective? Are the flaws by design as well? And, if so, wherein could the intelligence possibly lie? We can't all be spiders and Hugh Jackman. Some of us are blind naked mole rats. (I swear that's not a photo of me.)

Ready to Be Grumpy

2009-05-01T11:13:00.000-07:00

Last night I hung out with a few nurses at the nurses' station. My father had suggested I try this for a little human contact when bored. I thought, "I can't do that, they're working!" He said they might have more down time than I thought.

I needed to get out of my room, so I went downstairs to the "Cafe," the poorly named little all-night snack shop in the RRMC (Ronald Reagan Medical Center). When I returned, a nurse, seated at a computer in the nurses' station, asked me where I'd been. We started chatting, and I asked if she was busy. She said no, and invited me to sit with her, at which point she confessed that she was just reading TMZ.com. Though in her defense, she was reading a post about Toni Braxton's pericarditis. Whoever TMZ's new medical editor is, she's doing a bang-up job. Really top-notch reporting on Mary Kate's UTI.

The nurse and I hung out for a while, and I went on a little adventure with her to the all-night pharmacy. I may go into greater detail on all this in a subsequent post. But from my vantage point sitting in the nurses' station, I could see into the room next to mine.

And I saw my next-door neighbor (see "Old-People Problems" below), sleeping peacefully, with a full-time attendant sitting next to her, reading the newspaper. She was wearing a plastic yellow gown--I didn't see any signs outside the room warning of contageons, so I assumed this was because the old lady had been spitting on people so much. Lying there, she looked like any old lady, no more or less gnarled and weathered. Whatever compassion or empathy or spiritual-corporeal kinship I might've shared with her, I've managed to undo with one rude encounter with a Patient Affairs volunteer.

The volunteers tend to be elderly themselves: of the half dozen or so I've met, I'd put the average age at 75. The first night in the ER, I had several volunteers walk into my room without knocking and stare at me for a good 10 or 15 disturbing seconds before saying a word. One, when he finally did talk, went on and on about his bum shoulder. I'm sure this was done in the tenor of camaraderie, but all I could think was, "Dude, I've got an infection on my heart! Don't tell me about your bum shoulder."

When I asked a resident if UCLA had an official ombudsman service, she told me the Patient Affairs volunteers were the ombudsmen. When I pointed out that, while officially adorable, they didn't seem to be as knowledgible as I understood ombudsmen to be, she asked if I had problems with the care I was receiving. "No," I said, "I'd just like to talk to an ombudsman about some concerns I have." This was the first and only time I'd seen this particular resident (one of the many transients on my CCU (cardiac care unit) team). For some reason, though, she took it upon herself to tell the resident--and God only knows whom else--that I was upset with my care. So the next morning my resident woke me up at 7:00 am to apologize for whatever she'd done to upset me. Thus is the nature of liaison communication in the hospital.

A few minutes ago I exited the bathroom to find someone entering my room without knocking. Eliding the gory details, moving one's bowels in a hospital can be arduous, and even when successful, it's seldom satisfying. So I emerged from the bathroom clutching my telemetry box (or "telly box," a remote monitoring system) in one hand and the hardcover "The World According to Garp" that my girlfriend Katy sent me, and watched a little old lady enter my room.
Fig 1, a telly box.

Fig 2, a Telly's box. NSFW.

She smiled and stared at me for an uncomfortable stretch of time (perhaps Patient Affairs volunteers are trained in this awkward art?). We each stood on one side of the empty hospital bed regarding each other, as if in the set position to dash to the bed to determine who got it! Eventually she announced she was a Patient Affairs volunteer and proudly displayed the back of her ID badge hanging around her neck. I should get this out of the way: she was a predictably adorable little old lady. Itty-bitty, bright red wig, cane draped over her arm, massive antiquated hearing aid wrapped around her ear.

She asked me if the doctors and nurses were answering all of my questions, and I said they were, for the most part. She said I just had to keep asking them. Then she asked me if I had an advance directive--an especially eerie question coming from a 105-year-old. I said, "I really don't want to talk about this now," which seems like a reasonable request from someone looking at potentially high-risk heart surgery. She said, "Boy, you're not in a good mood." Now, I've been known to become too defensive too quickly. I think it stems from my being a native New Yorker.
Pablo Picasso, "Nueva York." Oil on canvas, 1937.

Whatever the cause, it's gotten me into trouble in the past. "Well," I said, "I've been here a week and I'm looking at at least two more." She smiled and offered me a crossword puzzle. I like crossword puzzles. But along with "Garp," Katy sent me a book of Times crosswords, so I felt covered. "No thanks," I said. Maybe I cut her off--slightly. But she left, muttering, "Someone's just ready to be grumpy," or something like that.

As I put this in words, she seems unreasonable. But in the moment I felt so awful for having been rude to her. Here was this woman, for all I knew a cardiac patient's widow, or grandmother, or whatever, who was merely asking me if there was anything she could do for me. I felt so bad that I briefly considered grabbing her in the hall and saying, "Let's try that again." I didn't.

And the guilt is starting to abate, as well. Part of me feels like, yeah, she's an adorable little old lady who's just trying to help, but a hospital patient should never be put in a position of feeling like they have to humor support staff (or anyone, for that matter). But it's troubling to me how markedly my mood is eroding over time in here.

Old-People Problems

2009-04-30T15:02:00.000-07:00

I apologize in advance for what I fear will be a lethally boring, dry, and humorless post--and I will take no offense should it go unread--but I'm subjecting my readers to it for a reason. I hope.

Last night, for hours and hours and hours, the elderly woman in the room next-door was screaming and wailing and fighting with her heavily accented African attendant--called a "care partner" at UCLA. The voyeuristic cannibalistic (and lazy) writer in me couldn't avoid eavesdropping, even though it very quickly became evident that the drama was uninteresting and incredibly repetitive, if deeply sad. Still, I transcribed the chunks of it I could decipher. I rarely heard what the staff said, in their forceful calming tones, but most of the old woman's words were clear, shouted through snarled, twiny vocal chords.

I know nothing about this woman. Strangely, I do know her name (which I won't use, of course), but I don't know what she looks like, what her cardiac condition is, or how old she is. I wouldn't recognize her if she walked into my room now. Unless she started shouting at me, which she probably would.

In trying to keep up with the muffled, painful exchanges, I realized that she was demented (and the nurses said as much--in the hours-long struggle, numerous attendants, nurses, and social workers were alternately recruited to mitigate and molify; and there were frequent discussions of Haldol, a powerful anti-psychotic, though I couldn't gauge whether any had been administered). There was nothing remotely interesting about the content of what was said: it turned out she was belligerant about not being allowed out of bed without assistance, and about the attendant's attempt to change her diaper. But the overall effect was pretty terrifying. I wondered if it was a dismebodied, auditory augur of my future: alone in a hospital room, angry and scared. Given my health at 32, what eventual alternative could there be for me?

Then this afternoon my friend Jamie stopped by with her 19-month-old daughter (and a Coffee Bean iced coffee, bless her heart), and we walked down to the hospital cafeteria for lunch. Jamie noted that what's interesting about my medical issues, and my consequent perspective on things, is that I've "got old-people problems." I suppose this is undeniable. Yes, I was born with congenital heart disease, and, due to medical advancements in the last half century, only now for the first time is there a generation Tetralogy of Fallot sufferers who have lived into middle-age. Something about my condition feels intrinsically childish. But pacemakers in general do sound like old-people problems (and there will be more to come on my struggles to get a young-people pacemaker). Long considered comic-relief by ad men, it turns out old people (a) have their own problems; and (b) were previously non-old people. So in that light I thought I'd post the partial transcript of last night's ruckus next-door.

Be warned, it's boring and repetitive--in content. Getting past that, though, I hope it takes on the formal abstraction of a prose poem. That somehow Gertrude Stein would be proud of this woman's creation, albeit unintentional.
Gertrude Stein. I'd like to squeeze those Tender Buttons, baby!

And I don't know anything about spoken-word poetry, but I imagine that this poor woman's paroxysmic protestations were both performative--in some self-pitying, addled, acting-out way--and genuine performance. The theatrics of suffering, or some such banality. It's disjointed and apparently meaningless, but with any luck that makes it all the more revealing.

David Milch, a writer I greatly admire and have been fortunate enough to briefly study with, says that, in "Moby-Dick," Melville subjects readers to the obsessive, overwhelming, and boring chapters about the whaling industry so that, in some sense, they will ultimately share Ahab's fixation and frustration. That, in some metonymic parallel, the reader's relationship to the novel will reflect Ahab's to the whale. To, as Coleridge puts it, transform the novel (and Ahab's quest) from a fanciful association to an imaginative one. Maybe my invisible old lady's words can transform the fanciful association of old age that we all possess into something slightly more imaginative and genuine...

OLD LADY: ...Let go of my hand! Let go of me. Let go of my hand. Let go of my hand. Let go of me! Let go of my hand, I said! Didn't you hear me?!

ATTENDANT: I'm not doing anything.

OL: Yes you are , you're being bad to me. I want you to call my husband. Right now. Right now. Right now. I want you to leave me alone, and stay away from me.

A: I don't want you to fall.

OL: I'm not going to fall.

A: Where do you want to go?

OL: I don't know where I want to go! I don't want to stay here with you. I don't want to stay here with you! I don't want you to touch me. I want you to get your hands off of me! Get your hands off of me. Get your hands off of me. I want her to get her hands off me! I'm sick and tired. I'm sick and tired.

NURSE 1: Just relax, close your eyes.

OL: I will not close my eyes. [many minutes later] Let go of me. Let go of me. Right now. Right now. Do you hear me? Right now. God damn it! Leave my hand alone. Leave me alone. I don't want you to touch me. Get away from me! Get away from me!...No, get away from me! Owwww! You bitch! [sobbing] Get out of here. Let go of me. Stay away from me! [several other nurses enter room] I want her away from me….No I don't want you to touch me.

NURSE 2: We just don't want you to fall out of bed. What's the problem?

OL: I want her to get her hands off me.

N2: Well she will if you get out of bed.

OL: I can get out of bed. [inaudible exchange] They're going to hear about this, don't worry!

N2: Okay, let's pull you up.

N1: We're gonna pull you up in bed.

OL: Leave me alone! Wait till I tell my husband.

A: You want me to call him?

OL: I don't care if you call him or not, I'm gonna tell him plenty.

N1: Okay, pick your legs up.

OL:Let go of me.

N2: We just want to make sure you're safe. Let's just relax, 'cause you're getting all wound up for no reason.

[many minutes later]

A: What did I do on your hand?

OL: You broke it!

A: I broke it?

N2: Are you cold or hot?...Okay…

OL: I don't want to be handled. Let go of my fingers. Let go of my hands. Now! Now. Get away from me. Get away from me! Don't push me now, I'm gonna call the police. Let go of my fingers now. Do you hear me? Now.

A [walking out to nurses' station]: Excuse me, Nurse, you don't have anything to calm her down?

NURSE 3: She called the husband and he didn't want her to get anything.

[later]

OL: Get your hands off me!

A: Okay, stay in bed.

OL: Don't you dare hit me.

A: I'm not hitting you.

OL: Yes you are!

A: I'm not hitting you.

OL: Yes you are!

A: You're hitting me.

OL: I don't care!

A: Okay, stay in bed, I don't want you to fall.

OL: Get away from me. Let go! Let go-oh.

A: Stop hitting me, it's hurting me. You're hurting my hand.

OL: Let me be.

A [returning to nurses' station]: Can you call the charge nurse for me? I need to talk to her.

[later]

OL: I'm not bothering you, leave me alone!

A: I don't want you to fall.

OL: I won't fall.

A: Let me change you.

OL: No!

A: You're wet, you smell.

OL: I'm not wet!

A: Yes, you are.

OL: Too bad!

A: You stink.

A [conferring at nurses' station]: She says she's gonna make sure I lose my job. She's hitting me. I need my job, so if you guys--if they don't give anything for her, I have to leave. Still they don't want to give her anything.

N3: Yeah, I'm going to talk to the charge nurse and Ill be back. [later, on phone] I don't know if you want to talk with the husband about what to give her, because I don't... [inaudible].

[later]

A: Don't pull this IV, you're going to hurt yourself.

OL: Leave me alone! Leave. Me. Alone.

A: If the patient were hitting and scratching, I'd expect some kind of intervention. She needs some kind of medication. Something….She can't strike out of the staff. This has been going on for 2 or 3 hours…the husband can’t… [inaudible].

[later]

NURSE 4: My name is [Nurse 4], I'm the charge nurse for the night shift. I'm just checking on you. You met [Nurse 1] here and [Attendant], right? [later, at nurses' station] Okay, so the doctor called, they're gonna let her get some Haldol. But you know how it is, as soon as she falls asleep…

[later]

A: Lay down.

OL: You are a pain in the ass.

A: You see when I'm touching you? When you try to get up from bed.

OL: Get your hands off me!

A: I will leave you alone when you stay in bed. Why are you hitting me?

OL: Because you annoy me....Will you stop it? Damn you! Get out of here, just get out of here!

A: Why are you screaming? People are sleeping.

OL: Don't you dare, damn you. Get off of me! You're gonna be sorry. Boy, are you going to be sorry. You are going to be sorry.

N4: Mrs. [Old Lady], settle down. We're just gonna clean you, and after that, were not gonna touch you.

OL: I don't want you to clean me, I can clean myself. Leave me alone, I said. Let go of my hand. Get off of me! I don't want you to clean me, I want to clean myself up.

A: You can't.

OL: Yes, I can. You're making me very angry....Stop pulling on me.

N4: Mrs. [Old Lady], we're helping you.

OL: You're not helping me. Will you stop it, you're hurting me! Bastards.

N4: That's not appropriate.

OL: I don't care! I don't like what she's doing to me....Leave me alone, you pig! You will close your mouth. Leave me alone, you pig....

Even if You're Not a Christian

2009-04-28T14:59:00.000-07:00

The Latin word for "health" and "salvation" is the same. So, when in UCLA, do as the Bruins do. It occurred to me, as I lay in a feverish delirium in the ER that first night, that the hospital call button is a lot like prayer: it's a comforting notion; there's some omnipotent, disembodied voice you're communicating with; and you can ask for whatever you want.

But, you ain't gonna get it.

I like to consider myself both pretty self-reliant and short-tempered. Normally, if hospital staff don't give me something I've requested, I go get it myself. (Thus my mini-desertions of the cardiac floor. I do have "patio privileges," but if there's no one around to grant me express permission, I've been known to wander off without the proverbial hall pass.) But when hooked up to wall-mounted machines, I'm a little more dependent than I'd like.

So during my initial day and a half in the ER, I often needed the call button. My calls were inevitably answered by a surly aide, or occasionally a surly nurse. "Yes, can I help you?" "Yeah, my telemetry alarm keeps buzzing." "I'll send your nurse in." Click. And then, as if by magic, a nurse would not appear.
A magician performs the classic trick of making a nurse not appear. But what does appear--also presumably via magic--is one nifty ponytail!

Eventually I reached up and turned off the monitor. Hours later a nurse came in and asked who'd turned it off. "I did," I said. "The buzzing was driving me crazy." "Don't do that. Use the call button," she snapped. Why hadn't I thought of that?

Because of the fevers and rigors, I had the chills. Several times I used the call button to ask for more blankets. "Absolutely," said the Mystical Medical Deity from Beyond. Suffice it so say, my multiple implorations went unanswered, and I shivered and sweated through the night. Hospital staff are apparently unfamiliar with the common usage of the word "absolutely." And maybe I don't use proper prayer technique.
Note how brunettes can right their errant ways. Blonds' souls are simply too weighed down by the evil that festers in their shriveled black hearts. It's a doctrinal mystery that has baffled theologians since Thomas Aquinas's Summa Capillus ("Highest Hair").

This is not the first time in my life that medicine and theology have collided like so many evil embryonic stem cells.

In January, 1987, I had my second open-heart surgery at Boston Children's Hospital. Oh, in Boston? Yes, in Boston. Memories of the 8 days I spent there have, of course, grown hazier and less accessible over time. But one moment persists: my father and I were in the floor's little playroom with another young patient's mother. In my recollection, her child wasn't there, though in retrospect this doesn't make much sense. Or perhaps like many parents in children's hospitals, she just needed some adult contact--not in the form of a doctor or nurse. Or she needed the fleeting reprieve from fear and anxiety about her own sick child granted by the presence of another one and his parent.

And I don't cavalierly wax poetic here--this woman was clearly embroiled in a significant spiritual moment. She looked at me, genuinely lovingly, and declared to my father, "He looks like the young Jesus."
Gerrit van Honthorst, "The Young Jesus." Oil on canvas, 1620. Note the infinite patience with which young Jesus regards his bumbling-carpenter father, Joseph, who yet again has to work all night to finish a job. Young Jesus looks tolerant, but he's thinking, "Really, Dad? Again?"

I was a little freaked out, my father probably more so, but my naive little mind understood that her utterance was somehow a compliment--and possibly even a compulsion. (Much the way a young Jesus likely would've understood, I might add.) She saw something divine in me. Maybe it was the light. Maybe it was my soft, angelic look. Maybe it was the Playmobil nativity set I was playing with.
Whatever it was, I know it was a willful, if subconscious, delusion. She saw in me what she needed to. I imagine whatever that was, it was something she could not bear to see in her own child. In proclaiming me Jesus 2.0, she miraculously cured me by endowing me with some sort of everlasting life. But as I get older and approach the age at which Jesus was crucified (and at which many comedians die--John Belushi, Bill Hicks, Chris Farley, Freddy Prinze), I wonder if there's a little more to that revelation. Perhaps if I assumed the role of Jesus, I would die and her child would live. Of course I don't believe she felt this consciously, though sometimes I still wonder why she kept putting ground glass in my jello.

Yet none of this can hold a holy candle to what happened at UCLA a few nights ago. The night nurse (an androgynous Southeast Asian whose English was far from great) came into my room to give me my nightly meds. She told me that "most open-heart surgery [sic--she meant patients who'd had surgery] are angry," and she made a frowny face in demonstration. "But not you," she continued. "You have nice face and nice body. You have beautiful skin and nice face. You can think about good stuff, or think about bad stuff." In all humility, I have been told I look like Josh Charles.
"S.W.A.T." (2003), starring Josh Charles (not shown). Follow the link for a picture of Mr. Charles.

Then she busted out the medical jargon, explaining the most important thing for open-heart surgery [sic] is to avoid cold, flu, and stress. I said, "Yeah, well it's kind of hard to avoid stress." She conceded that it was, with a burst of nervous laughter, but offered, "If that doesn't work. Pray to God." (I really want to avoid offensive caricatures here, but I need to try to phonetically spell the way she pronounced God: "gawrd." Even that doesn't really do it justice.)

"He'll help you," she continued. "Yeah, pray to God." I was probably too shocked to display emotions of any kind, but maybe she sensed she'd strayed into uncertain waters. "Even if you're not a Christian, pray to God. He'll fix you."
A sick child prays to God. Note the dog's incorrect praying position. Yeah, Rex wants us to believe he's praying, but I suspect he's sodomizing the bed--just look at his face! Let's hope Timmy is praying for Rex's dirty, shameful, dirty soul. Evidently, "No Dogs Go to Heaven!"

While I'm sure her faith in God's healing powers was sincere, this prescription hardly constituted a ringing endorsement of the cardiologists and infectious disease doctors whom I needed to "fix" me. Amazingly, she wasn't done: "Also, 'The Secret.' Go downstairs the gift shop, they have it. Book or CD. It's good!"
Shhh, it's a secret.

Needless to say, I ran right down to the gift shop and bought both the book and the audio-book. I plan to listen to it while reading it, in case the glare of its truth blinds me. Oh, crap, I just realized--what if the explosion of its insight also deafens me? Well, as the nurse said, "You can think about good stuff, or think about bad stuff." I will harness the power of "The Secret" and choose to think about good stuff: that "The Secret" will merely blind me. Frankly, I can only assume that is what will happen. And if so, dear readers, you'll forgive an abrupt end to Beneath the Gown.

What I loved most about the nurse's sermon, though, was, "Even if you're not a Christian, pray to [the Christian] God." The simultaneous awareness that I might not be a Christian coupled with the zealous insistence that I worship her God--worse, beg Him to heal me--deeply troubled me. Luckily I snuck out of the cardiac wing, went to the pediatrics playroom, and stole my new favorite toy.
Note the massive grin on the surgical patient's face. Someone's got a morphine drip! And if you think an operating room called "System X" makes a disturbing child's toy, come Christmas you should really steer clear of the Playmobil play set "Mr. Mengele's Dungeon of Doom."

Perhaps these tiny plastic doctors can perform a Jesusectomy. Let's pray to God they can.

Prologue: the Beginning

2009-04-27T15:07:00.000-07:00

Welcome to Beneath the Gown, a chillingly honest portrayal of the life of a hospital patient. AMA, lock up your daughters, 'cause the gown is coming off.

I am a 32-year-old man born with Tetralogy of Fallot, a rare series of congenital birth defects in the heart. Tetralogy of Fallot affects roughly 5 babies in 10,000, who typically experience a failure to thrive and are referred to as "blue babies." I was fortunately anomalous and did not experience failure to thrive, nor was I a blue baby. I was squatting a lot, however--a sign of fatigue in toddlers--and at 22 months had my first open-heart surgery. This was the beginning of my lifelong odyssey through the world of a chronic patient.

Needless to say, as I've grown, my relationship to my health, my doctors, and my health insurance "providers" has evolved and transformed and, at times, devolved into blind murderous rage. For instance, on the day Blue Cross of California settled the lawsuit brought against it by the state in 2008, it also refused to pay for a biventricular pacemaker for me (a pacemaker with a built-in back-up wire so I won't, y'know, die). Somewhere an insurance company medical reviewer just got his wings.
An insurance company medical reviewer gets his wings by denying a sick woman necessary medical treatment. Raping her is optional, but it can only help him achieve his dream of one day becoming medical director.

On Thursday, April 23, 2009, I was admitted to the UCLA Medical Center--now officially known as the Ronald Reagan Medical Center, presumably a nod to the $150 million in private donations raised in the "Bedtime for Bonzo" star's name. Other forces of evil whose names grace the engraved and illuminated glass plaque in the lobby of the Nancy Reagan Tower are: News Corp., the Walt Disney Company, and Diane von Furstenberg. So the new name is either in honor of the Gipper, or it's a long-overdue concession to UCLA's shameful history of selling weapons to Iran. Don't believe me? Take a look at this picture from the June 4, 2007, dedication.

First of all, what are those two stubby little things poking out of Nancy Reagan's bright orange missile silo, if not Lockheed Martin Hellfires? But that's not even the worst part. The funny little guy with the Governator is not who he appears to be. Say hello to Mayor Antonio...Ahmadinejad! Yes, yes, he's quite deceptive sporting the clean-shaven look, but the evidence is as undeniable as the fact that there are no homosexuals in Iran.
Fig. 1, "In Iran we don't have homosexuals like in your country."

Fig. 2, "In Iran we don't have homosexuals like in your country." Note the cunning absence of the beard, Iranian flag, and crescent-and-star symbol.

Scariest of all, however, is this meeting of the minds.
What an unholy dyad: one is an unstoppable robot assassin from the future hellbent on destroying humanity, and the other is Arnold Schwarzenegger! But enough about movie stars and widows of movie stars. This blog is about me and my ongoing stay in the hospital. But don't worry, I am at UCLA, so you can rest assured there will be plenty of movie stars making a cameo or two! As long as you count Britney Spears as a movie star, we'll get along just fine.

After suffering almost a year of cyclical protracted periods of fevers (culminating in a 105 fever and loss of consciousness on the morning of the 23rd), I was emergently admitted with a presumed case of endocarditis, an infection on my heart--likely originating from my pacemaker, which was replaced in July, 2008. With no real hospital rooms available, I spent the first 35 hours in the ER. The fevers and rigors persisted, though fortunately I now had people drawing blood every 15 minutes and giving me unnecessary, but very painful, abdominal injections of blood thinner. I was tethered to the wall behind my bed by an antibiotic IV drip and 02-sat clip on one arm and a blood-pressure cuff on the other. The ER gurneys are basically the dimensions of an ironing board, minus the plush cushioning. At 6'3" and 200 lbs. (all muscle and brain), my lying on the gurney was like a cat lying on a tongue depressor. Although much cuter, of course: they can bind my arms all they want, but nothing's going to stop this kitten from wagging his tail!
Typical kitten. Note, not a photo of the author.

Friday night I was moved to a proper room, about which I can't complain. It's private, big, and has an adult-sized bed and a flatscreen TV with cable. My friend lent me a laptop and the hospital's got free wi-fi. Which means I've got it much better here than I do at home. Plus, the endless parade of androgynous Southeast Asian nurses to excite and confuse me. I told one that my second open-heart surgery had been performed at Boston Children's Hospital, and she said, "Oh, in Boston?" You can't teach that in androgynous Southeast Asian nursing school.

Graduation ceremony at an androgynous Southeast Asian nursing school.

Friday and Saturday nights were rough, as the fevers returned and the rubber hospital mattress did little to stem the flow of sweat. While the echocardiogram and ultrasound could not visibly detect endocarditis, the blood cultures came back positive for coagulase-negative staphylococcus, bacteria typically found on the skin that are quite common and harmless...unless they enter the bloodstream. And after a thoroughly boring weekend, on Monday I had a transesophageal echocardiagram (TEE), which entails an echo camera being shoved down my throat so it can snap unobstructed pictures of my heart. Thankfully the hospital food had already dulled my gag reflex.

The TEE verified that, in fact, there is bacteria growing on my pacemaker, and possibly on my tricuspid valve. In my next post, I will discuss my doctors' gameplan for how to treat me. (See "ID, Please" above for details.) Hint: it involves wishing. And leeches!