Cinco de Mayo Clinic!

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

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

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...

(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

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

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

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.