Pt.lll: Notes from a Surprising Knee Sugery (Slipping Away, Heading Back)

The appointment was just a check-in regarding the blood clot and attendant ER visit. The atmosphere became easier, calmer when Dr. S. entered the chilly room. He asked specific questions about all post-surgery events, listened closely and checked my electronic medical file. His accented warm voice gave me pause a few times so I leaned in to better understand him. He seemed to possess two sought-after qualities: compassion and investigative skills. As a consequence, I felt safe sharing authentic experiences.

He was openly irritated that I’d been unable to meet with my primary care doctor after surgery, considering the crises. He spoke of the great responsibility to patients and how that can be misplaced amid hectic days and administrative work. But he and a few other like-minded doctors in the clinics kept open appointments for patients unable to see their own doctors, those who needed help sooner not later. I thanked him for this viewpoint and his availability but he demurred; it was his life work, what was necessary. He looked away a moment.

As the time came to an end Dr. S. asked me to remove my mask. He edged his stool closer, studied my face.

“You are much too pale, Mrs. Richardson. Your eyes do not look good. You look quite anemic. Please go to the lab immediately to get blood work done. I will let you know the results today.”

His adamance gave rise to anxiety that I set aside. It was a blood draw. I had had many recently. He might find I was a bit anemic; it had shown up sporadically over the years. And I had lost weight after surgery though was doing better with food.

At dinner time, Marc and I were chatting when I noticed there were two voice messages on my phone from 2-3 hours earlier. I’d forgotten to turn the sound on following my appointment.

The message shook me. Marc watched my face and put down his fork.

“Mrs. Richardson, I have been trying to get in touch with you. Your blood work indicates you have seriously low hemoglobin. You are in danger. You must go to the ER immediately to get blood transfusions. Please do this now; you could pass out or far worse.”

I played the message for Marc. We abandoned dinner, put on shoes and coats and left for another ER visit. I was, this time, frightened; we didn’t speak much on the way. I had told him Dr. S. was special. Now I sensed it was no mistake I saw him and no one else, and also when I did. I prayed for strength as my body trembled. I insisted Marc take me to the very best hospital, though it was 10 minutes farther and the highway was busy.

Inside, the numbers of people waiting to be seen was overwhelming. They stood in clumps; they lined the hall in various states of dress and degrees of composure. I couldn’t think of how long we’d wait. After I checked in and gave the details, I had more blood drawn. Then we were directed to an area to wait to be called. We passed large groups and lonely individuals in cordoned-off areas, many coughing or moaning, leaning against each other, some lying on gurneys shielding their eyes from the flourescent glare. I wondered how many had Covid or worse. Heart-rending children’s cries pierced me. As minutes ticked by, I was starting to feel more light-headed, oddly out-of-body. I leaned my forehead on a chair’s back as Marc held on to my shoulders. My operative knee complained much more; there was nowhere to prop it comfortably.

In an hour a nurse came for me, and in the ER room action was immediate. The lab results were in. My hemoglobin was noted after Dr. S’s initial lab visit as being 6.5. At the ER it was at 6.2. The standard range for this is 11.2-15.7. A doctor said I was bleeding internally. There were too few red blood cells to carry oxygen from lungs to my other organs, then the carbon dioxide back to the lungs to be exhaled. Hence, my sense that I’d fall down. But I was in a bed; I was hooked up to fluids and the nurse was calling for two bags of blood from the blood bank. Transfusions ASAP.

A blood bank… I mused. Where people’s donated/deposited blood is kept safe for withdrawal for the next patient in need. A precious commidity. A treasure to protect. A crucial lifeline, yes? I fell into a dreamy state punctuated by spikes of alarm.

I have rarely been so worried in an ER. I wasn’t sure about getting someone else’s blood; it was foreign to my body, a desperate act. I signed papers agreeing to it as well as a consenting to intervention for cardiac arrest if needed. The dimmed lights added to the sense of being captive in between states yet soothed my body. My mind drifted. Marc stood by; we had run out of talk. But I chatted with the nurses, joked sardonically–“Third time in an ER in just over 4 weeks, I’m setting my new record!” They were calmly focused, repeated it was a critical situation. I would, however, feel better in a few hours, they insisted. If all went well.

I was in that cave of a room for about 24 hours. I was taken off aspirin and Eliquis, a blood thinner for the blood clot in my calf. Another ultrasound showed the clot was no bigger and hadn’t moved. Within a couple hours a donor’s hearty blood was mixed with my unwell blood. I was informed that some people cannot tolerate other blood, had allergic reactions. A nurse had to wait with me for fifteen muntes to ensure my safety. I sighed–I so often had reactioons…but waited to feel it enter my arm and bloodstream. There was a burning sensation, then a coldness that eased as it mingled and coursed through me. It would be okay. I began to doze. More doctors and nurses came and went. I woke up when at one point there were 8 physicians and medical residents crowded in the room. St. Vincent’s is a teaching hospital. I don’t recall what they said. I was floating; words sounded empty of value. I was at last transferred to an intermediary care unit until it was determined if I needed full admittance. The hope was that I’d be treated in a more limited capacity. It turned into 4 days.

A private room; a shadowy, clean, quiet room. Safety of a sort. A nice recliner for Marc to doze in. The nurse assigned was soft spoken, moving gracefully about. I was told I could not eat or drink anything as next on the agenda was an endoscopy to view my stomach, and after that, if no bleeding site was found, a colonoscopy would be scheduled. I have had both several times in my life due to digestion illness since my teens, so this was not unnerving. It was imperative to find and repair the bleed–but it was more to cope with and I wondered how I could manage it. I could sleep a month. Of course, in a hospital nobody really sleeps.

That same day I went admitted to the Clinical Decision Unit was, coincidentally, was the very day my oldest daughter, Naomi, flew in from the East coast for a planned week’s visit. And so, her first sight of me after 9 months was in a hospital bed with IV lines, disheleveled, wane and yes, likely frail-looking. It was not a joyous occasion as had been expected with a giant hug proffered and returned. She gently placed her arms about me. I wondered if she thought: well, mom is really old now, isn’t she?…

I wanted to pull the covers over my head. One of the hardest things about the post surgical complications was that my children and grandchildren might think me terribly diminished. It wasn’t vanity but a fear that they’d iamgine me less than before, as not the same woman/mother/grandmother. Weaker, less able-bodied and mentally and spiritually capable.

She said, in keeping with her ways, “Sprang a leak, huh, mom?” Her bleary eyes and soft voice betrayed worry and sadness. One of her four sisters accompanied her; they provided support to each other. It was Naomi and Aimee, then Naomi and Alexandra. They kept Marc company, took him to the cafeteria for a lunch break. They chatted with me, hands laid upon my foot, arm. I was getting frequent texts from the rest of my big family and good friends. My son texted a drawing depicting healing paths for my body: me, being filled with light and love. I appreciated everyone reaching out. But tossed, turned and dozed, trying to mentally prepare for the early morning endoscopy.

Which, when it was done, showed no sign of bleeding.

My stomach even looked surprisingly good; an earlier diagnosis from years ago was no longer substantiated. I should have been more pleased. But it meant the problem was intestinal. Already depleted, with a throbbing surgical knee, the colonoscopy prep was rough but manageable.

And if the second procedure didn’t illuminate the issue, I would swallow a capsule with a camera in it so a view of the small intestine could be gotten. The very thought flummoxed me.

I prayed with and without words for clarity and safe treatment, smart doctors and any one else who held my life into their hands. We needed an answer. Two transfusions might not be enough; maybe I’d not be discharged soon. A bright spot was that within 48 hours I was feeling more energy–my hands and feet warmed up, my brain was clicking away. The nurses had said those additional red blood cells infused one with new life and enouraged me with words and gentle touch.

Blood–a miracle elixer that mainatains and saves our lives every day.

I’d had little idea until I felt better how perilously ill I had become, saomething every one must experience. When you are at low ebb so long, it is strange to move past that state, like moving from shadow to light.

I’d sensed things were not right but should have known that faintness when walking across a room or even rising from a chair were bad signs. I might have admitted the increasing exhaustion with higher heart rates, unusually cold hands and feet were were clanging alarms. The oxygenated blood wasn’t reaching my extremities; it was feeding vital organs first and foremost, as it always will do. I didn’t see convincing evidence of bleeding that I was told to be watchful of while using the blood thinner. I had questions and once called the surgeon’s office; he said “Not sure this is alarming but stay aware.” Later I learned that older blood appears black or n early so. I felt as though I’d failed to be smart enough. I’d failed to face a possbility of more harm occurring, to take charge when all was starting to unravel. Perhaps I was just too tired.

How much can the body take? Much, much more than one thinks possible. Much more than I was prepared to believe or accept. When I wanted to yell “Enough!”, I instead daily learned more patience. Even when difficulty is gnawing at your last nerve, patience holds you steadier: wait until this passes, endure then wait to see what comes.

The procedure successfully located an AVM, ateriovenus malformation, a significant cause of colon bleeds. The blood thinners (I was still on aspirin until then) triggered faster blood loss. The spot was cauterized and bleeding stopped. I wept in the recovery room. More doctors, blood tests. Instructions, opinions, prognoses (AVMS can bleed more than once; stay cognizant of signs). I drank tumblers of water and paper cups of tepid tea, ate the hospital food hungrily. Communicated with family and friends with happy words.

The next day, a Sunday, I was discharged. My very relieved husband and I were practically singing “Hallelujah!” on the way out. My knee even seemed to celebrate; it hurt less than it had in awhile.

And Providence St. Vincent’s Medical Center would keep humming along, busier than ever repairing and saving others–and caring for those who did not survive. I was one of the very fortunate ones. Rescued from crisis, provided a useful solution and hope. But, too, what was next? Life had come to feel more and more perilous. I hadn’t felt that in decades, since my heart attack at 51 as I hiked blithely along a familiar path. Peril arrives on a ghost horse; you often do not hear it coming.

But then I recalled how God shows up in the smile, hands, in the basic or brilliant acts of humans. How we have such power to help or hinder, love or deny, accept or defy. Those few days at the hospital restored a part of my missing faith in our species. In the medical system.

I had learned even as a child that life held signature characteristics like inconsistency and mystery– and trouble. But tamping down a frisson of anxiety that underlay relief, I opened a car window. Encouraged a damp rush of air to sweep through my hair. Took restorative breaths of nature’s array of perfumes. I was going home, my body salvaged again.

***Next week, the conclusion of Notes from a Surprisng Knee Surgery.***

One thought on “Pt.lll: Notes from a Surprising Knee Sugery (Slipping Away, Heading Back)

  1. I think both patients and doctors today are caught in a particular bind. Everything must be instant so doctors cannot take time to reflect, and patients should not confer with the internet, but also, we are to be vigilant and know our own bodies. Sometimes I think it all might even work against good health.

    Stunning photos, by the way!

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