August already; 5:30 a.m. and watching the sunrise.
Here on Med/Surg unit 4-7, there are not enough nurses this night. The charge nurse is doing floor duty. Administration said they would send a nurse from another floor, but then canceled it because the number of patients didn’t justify it. Then 4-7 got more patients, which is only part of the problem. The other part is acuity. Right now there’s a patient on the other side of the unit who is putting out a lot of urine, nevertheless her blood pressure is over 200 and climbing. During the night, my roommate’s blood pressure dropped to 80/36, which necessitated lots of invention. The nurse says that most of the thirty-odd patients on the floor have catheters. Too many too-sick people; too little staff.
So the nursing staff is running so fast that they are out of breath. I wake at 5:30 a.m. and need an urgent trip to the bathroom to poop. My catheter bag is full—1100 cc’s—which is five times normal. I ask for a glucose check and juice, in that order. The nurse tells me that glucose checks are done at 7:30, before breakfast. She needs to get a fresh urine sample for testing now. I’m too dehydrated to produce it, so she gets me juice. I hear her outside the door quickly detailing the list of her next four activities, including my urine collection and running to the pharmacy for emergency meds.
I get no glucose check and two cranberry juices; the nurse gets her urine sample. I have just had my second uninterrupted night’s sleep in ten years, and it is important to know if this is lowering my glucose level, but the nurse has more important things to do. That is a simple, absolute fact. So one of the things I am learning in the hospital is to wait my turn. I have lived alone forever. At home, what I need, I get immediately. Here in the hospital, I can hear my roommate, the hall bells ringing, the references to other patients’ needs, and I get feedback on where I fit in the community. It’s a pretty cool experience. I’m learning to wait. Plus getting better sleep helps a lot with patience.
When last I posted, I described the hellacious experience brought on by taking antibiotics into my drug-damaged body. I sobbed and yelled for a couple hours, then breakfast arrived. Carbohydrates have a calming effect. We talk about “comfort” foods as if their sole benefit was psychological, which is utter nonsense. Food being taken into the body is a physical process. Digesting a meal triggers all kinds of complex biochemical reactions, and somehow the body’s attention is diverted away from anguish. When I worked on the telephone support line, I learned that a peanut butter and jelly sandwich could reduce some emotional pain better than could talk. Prescribing food to ease pain should not become a lifestyle, but certainly it is an effective emergency treatment, and it’s always carbohydrates. You never heard anybody claim spinach salad as their favorite comfort food, did you?
So I got calmed down somewhat yesterday. The tears and pain were still just below the surface, but at least I’d stopped screaming. In the early afternoon, various members of my care team and I spent a couple hours in conversation about what to do next. The PA didn’t want to continue the catheter for fear of infection; she wanted one more dose of the antibiotic to clear the pneumonia. Dr. Ghaly wanted one more dose of antibiotic backed up with a tranquilizer or sedative to damp the emotional pain. The hospitalist wanted to transfer me to inpatient psychiatry. Well, hell yes, let’s treat the symptom instead of the cause. We knew exactly why I had gone crazy: atypical reaction to antibiotic. The cure is to withdraw the antibiotic, not transfer to psychiatry.
Four days earlier, when Dr. Ghaly had first seen me on inpatient, he formally asked me if I wanted inpatient psychiatry and I formally said no. With the formalities established so that he could record them in my chart, we went on to discuss what mattered. Now, when I tell Dr. Ghaly that the dorkhead hospitalist wants to ship me off to inpatient psychiatry and make me somebody else’s problem, Dr. Ghaly puts his fingers over his lips and, with his eyes twinkling, murmurs, “There are no beds available on psychiatry; there is a waiting list.” Stevie the Wonder Horse (and my Health Care Proxy) stands in the corner, leaning against the wall, with watchful eyes and a half smile. He knows I know what I’m doing and he’s just there to make sure it happens. His major job is to keep two doctors and a physician assistant from trampling roughshod over the rights of the short woman lying in the bed.
And what I want is comfort care. I have become progressively more uncomfortable over the past five years, and now I’m done with it. I will not take any more of the antibiotic. I will not scream at people like I did, and I will not endure the torment that I did. Later that night, when I told my friend how I had behaved in the morning—and some of the words I’d used to the nurses—then my friend’s eyes got big and she said, “That’s not you!” No, it is not. I am a nice person. Drugs have driven me insane. Under the influence of drugs, I cannot control my utterances. I know right from wrong, but I cannot live it. I can only scream obscenities. That is not me; that is drugs and drug damage. I will not go there—not even for one dose of antibiotic to knock out a strep infection.
What matters is my immortal soul, not my mortal life. Extend my life by a day or a week or a month by screaming obscenities at other people? Not gonna happen. I will go to my God with my mind clear and my heart filled with compassion; I will not exit screaming.