WHEN BREATHING BECOMES UNDER-RATED, AND PANAMA COMES CALLING

I recently had a bout of health issues that brought me through the Niagara Health System. Fortunately, I landed in our new hospital in St. Catharines, even though I arrived terrified and thinking I was going to die!  My breathing became very laboured and I was unable to walk anywhere without shortness of breath.  My heart was apparently overworked at 186 bpm and my blood pressure was very high.

I don't know about you, but I really don't want another 'near death' experience, however it might be defined.  A friend, my son and I arrived at the emergency department on the behest and urging of my doctor.  We noted a sign saying "Start Here".  I introduced myself and fortunately, this was the person my physician was speaking to before we flew down there.  I was referred to Triage Unit A, whereby a nurse sat me on the bed and tried to get me lie down (but breathing is even more interesting when I lie down).  They did an ECG telling me my heart is fine but "just a little fast" (one of many euphemisms).  

They took my blood pressure, checked my lungs and so forth, and then sent me back to the wait area.  It wasn't even a few minutes before somebody called in from the entrance to the A Pod. The A Pod had many, many rooms and private work areas.  I brought what I could, but I was unable to walk that far ... the nurse apologizing for making me walk all that way, but I did.  I was relieved when I was placed in my own "room".  In the old hospitals, they did not have separate room areas for emergency patients, just curtained off areas with separate monitoring areas.  This was a room, only separated from the nursing station by a curtain.  

This was very different; they had a large TV screen showing me my ECG readings, my blood pressure automatically taken every fifteen minutes, my heart rate and my respiration rate. What surprised me was how fast the nursing staff were able to stabilize me, aka get me breathing again, slowing my respiration and gradually bringing my blood pressure down.  My heart rate stayed at a worrisome 140- 150 bpm.  Nurses, paramedics and nursing assistants were all busy, coming back and forth, introducing themselves for each twelve hour shift, taking blood tests.  Once I tried to go to use the washroom, but even though it wasn't far I was totally out of breath,  One of the nurses brought me back.  I noted there were a number of police officers at the ER, which I found interesting.

There were several blood and urine tests taken, apparently ordered by the Doctor on Call - who I looked up, and found she was specialized in Emergency Medicine.  She was very nice, calming and reassuring for me, explaining each test as they took them.  While I had my husband and son there, I tried to imagine them as medical detectives, like on True Stories from ER on TLC or even House.  My son who was with me throughout the whole ordeal kept looking at the screen and trying to reassure me too.  He is a medical sciences student, interested in the medical field. I was sitting, remembering the uncomfortable position I was sitting in my bed.  The emergency room beds are nowhere nearly as comfortable as the beds on the hospital inpatient floors.

Noting I was not able to use the washroom, they brought a commode to the unit next to my bed, where I was told to ask somebody to come in if I needed to use it.  Over the night, there were incidents of paramedics bringing people into the Pod.  There were two "Code Blue", as well as a few "Code Whites" in the mental health section.  This poor doctor, alone at night as the sole physician on call, had to deal with two Code Blues, as well as one Code White in Pod A (a fellow who was drunk and did not want to go to detox).  Activity was high speed around me, while inside I was trying to control my breathing.  Even getting up to use the commode was hard on me, bringing my heart rate way up, my breathing, etc. and it took so long to recover ... 

The doctor came in and told me all my lab tests turned out all right, but they wanted to do a chest x-ray.  This was one of their stand-up models they had in the diagnostic section.  They page a porter electronically, who comes to my unit, grabs my bed and transports me literally to where I need to be to wait for my x-ray.  I looked around me each time they did this - there were always other patients, some older, some younger than me, also awaiting radiology.  A technician signals the porter to bring me into the room and then she took over.  I saw the huge machines around me.  She asked me if I can stand.  I was honest and told her it was a challenge, so she showed me a way to stand up without risking my balance.  After positioning me, she took several pictures of my chest and then had me back on the bed and back in the waiting area, for a porter to return me to the A Pod.  

The doctor came back and told me my chest was clear, but she wanted to do another test called the d-dimer test, which can hint at the presence of clots.  She told me if this is positive, I will be scanned and then there will be a diagnosis.  There was more blood drawn.  Later, I was told the d-dimer showed up positive, suggesting a clot.  They then arranged to send me for a CT Scan.  Again, it took some time, but the porter (in green uniform) came around to take me back to radiology and had me sit and wait.  I was moved over to another section where the technician spoke to me about what happens in a CT Scan and had me sign paperwork for the Scan and the radiation dye they put in people to make the veins show up better.  Because I was already on Metformin as one of my diabetes drugs, she explained people generally do not continue on it for another 48 hours after they take a CT Scan.  Inside, the technician knew to grab a pillow to allow me to kind of keep my head up a bit as she knew I could lie flat.   She told me I will be told when to not breathe and when to breathe.

After she went back to this room that was offsite, but exactly like it is on TV (you have technicians and nurses in a window area monitoring the CT screening as it is being completed, as they upload it into my patient record).  My bed then moved into the machine putting me in a large cylindrical area.  As it went on, I felt the dye go into my body (which takes place very fast) and then I heard a woman's voice say, "Breathe", and then the the cylinder turns around and I can hear the whirring and so forth, and then, "Don't Breathe" and the same.  This only took about four or five minutes and then I was moved out, transferred back on my bed and ported back to the A Pod.  It took some time, but I was told by a nurse that the new doctor on call will be in to speak to me.

It was a middle-aged short man who was funny as hell.  He came in and asked, "So you are the person who came into emergency and checked out right and is perfectly healthy, except for clots in the lung?"  He told me the CT Scan showed the clots clearly and they were pretty serious.  A respirologist was coming in shortly to order treatment for me.  He told me I would be placed on injectable blood thinners for a few days, until the doctor can assess any oral medications.  This lung doctor came in, told me that he was admitting me to the hospital and that he ordered some pretty strong blood thinners because the clots in my lungs were fairly large.  He asked me if I was sure I didn't have calf pain, or travelled anywhere or had recent surgery, etc.  The answer was no to all of that.  I told him I was on hormonal medications (which I am no longer on) and that being diabetic and being in a profession that doesn't involve a lot of walking around doesn't help.  He examined my legs and said they did not seem to be swollen, but he set me up for an ultrasound for veins in the leg, pelvic and hip, as well as an echocardiogram.

A nurse came in and injected me with a powerful blood thinner (Lovenox) and told me I will be injected each day in the morning and in the evening, 100 mg IM.  It is interesting that you do not really feel too differently on blood thinners than you do without them, but you bruise easily and in hospitals, they like to draw blood, as well as keep a vein open for saline solution, other medications, etc.  People like me have an interesting time getting these kinds of tests, where veins are sometimes difficult to find.  They were eventually found, but my right arm eventually looked like it went through the Boer War.  They then started on my left arm.  

The porter came calling again to bring me to the ultrasound area where the technician was very thorough and used the doppler all over my legs, behind my calf, behind my knee, and everywhere else where a clot might appear.  This took awhile, as she put me in very difficult and uncomfortable positions to do the test, but I just allowed them to do whatever ... then I was taken directly to the echocardiogram room.  The woman doing the echocardiogram was very nice, reassuring and did a very thorough job as well.  I can see the right ventricle of my heart working so hard to pump blood out with my attempts to breathe.  Inside, I was trying to calm myself ... I wanted to help get my heart to rest.  She also assured me that once the blood thinners take effect, the heart rate will improve.

Later, I was assigned a male nurse who was very friendly and he came in to speak to me, especially when I was beginning to feel afraid of what was happening to me.  I needed to use the washroom, so he went to get a female colleague to assist.  I was still not breathing and I wanted to know when this was going to get better.  He was the one who in a quirky way reminded me about how anxiety can be triggered by the high heart rate and breathing issues, and in turn, aggravate the heart to beat even faster into a vicious cycle.  The doctor put all my prescriptions in (and added some medications for anxiety).  He came in and took some blood tests, then on intervals, tested my glucose as well.  He did inject me with a small vial of insulin (which I had to take because of the CT Scan).  I couldn't sleep very well.  In fact, I don't think too many people sleep really well in a busy emergency department.  

I started getting food trays, which was a treat for me as I had not eaten or even received my blood pressure meds in almost two days at that point.  It was that evening when the nurses came around with my regular drugs including my blood pressure drugs, etc.  My son came in after he had been resting for the day and kicked my husband out so he can rest and my son can take over.  He brought his laptop and did some of his papers for school.  He kept quiet and allowed me to sleep when I could ... In fact, I did sleep and early in the morning, I noted my son was still on his laptop. I noted my heart rate was going down, my respiration was getting back to normal and my oxygen ranked between 96 - 99%, a good rating.  The nurse that was working with me told me my heart rate for the first time went below 100 while I was resting.  

He went off shift and another nurse came in to take more blood and do another glucose test, then later told me I was moving upstairs!  The St. Catharines site has 80% of its rooms as single rooms.  They then moved me to what was called the Telemetry Unit (where people often are sent after cardiac surgery, or pulmonary "events" like I had).  I continued to pay for a week of Wi-Fi/Internet access for this room, using my laptop and my cell phone to text people.  I had many friends and family members come to visit.  In my own room, I was less anxious and both my son and my husband felt comfortable leaving me overnight.  I was fine with that.  I was on monitoring for the first four days upstairs, then I was told the doctor liked my numbers which were going in the right direction, but they will do regular vital signs checks.  

I continued to need oxygen and injections, but on Monday, the doctor came in to tell me he was going to start me on oral medications twice a day.  He explained that the medication I was getting, while still a powerful drug, is one of the new ones that don't interact with foods and most medications like the old Warfarin/Heparin combination did and thus, requires less monitoring (because one is stabilized on a maintenance dose).  He also told me they will set me up with follow-up at their clinic and the hospital's thrombosis clinic for follow-up.    He also wanted to run another test on me, a mammogram (just to be thorough because there might have been a cyst or something that came up on the CT Scan).  (The mammogram did get done and that technician was marvellous! ... if anybody in Niagara needs a mammogram, go to St. Catharines' site of the NHS as the technician there makes it painless).  

At first, getting up and using my washroom was difficult, leaving me breathless and exhausted by the time I rang the nurse to take me back to my bed.  However, after each time doing it, I was less exhausted and recovered faster.  The nurse assured me that although going there would bring my heart back up to 130 - 145, it would much more quickly come back down ... which meant to me that this was going to get easier.  A few days later, I asked about taking a shower. My first attempt at a shower was difficult, but I managed to do this, as well as brush my teeth and refresh.  On Tuesday, my doctor came in to tell me that I can go home the next day.  He was very nice too.  He told me my numbers were much better and that he would ensure that all my prescriptions would get transferred over to my pharmacy on discharge.

Later at night, I was transferred to a discharge floor.  I had to set up again and felt my anxiety coming back on again.  I took a shower the next day and cleaned up and eventually went to the nursing station to organize my discharge (late afternoon, when my doctor was finally upstairs to approve my discharge).  They removed my vein hook up, gave me my ID badges and went over my prescriptions very carefully and faxed over referrals for both specialist clinics and I was able to leave on the Wednesday.  At home, I rested.  I set my medications up the same way they were in the hospital (and my pharmacist was very helpful in making sure the new drugs were taken and organized properly).  I want to say that the care I had received at the NHS hospital here in St. Catharines was very good and the medical staff, even the porters and kitchen staff, were very kind and accommodating and they made me feel more comfortable. 

I am back at work now, but could only put out a part-time (for me) schedule.  Most people work forty hours a week and now that's what I am doing, which is PART TIME for me!  I go and do what needs to be done and that's it.  Over eighty phone messages, several pieces of mail and a couple of faxes.  I did the email replies as well.  I am on an online support group for people that share the same condition I have ... many recover and move on, but some are vulnerable to repeat episodes.  I don't want repeat episodes.  

Then, as I come back out and find out what's happening in the world ... the Panama Papers have been released, or at least what the media is referring to as thousands of people around the world hiding behind offshore accounts, many of them likely not paying taxes in their own country ... one of my colleagues told me who was on the Canadian list.  I became so angry ... why these people think others should be paying their share of taxes for them or accepting cuts in public services.  I just came out of the hospital.  I don't want to see cuts in their service, as they gave me good care and I realize now I could have died.  The NHS saved my life.  These people who seem allergic to taxes now want to further drain the federal (and provincial) treasury so there is less money for important things like health care, education, social services and other things we take for granted in a civilized nation.

Fans of Donald Trump, Kevin O'Leary and others like that ... I don't understand them at all. Neither have a clue how the other 99% of us live, nor do they care.  They truly believe the "trickle down" theory as some kind of religion, which of course has been disproven time and time again.  These same people here in Canada mourn the loss of Stephen Harper.  I celebrate that loss, because I did not get one iota of benefit or find any opportunities to get ahead while Harper was in power, while I watched tax break after tax break get handed to people that can damn well afford to do without that tax break, because even with these breaks, these wealthy people aren't going to create more jobs for the rest of us ... nor are they going to make our small businesses work more in our favour.  People who are ridiculously rich don't care about the working class, the merchant class or even the so-called middle class ... in fact, the way they structure their arguments to keep the economy working in their own favour is to make the middle class and some of the merchant class hate the working class and in turn, all of them hate the poor folks that can't even seem to be elevated to the working class.

I have been warned that there are emotional and psychological effects of my health issues. Many in the online support groups have suffered from them.  But I try to go back to remember what one of the nurses that was in the hospital told me.  She reminded me that it takes a long time to completely recover from this thing, that I will have good days and I will have bad days and not to fret over the bad days, as it gets better over time.  Many of my cohorts are upset to learn that the medications do not get rid of the clots, but simply prevent the clots from growing and keeping new ones from forming.  My doctor told me this, so I know what to expect.  One's body usually absorbs them over time as the medication destroys the clots' support structure, so the clots eventually get re-absorbed into the body.  A few stick around.  One of the doctors told me he only had one in his many years of practice he had to refer to a surgeon to directly take the clot out (a fancy operation, he referred to it as).  

I have an appointment for follow-up and I will also be following up with the family doctor, but I just want to get better.  I make myself walk each day.  Sometimes it is harder to do, and other times, I am exhilarated to do so.  I noted that if I am stressed or pressured too much at work I am less effective, so I am trying to schedule this gradual reintegration.  The legal system still runs like it always did.  I still appeared before the same judges, justices and adjudicators I always have and met many of my colleagues in the process.  I just wish I can be as strong and effective as I was before.  I will write another post shortly in more detail about Panama Papers and why our social system needs to be revamped, especially given that easily fifty percent of all people are working in situations like I am: self-employed, contractors, part-time, no benefits.  I lost a lot of money because of this illness.  I just have to get better and get back on track, because there is nothing else I know how to do.  

I can no longer take breathing for granted.  I think the act of being able to breathe is highly underrated, and it has become so obvious to me through this experience.

Your thoughts?