Friday, June 7, 2013

A Penchant to be Misunderstood

I'm just a soul whose intentions are good
Oh Lord, please don't let me be misunderstood
Don't let me be misunderstood.

As I intimated in an earlier post, I have entered into the preliminary stages of a project to repair an acute AAA (Abdominal Aortic Aneurysm).  The definitive options assessment with the vascular surgeon did transpire on Tuesday, 21-May-2013 preceded by an ultrasound on my carotid arteries.

The CT Scan that the vascular surgeon ordered to double check the ultrasound measurements did reveal two significant items: gallstones and the AAA being 6.3 cm instead of the ultrasound measured size of 5.3 cm.  Ergo the condition was more acute than I bargained or hoped for.

But there is more.  I seem to have developed the unenviable penchant to escalate in accelerated mode an extant condition into a full blown crisis.  The ultrasound of my carotid arteries required that I had to fast for the occasion from midnight prior.  I therefore came home extremely hungry and promptly broke my fasting with a hard-boiled egg left over from my lovingly devoted wife Krystyna’s breakfast.

Shortly thereafter the onset of black diarrhea which lasted till 5:30 pm the following day had come to have defined the entirety of my existence.  It being a Tuesday, my primary care physician (PCP) was regularly scheduled to conduct her hospital rounds.  While I was with my vascular surgeon she left me a voice mail to call her at 12:30 pm on Wednesday to discuss results of the blood works done on Thursday, 16-May-2013.

I therefore held off going to the Emergency Room (ER) for as long as my strength lasted.  Besides I was not sure which ER I should go to.  I saw the options to be: The Good Samaritan Hospital in West Islip where my vascular surgeon could attend to me if the need arose.  I was acutely aware of the possibility that my internal bleeding had to do with osmotic seepage from the AAA.  The second alternative was Southside Hospital of North Shore LIJ in Bay Shore which was my PCP’s affiliated facility.

The lion’s share of my medical history having transpired at Stony Brook University Hospital (SBUH), their ER had the leverage of being a virtual default option.  It had the advantage of being the closest to my residence. Besides, my cardiologist was affiliated with SBUH and it has been said that in the hierarchy of medical sciences “Cardiology is King.”

When I did not get a call back from my PCP by 14:30 hrs, I wrote up the issues I needed to discuss with her and FAXed her the list as a subtle way of following up on the phone call.  This also had the added effect of elucidating the issues for my own edification and emphasizing the urgency of my cause.

She finally called me at 16:00 hrs.  The most remarkable results about the blood works were that the cholesterol indices were excellent and that the blood cell count had undergone a significant reduction since it was last taken six months earlier.  I had no clue how serious was “significant.”  She threw some numbers my way but they barely meant anything since I had no idea what was supposed to be the normally desirable value.

We mutually agreed that SBUH was the most prudent venue.  Meanwhile, Krystyna en route home from work urged me to wait for her before calling for the ambulance.  On arrival, she informed me that my countenance was on the green side of pale.  Ergo, I was bleeding much more than I had bargained for.  While I felt in full command of my faculties, I was on the wasted side of lethargy and getting further depleted in a big hurry.

The ambulance arrived within ten minutes.  The crew prepped me for the trip to the ER by promptly installing a standard-issue Intravenous needle into the one prominent vein located directly opposite my elbow.  I reckoned he was more concerned with complying with regulation than the longer-term implication of the IV location.  This was noteworthy because unless physically constrained it would be a tall order to expect me to completely avoid bending my elbow during my stay in the ER.

This was exactly what happened three days later.  The needle pierced the other side of the vein and the fluid meant for intravenous transfusion went into the flesh of the arm causing it to swell and harden, reminiscent of the nostalgic magkono, the renowned Philippine ironwood in Cagdayanaw, the southernmost village of my Philippine hometown of Claver, famous for the abundance of iron-rich laterite.

By the time I got to the ER I was more foggy than lucid.  When I went through the triage protocol, the people asking questions sounded to be in the adjacent room instead of being by my bedside.  So when I was asked about my alcohol consumption habits I gave them my boilerplate spiel about how it is the wont of aspiring writers, as I claim to be one, to have the proclivities of either beating up the wife or excessive indulgence in hard liquor.  And that since I could ill-afford to beat my wife up because of my inherent gentle nature, I gravitate more towards alcohol intake.

Alas, my vain attempt at subtle witticism proved unequal to the perfunctory rote of overworked and sleep-deprived medical internists.  For them it opened a Pandora’s Box of perceived alcohol dependence worthy of Jack Lemmon and Lee Remick in the 1962 Blake Edwards classic, Days of Wine and Roses. 

I was simultaneously subjected to a deluge of kids’ glove tenderness calculated not to harm the fragile character of the substance abuser and the assurance of counseling available aplenty to rescue the addicted from the quagmire of substance dependency.  Except that the poor tormented soul was supposed to be mine.

Two CT Scans and an X-ray later, the bleeding had been attributed to an advanced case of Esophageal Varices, presumably resulting from a damaged liver.  It remained to explore how and why.  From my standpoint at least, delving into the wherefores would be extremely important because my liver activity was supposed to have been closely monitored by my PCP.

But from the medical providers’ standpoint who had to go by my triage transcript, that the liver had been pronounced "half gone" meant, among others, goodbye forever to Napoleon Brandy. With a subtle touch of hyperbole, the Gastro-Intestinal (GI) attending physician at the Intensive Care Unit (ICU) ward counseled that even to look at an empty bottle of my coveted brand of alcoholic drink would trigger a bleeding of the liver of guaranteed lethal consequences.

This is so much a shock or maybe I have a case for a malpractice suit if I find a halfway decent enough lawyer. The issue is my Primary Care Physician was supposed to have been monitoring my liver's handling of the high dosage of gout medication I have steadily taken over a prolonged period. That I was never warned of how strained my liver had been surviving over the last few years should call for a speculation worthy of a Perry Mason. 

It had alarmingly become clear that the triage transcript virtually overshadowed the Plavix factor as the main culprit to cause the internal bleeding.  Alarming because the medical elite seemed invested in minimizing the deleterious effect of medication.


  1. The main thing now is that the vascular surgeon has to clear the procedure with the GI crew as well as the cardiologist. GI wants me off plavix but cardiology does not allow it. So my risk for the AAA fix has just increased exponentially.

    The GI scheme is to have me followed up every two weeks. I can imagine how it would obstruct the vascular surgeon's timetable for for the endovar and how long can I afford to wait given that I'm already 6.3 cm acute

    I have been on Plavix for three years and three months. Just got admitted to ER for gastro-intestinal bleeding, subsequently diagnosed as advanced esophageal varices. Stayed in the hospital for a total of nine days. The GI doctors wanted me taken off Plavix to help alleviate the condition. Cardiology agreed and reversed the following day on grounds that it would be too risky for the stents in my quadruple cardiac bypass.
    To complicate matters, I have a 6.3 cm AAA that’s scheduled to be repaired. I’m afraid the risk of my getting leakage from the aneurysm is exacerbated by continuing to take Plavix. But I was told that in medicine “cardiology is king.” What they say goes. How can I get off Plavix to fix my AAA?

  2. I got three units of blood transfusion which brought my red cell count up to acceptable level. I got the first shot at banding the esophageal varices on Tuesday, 28-May-2013 and got discharged on Thursday, 30-May-2013.

    Had a session with my cardiologist on Tu, 4-Jun-2013 and am scheduled for a cardiac stress test on 12-Jun-2013 and a followup endoscopy and varices banding on 13-Jun-2013.

    So all is well that shall end well. Good luck to all of us. Stay tuned, if you will.

  3. I don’t know if this is a purview of what’s coming next. But my inbox have been deluged with spam mail such as the below URL. Maybe it is just a fallout of my triage transcripts at SBUH ER. If I can prove this suspicion as the whole truth and nothing but, can I sue the hospital for defamation of character? Or do I need to first graduate from law school to do so? To graduate, I first have to get admitted into it. {}

    1. It behooves to spell out what actually is in the URL:

      Luxury Rehab
      Alcoholic Rehab Centers
      Alcohol Recovery Centers
      Alcohol Rehab Services
      Alcoholic Rehab Center

      All lines after the ":" being clickable hyperlinks.