Patient with Pain

Patience is an over-rated virtue that is hard to exercise…especially when you are waiting… or when you don’t have the time for it. Other factors that don’t help the cause are when you know you will be poked, knocked down and sliced through. Last Friday didn’t begin too well. I woke up to the abdominal pain from the previous evening. It had come out of the blue and since I did not have any food poisoning symptoms by morning, I brushed it off as an exaggerated form of gastritis. I reasoned that if I ignored it long enough, it would go away. But it lingered on and became worse by the time I was ready to leave for lab.

On one of the rare occasions that I chose to heed to common sense, I decided not to bike and walked slowly to the bus stop. As Murphy’s law (anything that can go wrong, will go wrong) had been invoked for the day, the bus was nowhere in sight. Given the subjectivity of public transport schedules, I waited for a full 15 mins before dragging my unyielding feet half a mile to the next stop. Another bus was due here in half hour, give or take 15 minutes, usually the latter. Sometimes I think that the psychology department of University of California, Irvine (UCI) has outsourced a project to Orange County Transport Authority (OCTA) to observe “bus rage” in commuters subjected to chronic wait-times. An hour and fifteen minutes since I left home, I was in lab. After all that trouble to get there I decided I would rather be somewhere else. I don’t believe in gut feelings, but today it wanted to be 5 miles away from the lab. So, the ailing gut and I walked down the winding paths of the green Aldrich Park, to the bus stop on campus. During another wait for an hour, I was determined not to be upset by small details.

When I entered Kaiser Permanente Medical Building, it was lunch time and the doctors were away. The earliest appointment that I could get was 90 mins away, but a nurse attended me within 10 mins. After she checked my vitals, I told her about the tenderness in my abdomen and the pain, which had become excruciating by now. She consulted with a doctor and between them, they decided that since I had a cough for two weeks, they would check my lungs first. From my high school anatomy days, I remembered that the lungs were in the thoracic cavity. I had pain in my lower right abdomen. But then again, I am not a real doctor! The nurse, after ruling out my lungs as the villain, recorded blood pressure when I was lying down, sitting up straight and while standing. Dr. Stephanie pronounced that I should go to the Emergency Care without delay to check on my abdominal pain. My boss, Susana, drove me to the Kaiser Permanente ER, a few blocks away.

After a brief 20 min wait at ER, I was registered with an identity wrist band and taken into the sanctum of ER. I had only noticed them on American television before, but this one looked pretty lame and deserted to me. I guess Irvine lives up to its name as one of the safest cities in US. Nurse Robert asked me to change into a gown and checked my vitals again. Everything was normal. Dr. Shapiro, the attending doctor in ER, was a very nice elderly chap. He was very apologetic when he prodded and pained my abdomen. He ordered some blood and urine tests right away. When he asked me when my last meal was, I realized that it was 8 long hrs ago, at 7.30 am. I had not felt hungry till then, and all of a sudden I had this irresistible urge to bite into something. He told me that it will have to wait and put me on saline drips. I was parched and requested Robert for some water. He was generous with two small pieces of crushed ice. No water or food. And then to drive home the point that he was serious, he extracted some blood. Since I had to wait, I decided I will read for a while to keep my thoughts away from pain. Robert handed me the book from my bag and we both smiled. The book was apt – “Why Sh*t Happens, The Science of a really Bad Day” by Peter Bentley. It is an interesting read and I strongly recommend it, but I couldn’t go beyond a few lines. It wasn’t the book that hurt.

My wife, Ramya, had told me earlier in the morning that it might be appendicitis…I had laughed… and it had stung. Then Dr. Stephanie thought so too. Susana opined the same during our brief ride to ER. It is hard enough to get two women to agree on the same thing at any given time. If three do, with all due respects, that is as sure a hex as they conjure them at Eastwick :) Although it was always at the back of my mind due to the nature of the pain, somehow I had not considered it a serious candidate. Appendicitis normally starts as a generic pain through out the abdomen before honing on to the right side of the area. Mine started off there without any history. I called Ramya to notify the situation…she had been up the whole night, calling me every now and then to check up on me. I also called my labmate, Adhanet, to update her.

Dr. Shapiro walked in with the lab results, which were all normal, except for some increased bilirubin. He wanted me to get an X-ray done as well as an ultrasound. Ernest, the nurse from radiology wheeled in the bed to the X-ray room. Part of me wanted to shout excitedly “faster, faster”! But the agonizingly aching part said that I should just close my eyes, rest and enjoy the ride. The hallways were all decked up with Christmas decorations. I commented about them and Ernest asked me if I was having a good time in the hospital. I strained my neck to see if he was joking. He looked like he was living up to the way his name sounded. The ultrasound was another painful experience that lasted for about 15 mins. At around 6.00 pm, I was wheeled back into Consulation Room 6.

The X-ray had not shown any calcification in the appendix and the ultrasound had not revealed any inflammation of the suspected organ. Dr. Shapiro drew me a cartoon of the abdominal cavity and explained to me why it was sometimes difficult to visualize appendix in an ultrasound. It sits snuggly behind the large intestine. I told him and the surgeon, Dr. Lilian Estrada-Linder, that I was not willing to go through an exploratory surgery, without any factual evidence to back up. She said that she had 20 years of experience in surgery and I had all the classic symptoms of appendicitis. I could wait for a CT scan but that would delay the inevitable surgery by a day and expose me to unnecessary radiation. After pondering over, I agreed for an appendectomy. I asked her to explain the entire procedure and signed away my rights to the vestigial organ that would be removed shortly.

I was taken to the second floor for surgery and greeted by Dr. Tiwari, the anesthesiologist and Dr. Stacy, an assistant surgeon. I think they both had a bet about how my first name was pronounced. I didn’t know what was at stake and I certainly didn’t want a sore loser against me. I told them to call me Sri. This was no time for formality. He would put me down shortly and she would cut me open later. One of the other surgeons came and prepared me for the surgery by pasting in biometric readers to various parts of the body. They reconfirmed one last time that I was indeed who I was before Dr. Stacy injected Fentanyl and some muscle relaxant to put me off to sleep. I was wheeled off and taken to OR. The last thing I remember was that I was put on the operating table/bed.

I never saw Dr. Estrada-Linder that night. But from what she had explained me earlier, I was operated laparoscopically. At some point of time after I lost consciousness, Dr. Tiwari would maintain the anesthesia with a mixture of oxygen, nitrous oxide and sevoflurane. Dr. Estrada-Linder would make three incisions – a 1.5 cm incision above the navel and two smaller 1 cm cuts below and left of the bigger one. Carbon dioxide would be passed into the abdominal cavity to bloat it up and make room to visualize and work with the small video camera and the surgical instruments. The camera feeds, illuminated by a halogen light, would be displayed on a larger screen and organs would be carefully prodded and moved around to gain access. When found, the appendix would be cut and removed out through the larger incision. The incisions would be sutured up, some strong narcotics pumped in and the gas mask would be removed. I would be taken into the recovery room to come back to my senses. The whole process in OR must have lasted a little more than an hour.

When I did come, I was “high”. My vision was blurry and I vaguely remember blabbering a lot. I kept insisting that I was in the same bed as I was when they prepared me for the surgery. The nurse kept pushing me down, so I guess I must have tried to get up. I woke up at 12.00 am and was told that I was in the in-patient room, 405. I felt itchy all over, I could not sleep and I asked the nurse to give me something to put me off to sleep. She gave me some more morphine, but that didn’t help. I was moving in and out of drowsiness every 10-15 minutes. It is horrible to not go to sleep when one is so drowsy.

Dr. Estrada-Linder came at 7.00 am and told me that I could leave by noon if I felt better after breakfast. I had severe pain in my right shoulder at around 8.30 am. It was apparently from the carbon dioxide inside the abdominal cavity. It was now pushing against the diaphragm and exerting pressure against the phrenic nerve. It became worse when I took my first steps. I had to get back and rest for a long time before I attempted again. I left my breakfast untouched except for a small piece of bagel and the carton of milk. After spending a few more painful hours, I was brought back home by my labmates, Adhanet and Nicole, who made sure that I was comfortable and provided for. My neighbors, Rangarajan and Padmini, took care of my culinary delights the first few days, as did Sonia with her support. Thanks to all the family and friends who have called and made sure that I didn’t feel lonely.

It has been a week since I came home and has been a lesson in patience and endurance. The abstract and the adjective form of the word patience is certainly an eye-opener. The pain has reduced considerably, but it still hurts every time I move. Although the scars from the surgery are healing now, they hurt more than just a painful memory. When Dr. Stacy was injecting the sedative into my left arm, the irony of life did not escape me. In a few minutes, I would be lying down naked in front of strangers. For a guy who was contemplating on moving out of academia into hopefully bigger bucks, doors to two of the most lucrative jobs would be shut down. Now, I can potentially never be a belly dancer or a stripper…ever ;)

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