Pulmonary embolism: the sudden blockage of a major blood vessel (artery) in the lung, usually by a blood clot. In most cases, the clots are small and are not deadly, but they can damage the lung. But if the clot is large and stops blood flow to the lung, it can be deadly. Quick treatment could save your life or reduce the risk of future problems.
She was feeling weak. She was feeling short of breath. Going down the outside stairs winded her. Going up the outside stairs exhausted her. At first she thought it was a cold. She saw her GP, who gave her antibiotics. But the symptoms persisted.
And then we were at the ER.
She never had any of the horrible symptoms – never had the sharp chest pains, never coughed up bloody mucus. She was just weak and easily fatigued by such normally mundane activities as walking from one end of the house to the other.
She had “substantial” pulmonary embolisms in both lungs.
I never found out exactly what that meant – whether it was a couple of giant clots or a whole bunch of small ones or how much clot it took to make “substantial” clotting. It’s one of those terms that is both alarmingly specific and vague enough to allow the imagination free reign.
Emergency Room workers are very calm and friendly. No matter what you are in for, they always seem to have that attitude that you have a cold, are staying home from school, and they are kindly grandparents who will bring you soup and make sure you are all tucked in and warm. So when she was diagnosed and the doctor came in to discuss the matter, it was in the manner of helping her decide whether she wanted a sandwich or soup for lunch. She was going to be admitted. They were going to keep her overnight for observation. Her condition was serious. The whole thing was related to us in that gentle, matter-of-fact manner that would have lulled me to sleep if it hadn’t been such dire news.
So they admitted her. I went home to take care of a few things. While I was gone, they moved her to Intensive Care. I got the notice. I almost lost it. In the parlance, “shit got real.”
Back to the hospital. This time into ICU. ICU is what everyone dreams of hospital care being like – it is quiet (but that’s because most patients are too sick to make much noise), rooms are spacious (because crash teams need room to work), and the staff to patient ratio is 1/1 (because disaster can strike at any time). She had been moved to ICU for 24-hour monitoring because of the possibility of a blood clot breaking loose from her lung, lodging in her heart, and sending her into cardiac arrest. She was now hooked up to many machines that went whir and beep and ping. There was a monitor over her head with lots of wavy lines and numbers. She had several shunts in her arms and hand.
Eventually a doctor came in – an internal medicine specialist this time, not an ER doc. The new doctor explained that there were two ways to treat pulmonary embolisms.
- Anticoagulants (AKA blood thinners). These work by preventing existing blood clots from growing, and new blood clots from forming. They rely on the body’s own defenses to eventually dissolve existing blood clots
- Thrombolitic medications (AKA clot busters). these actually dissolve existing blood clots, but there is a risk of excessive bleeding, particularly in the brain. The chance is around 2%.
At present, given her blood pressure and condition, the risk/benefits were about the same for each – for anticoagulants there was a mild risk as long as the clots were in place of a clot migrating to the heart and causing a coronary event. BUT, modern medicine knows a fair bit about treating coronary events. Thrombolitics would eliminate this threat, but instead carried the small risk of a stroke. Stokes = bad. We can’t fix strokes.
At one point the doctor asked her what she thought. Then the doctor asked me what I thought.
I hadn’t the faintest idea. The doctor would have gotten more information out of me by asking what I thought the optimal parameters for a Mars orbital insertion were. Unaccountably, I felt for just an instant that I should have paid more attention to those medicine commercials on TV. Had I missed one? “When YOU have pulmonary embolism, ask your doctor about…”
Needless to say I could offer no advice. It still bothers me that I was asked.
The doctor decided to go with the blood thinners.
That night when I got home, I thought about my feelings almost a year ago when she was first diagnosed with cancer. “Holy shit!” I thought then, “there is a measurable chance that Lump could kill her in a year or less!”. Then we hit chemo and I thought “Holy shit! There is a small but measurable chance that chemo could kill her over the next few weeks!”
That night it was “Holy shit! There is a chance, a real honest-to-God chance that my phone could ring at 3:00 am and inform me that she had died – TONIGHT!”
This caused me to lose a LOT of sleep during the subsequent nights. As I am writing this it is causing me to lose sleep still.
The thing about hospital stays is that they are largely quite boring. Of course this is by both circumstance and design – usually by the time one is in the hospital, particularly ICU, one is in pretty horrible shape, so such activities as dancing, marathon, and holding a book for extended periods are beyond one’s capabilities (though the advent of Kindle – smaller and lighter than a book – has mitigated the latter somewhat). Hospitals also try to reduce the stress and strain on each individual patient, so things like group singalongs, yodeling competitions, and dramatic readings from WEB du Bois are generally frowned upon. Entertainment consists mostly of sleeping, watching small televisions that are mounted too far away, listening to machines go whir and beep and ping, and occasional visits by someone who will stab you and draw your blood while making amiable small talk. Hospital tray tables are far too small for most games and frequently have medical supplies on them in any event.
So mostly what one does in a hospital is lie there. Or in the case of visitors, sit there.
“Fun” is not a word much used to describe this situation.
After a couple of days in ICU, she was moved to TCU (“Transitional Care Unit”). TCU is what most people think of when they think of hospital visits. The staff/patient ratio is considerably smaller, rooms are smaller and packed closer together, the patients are in better shape overall and so more fractious, and when you ring the nursing station with a problem or one of your machines starts going ping or beep or whir insistently it may be 10 minutes before anyone comes to see what is going on. It’s louder both because the patients are more active, because the staff has to talk to one another up and down the hallway, and because there are more alarms going off for longer periods.
I was still worried about the prospect of coronary arrest, so TCU scared the living hell out of me. Probably it shouldn’t have – she was largely out of danger (“largely” in my mind, meant “THERE IS STILL SOME DANGER!!!!”) and the staff of TCU seemed to be competent and compassionate. But it was strange – TCU felt more like emergency care than the emergency room and ICU did. I suppose it’s because in all those medical dramas there is always something going on causing the staff to run around and alarms to sound and the like, whereas in REAL emergency rooms and ICU there is a great effort made to keep everything calm and quiet.
There were a couple of patients in TCU who had some form of dementia. I imagine that it isn’t uncommon. They made a lot of noise and were generally less than cooperative. One kept trying to escape. I thought of how terrifying it must be, over and above just the terror of dementia and confusion, to find yourself in a room in a place where you know no one, plugged into a bunch of machines that go ping and whir and beep, with no idea where you are or how you got there or why, dressed in a gown that could not have been better designed to make you feel helpless and vulnerable. Many horror movies start out like this.
On her second day in TCU I am able to take a walk with her up and down the hallway. It isn’t exactly romantic what with medical personnel going back and forth (one hovering nearby to prevent a fall) and equipment parked here and there. And of course the privacy in the rooms approaches zero so I have to keep my eyes rigidly focused on the end of the hallway so as not to see into other people’s rooms. And I think to myself “This is someday. There will come that day, sometime in the future, where this isn’t a thing to get over, when this isn’t a few steps on the road to recovery. There will come a day, for her or for me or for both of us, when this is the best there is – a short stroll down a hospital corridor arm-in-arm.” And there is, I admit, a certain romance in that. One born of many other walks, long and short, over the years, through so many other places. A certain apprehension, of course, with the realization that we have likely taken our longest walks together, that if we are not closer to the end than the beginning (which is what it feels like) we are at best very much in the middle. The clock ticks more loudly, the calendar pages turn more swiftly. But there is also comfort in knowing that we will not face those last walks alone.
And then they let her go and I drive her home again.