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At their request, my husband recited the basic information: age, weight, height, etc. Pause. “Is she pregnant?” an unfamiliar voice asked.
“Yes”, my husband replied. “About 7 or 8 weeks … something like that.”
I wanted to yell, “Seven weeks, you idiot! How could you not know?” but no words materialized. He truly didn’t know exactly. He didn’t want a baby like I did. He hadn’t been the one obsessing about their temperature every day and using ovulation prediction kits in order to time sex during my most fertile time of the month. And he wasn’t the one who had an early miscarriage a few months prior …
Busyness and commotion permeated the air, but I couldn’t make anything out clearly. It was as if someone had glopped Vaseline in my eyes – no matter how I tried to focus, my world was translucent, at best. But I could hear and I could feel.
What felt like a plastic bear-nosed clear mask was hastily placed over my nose and mouth and soon the familiar “fssssss!” sound of oxygen filled my ears. Now knew what my patients felt when I strapped that blasted thing on them and why they immediately reached up to take it off. It seems instinctual to want to remove something covering one’s nose and mouth – even if that “thing” is providing critical oxygen. Through my foggy brain I also remembered my training: applying oxygen is standard procedure for someone in any form of respiratory or cardiac distress. I didn’t perceive myself as having either one of those two predicaments, but I wasn’t able to be objective in this situation. I wasn’t the one managing the airway this time. Fortunately, my human instinct to remove the mask was precluded by my physical inability to do so – I was simply too weak to move or to care.
Little round cold sticky things were being stuck to my chest and instantly I heard another familiar sound: the “beep-beep-beep-beep” of my pulse on the portable ECG machine that the paramedics had.
Shit! I thought. It was my pulse that was beeping! “Beep-beep-beep-beep …” Wait a minute. This is bad. This is very bad. The rate sounded very fast – too fast. The heavy weight of reality was piercing its way through my foggy, surreal world.
I vaguely remember looking at the ECG monitor on the floor near me. Yes – my heart was racing. It must have been … what? 120 (beats per minute)? 150? My blurry eyes couldn’t make it out. Holy crap! I was in shock. Every nursing textbook I’d ever read and 20 years of nursing experience shouted at me: That’s not normal – a normal, healthy adult does not have a resting heart rate of 150 while lying immobile on the floor!
While all this was going on, I vaguely recall the blood pressure cuff being applied to my left arm and squeezing tightly, then slowly releasing … then tightening again and releasing … then tightening again … Why was it doing that? Couldn’t they get a blood pressure? Good God. More voices …
Next I felt another kind of tightness on my right arm – the familiar rubber elastic band that was used when starting I.V.’s – and the needle poke that followed. Thank God I had saved them some good veins, I thought. What ex-addict type thinking! I was actually proud that I had reserved my larger antecubital veins in case someone might need I.V. access. Sad, isn’t it?
During my active addiction, I recall hypocritically priding myself when working in the operating room with indigent I.V. drug addicts. I’d think, “Geez, did they save me any veins to start an I.V. or is this going to be like looking for a needle in a haystack” (pun intended)? As I lay on my bedroom floor while the paramedics tried to start an I.V., I thought how pathetic my thinking was – that I was actually proud that I’d saved them a few good veins. People focus on the damndest trivial things when under extreme stress, don’t they? Like focusing on whether one’s underwear was clean while being extricated from their mangled car by the Jaws of Life.
I felt the cool surge of I.V. fluid rushing up my arm as the paramedics prepared me for transport. I heard an EMT ask, “Does she have any health insurance?”
“Yes,” my husband replied. “We have Kaiser.”
There was a distinct, brief pause. The EMT continued, “That’s good but … she’s going to UCSD.” The implication being, of course, that I was too medically unstable to transport across town to the main Kaiser hospital. UCSD was a block and a half away – they could practically coast there from my house.
The trip down my driveway on the gurney felt like I was on a rickety airplane runway. Black and white flashes appeared before my eyes with each tiny bump. The jarring caused indescribable, searing pain, yet I barely had the energy to moan.
As the EMT’s loaded me into the waiting ambulance, an ache in my right arm became more and more apparent. I managed to whisper loudly, “It’s hurting … the I.V. …” and I motioned my head toward my right arm.
“What?” a male voice said.
“The I.V. It hurts!” I repeated, trying to talk over the “fssssss!” of the oxygen and other noisy contraptions in the ambulance. I used what little energy I could muster to raise my right arm slightly. Yowch! I thought. Yep – it’s infiltrated. In my head I shouted, “Dammit, people! The I.V. has infiltrated. Change it!” yet no words ever left my lips.
“The I.V.?” the male voice asked. “Something’s wrong with the I.V.?”
I nodded and whispered as loud as I could, “Yes! It hurts!” Then a thick fog covered my eyes and I slipped into some semi-conscious state – neither unconscious nor fully aware. A very bizarre, surreal state.
Searing pain from the movement of the stretcher wrenched me back into reality. I was being taken out of the ambulance and wheeled up a ramp through doors with a large label: “EMERGENCY DEPARTMENT” in unmistakably huge, bright red letters.
I was thrust into a room of bright lights and commotion. Every movement of the stretcher brought excruciating pain – yet I had no breath to cry out. They wouldn’t have heard me anyway with that darn mask noisily blasting oxygen in my face. I felt all of the paramedic’s monitoring equipment being exchanged for those in the ED and I heard a brief report being given by the EMT.
Amidst the poking and prodding, I felt the sharp coldness of ultrasound gel being applied to my abdomen. Then intense pressure as the probe was moved around my belly. Black, white, blue, and orange flashes of light raced before my eyes against a dark background. The piercing pain overcame my inability to vocalize and I let out an audible moan. The pressure let up a few seconds later, and I settled into my familiar Vaseline-smeared fog.
Then I heard what confirmed what that pesky little voice had been trying to tell me all along and which I had been deliriously trying to deny: “Free fluid in the abdomen,” a male voice pronounced above all the clatter. A small tear trickled down the side of my face. More needle poking ensued as the ED staff attempted to start another I.V.
In a strange sort of paradox, the more I felt Death’s slowly-tightening squeeze, just that much more I let go. The onion-like layers of denial and pride and stubborn independence peeled away much easier now … I was surrendering the fight.
Suddenly, a man’s face was thrust into my view. I don’t recall what he looked like as I was unable to focus – that thick film still obscured my vision. He delivered the final blow that shattered any remaining shards of denial I held. “Susan, we think you have a ruptured tubal pregnancy. We need to get some fluids in you quickly, so I’m going to put a big I.V. line in right … here,” the man said as I felt the pressure of a gloved finger just below my right collarbone.
Of course you are, I thought. A central line (an I.V. catheter whose tip lies just outside the entry into the heart). It is standard procedure in a case like this. That’s just great, I thought as I closed my eyes in passive consent.
I felt the cold alcohol and betadine swabs hurriedly swirling below my right collarbone as they cleansed the site, then the distinct stickiness of the sterile drapes being pressed to my skin. No offense to anyone, but I prayed that the hands that were doing the procedure were skilled ones. Having been in the medical profession for over 10 years (four of those years in a university hospital setting ), I feared that a medical student or 1st-year resident might be attached to the hands about to thrust a catheter in or near my heart. “Please …” I prayed. “Please get right the first time!”
I heard a voice call out, “What’s her crit?” The hematocrit (or “crit” for short) measures how much space in the blood is occupied by red blood cells (ml of red blood cells per 100 ml of blood). This number varies slightly, based on age and gender. For an otherwise healthy adult woman, a normal hematocrit would range from about 35 – 45 %.
“Her crit is 18 (%)!” was the answer. I thought I hadn’t heard it correctly – it couldn’t be that low.
Then the initial voice called out, “What’s her blood type? Anyone know?”
My attention was instantly brought back to the cold area where they had just swabbed and draped as I felt a little poke and a sharp sting (Lidocaine, probably, to numb the area), then pressure just below my right collarbone. Then more pressure. “Please get it in the right spot …” I prayed. I knew that getting it in the wrong spot meant that my bad situation could quickly become worse, perhaps fatal. I was already circling the drain as it was …
The pressure on my collarbone released, some tape was applied to my skin, off came the drapes, and
“Yes”, my husband replied. “About 7 or 8 weeks … something like that.”
I wanted to yell, “Seven weeks, you idiot! How could you not know?” but no words materialized. He truly didn’t know exactly. He didn’t want a baby like I did. He hadn’t been the one obsessing about their temperature every day and using ovulation prediction kits in order to time sex during my most fertile time of the month. And he wasn’t the one who had an early miscarriage a few months prior …
Busyness and commotion permeated the air, but I couldn’t make anything out clearly. It was as if someone had glopped Vaseline in my eyes – no matter how I tried to focus, my world was translucent, at best. But I could hear and I could feel.
What felt like a plastic bear-nosed clear mask was hastily placed over my nose and mouth and soon the familiar “fssssss!” sound of oxygen filled my ears. Now knew what my patients felt when I strapped that blasted thing on them and why they immediately reached up to take it off. It seems instinctual to want to remove something covering one’s nose and mouth – even if that “thing” is providing critical oxygen. Through my foggy brain I also remembered my training: applying oxygen is standard procedure for someone in any form of respiratory or cardiac distress. I didn’t perceive myself as having either one of those two predicaments, but I wasn’t able to be objective in this situation. I wasn’t the one managing the airway this time. Fortunately, my human instinct to remove the mask was precluded by my physical inability to do so – I was simply too weak to move or to care.
Little round cold sticky things were being stuck to my chest and instantly I heard another familiar sound: the “beep-beep-beep-beep” of my pulse on the portable ECG machine that the paramedics had.
Shit! I thought. It was my pulse that was beeping! “Beep-beep-beep-beep …” Wait a minute. This is bad. This is very bad. The rate sounded very fast – too fast. The heavy weight of reality was piercing its way through my foggy, surreal world.
I vaguely remember looking at the ECG monitor on the floor near me. Yes – my heart was racing. It must have been … what? 120 (beats per minute)? 150? My blurry eyes couldn’t make it out. Holy crap! I was in shock. Every nursing textbook I’d ever read and 20 years of nursing experience shouted at me: That’s not normal – a normal, healthy adult does not have a resting heart rate of 150 while lying immobile on the floor!
While all this was going on, I vaguely recall the blood pressure cuff being applied to my left arm and squeezing tightly, then slowly releasing … then tightening again and releasing … then tightening again … Why was it doing that? Couldn’t they get a blood pressure? Good God. More voices …
Next I felt another kind of tightness on my right arm – the familiar rubber elastic band that was used when starting I.V.’s – and the needle poke that followed. Thank God I had saved them some good veins, I thought. What ex-addict type thinking! I was actually proud that I had reserved my larger antecubital veins in case someone might need I.V. access. Sad, isn’t it?
During my active addiction, I recall hypocritically priding myself when working in the operating room with indigent I.V. drug addicts. I’d think, “Geez, did they save me any veins to start an I.V. or is this going to be like looking for a needle in a haystack” (pun intended)? As I lay on my bedroom floor while the paramedics tried to start an I.V., I thought how pathetic my thinking was – that I was actually proud that I’d saved them a few good veins. People focus on the damndest trivial things when under extreme stress, don’t they? Like focusing on whether one’s underwear was clean while being extricated from their mangled car by the Jaws of Life.
I felt the cool surge of I.V. fluid rushing up my arm as the paramedics prepared me for transport. I heard an EMT ask, “Does she have any health insurance?”
“Yes,” my husband replied. “We have Kaiser.”
There was a distinct, brief pause. The EMT continued, “That’s good but … she’s going to UCSD.” The implication being, of course, that I was too medically unstable to transport across town to the main Kaiser hospital. UCSD was a block and a half away – they could practically coast there from my house.
The trip down my driveway on the gurney felt like I was on a rickety airplane runway. Black and white flashes appeared before my eyes with each tiny bump. The jarring caused indescribable, searing pain, yet I barely had the energy to moan.
As the EMT’s loaded me into the waiting ambulance, an ache in my right arm became more and more apparent. I managed to whisper loudly, “It’s hurting … the I.V. …” and I motioned my head toward my right arm.
“What?” a male voice said.
“The I.V. It hurts!” I repeated, trying to talk over the “fssssss!” of the oxygen and other noisy contraptions in the ambulance. I used what little energy I could muster to raise my right arm slightly. Yowch! I thought. Yep – it’s infiltrated. In my head I shouted, “Dammit, people! The I.V. has infiltrated. Change it!” yet no words ever left my lips.
“The I.V.?” the male voice asked. “Something’s wrong with the I.V.?”
I nodded and whispered as loud as I could, “Yes! It hurts!” Then a thick fog covered my eyes and I slipped into some semi-conscious state – neither unconscious nor fully aware. A very bizarre, surreal state.
Searing pain from the movement of the stretcher wrenched me back into reality. I was being taken out of the ambulance and wheeled up a ramp through doors with a large label: “EMERGENCY DEPARTMENT” in unmistakably huge, bright red letters.
I was thrust into a room of bright lights and commotion. Every movement of the stretcher brought excruciating pain – yet I had no breath to cry out. They wouldn’t have heard me anyway with that darn mask noisily blasting oxygen in my face. I felt all of the paramedic’s monitoring equipment being exchanged for those in the ED and I heard a brief report being given by the EMT.
Amidst the poking and prodding, I felt the sharp coldness of ultrasound gel being applied to my abdomen. Then intense pressure as the probe was moved around my belly. Black, white, blue, and orange flashes of light raced before my eyes against a dark background. The piercing pain overcame my inability to vocalize and I let out an audible moan. The pressure let up a few seconds later, and I settled into my familiar Vaseline-smeared fog.
Then I heard what confirmed what that pesky little voice had been trying to tell me all along and which I had been deliriously trying to deny: “Free fluid in the abdomen,” a male voice pronounced above all the clatter. A small tear trickled down the side of my face. More needle poking ensued as the ED staff attempted to start another I.V.
In a strange sort of paradox, the more I felt Death’s slowly-tightening squeeze, just that much more I let go. The onion-like layers of denial and pride and stubborn independence peeled away much easier now … I was surrendering the fight.
Suddenly, a man’s face was thrust into my view. I don’t recall what he looked like as I was unable to focus – that thick film still obscured my vision. He delivered the final blow that shattered any remaining shards of denial I held. “Susan, we think you have a ruptured tubal pregnancy. We need to get some fluids in you quickly, so I’m going to put a big I.V. line in right … here,” the man said as I felt the pressure of a gloved finger just below my right collarbone.
Of course you are, I thought. A central line (an I.V. catheter whose tip lies just outside the entry into the heart). It is standard procedure in a case like this. That’s just great, I thought as I closed my eyes in passive consent.
I felt the cold alcohol and betadine swabs hurriedly swirling below my right collarbone as they cleansed the site, then the distinct stickiness of the sterile drapes being pressed to my skin. No offense to anyone, but I prayed that the hands that were doing the procedure were skilled ones. Having been in the medical profession for over 10 years (four of those years in a university hospital setting ), I feared that a medical student or 1st-year resident might be attached to the hands about to thrust a catheter in or near my heart. “Please …” I prayed. “Please get right the first time!”
I heard a voice call out, “What’s her crit?” The hematocrit (or “crit” for short) measures how much space in the blood is occupied by red blood cells (ml of red blood cells per 100 ml of blood). This number varies slightly, based on age and gender. For an otherwise healthy adult woman, a normal hematocrit would range from about 35 – 45 %.
“Her crit is 18 (%)!” was the answer. I thought I hadn’t heard it correctly – it couldn’t be that low.
Then the initial voice called out, “What’s her blood type? Anyone know?”
My attention was instantly brought back to the cold area where they had just swabbed and draped as I felt a little poke and a sharp sting (Lidocaine, probably, to numb the area), then pressure just below my right collarbone. Then more pressure. “Please get it in the right spot …” I prayed. I knew that getting it in the wrong spot meant that my bad situation could quickly become worse, perhaps fatal. I was already circling the drain as it was …
The pressure on my collarbone released, some tape was applied to my skin, off came the drapes, and
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