Detour from Normal (6 page)

"You hang in there. We'll get you squared away." With that, Dr. Edwards smiled reassuringly and left the room. Shortly after that a patient transporter arrived, and a nurse again unhooked me from my IV rack. Once more I got to count the lights. I ended up in what looked like the surgical prep I'd been in prior to my surgery. One last turn and I
was in my parking space. My wheels were locked and the drapes pulled around me. A few minutes later, a nurse pulling a cart full of medical instruments parted the drapes.

"Good morning, Mr. Dickson. And how are you doing today?"

"I've definitely felt better," I replied.

"Aw, it'll be all good from here, I promise. I'm Donna, and I'm going to be installing a PICC line for your Diflucan so you can finally get a square meal." Donna was very cheerful, very blond, and very chubby. I liked her immediately.

"How's that?"

"Once we get your PICC in, you can be fed intravenously."

"That sounds yummy. I'm starving. Will it help with that?"

"Sorry, it doesn't go to your stomach. You'll feel as hungry as ever, but at least you'll have more energy and stop losing weight. You'll still be thirsty though."

Donna had the most colorful getup I'd seen at Desert Hope. She was wearing floral-patterned fifties glasses and a flower-print bouffant cap that almost matched her glasses if I squinted hard while looking at them. "That's too bad. I like your glasses and hat. They're very...cheery"

"Donna has a whole collection of those glasses," someone yelled from outside the curtain.

"But sadly they only make this one bouffant," Donna said, pointing toward her head.

"What's a PICC line?" I asked.

"It's a peripherally inserted central catheter."

"Why do I need one?"

"Well, since we can't feed you any real food with your intestines shut down, we're going to give you TPN: total parenteral nutrition.
You'll also be getting Intralipid. Those are like all your meats and veggies rolled into one. You could live for years on them. Unfortunately they're both toxic to your veins. Diflucan is pretty nasty too. The PICC line will go right into your heart, bypassing all those delicate veins. There's such a flood of blood in there that everything we put in will immediately get diluted and therefore be safe for your blood vessels from that point on."

"You're putting a tube into my heart?" I asked in disbelief.

"Yes, this little tube." She wiggled a thin, floppy blue piece of plastic tubing. "It will go into your arm, across your chest, then all the way down into the old superior vena cava and say 'hello, baby' to your tricuspid valve." As she explained the procedure, she manipulated the thin blue tube as if it was a puppet, and I laughed.

"Will I feel it inside me?" I asked with worry. I imagined that it must tickle, flopping around inside my heart.

"Fortunately, there aren't any nerves in that area, at least not the feeling kind." She hummed as she picked up some things from her cart, then she turned and draped a sterile paper-like blue sheet over me. "Got to put one of these down for the blood spatter—it's a real mess putting a PICC in." My eyes widened. "Just kidding, honey, this isn't a surgical procedure, but we have to keep clean. Wouldn't want you to get any infections in your condition, would we?"

"You're funny, but I think I've already got that one covered," I said. It was nice to hear humor. Most things—in fact, everything—about me had been purely business for a while, at least since Dr. Bonjani had been my pee cheerleader, I thought with a smile. She picked up some scissors and cut a hole in the sheet and placed it over my arm. She taped around the hole so that, in the end, it looked like a circle of skin unattached to
anything. It didn't seem like my arm when I looked at it. Next she turned on a machine attached to her cart.

"All right, I'm going to check out your lovely veins and see if we can't find a good one to poke." With that, she applied some cold jelly to my arm and began to move an ultrasonic wand against my skin. As she looked at the instrument's display, several thick noodle-like veins became apparent. "Ah, there's a real beauty. You get the prize for best vein of the day. Of course, you're my first vein of the day. Now I'm going to introduce a very sharp needle into your arm. I'm going to be looking at the needle on my ultrasound so I can poke it right in the center of that big fat vein. It's going to sting a bit. After that I'm going to feed a wire into your vein."

I winced as a needle broke my skin. There was a pressure as it bit into the vein, but I noticed nothing as she snaked the wire through the needle tip into the vein. "There, that looks marvelous," she said, pulling her wand away. I looked down and there was a piece of wire sticking up in the air from my arm. It vibrated like a spring with the slightest movement of my arm. A few drops of blood trickled away from it and were stopped by the sterile paper cover.

Donna turned the ultrasound off and wiped the gel and blood away with alcohol. "How are you doing?"

"Hanging in there, what's next?" I asked.

"Now I'm going to numb you with some Lidocaine." She pulled out the "big gun," an enormous needle used for Lidocaine. "This is going to feel like a bee sting. First it'll sting, and then it will burn. But not for long."

Ouch. That one hurt, but she was right about the pain going away quickly.

"All righty then. Are you still with me?"

"Yeah."

"Good. You might want to turn your head away for a minute. I have to cut you with a scalpel to enlarge the site for the inducer. After I cut you, I'm going to slide the inducer down the wire and press through the vein with it. Then we'll remove the wire and feed the catheter down through the inducer and into your heart."

"Uh, OK. You just do your job and I'll try not to think about it," I said. I didn't feel the incisions at all, but I felt the pops when the inducer broke through my skin and again when it popped through my vein.

"Pops are good. You've got tough skin and veins. Of course, you're just a young pup, so I guess that's to be expected."

"Hey, when you're done here, can you come back to my room with me and make me laugh all day?" I chuckled.

"I would, honey, but you know how it goes. I have so many other people to save. OK, we're on the home stretch." She set down her measuring tape on the sterile paper and held the blue tube near it. "That was a close guess," she said as she snipped about an inch and a half off it.

"Hey, when we're done, can I have that little piece you cut off? This has been very fascinating, and it will help me remember you."

"Sure," she said with a wink and set the small piece aside. "Now I'm going to remove the wire and feed this tube in, but before I do, I want you to turn your head and tuck your chin on your shoulder. It could easily go up your jugular vein instead of down into your heart. Holding your head like that closes off the jugular a bit and discourages the tube from going up that way."

I immediately did as she said. "OK, here goes...got it. Now I've got to flush the PICC with saline. I want you to look forward while I inject
saline solution into the tube." She connected a big syringe filled with clear saline solution to a connector on the end of the blue tube. "All right, when I inject this, tell me if you feel any coldness in your neck or hear a popping sound in your left ear. That would mean that the tube went up the wrong way, up your jugular. Here goes...nothing?"

I didn't hear or feel anything. "Nope."

"Then let's get you cleaned up and out of here." Donna cleaned up the PICC insertion area; dressed and bandaged the wound with a clear, skin-tight bandage; stabilized the line with an adhesive mount; and taped down a second PICC line that split off from the first at a joint. After that the paper sheet came off. "That's it, young man. I just need to get you off for an X-ray to make sure everything is in the right spot, and then you're on your way. Oh, one more thing, Mr. Dickson," she paused, looking at me sternly. I didn't have any idea what she was about to do, which was the really great thing about her. She reached toward me, holding the little blue piece of PICC line. "I don't know why on earth you want this, but here it is."

I smiled and took it from her, clutching it in my hand. I wasn't going to let go of it until I had a safe spot to keep it. "I have a treasure box at home with weird things that only have meaning to me, like the clamps that held my daughters' umbilical cords while I cut them at their birth. I'm going to put it in there. Thanks."

"Well, that's a new one. Hey, it's been really great, Mr. Dickson. I hope you recover soon."

"Me too," I said.

"The technician will be here shortly to give you a chest X-ray. I'll quickly check the X-ray, and if everything looks good, we'll send you back to your room."

She patted me on the arm and smiled, then took her cart and disappeared through the curtains again, pulling them closed behind her. Everything went well with the X-ray, and I was wheeled back to my room. I placed the blue piece of PICC tube on the cart next to my bed and kept a close eye on it until I could figure out a better place to keep it. Ultimately, it did end up in my treasure box.

Shortly after my return, a new bag appeared on my IV rack: Diflucan. As soon as the Diflucan made its way through my PICC and into my heart, my chest was on fire. There was a battle for my life raging inside me, and I hoped that the infectious disease specialist had made the right choice.

Sometime later two additional bags were hung on my IV rack: a small bag filled with white Intralipid and a larger bag filled with yellowish TPN. Another pump was added to control the flow of my nutrition, and two tubes ran from the pump to my PICC line. I was very anxious for my first meal in over a week. I didn't know it at the time, but I'd lost over twenty pounds, and to everyone who knew me, I looked like death. When the fluids first rushed into my heart, it was overwhelming. It was a sugar rush times ten. My whole body flushed, and I felt a sudden burst of energy as every cell in my body reacted to the nutrition at almost the same instant. It was an unbelievable feeling. From that day forth, I called the bags my meats and veggies. They were my constant companions until my bowels turned on.

There was one other matter of business I had to attend to. I reached for the push button that I had been insisting should be disconnected and pressed it every six minutes until the pain in my behind went away. Before long I was sleeping like a baby.

I opened my eyes as morning light crept around my curtains the next day. I'm alive! I tried to fill my lungs with air, and they filled effortlessly. I can breathe! I was rested; I had no pain—everything was looking good except for my belly. It was distended beyond belief. I looked as if I was at full-term pregnancy. How can I live with my intestines shut off? I wondered. When I asked the nurse, she said it was up to God whether or not he was going to turn my intestines on again, and when. If everything went well, that could take anywhere from two to nine days. In the meantime they gave me Protonix, a
proton pump inhibitor
drug, to control
gastric acid
secretion. Since there was no food in me, it helped prevent my insides from being digested by my own stomach acid.

Before my surgery, my kids weren't allowed to see me. Aside from Beth, who visited several times every day, few other people came. It's not that no one wanted to see me; it's just that I was too much of a reminder of how fragile life is. I was too close to the edge. It just took one person talking about how bad I looked with all the tubes delivering chemicals into me, machines beeping, my big pregnant belly, and gaunt looks from the weight loss, and everyone just relied on that person from then on to keep them informed. It was actually a good plan; I was too busy fighting for my life to entertain them. After my lungs cleared and I started getting three square meals a day through my PICC, I really perked up. After that, more and more friends and relatives visited. People gave me blessings and gifts or just sat and talked with me. Since my daughter Kaitlin was old enough to drive, she and her younger sister, Hailey, even stopped by several times. It was wonderful seeing everyone and knowing that I was on the mend and feeling so much better. The only problem I had left was my ever-growing abdomen. It was the single party crasher—the only thing still causing me misery.

I'd finally had enough and called the nurse in. Since I was feeling better, I was starting to get to know everyone's name, which had been difficult for me with all the turmoil and my medical condition in previous days. That morning Nurse Maggie responded. She was my favorite nurse and was like a mother to me. In looks and manner, she reminded me a lot of Beth. She was always concerned for me and was a dedicated problem solver.

"What's the matter?" Maggie asked as she entered the room.

"Is there something we can do about this?" I asked, pointing to my big belly.

"Well, I don't know if it would help or not, but I can talk to the doctor about inserting an NG tube and see if it would drain some fluid," she said. She explained that an NG tube went up your nose, down your throat, then all the way down your esophagus into your stomach and would allow any fluid to come out. It all seemed pretty tame.