Day 3 "So What Does That Mean?"
Continued from post below:
Tuesday, December 14, 2004: “So What Does That Mean?”
The next morning the girls woke early, eager to make the day pass quickly. I was going to the hospital; they were going to classes, and by afternoon, mom would probably be home. We made sure the house was picked up as we left. I stopped by the office to tie up some loose ends, and an hour later, I was wondering the halls of the unfamiliar hospital like a lost lab rat. With the help of some smarter rats, I finally found the right hall and room.
Julie was feeling fine considering she had hardly slept. Every hour had been punctuated with some scheduled interruption or other. And at 1:00AM, a new patient was brought to “bed one” behind the drawn curtain. (Clinically speaking, she was a morbidly obese “possible stroke” patient [though they’d pretty much ruled it out by morning—the stroke not the obesity.] For breakfast, Julie got a bowl of oatmeal and a bran muffin, which was fine, but the ailing lady on the other side of the curtain called the kitchen and ordered bacon, sausage, eggs, hash browns—the full “farmers breakfast”—and she got it!.
“So What does that mean?” Julie mouthed.
“That’s a good sign,” I whispered, “It probably means they have high hopes for you and that they attribute your fine figure to eating light breakfasts.” Oh, that such kind truths always fell trippingly off my tongue.
Just then a nurse came in, wrote some new numbers on a small chalk board on the wall, then left. Blood pressure was still good. Troponin was now point two one (.21). The other letters and numbers were meaningless to us.
“So what does all that mean?” Julie asked.
“Well, the one that starts with “t” is up slightly, but only slightly,” I said.
“Isn’t that the one they want to go down?” she asked.
“I think so, but we need some sort of range to know what it means.”
In stepped a polite Middle Eastern man with a kind accent. I knew before he spoke that this had to be Dr. Abuman. I’d heard through the grapevine (a medical grapevine that until the night before I didn’t know existed) that he would be Julie’s doctor, but I had forgotten how to say his name. He asked Julie to tell him about her Monday “episodes” as he called them, and she ended her story with two questions that were very important to her: Did she have a heart attack? And if so, was it brought on by something she did? She was pleased with both answers:
“First of all. No. This was not a heart attack. It’s semantics I know, but I would simply call this an episode. Something got your attention and you got our attention and now together we want to learn what it is. But if a heart attack is… let’s say a hundred points; what you have experienced is about a half of one point. I understand why you ask, and I tell you have my permission to not call this a heart attack—there is no damage to your heart for instance, but the last two EKGs show something that the first two did not. As to your other question…. You are what? A teacher? Very active. You work hard and go go go… This did not cause your episode.
“I didn’t think so. I do try to get a lot done in a day,” she explained, “but it’s not at all stressful for me.”
“When we say “stress on a heart” we do not mean stress as in “hectic day stress” we mean not enough oxygenated blood is getting to heart muscle (that’s what triggers the troponin level). In your case we suspect the front left muscle which is most important was involved. But that is an urban legend about stress, I say. With someone your age and healthy like you, doing your job and being busy has nothing to do with this episode. When we fix what is wrong, you’ll still work hard just like you did before. You did nothing to cause this. It is most likely heredity.”
“You say ‘when we fix this.’ What does that mean? Am I not going home today?” Julie asked.
“We’ll see. I don’t think we’re going to put you on a treadmill. I’m waiting on a call from one of my partners, Dr. Ryder.”
I tossed in a thought I’d been holding, “I noticed that the trobonin level is up a little,” (still not sure how to say the word) “but what does that mean? Can you give us a range or something to compare it to?”
“That is a good question? That is why we are both optimistic and… uh…watchful.” He wrote a new slightly higher number by the word “trop” on the chalkboard. “This went up slightly in the 5:00 sample, but the count is still very low, but troponin is very specific enzyme to heart muscle. That’s why even when it’s very low we pay attention. I’m going to go call to Dr. Ryder discuss your last EKG, see a few others, and then I come back.”
His words were sensible and somewhat reassuring—especially when a nurse came in a little later and wrote the most recent troponin number on the board. It was lower than the one Dr. Abuman had written.
“That’s good, right? Are you sure that’s the most recent test?” we asked.
“Yes, it just came back,” she said.
“So what does that mean?” Julie asked, “Can I go home today?”
“I really can’t say. It depends…but you’re right that the count has peaked and that’s good. The doctor will be able to answer your other questions.”
Dr. Abuman came in as the nurse stepped out.
“I just talked with my partner, and we are not going to put you on the treadmill, because that tells us very little in your case. We know from the EKG that there was an irregularity. Little? Yes. But you’re young and should not have to wonder ’about this. We also don’t like to wonder, so we are going to send you to Mercy for a “heart cath.” Do you know what this is?”
“We do, but that one count went down. That’s good. Last night’s doctor said I could do the treadmill if that went down,” she said hoping to change his mind.
“Yes, that’s true, and that means we caught something before it happened, but we now know more than we knew last night and the heart cath may show us what we caught. It will give us a true picture.”
“Is something wrong,” Julie asked.
“We won’t know without a cath, but I think there is something. I could be wrong. I’m not 100% sure, but about 95% sure that they will find a blockage in the left-coronary artery, and in your case, I think they’ll find just one. This would be corrected simply with angioplasty and a stint all at the same time. It is very common procedure. This is not surgery it’s just a procedure.”
“Can we go ahead and do this today?” Julie asked, still eager to go home.
“I don’t think so, but I will check. Maybe.” He smiled at her spirit.
“Will you do the procedure?” He had earned her trust.
“I can’t because I’m the attending physician here all week, but my partner, Dr. Ryder wants to do this for you and will work you in as soon as possible. He is very good. I think this will be tomorrow morning. They will take you to Mercy by ambulance, but don’t be frightened. It’s just policy.” He stepped toward the door and turned, “It’s good that you came. Don’t worry. We’ll take care of you.”
Her smile turned to a sigh as he left, “Another night. Will you stay with me?” I assured her that I would.
In thirty short minutes, we had gone from a postponed walk on a treadmill to a scheduled ride in an ambulance. In spite of Dr. Abuman's reassuring explanation—just and episode, just a procedure, just a policy —we felt like this had escalated to a new level. Until then, we had assumed that Julie would be back home, back to work, etc. saying “Guess where I spent the night?” They’d laugh and things would go on as usual. We had told only a few people where we were because there was just nothing to say. Though there was still no alarm, a three-day disappearance is harder to explain, so we called our family and some co-workers to assure them all was well.
Just before lunch, Julie’s sister Melanie called back to tell us she and their mother, Donna, had gotten tickets to fly in from Kansas City that same day. Julie tried to talk them out of it, but Mel reasoned that Julie would go if this were one of our daughters, and Mom was coming—simple as that; and since Mom was coming, she was joining her—simple as that. Julie smiled as she told me and pretended to “wish they wouldn’t do that,” but from then on she felt much better about the whole thing—still wanted me to spend the night—but was less anxious about the girls being home alone. The arrival of Grandma and Aunt Melanie was a bright spot of the evening.
To some, I suppose, it may seem a little unnecessary that I spent the night at the hospital, but of the nearly 9,000 nights since our first together, we have probably been apart less than twenty-five. (Most of those were my trip to Israel in 1997.) I don’t know many couples who can say that (or who would even want it to be so) but for us, it’s normal… and just one of the benefits of having worked at the same school with the same schedules, conventions, Senior Trips, etc. for twenty-five years.
Tuesday, December 14, 2004: “So What Does That Mean?”
The next morning the girls woke early, eager to make the day pass quickly. I was going to the hospital; they were going to classes, and by afternoon, mom would probably be home. We made sure the house was picked up as we left. I stopped by the office to tie up some loose ends, and an hour later, I was wondering the halls of the unfamiliar hospital like a lost lab rat. With the help of some smarter rats, I finally found the right hall and room.
Julie was feeling fine considering she had hardly slept. Every hour had been punctuated with some scheduled interruption or other. And at 1:00AM, a new patient was brought to “bed one” behind the drawn curtain. (Clinically speaking, she was a morbidly obese “possible stroke” patient [though they’d pretty much ruled it out by morning—the stroke not the obesity.] For breakfast, Julie got a bowl of oatmeal and a bran muffin, which was fine, but the ailing lady on the other side of the curtain called the kitchen and ordered bacon, sausage, eggs, hash browns—the full “farmers breakfast”—and she got it!.
“So What does that mean?” Julie mouthed.
“That’s a good sign,” I whispered, “It probably means they have high hopes for you and that they attribute your fine figure to eating light breakfasts.” Oh, that such kind truths always fell trippingly off my tongue.
Just then a nurse came in, wrote some new numbers on a small chalk board on the wall, then left. Blood pressure was still good. Troponin was now point two one (.21). The other letters and numbers were meaningless to us.
“So what does all that mean?” Julie asked.
“Well, the one that starts with “t” is up slightly, but only slightly,” I said.
“Isn’t that the one they want to go down?” she asked.
“I think so, but we need some sort of range to know what it means.”
In stepped a polite Middle Eastern man with a kind accent. I knew before he spoke that this had to be Dr. Abuman. I’d heard through the grapevine (a medical grapevine that until the night before I didn’t know existed) that he would be Julie’s doctor, but I had forgotten how to say his name. He asked Julie to tell him about her Monday “episodes” as he called them, and she ended her story with two questions that were very important to her: Did she have a heart attack? And if so, was it brought on by something she did? She was pleased with both answers:
“First of all. No. This was not a heart attack. It’s semantics I know, but I would simply call this an episode. Something got your attention and you got our attention and now together we want to learn what it is. But if a heart attack is… let’s say a hundred points; what you have experienced is about a half of one point. I understand why you ask, and I tell you have my permission to not call this a heart attack—there is no damage to your heart for instance, but the last two EKGs show something that the first two did not. As to your other question…. You are what? A teacher? Very active. You work hard and go go go… This did not cause your episode.
“I didn’t think so. I do try to get a lot done in a day,” she explained, “but it’s not at all stressful for me.”
“When we say “stress on a heart” we do not mean stress as in “hectic day stress” we mean not enough oxygenated blood is getting to heart muscle (that’s what triggers the troponin level). In your case we suspect the front left muscle which is most important was involved. But that is an urban legend about stress, I say. With someone your age and healthy like you, doing your job and being busy has nothing to do with this episode. When we fix what is wrong, you’ll still work hard just like you did before. You did nothing to cause this. It is most likely heredity.”
“You say ‘when we fix this.’ What does that mean? Am I not going home today?” Julie asked.
“We’ll see. I don’t think we’re going to put you on a treadmill. I’m waiting on a call from one of my partners, Dr. Ryder.”
I tossed in a thought I’d been holding, “I noticed that the trobonin level is up a little,” (still not sure how to say the word) “but what does that mean? Can you give us a range or something to compare it to?”
“That is a good question? That is why we are both optimistic and… uh…watchful.” He wrote a new slightly higher number by the word “trop” on the chalkboard. “This went up slightly in the 5:00 sample, but the count is still very low, but troponin is very specific enzyme to heart muscle. That’s why even when it’s very low we pay attention. I’m going to go call to Dr. Ryder discuss your last EKG, see a few others, and then I come back.”
His words were sensible and somewhat reassuring—especially when a nurse came in a little later and wrote the most recent troponin number on the board. It was lower than the one Dr. Abuman had written.
“That’s good, right? Are you sure that’s the most recent test?” we asked.
“Yes, it just came back,” she said.
“So what does that mean?” Julie asked, “Can I go home today?”
“I really can’t say. It depends…but you’re right that the count has peaked and that’s good. The doctor will be able to answer your other questions.”
Dr. Abuman came in as the nurse stepped out.
“I just talked with my partner, and we are not going to put you on the treadmill, because that tells us very little in your case. We know from the EKG that there was an irregularity. Little? Yes. But you’re young and should not have to wonder ’about this. We also don’t like to wonder, so we are going to send you to Mercy for a “heart cath.” Do you know what this is?”
“We do, but that one count went down. That’s good. Last night’s doctor said I could do the treadmill if that went down,” she said hoping to change his mind.
“Yes, that’s true, and that means we caught something before it happened, but we now know more than we knew last night and the heart cath may show us what we caught. It will give us a true picture.”
“Is something wrong,” Julie asked.
“We won’t know without a cath, but I think there is something. I could be wrong. I’m not 100% sure, but about 95% sure that they will find a blockage in the left-coronary artery, and in your case, I think they’ll find just one. This would be corrected simply with angioplasty and a stint all at the same time. It is very common procedure. This is not surgery it’s just a procedure.”
“Can we go ahead and do this today?” Julie asked, still eager to go home.
“I don’t think so, but I will check. Maybe.” He smiled at her spirit.
“Will you do the procedure?” He had earned her trust.
“I can’t because I’m the attending physician here all week, but my partner, Dr. Ryder wants to do this for you and will work you in as soon as possible. He is very good. I think this will be tomorrow morning. They will take you to Mercy by ambulance, but don’t be frightened. It’s just policy.” He stepped toward the door and turned, “It’s good that you came. Don’t worry. We’ll take care of you.”
Her smile turned to a sigh as he left, “Another night. Will you stay with me?” I assured her that I would.
In thirty short minutes, we had gone from a postponed walk on a treadmill to a scheduled ride in an ambulance. In spite of Dr. Abuman's reassuring explanation—just and episode, just a procedure, just a policy —we felt like this had escalated to a new level. Until then, we had assumed that Julie would be back home, back to work, etc. saying “Guess where I spent the night?” They’d laugh and things would go on as usual. We had told only a few people where we were because there was just nothing to say. Though there was still no alarm, a three-day disappearance is harder to explain, so we called our family and some co-workers to assure them all was well.
Just before lunch, Julie’s sister Melanie called back to tell us she and their mother, Donna, had gotten tickets to fly in from Kansas City that same day. Julie tried to talk them out of it, but Mel reasoned that Julie would go if this were one of our daughters, and Mom was coming—simple as that; and since Mom was coming, she was joining her—simple as that. Julie smiled as she told me and pretended to “wish they wouldn’t do that,” but from then on she felt much better about the whole thing—still wanted me to spend the night—but was less anxious about the girls being home alone. The arrival of Grandma and Aunt Melanie was a bright spot of the evening.
To some, I suppose, it may seem a little unnecessary that I spent the night at the hospital, but of the nearly 9,000 nights since our first together, we have probably been apart less than twenty-five. (Most of those were my trip to Israel in 1997.) I don’t know many couples who can say that (or who would even want it to be so) but for us, it’s normal… and just one of the benefits of having worked at the same school with the same schedules, conventions, Senior Trips, etc. for twenty-five years.
posted by .Tom Kapanka | 10:53 PM
1 Comments:
Comment above found 3-22-08.
Don't you love finding random comments 30 months after you write post?
I missed the Hot Rod Halloween...
Things could be worse. =)
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