23 March 2010

Put your right foot in, take your right foot out . . .

One of the few ways I can still amaze my wife after almost thirty years, at least when I'm not irritating her by doing the very same thing, is by remembering little details of of a place and time. What really makes her shake her head is that I can tell you, draw a floor plan if I must, exactly how the ER was set up in 1954 when I would be passing through on my way up to the wards; but, except for a very few exceptional bleeds I will not be able to remember what was bleeding where to save my soul. It completely baffles my wife.



It has always been like that. You would think that going over the history, method acquired, duration, severity, previous attempts at the same bleed, etc, etc five times during the admission process would somehow embed it firmly in my memory. You would be wrong. The next time I was admitted to the hospital, no matter if it was the next day, a couple weeks, or a month or two later, I would be back trying desperately to remember why and when I was there the last time. To be fair, most of my hemorrhages had an air of monotony about them that would warm the cockles of an accountant's heart, but it was still just a bit embarrassing not being able to remember when or where my last bleed occurred. Eventually—actually more like in old age—I started keeping a journal listing my bleeds and the dates, location, treatment, etc just so I would be able to tell the doctor, or ER nurse. The only problem with the journal is that I often forget to make the entries. But we forge on.

What I am trying to say is that I have always been able to remember the very trivial, like what Dion wore on his first appearance on "American Bandstand," but I draw a complete blank on the more important moments; which is my way of saying I have completely forgotten this girl's name and how I met her.

I believe her name started with a 'D', which is as good a letter as any, so I'll call her Donna, and I have a hunch I met her at the Prehistoric Forest.  Prehistoric Forest was a tourist trap/roadside attraction in the Irish Hills area of Michigan, and the summer between my junior and senior years in high school I worked there as a tour guide. It was the perfect job for a young man with a highly developed interest in young women, and I had more than a few dates because of it. I think the chain of events went something like: I met Donna and got her phone number when her family stopped in at the Prehistoric Forest; then I had this hemorrhage; and finally Donna and I went out on our one and only date. Some of the details may be incorrect, but I know I had the hemorrhage, and I know we had the date.

The hemorrhage was a doozie. My knowledge of neuro-anatomy is, on a good day, sketchy at best. I have a pretty good idea of the general whereabouts of the brain and spinal column. After that, what started out as a kind of vague awareness becomes total ignorance. However, there is, I guess, a spot down near where your leg meets your torso where some nerves and blood vessels share space in a tube-like thing, and inside that tube-like thing is where my body decided to experiment with some spontaneous bleeding not long after I apparently met this girl not really named Donna. (Diagram that sentence, Sister Rose. I dare you.)

At this time treatment for bleeds consisted of what was essentially the second or third generation of AHG—the horrendously named Anti-Hemophiliac Globulin—but I think it had a new name which I have forgotten. They might have taken to calling it AHF (Anti-Hemophilia Factor), I don't know. There were a lot of variations on a theme at the time, and they all seemed to be experimental. Cryo-participate was still a year or so in the future, and the focus was on finding something, anything, that was consistently effective.

You also have to remember that I was a teenage boy whose attention could very easily get distracted by a passing student nurse. When an attractive young lady was making my bed, or just on the ward. you probably could have hung neon purple icing on my IV and called it "Bleeder Glop," and it's even betting that I wouldn't have noticed.

Anyway, the new AHG, or AHF, or whatever, was basically a freeze-dried powder that had to be mixed with sterile water. The problem was that it dissolved about as easily as ground glass, and would form a more or less permanent foam if stirred even slightly vigorously or shaken at all.  The nurses really didn't have time to mix it, and the blood bank didn't feel mixing the stuff was their job. (Our products were handled by the hospital's blood bank pretty much up until the late 60s or early 70s.) So we, the patients that is, often got assigned the job.

Thirty minutes or so before your treatment was due a nurse would bring in three to six tube-like vials. They were about an inch in diameter, and about six inches long, and were handled with the same care and overt steadiness you would give to nitroglycerin. You would then spend the next half hour or so gently rolling them back and forth on your bed until they had finally mixed. The nurse would then draw the contents of each vial and inject them into a larger bottle which would then be hung and finally you would get your treatment through an IV. This procedure also had to be done smoothly and gently. If the nurse injected the fluid too quickly into the large bottle you could end up with a bottle full of froth that could never be coaxed through an IV tube, let alone a needle. Makes me tired just thinking about it.

I don't know how effective it was as a coagulant, but it was amazingly sticky and would have made an excellent glue.

This hemorrhage soon let us know it was no run of the mill joint or soft tissue bleed. It felt like a white hot spike was being driven into my groin, and soon had my complete attention. This was before the hospital allowed guys with hemophilia to be given narcotics, and we pretty much had to find our own way of dealing with the pain. None of my usual practices worked. Actually, they never really worked all that well, but they usually allowed me to get through the day with a modicum of sanity. This time there were several days I couldn't even scrape up a modicum.

One of my life's truly selfless hero's arrived just in time. Like I said, Hospital Policy did not allow bleeders to be given narcotics. Since we always seemed to be bleeding it was feared they would be creating addicts right and left if they opened that cabinet. This young doctor, I believe he was a Simpson Fellow but I'm not sure—he was definitely through his internship and first couple years of residency—anyway, after a couple of days watching me have my fun he decided enough was enough, and not only ordered, but personally administered a hefty dose of morphine.

I don't know what kind of trouble, if any, he got into for this breech of policy, but the shot, and one or two after, allowed me to get through the worst of the bleed. In hindsight I also think it might have helped the healing process. When you are in pain with a hemorrhage the muscles around the bleed tense up and put a lot of strain on the area that's bleeding. It's my belief that this strain, and constant tension, don't allow the tiny vessels that are bleeding to heal, and if you can relieve the pain the muscles relax, which takes the strain off the injury and allows it to begin healing.

Anyway, the hemorrhage finally resolved itself, and sometime around the third week the discussion during rounds turned to sending me home. The only problem was, my leg didn't work.

The hemorrhage had pinched a nerve or two and the muscle responsible for straightening my right leg and keeping it straight was no longer receiving orders. For you anatomy buffs out there, I think it was the rectus femoris, which also has some role in flexing the thigh. The upshot of all this is that walking was just a bit iffy. My foot wouldn't come forward like it should when taking a step, and it would drag like I was doing a bad imitation of the mummy; and when I was standing still it was more a matter of balancing on my leg, and every now and then it would just collapse at the most inconvenient times. Dancing was definitely right out. I also had trouble—as in couldn't do it if you paid me—lifting my foot/leg to cross them or do something mundane like move my foot from the gas pedal to the brake. And as for actually pressing the brake pedal, well, we'll get to that in a minute.

About two weeks after I got home I called Donna. (Remember Donna? I talked about her a little bit several paragraphs back. Nice girl. Lived on a farm outside Dundee. Had two big farm dogs that looked like they brought down the occasional bull just for a snack; and a father who could palm bowling balls, had a cabinet full of very nice shotguns, and some rather strong opinions about curfews.) I explained to her that due to an injury incurred during some very hush, hush work for an agency I couldn't disclose, I had been unable to call her until now, and was wondering if she'd be interested in taking in a movie.

She couldn't that weekend, but indicated that the next weekend was open for consideration. This was perfect because it allowed me another week to practice some moves. (Please, don't think that way.) Specifically, getting my right foot off the gas pedal and onto the brake, and then if there was time, pressing the brake pedal. I worked on that for several hours every day. It is now my firm belief that young men that age, or perhaps any age, would be much more responsible about their physical therapy, if as a collateral result there was the vague glimmerings of a hope of a possibility of a very pleasant evening with a rather attractive young lady that if followed up properly might possibly lean toward additional, even more very pleasant evenings with said attractive young lady.

Now, my parents had some rather old fashioned ideas about safety, and had made it clear that I wasn't driving any car, even the '53 Ford Dad drove to work and I used for dates, anywhere until that leg was functioning properly. I pointed out that this would all be a moot point if we had a car with an automatic transmission so I could use my left foot on the brake, but my logic was wasted and both Mom and Dad said they were willing to show me a moot point if I really wanted one. We had a couple of debates about the meaning of 'properly' which I lost, and Mom started making dark hints about perhaps driving Donna and me to the movie. This was clearly unacceptable.

I worked feverishly on lifting that leg onto the brake pedal. I developed a move I thought was quite ingenious. Instead of reaching directly for the gear shift, I would dip my hand down and quickly grab my leg and throw it onto the brake pedal. I practiced the move for hours in the driveway, and then along the country roads near our house. Finally, the motion was so smooth it almost definitely looked safe, and I was ready for the big test.

I was so nervous I think I had to change my shirt when we got home, but I had passed. I had driven Mom to Kroger's and back safely, and they decided to let me use the car.

I made the drive to Dundee, about twenty miles, and found her family's farm south of town without any mishaps. Now, I still usually used a crutch on my right side when walking just to keep from falling when that muscle didn't pay attention to its duties, but in the interest of looking cool I left it in the car when I went up to her door. The dogs were circling, waiting for their chance, but somehow I made it to the door without stumbling. Donna's father seemed to think my surviving the walk from the car an indication of something or other, and only gave me mildly threatening looks while I waited for her. The dogs just watched sullenly when she and I went to the car, and we started the drive back to Tecumseh.

Everything was going smoothly. I was being so suave and witty Cary Grant could have taken notes, and I was managing the brake more smoothly than Fred Astaire could dance. When we got to the theater she was laughing, and seemed to be having a great time. It's just too bad I had to actually park the car.

Pulling into the parking space I made my patented grab at my leg. Unfortunately my toe got caught on the brake pedal, and I couldn't flip my foot onto the damn pedal. I jerked at the leg a couple more times, but only managed to look like I was having some kind of spasm. Luckily, we had been going very slowly when we pulled into the parking space, and the city had very kindly put a large telephone pole in front of that particular space.

Donna was out of the car like a shot, acting as if she'd never seen anyone use a telephone pole to stop before. As I got out my leg buckled up under me, and it seems she had never seen anyone genuflect when exiting an automobile either. That night's showing of an Audie Murphy western and a Steve Reeves Hercules film didn't help my cause much either. By the time it was time to go the seat to my right was cold enough it would have come in handy when I had a bleed.

Later the next week I tried to call her, but her dad seemed to think she was going to be busy for at least the next twenty years, and suggested I wait until then to call again.

Still kind of wish I could remember her name.

4 comments:

  1. Hey Guy - Great stuff as always. I really enjoy your posts! Andy

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  2. Great story. Really wish they would make a weekly 30 minutes sitcom out of it.

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  3. I love your writings! Keep up the good work!!

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