Rick Clark Cancer

Fever, morphine, enema and other fun times
5/7/2003 thru 5/19/2003

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I write this several months after the fact. I procrastinated, partly because I have some complaining to do.

A word of advice about hospitals. Go to the smallest one you can find that can get the job done. Sturgis Hospital would have done just fine feeding me broad spectrum antibiotics while the blood culture grew, confirming that I needed (surprise) a broad spectrum antibiotic.

Cleveland clinic is as big as a midsize city. Each floor is a neighborhood, some being better than others, some at war with each other or themselves. My earlier stay was on a good floor. This time I ended up on the very floor the senior intern had carefully kept me off of before. (Perhaps this was my punishment for not having paid my bill yet).

The ambulance crew installed me in the hospital bed around 9:30 pm. It was May 7th. After a little while, a soft spoken intern came in. She said she had read my history (bless her!) and would only need me to fill her in on what had happened since I left the clinic yesterday. Didn't they leave the chart from the emergency room? Not that she had seen. So I told her about the pain, the laxative, the chills, and the shaking. It was several days before I figured out that the emergency room chart that had been carefully brought from the other hospital with me had been immediately sent down to the records department, where it was completely out of reach of any doctor for a week. Now there is a policy that could stand some rethinking.

Then she did all the usual poking and prodding. I didn't do nearly so well on the standing blood pressure trick this time. Suddenly the room somersaulted over my head, and I found myself looking at the good doctor over my distant knees. "No walking to the bathroom for you!", she said. When she was done and I was oriented properly in the bed, she ordered some pain killer and anti-biotics for me, and left.

The nurse gave me a bed pan, observing good naturedly that she wasn't paid enough to pick me up off the floor if I tried to walk to the bathroom. The bed pan was not one of the shiny metal ones that you see in old hospital shows, with a shape we all recognize immediately even if we've never used one. It was plastic, just strong enough to do the job. I wasn't quite sure which way it went.

The laxative I had taken the night before was a gift to myself that kept on giving. So I soon found that no matter which way I turned the bed pan, the narrow plastic edges cut into me. It was too shallow, and it had no inside rim to catch slosh. The upshot was that nobody other than an accomplished contortionist in perfect health could use it without making a god-awful mess. I was neither, and so had to call the nurse in to help clean me up. While she was there, she told me the doctors didn't want to give me Tylenol because they wanted to watch the fever as an indicator of the infection. But fentanol was on its way from the pharmacy.

This was the pattern for several days. Often cultures grow in two days, but this one took about five, plus one for a drug sensitivity test. So I only got a little Tylenol when my fever was very high and prolonged. And for some reason this floor was stingy with other pain killers.

There was no hope of sleep without pain killer. My muscles and joints and head were all aching from the high fever, and my gut was having some of its usual complaints. The nurse had a couple more opportunities to assure me that the fentanol was on its way. It finally arrived - at two in the morning. How can it take four hours for something to find its way up from the pharmacy? Don't they realize that when pain killer has been ordered its because someone is in pain?

The fentanol coursing through the IV helped a lot, though I still drifted in and out of sleep. Partly because the nurse was ordered to take my temperature frequently. The anti-biotic (Zosin) arrived from the pharmacy at 8 a.m., 10 hours after it had been ordered. What has the pharmacy got against this floor?

The intern and a slightly more mature doctor came early in the morning to check on me. Apparently a blood culture had been ordered, and had not happened. It surfaced that no phlebotomists were scheduled last night, and the nurse had essentially ignored the young intern's request that she do it instead. The older doctor's jaw tightened. "They're supposed to do those", she muttered. The nurse was called in, and there followed an awkward discussion in which nothing was resolved.

I saw then why the intern a month ago went to considerable trouble to keep me off this floor. There was a crackling tension between the nursing staff and the doctors. Only the female doctors, I later observed. Whatever happened to sisterhood? The undercurrent of conflict made me uncomfortable. I didn't want to be the rope in their game of tug-of-war. The nurse came back in later burning with resentment, and apparently feeling a need to explain her side of what I had seen. "Don't know what their hurry is for a blood culture. You've already been given anti-biotics so it's too late to get a good one". I believe a phlebotomist eventually drew the culture.

To my surprise the doctor who did my stent dropped by. He was pleased to see that the yellow was already starting to fade, at least from my legs. I mentioned that I was also looking forward to my gut pains fading. His brow furrowed. He said he didn't expect the stent to have any effect on that part of my problems. Oh, man. Well that was an unexpected disappointment. But at least the Octreotide should help.

I drifted in and out of sleep. Fever spikes woke me up and left the sheets soaked with sweat. At least the nurse finally got tired of changing my bed pan and found a bedside commode for me. Patti drove back down, having made arrangements for the kids at home. Seeing that I now had a visitor, the staff promptly took the visitor chair out of the room. At least she could sit on the commode with the lid down. It was her perch for nearly a week.

The next day, I got a visit from the palliative medicine doctors. They had been called by the intern who first checked me in, as she was concerned that I didn't seem to be getting anything for discomfort. They said they would recommend a morphine drip and Octreotide. Since they were women (and not even assigned to the floor), their recommendations were ignored. I got neither that day or night.

Unlike my prior stay at the hospital, I had no eating restrictions. I ate as heartily as hospital food permits, with an eye to keeping my weight up. But as the diahrea began to recede, my intestines were getting more and more uncomfortable. I told the palliative medicine doctors that I had gotten neither the Octreotide nor the morphine. This time they specifically prescribed it. I asked the floor doctor to make sure the prescription had made it to the nurses chart.

Come afternoon I was still more bloated, but had still gotten neither prescription. I asked the nurse about it and she said she was unaware I was supposed to get them! I finally got her to chase down some Octreotide. As she connected the medicine bag to the IV, I wondered what kind of relief this drug was going to give me.

Then it hit my veins. Instantly, my stomach cramped up and I felt completely full and distended. Oh no. This was having exactly the opposite effect from what I wanted! I regretted insisting on them giving it to me. Now I was going to need that morphine.

The nurse said that the morphine was on its way. But then there was an evening shift change, and I still hadn't gotten it. When I asked the new nurse, she said, "Oh no. That was a mistake. It's been cancelled." I had to be quite insistent that it was not a mistake. Eventually I got set up on a morphine drip, .2 ml/hr, with a booster up to 2 mg every 2 hours if needed. At .2 ml/hr, the drip rate was like that of a stalagtite in a cave. It seemed I would get more if they just waved the bag over my head and muttered some incantations. But maybe they knew what they were doing and I would get some sleep this night.

I did get some fitful sleep, but daytime on morphine was unsettling. I would close my eyes, but still see the room. Then the room would start changing, or I would get up and leave it, or strange people would come in. Knowing something was amiss, I would wake with a start and open my eyes. I had them take me off the drip for the daytime.

By now the diahrea had stopped, but so had everything else. I had developed a huge potbelly hanging on my bony frame. I felt full of gas, like a beach ball with a spine. I complained of this to the floor doctor. He prescribed Regulan to take before meals to help things along.

This was Sunday. Patti was visiting after church. I got a lot of belly pain after trying to eat. I eventually convinced Patti to leave. She didn't want to while I was in pain, but I didn't want her to see me on morphine.

All the while, the yellow in my skin was fading. At least that was working.

Good news come Monday. Patti says we were accepted by Michigan Medicaid! Thank God! And thank the politician who proposed the "Group 2 Caretaker" provision of Michigan Medicaid. Thank the legislature that passed it. Thank the lawyers that filed the injunction to prevent the Governor from eliminating it this year. Thank the taxpayers (including myself, I suppose) that funded it over the years. And many thanks to the doctors and hospitals that accept Medicaid patients despite the relatively low payouts and incredible bureaucratic hurdles and delays they experience to collect.

A palliative doctor came around again. I showed him the size of my belly, and told him of my discomfort. He was surprised, and offered to transfer me to his floor. He could do that? Great!

Patti and I had become very frustrated with this floor. The nurse call button didn't seem to work. That is, someone always answered it and said either "OK" or "I'll tell your nurse", but what you asked for half the time either never got done or was done a ridiculous amount of time later. Generally when a nurse or assistant wandered in at random (having not actually been told of our request). The people we actually saw were almost always courteous and helpful while in the room. But getting someone to the room was hit or miss. And if they had to leave for another call or some supply that wasn't actually in the room, we felt immediately forgotten. If they couldn't do what you wanted (like when they were out of spare blankets), nobody would get back to you to tell you that. If there was a shift change, patient requests never seemed to get passed on to the next shift. It seemed to me the intentions of the individual people were OK, but the system was stretched just a little too tight to work properly. I'm not sure if my roommate and I would have survived some of those days without Patti and my sister Becca stubbornly acting as advocates for us.

The palliative medicine floor was right below this one. They moved me that evening. The difference was amazing. I felt as if I had left a reform school dormitory to visit a rich aunt. Aunt Martha Brewster in Brooklyn, to be precise. Not that I actually have an Aunt Martha, but by coincidence my nurse had played Martha in the play "Arsenic and Old Lace", the same play in which I was to play the nephew before my medical problems yanked me off the stage.

Anyway, it was a huge private room. I geuss they figured severe pain patients didn't need to listen to each other scream and moan. One end was carpeted, with several lounge chairs, including one that could be opened for a visitor to sleep in. There was even a small fridge visitors could leave you goodies in. A nice Amish quilt hung on the wall, too. The next morning I was to find out that the silverware was wrapped in a cloth napkin, not plastic; the cereal bowl was glass, not plastic; The response to the nurse call button was prompt; and they even bring you a newspaper! I couldn't imagine what this room cost.

This being the pain specialist floor, they really upped the morphine dose. Good night's sleep, here I come! Well, no. La-La-Land is not all its cracked up to be. Why on earth would anyone get addicted to morphine? I heard voices all night long. I don't mean just the odd word or phrase whispering out of the shadows. I had a constant parade of imaginary chattering visitors circling my bed. Most of them claimed to be distant relatives of Patti. My body might have been resting, but my mind was exhausted. I knew they weren't real, but that didn't make them any less noisy.

The next day, my X-ray results came back. It turned out I had very little gas in me, most of that volume was stool. My self image was changed from being a beach ball with a spine to an even less appetizing one. A sack of manure with a spine. They weighed me at 165 pounds. So about 20 pounds of manure as a matter of fact.

It was getting worse, not better. I tried to eat, but there was just no room left. They didn't have drugs enough to overcome the discomfort. They tried to give me a "stool softener", which I refused. What little stool I got out was already diahrea. The problem wasn't blockage, it was just failure to move. Finally the nurse said, "Well, I guess you'll need an enema."

She sounded as if she dreaded that at least as much as I. She said they had two kinds. She would give me an over the counter, self administered one first. If that didn't work, well, there was "the other kind".

The first kind was a little squeeze bottle. It didn't work. I didn't get much more out than went in. So I got to experience "the other kind". She hauled in the equipment. It apparently involved garden hose and industrial strength detergent. The bathroom door was propped open and a path was cleared between it and the bed. My IV rack was disconnected from the wall and the wheels pointed in the right direction. A half gallon bag of milky fluid was hung from the top of the rack, attached to the aforementioned hose.

The nurse took a deep breath and said, "OK Mr. Clark. Bend over."

When the bag was empty, and I had waited the requisite amount of time, she said "OK. You can go now." I pranced as spritely as my puckered behind allowed to the toilet.

This was much more successful. Over the next hour or two I experienced much relief. Not the twenty pounds implied by the scale, but enough so that I wasn't ready to volunteer for another enema. The enema also kicked my kidneys into overdrive. I passed 2 gallons of urine that night. So apparently, my intestines weren't so much filled with stool as they were swollen with fluid.

I improved greatly over the next couple days. My fever faded, except for the occasional spike. My jaundice continued to fade. Belly got down close to normal size. They replaced my three times a day Sandostatin shot with a monthly ALR shot, gave me a bunch of antibiotic pills to take home (Ciprofloxin), and discharged me on Friday, May 16th.

I was still pretty wobbly for a couple of days. It was nice to sit in the sun, and take naps as I needed them. It was also nice to see my kids, and other people I knew. The doctors had given me a prescription for oral morphine, but I didn't fill it. Even so, a couple nights later I was kept up by another chorus of imaginary voices. This time they were all doctors circling me and taking credit for my remarkable recovery. I had to go for a two mile walk at 4:00 am to clear my head of them.

It sure is nice to feel sunshine, and see friends and family (outside the hospital) again.

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Copyright 2003 by Rick Clark and heirs. Non-commercial users can link to or copy freely, so long as copies are in whole and include this copyright notice. Commercial users please contact rbclark@pobox.com or the current address at web site rbclark.sturgis.mi.us. If you found a way to make money off this my wife and kids (or I. I might be around a while yet.) could use a piece of it.