First Brush with Anemia

October 28, 2011

Prologue

Who knows when this really started, but I have been feeling very weak since my serious car accident on the evening of September 25, 2011. Even short walks have had me feeling utterly exhausted and it has been an effort to walk even a couple hundred yards without resting.

Let's go back a little farther. For the last year I have been feeling weaker and even small exertions have left me panting for breath. I have generally been fairly robust even though my physical fitness has never been exemplary.

And further back, even in my periods of peak (for me) fitness I have easily become short of breath. The story that follows may well be the culmination of a life-long ailment that has remained undiagnosed my entire life or it may be a recent development. Tests in the next few weeks may shed additional light on the back-story.

A Case of Nerves Leads to a Sleepless Night Before a Bus Ride

Let's start this account with the evening before the morning of October 26, 2011.

I had an appointment with my primary care physician, Dr. P., for Wednesday, October 26, 2011, at 9:00 am, for a routine follow-up on diabetes and weight control. I don't normally schedule early morning appointments. I'm a night person and do my best work after being awake for several hours so I rarely hit the pillow before 1:00 am. For some reason this appointment was for the morning.

Ever since the accident I am carless and have been depending on the Orange County Transportation Authority for my day-to-day needs. They have been working well (for the most part) for local and even semi-local day-trips. I have come to embrace the Senior Day Pass. While my contact with genuinely crazy people has increased by an order of magnitude, the bus experience has been generally acceptable/bearable. But getting from my house to Gottschalk Medical Plaza at U.C. Irvine is not as easy as it might be; the walk at both ends of the bus ride is longer than normal and the bus runs infrequently. To get to my appointment at 9:00 am, I need to leave the house before 7:45. If I miss this bus I miss the appointment. Even if I catch the bus I am worried about my fatigue and walking nearly a mile to the doctor's office. All this causes me to worry and is probably why I didn't sleep more than an hour all night.

At least I showered and shaved the night before so all I had to do was throw on some clothes and get to the bus stop. I make it with time to spare. The #178 bus to UCI was awful. Here's a clue to the OCTA bus numbering scheme: double-digit routes are the bread and butter and are fairly predictable and reliable. Triple-digit routes are way flakier. More on that subject later. Half an hour bus ride got me to University Town Center and I walked the .82 miles across campus to Gottschalk. I got pretty tired on the 20-minute walk, but I've been getting pretty tired a lot for the last month.

You Don't Look So Hot

As I am walking back for my vitals, Nurse Susan looks at me funny and asks, "How're you feeling? 'Cause you don't look so hot." After vitals she has me lie down in the exam room. Before Dr. P. came in, one of his medical student came in and did a pretty good job but she didn't really touch on the fatigue. Dr. P. comes in next, mentions Susan's comment to him about her concern, asks a few questions, then sends me off to the lab for some blood samples. After the lab work I am done.

After a tiring walk back to the bus stop I learn that the bus only comes by once/hour and I just missed it. So I get a delicious Lee's sandwich on a fresh-from-the-oven baguette and wait. An hour goes by — no bus. A student calls OCTA and learns that the bus doesn't stop on that side of the street during certain hours, but on the other side as part of a terminal loop! So we cross and wait for another hour. Triple-digit bus routes: avoid if at all possible. That's my take-away from this.

By the time I get home it's been a 6 hour trip for a 10-minute (they always end up taking 1 hour) appointment. As an aside, also going home at that time were two cute UCI girls that had ridden in on the same bus as me six hours earlier. Also some weird guy who had gotten off and back on near the airport. I get the feeling this bus has a lot of regulars.

Sleep, Glorious Sleep...

I get home, tired from not sleeping and exhausted because of the blood situation. I crawl into bed and feel the welcome warmth of sleep take hold only to get jarred to alertness almost instantly by the phone. It's Dr. P. saying my hemoglobin count is really low and we need to decide what to do. He wants to schedule me for the Infusion Center as an alternative to the hassle of the ER. He says he'll make a few calls then call me back. When he calls back he says he studied my hemo count some more and told me to get to the ER, stat. He called ahead to pave the way for me and gave me the name of an ER physician, Dr. Rudkin, who had been briefed and was expecting me.

Whoopee! Another bus ride!

So I arrive at the ER at 5:00 pm after an hour bus ride from Lexington Lane. Not many crazy people on the bus this time, but packed to the gills with students and some working folk. But this is a nice double-digit route with more regular service and it goes practically door-to-door between Lexington Lane and UCI Medical Center. I am semi-comatose — the walking unconscious.

Triage

At 5:00 pm the ER was almost empty; still too early for the gun-shot victims, I guess. I checked in, got a wrist band, and within 5 minutes was in triage. They did a hemoglobin count and proclaimed that they couldn't wait for a bed to open up in the normal ER; they needed to start me on blood right away. Right as they are about to hook me up a bed opens up and I move into a private room in the ER!!! With TV!!! They start me on saline right away and do some more tests including some poking "down there." Later the test comes back negative for blood "down there" and that is a very good thing!

ER

Then I got moved to the regular part of the ER with the curtained partitions where you can hear all the other cases happening. The ER kept wanting to check me into the hospital, but I kept reminding them that Dr. P. had struck a deal with the supervising doctor that they would change my oil, then test to see if I improved. They would check on my claim, confirm it and let me stay. Checking into and out of the hospital adds many hours to any visit. On the up-side, the hospital is more comfortable than the ER.

I kept sliding toward the foot of the gurney. It was painful and difficult to hitch back up because of the separated shoulder from the accident and the IV stuck in my arm. Later an orderly made some adjustments to the gurney so I no longer had to deal with that. I was grateful.

A few hours into my transfusion they wheel a guy into the next stall who was drunk and jumped out of a 3rd story window. He kept saying that he wasn't drunk and that he fell and the doctors are all, "Yeah, right..." and I can hear them talking about his blood/alcohol levels. He really screwed up his foot and moved off to immediate surgery after a few hours in the ER. Poor guy. Most likely he will never walk without a very noticeable limp.

So I got two units of blood, each one taking about 2 hours, plus waiting about an hour after each bag for ER personnel to get time to attend to me. After the 2nd unit they took a blood sample to the lab for a hemo count. An hour later the results came back at 7.1 grams per deciliter (gm/dl), up from the 5.9 I tested in triage. 13 gm/dl is normal. They told me that they didn't discharge at lower than 8 gm/dl and that they were checking me into the hospital.

This causes major anxiety for me because on one hand if I check in I will get fast-tracked for tests including the colonoscopy. On the other hand it would add minimum 12 more hours to my stay and likely 24-48 more hours. I had made no provisions for being out more than a few hours and needed to get back home to feed Nibbler, answer some clients' emails, etc. My front door wasn't even locked. So I signed the Discharge Against Medical Advice waiver which didn't make the ER staff very happy. They sort of yanked the IV out and that was alarmingly messy and uncomfortable. They pointed and said, "The door's that way."

You Guessed it — Another Bus Ride

At 3:00 am I was out in the cold in shorts, a tennis shirt and, luckily, a fleece sweater. As a walked to the bus stop I felt better than I have all month, maybe longer even. That 1.2 gm/dl raise in hemoglobin made a HUGE difference in my endurance and energy!

I check the schedule posted at the bus stop. Next bus home: 5:00 am — two hours. Those were two miserable hours spent on that bus-stop bench in the dark cold. I credit decades of off-shore racing at night with my tactics for conserving warmth and keeping a positive attitude.

Home Again, Home Again, Jiggety Jig

We wouldn't think anything of being stuck out in a race like that. We might have been better dressed, but the temps were the same. At least I was dry! In fact, that is how I felt — waiting for that bus — like I was on the weather rail on some cold dark beat. Conserve heat, do what it takes to get the job done, dream of a warm haven.

At 6:00 am I was finally home, 14 plus hours after I left. Starting with the early morning visit to Gottschalk I had been away for 23 of the last 24 hours. My head hit the pillow and I was out for a blessed 4 hours of sleep.

It's now Thursday, October 27, and I was supposed to go sailing with my friends the pistachio growers from Inyokern but I needed to coordinate my next moves with Dr. P. So I connected with them via phone, we had a meet and greet, then I sent them off to the harbor while I went back home to wait and see what's what. Plus sleep a little more.

Thursday afternoon Dr. P. called and we discussed what was next. He faxed in a prescription for an iron supplement and we set up an appointment for next Wednesday. He is setting up an appointment for a colonoscopy in the near future. I took the bus to pick up the prescription and do a little grocery shopping.

Normalcy Restored

By the time I had finished at Albertson's the sailors from Inyokern were in and were able to pick me up at Albertson's. We went back to their motel for a quick freshening up then down to the Pavilion where sailing buddy Rob ("Sail Smile") was having a get-together for his birthday. Max and Christine enjoyed meeting the more casual faction of the sailing locals and we had a great couple of hours with the very decent and cheap happy-hour appetizers.

We were at a table slightly off to the side of the birthday party because we got there a little late and the long table was full. As the waitress is bringing us some calimari and quesadillas she asks us if the noise is disturbing us. We just smile and say, "What noise? Oh! You mean the sailors?"

So what started off as a very unpleasant, then terrifying 24 hours finished off on a decent note with an optimistic outlook. In no way are we out of the woods yet, but the journey has been started and that's what counts.

I slept the sleep of the righteous and content.

Postscript

Dr. P. is currently thinking I may have "the family disease" - diverticulosis, which is what my father has and my sister too. We'll learn more in the next week after the "poke 'n' peek."

one week later • web log : : acme novelties