D e s e r t E x p o s u r e
December
2008
The Snake and I
Page: 2Suddenly I felt worse, so I ended the call with Caitlin. "I feel really bad here, y'all," came from me and suddenly I was surrounded, my gurney was tipped head down (called Trendelenburg), someone was saying my pulse was in the 30s and my blood pressure was in the 50s, and those aren't good numbers. I don't remember how they knew my blood pressure so fast; I do remember feeling a way I've never felt before. It was something like the feeling one gets just before vomiting, but I wasn't really nauseated. It must be the feeling you gets as you faint, but I've never fainted so that's a guess. It was like being both here and there and not knowing which was what.
Someone else said, "Get the pacer pads," and a nurse was putting them on me. Then, in another moment of brilliance, I, the trained physician, said, "Don't do that, it will hurt." I laugh now as they did then. After all, what are some little shocks compared to the pain that was now not just in my foot, but climbing my leg, which had already swollen well above the knee? Further, if indeed I did need to be paced, it would be that very pacing keeping me alive and I really probably wouldn't file a protest. I guess my thinking was, perhaps, not at its best.
Good fortune followed. I never did require pacing, though I got close once or twice more. Lots of IV fluid running into both arms seemed to be adequate as a start. Then, maybe an hour and a half or two after arrival in the ER, the anti-venom was finally ready.
In these trying economic times, the anti-venom is its own adventure. Though much safer than what was used a few years ago, it still carries some risk for medical complications and a virtual guarantee of economic ones. It is about $1,750 a vial and I required a total of 12 vials (in retrospect, I perhaps should have been given more). Surprisingly, this is a moderate dosage, not extreme. I have seen as many as 22 vials given in extreme cases, particularly when there is a long time between snake bite and medical care.
Once the liquid money had started flowing into my veins, I was transferred from the ER to the medical ICU. Now, I have spent much of the last 25-plus years in hospitals because that is where I work, so some of this experience may have been a bit less traumatic for me than for some. Still, I got a completely different perspective from a hospital where I had never been before, nearly upside-down with feet up and head down. The primary view from this position is the ceiling.
I arrived in the ICU in one piece, still breathing and with my heart doing its own work unaided. My nurse was a rugby-playing Canadian man named Ron. He was great. He assisted me in finalizing the transition from regular human to patient by helping me from "civvies" to the highly stylish, if somewhat revealing, hospital gown. The movement required was surprisingly painful.
As I settled in and tried my best to answer yet again all the usual questions that one is asked myriad times by myriad people, how far into a haze I had descended became more apparent to me. The challenge of the evening was balancing pain control with the maintenance of blood pressure, which unfortunately are goals that can be at odds with one another. Despite liters of IV fluid, my blood pressure was only in the 80s to 90s (systolic, or the top number) and the nurse could not give me any narcotic for fear of further lowering it. I couldn't take any kind of aspirin or related pain meds because they interfere with platelet function and worsen the problem with blood clotting that already was significant from the snake's venom. During this time, the swelling was relentlessly progressing so that by the wee hours of the morning I could leave a dent knuckle-deep in my hip from the bites on my foot. It was a long night.
As morning approached, though I was still very sick and quite miserable, neither my survival nor my ultimate recovery seemed quite as uncertain to me as they had the night before. I wanted my wife. I thought I should call her before her flight, but after she had slept. It was a simple little call: "Hey, honey. Not to worry, everything's fine. I just happen to be in the ICU with multiple IVs, pacemaker pads and anti-venom dripping in. The weather's great." Well, that's not exactly what I said, but I was trying to communicate that really, I was OK. I don't think that part went so well. When she finally did arrive hours later, however, she was an angel manifest. From that point on the gifts amidst this horror emerged and began, ever so slowly, overcoming the costs.
Maybe, just maybe, that is really the point of all this. The gifts.
We are vulnerable beings on the physical plane. A creature that itself probably weighed less than five pounds changed my outlook and came treacherously close to extinguishing it in a mere moment. As the first drama receded, during times that the balance of pain control and narcosis allowed, I began to get glimpses of understanding about my own vulnerability.
The next couple of days were spent in the hospital with very good nursing care. My blood pressure came up and finally pain medicine was available. This time is a bit of a blur. I became quite anemic from the effects of the venom. On the last day I began to try to move around a bit, but the pain was searing any time my foot was not elevated. I was pretty weak. Just maneuvering to the bedside commode was both immodest and excruciating. Still, healing had commenced.
There were moments of frustration and moments of laughter. On day three, I was discharged from the hospital with a final touch of humor. My nurse on that last day looked to be about 11. She was asking me her nurse questions and when she got to "what is your work?" I answered that I was a doctor. She apparently was shocked. Why would I say that? I can only quote her: "Uhn-uh, a physician? Shuuut uuup!" I found this hilarious but also a reminder of the mythology that would suggest that those of us who happen to doctor for a living are somehow made of something different from the rest of "regular" folks. Lying in that bed, unable to really take care of myself, I was certainly reminded of just how regular I am.
I've now been home for quite a few weeks. I am just beginning to be able to bear a bit of weight and the swelling is now limited to the foot and ankle. A component of my blood-clotting system called platelets fell last week to very low and I had a little bleeding under the skin, but that has now resolved. I know I will be rehabilitating for some weeks to come. I am on the mend, but somehow I am not the same. I have been the recipient of not only a violent envenomation, but also of so much more.
Above I mentioned gifts. That is what I take from this experience more than anything else. I have been given a much deeper understanding of who I am, stripped of my titles, and even of the physical abilities by which it is so easy to define myself. Under all that I am just a man. I have worked at my job a few days and found it remarkably difficult physically, yet the support and care of those with whom I work has filled my heart. I have come to an even more powerful experience of love: that of my wife, my family and my community.
A couple of rattlesnake bites that landed me in the ICU and waved my mortality before me have left me less traumatized than thankful. Not to suggest that I would be interested in a repeat performance — no, once is enough. Yet, I would not wish for this not to have happened. The many costs of this event are repaid with interest by what I was given on a Tucson desert night.