While in the Intensive Care Unit (ICU) after being in a coma, time appeared to move slowly. Each day the dressings on my leg fasciotomies and blisters were changed. The dialysis tech attended to the dialysis machine and treatments. Nurses gave me my medications throughout the day. The TV became my best friend as I passed the time. I do not watch a lot of TV, but I enjoy some of the shows on the History Channel and that is was how I passed the time, when I wasn’t watching the Pittsburgh Penguins
One morning at about 6 a.m., the surgical team was making rounds and came to visit me. I was not too alert that day. I was tired from the meds and I had my days and nights mixed up. I was listening to one of the medical resident students tell another student about mean arterial blood pressure (MAP). He said MAP pressure was a measured parameter and systolic and diastolic pressures were calculated. I thought that MAP is calculated and S/D is measured. I was too tired and drowsy to respond, but I made a point to remember what he said.
The next morning I made sure I was up and alert at 6 a.m. When they finished checking on me, I pointed to the resident student and asked him to repeat what he said the day before about blood pressure measurements. He responded that I was not awake and he was sure that I did not hear him the day before. I assured him that I remembered what he had said and asked him to repeat it.
This grabbed everyone’s attention and they encouraged him to repeat himself. So, he began talking about systolic and diastolic pressures being calculated and mean being measured. I asked him how mean pressure is derived and if he knew the formula. He did and said that S-D/3 plus D is used to get the MAP. I stated that if you use a formula to calculate it then it must be a calculated parameter. I think this is when he realized that he had confused the terms of calculated and measured. I asked him to calculate my mean pressure and compare it to the monitor values. He took out his phone and started the calculations. Before he could answer, I stated that it was most likely 2-3 mmhg off from the displayed value of the monitor. He confirmed that it was slightly different than the monitor and asked how I had known. This continued to garner the attention of the surgical team.
I asked someone to get me a tablet and pen so I could explain how the monitor uses integral calculus to calculate the MAP. I drew a blood pressure waveform and used the analogy of a civil engineer making a road through the mountains, pushing the peaks of the mountains into the valleys. One peak to one valley, when we are done we will have a flat road across the mountains. The elevation of the new road is the MAP pressure. Integral calculus is what the monitor uses to calculate the MAP from the systolic, diastolic and shape of the waveform.
When I finished, the lead surgical physician leaned over and told me it was the best explanation of MAP pressure he had ever heard and that he now had a much better understanding of it. We all had a good chuckle over the lesson and I invited them back the next day for another one. The story of the professor in the ICU giving lectures to the physicians spread through the nursing staff and several nurses commented on it.
After being in the ICU for about a week, I was moved to a med-surg unit where I was placed on intermittent dialysis. Next to being on a ventilator, the intermittent dialysis treatment was by far my least favorite. I was connected to the dialysis machine and the treatment took about four hours. During this time, they tried to pull off several gallons of fluid.
During the treatment, I felt very cold and was unable to get warm. They placed a hot air blanket on me. My wife, Amy, brought in a wool blanket and a tassel hat, but I was still freezing and could not warm up. At the end of the treatment, I felt exhausted and just wanted to sleep. On occasion, my legs would cramp as well. This gave me a new appreciation of what individuals go through who are on dialysis on a regular basis.
After about seven days of treatments, my kidneys started working again but my electrolytes did not stabilize. However, I was producing enough urine to prevent the need for more dialysis treatments. As time continued, my kidneys returned to normal.
One morning while in the med-surg unit, a physician came in and talked to me about performing a bone marrow biopsy. He said it could help identify the cause of the blood clots and could possibly identify any cancer in my body. I agreed to the procedure. It was done in my bed and was painful.
A needle with Xylocaine was used to provide a local anesthetic to the skin, tissue and bone. The needle was inserted at several locations and the shots were similar to those one gets at the dentist. The physician gave the Xylocaine some time to absorb into the tissue and returned with a drill. The bone marrow sample was taken from my pelvis requiring me to roll on my side. The drill bit went through skin and tissue and into the bone. I was surprised that I could feel the drill bit when it went into my bone marrow. The bit had a tip that was able to withdraw the marrow and parts of the bone. The physician examined the retrieved specimens. Luckily, he was pleased and the procedure was over.
A small adhesive bandage was placed on my skin where the drill had entered and it was all over in several minutes. I asked him if I could take a photo of the drill and the bit that he had used to take the sample. I explained that I teach about medical equipment at Penn State and could use the photo to explain how the equipment is used. He agreed and we both took pictures of the equipment.
During my time in the hospital, I liked to kid around with the physicians. One day a physician asked if there was anything that he could do to make me more comfortable. I thought for a moment and said, “How about a beer?” We joked a little and then he asked, “Do you really want one?” I said, “Yes.” He said he would take care of it.
When dinner came that evening, there was my beer. I was amazed and it tasted great (even though I didn’t finish it). I talked with the nurse and asked how this was possible. He explained that when they have patients that are also alcoholics they give them some alcohol on a controlled basis to reduce withdrawal symptoms and to keep them calm. So I enjoyed some beer with my pain meds and my hospital dinner.
Life was great!
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