Returnings II: Prelude to the Main Act

Rose Sélavy and I dodge the ecchymosis of the Eskimos with exquisite words.

1.

The slug underneath this entry’s title is a rather bland translation of a French phrase (‘Rose Sélavy et moi nous esquivons les ecchymoses des Esquimaux aux mots exquis.’) the name of a series of records made by the my favorite artist, Marcel Duchamp. The records are not typical audio recordings, but rather optical illusions that only take place when the records are rotated in precise directions and at specific speeds.

However interesting (or not) this may be, the reason I even bring it up is that it is perhaps the only utterance in 20th century literature that includes the word ecchymosis (Greek: ekkhumōsis, ‘escape of blood’) — a word that was to become the center of my attention for the first seven days I spent in the hospital, in isolation, waiting to get over the cold virus so I could go into surgery for a lung transplant.

With this type of surgery, deep vein thrombosis, a condition where a blood clot forms in a deep vein, usually in the leg, is a big worry. These clots can cause pain, swelling, and potentially travel to the lungs, leading to a pulmonary embolism, a serious and potentially life-threatening condition. So, within an hour of arrival and unpacking in my new home, I was receiving subcutaneous heparin shots three times daily. At first, these were not too big a deal, I’m an adult and accept that pain and discomfort are often a part of life, plus the needle is not all that big.

So off we went, day after day, three times a day. First into the belly, then the thighs, then wherever we could. And soon they began to work their wondrous actions, both inside and out. Within an hour of each injection,n a rather large, purplish bruise would surface above the injection site. Mind you, these are not really bruises. Bruises are a category of their own. When you bang your elbow on the kitchen cabinet, you get a bruise. These were a level up from bruising. These were ecchymosis.

Ecchymosis

With ecchymosis, the blood vessels, especially capillaries, are damaged and blood is released into the surrounding tissue. This leakage causes the skin to show some form of loss of color, from bluish purple, green, and yellow, as the body repairs itself. I was now receiving three new ones of these per day. Perhaps even worse, the puncture where the needle entered the skin would continue to leak blood, sometimes for a day or two, and since it did not clot, leaving the soaked gauze or my gown dyed a beautiful, vibrant red color.

2.

The nurses on the eleventh floor of Brigham’s Thoracic Surgery Center are a special breed. Most have over 15 years of experience in lung transplant medicine, which is in itself a special calling. I’ve likely worked with well over 25 different nurses and can only think of one or two that did not meet the high standards of the group. Their laconic (Greek, pertaining to the Spartans, famous for saying much in few words; concise, abrupt) response to my gradual purpling was often ‘Ooh, that one is a nice color.’ None of this was being helped by the extra effects of the Plavix I was also taking due to the recent stent.

I’ve been told that in the world of thoracic medicine, lung transplants are top of the food chain. They’ve told me that from a nursing perspective, it is the most complex of the transplant surgeries, exceeding even heart and kidney transplantation, which makes sense when you realize that all other forms of transplantation are ‘closed’ off the the outside world. Lungs, on the other hand, have to constantly interact with the outside environment, and all those pollens, viruses, and other bad boys. So things can go south fast.

The normal procedure to even qualify for a lung transplant is so daunting and demanding that I often wonder how we got through it. Well, actually, I don’t. It was the work of The Girlfriend, my lovely Martha, who worked the phones, the forms, the requirements, the visits, the scheduling, and a plethora of other boxes that needed checking. Lung transplantation is not for the faint of heart, and without proof of a viable and robust support system, applicants won’t even be considered. We brought the entire D’Adamo Crew (Martha, Claudia, Emily, and Emily’s fiancé Mike) to sobering meetings with the social worker on the team who made sure we all knew what we were getting into.

Then testing, testing, testing. They’re big into the esophagus here. I suppose because reflux is a common way to make lung fibrosis worse, as you can inhale the corrosive acid fumes escaping from the stomach. They also want to make sure the esophagus has enough motility so that you don’t aspirate stuff from your meals into the lungs. Esophageal testing is not fun; they essentially shove a cable TV wire down your nose and into your esophagus and wait for activity. For an hour.

They don’t neglect the mind either. To that end, I spent a moderately entertaining afternoon with the team psychologists to determine if I was crazy enough to get transplanted. No, just kidding. I’m not sure they tested me for craziness, but they certainly did all those cognitive tests we’ve all had. Draw a clock and put the hands at twenty-to-eleven. Try to remember these four words and repeat them after a while. I did not do so good on this one (2/4), but I’m not wired to prioritize this type of behavior. On the other hand, when the tester read me a rather lengthy story and then told me she was going to read off twenty words, I should say if they were either contained in the story or not. I was 20/20 at identifying these words, a level of perfection she had never observed before. However, I think that’s how coders train themselves to look at things — to always look at what you are seeing or not seeing.

At the end of the week in isolation, I was now very purple and apparently Rhinovirus-free. Within one hour, the day nurse and PA came in and announced that they appear to have a viable single lung, and it’s looking like, if all goes according to plan, I’d be going into surgery in the morning.

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Next: Returnings III: The Exceptional Patient