One year ago today I woke up in the UVM Med Center ICU. Hooked up to machines, Heparin flowing into my arm, oxygen cannula in my nose, worried friends and family blowing up my phone. I had been in the hospital for about 40 hours, in a few more I would walk out under my own power.
That week had been rough, I wasn’t feeling well and I didn’t know what was wrong. Allergies popping off, a knot in my calf as the evidence that I was almost 40, difficulty breathing as a fat man trying to adjust to the June heat. I didn’t think much of it for the first few days, then it got worse, and I still didn’t think too much about it. Friday I spent the night putting together a piece of patio furniture while wondering why I was sweating and out of breath, probably just the humidity. I had a relaxing Saturday and planned a night out with some friends. I was fine, or I was at least practiced enough at pretending I was fine that I could mask it. **Narrator voice** “He was in fact not fine, not fine at all”
I took it easy when I was out with my friends, 4 bars, 3 lager beers. I was driving, and it was hot, and I wasn’t feeling great. I decided it was time to call it a night and in the walk from Mule Bar around the top of the Winooski circle I realized something was wrong. I couldn’t catch my breath and had to puke in a trash can, alarming behavior for someone who has only had three small beers. When you are walking with a friend who used to crack fluorescent lightbulbs over his head and you see serious concern in his eyes you should know that it is time to get checked out. I of course realized that something was seriously wrong, so I did what I thought needed to be done, I tried to sleep it off and see if things were better in the morning. Spoiler alert things were not better, double spoiler alert, I did not go get checked out immediately. Instead I went out to breakfast with my mom, and tried relaxing on the couch, and eventually at the prodding of my cardiology nurse friend I conceded and drove myself to the ED.
I dragged myself into the ED with a pulse rate of 155 and an O2 saturation in the low 80s, sucking air after having to stop twice on the short walk from my car. The professionals at UVM had me hooked up to wires and oxygen in no time, CT scan, blood work, family history of my father having PEs in his 30s and 40s. Less than an hour later I was meeting with the specialist discussing the Multiple Submassive Bilateral Pulmonary Emboli that had deposited themselves into my lungs. Luckily I was able to drop that I was a pharmacist so we could skip the background options and jump right to TPA to bust the clots up. 3 hours after I walked in the door I was up in the ICU with every 15 minute monitoring for brain bleeds.
I have spent a lot of time complaining about nurses I have dealt with during my career, ICU nurses are a different breed. I had several great nurses, a charge nurse who took one on one overnight duty, a beautiful caring woman who I have subsequently seen on Hinge (but missed my opportuning for a meet-cute), and a sassy queen of a man who makes me glad to be an ally during pride. Several friends stopped by to make sure I was ok and to prove that I will always have people who stand by my side. A series of doctors took turns being alarmed that a relatively healthy 39 year old would throw a PE, and berating me for being a dumbass who drove himself to the hospital. Through the power of modern medicine I was discharged directly from the ICU less than 48 hours after I showed up, pumped full of Eliquis and with a new respect for the ability to use the restroom without having to have a spotter. I did let my friend drive my car home so I got to walk to the front of the hospital and take an uber back home.
I was still in rough shape and needed to take a week off work in order to get myself together. Immediate recovery was pretty smooth, with lots of support from friends, family, and Instacart. It took several weeks for my lungs to get back toward normal and walking even to my car left me panting. Over the next few months I generally got my wind back and my life pretty much went back to normal. There was a significant, but manageable, amount of debt that I needed to come to terms with. And a new PCP to replace mine who had retired a year prior, plus a new hematologist, and a bevy of follow up tests and exams. The adjustment to being on twice daily blood thinners (I talked them out of wafarin) has been an interesting experiment in pharmaceutical compliance. There is a nice meme of someone whispering “Still punk as fuck” while reaching for a weekly pill planner, I feel it.
6 months after everything went down I did a stressful 10 day medication washout and a bunch of blood tests. It turns out that I have genetic defects of PT-G20210A and Factor V Leiden, each of which result in an increase in clot formation, when you have both it is a bit of a 1+1=5 situation. Apparently having one is kinda common, having both is rare enough that my hematologist has only ever seen one other patient with these mutations in her career. This helps explain my Dad’s two PEs before he turned 45, plus mine before 40, luckily my brother took the test and only has one of the mutations. Getting the hard data helped to alleviate some concerns and allows me to settle into a lifetime of taking Eliquis (this is not paid promotion for Big E, but if they are willing to sponsor me I will gladly take free samples).
Physically I am mostly back where I used to be. I got into the gym a good amount this winter and have been spending a lot of time walking outside now that the weather has turned, I’m even thinking about getting a heavy bag and doing some boxing like I used to. I do still get short of breath, especially when going up stairs or when my allergies are acting up and I’m all gunky. There are some periods where I get a bit of the full body malaise and worry that things are happening again, I get hyper vigilant about any type of pain in my legs. From time to time I can feel the “spots” in my lungs where the big clots were, it is probably psychosomatic since it fades when I don’t pay attention to it.
Psychologically having an event like this is supposed to change you. You are supposed to wake up and have a new lease on life. I don’t think it was the case. I was grateful that I didn’t die, I tend to spend more time on the porch enjoying or looking at the sunset than before. I tried cutting back hours at work, and when that didn’t reduce my stress I found a new job that starts next week and hopefully I will have better work/life balance. My medical history has become much more of a point of discussion with my family and seems to work its way into conversation on first dates, but overall it doesn’t seem like a defining factor. Much like diabetics have been re-branded as people with diabetes I feel like I am someone who has had a medical event and doesn’t want to repeat it, but doesn’t dwell on it. I have mostly the same life I had 53 weeks ago, just with a pill planner and a myChart.
A few weeks after I got back on my feet someone asked me how I was doing. I tried to shrug it off but he dug in and asked some deeper questions. I told him that it actually wasn’t scary. I knew something was wrong and once I pulled my head out of my ass and went to the hospital I trusted the process and the professionals. I was able to use my clinical knowledge to make informed decisions, and lean on the support network that I had built up. It was a trauma, but it wasn’t the end of the world. I have gotten lucky, almost 40 years with no serious medical issues, but one day it caught up to me. After narrowly avoiding car accidents, never having surgery, only having minor broken bones, and limiting my only ambulance trip to one night of drunken shenanigans I was laid out by two little genetic mishaps When we were young punks we all lived like there was no tomorrow and we wouldn’t live to see 30, and many of my friends didn’t. I guess that some of us are left holding the bag, with our pill planners and hospital bills. I don’t think I am invincible, but then again, almost dying has never killed me before.
Owen Foley 