Wednesday, February 26, 2014

I own a brand new Promus Premier and here's how it happened

Well, I’m the proud new owner of a Promus Premier. I’ve had it for a week now and it’s as smooth and quiet as everyone said it would be.

Nope, this isn’t a new hybrid vehicle from Toyota; it’s the centerpiece of the “Everlimus-Eluting Platinum Chromium Coronary Stent System” — I bet you can’t say that ten times in a row. That’s right, I now have a small piece of bare-metal in my distal right coronary artery. It was either that or else. . .

So here's the tale.

Last Wednesday February 19, started out pretty much like any other workday. Late that morning I walked over to a nearby Starbucks with Bryan, a colleague from work. On the way back I stopped to pick up a sandwich for lunch. Less than an hour later, while standing in front of the computer (I generally stand, not sit at my workstation) I started having a burning sensation in my chest. At first I wasn’t particularly concerned — I had had this feeling of “burning” two or three times before during the past several months and it always went away.

Not this time.

The discomfort became increasingly intense and then I started to feel sweaty — a sure sign that my body was under attack. I quickly realized that this problem wasn’t going away this time and decided that now was the time to go somewhere to be treated — and the sooner the better. I walked over to Kate’s office and asked if someone could take me to the ER. Jamie said he’d be happy to and left to get his car — in the meantime Chris walked with me downstairs to wait for my ride. Kate in the meantime thought it best to call 911 — and she was spot on here. Campus Safety & Security soon arrived and waited with Chris and me until the ambulance came. As I sat downstairs just inside the front door the discomfort continued unabated. I focused on my breathing.

As soon as the paramedics pulled up I walked outside, no stretcher was needed, and climbed inside the truck; I was placed on a stretcher straightaway. They tried starting a line on me, first the right hand, then the left — three times and each time the stick was good but the vein blew out. Meanwhile they also ran an EKG (electrocardiogram) calling that information into the hospital Emergency Room. In my stupor — by then I was also feeling fairly agitated — all I could make out was something about a “block” and “ no P-waves” whatever that meant.

I fumbled to get at my phone and handed it to one of the paramedics and asked her to call my wife and tell her what had happened. She nicely but firmly replied, “I’m sorry but we’re not allowed to do that.” I hit speed dial and got Susie’s voicemail. I told her what I had overheard the medics saying about the EKG results and hung up. She sent me a text a few moments later saying she was on her way.

In less than two minutes the ambulance was backing up to the Emergency Room at Rhode Island Hospital. The medics pulled me out the back and wheeled me inside. After a few minutes of uncertainty over which room I was to be placed in, I found myself with a new set of monitor leads while someone tried to shave the hair on my chest, new faces hovering over and around me, starting not one but two lines on my right arm (back of the hand and elbow), while pulling my clothes off (oddly I felt no embarrassment here). The doctor — whose name I’ve forgotten if I ever knew it — appeared calm and reassuring throughout. Little seemed to matter; I felt oddly distant, disconnected.

A few moments later I saw Susie standing inside the doorway. That was a relief and I sensed good things were on their way.

A nurse then brought me a paper to sign after which I was whisked out of the room, down the hall to the nearby cardiac catheterization lab. I heard someone mention something about morphine. The last thing I really remember is a young woman shaving the right side of my groin — the idea was to use the femoral artery as a point of entry so they could inject dye into my arteries to search for the blockage. Once found the idea was to run a catheter up the artery and embed a metal stent to keep the blocked area open. Forever. I have to take their word for it since I was in a state of blissful indifference at that point.


As I started to regain some grasp on reality I sensed being taken back out into the hall and wheeled into an elevator up to the cardiac coronary unit. (on the 5th floor) During this short trip all I could make out was the sound of the portable monitor beeping and it struck me that that was my life in audio format. This was a queer sensation to be sure.

Once upstairs, they moved me into room 505 — only one bed and with a great view of Interstate 95 and the Narragansett Bay — quickly settling me onto one of the coolest beds I’ve ever slept in (every time I shifted position it self-adjusted the mattress’s various air bags), hooking me up to yet another monitor.

I looked up at the clock in my room and noted it was a little past 3pm. I had been in the hospital barely two hours.

For the next six hours or so I had to remain flat on my back to insure that there was no bleeding from the femoral artery (they had also placed my right leg in sort of a leg brace to insure I didn’t go flailing around). Throughout the rest of Wednesday and all of Thursday I lay still, eating little, sleeping even less. Nurses would come and go, frequently checking my two dressings, the femoral artery and the inside of my right wrist — I learned that the cath lab had initially tried to use the right wrist as a point of entry but that didn’t take and so now it had a pressure bandage on to reduce the potential of a hematoma.

And of course someone was always taking my vital signs, pulse, temperature and blood pressure. They have this contraption that is now used to take your temperature — mercury being frowned upon — it is a short, stubby metal wand-like thing they run along the forehead and down the side of the face.

And speaking of medieval implements, they now use an automatic blood pressure cuff: placed the upper arm it’s left to check your BP according to a certain configured logic. What actually happens is, without warning the cuff begins to tighten and squeeze and squeeze and squeeze until it feels as if the arm is being severed ever so slowly. Try to imagine waking up in the middle of the night with that baby on your arm. Man, what the Inquisition could’ve done with that handy little tool.

Since they needed my bed for a more serious cardiac case, at about 10:30 Thursday night I was roused out of my semi-sleepless state, moved upstairs to the “step-down” unit and placed into room 605 — exact same view as my previous room but one floor up.

Susie was with me much of the time, of course, and Dick and Dorothy came to visit Wednesday and Thursday evenings; one of my colleagues from work, Scot Borowy dropped by Thursday and we chatted for a half hour or so around noontime. Scottie had dropped off a book, Dan Winters’ “Road to Seeing,” and I spent the better part of Thursday savoring not just the photos but also Winters’ observations into the vagaries of life, a particularly and curiously relevant theme for me right at that moment.

Otherwise most of the time I dozed off and on. Anything resembling deep sleep still eluded me: aside from the frequent dinging of monitor alarms in my room and around the unit — rather like car alarms in the inner city, and no one pays any attention to those either -- I would also occasionally ding my right hand or move my right elbow the wrong way, both places where I still had lines in and the feelings would be none too pleasant. And of course, the nurses would drop by every so often to take blood (early in the morning) or check my “points of entry” or take my vital signs. The choreography was pretty much the same hour-by-hour, day-by-day.

It comes as little surprise that I started pestering the doctors for discharge; I was nearing my time to leave. My cardiologist, Dr. Gilson informed me at first that I would probably be discharged Saturday, but then Friday morning I got wind of the possibility that I might be discharged that very day.

And so I was.

Susie left her shop about 3pm and brought me a change of clothes — I didn’t want to leave the hospital in the stylish 1960s hospital gown that shows off the very best a patient has to offer. After dressing, we chatted briefly with Dr. Gilson about medications and I got my instructions for how I was behave in the near future. Off we went to the elevator, down to the main floor, out the front door, into the Mini and home.

I’m to stay at home for a week doing as little as possible — although some will say that’s hardly different from my previous behavior.  I’m supposed to “lay low”, and not lift anything heavier than a gallon of milk. My diet will change a bit — but frankly not too much; anyway that's a work in progress. I hope to push myself toward more routine exercise once I complete cardiac rehabilitation. I will also work on not letting the small nuisances of life and those too-often annoying people bother me so much. But that’s another story. . .

Aside from the lack of sleep, the terrible food was the only really negative aspect of my short hospital stay. The nurses acted professionally and by-and-large were generally attentive – although I was struck by the curious fact that the nursing assistants were all middle-aged men. In any case, they, too, were pleasant and generally went about their work in a professional manner.

I must single out one special person, however.

My last nurse in the coronary step-down unit was a young woman named Allison (I never did learn her last name). She struck both Susan and myself as professional, confident, and engaged but she was much more than that. She was genuinely caring: she was the one person I met who reached out as a sincerely interested caregiver, someone who realized we had concerns and who worked quickly and efficiently to help us resolve them. She struck me then and the image clings to me now that she is the epitome of nursing, she is what being a nurse is all about: the patient and his care is first and foremost. Thanks, Allison; you made a difference, believe me.

Life is short. I'll say it again in case you didn't get it the first time (I sometimes forget myself): life is short.

Monday, February 17, 2014

Valentine's Weekend at the French Tarte at the Winter Farmer's Market

Winter weather here in Rhode Island ("voh dilund") has been on-again, off-again; cold temps, snow showers, snow flurries, snow storms, ya want snow, we got it!

Anyway, right now it's on again.

Several inches are expected to fall Tuesday and that should make for a fun commute for most of us downtowners. Of course, we've been spared some of the more terrible aspects of winter to date: nightmarish inch-thick layers of ice that hit much of the Souther tier of the eastern US and the major snowfall that has inundated western Michigan.

Work has been good for both of us: the French Tarte continues to sell out each Saturday and beginning last Friday she's now open on Fridays as well. Susie and Lee area doing a brisk trade, as they say, and why not? No one else around these parts even comes close to making such incredibly delicious, handmade French-style pastries.

Otherwise, things have been quiet here, without any detectable excitement. No recent day trips, no incredible dining experiences; just good food at home and counting the days until we head off to England and the ancient past following those long-gone of Roman legions striding up and down Northumberland.
cherry almond Breton tart

chocolate hazelnut truffle tart



vanilla bean flan

matcha raspberry financier

pear ginger financier

chocolate moelleux

lemon ricotta cake

rustic dacquoise with salted caramel filling


croissant aux amandes



apple puff

end of the day. . .