I am the ostrich, Goo goo ga joob

Oh, Happy Day!

My heart is basically unchanged from the last echo in August 2008. Hooray! The same doctor who called me last year, and managed to scare me to death, called a few minutes ago. He chose his words carefully and I asked no questions -- it was a refreshingly short and sweet conversation.

If you read just a few of my posts, you know that I am obsessed with detail, as if by managing them all, I might bring order out of disorder. (You know, *that* old trick!) So why approach the echocardiogram results in the manner of a head-in-the-sand ostrich**?

Because it is something I cannot control. Because I have decided to trust the cardiologists. Because I made myself ill yesterday, wondering what having an aortic dissection might feel like, if -- that is -- I were so lucky as to survive long enough to feel anything. Because I entertained notions of having endocarditis again, or left ventricular failure -- that which left me with severe cardiomyopathy a decade ago. (And from which I spontaneously recovered! Turned out to be lupus-related.) I remembered how difficult it was to do anything as strenuous as, say, turning over in bed! Remembering that has been good for me, reminding me that the fatigue I feel now is oh-so-benign in comparison.

I was also very passive because just going to that hospital triggers reliving the traumas of May 2002.* In the aftermath of that horrid, life-altering, and criminal experience, I think lies were told to my cardiologist -- a man that I highly respected. I know now, after getting my medical records, that my heart doctor was the one I should thank for my survival -- he did the initial resuscitation and got me from the orthopedic floor to the ICU. I am so thankful to him and suspect (read: *know*) that the orthopedic surgeon (Carson) and the Head of Anesthesia told him I was suing, that I blamed him, or something. Because he completely changed.

[[The Anesthesia Chair? Sweeney Todd? At the time, he doubled as my pain management doctor, unfortunately -- God did he turn out to be a conniving, self-involved, heartless bastard -- and yes, I would slap the "criminal" label on him, too. Maybe more easily than anyone else besides Carson. He was in a position to do lumbar blocks and early intervention physical and drug therapy *immediately*. How dare he not report what state investigators eventually decided was a Sentinel Event? How dare he make light of what they all did to my effing life, choosing to moan to me, instead, about the changes investigators insisted be made in his department? Above all? How dare he not diagnose and treat my CRPS for over 19 months? In the days before yesterday's echo? I dreamt about meeting Sweeney Todd and Kelman in the elevator at the Doctor's Building. I was mute. Unable to speak. When we all exit the elevator, the doctors start to walk off. But Sweeney Todd turns around, walks over to me, sneers {He kinda looks like Cheney} and whispers: "What was that, Retired Educator? I can't hear you..."]]

I have asked The Fredster repeatedly if my memory is correct -- the memory of this same cardiologist telling me that I no longer needed to be followed, that I need not make another appointment. Fred was there, you see, and sometimes I need confirmation that what I remember is correct. Because this memory makes no sense! Of course, I needed to be followed, and, of course, I needed to make more appointments -- this was part of what the guy who called today was screaming at me last year. ("Why haven't you been seen? Why haven't you been having yearly echos?" and other pithy observations, such as -- when I asked what symptoms to watch out for with this aortic aneurism thingy -- "There won't be any symptoms. There won't be time." Oy! I thought I felt the very heart under discussion sink.)

This year? In a matter of minutes, I was literally breathing easier. My neck seemed to untangle itself, along with a disparate collection of sensitive internal organs. I felt like a walking miracle. Except for the walking part, I believe I am!

The aortic valve is maybe a little more "thick," the aortic insufficiency still moderate, and the aortic "dilatation" is just a smidge larger (+.14 centimeters to 4.79) -- but these observations don't amount to any real important clinical change or call for any intervention. I am "good to go" for surgery on the 27th. No growth on the valves -- that was also a concern, given the bacteria floating around in me.

An infinitely better reaction than that of last year:

dear all,

would anyone like to borrow some trouble?

i had my echo at 8:30 this morning. i asked the tech how it looked and she gave me a thumbs up and a "looks good to me." so we go home and i plan to pay some bills, declutter my piles of paper, etc.

ring ring ring.

it is one of the cardiologists. he is talking fast, and i cannot understand the words.

so... my heart is pumping well. i still have my usual aortic regurgitation from my bum aortic valve. and then there was that other thing. oh what was it?

oh yeah! where the aorta attaches to the heart ("the aortic root"), well... it is kind of dilated. like in an aneurism. i become a regular chatty cathy -- i ask if this precludes me having the surgery on monday and he says, no, that will be fine. then he starts to yell at me about how i need to have echos regularly -- that they found this dilation back in 2003. i don't *remember* that! (after i hang up and am talking to a weeping fred, he reminds me -- my cardiologist told us that it wasn't as bad as it looked on the echo -- and that i did NOT need to foillow up with him anymore! fred remembers that vividly.)

anyway, it measures 4.65 centimeters. i ask what needs to be done about it -- and the guy fairly hoots! (he actually was very nice) "major open heart surgery," says he.

well, what kind of symptoms should i be looking out for? and i am getting a chill just typing his response.

"you won't have any symptoms."

as in, it blows, i die. (hence, the weeping fred.)

there must be something extremely wrong with my mental health, this all seems like a great big joke to me! whahaha! what's gonna happen next?

i told fred that this is definitely an incentive to live in the moment.

so -- i guess it is a good thing i don't have hypertension.

whahahahahahahahaha!


******************************************************************************************************************* * Should you, Dear Reader, deign to click on the hyperlink and go visit the post over in Happy the Hospitalist's Land, please also note this comment I added as a sort of amendment. Then, as now, my tiny case of PTSD was rearing its ugly head:

La Belle et Bonne Bianca Castafiore, here. I serve as the willing public persona to one Retired Educator -- retired precisely due to the événements detailed above. We failed to provide a few details, not because they were not salient, but because it is difficult to type without shoulders!

**There was a third surgery to that illustrious hospitalization. When my cardiologist was working on me, he inserted a line in my femoral artery. A hefty little embolus formed a day later and emergency surgery was necessary as my leg was pulseless and a lovely ciel blue. *That* complication? Blameless and completely acceptable by me, something that occured in the order of things. Unfortunately, in the aftermath, our relationship was sacrificed to the Medico Brotherhood of Paranoia.

**My surgeon disappeared for a week after the ICU fall. I asked to have a new surgeon -- that request was both squashed and denied. I asked to see a patient advocate and was told that there were not any, but would I care to speak to a nun? Wile E. Coyote had nothing on these people. When I left the hospital, we thought that I had made three complete incident reports, and I *trusted* that there would be some record made in my chart. Dumb. Dumb. Dumb. What did I recommend in those lively conversations? Inservice education about adrenal insufficiency and how to spot the admittedly vague symptoms in patients undergoing surgery. Dumb. Dumb. Dumb. Legal action? Not even on my radar. I was being told that the incredible sensitivity and horrible shooting, burning pains in my leg and arm were the result of "too much pain medication" [?] and/or "a psychological problem." Would I care to see a psychiatrist? Rather than be offended, as I was, I should have said "yes." The nun, the shrink, and I might have really hit it off. Add a social worker and we had 4 for bridge.

**This ought to interest everyone. I was thrown into a Hell after all this happened -- I kept returning to the same doctors because my trust was not eroded. (Okay, so I am an idiot.) I thought and expected that people would be honest with me. When I finally went to a new neurologist, he left the exam room after about 5 minutes and came back with a heavy tome that had pictures of "classic" presentation of CRPS. Those photos might have been of me, they were that similar. He is wonderfully direct, and even though part of the same system as my former neurologist, quickly laid out the apparent plans for obfuscation that I was up against. Apparently, it was expected that I would sue. I would love to have sued... but had no capacity to handle anything but getting through the day. My friends and loves were angry with me... they would apparently have felt better were I to receive money. Go figure. Anyway, New Neuro Man tried to throw all available treatment at my CRPS, then still confined to the right leg and the left arm, and I tried to find some peace. I did, though, contact the state and report what I felt was a pretty awful state of affairs, and the previously mentioned Sentinel Event was declared, and investigators descended on the joint for a few days. Following that, I was dropped like a hot potato as a patient by everyone except my internist and my newly acquired neurologist. There is a 2-year statute of limitations for legal action. I had contacted the state medical society about the surgeon's various bizarreries (I cannot write about them, cannot take that stress), and they answered that he could not be censured or even investigated based on the information given. Whatever. I had completely given up trying to get the hospital to even pay those few bills it promised to cover (ambulance, bed, PT), and was living on 2/3 of my teaching salary -- the pay out of my longterm disability insurance. We had bought a house just a few months before this surgery -- a place to slum when we strayed from
Marlinspike Hall, deep, deep in the Tête de Hergé. Ten days before the statute would expire, I received a call from the Legal Dept of the hospital, asking me to please submit any outstanding bills relating to that hospitalization. I was of (at least) two minds and told them so. "Here are the bills you promised to pay," I wrote, "and here is what you ought to feel compelled to pay, because it would be the right thing to do." Negotiations began and they gave me a [very] small settlement.

Have you ever heard of an unsolicited settlement before?

**The last thing I have to say is that it is true that an apology and openness and Real HELP would have met all my needs, and might have saved my life from being ruined. Please, doctors, nurses, and administrators -- give that a try before you mire yourselves in heartless paranoia and ugly assumptions.

**I am not sure that you've done me any favors, making a post of my info -- but I am having to relive it anyway, given that today's circumstances link up with those of yesteryear. Did a hospitalist save me? Yes, though no doubt my internist would have come through, stud that he is. I never met the man. I have a smudged and bent card with his name on it and am told by the Fredster that he was incredible and that I am lucky he was there. If this is the kind of thing you do, Happy -- well... God bless you.

December 22, 2008 5:10 PM
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** "Ostriches have three main strategies when attacked. They can run away, they can kick, or they can try to hide (eg, when nursing the eggs). When hiding, they will sometimes lay flat on the ground, with the long neck and head also on the ground. In the rippling heat haze of their native Africa, they can look just like a grassy mound.

The myth that an ostrich will stick its head in the sand, in an effort to hide, may have begun with that great Roman thinker, Pliny the Elder (23-79AD). His real name was Gaius Plinius Secundus. Pliny was a man of intense curiosity about the world around him. His nephew, Pliny the Younger, wrote about him, “He began to work long before daybreak. He read nothing without making extracts; he used even to say that there was no book so bad as not to contain something of value. In the country it was only the time when he was actually in his bath that was exempted from study. When travelling, as though freed from every other care, he devoted himself to study alone. In short, he deemed all time wasted that was not employed in study.”

In 79 AD, Mt. Vesuvius erupted - and covered and then preserved the city of Pompeii. While most people ran away from Vesuvius, Pliny went straight into the danger zone to look, learn and rescue survivors - and died in the attempt. In his honour, the most violent volcanic eruptions (such as Krakatoa) are called ultra-plinian.

Before his death, Pliny had almost completed one of the earliest comprehensive encyclopaediae. His Natural History, in 37 books, was a remarkable attempt to summarise all the knowledge known to the Romans. He claimed that he covered some 20,000 topics, which he partly got out of some 2,000 books, which in turn were written by some 100 authors. In fact, he was one of the first writers to acknowledge other authors from whom he quotes, and also one of the first to have a table of contents. His Natural History remained a fundamental source of knowledge to the West through the Dark Ages.

So what did Pliny have to say of ostriches? In Book 10, Chapter 1, he writes, “…they imagine, when they have thrust their head and neck into a bush, that the whole of their body is concealed”.

Historians assume that this single sentence is the root of the myth about ostriches burying their head in the sand."