Crash!

Crash!  That was the sound of me hitting the floor at 5AM Friday morning, May 3.  I had gotten up out of bed to go to the bathroom, using crutches, as I had come to require either crutches or a walker to relieve weight from my painful right hip.  But I never made it beyond the end of the bed.  I must have blacked out, as I hit my head and neck on various pieces of furniture on the way down.  Barbie was up in a flash, and it was pretty clear I was badly hurt.  I simply couldn’t put any weight at all on my left leg.  We did manage to get my seat onto a walker so that I could get back to bed.

Clearly something was going on Thursday night/Friday morning.  I was cold all night long.  I just couldn’t generate enough heat to get warm in spite of being under a full load of blankets.  And then when I was on the floor Barbie took my temperature, and it was 102.5 degrees.  I probably had not paused to let my head clear after getting up because I was so cold.  Clearly a mistake.

Barbie called 911, and the EMTs arrived to transport me.  At first, they were reluctant to take me to Beth Israel in Boston, as that entails passing half a dozen hospitals perfectly capable of dealing with a broken hip.  But once my underlying disease was explained, they were OK with transporting me directly there.  They gave me a shot of fentanyl, as they explained that the ride would be pretty rough.  Then it took some pretty fancy maneuvering to get me onto a flat board and downstairs, as neither stairway in our house is a straight shot.  Luckily, I arrived at the BI Emergency Room pretty quickly.

Barbie joined me there, after necessary clean up from the accident, preparing the house to be abandoned for an unknown number of days, and taking our dog Otis to a kind neighbor’s. Then we had a pretty long wait.  They took x-rays and administered the normal batch of diagnostic tests.  But mostly it was just waiting.  There was a certain amount of ER drama.  A person in the stall next to me was out of his mind from drink or drugs, carrying on at the top of his lungs.  Eventually a number of large people overcame him, and they got something into him that quieted him down.

At around 3PM Jack Wixted, a surgeon in the Orthopedic Department, arrived to explain the he would repair my hip Saturday morning.  A decision was needed as to which repair alternative to employ.  The choices started with doing nothing, the choice for a 93-year-old with dementia.  The next choice was a pin and repair of the broken end of the femur.  Given that my multiple myeloma had probably weakened my bones, there was concern that there might not be hard enough bone to drill into.  Also, the fracture was further out on the head of the femur than my right hip fracture in 2010.  The third choice was partial hip replacement surgery.  This would be a much more intense operation, and there was concern about the blood levels I had been exhibiting over the last few weeks.  Yes, they could give me platelets and top up my blood with infusions, but transfusion/infusion results are never as good (or predictable) as using blood you generate on your own.  Long term, the results of the replacement surgery would be better, but the potential complications of a much longer, much more invasive surgery were a concern.

The decision was not clear cut, and Jack needed to consult with the oncology team.  We also called our physician daughter-in-law, Bridget Quinn, into the discussion, so Jack went away while all the players could be assembled for a consult.  About this time a doctor appeared, whose function was to survey people in the ER who may be feeling that they are being ignored, and find the resources to make their treatment progress.  We told him that 30 minutes earlier he would have found us in need of his services, but no longer.  He was still helpful, and since I have spent lots of time in the ER waiting for something to happen, I thought having a doctor specifically assigned to play that role was a welcome improvement.  At the very least, it shows awareness of the problem.

Eventually the consult happened, with a clear consensus for the middle option, the pin and repair.  Then it was a question of a room for the night.  Eventually I was transported to the Farr building and a room on the orthopedic ward.  The drama encountered there involved the mental state of my new roommate.  I assumed initially that he was on an extended cell phone conversation, as he was frequently making angry and emotional comments.  But it turned out that he was just afflicted with dementia.  The climax was around 4 in the morning when nurses had to come in and clean him up in multiple ways, since he had soiled himself and gotten blood all over everything because he pulled out his IVs.  I was very impressed by the patience of the nurses and their cheerfulness in the face of a major event that was anything but pleasant. 

I had the impression that I would be the first operation of the day, but I wasn’t transported down to the Operating Room until 10:30.  The Beth Israel operating room waiting area is impressive in its size.  Clearly it operates at a fraction of its full capacity on the weekend.  You meet the full staff ahead of time, so you have confidence in the anesthesiologists, nurses, and assistant surgeons who will work on you.  I actually went into the Operating Room itself at 11:45, and in no time flat, I was out.

I became conscious again at 2PM, and they said the operation went well.  The surgeon explained that there were no complications, that there was enough bone at the head of the femur to drill into, and that the bone was strong enough to hold the pin.  So, the broken hip was repaired with a minimum of drama, but that was far from the end of the story.

On Sunday, literally 24 hours post-surgery, a physical therapist came by to get me moving the left leg again.  The muscles in the entire leg were traumatized by the surgery, and moving it at all took major effort.  She had me get up out of the bed and into a chair.  They use a crane that is built into the ceiling above the bed to do that.  They put a sling under you and hook it up to the lift in the ceiling.  Then they pick you up like a sack of potatoes.  (Barbie thought I resembled a massive baby being delivered by a huge stork.) The sensation the first time is unnerving, as your appendage that was just operated on is deathly afraid of being moved.  But by the second move, it felt almost normal.The physical therapist gave me a list of 6 exercises to do.  At first doing even one was a challenge.  Now, on day op + 5, I can do most of them for the suggested number of repetitions.

 

An administrator came by and explained that physical therapy at the BI is primarily intended for evaluation of readiness for moving to a rehab facility.  She took our information and produced a list of 3 places quite close to home that provide the required services.  We now need to get serious about making that happen.

The second night with my demented roommate was a little less dramatic, but at 4 AM he did have to be cleaned up again.  At least that time there was no blood.  He moved on the next day, and he was replaced by another roommate that was much quieter.  His main offense was requesting Fox News on his TV.  Luckily, he had earphones, so we didn’t have to listen to it.  But he didn’t get the concept of the nurses call button, so when he called out for a urinal in the middle of the night, I rang my nurses call button and ideally prevented a mess.  But again, by late in the night the nurses had to be back cleaning things up.  I decided that the patient population in the Farr building is in much worse shape than the patient population I am accustomed to in the Hematology / Oncology ward located in the Feldberg building.  On Tuesday I was switched to the Hematology / Oncology ward on Feldberg 7, my familiar home here at Beth Israel.  I’ve never been immobilized while I have stayed here, so it has become clear to me now that mobility is a blessing.

A continuing concern was when would I be able to resume my multiple myeloma treatments.  So far, those treatments are still on hold.  It turns out that x-rays revealed that I had pneumonia in my right lung.  Perhaps that is why I was so cold and running a fever Thursday night / Friday morning.  The x-ray information could also signal the presence of a pulmonary embolism.  I’ve had 2 in the distant past and a hip fracture and multiple myeloma are risk factors for emboli as well.  So, all sorts of diagnostic tests have proved that what I have is pneumonia, not an embolism.  It appears that antibiotics have done a good job of treating the pneumonia.  For the first time, however, I ended up on oxygen, as it seems the pneumonia interferes with oxygen exchange.  Gradually, I was able to move away from requiring that assistance.

The myeloma treatment suppresses blood counts and impedes healing.  Had I shown up last Friday (as originally planned) and they detected the pneumonia, they certainly would have delayed treatment for a week.  The current plan is to get me into rehab and then resume the multiple myeloma treatments.  They did request a free lambda test, and the latest reading is 792.  The prior week was 584 and the week before that was 796, so it is going in the wrong direction, but not disastrously so.

For the next iteration of this blog I hope to have x-ray pictures of my hip pre- and post- operation.  I have access to a patient area of the BIDMC website that has information about x-rays, but not the actual images.  They have narratives of what was learned from the x-rays only.  Pretty boring.  Stay tuned.