Chapter 16

THE PEG & THE TRACH

Blowhole

Lucky for me, these days the goal of a hospital stay is “to get you the heck out of the hospital.” From what I understand, this is not a financial consideration or a need for beds as much as it is a safety issue. People are not in the hospital for attention, to watch TV in bed while someone waits on them, or for the food variety. People are in hospitals because they are very sick. It is a concentrated population of sick people. The worst germs and bacteria are in the hospital. Unlike a CDC laboratory, these germs and bacteria are not contained; they are floating around in the atmosphere every time a sick person coughs, sneezes, or even breathes. To put it in perspective, a hospital has more germs in it than a public bathroom. Let that sink in.

To make matters even more interesting, when you are sick in the hospital, your immune system is compromised, because you are, well, sick. Therefore, you are more susceptible to being infected by all of this air-and surface-borne ick. For instance, the pneumonia I caught in the hospital was treated very differently than it would have been if, say, I had caught pneumonia at home and then went to the hospital. It was a hospital-borne illness, which is distinguished from a hospital-born baby in that it’s very dangerous. I mean, some hospital-born babies are dangerous, but I don’t think there are any studies proving that it’s due to their being born in the hospital. At least not yet.

Henceforth, it is in everyone’s best interests to get you out of these germ-infested hellholes as soon as possible. Since it will take a long time to get you to a place where you can take care of yourself, you have to start thinking about home nursing care. I was thrilled with this idea, because I was at the point where being away from my children was actually making it harder for me to heal due to mental and emotional stress. It looked like my recovery was going to take a lot longer than anyone expected, so if I could have a nurse at home where my children were, it would mean I could recover both physically and emotionally, a win-win situation.

Almost two weeks into my hospital stay, we started looking at things that were keeping me in the ICU that would not be an option for home health care. First, there was the endotracheal intubation helping me breathe. Couldn’t do that at home. Dr. Bederson hesitantly suggested that I get a tracheotomy. My only previous experience with this term was on a rerun of MASH I saw as a child when Hawkeye had to teach Radar (over a walkie-talkie) how to slit an injured soldier’s throat with a razor blade, and then stick the tube from a pen cartridge in there so he could breathe again. I was assured that they performed this procedure a bit differently at Mount Sinai.

Apparently, this option of the tracheotomy would allow me to go home sooner, because it would replace the intubation that I periodically needed. The thought of getting rid of the huge plastic tube shoved down my throat brought me closer to a feeling of joy than I had experienced since this whole ordeal began. It wasn’t actual joy, but it was very close.

Of course I wanted the tracheotomy! I felt like a puppy that was about to get off the leash for the first time.

“Yes! I’ll take the trach!” What had been holding us back from doing this before?

“There will be a scar on your neck,” said Dr. Bederson.

I didn’t care. I mean, I really didn’t care. It suddenly struck me how amazing it was that for all of the seriousness of the medical procedures, Dr. Bederson was always thinking ten steps in the future: He was hell-bent on saving my facial nerve so I could keep my face. He shaved only the minimal portion of my hair needed to enter my skull for the craniotomy. Now he was worried about a scar on my neck.

I had been so consumed with just getting through each moment, I was completely unconcerned with the future, even though my surviving this had everything to do with my future. Dr. Bederson was so confident in my living through this and recovering completely that he was considering how I would feel about my appearance in the future, because there actually would be a future when I was well! That’s the kind of confidence you want in a doctor. But meanwhile, a scar on my neck was nothing compared to getting out of there. “Let’s do it!” I mouthed enthusiastically and gave a weak thumbs-up.

What I didn’t know about a tracheotomy, or having a hole in your neck in general, was that things normally contained in your mouth when you coughed had new freedom to escape. Jim called it my “blowhole.” Enough said.

It’s Your Favorite Foreign Movie

The next thing to do away with was the nasogastric food tube. A more home-care-friendly option was something called a percutaneous endoscopic gastrostomy or, for short, the PEG. It’s when a hole is cut in the abdominal wall and a tube is inserted so that you can get the food goo, water, and medicine pumped directly into your stomach. When I was given a choice to stay on the nasogastric tube or switch to the simpler PEG, I was overjoyed. It’s the little things. Sure, the complication risks included:

• pain at the PEG site

• leakage of stomach contents around the tube site

• dislodgment or malfunction of the tube

• infection of the PEG site

• bleeding and perforation (an unwanted hole in the bowel wall)

… and other charming side effects. But compared to the tube-up-the-nose-attached-to-a-machine-in-the-hospital option, it sounded like a piece of cake. Did I mention that I could not have cake? The point is this: When given the choice between staying in the hospital unmolested further or being able to go home if I underwent more surgical procedures, it was a little bit like meeting a crossroads demon. Would you sell your soul to save your child? Would you get holes cut into your body to get off the hospital machines? I had to make sacrifices in order to get home, and I was willing to make those sacrifices. Maybe if I had been a Victoria’s Secret bikini model, I would have hesitated for a moment, but for me, if it meant getting home, bring on the knife.

Lizzy was there when I was uber-gurneyed into the OR for the PEG procedure. We sat in the waiting room outside the OR for a long time. The Chew was playing on the high-mounted TV. Does every medical waiting room show The Chew? In my current state, the show seemed like a form of medieval torture. Liz kept looking for a way to turn off the TV as she saw that I was mesmerized and tormented. There did not appear to be a button on it. “Sick of it,” said Lizzy.

I cheered her on: “Throw a medical gown over the screen!” I remembered it was her birthday. I kept mouthing to her, “This is the best birthday ever!” She agreed. Some new characters in scrubs appeared to wheel me into the procedure room. Lizzy waited outside the door for me to emerge reborn in all my new PEG-inserted glory.

After the procedure, Lizzy was next to me, holding my hand. I blinked my eyes open, face-to-face with a blurry doctor I’d never seen before. “How are you feeling?” he asked.

“Hungry,” I replied. I couldn’t wait to put my new PEG to work, ingesting large amounts of highly processed foodstuffs directly into my stomach without passing “GO.” The doctor started coming into focus. “Thank you, Dr….” I had to look at his name tag, there were so many doctors. “… Hamburger?” Either I was hallucinating from hunger, or his name tag actually read “Dr. Hamburger.” I looked around for Nurse Mustard and Orderly Milk Shake.

“Umm, is your name Dr. Hamburger?” I whispered trepidatiously.

“Unfortunately, yes,” he replied sadly, as if this question dominated his career. I imagined his name trumping all other achievements he’d made:

Dr. Hamburger: I’ve discovered the cure for indigestion!

Other doctors: Oh, great, now patients can eat hamburgers! lol!

Lizzy was grinning from ear to ear. Happy birthday.

“Wait, you are a gastroenterologist and your name is Dr. Hamburger?”

“No, I’m an anesthesiologist.” He seemed defeated. It would have been much cooler if he were Dr. Hamburger, the stomach doctor.