Back to the story. Upon the request of my urologist speaking with the attending ER doctor, I was sent to a real hospital. I got a ride in an ambulance for the first time that I can recall. The urologist, Dr Adamu, advised that I be admitted for 24 hours of CBI (continual bladder irrigation) asap. It’s Tuesday evening by now.
Upon arrival to McAllen Medical Center, a member facility of the South Texas Health System, I am transferred to a room on the 7th floor immediately, around 9 PM. As it turns out, I have to wait a long time before the CBI is actually done. We inquire as to why the CBI isn’t getting under way, and we are met with “There are no official orders right now.” Dammit. No official orders came through from the stand-alone ER, nor was there any from the urologist. I find out later that his preferred hospital of choice is across the street: Rio Grande Regional. Did he send the order to the wrong hospital. I’ll never know. Meanwhile, I am put on IV fluids. I’m pretty sure that was not on the orders, but they did it anyway. As I recall, the nurse says they (the stand-alone ER staff) put the needle in the wrong place; she would rather have it on the back of my hand. I am wondering why they even put one, since the ER didn’t give me fluids.
During the night, I start to remember that there were indeed signs of this blood in the urine before, but only slightly. I can recollect that at times, I would notice one single drop of blood in the toilet bowl. But since my skin sometimes has small blood-filled pimples that pop at random times (due to my rolls of fat being skin-on-skin) I think nothing of this. I also start to remember that often, I would notice a dark yellow, even brownish color of pee in the bowl. However, since my toilet has the white porcelain eroded in the base of the exit area, it doesn’t register that my urine is an odd color. They say hind-sight is 20/20. The signs were there, but I did not pay attention to them. And since I sit to pee, I don’t notice the stream as it exits my body. If I were to be standing while peeing, maybe I could have noticed it was brown/rust color as it flowed, and not yellow. C’est la vive.
All through the night, I am poked and prodded. Just kidding; I get blood pressure checked, and even my sugar levels. My BP was still relatively high (140’s). There was a 2-hour period that no one bothered me, but I was too stressed to sleep all night. I even got sponge-bathed once a day. (They use special, heavy wipes, not sponges as it turns out) I have still not eaten or drank anything. But at 7:30 AM, breakfast is served. Bland scrambled eggs, a biscuit, orange juice, coffee, and sugar-free Jello. I am not necessarily hungry, and am afraid to drink anything because it would create more urine, not to mention the fluids that are keeping me hydrated. I do eat the sugar-free Jello. Funnily enough, the coffee came with 4 packets of sugar at my disposal. Go figure.
At about 9 in the morning, the “order” finally comes in for the CBI. By 11 am, the medical staff starts the irrigation. I can hear the nurses talking over me, stating that they (the stand-alone ER) gave me the wrong foley type. Apparently, I need to have the 24 gauge, with 3 access points. Also, the bag I had was only a 1000ml capacity, but is supposed to be at 4000ml. So they remove the 18 gauge, and insert the bigger, 24 gauge. Minimal discomfort. It feels more weird than painful. Ironically, the bag they used was only 2500ml capacity. It’s not a big deal, it just means they have to empty it out more often. My pain on the number scale of 1-10 is at a constant 2, by the way.
How does CBI work? Well, they take a gallon of liquid, saline I believe, and hang that next to the regular IV fluid bag. (The IV fluid(s) go into my vein, while the CBI goes into my bladder) They then allow the saline to fill my bladder through one inlet of the foley, and then it “flushes” out through the outlet of the foley. They can control the flow using a pinching mechanism made of plastic. If I can reach it, I could also control the flow – which is not recommended [for a patient to do]. This irrigation gradually erodes the blood clump that has gathered in my bladder, slowly but surely. I say clump, because the blood is probably being produced by my left kidney, not the bladder. Otherwise, I would say blood clot. It’s not a clot per sei, but rather a collection of blood, clumped together in the bladder. Work with me on this one, please.
A gallon is about 3785 milliliters, but the bag is only 2500ml, so this means that once a CBI bag is done, the outlet bag should have been emptied at least once, and still have half a bag-full left. This is not counting my normal urine production, mind you. I’m not sure what flow they had it set to, but after 20 minutes or so, my bag was full and ready to be emptied.
What happens when the bag is full? Good question. Well, when the bag is full, it does not allow more liquid. So, my bladder is no longer eliminating fluids, but the CBI bag is still dumping saline into my bladder. This expands my bladder. This hurts, and my pain number quickly climbs to 4, 5, then 6! I press the call button, and within minutes, someone stops the CBI flow, thank God, and then empties my bag, noting the amount on a pad of paper. I don’t remember if it’s a nurse or CNA. Instant relief! Pain is back down to a 2. They then restart the flow. But this time, I notice the flow is slowed down a bit, probably by accident, but I strongly believe it’s done on purpose. (So that my bag won’t fill up as fast – which means less work for the nurse or the CNA) Pain number is now at a constant 1. The flow is about 40%, but probably, previously at 50 or 60%. It seems that my pain level is proportional to the flow, maybe.
Is this a new strike? Let’s give them the benefit of doubt and not call this a strike.
Lunch is served. Bland grilled chicken, bland mashed potatoes, Jello, and a small sprite in a can. I take one bite of the chicken, and eat the Jello, but that’s all. I wish I had a pinch of salt, but only a packet of pepper and a packet of herbs was included. Note to self: Bring salt from home next time. Meanwhile, my mom has been with me all this time, save the ambulance ride. God bless mothers. My dad did visit, but since he can’t drive at night, he opted to leave after visiting hours were over; at 8 PM.
It’s now Wednesday, July 12th, by the way. By 7 PM, the new 12-hour staff comes in, and they go into each room, both the current nurse, and the incoming nurse and CNA. I overhear one say something along the lines of “And I had to keep coming in here every 15 minutes to empty that bag!” It was more like 25 to 30 minutes girl, but I digress.
The new nurse, Marisol, was very pleasant. She told me she was going to try to track down a bigger bag, so that I wouldn’t be in pain so often when it would fill up. (And so that she also didn’t have to come and empty the bag ‘every 15 minutes’) Little did she know, my mom was helping me keep track of the output bag levels, and I would stop the flow of the CBI on my own, and then press the call button. Forgive me, but I was not interested in inflating my bladder and possibly wetting the bed, nor the sudden pain. Once I heard the knock at the door, I resumed the flow. I feel pretty proud of myself.
As an aside, I later find out, via the floor supervisor, Diana, that their policy is to not exceed 15 minutes from the time the call button is pressed, to the time someone comes in, in person. Each shift is different, and you quickly learn if you have to pre-empt your calls. (Press the call button before you think you’ll need help)
Eventually, Marisol did find “the last 4000ml bag in the whole hospital” that night; at least that’s what she claimed. She says she found it in or near one of the operating rooms on a different floor.