Time Buffers… It Does Not Heal All Wounds

Four years ago this morning, my dad called me at around 8:00 a.m.  He knew I generally slept until noon (up all night), so I knew it was something different and serious before I answered the phone.  He told me he couldn’t walk right, and asked if I could come to the house and see what I thought (have been an RN since 1985, though disabled for the last 15 years- I keep up with medical stuff by keeping myself alive).  I asked him if I had time for a shower, anticipating we’d be going to the ER, and he said yes, but don’t take too long. Dad had been having back issues and some weird symptoms on and off since the November prior to March 3, 2016.  He needed a better work-up, and at this point, the ER was our best bet.

I took my shower and packed my meds/insulin figuring that I’d be away from home for hours.  Then I drove to the house.  I wasn’t really prepared for what I saw.  Dad stood up when I came down the hallway after letting myself in with the garage door opener I kept for checking his house when he was on vacations.  Dad was standing next to the bed, with ‘balance’ that looked like someone trying to stand on an inner tube in a pool.   He had no clue where his body was in space (proprioception problem).  I told him to sit down, and I’d get what he needed.  First order of business was breakfast, even though I suggested he wait because of any lab tests  that might be done, but if I didn’t feed him, he wasn’t going to the hospital.  OK… food first.  I don’t even remember what I got for him. I do know it was in a bowl, and doubt I made oatmeal, so likely cold cereal.

His lady friend (not going into detail about her, as she was a self-serving “care taker” who was handy on occasion) came over and got some of his belongings together to take in case he was admitted.  I wasn’t going to take him home in his condition, so started getting my speech ready for that conversation with the ER doc.   I got his electric shaver and warm washcloth, as well as his toothbrush- he wasn’t going anywhere ungroomed.  Then I told him I was calling 911, since I knew there was no way to get him in and out of the car safely with what I saw of his balance issues.   He didn’t argue.  I knew he was scared.

The ambulance took some time to get to the house, as his address was in the county (by one block), and the station responsible for sending emergency help was several miles away.  They came in and got him loaded up, and I told them in no uncertain terms that we were to go to a specific hospital that wasn’t the closest.  His vital signs were fine, and he was not in respiratory, cardiac, or any other distress physically.  They agreed.  I followed in my car (and lady friend took her car).

I told the folks at the ER that I needed to be back with dad, since he tended to downplay things to strangers.  They needed to know about the months of erratic symptoms.  They also needed to know that dad would not do anything medically unless he could ask ME if it was legit.  He used to say he was getting a return on his investment in sending me to nursing school.  They let me back as soon as they had him gowned up.  He was terrified.

As with any ER, it takes time to sort through everything and get testing done.  We were there for at least 9 hours, in which time he had several tests done, including an MRI that almost didn’t happen because of dad’s claustrophobia.  He almost changed his wishes for a traditional casket burial because of claustrophobia.  They sedated him (a Benadryl made him loopy for a couple of days, so the stuff they gave him IV really made him blotto, which is what he needed so the MRI could happen).  They found some strange lesions on his spine- not what we were expecting.  There was talk of sending him home (alone), and I pitched a semi-dignified fit.  They said that the ER was for finding problems – and not necessarily to admit people. I told them of his living situation, my disability in not being able to care for him adequately when he couldn’t transfer safely, and the other safety issues in sending him home.  They did admit him, and he never saw his home of 40 years again.

I’ll never forget that day, or the 19 hours on April 3-4, 2016, just a month after he was admitted, and going a rehab facility that repeatedly blew off his complaints of abdominal pain.  On April 4, 2016,  he died after a diverticula that hadn’t been diagnosed ruptured and caused catastrophic infections in his abdomen, extending into his bladder and  filling it with gas.  He was a great dad- and I’m so fortunate to have ‘landed’ with him when I was adopted at 10 days old.  He is still missed daily, though it’s easier to remember the good and goofy stuff.  My mom died in 2003, and I couldn’t anticipate the devastation of losing my last parent, and the one who was constantly looking out for me and my best interests starting from that first day in 1963. I didn’t grow  up with siblings.  My mom did things in her own way to show her love, but dad was more open about it. We had a great relationship when I became an adult, and I could tell him anything.  When I was younger, I didn’t appreciate his work stress, or the ways he made sure that all vacations included things just for me along with general sight-seeing.  He’d go out of his way to make sure I got something special out of each trip.

I now live in his house (was also my home for 9 years as a teenager through nursing school), and I’m so thankful.  I have him, and my mom, in every room of this house, whether it’s some trinket or photo, or memories of things that we did here.  I couldn’t live anywhere else.  It’s home.  It’s my family in a house.  It’s what I have left.

Blood Sugar Dump And Falling Into Walls

I didn’t feel that great yesterday.  Nothing specific, just a headache (which isn’t unusual for me at all), some queasiness, and just not feeling right.  So, I limited what I ate to jello, mashed potatoes, and other bland foods that provided some carbs to deal with the basal insulin dose I take twice a day.  The bland food helped the queasiness, and I figured I’d had enough carbs for the insulin.  I’m usually pretty good with my diabetic and  RN knowledge (nearly 28 years since graduating from nursing school; 20 years as a working RN taking care of a lot of diabetics, 17 years as a diabetic, and 8+ years of being disabled and learning a LOT from a patient’s point of view). I figured wrong.

I went to bed around 6:30 p.m.  Normally, I’m up until 2:00-3:00 a.m., easy.  I’m a night owl. And don’t talk to me before noon.  But, I was really tired, so I decided I’d either go to bed, sleep for a few hours, and then resume my normal night owl schedule, or I’d sleep straight through. I didn’t care.  I was still awake at 7:00 p.m., so decided I’d just take my nighttime meds (including my main dose of Lantus insulin) and be done with it for the night.  I crawled back into bed and fell asleep.

At 9:40 p.m. (it’s written down in my blood sugar log) I woke up to go to the bathroom, but felt really odd.  After falling into the walls walking to and from the bathroom, it dawned on my that I needed to check my blood sugar. It was 37mg/dl; I double checked it and it came back at 40mg/dl. It shouldn’t go below 70mg/dl, and my endocrinologist doesn’t want mine below 80mg/dl because of my history of epilepsy; I’m prone to seizures anyway- no point in adding hypoglycemia to the risks.  I was still with the program enough to grab one of my tubes of ‘gel’ candy (‘Squeeze Pops’ – cheaper than products marketed to diabetics, and tastes like Jolly Rancher candy, but in a tube, and a gel consistency). With some of that on board, I got some ginger ale. I checked my blood sugar about every 10 minutes until it had settled in the 90s (took about 30 minutes).  That was ‘safe’ enough to go to bed. I knew I needed a fat and protein source to keep from having rebound hypoglycemia, so justified a Reese’s Peanut Butter Cup 🙂  I was still really tired, but at least didn’t feel like I was having for force myself to stay conscious. That was better.

It’s really important to not ‘just’ do the simple carbs, or the hypoglycemia WILL come back.  I’ve been treated in a local ER, and they are clueless about the protein/fat source after getting the blood sugar back up. One time when I’d been brought in by ambulance for hypoglycemia, I was sent to the waiting room to wait for a cab, and was told the cab would be there in 45 minutes. The basic instructions for hypoglycemia are to  have a snack if the next meal is more than 30 minutes after treating the low blood sugar episode.  That’s ‘diabetes 101’ for lay people, yet the genius ER nurse was either clueless or just didn’t care (typical of that facility’s ER). When I was waiting for the cab, my blood sugar went down to the 50s again, and I told the triage desk person. She told me that since I’d already been seen, one of the nurses would talk to me IF she got time. I was safer in the cab going home.  It was really pathetic, and there’s no excuse for them.

My endocrinologist had prescribed a glucagon kit to me somewhat recently- but I live alone. Glucagon is designed for someone who has already lost consciousness, and requires someone else to mix the syringe of sterile solution with the little vial of powder, mix it up, pull it back into the syringe, and ‘shoot’ the person who is out of it.  I’m not sure how that is supposed to help me, except that I’ve dropped to the 30s before and couldn’t get it to come back up, while remaining alert. (I ended up calling 911 for that one, and getting IV D50W- that stuff feels awful going in)  I guess I could shoot myself.  Glucagon can be given under the skin (subcutaneously) or into a muscle (intramuscularly), so basically any good dart throw at the person will work.  I could do that. My outer mid-thigh would probably be the best place to aim for… a fair amount of real estate for a blurry eye and shaky hand.  But the kit I’ve got right now is expired by a month. It would probably still work, but last night, the edible carbs were working. I need to call the pharmacy for a refill on the glucagon….

For those ER nurses (and others; I’ve given it a few times working on a med-surg floor) who have given D50W, here’s a little inside information. The stuff doesn’t feel good.  It causes a strange warm feeling, and a feeling of needing to go to the bathroom NOW.  It’s unpleasant. It can also cause dehydration, depending on how high the blood sugar goes, with frequent urination and hyperosmolar  diuresis (frequent peeing from concentrated sugar in the blood).  Knowing this, and offering to help someone to the bathroom would be nice.  Go a little slow pushing the stuff- a few extra seconds isn’t going to cause brain damage.

It’s also important to realize that the half-life of D50W is dependent on the degree of hypoglycemia and the individual patient. Once it wears off, the blood sugar drops again UNLESS there is something to help prolong its effects, such as fat and protein.  Peanut butter and crackers, a candy bar, milk and crackers, or other protein/fat source is needed.  That’s also the reason that those items are not good for treating the severe low blood sugar. For ‘borderline’ or mild hypoglycemia (above 60mg/dl those will probably work OK… but always listen to facility policy if you’re treating a patient; if something goes south, that will be the criteria used to judge you).   The blood sugar will not rise quickly with protein and/or fat in the item being used to treat it.  Candy bars are NOT good ‘first aid’ for hypoglycemia, and will delay return to normal blood sugar because of the fat and protein. Once the blood sugar is raised with simple carbs, it’s necessary to give a fat/protein source- not before.

Anyhoo… I survived the night.  I hate the feeling of having low blood sugar, and last night included balance problems. Had the walls not been there, I would have hit the floor, which would have been bad news for my knees.  I’m not feeling that great today (same queasy, fatigue stuff as yesterday), but know to check my blood sugar more often today.

September 11, 2001

My dad called me around 8:00 a.m. Central Daylight Savings Time to ask me if I had the TV on. “You won’t believe what they have done”.  They. THEY?. They… I was 5 days post-op from having scalp surgery and vein stripping on one leg, and was still a little out of sorts from the anesthesia and healing process from that.  I dragged myself out of bed and turned on the TV.

At first it was just too much to process. There was smoke coming from both of the World Trade Centers.  They.  It was incomprehensible that fighting a fire at that ‘altitude’ was going to work.  I was having trouble knowing what to think, what to do, what to feel… and I was a couple of thousands of miles away.  They were doing something to us in New York. I saw footage of thousands of people just looking up, their expressions a conglomeration of shock, disbelief, and horror.  How many people were in the Towers?  At that time, estimates were as high as 50,000 regular employees of the buildings and businesses in them. That number didn’t even register in my head.

I saw  replays of the second plane hit the other Tower.  The fireball.  The people who had to have died instantly and then the ones who were trapped filled my head.  The news kept showing people waving jackets and improvised ‘flags’. But they were too high.  When I saw footage of the second plane hit, I knew who they were.  Bin Laden was the one who had done other attacks, but nothing like this. His minions were attacking the United States.  Here.  I called my dad back to ask him if I should go get my car filled up with gas. I don’t know why that was important, but it seemed that everyone gets gas during an emergency.  Nobody knew all of the targets at that point, and I was in Texas. Lots of military bases in Texas.  For some reason gas seemed important. But I was immobilized by what I was seeing.

Another plane hit the Pentagon at 8:37 a.m. CDST. The Pentagon? How could anything get through the Pentagon?  More dead. More trapped. More hurting. Families watching, waiting… More fire.

I watched the South Tower implode at 8:59 a.m. CDST.  How could that happen?  It was a huge building full of people.  Full of people.  How many were trapped, but alert, as the floors started to fall out beneath their feet?  How many knew exactly what was happening as they fell 70-90 stories to their deaths?  How many were instantly incinerated when the planes hit?   How many really jumped?  Then the second tower went down. How many families were watching their loved ones die?  Were they alone? Was someone with them as they watched their lives change forever?

At 9:03 a.m. CDST, the fourth plane went down in Pennsylvania, obliterating it.  The stories were scattered about what had happened, but word was that the passengers got control of the plane and crashed it themselves.  More lack of comprehension, and awe at their presence of mind in the middle of the crisis when I was dumbstruck many states away.  What had they felt? How had that group of people been on the same plane, and able to enact a plan to avoid more disaster and loss of life as they heard of what had happened in NYC and DC?  How had they been able to call loved ones ahead of time and get word about what was happening?  How were those loved ones when they heard news of that plane going down… Was someone with them to offer some token of support in a situation that defies the scope of ‘normal’ grief?

9:28 a.m. CDST- The North Tower falls.  The debris and aerosolized concrete  and building materials blanket the end of Manhattan, while the rest of the city has amazingly blue skies. The tops of the towers are both gone; the city is engulfed in particles of walls, papers, paint, office equipment…people.  The steel frames were bent and twisted when what little of what was left  materialized on the TV screen. It was still hard to really understand the magnitude of what had happened.  I was numb.

The next two weeks, I was off of work because of the surgery, and 24/7 for much of that time, the news channels were glued to the coverage; cable stations ceased programming. I was immersed in the news about the attacks continuously.  For some reason, I couldn’t turn the TV off.  I had to know what was going on. Were there more attacks?  Were we safe?  I’d see the shots of people putting up photos and descriptions of their missing loved ones on fences and walls near the Trade Center site.  They had to ‘know’, but also had to hang on to a bit of hope until there was none left to grasp.

Rescue workers were going through the wreckage of the Towers with buckets, pausing only occasionally when a body was found.  Everyone stopped working, paying their respects to the person coming out in a flag covered stretcher.  The NYFD carried out their priest on a chair. Dead.  Both the NYPD and NYFD lost SO many of their own.  How unfair that anybody die, but they died going in to help the others.  And the buildings caved in.  They didn’t have a chance up in those buildings or near the bottom where the twisted pieces fell.

Dogs wore special boots to keep from shredding their paws on the steel and glass.  They were there for survivors at first, and then those who were temporarily buried in that burning metal tomb.

In total, 2,606 people died in NYC, 125 at the Pentagon, and 40 in the plane crashed by heroes in a field in Pennsylvania.  The youngest to die was 2 1/2 years old.  Ninety countries lost citizens.  Nineteen highjackers also died, but I refuse to add them to the total victim count. In total, more than 2975 people were killed in the span of  102 minutes.  For what?  

In two days, it will be the 11th anniversary.  I still can’t see documentaries about that day without dissolving into tears, and I wasn’t even close to the situation.  This had no ‘borders’ or ‘city limits’. This was an attack on America, collateral damage in the form of foreign nationals- our friends- be damned.  It still makes no sense.  I still wonder how the people in NYC deal with their grief, and how the families of the victims are doing.  I wonder how those who inhaled that stuff  have fared; various illnesses have been reported- in those who were there to help.  My guess is that the actual number of victims is really unknown; the families and friends of those who actually died will never be the same. They are victims,too. And survivors.

September 11, 2001 showed the vulnerability of all of us.  While I’ve gone through a personal attack in my home, the magnitude of 9/11 isn’t something any of us could comprehend.  There are countries that go through terrorism regularly, but not us. Oklahoma City was the closest we got to knowing what that is like. Even the first WTC bombings didn’t come close to 9/11.

I changed that day.  The fact that life can be cut short in a nanosecond at the hands of lunatics was graphically shown for days on end.  For the first few weeks after I returned to work, I was overwhelmingly annoyed when my coworkers talked about everyday mundane ‘problems’ (matching shoes to a dress for some 3rd rate banquet? Puhleeze).  It took me a while to get out of those two weeks, and back into my regular life.

But I’m so insignificant in the grand scheme of things.  What about those families and friends, and now the survivors of those lost in the wars fought in response to 9/11.  In many ways it has been a world war.  I’ll never forget that day, and I hope those who were too young to remember it will grasp the magnitude of that day and learn from history.  I hope that we can regain some of our prior sense of safety without neglecting common sense.  It happened once… we can never guarantee it won’t happen again.  But we have to go on living if we are to really honor those who were lost.  Otherwise they win.