blood test

THE ER PART I by Nora Logan

I spent over 26 hours in the ER at Weill Cornell. They didn’t have a bed for me on any of the wards (and didn’t know what was causing my liver failure so were not sure where to put me). At that point they had yet to rule out an infectious disease. The 26 hours (not that I was counting) were a test of my patience, which at that point was a small thimble compared to the deep well I’ve had to dig since. If you think of a hospital in the way you would any hierarchy, the ER is at the very bottom rung (A&E for my UK people who never watched the extremely popular TV show ER - it's understandable if you missed it, it was only on for 15 years). No one really wants to be in the ER: the patients, the doctors, the nurses – it’s a hellfire like few others in the world. I may be exaggerating, but only slightly. In my extensive research on the ER, the only person I've met who didn’t mind it is a sweet friend of mine who was a volunteer at the hospital at the same time I was there (the second time round) and would come visit me when she had a shift. We would discuss the flaws in the system, and her reverence for being witness to the inner workings of the ER always struck me. There is something to be said for being in the thick of it, in the place people come when they're in dire straits Unfortunately in this country, where our healthcare is in such disarray, where we currently have 28 million uninsured people – people who go to the ER often as a last resort because it’s easier to walk away from the bill—or because they have no other options. 

If you're in a situation like mine, where you'd be very lucky if you even get to leave, your best bet is to hope that they want to get you out of there as soon as possible, and let it all wash over you. Before they really knew the full extent of my liver failure, they gave me morphine to take the edge off. I look back on that short-lived morphine moment as a warm bath of narcotic reverie. I remember, so vividly (well, I'll admit that it's not a crystal clear memory, but I have a fuzzy, opiate-laced general idea about what was happening), when they picked me up to transfer me on to a gurney and wheel me from my little bed to my first MRI. I looked up at the ceiling and had the distinct sensation that I was being rolled through a jungle. I could hear the sounds of the busy ER. The beeping of machines, the moaning of patients, the chatter of doctors, the nurses shouting back and forth to one another about bringing this piece of equipment or that syringe or this medication, it was all there in the background. But there were also more ethereal sounds triggered by the drugs (I believe they were a hallucination, although this can only be confirmed by my eardrums and imagination which unfortunately do not have their own spokespeople, so it's essentially up for debate). 

I was wheeled through a ward filled with murals, presumably for children (although I grew attached to them with each passing MRI or ultrasound), replete with cartoonish tall grass, butterflies and other animals. The pastel colours made me dream of a canopy of green, while the loud sounds of crickets and other high-octane noises bubbled up. A persistent buzzing—like a heart monitor flat lining—formed a helmet around my head. None of it was real, and yet there I sat. I associate my time in the ER with an escalating sense of panic, a similar experience to a comedown off drugs. And hey, it was. At a certain point, the offer of morphine stopped (just as the expression on just about everyone's face got more grim). The information increased in seriousness. New doctors kept coming, and although I kept the jokes going with my friends: 

"I'm never going to sleep it seems but that works out for me because you know I love to party. I am going for an MRI and hopefully having a blood transfusion cancelled because it's unnecessary [keep that dream alive, Nora of the past]. Sorry for the massive group chat but a lot of you are asking and since all the doctors love me so much and want to find out what this weird place called Bali is and where I picked up whatever the fuck this is it's easier to explain here rather than lots of texts. For now I basically know nothing but still have all the same symptoms and will hopefully know as some point in the next day or so. Love you bye. X".

Looking at the texts now, I'm amazed at my optimism, which would (sort of) last more or less all the way through to being listed for a transplant in the step-down unit on the 5th floor, when the grave reality of my situation set in (even then I was convinced I wasn't dying and kept saying things to the effect of "honestly everyone, I am definitely reversing this liver failure, don’t mind me! Is the F train running today? Need to get home later.")

When the silent stop order on the drugs went down it became all too clear that this was not a joke. But it was a lot easier to pretend like it was, especially since it's near impossible to get any sleep at all in the ER. They wouldn't even let me take an aspirin. Are you familiar with the feeling of your liver rapidly deteriorating at break-neck speed without pain or anxiety medication or anything whatsoever? It's sort of like nails scratching a chalkboard repeatedly 24/7 for 10 days. It's chill. The experience was so unbelievable, I was sure I'd be waking up from a low-rent badly-lit nightmare at any moment.  And If I hadn’t been the one who experienced it, I wouldn't actually think it bearable. 

During my time in the ER, I saw all manner of bizarre sights reserved only for the preternatural setting of a room that is essentially a holding area for any and all manner of illness. Think about it. Whether you’re coming in for stepping on a nail in a warehouse party or a building site, your kid fell down in the park and split their lip, you’re a drunk who comes in weekly, you’re an elderly person who lives alone and you’re scared because you don’t feel well and don’t know where else to go, you’re seeking pain medication for some phantom back problem, you just had a brain hemorrhage, you got into a fender bender, you have food poisoning or, like me, your liver is failing (the list goes on, and on), it all exists together, in this ground floor vacuum. You can witness the best and worst of humanity in an ER. The stakes can be really high so everyone is tense—from the patients to the nurses to the doctors to the aides to the janitors. Everyone reacts differently—someone could be completely distraught over a sprained ankle or worryingly calm about a massive heart attack or vice versa. On top of that there are so many variables to everything. It's hard to keep your head above water as a patient. I can only begin to imagine what it must be like as a health professional.

The really weird stuff happens either very early in the morning or very late at night—it’s when the zombies come out to play (or nervous parents come in with toddlers with temperatures). I clearly remember a wasted guy in his 40s come in around 3am screaming at the top of his lungs (which isn't so out of the ordinary, we've all heard a story like this), the staff at once wearily pleading with him to settle down but also completely ignoring him, because they've seen it all before. He would not leave and he would not shut the hell up. The woman next to me was wailing in pain and she would also not shut up—she wanted to be seen by someone—anyone. She was indignant that she was so willfully ignored (and probably disgruntled that I was fast becoming the It Girl of the ER). She was being ignored. That's what happens in the ER. Once that morphine wore off and I no longer felt like I was a panther in human form in the Amazon, it was interminable. I had so many doctors come in and out of our little room, the only thing separating us a tiny, thin piece of material that passed as a curtain to come see me, asking me questions - doing their work, trying to solve the case of the mystery liver failure, which only increased her loud frustration (understandably). Even with the constant flurry of people, I felt ignored too—that’s just what it is to be in the ER. The moral of this particular ER story is to get as much morphine as possible when you're spending 26 hours in the vortex. Failing that, keep your phone nearby for jokes from friends and keep your interactions with the drunk guy at 3am to a minimum. Oh yes, and find the least used bathroom and use it exclusively.

AFTER THE PARTY, IT'S A DOCTOR PARTY by Nora Logan

IF YOU CAN believe it, that Sunday of the wedding was the 19th of July. I didn't end up going to hospital until the 27th. I lived a lot in the 8 days leading up to it. I was dying and I had no idea (not to beat a dead horse but let's beat that dead horse). To this day, I still believe I really and truly had no idea. And I was misinformed. I go into work on Monday morning the 20th of July. And I'm really a hurting unit, so I write a Gchat to my friend Al, I have to go to the real doctor. The trouble was, I didn't have a GP. So Al suggests that I try this place her friend goes to that is basically for people who need a gyno or go for yearly check-ups and they just want a nice calm atmosphere when they walk in and water with fresh slices of lemon in an oversized mason jar and couches from a Swedish design shop that isn't Ikea but basically has the same furniture at a higher price point and some sweet Norah Jones or Jason Mraz or Coldplay or Tibetan gong music playing in the waiting room. Like not cool music, but not waiting room music - you know? It's basically bougie as fuck and you have to pay a membership to be a patient there. They promise you better service, no waiting for appointments and more attentive treatment. It's dumbfounding to me that this is what healthcare has come to in America, but they have a great website and I love easy listening so I bit, I chomped down hard on the proverbial Kool Aid. I was desperate and so I pulled out my plastic and made an appointment. Also, since I didn't have a GP, I couldn't get any appointments for the same day on ZocDoc and at least this place came recommended. I have since got my money back for this membership because of the part they played in my care, which I honestly have to say was negligent.

Ken Kesey's Magic Bus 'Further'. These guys were for sure drinking the Kool Aid. Known as the 'Merry Pranksters'.

'Of course, they could fit me right into the schedule, no worries, come on down.' I got an appointment for 3pm that day. I went into my boss' office and said listen, I have to go to the doctor, and she said 'Yeah, you don't look so good. I can see you're unwell.' So I stay at work until about 2ish and bust out of there and hop down to 23rd street on the subway (it's weird that the most distant memory for me in this story is not the actual memories but what it's like to take the subway anywhere. So fast. So efficient. So germ-infested. So many pizza rats). I was so half-baked at this point that I didn't realise that I was going to see a Nurse Practitioner, not an actual doctor, not someone who had years upon years of experience, not someone who would recognize jaundice as a serious sign of trouble or say definitively 'BITCH, GET YOUR ASS TO THE HOSPITAL RIGHT NOW'. I have since pictured people going into this clinic for when they have something like acid reflux or multiple yeast infections or UTIs or Athlete's Foot or genital warts or Verrucas or a papercut or some other (admittedly annoying) but largely innocuous health issue. They're not the people you go see when your liver is about to fucking fall out of your vagina. I am pretty sure that's not how it works I would have to check with my doctor to make 100% sure but you know what I mean. But they're who I chose as my health professionals. I felt pretty angry at the woman I dealt with there for a long while. I oscillated between, well, she didn't know me, I walked in as a stranger with yellow eyes and she didn't know me from Anna. (Yeah, yeah the expression is from Adam but #girlpower). Who knows, maybe I scared her. 

bey

I don't want to say she was incompetent, because the woman really was not. I am confident that she is good at her job but I don't really know if she deals with this sort of thing all the time. I think it was a perfect storm for me and just bad luck that that's where I ended up. I walked into her office, after sitting in the lovely, gorgeous waiting room with huge loft ceilings, sipped on some artisanal lemon water and listened to some trendy easy listening across from a well-manicured Flatiron woman who had most likely just come from Dry Bar or is one of those mythical creatures that gets her hair blow-dried 3 times a week and was rocking a next day blow out. Either way, I was in a place where health problems exist, but we can make it all better with interior design and making it seem like we're at Soho House. EXCEPT NO BUT YOU CAN'T DO THAT AT ALL NOT WHEN YOU'RE REAL FUCKED UP.  I went in to present the facts. Bear in mind, this is the second time I'm repeating the Bali story, because this is only the second medical professional I'm seeing. 

This is what this doctor's office had in mind when it was targeting clientele. People with entire Pinterest albums full of candles and crystals. Which is someone I could probably be if I really put my mind to it. Photo courtesy of SoulMakes

I tell her what's up and I tell her my theories (at this point I had a bunch of theories cooked up in my head, some of which I never shared with medical professionals, some of which I did). This woman is newly pregnant and just starting to show, I was so excited for her! I had just come from seeing my godson and nephew and how far along is she and does she have another kid or is this her first and you know just the normal small talk. Nothing. Woman gave me nothing to work with. It was pretty much like getting blood from the stone. She was so chill and nonchalant that I was truly thrown by it. And I hate chit-chat, I don't love small talk, let's get down to business for sure 24/7 if I don't know you, let's not waste time talking about our lives. I don't care, you don't care, neither of us care so let's just get down to what we're here for. But something about her attitude was so bizarrely asleep at the wheel that I was like, I have to get human with you on some level. I need your help and you are not giving me anything here so I need to endear you to me SOMEHOW (more on how I was the most charming and loveable patient NYP has ever seen later). 

I had been having a pretty good year, I was exercising constantly, drinking gallons of green juice, wearing cute outfits and feeling pretty good about the direction I was going in. Photo courtesy of Feedly.

So I move on from the small talk, I was pretty painfully aware that I wasn't going to be buddy buddy with this person: so let's do this thing. 'Basically, I went to Indonesia for 2 weeks, I started vomiting not this past Friday but the one before and it's been pretty steady ever since.' (UH, HELLO THAT'S OVER TEN DAYS WHY DIDN'T SHE TELL ME TO SPRINT TO THE HOSPITAL LIKE DON'T TAKE A CAB JUST FUCKING RUN RIP ALL YOUR CLOTHES OFF AND SHOW UP READY FOR TESTING), 'and I've now developed this jaundice; I'm exhausted and I just can't shake it and it's strange because at first I thought it was jet-lag but now it's just lingering and I don't know what to do. Also I think it has something to do with my ovaries so if you could check those that would be great.' I had this bizarre hunch that there was something wrong with my ovaries. Let me explain.

Photo courtesy of Rachel Antonoff

I had this guy, Pak Durit do this very intense massage on me in Bali. He's friends with my friends and he is an older guy, a healer, a medicine man (Pak means Mr. in bahasa Indonesian, but it's a respected way to address someone, it's mostly for an older person. The female version is Ibu). He comes to your house. The whole story is much longer than what is intended for this post but the first time he did it he touched on a point in my shoulder (from which I had been healing from a surgery for the previous year) and I completely lost my shit. He pushed on an emotional portal or something and I started uncontrollably crying for almost two hours. I got on my scooter to drive to dinner with tears streaming down my face like just bawling my eyes out in the rice paddy. It was wild. Needless to say, I definitely scared the children: 'Aunty No-Wa, why are you so emotionally unhinged?!' Just kidding they didn't say that they are both under 3 years old they don't know how crazy I am yet. Anyway, I saw him again before I left because dude is really a miracle worker, the above anecdote notwithstanding (for what it's worth I thought that emotional release was so rad and just what I needed). When I was lying on my back he went up to my abdomen area and touched on something there. He goes 'Sakit disini' I say 'Sakit mana?' And he points. Pak Durit doesn't speak English and I do not know the words for any of my insides in Indonesian. He was saying 'You're sick here' to which I answered 'Where?' THE NEXT PART IS MY BAD. So I can't exactly remember but I think I somehow worked out that he was pointing to my ovaries. And to be fair, I did end up having cysts on my ovaries which is actually very common and nothing to worry about.

A text I sent to my friend Jenny right after massage-gate 2015. I always laugh at her reply 'That sounds really crazy...' loosely translates to 'You are a total nutjob Nora...'

But I just couldn't let the ovary thing go. I remember it being the morning of my transplant or maybe the day before and asking my surgeon 'Is someone going to listen to me about this ovary thing or WHAT?' No one would let me have a goddamn ovarian ultrasound because they basically knew for a fact that I was dying of liver failure. But I couldn't let go of it. I was like YO MY FRIEND DURIT SAID IT WAS MY OVARIES AND DUDE IS NEVER WRONG. I didn't end up getting that ultrasound until after transplant (when I insisted on it) and ooh buddy it was painful with a gaping Mercedes Benz scar in my middle and having had a catheter in me for days on end. Insert Kelly Clarkson lyrics here. But Pak Durit also looked pretty scared when he was telling me, and he maybe was feeling something wrong with the liver, too. And maybe he could feel that I was in for an absolute world of hurt. And if I had been staying in Bali, I would have been. I would probably actually have been dead by the 6th of August instead of getting a second lease on life. So I think that's what he was so scared about. I can't wait to see him again so I can ask him what went through his mind. I am going to have to learn the words for liver, intestines and ovaries in Indonesian by then which I think I can do and also where the ovaries are in relation to the liver. No I know that second one now so that's one thing I've learned from this experience. Basic human anatomy which I think you're supposed to learn when you're 12 or 13. I'll get back to Durit in another post he is a wise man and an absolute legend. I have wondered, so often, if he knew right there and then what was going on. If it could have saved me all this to-and-froing from Urgent Care to nurse practitioners. I don't know why neither myself nor Claire thought to call the guy in between. Oh well, spilt milk and all that. 

At dinner with the kids and still crying my fucking eyes out. Claire was not impressed. I was like her third child. 

So the most nonchalant, lackadaisical Nurse Practitioner on the planet gets an earful about how I think I have something wrong with my ovaries (Why? Oh, just because, I just have this feeling, you know I'm in touch with my body. No I did not tell her that a Balinese medicine man told me so now I have accepted it as truth).  I know she was pregnant so this is probably not the case but she honestly looked like she had taken a massive rip off a bong before she saw me. I just was not interesting at all to her. Or maybe I terrified her because she was pregnant and I could have some insane tropical disease. Indonesia was, after all, an obsession of every single doctor I met. There was indeed the possibility that I had Hepatitis E and that's what she presented me with. She ordered some labs, she asked for me to send her the blood work I had done at the Urgent Care place and she prescribed me some Compazine (an anti-nausea medication that I would come to know and love with the utmost affection and gratitude, shout-out to Zofran too, love you buddy, thanks for getting me through the first 6 months post-transplant). 

Pak Durit, me and the kids looking on as I got worked THROUGH by him. Look at how cute those kids are. Damn, my ovaries are telling me to procreate so I can have some cute kids like this. 

Meanwhile, I asked my mother to drive me back to Brooklyn because for one, I was just staggering around like a goddamn drunk and also because I hadn't seen her since I got back from Bali. So she picked me up in the car on 21st and 5th and we drove back to Greenpoint. I asked her to stop at this pie shop called The Blue Stove and I got us some apple pie and some other cheese thing and some iced teas. We sat in my back garden and we each smoked a cigarette (best way to quit smoking--go into hospital for 30+ days and don't leave at all and have a few surgeries in between). She cleaned my pool because she has a compulsion to clean things and make everything 'nicey-nice' as she would say. Anne and Barrie were having dinner at a place down the road from me and we went to meet them to say hi. I picked up the Compazine at CVS but they didn't have it so I went to a different CVS down the road which did have it and then I spent another night hugging the toilet bowl. My poor roommates. I don't know how much they could hear but it wasn't pretty, the auditory section of my nighttime routine was not the most calming environment to be in. I remember Keenan sending me off to work everyday 'So you're gonna go? You ok?' 

My mum came to Brooklyn to hang out with me on the Monday after my doctor's appointment, she cleaned the pool.

So the Compazine doesn't work and I'm going for more blood work and urine testing in the morning. And it's only Monday night. We have another 7 days of this shit. God only needed 7 days to create the world and I only needed 7 to realize that I was in a world of trouble, one foot in the ground and knee deep in horse shit and more importantly, needed to get myself to the Emergency Room STAT. Oh wait sorry I needed 17. Guess I'm not God after all. The next morning I would go into their testing facility and pee in the cup. The results would show up as 'Cloudy' and 'Abnormal'. So many Abnormals in that test report. So many. One thing is for sure, I only have the medical degree I received from being in hospital for over 30 days (they give one to everyone once you reach a certain amount of days + procedures), but this urine does not look like the urine of a healthy person. 

I show you this photo of my urine not as an overshare but because to give you a true life story of what you get at a bougie medical office in NYC: burlap bags for urine. Like an episode of Portlandia, but exponentially worse.