THE ER PART II by Nora Logan

Recently my platonic life-partner Layla sent me a recording she took when I was in the Emergency Room. I started to write a post about the ER in 2016, just a few days before I was hospitalized for rejection, a lot of which I used for my previous post The ER Part I. As I slipped into acute liver rejection, my recovery morphed into relapse and the course of things dramatically shifted. I've often looked at the draft of these posts and even opened them, stared blankly and moved on. I think having as serious a set back as I did made it all but impossible to talk about the ER in a pithy way (as originally intended). Because the narrative changed, I no longer had my neat little bookends for the chapters in my story. Here's the one in which I enter the ER, here's the one in which I have the transplant, here's the one where I emerge from the hospital triumphant, never to darken its doorstep again. That setback taught me that I could land back in hospital at any given time, such is the nature of being a transplant recipient. But it's also the nature of being human. I could break my toe and have to go in and I could go in to have a hernia removed as a result of muscle mass around my scar. For me to wrap my head round those variables is what I had to eventually come to terms with. But then, I couldn't possibly imagine going over ‘The First 24 Hours' at a moment when I was again in a prison of my medical history. 

When I listened to the recording, it all came rushing back like when you are trying to dive into a pool but you actually do a belly flop and it hurts like hell. You know that being-bitch-slapped-by-the-water feeling? If you're anything like me (which maybe/hopefully you are decidedly not), it's a feeling of 'ugh I never want to experience that again but maybe I should try it just one more time to be sure'. The first 24 hours in a hospital, especially when you enter said hospital with a mystery illness are at once eventful and mind-numbingly boring. Just the conversation from the recording goes on for quite a while. I've transcribed some of it here to give you a sense of the many, many, many conversations I had with doctors who were trying to figure out what was wrong with me and save my life (and to avoid transplant). I've made mention of these conversations at length on this blog, and I am sharing it here as an example that when doctors are trying to get to the bottom of something, you best believe questions will be asked over and over and over. In my experience, doctors do not like a head-scratcher - like most human beings, they like to have a definitive, scientific explanation for something. Anyone who has been through any sort of serious medical experience (or even not-so-serious) know about these questions, and they get old fast. I can see it now in a new light: doctors are detectives and all they have as evidence is blood-work and answers from patients (who happen to also be the most unreliable sources in the world). Turns out they weren't trying to torture me for the sake of it! 

Despite the tenderness I now feel towards the medical team who were deciphering my blood tests and often unreliable responses, bear in mind that I was asked these questions repeatedly over a 2 week period. From an unimaginably large multitude of medical professionals. I don't know how I didn't lose my shit more often. 

Doctor: You know..warbled..little bit higher than I would like so I do want to keep you here to figure it out I fully anticipate figuring out what it is. So I don't want you to worry about that. [She's referring to my liver enzyme levels, which would continue to shoot through the roof.]

Me: Ok

So the question is what is it? There is a whole gamut of things that the liver could have problems with. Virus, clot, other types of infections, autoimmune disorders, there's like tons and tons of different things. So then the other question is teasing out what it is and what do we do for it? Ok? That's going to include probably a thousand blood tests. The ultrasound which we have to take a look at. There's going to be even more blood tests. 

Me: This is my mother. 

Doctor: Nice to meet you.

Mama: Nice to meet you.

So again, a thousand blood tests. Some of them come back quickly, some of them do not. So we're going to have to figure out what they are. The ultrasound, which I wait for that to be read by the radiologist, ok? [sic]

Me: Ok

Doctor: If we really need to, I can always do a liver biopsy. I have like 15,000 tests I can do so, now, what is easiest and what is going on for you? To start we'll do the liver tests, the blood tests. So you should anticipate getting a lot of bloods drawn today. So we'll be like vampires, we're just going to take and take and take.

Inside I thought: 15,000 tests?!!?!?! What the shit is she talking about??!!! Instead I said:

Me: I love it. 

I told you I was charming. First rule of ER: charm them. Make them love you. Be in acute liver failure.

Doctor: So we're going to try and get, hopefully, ideally if I can just get it from a liver blood test, then we're done and I can just get the answer for you. If not we do other tests, not a big deal. So my turn to ask you questions if you don't mind. I heard you went to Indonesia. 

Is that a question though, really, doctor?

Me: Yes. 

Doctor: Fantastic. Why'd you go? 

Me: I used to live there for 2 years and my best friend still lives there and my godson lives there and I have never met him so I went to meet him. 

Doctor: Oh, nice. 

Me: Yeah, it was great. 

Doctor: How long were you there for? 

Me: I was there for two weeks. 

Doctor: And when'd you get back? 

Me: On the 14th, I got back on the 14th, I left on the 13th of July. 

Doctor: Now, before you left, any problems? 

Me: Yep, on the 10th...

Doctor: Before you left from the US, before even going there.

Me: Oh, no. 

Doctor: Healthy girl. 

Me: No. Super healthy

Ok Nora, chill.

Doctor: Anything at all? 

Me: I was like working out all the time, feeling great [I mean, she doesn't need to know how great you are at exercising, Nora]. I had had a shoulder surgery but that was you know...

Doctor: Where'd you have your shoulder surgery? 

Me: I had a labrum repair. 

Doctor: Here in New York? 

Me: Oh, where did I have it? At Langone. 

Example of hilarious doctor patient misunderstanding here.

Doctor: Now, I'm gonna guess they checked blood tests before that procedure because almost always we do. 

Me: Yeah, it was last year, yeah, I think they did. 

Doctor: Did anyone tell you anything was wrong? What'd you do, just like do some crazy...

Me: Yeah I had multiple dislocations over ten years so...

Doctor: Oy ok, so you had some procedures. Got it, ok. Since then you were doing ok? 

Me: Uh, yes.

Doctor: And no problems with the anesthesia?

Me: No.

Doctor: Were you taking any pain medicines for the...?

Me: Yes, throughout the time I was recovering, I would say what like probably two months? I was taking the codeine and percoset. 

Doctor: And in 2 months you haven't been taking that afterwards? 

Me: No, it was last year. 

Doctor: Right, so 2 months after that, so like the past 9, 10 months you haven't been taking anything? Not even..

Me: No, I took Aleve, yeah, I took Aleve for quite a while because I ended up getting a pinched nerve from being in the sling.

Doctor: Got it. 

Me: So I probably took Aleve longer than I should have. 

Doctor: So Aleve but no Tylenol? 

Me: No, I don't like Tylenol. So I never really take Tylenol. 

Doctor: So when was the last time you took anything over the counter? Including Aleve? Not counting, like we're still talking about before you left to Indonesia. 

Me: Before I left? 

Doctor: Yeah. 

Me: I may have taken an Aleve or two in like the couple of weeks leading up. 

Doctor: But like one or two, not like everyday with a bunch? 

Me: No, no, no. 

Doctor: Ok. So you left feeling great, happy to see your godson and then I heard you got sick there. 

On and on and on the merry-go-round it went. 

The way it started was this. I went to work in the morning. I had an ultrasound scheduled at Beth Israel for 12pm. My mother met me there, and I went in for the ultrasound. Whilst I was waiting, I called my insurance and checked which hospitals were in my network. It was between Weill Cornell Presbyterian and St. Luke's. My mother looked at me and said: 'We have to get you to the fucking hospital. No more of this waiting around.' The upside for Weill Cornell was that we were already on the East Side (at Union Square) and both my mother and other family members had been there already for procedures and surgeries. The upside for St. Luke's was that it was closer to my parent's house. We decided that didn't matter, really, and chose Cornell. Thank god we did. No shade to St. Luke's, but I had no idea I'd be needing a liver transplant at this point, and I was going to one of the best hospitals in the world specifically for liver transplant. 

After the people at Beth Israel told us we would have to wait 48 hours for the results, we hailed a cab and told the guy where to go and to go quickly. We called my dad. We got to the ER. I sat in the waiting room chair and firemen in full fireman regalia passed by. A volunteer handed sandwiches out. I tried to take a bite of a tuna one and nearly threw up all over the linoleum floors. They called me in for testing behind the plexiglass. The got me a bed. We marveled at how *relatively* quickly they got me admitted. We weren't in any sort of state to fully understand the reason for swift action: bitch was yellow and getting yellower, and they didn't see me leaving anytime soon. And I haven't, really. I still go back to that hospital once a month, with pleasure (and sometimes complaint due to it's wildly inconvenient location).

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.