nurse practitioner

THEY THOUGHT IT WAS HEP E AND MADE ME LEAVE THE BUILDING by Nora Logan

I WENT INTO work after urine and blood testing on Tuesday morning and it was pretty brutal. Things were, unsurprisingly, not going well. I should have, as I've said before, just packed up right then and paid $100 to take a pedicab to the hospital or just found the first police officer with a horse and got him to let me bareback up 5th Avenue. But I wanted to wait a cool 7 more days before I really and truly got the message and, after an awful ultrasound at Beth Israel, checked with my insurance about which NYC hospitals were in network and took a cab up to New York Presbyterian (even then, it was my mother who threw her hands up and said: enough is enough already). So I'm sitting at work and my liver is just casually failing and I feel so unbelievably shit and by this point I'm getting sort of scared but not thinking your liver is really on it's last legs you need immediate medical attention because I didn't know and I also didn't have direct contact with my liver like I do with my new one. Nothing like a transplant to get you really in touch with your body. And also, we hadn't got the test results back yet. And because the actual last thing from my mind was my liver failing and the only thing more preposterous than having my liver fail was the idea of having a transplant. I mean, I didn't even know what a transplant was. I still am not quite sure what it is. No, ok I admit, I knew then and I know now, but like a lot of you who might be reading this blog and going, I just don't really understand and it's so out of the realm of possibility and I can't even conceptualize and oh that's the sort of thing that happens to other people and it seems so sci-fiey and I'm just not educated on it. I didn't know anyone my age at the time who had ever had any sort of transplant. The closest I was to it was my friend's mother, who has had a couple of kidney transplants and is one of the strongest people I've ever met, but like the twenty-something I was, I never paid it too much attention. It was also far from my mind because I was TWENTY EIGHT YEARS OLD AND WHY WOULD I EXPECT TO BE DYING? Have you noticed that in your twenties you do all manner of terrible things and make awful decisions because you really have no concept of dying or death? I guess it's a pretty common theme through out history and all of art and literature so I'm not breaking ground here. I used to drive a motorbike in Indonesia everyday for 2 years with my headphones in on full blast weaving in and out of traffic as if I was Evil Knievel. I don't even have a real driver's license. That doesn't even scratch the surface of idiotic things I did in my 20s.

Photo courtesy of We Heart It

I have since found out that there are a great number of young people who have to have all sorts of transplants, and a lot of them are children. Although the average age of a liver transplant patient veers more on the side of 60+, it's really not uncommon to see young people having to have these operations. What surprised me even more, is that 1 in 5 people who go into liver failure never find out the cause. There's such a stigma that surrounds liver transplant in particular in society at large, that it's just old alcoholics and drug addicts. I've experienced this stigma first hand, which I'll talk about later. It's a complete fallacy. Yes, of course there are alcoholics and drugs addicts who have to have liver transplants, and they are also completely deserving of them. Liver disease  often stems from another disease: addiction. But there is a whole host of other people, too, who never know why but their body just fails them. 

Warner Bros. via    gif-database.tumblr.com

Warner Bros. via gif-database.tumblr.com

My friend Alex suggests I go try to take a nap somewhere. Which is just not really done, at least at my job, and I would assume all of your jobs unless you work at Blockbuster in the 90s. I don't think anyone has successfully napped at work since 1996. First I go to my friend Zarah's office which is otherwise known as a broom-closet. It's great for hiding because people don't know where it is and she can't really be found. At the time, anyway. She has now graduated from broom-closet office to office-office. I've since returned to work but I still can't find her. So I'm lying on the floor in her tiny office contemplating my fate and Zarah is doing work and wondering what the hell I'm doing and giving me a look like 'Fuck man, you look like shit.' Fair dues, I did. She was polite enough to not say those words though. She talks a lot with her eyes. She kindly let me use her space for a good 15 minutes and then I staggered back to my desk. This was unsustainable: the fatigue was so bad I went back to my desk, then to the toilet, then did a lap around the office and then, feeling skittish, back to Zarah's office.

Oh, I'll just be over here quietly avoiding my liver failure. Photo courtesy of observando.net

Then I remembered there is a sweet nap room upstairs at the nurse's office. So I walk in and tell them 'I'm just so tired and feeling unwell, do you have somewhere I can take a nap?' At first, they let me use the room, you just go and sit in a comfortable chair and breathe deep breaths and attempt not vomiting. Oh wait that was just me in that moment. If anyone else were to use it they would just find a calm and peaceful environment. It was somehow connected to the office by a sliding door and I could hear them start to discuss my 'case', much to my dismay. I essentially blagged my way into this nap room unnoticed and the nurse on duty (she was smart and experienced) wanted to know why I was here and why I needed a nap. So she grills me, gets me up out my nap chair where I was having a great time not vomiting. 'What's going on? You were where? Bali? What? Why are your eyes yellow?' So I told her the story, 'I'm under the care of a doctor who thinks it could be Hepatitis E,' (minor lie, she wasn't a doctor), 'but I have tested negative for A, B and C. And yes, I was in Indonesia'. This is where she switched on me. 'You can't be in the building if you have a potentially infectious disease, you're just not allowed on the premises, if you stay any longer we are going to have to contact disease control.' Um, excuse me? No no no. You don't understand, I just had two weeks off and then I got stuck because of a volcano situation which is just like me to get stuck in a volcano cloud and I missed another day and a half of work and it just doesn't work like that and no I am not leaving the building. What actually came out was a swift nod (she was very scary and authoritative, to which I generally respond) and 'Ah ok, well can I go downstairs and tell my boss and get my things together? Do I have to leave right this minute?' She let me stay to tell people I was barred from the building and gather my things. 

It was then that I decided to call the Nurse Practitioner I mentioned in my previous post. I had already been trying to get her on the phone because this was all getting a little too real and I wanted my test results immediately. It was extremely difficult to get her on the phone, she had patients back to back and she was running around. When I finally do get through to her, it's that same old asleep at the wheel attitude - if I didn't know she was pregnant I honestly could have sworn she was chaining joints. 'Hi, I really don't feel any better, I'm still vomiting all the time and I just took a nap at the nurse's office at my work which is really not normal for me. Do you think I should go to the ER?' 'Well you can go in if you want to but honestly I think it's Hepatitis E and we should just wait for those test results to come back.' I swear this is the medical advice I was given. It's jaw-dropping looking back. 

Would have loved a little direction like Patsy would give. 

I know you could be reading this and going ... well you know, the girl was in liver failure, after all, maybe she has a foggy view of things. Oh, I was for sure foggy. But I remember how this all went down. It was life and death, after all. And I have NEVER got to say that before and meant it. So you better believe I'm going to commit everything to memory. Also, as proof, here is a direct quote from an email exchange the very next day with this woman on the 22nd of July (5 days before going into hospital), and the first time I found out my liver enzymes were abnormal:

'I am assuming that this is hepatitis E  - you could come back here for the test during lab hours which are 8am-11am or 12pm - 3pm  - I will order it. I don't know that going to the hospital will speed anything up, but they would be able to give you some IV fluids and some IV anti-nausea medicine, so it depends how you feel.'

IT DEPENDS ON HOW I FEEL?!?!?!?!? DID SHE NOT SEE ALL THE ABNORMAL TEST RESULTS?!!? I was in a fragile state, and for that very reason that I was a bit foggy and out of sorts, I needed my medical professional to tell me to go to the fucking hospital. Not 'feel it out myself'. She was, what can only be described, as trippin.

HELP ME HELP ME HELP ME HELP ME HELP ME. Photo courtest of Whimsy Dreams

I do the long walk from the elevators back to the office and steel myself to prepare to tell them I'm leaving the building and why. I relay the news to my boss and I somehow still feel guilty despite it being completely beyond my control. My problem was that I was under some delusion that any of us have any control over anything at any given time. She's very kind and she says well you absolutely have to go, maybe next time don't go to Bali though, just an idea. So I jump into the G train and go back to Brooklyn. My feet are like weights. I'm on a chain gang and the chain gang is my body because my body isn't working. That night, another beefa, Layla, comes over to take care of me. Layla is a good girl: she's a mother hen, a protector and was another one of my dragons throughout this experience and has been there with me all along the bumpy road. She came over to cook dinner for me because she wanted to help and I think it's more than likely I probably requested her cooking services. She had been away for a few weeks and we wanted a catch up and she offered to come round with food.

Layla that beaut when she first came to see me at Club Cornell, as I affectionately call it. 

Her mother is a doctor and another very wise woman (apple doesn't fall far from the tree) and part of me thinks, looking back, that the daughter of a doctor in Layla wanted to come have a gander at me, give me a once over for herself after hearing my symptoms. And probably see her mate too. So she comes round my house, we hang out and she catches me up on the last few weeks and we have an early night. It's a pretty nice evening, everything considered. It's high summer and there are obviously lots of stories to tell. We hang out with my roommate Keenan, who is seeing me through this whole thing and living it with me, day-to-day, and none of us can really understand what's happening. So we choose to, for the most part, ignore it and carry on as normal. This is only Tuesday night. At this point, and I can't stress this enough, I didn't even know my liver enzymes were up. I probably had a couple of glasses of wine. Ignorance is bliss. 

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. 

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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.