I’ve been admitted (I wrote this in the hospital)

A while back, I came down with a cold, the normal sniffles and coughing, no big deal till about a week ago; I woke up in the middle of night in a coughing fit which felt like my lungs were covered in slime. I bent over the side of the bed and coughed it all up into a trash can and felt fine. I turned on the light and the trash can was covered in blood. Yuck.

But there were no other symptoms so I went into work the next day and told them in my understated way that I had coughed up some blood in the night. Thinking maybe it was a bloody nose or such. You know us medical guys, unless we’re really hurt, we usually don’t worry about it. No problems or coughing that night and my cold had been cured (somehow the blood in my lungs had cleaned out the cold is my theory).

The next night, I got a tickle in my lungs and coughed up another couple of teaspoons of blood. Each night was like that, my lungs would get gargly and I would hack up a couple of tablespoons of blood. Thursday, I gave myself a PPD test (test for tuberculosis to you non medical types) and talked to a few of my doctors (I’m working with 8 during this training).

I told them it wasn’t a big deal, get an X-ray on Monday and follow up with someone in San Diego when I got back. Well Saturday rolls around and I had an attack that morning and coughed up about a half cup of blood into the trash can. The PPD was negative at least. Clearly, this had my doctors concerned and we debated about going into urgent care, I told them to hold off and we could handle it on Monday morning. Maybe that would be the only attack that day, I went home after lunch, was doing my laundry and coughed up another half cup.

Mildly shaken by the loss of so much blood in a day, I finished my laundry and called the doc who was covering that shift and told her, "Yeah, I think it’s time for a visit to the emergency room". I caught a ride there checking in at 3 and was put into a room, they gave me a emesis basin which I immediately filled to the 100ml spot with blood and had a new EMT stick me for an IV (which I ended up using for my entire stay). Now I had something to count how much blood I’ve been coughing up, by the end of the night I had filled 4 basins to the 100 mark. They drew 10 or so tubes of blood, then did an EKG, a chest X-Ray, filled a bottle with pee.

Being the leading enlisted medical dude and nice guy I am, I’ve had tons of visitors and well wishers. In fact, a group of my folk came by late last night and serenaded me to sleep (a very tipsy group of doctors and corpsman, it was Saturday nigh). How can you beat that?

At one that morning they decide that they’re going to admit me and I’m to have a CT scan the next day and I can’t eat solid food and eventually stick a camera in my lungs. Our theory so far is that I’ve broken a blood vessel in my lungs and every time I do anything strenuous it breaks open and blood leaks down.

Update #1

Today my boss came by with the book I wanted to buy and later (when I can eat again) is coming by to give me a carnie asada burrito. My biggest complaint right now is that I’m starving, haven’t had anything solid to eat since yesterday morning for breakfast and am eagerly awaiting a yummy monster burrito. They came in this morning to tell me I can’t eat anything at all. I’m beginning to get why people complain about hospital gowns, trying to keep myself covered while moving around seems to occupy a fair portion of my ambulatory time.
It is a bit worrying coughing up blood and being on the other side of the medical profession. I think this is the longest time I’ve ever been in the hospital. Well hopefully I have something that can be fixed. Well I’m going to take a nap till someone comes to tell me to do something.

Update #3 Sunday afternoon

Just had my first CT scan, let me share the experience with you. They set you on this sliding bench that goes into a donut, I’m sure there are pictures of them online. It pulls you in and this female voice says "take a deep breath and hold it" and you slide out. The second time it pulls you in, all of this machinery starts spinning around and it feels like you’re in a time machine. Once more you hear, "take.." and you slide out.

Before the third time, the tech comes out and says she’s going to inject you with iodine dye and the common side affects are your whole body feels warm, feel like you’re going to pee, you get a funny taste in your mouth, pain in your arm or nothing at all. She hooks it up, runs behind the barrier and power drives half of a soda can’s worth of this evil fluid into my arm, I can see the vein change color and immediately I go hot and it feels like there’s molten lead in my veins, my groin feels hot like someone poured a cup of hot pee on me. The machine has slide me in and says "take a deep breath and hold it", I do with difficulty because the funny taste that I got in my mouth was one of my mouth watering which is a precursor to hurling. The tech come out and I ask, "is that all?", she says yes and tell her I’m about to vomit. She grabs a trash can and I throw up the 2 containers of Jell-O I had for breakfast and dry heave a bit more, this causes me to go into another bloody coughing fit.

Bleh, CT scans are for the birds, hope they found something.

(Doc brought me the carnie asada burrito from a place called Burrito King and Paul, they’re not all that, the burrito was huge but I’ve had better)

Update #4 Monday night at 11

The nurse comes in and tells me the doc can fit me in for the Bronchscopy sometime in the morning and nothing by mouth after midnight. Meanwhile, I’m totally caught up in Kevin J. Anderson’s Metal Swarm. If you haven’t noticed, I don’t go crazy in boring lonely places, as long as I have a good book, everything is peachy (thanks Doc Davis for picking it up for me). I pushed because well, I’m dumb and couldn’t stop reading, it was 2 when I finished went to sleep (I was already in bed).

Update #5 Tuesday morning at 5:45

The lights go on and I imagine I’m back in boot camp again, a bright and shiny nurse comes in with the most cheerful voice says, the doctor can fit you in right now. I say wait a second, brush my fangs and use the restroom and a pair of orderlies comes in an wheel me away. We get down there and I’m talking to the respiratory therapy nurse, she belongs to the local Navy League. People are coming in, an X-Ray tech with a C-Clamp shaped X-Ray machine, there’s a craftsman tool box full of medical stuff, one of the techs gets a syringe and tells me its lidocane and squirts it into both nostrils. It goes in my left nostril and stops because that nose is stuffed up so I make sure to let him know to use the right one. Finally the doctor comes in and shakes my hand says good morning and the nurse is preparing a to shoot something into my line and I say "is this where I’m supposed to start counting backwards".

Then I’m talking to her again and everyone is gone. I look around and it’s like I time traveled and my throat and lungs are sore. I look around in bemusement and they wheel me back to my room and I finally take them up on the offer for morphine, well since they were offering, I don’t want them to think I don’t appreciate it. This is where I make a couple of phone calls and remind people I work with how to pack things and call relatives and friends. But I don’t remember doing any of it. Doc Davis visits I think but I’m not really sure about that but I do remember my mom and my sister Crystal visiting that afternoon. I’m flying high but not that high.

Update #6 Wednesday

Three of the local Chiefs come by for a visit while my mom and sister are there. One of my corpsman has packed up my room in the suburban in hopes that I’m going to be discharged. The Doctor comes in and tells me the TB test is negative from the stuff he collected from my lungs and that I could be discharged for follow up care in San Diego. Mom buys us lunch and I drive the Beast (I'm afraid to let other people drive her because she bucks) back to San Diego where I sleep in my own bed.

Things I did during my time there, I read The Road by Cormac McCarthy, a extremely well written post-apocalyptic book about a man and his son. I can relate, the man spends most of the book coughing up blood. It made me sad and miss my son, very bleak novel, I highly recommend it. I also asked each of my nurses for a sponge bath, sorry, I've always wanted to ask for one now I had lots of chances. No I didn't really get one, I had a private shower in my room and I wasn't having any problems with my walking.

Army Spc. Mark Ryan Climaco Caguioa

MaryAnne from Soldiers Angel Germany pointed me out to Mark's story last week and I told her I would write about it after reading into it more, here are my thoughts.

Corporal Caguioa was the son Filipino immigrants, raised in Stockton and graduated from Bear Creek High School class of 2002. After high school, he worked at a sushi chef before enlisting in the Army in 2005 and deployed to Iraq in October of 2006.

On the 4th of May 2007, he lost both of his legs from an improvised explosive device and later lost his left arm. According to the news reports I’ve read, he also had some major head injuries and was given 6 units of blood. He later died on the 24th of May and President personally went and offered his condolences to his family the day following.

This is where the story gets strange, multiple Asian and Filipino news papers started coming out with stories about Cpl Caguioa receiving the wrong blood type. What bothers me here isn’t the story that someone received the wrong blood type but the way that it was released. So far, I’ve read 7 stories about it and 5 of them say that he was B positive and received O positive blood (which is actually the proper procedure, O being the universal donor) and 2 that say that he was O positive and received B positive blood (which is generally considered a bad thing). But having the 2 different stories out means that one side or the other is totally wrong. It's a black or white deal, yes or no in this case. If you don't know the answer, then don't publish till you do.

If this story told to the press was released by Mark’s family, I could understand that. They would have access to Mark’s medical file but the only way the military is going to release that information is following an investigation. Have you ever seen a military investigation lasting less then a week? I think the news media involved here should have waited before jumping the gun. Publishing in haste without proper editorial review labels your paper a tabloid which is one step away from blog, at least you get paid for what you write.

Here's a link to the stories on Mark

Mark had some massive injuries and it would have been a miracle if he survived even a few years ago but military medicine has taken up the miracle business lately if you haven't noticed. We save people would have been written off and the idea that we didn’t do all that was possible for Mark is wack. Even with doing everything under the sun, people aren’t machines, medicine isn’t like replacing out a worn out belt or bolt. There is a reason they call what I do practicing medicine because we do practice, each day we're learning more about the human body. We can’t know or see everything that is happening inside but we try. If we did, there would be no death or aging and the common cold and HIV would be things you read about in a history book. We’re damn good but we’re not even close to reaching the limit of what’s possible. And in cases like Mark, I think he was at that limit.

Privacy is a big deal in the medical community, one of the quickest ways for a corpsman to get busted down is to break patient confidentiality. I’ve seen some fairly interesting things in my line of work but make it a point not to talk about it to others, not in person nor on the blog. In a case such as this, if there was a someone who talked to the press about a patient, using his real name about a patients medical history. That person likely has some heavy brass breathing down his neck and believe me, I don't feel sorry for them one bit. This is a serious business that we're in, part of being professional is that we play by the rules and don't make them up as we go. Having your name published as the source for that medical information about a patient? I wouldn’t want to be in your shoes man unless that was your job as a public affairs guy to give out that information as an official statement from the hospital.

Rest in peace Mark, my prayers go out to you, your family and fiancée Megan.

PTSD Questions

Over the last few weeks, I’ve been receiving emails from people asking about PTSD and if I know any of my Marines who are willing to talk about it. First thing is, I’m not going to give out medical information on any of my patients. Not that most of the ones that I know mind talking about it, it’s a matter of me keeping my job and out of jail. I can let them know that someone is interested and pass on the information though and I don't mind you asking

Most of the PTSD cases that we run into in the airwing side are an entirely different ball game then the stories you would find if you were to ask the average ground pounder. Our usual supects for airwing mental issues come from separation anxiety, problems back home, adjustment disorders and issues that come from sending people to a war zone who should have never made it past MEPS.

My advise to all of these people is to go to the source, I have some fine fellow milbloggers in my sidebar who have been though the ringer and have blogged about it. Blown by IED’s? Check out Liz (as she put it "got my happy ass blown up" on Dec 4th 2004, scroll down), Rebel Coyote (one of the first milbloggers blown up), Chuck (who's has been getting chopped up on a weekly basis), Solder’s Life (was incountry for 3 months) and the latest one JR Salzman (who was just hit a couple of weeks ago). If their stories don't bring what we're doing home, then you're heart is made of stone. Want to see the baggage of PTSD can do? This is Your War put's that into prospective and Combat Doc has also blogged about it (H/T Madtom even though I read him enough to know). There are probably more people on my side bar who have blogged about it but if you haven't noticed by the size of my blog roll , it would be a full time job keeping daily tabs on everyone.

These guys are the experts and have been in the "shit", most of my time was spent putting band aids on boo boos, handing out meds and filing paperwork, plus keeping everyone around me happy. The only time I saw blood flying and people screaming around me was done flying CASEVAC or at the main hospital working on total strangers, I can honestly say, not a single one of my guys died under my watch. It makes a big difference on your mental out look if you know your patients or not.

Whoop, there it is...

I made a trip to the ER last week and it wasn’t for work. My wife was having coughing fits and after pouring my considerable medicine cabinet full of anti-coughing drugs into her without any improvement, I know we had to do something more. After each coughing fit, she had a harder and harder time catching her breath and the coughing started to get a seal barking like quality so I did what any good medical guy does when he’s over his head and brought her to the ER. On the drive there her voice went out and every breath was a gasp and by the time we went through the door, the veins in her neck were sticking out and she really did sound like she was about to croak.

One way to always ensure quick service in a crowded full of people is to have a loud barking cough, have your eyes roll up in your head while doing it and turn blue at the same time and not being able to communicate a word. She beat all of my personal records for getting quick service to my Marines. A very nice staff (thank you Naval Medical Center San Diego) brought her to a bed and had an IV into her arm in minutes. After pressing some IV steroids and antibiotics into her vein and an inhalation treatment she was able to whisper, whew. During all of this, they did a CT and X-ray of her throat and chest and drew a bunch of other labs. Finally the friendly resident came by and let us know she had whooping Cough.

Whooping Cough? That’s still around?

Guess so, there’s been an 11 fold increase in whooping cause cases in adults in recent years and if you google any news search engine you’ll find plenty of stories and sites dedicated to the subject. Figures it would have to hit us. Well she’s now hopped up on some high priced government sponsored drugs and we're buying stock in cough syrup.