Category: Hospitals and Doctors

A Reflection (and PSA) on Coping

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During precisely the semester where I needed my health to behave, it decided to throw me for a loop. While I was vigilantly aware of any possible gastrointestinal symptoms, my immune system was failing to fight an infection — an infection that would later turn into an abscess, an infection that would take me to the ER to spend 8 hours waiting for 2 ultrasounds and an aspiration, and an infection that would eventually lead me to be placed on 2 weeks of Clindamycin, an antibiotic notorious for being harsh on the digestive system.

As with everything dealing with chronic illness, experiences related to health delve deeper than just physiology. While your physical form is simply sitting in an emergency room bed, the presence of your emotional form is not quite as obvious. When physicians shadow over your physical form, your emotional form may be reminded of specialists cycling in and out of the room considering emergency surgery. While your physical form is transported to radiology, your emotional form is reminded of dizzily taking the same path after being given opioids for the pain. While your physical form accepts 1 mg of Dilaudid before the aspiration, your emotional form remembers being given 2 mg after surgery and forgetting to breathe as a result.

As a result of remembering, your emotional form begins to cope. It makes jokes with the nurses. It worries about your loved ones sitting by your bedside. It picks up your laptop and starts writing that paper you CTRL+S’ed when you decided to drive to the hospital.

Of course, when you’re finally discharged, the coping doesn’t end. When you get home, your emotional form puts your physical form to sleep. When you wake up the next morning, you plead with your emotional form to go easy on itself — it’s had a long weekend. It has a long week ahead. Your emotional form complies… kind of. It pushes the exhaustion behind, it keeps going and only succumbs when your physical form pleads with it to stop. When you take two exams that week, your emotional form fails to pull itself together, dragged down by the lethargy inflicted by the antibiotics on your physical form.

Many nights of long sleeping later, your emotional form starts pulling itself together. 11 days later, the antibiotics take their toll on your physical form, your emotional form begins to lose itself again. The abdominal pain inflicted on your physical form reminds your emotional form of nights spent crunched up into a ball in your freshman year dorm.

As a result, the coping resurfaces once more. You ignore your physical form — you go to the gym, you make dinner for your friends, you struggle to find the excuse to give your physical form a break. When the weekdays come, as you walk from your checkup in the hospital, you take acetaminophen to quiet your physical form — your emotional form must continue to function. There is no alternative. When you go to class, you ignore the abdominal pain. Practically speaking, you are only your emotional self. Your emotional self feeds into its Hermione Granger complex and distracts itself with the laws of circuits and electricity. The next morning, you try to remind yourself of your physical self and go to the gym, only for exercise to serve as a coping mechanism so your emotional form can conquer the uncertainty of your physical form. Your emotional form continues to exactly what it did before your physical form reminded your emotional form of its presence. It’s not that you, the whole you, can’t miss class, or shouldn’t exercise. It’s that your emotional form can’t miss class or a workout. Your physical form can (and probably should), but your emotional form can’t — it’s coping.

All this to say that when assessing the ability of individuals with a chronic illness, it is mistaken to think of them as a whole. Just because I’m at your party, or in class, or at the gym does not mean I’m not in pain. Sure, it probably means I’m not in absolutely debilitating pain — if I were I wouldn’t be able to crawl out of bed. But it doesn’t mean everything is “fine,” it just means I’m coping. Behind the veil of a fully functioning person, your abdomen may feel like it’s being stabbed. Behind the veil of a fully functioning person, your physical form is absolutely exhausted. Your emotional form is fully functioning, but your physical form is not. As human specimens functioning within society, we are privy to a tendency to make assumptions. Often, when assigning these assumptions to individuals with chronic illnesses, doing so is ableist. Those with chronic illnesses are unlikely to be forwardly vulnerable about their physical form — they can’t, they’re coping. Instead, it may be valuable to create a safe space for these individuals — one which encourages them to mend the divide between their physical form and emotional form. Those around you who are in pain are likely to thank you.

This Is How You Can Help Me

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Whether I’m in a full-on Crohn’s flare or getting some initial warning signs that I need to slow down, I usually end up alerting someone. “I actually can’t make it tonight, I’m not feeling great” or “Actually, I think I might just need to go to sleep early today” litter the blue boxes on my iMessage screen. One note before I continue: I HATE canceling plans for the sake of my disease. However, taking a break to care for myself means that I’m not sitting at dinner thinking about what’s going on inside my digestive system, and can instead enjoy your company more thoroughly later on.

Most of my most caring friends will usually ask what they can do to help when I alert them to my sub-par state. I’m notoriously bad at asking for help, that much is clear. Granted, what I actually need is not generally communicable via text message, so I’ve decided to delineate that here. I hope that this is helpful whether you’re someone with a chronic disease, or whether you’re someone who cares about someone with a chronic disease. 

This is how you can help me:

  1. Keep me company. Feeling like you need to slow down is incomparably boring. It involves a lot of lying in bed and sleeping or lying in bed trying to sleep. I probably won’t see as many people as I would if I was feeling 100%. Therefore, one of the best things you can do is keep me company in a low-energy way. Sit with me and watch a TV show. Hang around my house with me and motivate me to do my homework.
  2. Understand. I’ve had a number of friends who demonstrate a significant degree of disappointment when I can’t do something I had agreed to. I would be disappointed too if someone canceled plans I was looking forward to. Please, please, please try to keep the majority of your disappointment to yourself, though. It’s helpful to know that you want to spend time with me. However, please know that I don’t want to cancel plans, and knowing the degree to which I’ve upset you makes me feel like a letdown.
  3. Communicate sympathy, not pity. Communicating pity means telling me how bad you feel about how sick I feel. Communicating sympathy means telling me how bad you feel about how sick I feel, and then reminding me that you care about me, that you’re trying to understand, and that you look forward to spending time with me once I’m doing better. 
  4. Check up on me. Sometimes, talking about my disease to other people feels like I’m burdening them. Often I won’t tell my friends if I’m not feeling great because it makes me feel as though I’m talking about my condition yet again. So if I do give the impression that I’m not feeling my best, and you happen to remember, shoot me a text. It’s a great reminder that you care.
  5. Be there once I’m feeling better. This is probably the most important one. I promise I’m not “flaking on you” and I swear I’m not a buzzkill. If I’m doing my homework and going to class anyway, that’s probably because it’s all I’m spending my energy on. My body is telling me I need to slow down and rest, and I’m listening to it, even if I don’t look sick from the outside. Therefore, the most helpful thing you can do is to be there when I feel better. Whether it’s a few hours or a few months, I’m going to need people to care about me and spend time with me once I’m doing better. Please please please stick around. I promise I’ll be a top-notch friend once I’m in full working capacity.

None of these things are easy to say, so I hope that this post helps you out. Feel free to send it next time anyone asks what you can do for them.

Reflecting After Two Years

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Alright, first things first — for a while, I think this blog is going to turn more into a place of reflection and less of a place where I provide advice (although reflection can lead to some helpful observations). I’ve been putting a load of my helping energy into the Patient Advisory Council of ImproveCareNow, which has become an outlet for the advice I can give. Two years post the emergency room visit, however, I’m finding that I need a space to reflect on who I am and how that experience changed me.

I’ve had people tell me that I dwell too much on 2016. How could I not, though, when 96% of my most life-changing experiences up until this point happened over the course of those 12 months? Yes, going to college is life-changing. Moving to the United States — also life-changing. But having your body stop you in your tracks after years of lack of self-respect? That’s revolutionary.

This Thursday, March 8th, is the two year anniversary of when I Ubered to the hospital with so much pain that I legitimately could not stand upright. I had attempted to manage the daily pain with over the counter painkillers and balanced going to class with lying down as soon as I could get back to my bed and falling asleep for 14-16 hours a night. At that point, I was only able to stomach plain chicken breast and mashed carrots, which I was asking my friends to sneak out of the dining hall for me — even making my way into that loud, crowded space was too much to ask. On March 8th, 2016, I went to class in the morning and was out of breath as soon as I got there. After class, I sat down on a couch and quickly realized that I was in so much pain I would be unable to get up. The pain fogs my memory from there — somehow I managed to get to my dorm and realized that I could not walk up stairs or stretch out my body. Somehow I managed to call an Uber and make it to the emergency room. Somehow I ended up lying on a trolley shaking from the amount of pain I was in. Until the ER doc told me that my inflammatory markers were through the roof and I was going to likely have surgery during the next week or so, I was still in denial.

Prior to this point, I had not been kind to my body. I was not sleeping enough and in normal enough intervals. I was not being meticulous about what I ate. High-school had instilled such a degree of stress in me that I cherished the 40 min bus rides home because carsickness gave me an excuse not to study. To make matters worse, I thought that my social life had to be perfect and would turn into a ball of anxiety whenever anyone was upset with me. I hadn’t had a terrible flare up of my Crohn’s Disease for the past 4 or so years, so I didn’t remember the pain or the exhaustion (a common problem in pediatrics). I was ready to ignore the warning signs my body was giving me and push it to its limits, chronic disease or not, for the sake of success (whatever that means). I was in complete and utter denial. By the summer after my senior year (23 college and scholarship applications later), I had completely shut off my ability to process what was happening to my health.

There’s nothing like 3 and a half surgeries and a case of severe shingles to really knock you back to where you should be, though. I’m almost grateful that my recovery was not anywhere near as easy as I had hoped, that only one of those surgeries was expected, and that I got shingles to boot. Without all of that, I don’t know that I would have been able to realize what really mattered to me, figure out my relationship with my body, and understand what my priorities should be. I’m not sure that I could completely process this all last March — the memories were too fresh and I could almost still feel the IVs in my arms. Two years later, I’ve had that time. Here are some things I’ve learned.

  1. Sleep and good nutrition should come in at number one on your list of priorities. I don’t care that you have a midterm. It can wait so you can get 8 hours of sleep. Try learning some better strategies to focus during the day. There is always time for this. Don’t convince yourself that there are more important things in your life.
  2. The people who matter are those that will make time for you and come to your bedside because they know you need them, and not because you’ve asked them to. Don’t let them go.
  3. When all of your friends know you as someone who’s sick, it can be difficult for them to adjust to your health. You have so much more energy! Life is exciting! You don’t have to flake on every dinner plan! Ease them into it.
  4. Listen to what your body needs. If your eyes are shutting, don’t drink another cup of coffee. If you’re hungry, don’t deny yourself a meal to save time. If you need to skip a class because your brain needs you to, do it. No academic curriculum is worth your mental health.
  5. Respecting your preferences is paramount. If you don’t want to engage in the same kinds of social activities as your friends, don’t. You are wonderful because of who you are. Respect yourself for that.
  6. When you’ve had a serious medical event, people tend to flock to help you at first, and then slowly drift away as your event continues to extend. This is okay. Different people have different tolerances. Maybe just don’t marry or fall in love with any of the ones who can’t handle it.
  7. If you find something you love, stick to it, even if that means that you have to let people down by committing less time to things that don’t interest you anymore.
  8. Having your shit together can be intimidating. Don’t apologize for that. You are respecting what you need to do for your own well being. Stick to the people who will respect it (and joke about how much of a mom you are).
  9. One of the most powerful things you can do for others and for yourself is to turn your negative experiences into advocacy. Help other people with what you’ve learned. It’ll help make you happier and process better.
  10. Surgical recovery is hard and disheartening and can completely change the way you see your body. If you need to go see someone, do it. Treat a therapist like you would the rest of your medical bills — your mind is just as important.
  11. Laughing about it is okay. Yeah, I have nerve damage from shingles in my right hip. Sometimes it sucks that it hurts to wear a backpack. But hey! It makes for a cool party trick when my friends tap my hip and I can’t feel it. I promise this is a lot funnier said out loud.
  12. If you need to stop processing your experiences while they’re happening, that’s okay. Keep them in a little backlog of things to think about. You’ll pull through.
  13. Be proud of yourself for overcoming all of the adversities you’ve been presented. You are capable, you are strong, and you can continue to persevere.

 

The Best Supplies for Packing Incisions

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I think I’m writing this post as a cathartic experience as well as to help people.

Last Friday, my surgeon took me back into the OR and opened up my ostomy reversal/takedown incision for the second time. This time, rather than just cutting into it with a scalpel without numbing me, he decided to actually knock me out so he could “be a little more aggressive”.

He didn’t actually find the stitch he claimed may have been stopping my incision from healing, and left me with a 3 inch long/2 inch deep hole to show for it.
THANKS.

If they’re leaving an incision open, though, it’s likely (hopefully) for a good reason. Packing the incision rather than just stitching it up lets it heal from the inside out. If the surface of the skin heals before the inside of the incision, the inside could fill with fuild and leave you with quite the abscess.

Anyways, even though I’m a little bitter, I thought I would write a post about how to pack larger abdomnial incisions/products I’ve found to be especially helpful in this endeavor.

Firstly,
USE HOSPITAL GRADE GAUZE. I’m currently packing my incision with 4×4 surgical gauze. I soak it in saline, wring it out, and then use a cotton tipped applicator to pack it. I do this softly, to make sure I’m not actually hurting myself in the process. I’ll put a corner of the gauze into the incision, push it in with the applicator and then cut off the excess.

The gauze they sell at CVS or Walgreens may seem great, but the soft, clothlike texture won’t absorb nearly enough fluid and isn’t flexible enough to fit well. Additonally, the soft texture makes it so that the gauze can’t clean up any issues you’re having inside of the incision.

To cover it up, I’ll put another 4×4 gauze on top, and then cover it in this tape. It seems to be pretty fluid-resistant and essentially acts like a giant bandaid you can choose the size for yourself. My nurse said they hide it in the sugical clinic because it’s so good.

If you don’t have quite as large of an incision, or if you need something to cover up a smaller issue, Bandaid’s Clothlike bandages are really good (BandAid Tough Strips).

The annoying thing about abdominal incisions specifically is that your abdominal region is one that’s constantly changing shape – you bend over, stand up, sit down, eat food that makes you bloated, etc. This can make it difficult to find dressings that will actually stay on your body.

If your incision is draining quite a bit, I’ve also found these bandages to be good. They’re foam so they protect the incision, and they’re ridiculously absorbant. Granted, they’re also pretty expensive, but I’m all in favor of treating yourself when you have a hole in your abdomen. Most importantly though, they don’t give me allergies!

Lastly, use this opportunity to get to know your body a little better! I stood up with my incision unpacked and looked into it with a mirror. Granted, I tend to be fascinated by this kind of thing, but it’s still pretty cool. Gory, but interesting.

I’ll be writing more posts when I’m home next week and not dealing with organic chemistry exams and having visits to the OR.

Thanks for reading!

 

College and the Emergency Room (ER)

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Over the course of this past year, I’ve had two different surgeries. In March, I had an ileocecal resection, and an ileostomy takedown in May. For my surgery in March, I was in the middle of the second semester of my freshman year (I conveniently ended up in the hospital right before spring break), and my surgery in May was right after final exams. I thought I would record my experiences both with the Emergency Room, and with Surgeries while being in college, as well as provide any tips if any of you find yourselves in these unfortunate situations.

I had been having intense pain (to the point of being unable to walk) in the lower left quadrant of my abdomen for two whole days before going to the emergency room. I told myself I could put up with the pain, take acetaminophen to calm it down, and generally just try to put it in the back of my head. This was my first mistake. When the acetaminophen isn’t calming the pain for as long as its supposed to, or not breaking it at all, it’s time to go to the Emergency Room. I bet that if I had gone to the ER when I realized that I couldn’t manage my pain on my own, I wouldn’t have been in such bad shape when I got to the ER.

Luckily, the ER was relatively close to my dorm (I took an Uber there, freaking out the driver in the process). However, make sure you have a way to get to the hospital quickly if the need arises. Once I got there, I registered and they took me into pediatrics. Don’t try to be brave and tell them you’re in less pain than you’re actually in. Your body is being damaged by the fact that you’re withstanding immense amounts of pain, so don’t underreport the pain you’re in. The doctors generally won’t give you more painkillers than you actually need. Don’t put up with the pain if you’ve been given painkillers and they’ve done nothing, either. Sure, some painkillers take 20 to 30 minutes to kick in, but if time has passed and you’re still feeling the same pain, tell your nurse. Nurses are your best resources in the Emergency Room. When I had my first surgery, we quickly discovered that morphine does nothing for my pain, but I only reported this to anyone after two days of putting up with full fledged post-surgery pain.

Being in the emergency room for the first time by yourself is definitely daunting. You have to fill out a bunch of medical forms, and possibly make decisions about your own well being while you’re there, decisions you may be unused to making. Tell your closest friends that you’re in the hospital so you have someone there with you. I was in too much pain when I got to the Emergency Room to talk to my parents or try to text them, so it was great to have a friend there for not only support, but also to help me out with contacting my family.

Don’t tell your parents that they can’t come if it seems like you’ll be there a while. Although you may feel like you can manage the situation yourself, it will be much better for both you and your parents’ emotional states if they’re there. Eventually, your friends have to go to class, and you’ll be by yourself. You want someone there to vouch for you when you don’t feel like you’re able to.

If it seems like you’ll be staying in the hospital, make sure you let your professors know. Make a group email with all of your professors’ emails and send them emails updating them on how you’re doing and how it looks like things are going to go. They’d much rather get a number of emails than be surprised when you don’t show up for three different classes. If they don’t know about your condition, tell them politely before explaining your current medical situation. Don’t be shy about this — most professors are willing to help you out in a situation like this.

If you had any packages you were going to have delivered like I did, you can usually email the shipping department and ask them to authorize a friend to pick them up for you. 

Also, let your RA know what’s going on. If your parents or friends need to get into your room to get you clothes or supplies, it’ll be convenient for your RA to know that.  They’re there to help you, whatever the situation.

If you’re coming to the emergency room and you have a doctor at the hospital you’re visiting, call your doctor’s office on your way there (if you can) or send them an email to make sure they call the emergency room before hand and explain some of your history/why you’re coming in. They can better prepare for you if they know you’re on your way, and your doctor can inform them as to any steps he/she wants to take when you get there. Plus, this can make triage and registration a lot faster.

Most importantly though, don’t be frightened. You can do this. The people in the hospital are there to help you. Finally going to the emergency room felt like a breath of relief for me, because it meant that I wasn’t the only one worrying about my health anymore, and that at least part of my suffering would be over soon.