Welcome to Our nightmares

It’s happening again. The blood. He can see it, flowing under his skin, making itself known in black and indigo bruises, bringing pain along with the need for medication to control it. But it’s different this time. He’s at home.

Lawrence is sitting in his living room, sun streaming through the window, warming him, dulling the pain. The wing chair feels comfortable. It wraps around him, cocoons him. But he’ll have to stand up soon, go for a pee. The pain will ratchet up then, hitting seven or eight on the self-assessment scale.

The scale is stupid, Lawrence thinks. Until your insides have being ripped apart like his were eleven years ago, how can you conceive of what a pain ranking of ten feels like?

That’s not a problem this morning. A bottle of Hydromorphone sits on the kitchen island next to the Extra Strength Tylenol. If the pain gets out of hand, he can take an extra pill. Swallow it down.

It wasn’t always like this. Lawrence had surgery when he was a teenager. He’d had scar tissue removed from an eyelid that had been cut in a car accident. His father had run into the back of a car that had stopped in the right lane of the highway on a hot and sticky July afternoon.

Lawrence remembers being loaded into an ambulance and taken to the rural hospital near his family’s farm. His family doctor was in the ER that afternoon to stitch up his eyelid, lip and forehead. It was the doctor’s on-call day at the hospital. Back then general practitioners did more than refer patients to specialists or recommend they go to Emergency.

The result wasn’t perfect. Lawrence had a visible scar and his eyelid was a bit disfigured, but he didn’t really notice.

That didn’t last. The next summer, Lawrence dove into the farm pond. His eyelid hurt when he surfaced, a sudden sharp pain. The scar had spread.

He wasn’t privy to the conversations that followed, as his parents balanced his father’s guilt, and the desire to make things right, against the financial cost and how it would impact the family of eight.

Lawrence sat in a taxi cab with his father on route to the hospital, listening to the tick, tick, tick of the meter. He didn’t want to go, didn’t want surgery. Each tick increased his fear.

Fifty years later, Lawrence still remembers the kind, caring nurses who always seemed to be there when he needed them, and his angst when the surgeon said he’d have to spend a third day in hospital because the operation had taken longer than expected.

He’s had very different experiences in hospital since then. The nurses have been no less caring, but there has been more than one long wait after he pressed the call button, and physicians who wouldn’t wait for his pain meds to take effect before undertaking bedside treatment that caused him intense discomfort. Time is in short supply.

Lawrence is remembering those experiences, contemplating how much things have changed since that time, as he lies in a Day Surgery bed waiting to go into the OR where his hernia will finally be fixed. He’s waited more than a year for a surgery date. In that time his relatively small hernia has grown large. When he gets up in the morning, it’s only a matter of seconds before his intestine pushes out through his abdominal wall and settles in his scrotum, just short of his right testicle.

What could have been a quick fix has become much more complicated surgery. It takes a four-inch incision in his skin for the surgeon to get the space he needs to push Lawrence’s intestine back into place, then close and mesh his abdominal wall.

Despite being administered two anesthetics – a spinal hadn’t worked immediately, so Lawrence was given a general anesthetic – there’s no suggestion that he should spend a night in hospital. In 2024, hernia repair is day surgery. Cut, push, stitch, and send the patient home. That would hold true for Lawrence too, his past bleeding issues notwithstanding.

Lawrence wakes up in Recovery. A check of his vital signs and a bit of monitoring, then he’s sent down to Day Surgery to await discharge. He’s told that he must be able to urinate before he can go home.

After an hour or so, he’s asked if he can wiggle his toes, lift his knees off the bed, and feel the touch of a nurse’s hands on his feet. All good. But when they get him up to urinate, he can’t. Lawrence is incontinent. A bit of pee dribbles down his leg, wetting the front of his hospital gown.

His bladder is frozen solid from the spinal. Eight in the evening rolls around. Day Surgery is set to close. The nurses send him back up to Recovery. Lawrence’s wife is told she has to return to the Day Surgery waiting room. She’s not allowed to sit with him in Recovery.

It’s almost nine. Only one other patient besides Lawrence is in Recovery. The nurses want to call it a day. They scan his bladder. It’s full of pee, but still frozen. He can neither feel it nor control it. So they insert a catheter – Lawrence doesn’t feel a thing, his penis is frozen too – and they give his bladder twenty minutes to drain. Then it’s catheter out, diaper on, and Lawrence is discharged.

Making it home feels good. It’s so different from his other recent hospital visits, the first in 2013 when he went to Emergency with stomach pains, spent a gruelling two hours waiting to be seen by a doctor, and was promptly admitted. All he remembers is getting into a ward bed, waking up briefly in the Intensive Care Unit, and someone saying that he’s being transferred to a larger hospital where they might be able to stop his internal bleeding.

But he does remember what came next. The ambulance ride, lights and siren on, arriving in Emergency, and the long wait, in extreme pain, to be seen. How could that possibly make sense? He’s been transported from an ICU to get potentially life-saving surgery in a different, larger hospital, and dumped in Emergency. There’s a drug addict in the bed next to his, screaming for attention, needing Methadone. Finally Lawrence’s stepdaughter loses it. Insists that someone at least look at him.

Eventually he gets moved into the larger hospital’s ICU. He’s only been there a few minutes when he’s told off by the doctor in charge of the unit for pressing the call bell during a staff shift change and requesting help. Advised in no uncertain terms that he would have to wait. Couldn’t he see that people were busy? Lawrence holds his pee.

He’s a week in the ICU. Lawrence doesn’t remember a lot of it. His wife went through hell, watching him writhe in pain as nurses and doctors struggled, brutally at times, to insert a catheter into his bladder and keep his kidneys from failing. They manage to ram one into his prostate. It didn’t work, and was eventually removed.

Lawrence also remembers a surreal trip to the operating room, hallucinating about black spiders hanging down off the ceiling. Two hours later, an urologist succeeds at putting a catheter in. Lawrence’s kidneys start working again.

Ten years later, he’s back in an ICU. His surgeon had told him that he was being discharged after an appendectomy. Lawrence said he was dizzy and weak, not ready to go. The surgeon insisted. Lawrence stood up, then passed out on the floor. He’d been bleeding internally, unnoticed, for two days.
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It came as a shock, those five words: We’re going to admit him. He’d fallen sick on vacation in Hawaii. A bad cold had morphed into something much worse. He coughed up great gobs of phlegm, couldn’t eat, and soaked the bed every night with sweat.

My husband. I could have killed him when he insisted on going to work a couple of days after we got home, despite feeling like death warmed over. He lasted half day in the office, then made the hour long commute home and put himself to bed, which is where he should have been in the first place.

I found out later that he’d stopped at the sweet shop on his way home, to buy me a box of chocolates and a card for Valentines’ Day. Larry had walked to our house from there, so weak that he almost didn’t make it.

A few days later, he insisted on going back to work, and staggered his way onto the bus and into his office despite my protests. He lasted a couple of days, then put himself back to bed.

My recurring nightmare began shortly after that. He told me that he had a bad pain in his abdomen, and that he was going to the walk-in clinic. The doctor gave him a referral for an ultrasound, and told Larry to go to Emergency if the pain got worse.

It did. Which I why I found myself sitting with him there two days later. Larry got up to use the loo. Afterwards, when he was walking back toward me, he passed out. Two nurses managed to catch him before he hit the floor. He’s seen by a doctor and admitted shortly afterwards.

I sit by his bed for hours. Neither of us can believe he’s there. Finally, I go home. He needs to sleep, I need to take our dog out for a last pee and be comforted by him. Pippin is the rock I hang on to.

The call comes later that evening, after I’ve arranged with a friend and neighbour to walk the dog the next morning: “We don’t think your husband will make it through the night. If he has other family, you may wish to call them.”

I phone Larry’s sister, Jenny, the physician. She says she’ll let his Mum and siblings know, and to call her if I need anything. What I need is a miracle. I say a prayer in my head, phone my daughter to tell her what’s happening, then call my youngest sister, and drive back to the hospital in shock.

Visiting hours are over. It’s quiet. I find the Intensive Care Unit and am told the rules. But they let me in. I sit with my unconscious husband. Watch as bags of fluid and blood drain into his arm. Morning comes, a day passes. There is no change.

I go home, hug my Pippin, try to eat, and attempt unsuccessfully to sleep. I need to stay strong for Larry. I need to be there.

Jenny calls. She, Larry’s mother, another sister and his two brothers are flying in that afternoon. My sister Cath will arrive before them. Only things change. Larry’s doctor knows a surgeon at Vancouver General who has experience tying off bleeding arteries to stop internal bleeding. They consult, conclude that it might be worth trying. I have hope again.

Larry wakes up as the doctor inserts large needles into his neck, just in case he needs dialysis. He tells me that it’s OK, if he doesn’t make it, for me to fall in love with someone else. That he wants me to be happy. I don’t tell him how scared those words make me feel.

I follow the ambulance, my daughter in the passenger seat beside me. We’re anxious. Trying to keep up. I run a red light.

Emergency is hell. Larry has had nothing to eat or drink for three days. Now that he’s awake, he’s desperately thirsty. But he’s not allowed even a swallow of water. The best the nurse is willing to do is give him a damp sponge on a stick – a moisture lollipop – to put in his mouth. But the nurse is run off his feet, trying to help the addict in the next bed. Finally my daughter loses it – demands attention for her stepfather – I’m too much in shock to do it myself.

Teams of doctors come down into Emergency to examine Larry. Finally, they move him to the ICU. There’s a haematologist in charge of the unit.

My sister arrives. It feels so good, that shoulder to cry on. Then Larry’s family starts to dribble in. Naturally, they all want to see him. But patients are only allowed two visitors at a time in ICU. I hate to give up my place to one of them. All I want is to spend every possible minute with my husband.

Things get worse. I walk into his room one morning. Larry is in what looks like a straightjacket, screaming as a male nurse is trying to ram a catheter into him. Jenny assures me it’s necessary and leads me back to the waiting area, but that image remains etched in my mind. The procedure fails.

Larry’s kidneys struggle. He’s barely with us. I’m trying to stay strong for him, but it’s hard.
A young urologist comes to see Larry. He’s got wires and cameras, and he’s confident that he can insert a catheter into Larry’s bladder. Only he can’t, and in the process of trying he rips Larry’s insides, causing him intense pain. My husband is praying to God for help. I can’t imagine the agony he’s in.

Finally the urologist gives up. Larry’s scrotum and penis are a dark red colour, swollen to fifteen times their normal size. He’s barely conscious. I sign the consent for them to attempt the procedure in the OR. Then we wait.

I sit holding Larry’s hand before they take him away, but I’m not sure he knows I’m there. After he’s gone, all of us stress, watching the clock, hoping that he lives through the surgery. I could have screamed.

After two hours, Dr. Mah finds us. He’s got a catheter in. Larry’s alive. Then we wait for him to come down out of Recovery.

Larry said afterwards that his nightmare began with the pain caused by the wires and cameras. It continued in a miserable ward room, full of noise but not sleep, with pain followed by more pain as he undergoes bladder irrigation to clear the blood clots blocking his catheter. Eventually it morphs into a bad dream.

His hospital stay and bleeding drag on for five more weeks. We finally take him home. His memories of that time fade. They don’t return for ten years, and only briefly, when he finds himself in the ICU again, bleeding internally, and praying, following an appendectomy. The recurrence fourteen months later, when he bled again following surgery to fix a hernia, was just a hiccup.

But my nightmare has persisted. Images of his pain are burned into my mind. They still haunt me at night, still resurface in my daydreams. The fear has never left me; the worry that he could bleed again, the understanding that it could take him from me.