Wilmette, Illinois, USA
|Needle and thread stitching up a
wound, artwork. By Mary Rouncefield.
The six-inch scar is high over my left femoral artery in my inner thigh. It is healing well now and is pain free. The scar marks the place where a vascular surgeon extracted a clot that was blocking the popliteal artery.
“I fished it out for you,” he told me.
Surgeons have a way with words.
It was a late Wednesday morning when I woke up with pain in my left foot. I never wish to miss a Wednesday with an illness or anything else for that matter — it is my free day and I am alone to do whatever I want. My spouse has an all-day bridge game; grocery shopping is on Tuesday; Monday is laundry day; and when there is a Wednesday White Sox game, I purchase a ticket, walk to the Purple Line at the Linden elevated stop, and bask in baseball.
But the foot pain was insistent and intense. Gout, an insect bite, trauma, I thought. These are some of the maladies that can cause joint pain severe enough to interrupt sleep. But this pain was special because instead of feeling warm, my foot felt cold. Very cold.
We are surprisingly good at detecting even a few degrees of temperature difference between limbs. The back of the hand is more sensitive to changes than the palm. Remember your mother placing her hand on your forehead when checking for fever. “No fever,” she would say, rolling her eyes. “Get dressed because I know you don’t want to miss the math test.”
“Honey,” I said, nudging my wife awake. “You need to get dressed and take me to the emergency room.” All the while, I searched for my pulses. The dorsal pedal pulse was absent, but that has always been a tricky pulse for me to locate. My left posterior tibial pulse was undetectable.
The hour-long surgery was successful. The blood flow was restored and the foot pain became history. Atrial fibrillation is the usual cause of an unexplained arterial clot at my age. But I have never had an arrhythmia, and a routine echocardiogram performed before surgery revealed no abnormalities. The source of my clot has remained unexplained, even after a battery of tests.
The hospital room I was assigned to was clean and small, but filled with electronics above the head of the bed and enough controls to satisfy a Mercedes engineer. A large whiteboard listed the name of the nurse in charge and other personnel, the daily schedule, and phone extensions for ordering food and contacting just about anyone in the hospital. Personal information was invited at the bottom and my wife wrote: Michael is pleasant and easy going. I believe, under the circumstances, she was overly generous.
The surgeon and my internist arrived early the morning after the surgery. I had not eaten in thirty hours. Lying supine on complete bed rest, I was awakened every two hours for Doppler studies of my pulses, struggled to urinate into a plastic urinal designed during the Inquisition, and was told about more planned tests that would require anesthesia. I was to remain NPO (Latin: nothing per os, or nothing through the mouth), meaning, I would continue to starve. And so I began to yell.
I yelled at my two doctors about their choice of blood thinners and the fluid deprivation. I told them if I fainted when I finally got out of bed, I would know whom to blame. I yelled about the every-two-hour pulse schedule that prevents sleep, and the starvation, and the new procedures that would require more anesthesia. I yelled about the liver scan planned for that afternoon that had no purpose that I could think of.
My internist turned his back to me and carefully walked to the whiteboard, picked up the cloth eraser, and erased the pleasant and easy going part of my wife’s description. He turned to me and managed a smile.
I was well enough to go home on Sunday.
MICHAEL ELLMAN, MD, is a retired Professor of Medicine at the University of Chicago and a writer. His collection of short stories, Let Me Tell You About Angela, was well received and was an Eric Hoffer Award Finalist. His novel, Code-One Dancing, is also worth reading.