Some pacts are meant to be broken
The Pact
I made a pact with my husband that our goal was to stay out of the hospital when the social distancing order began in mid-March due to the COVID-19 outbreak. This “no-hospital-pact” was my instinctive reaction to the pandemic because I hate going to the doctor. My dislike of doctor appointments has been a regular point of contention in my marriage. I only make routine check-up appointments begrudgingly when I grow tired of my husband’s relentless badgering.
To maintain the pact, our plan was to keep our distance from others and to remain healthy by running three miles a day. I had a head-start on working from home, as I had started a brand-new business as a freelance illustrator and consultant over a year ago. My husband had more of an adjustment. He had begun a new career as a science teacher last fall, and he needed to convert to an online teaching platform when his school closed down. For both of us, continuous change had been a regular component in our lives in the past year. We viewed remote working while living together as just another adaptation.
We divided our house into individual work zones, and our pandemic homelife began looking like many others at this time with seamless days of varying ratios of sleeping, eating, working, exercising and binge-watching TV. Small interludes, like taking our dog to get treats at the neighbor’s house and our three-mile runs, were the highlights of the day. We established a bearable and controlled work/life routine.
Best Laid Plans
I recognize that the “no-hospital pact” was my way of trying to control my fear. A pact helps create a framework between people so something bad is avoided like war, overeating or bungee jumping. I don’t mistrust science and medicine. I instigated the “no-hospital pact” with my husband because I fear the cost and inefficiency of medical treatment. A pact creates an imaginary security bubble. If we keep our pact, we can safely discuss the new hot topics of toilet paper, getting groceries and SARS-CoV-2 with others from a distance through video chats, texts, social media and phone calls.
As with all the best laid plans, expect the unexpected. In my case, the unexpected started with an early morning stomachache. I woke up on a Saturday and had a dull ache in my side that didn’t go away as the morning progressed. I didn’t want to get him worried, but the pain was bad enough that I told my husband I’m wasn’t feeling well. My husband immediately started an interrogation to determine the seriousness of the situation. Because I wanted it not to be serious, I decided to ignore the pain and went with him for our daily run. I hoped the problem was the jalapeno corn bread I ate for dinner the night before. After the run, the throbbing got worse.
I decided it was time to call my Mom, who is a retired nurse. My Mom asked a series of measured questions, and we confirmed my pain was mainly in the right quadrant of my lower abdomen. My Mom then recalled our family history of appendicitis. The grimmest reminder was that my great grandfather died at age 38 because his appendix burst. I let the information sink in and came to the decision that I needed to break the “no-hospital pact.”
Saturday at the ER
My husband and I agreed that I would go to the emergency room, but I realized I didn’t know which one. Through all our job changes, our insurance carriers switched three times in the past two years. After some struggle to find my latest insurance card, I called and talked to a support person who said the recommended hospital was one about a thirty-minute drive from our house.
We headed out to the hospital wearing two homemade masks. In my effort to feel like I was helping during this outbreak, I had sewn a bunch of masks to give to family and friends. The masks are special because they are made from material from my husband’s late-Mom’s festive vests. His mask was made with a tiger print and mine with a Southwestern pattern. As we drove up to the ER entrance, we passed the tents reserved to check-in the COVID-19 patients. I started questioning whether the pain in my stomach was truly serious.
The parking lot was surprisingly empty, and only a couple of people were sitting outside. Everyone was wearing masks. We entered the hospital double doors together to be greeted by someone checking temperatures. The temperature checker told my husband he could not enter as only potential patients were allowed inside. After my temperature check and a rushed goodbye to my husband, I proceeded into the ER alone. The last place I wanted to be was checking into the ER. I had broken the pact, and my fear was being realized.
The Gray Mile
I would like to say that my initial hours getting processed in the ER were better than I expected, but they were not. My condition gave me a credibility problem. I wasn’t bloody or buckled over in pain. All I could tell the intake ER doctor was that I had a chronic pain in my stomach around a level five on a ten-point scale. Maybe, I should have given a higher pain number, but all pain seems relative to me between five and ten. After my blood pressure was taken, I was told to wait in the hall and keep the blood pressure cuff dangling on my arm.
I could hear the next person’s intake interview as I waited to be called into the blood drawing area. My time soon came, and I went into a small, gray room. They needed blood for tests and to insert an IV for a contrasting CAT scan to confirm appendicitis. I hadn’t eaten or had a drink of water for hours since my stomach had been hurting non-stop since the early morning. In this dehydrated state, I didn’t realize I was a phlebotomist’s nightmare. I noticed the staff was also stressed and frazzled. The technician said they didn’t have enough people because of scheduling cuts due to the significantly lower hospital traffic since the pandemic began.
After six attempts by one technician and two nurses, they managed to insert an IV but still couldn’t draw enough blood for my tests. Because I reached the poke limit for all available staff, I was left alone to wait in the grim room. Looking at a stray drop of blood on the floor, I started to cry behind my homemade mask. I texted my husband that maybe this was all a mistake.
Don’t Give Up
In the midst of my misery, I heard my first name being called. I faintly responded from my spot as I was unsure if they meant me. I then heard my full name being called, I responded loudly. A kind nurse came in view. The nurse said she was there to take me to get a CAT scan. I mentioned that they hadn’t gotten all my blood, but she took me with her anyway. I was being rescued from further bloodletting.
Some people are true givers. I was fortunate to be cared for by many individuals who were generous and giving in the following hours. My blood-room rescuer made sure I got a wheelchair to sit in while I waited for my CAT scan. A patient and instructive CAT technician ensured that I was comfortable during my scan. Afterward, I was delivered into my own room in the ER where a new nurse gave me a warm blanket. I slowly started to feel a grain of trust build that nudged my fear to the side.
Due to the hospital’s no visitor policy, I had to remind myself to give my husband a status update. My husband constantly tells me I am terrible at communicating by phone. Being my own health advocate was tough between the pain and tests, but my phone was my only lifeline. I called my husband and shared with him that I didn’t have any results, but I had a feeling that my appendix was bad based on the look in the CAT technician’s eyes after my scan. Soon after I hung up, my ER nurse came in and confirmed my diagnosis was appendicitis. For a moment I was comforted by the news. I conceded that if I had stayed at home because of my “no-hospital pact,” I would have been in more danger there than seeking care in the ER.
A Time to Commit
My fear started to increase when I realized that I would need to make a decision. I foresaw choices between staying and going depending on the condition of my insides. The same ER doctor, who checked me in, came by my room and shared that the CAT scan showed my appendix was intact but pretty inflamed. He was surprised I wasn’t showing more pain. I asked him if I needed surgery, and he replied that the surgeon would be in touch soon to discuss my options.
As I texted my husband the news, my phone rang showing an unknown number. I hesitated but answered to find out it was the surgeon calling me. My surgeon was surprised that I answered the phone as she explained that she calls instead of visiting to limit direct exposure with patients because of COVID-19. The surgeon explained that my appendix did not show signs of perforation, but it was twice its normal size. She added my appendix had two stool balls. She explained that I could have my appendix removed today or elect not to have surgery and go home with antibiotics because of pandemic concerns. She mentioned that antibiotics don’t usually clear stool, and the risks were a burst appendix, sepsis and a long hospital stay. I thought of my grandfather dying from a burst appendix and wondered if we weren’t in the midst of a pandemic whether options other than surgery would even be discussed.
I weighed my fear of getting COVID-19 with the unknown of using antibiotics to stop my appendix from bursting. I didn’t want to come back in worse condition and go through everything again. I had enough data to trust that moving forward was better than going back. I called and talked to my husband to confirm my decision to have surgery, and he agreed.
The Next Level
Once I was committed to surgery, another level of care began. I couldn’t help comparing the experience since arriving into the ER to a strange computer game. I had passed through the beginner stages of blood taking and scanning with one set of staff. Now, I was in the expert level with new staff, new challenges, and new decisions.
My ER nurse was great; she empathized with my pain and aloneness. She offered me morphine, but I declined. I was worried about the cost of anything that wasn’t necessary. The more I thought about the cost, I supposed that I probably owed thousands already for the blood draws and CAT scan. Thirty minutes later still in tremendous pain, I decided to take the morphine agreeing with the nurse’s comment that this was a good time to take it. As the morphine coursed through my body, it eased my pain and released me from the guilt of not being in control anymore.
I still wasn’t able to see my husband. Our last goodbye was so rushed that it felt like he dropped me off at the mall. My ER nurse informed me that I wouldn’t be able to see him prior to my surgery, but that she could meet him for me. She graciously asked if I wanted my husband to watch my belongings and took them to the front door where she spoke with him. I knew he was upset that he couldn’t be with me. We exchanged “I love you’s” by phone even though he was less then 50 feet away. Stuck in my ER room, I was left with two possessions, my phone and my homemade Southwestern patterned mask. My husband reminded me that his Mom was with me. I didn’t realize when I first made my mask how much comfort it would bring me.
Trust = Integrity + Intelligence
In preparation for my operation, I signed multiple formidable documents. I had an EKG, and I faced two more blood draws. My husband let my family and friends know what was happening, so I received multiple texts and a couple of calls offering prayers and encouragement. I was on my own, but I felt loved.
I was wheeled up to the pre-surgery prep area to be greeted by two exceptional recovery room nurses. They tended to me like I was a precious, fragile object. In this calm and cared for state, I finally met my surgeon.
Since arriving at the hospital, I had to trust people by looking only at their eyes. My surgeon’s eyes were kind and competent as she introduced herself by showing me her ID picture. When I had spoken to her earlier on the phone, she had asked for my occupation. I said I owned my own visual design business that combined my science background with my art skills to elevate stories. As we spoke face-to-face, she asked me more about my business and shared that her husband also left a career in science, neuroscience, to focus on visual design. I felt an instant connection with her.
My surgeon kindly agreed to a quick conference call with my husband as she outlined what the surgery would involve and the expected outcome. I knew from my husband’s questions and her responses that he was confident in her ability. He even mentioned that he was highlighting great women in science in his class this week. My surgeon smiled with her eyes. After the call, my surgeon left, and I met more operating room staff. Each person asked me a series of the same questions to make sure we all agreed to what was about to happen. I started getting a lot of things attached to me and knew it was almost time.
Operating Room Nine
When it was time, I was transported out of the recovery room area down a dark hall and into the operating room. I remember the operating room number was nine. With my ER room number being thirty-three, thoughts of leveling up in a game came back to mind. As I was wheeled through the doors, I was taken aback at the whiteness and brightness of the room. It was as if all the dimness I had encountered during my journey through the rest of the hospital was purposeful so this moment would be transcendent. The room was both soothing and eerie.
My surgeon must have seen my conflicting emotions reflected in my eyes because she leaned down and started speaking to me as I was being prepped on the operating table. She said she loved her job and had performed over a thousand appendectomies. I appreciated my surgeon’s attempts to assure me, but I already knew I was in good hands with her. I trusted this new stranger who was about to cut me open. When my surgeon had shared the information about her husband’s career change, I knew only a confident and loving person supports a spouse who leaves a secure job to follow their heart. My husband and I had done that for each other. I knew I was going to be ok.
Grateful
I opened my eyes, and I was back in the dimly lit recovery area. My recovery room nurse was quietly asking me how I was feeling. I had survived. My nurse said the surgery went well and that my husband was on his way to pick me up. I remember feeling woozy but extremely hungry. My nurse brought me packs of saltines in a coffee filter and a ginger ale. I took my mask off to eat.
As the anesthesia started wearing off, I sat with my coffee-filter saltines and chatted with my nurse about various topics trying to prove I was in my right mind to go home. It was in this state that I looked up and saw my husband at the side of my bed wearing his tiger mask. His first words were “Why aren’t you wearing your mask?” He was still trying to protect me even though he had to trust strangers with that job for most of the day. I was surprised he was finally next to me and not confined outside to the hospital’s front doors. They let him in because he was the only one who could legally check me out.
As we drove away from the hospital at 2:00 a.m., I realized that my journey in the hospital from check-in to completed surgery was less than 12 hours. I was amazed at how little time had passed to have gone through so much.
In this short period, I learned that pacts only work until they need to be broken. I broke my “no-hospital pact” because I decided dying from a burst appendix was a greater detriment to my health than my fear of going to the ER and risking exposure to COVID-19. If I had let my fear win, I could have done myself grave harm. Instead, now I can share my story of the time I trusted a group of medical experts to fix me during a pandemic and came out a wiser person in the end.
Thank You
I was in good hands and want to thank the people I remember who did their best to care for me. Thank you Long, April, Gertrudis, Thomas, Cimi, Kelly, Teresita, Kenya, Christian, Arlene, Henry, Dino, Dr. Vu, Dr. Khoe and all healthcare providers for the service you provide to patients in need.
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Julia Fletcher is founder of JEFS Storytelling Arts, a graphic design studio, where she uses her unique research skills and artistic talents to create custom visual stories that help clients’ increase engagement and promote the education of their audience.
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