October 20, 2017

Day 19 - Fly Home

I try to sleep, but I am not very successful. I sleep maybe from midnight to 2 AM. About 2:55 there is a code blue called. I check, it's not for me, at this point I wouldn't be surprised. It does result in every staff member scrambling. Even at this hour the unit is staffed with about 12 to 15 people divided into 4 teams with about a dozen patients assigned to each team.

Precisely at 3:00 a nurse comes to wake me. My last vitals are checked, I'm given my last drugs. I remove the last electrode patches from my body. Some are easy, some are stuck to last forever. She even finds me a tooth brush, mine is deeply buried in the suitcase. Freshened up, and in more or less clean clothes I am ready.

About 3:15 the call comes. The cab is here. I thank the staff and express the hope that the next time we meet it is in Florida or on a cruise ship. One person takes me in the wheelchair, another of the nurses hauls my two suitcases as far as the elevator.

The front door is a little problem. Not for getting out, but that no one can get back in from the outside. Fortunately there is another staff member nearby to hold it.

It is chilly, there has been a good frost tonight. The streets are nearly deserted. The cab driver is very interested in talking about our current President, like most Canadians he is very nervous, almost scared.

Twice on the way to the airport we have to stop for deer in the road. The driver says he often has a run to the airport in the early morning, and deer are quite common. I pay the cab fare by credit card, but give the driver a cash tip including several $2 bills. Having never seen them before, he is intrigued. Being brand new, and in sequential order makes them even more special to him. He helps me with my bags right into the airport terminal. No cops here telling him to move on.

There are only a handful of passengers at the airport. There is a kiosk for check in which I manage to navigate through. One employee didn't show up this morning, so one person is split between scanning checked luggage before it is loaded and processing passengers so they can board.

Mine is the second flight, so I just find a seat and wait my turn. Every passenger is assessed a $25 fee for airport improvements. A task which has begun but is progressing very slowly.

They label it as two gates, but really there is only one door. No ramps, just walk across the tarmac, and climb the stairs into your plane.

My turn. A small 2 engine prop plane that carries about 40 passengers, there are 2 empty seats. The single flight attendant is having a hard time getting passenger co-operation. Maybe its just too early to understand that you have to take the ear buds out of your ears and your bag needs to go under the seat.

Due to the heavy frost, we have to be de-iced before departure. We leave about 30 minutes late.

The flight to Montreal is smooth, I can't see out the window, but it is dark most of the way anyway. We land late, and I have limited time to make my connection. I have asked for wheelchair assistance. The guy starts on the way, I have my small suitcase in my lap. My large suitcase has been checked thru to Orlando. His pace is double what mine would be.

After about 5 minutes, he commandeers an electric cart. This moves about 5 times faster, beeper honking constantly. We make good time. He calls his supervisor several times to let him know of our progress. Where I need to go must be as far as possible to go from where I landed. We change vehicles again, he doesn't work that section of the airport. A stop at Canadian customs and security, yes every buzzer goes off as usual. Finally I am passed and we head to US immigration for a similar process. Global entry doesn't help me here. Eventually I am on my way. The gate is so far away, the gal isn't even sure how far it is. I see gate 73, about 100 yards ahead. The terminal waiting area is empty, as she rolls me down the ramp I hear an announcement that all passengers are aboard and the door is closed. I hope not, I'm not on the plane yet!

I board to find my seat occupied, expecting a no show, someone else changed seats. I don't care, the plane's door is closed and we begin to move before my baggage is in the overhead bin. Probably I have been the topic of speculation as to why the plane isn't leaving, it obviously was being held for me.

The plane is an Airbus 310. Luxurious compared to the last plane. There are two empty seats in business class and a few isolated seats scattered around the main cabin. A delicious fruit plate for breakfast with real linens,china and flatware. No free drinks for me, a glass of club soda will be fine. The flight is smooth, and I actually sleep for a few hours.

We make good time to Orlando, arriving a couple minutes early despite our late departure. Again with wheelchair assistance I arrive at baggage claim a few minutes before the luggage. My bag is the first one off, I call my waiting driver, Adrienne, and am headed to my house. With little sleep the last four days, I let her drive.

I tell her a little more about the details as we drive home. It is difficult, my ears have failed to equalize to the change in air pressure. If its not one thing it's another.

Day 18 – Heading Home

It is Wednesday, October 18th. I'm scheduled to be discharged this morning to begin my journey back to Florida.

I awaken at 5:30, walk to the washroom, and as I return to my room become aware that part of my tongue is swollen. I bring this to the attention of the nurse a few minutes later when she comes to check my vitals. There is an ensuing consultation with several of the doctors an I am given a large dose of benedryl. I react to the benedryl, but no reduction in the swelling. The lymph nodes in my neck are obviously enlarged. Discharge today looks unlikely.

The doctor arrives expecting to sign my discharge papers. He is disappointed in my condition, and surprised to find the swelling. He orders more blood tests and wants further intervention from the cardiologist.

I am given more drugs, and the swelling subsides. My symptoms are controlled but the causes remain elusive.

The cardiologist arrives armed with all the lab and recent test results. We discuss my history in detail, both my long term medical history and the short term sequence of events. He concludes that while there is the possibility of a minor cardiac contribution to my condition, this is not significant enough to have caused the shortness of breath and is unrelated to any swelling. He is going to confer with the rest of the team, and my Doctor will be back with me later in the day.

It is time to call Adrienne and bring her up to date. Unfortunately the plane tickets are non refundable, but there are a few hours left in the 24 hour cancellation period. I tell her to cancel the flights, and we will just rebook when needed. There are still seats on tomorrow's flight, so this is not a flight that is always sold out.

About 4 o'clock I get word that I am being moved to the internal medicine floor somewhere else in the hospital. I'm barely settled in, haven't even met any of the staff when my Doctor arrives. He has a plan.

They are now convinced that the swelling is most likely a side effect of a maintenance drug I take, I am not surprised as this is a common side effect. Still no definitive cause for the shortness of breath, but many possible causes have been ruled out.

The objective is now changed to get me safely to Florida.

I will be discharged at my convenience to go directly to a plane.

Use of the suspected drug is suspended.

As I am discharged I will be given a dose of steroids to counteract any swelling, I may just happen to have an additional dose with me while I travel, just in case.

If nothing adverse occurs, I will start the discharge process at whatever time is needed to catch my plane.

The Doctor and I meet with the head staff person to discuss the discharge arrangements. If they have ever discharged a patient in the middle of the night they are not acknowledging so, but say with confidence they can do it.

I am in contact with Adrienne to rebook my flight. Of course this doesn't work either. The airline will no longer accept my credit card. I understand, people shouldn't be booking and canceling the same flight within a few hours. I give her another card to use. Have I ever mentioned that I always carry more than one credit card when I travel? Just for time like this.

I call my PCP and arrange for an appointment a few days after my return to Florida. Arrangements are made to have all my hospital records faxed to her, at the moment 44 pages and counting.

Adrienne confirms that I am booked on the 5:45 AM flight.

I have dinner, take a shower, and repack my suitcases. I need to know what is where to get through airport security and US customs. Though not neatly packed, everything of importance is accounted for.

I am free to walk around the corridors. I don't bother other patients, but talk with the nurses at the station only when they are not busy. One of them frequents central Florida once or twice a year and is very familiar with the area where I live. Actually just getting up and walking around results in lifting my spirits and helping me feel better.

The planes are booked. The nursing staff has arranged for a taxi to pick me up at the proper entrance door. My records have been successfully faxed and received by my Doctor.

I will be awakened at 3:00 for the next leg of my adventure.

Day 17 – In Hospital Trauma Center

I can't start by saying "when I awakened this morning", because I have not slept a wink in the past 24 hours.

I have been pondering whether to return to ship, or return to Florida. No definitive cause for the breathing difficulties has been found yet. The ship is close to good medical facilities for a week, but then will be pretty isolated in open waters far from the US.

The doctor arrives. He really has no additional information. I probably will be OK to go back to ship, but they just can't find what was causing the shortness of breath.

I tell him that I have made a decision, and will cut the trip short. He is aware of flights leaving Saint John headed to the states, there are several each day, and suggests it will be best then that I stay another day for observation to be sure, and that I will be discharged first thing the next morning in time to catch a plane that leaves late morning or noon. 8:30 or 9:00 AM discharge at the latest. He asks me to have him paged if there is any delay in my discharge.

We have a plan but I alter it a bit. I text Adrienne, ask her to find me a hotel for Tuesday night, and book flights for Wednesday instead of late Tuesday. I now have a buffer of time between discharge and catching a plane. Royal Caribbean customer care team would have made these arrangements for me, but I trust Adrienne much more than Royal. She is good at this type of stuff.

She finds a Holiday Inn close by, and books me on a flight to Montreal and then to Orlando on Wednesday leaving at 5:45 AM.

As she is looking to make travel arrangements, I become aware that I really don't even know where I am. I have to ask one of the nurses. There is both a Saint John and a Saint Johns, an easy confusion, and insignificant in casual conversation, but very important in booking flights. I am in Saint John, New Brunswick, not Saint Johns, Newfoundland.

Adrienne makes a reservation for me Wednesday at a Holiday Inn about a mile away, and for flights leaving at 5:45 AM on Thursday for my return to Florida.

I find the hospital staff very pleasant and the Canadian accent I can handle quite well. I learn that I am designated as an "international patient", but often referred to in private conversation as the "cruise ship passenger".

They have had cruise ship passengers here in the past, but it is not a frequent occurrence.

Throughout the day I am spotted by previous staff that are surprised to see me. A couple of guys from fire and rescue that moved me off the ship stop in and we chat for a bit. Much of the staff is working 12 hour shifts. I hear at least one say this was his 15th straight 12 hour day without a day off!

Monitoring is continued, and I am given a steady flow of various drugs and antibiotics. With all the monitors, bells and ringers it sounds like a carnival with so much commotion. My now having added the use of my phone only adds to the confusion. Yes, of course I can use my phone, rules and regulations for patients are basically non existent.

Whenever an ambulance is on the way, the initial call is often broadcast throughout the entire area. About 4 o'clock a particular call springs everyone into action. They need my room.

Within 60 seconds I am moved out, the room cleaned and sanitized and ready for the next patient. I am delegated to a space in the hallway in front of the nurses station counter. Within 30 minutes I am moved to the the acute ER next door. A similar arrangement except the rooms are smaller and there are 45 instead of 25. Most of the staff is new to me, but a couple I recognize from the day before. Each day staff is assigned to a location where they are needed, but also qualified.

Subsequently I learn that this is a 600 hundred bed hospital which also has a third ER which has 72 beds for patients needing routine ER care. Certainly there are hospitals that are larger, but this is the largest I have ever been a patient in.

I quickly settle in to my new environment. There is a chair, so I can get up and sit if I wish. There is a washroom down the hall, I just need to disconnect myself from all the monitors when ever I need. I actually get a dinner plate here, Ham, carrots, mashed potatoes and a fruit cup for desert. It tastes delicious, the first real food in a couple of days.

My breathing remains fine. I still have the lingering effects of the cold as expected, never have had a fever, and my oxygen level remains normal hours after removing supplemental oxygen. I'm feeling pretty much back to normal except for the cold.

Finally about 2:00 AM I fall asleep.

Day 16 - Part Two

It seems like a 20 minute ride to the hospital. I learn it is a level 1 regional trauma center serving the province of New Brunswick. Vitals remain the same, no improvements, but no deterioration either. They begin a more methodical approach.

If you are having a heat attack, a dose of this should help, you will tell very quickly. Probably just hearing the phrase heart attack probably makes my pulse jump a little. Any better? No change I reply. Lets give you some more. This is repeated 4 times. Same result. Move on to medication two. This should open up your breathing passages. One dose should help, again repeated several times. I can tell no difference. We arrive at the hospital.

The medical team is waiting as I am wheeled into the trauma center. Immediately blood is drawn for blood work. Sure glad they use the IV already in my arm. They start at the beginning. As the questions begin I reach into my pocket and hand them the yellow card, even has insurance information. Everyone wants to know how they are going to be paid.

Their approach is a little more broadsided. Multiple drugs are administered nearly simultaneously, with the assumption that one of them will arrest the condition.

I must be medically stable. My oxygen level has obviously improved and I feel better. The frenzy subsides to a level of constant attention. More discussion about how this came about. The underlying cold, more detail of my medical history, allergic reactions, etc.

Many possible causes remain on the table. Time to find it. First up CT (I think) scan looking for any blood clots. I'm taken to radiology. They are waiting, my name is checked and verified. I am asked about allergies. "Contrast Dye" I respond. She freezes, makes a phone call and they have me on my way back to trauma center.

The staff is in constant radio communication. Shortly they stop and head back to radiology. Trauma was aware of my allergy, but feel they already have given me enough drugs to counter any reaction. Just to be safe they are sending someone, drugs in hand, just to be sure.

The contrast dye is given without reaction. Subsequently I learn that contrast dye has been reformulated in recent years with a resultant reduction in allergic reactions.

More blood work, X-Rays, breathing tests, constant monitoring, the work continues.

About the time the ship is leaving for its next port, absent one passenger, my luggage is delivered to my hospital room. I'm confident they have most of it. It is easy when everything needs to be packed, and the room empty when you are finished.

Though there is absolutely nothing they can do, it is time to let my family know what is happening. I get my phone and send Adrienne a text to let her know that I am off the ship and in the ER.

About 10:30 or 11:00 the Doctor returns. No definitive cause has been found, they want me to stay the night, and he will consult with the other doctors to determine if there is any reason not to return to the ship. I will be discharged sometime in the morning.

Royal has a special customer care team to assist passengers during times like these. They are the team that makes sure luggage gets to me, finds appropriate medical care anywhere in the world, and reaches out to help contacting relatives, finding transportation, or helping in any way they can. They have talked to the hospital several times to inquire on my status, I have overheard the conversations, and they have tried to reach me more than twice, but I can't usually get to my phone, or it has been off.

Sleep is impossible. Side effects of some of the drugs, high level of anxiety, and too much happening. This section of the the ER has about 25 beds around one central doctors station. I am just a few feet away and can overhear nearly every conversation amongst the staff. Conversations fall into several categories. Discussion about one of the patients, complaining about some silly management directive, or the exchange of the latest jokes or sports scores. Exactly what I would expect to hear in nearly every work environment, I think the formula is universal.

The hospital is over capacity, so I can't be moved to a regular room. I am kept in the trauma ER.

Day 16 – The Perfect Storm

Monday October 16 – Arrival in Saint John, New Brunswick. During the night we have 10 foot seas. I barely feel any motion in my cabin, but later I will hear other passengers talking about how bad the ship was rocking during the night. Face it, I am used to it, others are not.

When I awaken, I'm winning, my cold is losing. There is a little swelling in my right hand and lower lip. I have had this angioedema occur several times in the past 4 years. I feel pretty well, at least well enough to venture out, but I will wait until after lunch to make a final decision. My tour is in the afternoon. The weather is good, cool but no rain. My usual bowl of cereal for breakfast.

We arrive about 10:00 and passengers head off the ship in large groups for various tours, mine will be one of the last of the day. I find a chair on deck 5 and check my email. At nearly every port we have had very good local cell service.

About noon I head to get a bite to eat, nothing looks appetizing, I grab a slice of Pizza and an Iced Tea. One bite but it doesn't taste like pizza, but I don't know what. I take a few sips of tea and head back to the cabin.

I suddenly realize that I am out of breath even though I am not exerting myself. I make it to my cabin, 7 decks down and on the opposite end of the ship, but have to stop and rest. I sit in the cabin for a few minutes to gather my senses. This is not my usual self. I'm not an athlete by any stretch of the imagination, but I don't have issues slowly walking along the corridors of cruise ships large or small, and this is a small ship by comparison.

Just run down from the cold? Maybe, but I felt pretty good earlier in the day, but that's the way colds work, you are usually at your best early in the day and the cold takes over as time goes on.

Make a prudent decision, do I go or skip the train ride and shore excursion. Actually I looked up some reviews for it on the Internet last night, and many reviews were pretty negative. Disappointing, but I'm not missing a lot. It is not like I haven't ridden an excursion train before.

I sit in the cabin for a bit and my shortness of breath does not improve. There is only one option, see the ships doctor. I check and the office doesn't open for 3 hours. Waiting would be procrastination, not a smart decision. Time to call.

The phone system has a dedicated button for medical. The phone rings and rings, no answer, not surprised, the office is closed. Who sits in a closed office?

I try the front desk button. Even with most passengers off the ship, there is always someone at the front desk or the back office to answer the phone. Same response, no answer.

Another button is just labeled emergency. In my judgment this would be the button to use if there were a fire, or someone fell overboard. It is answered within several rings. It obviously goes directly to a manned command center somewhere on the ship. Actually I think it is between the elevator shafts on deck 2. I explain that I have shortness of breath and that I am in my cabin and would like to see the Doctor.

Within a minute a security officer arrives quickly followed by other staff with a wheelchair and a nurse. Another minute and I am in the medical facility, one deck below and less than 50 feet down the corridor. My condition has deteriorated as my anxiety goes up. No, I don't panic, but there is the realization that this could be a serious issue, or at least I have triggered the mechanism to handle the most serious of emergencies.

Am I having a heart attack? Was that bite of pizza that didn't appeal to me contaminated with a piece of shellfish? Is what I have been thinking to be a cold not really a cold but something more serious like pneumonia or worse? Every ship has passengers from all corners of the earth, strange and unusual illnesses can circle the globe rapidly. Norovirus? Dreaded on every ship, but quite common in any area with lots of people in close quarters. There are countless possibilities.

The nurse, obviously the leader in the medical department, springs into action, immediately blood is drawn, as my vitals are monitored and an EKG recorded. My oxygen is low, no surprise that fits with my only symptom of shortness of breath. Oxygen is started, and an IV placed in my arm.

Simultaneously a barrage of questions, most are answered by a little yellow laminated card I always carry in my pocket. I have carried this for over 20 years, and is kept updated whenever anything changes. This is the first time I have used it in a real emergency. Allergies, major surgeries, known medical conditions, prescriptions and OTC drugs, emergency contacts, all listed on one little easy to read card.

Armed with the results of the first blood tests and my history I am given several medications. Blood work again, continued monitoring, a constant barrage of radio communications.

The pecking order of the office is soon obvious. The nurse runs the operation, but makes the Doctor feel like he is in charge. She suggests, he says yes. Initial investigation doesn't reveal too much. Slowly the facility fills with other staff members. A decision was made to call local emergency medical staff. I don't remember any participating in that decision, but it is well understood that one of the main goals of the ship medical staff is to transfer any serious problem to someone else if possible. We are tied up to the dock, I am much easier to transfer than the patient last week that risked his life as he was handed over to a Canadian Coast Guard vessel.

I must have my passport to get off the ship. Where is it? I am asked. "In my safe." I respond. They will get it, several radio calls to the man with the secret safe code. They can't get the safe open. I tell them "the code is 9948". So much easier.

Just like in Florida, the Saint John EMT is a combination of Fire Department fire and rescue and an ambulance team. The medical facility is now crowded.

At this point I have already been given numerous injections, I'm sure my pulse is racing a mile a minute, but that would be true just from all the activity. My shortness of breath is really the same as it has been since this all started, not really worse, certainly no better.

They are almost ready to wheel me away, but still no passport, and they suddenly realize I have not given them consent to treat. That detail is taken care of and an envelope arrives with the contents of the safe.

As we leave the medical facility I am given three envelopes. One with my passport and other stuff from the safe and my phone, a second with a copy of all medical records from the ship, and a third with an additional copy of the medical records for me and my bill from the ships Doctor office. I now know what he was doing.

I am wheeled through the bowels of the ship to a forward ramp, I think the one that is being used by the crew today. It goes directly to the pavement. An ambulance is 50 feet away. This time I am the subject of observation for any nearby passengers. I look, but don't recognize any faces. I would have waved, but they have me pretty well strapped in.