As I said in my last heart surgery blog ‘So I met my Surgeon’ I needed to have two tests done before they would book my surgery date. On Wed April 24 I had a CT Angiography at a new hospital in South Calgary. The day of my test, my good friend Kim picked me up and drove me to our destination. well… what we thought was our destination. you see, there are Two new health facilities in south Calgary and, due to the quirkiness of the people who name these facilities, they are a few blocks apart and both have South in their name… who would have thought it possible? So, of course, we ended up just on time for my appointment – but at the wrong hospital. Luckily this is a common occurrence and the woman in reception adroitly turned us around and got us headed in the right direction. It was a quick drive from one facility to the other, but we marveled at the shortsightedness of the town planners or whoever was responsible for putting facilities named the South campus Health and the South health Region in such close proximity and with such similar names. When we arrived at the correct hospital, Kim dropped me off at the door so I could get where i needed to be while she tried to figure out where to park. Being completely lost – and now late – I asked at the main reception and they kindly took me to the right place….on the other side of the hospital on the 3rd floor. Lets remember that I have a heart problem – I was Tired by the time I got to cardiology diagnostic Imaging and was glad to plop into a chair. I explained that I was late and why – the receptionist rolled her eyes and said ‘this happens all the time!’ Really? why on earth doesn’t someone change something then? oh well. I dashed off a quick text to Kim telling her where I was: ‘other side of the hospital, 3rd floor, good luck!’ and relaxed for a few minutes.
Just as Kim got there, a nurse came out and called my name. I waved to Kim, handed her my purse (why? i could have left it in the locker they gave me…) and followed my nurse. He was a young man and, as it turned out, a tad nervous. Did I mention that this was a teaching hospital? yeah… so we got to a change room and he informed me that I should remove everything down to my waist but I could leave my pants and shoes on. The delightful gown he handed me was to be put on, opening to the front, and when I was ready I was to let him know. I eyeballed the gown skeptically… This was a One Size Fits All gown and I am not a One Size Fits All sort of woman. ‘Do you have a larger gown?’ I asked him. He looked uncomfortable and assured me that ‘most’ people had no problem and in fact the gowns were larger than they looked. I eyeballed him for a few seconds. seriously. I am a full figured woman. really full. over full. voluptuous plus. There was no way this gown was going to ‘comfortably’ fit me. But I am not a shy woman – never have been, don’t know why – so if the gown didn’t fit, it would be this charming pink cheeked student nurse who was going to feel awkward about it. I popped into the change room, donned the gown – more or less – and hailed my nurse. He was professional enough that he didn’t gape, but we did stand there for a few moments both coming to grips with this situation. The gown fit me snugly and for the most part we didn’t have a problem. But I am large breasted (yes, i said it!) and frankly, the cut of the bodice would make Mae West blush. Whatever. After digesting this he pasted on his cheery smile and said ‘Right! lets get you settled’ we walked around the corner to a curtained room – it looked like a bed in an emergency room – and he indicated i should sit down. ‘we’ll start an IV for the dye test, and we need to make sure your heart rate is down to below 60. Did you take your heart medication this morning?’ ‘nope’ i said, ‘ i called yesterday and they told me not to take it – the beta blocker would slow my heart down to much’ i was proud of the fact that i had thought to call – the people who made these appointments for the hospital frequently forgot details such as these. For instance, they would tell you to fast but unless you asked would not say if you should take your usual medications. He frowned at me ‘hmm, that’s not good. we would have wanted you to take your pills so your heart rate was down..hang on’ he hurried off to speak to the cardiologist. After a few seconds he came back ‘we are going to give you 2.5 mgs of your normal pill and then if your heart rate doesn’t come down we’ll give you another pill’. this confused me as i normally only take one of these pills a day and in the past when i had been on a higher dose it made my heart rate go so low i would faint when i stood up, not something i looked forward to. of course worrying about this made my heart rate go up…
after i was all hooked up to a heart monitor and had taken my first dose of beta blocker, the nurse came back and said ‘now i will put your IV in. We had 5 nurses here to observe but since you were late they all went to lunch and it’s just me.’ i wasn’t sure why he felt he needed to tell me this, until i realized that he was nervous… great. ‘how many IV’s do you do in a day?’ I asked him casually. ‘oh, one or two…’ he said, not quite meeting my eyes. He was very industrious in his preparations, got out all his little poking things and rubber gloves and tourniquet. he looked at my delightfully fleshy arms and pursed his lips. ‘do they normally have trouble finding veins?’ he asked. ‘nope. They’ve never had a problem…’ yet, i thought… first he checked my right arm. then my left arm, examining the crook of the elbow. ‘i see you have had bloodwork done recently’ he observed pointing at the small red puncture mark. ‘yes, i needed to have that done for this test’ i said. ‘yes’ he said. after looking at both arms twice he decided to have a go at the left arm. he put the tourniquet on, and i swear he was counting ‘one, two, three’ under his breath, and plunged the needle in. it didn’t hurt – i could feel the pressure but no pain. with one hand on the IV he used the other hand to undo the tourniquet and then gently pushed the needle further. ‘hmm…’ he said, ‘ it won’t advance’ ?? OK… i said nothing – i didn’t want him getting more nervous while he had a pointy thing in my vein… He furrowed his brow. ‘i think i need to flush it with saline solution’ he looked a question at me. ‘sure’ i said – not really certain what i could contribute to this process. Still working single handed as his right hand was committed to holding that needle in my arm, he produced a large syringe full of saline and attached it to the IV. he gently depressed the plunger and… nothing happened. At least from my end, nothing happened. ‘it’s not advancing’ he muttered again. he put the syringe down and sat back for a minute – hand still on my IV. ‘I think i better try the other arm’ he said, ‘this vein just won’t work’. Ok, Enough…’Is there someone who could help you with this?’ i asked ‘It’s kind of important to me that this is done only once…’ ‘yes’ he brightened visibly ‘i’ll go get the nuclear tech’ and he dashed off. i sat there with the IV in my arm, holding a piece of gauze in place. I’m sure my heart rate was going up again… a few moments later another cheery young man who exuded MUCH more confidence entered my cubicle ‘hi there!’ he said, ‘let me see how i can help you’. he removed the existing IV, checked my other arm and quickly and painlessly put in the IV. it took about 3 minutes all told. i was much happier with the nuclear tech. He went on to explain that my heart rate which had been coming down, was going up slightly again – no wonder with my second IV of the morning. He was going to give me a second dose of the beta blocker to get that heart rate down. it crossed my mind that if they did all the unpleasantness – iv’s and such – before they took your heart rate it would come down in a much smoother curve rather than the down and up they were seeing with me. He gave me the second dose and then left me for 45 minutes to give me time to get my heart rate down. i sat and thought calming thoughts, looked out the window at the mountains, admired my shoes… a magazine would have been nice. after 45 mins the nuclear tech came and escorted me to the CT scan room. This part, he assured me, was a breeze and would go quickly.
The procedure room was light and airy, pretty much what i expected. they indicated that I should lay down on the CT scan table and made me comfortable with a pillow under my knees and behind my head. i had to have my arms above my head so the IV and various and sundry tubes didn’t interfere in the scanning process. The nuclear tech guy appeared on my left just above my head. ‘ok, so we are going to do a quick scan without the dye – just slide you into the CT tube for a pre-dye test – then we will bring you out, give a quick dose of the dye and do a second scan to make sure you don’t have a reaction to the dye. After that we wait a few moments and then do the full dye scan which takes about 10 minutes. and then we’re done!’ i liked how optimistic he sounded. ‘but first’ he said ‘we’re going to give you a dose of the beta-blocker’. uh oh ‘hang on a second’ i said quickly, ‘i’ve already been given 2 doses when i normally only take one. i do get quite faint if i take too much and i hate it when i faint! are you sure i need this?’ he waved his hand at me dismissively ‘I’ve given people 10 doses before – this is through your IV and not orally so it’s in and out of your system much more quickly. you’ll be fine!’ i was a bit skeptical but they apparently knew better than i did… he administered the dose. we waited for about 5 minutes all patiently watching the heart monitor to ensure my heart rated slowed as it should. it didn’t quite make it below 55 beats a minute. rats. He appeared above my head again, syringe in hand and quietly gave me one more dose. So lets see… that would be 4 doses now? i closed my eyes and thought quieting thoughts…. Suddenly over an intercom system of some sort he said ‘Sandy? we’re going to put you in the CT tube for the first part of the test” yay! i kept my eyes closed and my arms above my head. the machine started to hum and the table i was on slowly slid into the tube. A pre-recorded female voice told me to breathe in and then out, in and then out, in and then hold! i held. and waited. and held. and was just beginning to think that woman better tell me to breathe again when she said ‘and breathe normally!’… thank god. slowly the table withdrew from the tube. my helpful nurse from the beginning appeared on my right ‘ how are you doing?’ he asked. I nodded ‘pretty good’. he looked at the numbers on a machine beside me, wrote something on a clip board. the nuclear tech appeared beside me ‘Good job!’ he said enthusiastically ‘I’ve laid still before’ i commented – not really sure his enthusiasm was warranted. he didn’t seem to notice my dry humour. ‘Now we are going to do the test run with the small dose of dye’ he said ‘but first we’re going to give you another dose of the beta blocker’… uh, that would be dose number 5… ‘are you sure this is necessary’ i asked, lifting my head and trying to see the heart monitor ‘ that’s like, 5 doses!’. he patted my arm ‘don’t worry, you’ll be fine!’ and injected the beta blocker. we sat quietly waiting for my heart to cooperate and after a few minutes his voice came over the intercom ‘ok Sandra, we’re going to begin again’. i closed my eyes and the table started into the tube. ‘and we’re administering the dye’ his voice came again. i lay still listening to all the sounds and noticed a muffled hissing noise… weird…. and my arm felt unusually warm, but they had warned that the dye would make my blood feel warmer than usual. so i lay and listened to the pre-recorded voice tell me to breathe, and not breathe and breathe again. Sure enough after a few seconds i could feel a warm flush down my chest and into my nether regions… it totally felt like i wet myself, but they had warned me it would feel like this and after the initial warmth it was clear that i had retained my dignity. after 5 minutes this part of the test was over and as the table withdrew from the tube my nurse again appeared on my right but with a little less composure than before. ‘you leaked!’ he said with some distress looking at my arm ‘what?’ i craned my neck around to see what he was looking at. sure enough the warm feeling on my arm was from a leak in my IV tube. great. i had radioactive dye all over my arm. Nuclear Tech guy and nurse guy had a quiet discussion then they fiddled with my IV again. ‘we’re going to have to disconnect some of these tubes, there seems to be a leak somewhere and the dye is getting out’ the nuclear tech said with a forced smile. ‘if the dye is getting out, does that mean air is getting in’ i asked, pretty concerned that air getting into my veins was a bad idea… ‘no of course not!’ he said with false cheerfulness, ‘do you want a Xanax’ he asked suddenly ‘uh, no’ why on earth would i need Xanax now? i wondered, worrying that this was going to make my heart rate go up again. A new nurse – a female – appeared beside my head. ‘hello!’ she said ‘ seems you are giving us some problems’ she grinned at me easily. ‘we’re going to recalibrate the dye delivery system and then we’ll be back on track’ she patted my arm reassuringly. after a few minutes of quiet conversations and whirring and grinding of the machine, it seemed all was on track. ‘ok’ nuclear tech guy said ‘we’re set’. everyone disappeared again. the table started into the tube, the pre-recorded voice was just starting her monologue when i heard that ‘pop’ again, but this time it was accompanied by a spray of fine mist all over my face and hair ‘Stop! Stop!’ i shouted ‘It’s spraying me in the face!’ the pre-recorded voice faded out mid sentence and the table stopped and i slowly reversed out of the tube. that shit was everywhere, and it was sticky. i had my eyes closed to avoid getting the dye in them, and someone came over and started fussing with the machine. ‘can you leave the machine for a moment and wipe my face off, please!’ i asked and, yes, my tone was a bit demanding. from my right a hand touched my arm then i felt a cool cloth on my forehead ‘its on my eyes’ i directed. the cloth moved to my eyes and after a moment i could open them. ‘what the hell was that?’ i asked. the female nurse appeared on my left. ‘it’s fine’ she reassured me ‘there just seems to be some sort of problem with the dye delivery system’… how is that fine? i wondered, keeping my mouth shut. i was tired of this in and out of the tube game and worried that i had radioactive dye all over my face and i wanted to be done. deep breath. nuclear tech guy was impatiently hooking up and unhooking tubes and things, nurse woman was standing holding my arm reassuringly. the IV site was becoming quite sore because as they hooked and unhooked things they wiggled the tubes and it pulled on the site. ‘do you want a Xanax now?’ the male nurse on my right asked. ‘no’ i snapped ‘no i do not want MORE drugs! lets just get this done!’ i was aware that if we didn’t get this done today i would just have to come back another day and start this all over again, so i was very invested in them getting the darn machine fixed.
finally, they seemed to have things under control and, once again, nuclear tech guy showed up on my left with syringe in hand ‘uh, your heart rate has gone up a bit… we’re giving you another dose’ no doubt, i thought. we waited. 5 minutes. 10 minutes. Nuclear Tech guy showed up again with the syringe ‘just one more dose…’ i gaped at him ‘are you kidding me?’ i asked ‘ i normally take 2.5 mgs which your staff told me NOT to take. then i show up here, you are now giving me, ‘ i counted back in my head’ SEVEN doses and I’m supposed to believe that this won’t affect me in any way? I think i’d like to speak to the cardiologist before we go any further’. i was firm but not rude. OK, maybe a little rude. The nuclear tech guy looked at the female nurse. she looked at me. then she looked back at Nuclear Tech guy and nodded ‘Go get him’. off he went and we waited another 5 minutes. a new face appeared on my left ‘ hello Sandra. i hear you have concerns about the beta-blocker?’ i nodded, ‘i don’t usually take 7 doses in a day, and i’m worried about my ability to function when i stand up since my blood pressure will be so low’. he nodded sympathetically, ‘yes, i can understand that, but this dose is a fast acting dose’ seriously? there’s a fast acting beta blocker? ‘ and it will be out of your system within 4 hours’ ok, 4 hours is not fast acting… ‘so i’ll feel a little light headed and such when i’m up and about again, but my heart won’t actually stop beating on exertion?’ he looked shocked ‘no of course not! we would never put you in any danger!’ i nodded ‘ok, i’ll take your word for it. but the popping, spraying IV tubes don’t exactly instill confidence’ i said. he looked a little non-plussed and backed away from the table. the female nurse and the cardiologist had a murmured discussion then she came back ‘do you want a Xanax now?’ she asked brightly. oh. for. God’s. Sake. ‘no thank you’ i enunciated ‘i do not want a Xanax now. i do not want it in a box, i do not want it with a fox. i do not like your xanax man, i do not like it Sam-I-am’ her smile faltered and she turned to the nuclear tech, she apparently didn’t appreciate my Dr Seuss-esque humour. ‘lets get going’ she said. without further ado they disappeared and the pre-recorded voice started her instructions again. i was put into the tube, no popping noise, dye administered, tests done and i was out before i knew it.
they had me sit up, carefully supported by two nurses and told not to get up for a few moments. Nuclear Tech guy came and unhooked my IV and put a cotton swab and some tape on my arm. i felt a bit dizzy. the female nurse bent down to look in my eyes ‘ do you have someone to drive you home?’ she asked. ‘Seriously?’ i asked amazed that no one had asked me this before ‘ seriously, after 7 doses of beta blockers and offering me Xanax a number of times, NOW you ask me if i’m driving?’ i shook my head in disbelief ‘yes. yes i have a ride. but what would you do if i did not have a ride?’ she just stared at me. ‘well you do have a ride, so that’s good’ she said looking away. ‘but if i had not’ i insisted ‘if i did not have a very patient friend waiting in the waiting area, what would you do then?’ she shrugged, ‘you’d have to remain her for 4 hours till we were sure the beta blocker was out of your system i suppose’ . and that was the end of that. the male nurse who had greeted me initially came and collected me not making eye contact. i suspect i was now ‘a difficult patient’… i walked unsteadily back to the change area, retrieved my clothes from my locker changed in the little change room. i threw the wee hospital gown in the bin of used gowns, and then went through the doors to the waiting area. i looked at the clock. it was 4:05pm. Kim had been waiting for 3 hours.
While this was not the worst test i will have to take – there is a trans-esophageal ultrasound (or TEE) i have to undergo on June 13th – it certainly was a test that did not instill confidence by the administering team. i’m happy that the TEE is scheduled back at my regular hospital with the cardiac team i have been seeing for 13 years. i’m pretty sure i won’t have things popping and trickling in that test. at least i most certainly pray not.