Back to four walls!
I had scarcely been home for a more than a week and for a few days of that, I had elephants around the bungalow for most of a 24 hr day. I would go to sleep to the rustle of stripping leaves and crack of twigs as a family of moms and calves fed quietly nearby, the youngsters getting bored and boisterous and trumpeting defiantly but quietly in the still nights of Late Winter. For me though, I would fall asleep with a feeling of being guarded, accepted, of being the safest person on the planet.
After only a few days home, for some inexplicable reason, my kidney had taken a dive and my creatinine levels had shot up over 1000 percent. My return to the transplant ward was as welcoming as a return visitor to a well-frequented Safari Lodge; the regular nurses and sisters instantly made me feel at home albeit not in the same state that they had discharged me to go home.
I was once again very uncomfortable and in pain as I waited to be admitted and after the requisite time waiting for a bed, to have bloods taken and scans ordered, I became quite depressed to find that I was in a high care ward, with no windows to the outside, but ringed by windows either to the neighbouring patients or the corridors on either side. Gloom under bright white fluorescent lights that everyone seems to forget to switch off when they leave the room.
The first morning didn’t start too well, being told of the immediate diagnosis and prognosis and the subsequent insertion of an IV line, a catheter taped to my right thigh and a Quentin Line inserted into my left femoral artery and sewn to the inner left thigh. This rendered me immobile and flat on my back with tubes restricting any movement. It wasn’t long after that that the first of a number of machines was wheeled into the room. I think over the many weeks of this safari, the only machines not to come to me were the big ones like CAT scan sized things.
The Quentin line is a temporary catheter for acute dialysis and with the discomfort it brought, it also brought a plethora of additions to my own medical lexicon. It has three tubes stemming out from the one inserted into the artery, a red one and a blue one to link to the dialysis machine to send and receive the blood and a brown one for vital Intravenous access. My first glimpse of The Machine gave me the impression that it was a hand me down from a private hospital, something that was high tech in the seventies. With The Machine running, noises like something out of a seventies sci-fi movie emanated as it bleeped and blooped and squeaked, cycling my blood through five hours of dialysis before I was removed from it to pass another night of what becomes another night in a General Hospital’s safe embrace.
On some days I was wheeled up to the Acute dialysis unit and treated there, on some days or nights, a machine would come down to me, and so began a routine that had one day merge with the next as I sank deeper into the cycle of a debilitating condition that seemed yet to be decided upon.
Based on the daily blood tests and other data, another biopsy was called for. A sonar scanner was wheeled in, the Professor and his doctor-in-training minions gathered around the bed and the biopsy duly done. This time around, though, the results took a lot quicker to come in, it took only a few days. The kidney had an infection as well as the nephritis that was picked up the previous biopsy.
All the scans and blood tests also showed that the kidney was failing fast and some drastic treatment was needed. Fortunately, my old room with a window became available and shortly after being moved, I awoke one day to a shrill-voiced Nursing Sister from the National Blood Service who was desperately setting up a machine that looked like a cross between a washing machine, a tumble dryer, and an old ATM but this spinner was for Plasma Replacement Therapy. It sent my blood through a centrifuge, which separated my plasma and inserted fresh, frozen golden yellow fluid that had me making up all the ingredients of the various shades of plasma that was donated.
They alternated the plasma therapy days with dialysis days and for the few days of PRT, I had yet more blood infusions, scans, x-rays, and the usual blood tests but my hemoglobin, white and red cell count went haywire.
By now I must have been about two or three weeks into this admission, Dialysis was doing its thing but my body and most importantly, my kidney, wasn’t. I was overloaded with fluid and my lungs were sucking in a third of their capacity, which meant that I needed to suck on oxygen constantly. A different course of therapy was prescribed, something that seemed to be a last resort sort of thing. Finally, they used the brown connection on the Quentin line that I had wondered about. I am not going to elaborate on the ATG, it didn’t last long although I think it was supposed to have been a few more sessions.
It was around this time, during the main doctor’s rounds, when the prof and his minions were on their last room of the Transplant Ward facing their most difficult and stubborn patient that that very patient learned of his predicament. And his future.
The kidney I had explored so much of Africa with, was in failure.
The kidney that had allowed me 14 more years to satisfy my hunger for knowledge of African wildlife and their world, wanted back in the city.
I had woken that morning feeling much better than I had the previous 3 weeks. It was a new moon, the Spring equinox was ushering in a new year for some of us and I felt a fresh surge of wellness. I stood at the window after my daily bath and shave in a basin and was standing in the glass-filtered sun when the medical entourage appeared at my door. No one came in.
We all gave a pretentious Hi! After the rapid update and usual placations in my direction, I was informed that I was now in renal failure and not ERD, End Stage Renal Disease, for the second time in my life. We discussed a few things, or rather I fired a rapid few questions that mostly didn’t even reach the lab coats and stethoscopes and it wasn’t but a couple of volleys of indirect answers that came back my way. There will be time to talk and it is a big hospital.
It is almost a given that at some point a transplant can, or will, or may fail. Living with a new kidney is this gift that we get that can, or may, or will have an expiry date, I was well aware of this and have lived with this knowledge ever since the whole ordeal began half my life ago. It is the harsh reality of arriving at the expiry date a little unprepared that has a tendency to be unsettling.
My sublime mood that was enhanced by the morning sun as it bathed half the room, waned and my day crashed like our currency does when the President reshuffles his cabinet or fires a finance minister. Only worse. The news drained me and I sank back into the canoe of a bed to contemplate the implications.
During the ATG therapy, I experienced extreme pain in the joints of my legs, particularly the knees after the infusion was done. My physical state deteriorated somewhat and, despite being practical about the whole ordeal knowing this day would come as well as its implications, I don’t think my gloom had much to do with the decline. I became one of the weakest versions of me that I have ever been. I was a shuffling zombie on my visits to the patient’s tea room, which grew less frequent as I sank deeper into the hospital bed, staring at the ceiling and the stillness my only solace.
One morning, most likely one of the busiest times of the day, I ventured to the little tea room to retrieve some milk from the communal fridge for my breakfast. I kept dropping things as I stood at the ancient microwave heating something up and the constant and rapid up and down was adding a lot of dizzy to my already lightheadedness and lack of oxygen. I made it to the T junction in the passageway of the ward not very far from the tea room and collapsed down and forward, into the opposite wall but was sort of saved by the medical chart easel of the adjacent room.
The nurses came out of nowhere and were very quick to respond but I had tried to grab the easel with my left hand, arm, elbow, anything, to stop the fall and the shoulder popped. This is something that I have had to deal with for 20 years, thanks to a tangle with an elephant and before anyone could lift me, I needed help to pop it back in its socket.
I mention this little episode because this led to then further decline and with hospital rules and fear of me falling, I was moved closer to the nurse’s station, to the high care rooms so they could keep an eye on me. I said goodbye to sunshine that day.
I don’t know where some time went, one day I was either suddenly wheeled up to the acute dialysis ward or a machine was rolled into mine. I was becoming somewhat familiar with the dialysis routine only in that I was having my blood cleaned from time to time but never a routine in that it happened at predictable times. By now, at least I no longer had the catheter but it was necessary to insert a more permanent access to an artery than the Quentin Line. There was no time to wait for tissue to heal using any other avenue and so I was scheduled for a Permcath insertion. Or attachment. Or invasion.
It sounded simple enough; only another internal tube, this time with only two external ports, not three. The details can be found on any search engine. But this time, the thing was inserted in my neck; internally, into the Jugular and externally into the upper chest, right where I have a new scar! Externally I have the two tubes dangling down my chest but they are wrapped in gauze and plastered down so, at first glance, it looks like I have had major chest surgery. I wondered how I would sleep or bathe and do other things but now that time has passed, I have learned much and have much more to learn.
After a couple of weeks of debilitated confinement, mostly in the windowless room, something changed and the fluids that The Machine was supposed to take out, began staying out and my edema improved with the knock-on effect that my lungs improved and so did my breathing. In fact, a lot began improving. In one week I lost 11 litres of fluid, which brought me down to a skeletal dry weight for all future sessions. I soon no longer needed the oxygen and resumed my Tim Conway impressions shuffling to the tea room.
I was discharged last week, having maintained my dry weight for a few days and I have had my first taste of going back only as an out-patient for my three sessions on The Machine. For the most part, the week went well. I am adjusting, there is a lot more to learn and discover and I have a whole new way of life that I have to live ahead of me and many flowers to find. Mopane Grove won’t see me for a while and I cannot express my thoughts about not being able to go home for quite some time. I have to push those thoughts aside because first I have to find somewhere to dialyse.
To Be Continued…..