Nick Gets a Spiral CAT Scan

Nick after release from Dominican Hospital

The Friday before Good Friday 2013, I was bringing up my laundry from under the deck, a vertical distance of less than 30 feet, when suddenly I felt like I was back on Mt Shasta--I could hardly breathe, and my heart was racing. I put down the laundry and rested. Back to normal, I did what anyone else would do--I hoped it would just go away. But it didn't. So I decided to see my doctor a few days later on Monday. He checked me out, advised a few blood tests and chest X-ray in Santa Cruz. I returned in the evening from Santa Cruz to my doctor's phone message (he had received the blood results) to call him immediately. I decided to wait till morning but in his second phone call he advised me in person to go to Dominican Hospital immediately. I called my friend Reno who drove me (about 10 PM Monday) to the Emergency Room at Dominican.

We signed in. And waited. And waited. Due to the large numbers of Americans who lack Health Insurance, all hospital Emergency Rooms in the USA have become doctor's offices of last resort. And consequently Dominican Hospital's ER is not a swift emergency treatment center but a de facto doctor's waiting room.

Reno and I waited some more and finally (around midnight) were instructed to fill out forms and wait some more--this time inside a large room to which nurses and doctors had access. I was tagged with an orange wrist band with name, number and bar code. A nurse's aide arrived with a machine on wheels to take my "vital signs"--blood pressure, pulse rate, temperature and blood-oxygen level. As long as I stayed at the hospital, I could count on some woman with a vital-signs cart arriving every few hours to take these measurements. The numbers showed up on her cart in great big digital displays. I noticed that my blood pressure was unusually high, mostly I guessed, because I was scared because I didn't yet know "what was wrong" with me.

Nick wrist-tagged at Space Station Dominic

Now it was early Tuesday morning, in a dimly lit room somewhere in the bowels of Dominican hospital. Except for my birth and a few outpatient experiences, I have never spent time as a patient inside a hospital so I decided to open my sensors and pay attention.

The first thing I noticed was that no one wore uniforms. The doctors, nurses and nurse's aides wore clothes that ranged from somewhat glamorous, to causal, to individualized, veri-colored, fashion-trimmed variations on traditional nurse's uniforms. The only white lab coats I saw at Dominican were worn by the men and women in the pharmacies.

Everyone seemed to be wearing clothes of their choice. But the official people were separated from the patients by the cluster of security cards they wore pinned to their bodies. These costumes reminded me of my times in physics labs like Los Alamos where the staff wore whatever they pleased but everyone without exception wore some sort of photo ID. I felt right at home (at the St. Dominic's Linear Accelerator Center). The only difference was that at St Dominic's, there were more women with badges than at Los Alamos.

Because of my symptoms and blood results, the docs had scheduled me for a Spiral CAT scan of my lungs. But that required a lot of waiting in the basement of the "accelerator center." Now it was long after midnight, and the "night people" began to emerge from their warrens. A nurse wearing a tight black gown, flashy jewelry and a surgical mask stopped by to chat with us waiters. My vitals were taken again as well as some blood samples.

More nurses in different outfits (one an intern, working for zero$$ on a 12-hour shift) arrived and prepared me for the CAT scan. This involved fitting my right arm with an IV shunt through which various liquids could be conveniently inserted into Nick's circulatory system.

We waited some more. Finally (around 3AM) I was loaded onto a gurney, shot up thru my IV shunt with an X-ray contrast liquid (probably sodium iodide) and wheeled into the CAT scan room.

Which looked like something out of Star Trek--a white doughnut-shaped ring (made by Siemens) into which my body was transported on a motor-driven bed. The entire scan took only a few minutes.

The results came just as fast but I was returned to the dim-lit waiting room to await a doctor who was qualified to interpret the scan. When Doctor "Matthew" finally arrived, Reno and I asked to see the pictures. They showed up on a gigantic screen but were indeed as incomprehensible to a layman as the pictures from a particle accelerator.

My stay at Dominican taught me the meaning of two new medical terms--"thrombosis" and "embolism". "Thrombosis" means the formation of a blood clot. And "embolism" means "blockage",
from the Greek word for "insertion". Nick's Spiral CAT scan showed that he had a blood clot (thrombus) in his lungs--a condition known as PE (pulmonary embolism).

But not just one clot. Dr Matthew used the word "bilateral" which means I had at least one clot in each lung. When we looked at the scan, Dr Matthew pointed out some of the embolisms on that cross-section, then shifted to another cross-section and pointed out other embolisms. "What about this?" I asked, pointing to a gray part of the picture. "O yes, that's an embolism too." Reno used the term "shotgun" to describe his layman's impression of the condition of my lungs.

On the basis of this CAT scan image, Dr Matthew admitted me to Dominican Hospital for further observation. And Reno left to catch a few hours sleep before he had to to get up and take his son to school.

Map of human circulatory system

After Reno left,  I waited for awhile until I was assigned a room (1222) in a part of the hospital called "the Overflow". I was wheeled to my room but by now it was dawn and the hospital was going into day shift.

Nick's diagnosis was Pulmonary Embolism (PE). Somewhere in my body, blood clots (thombi) had formed, and were carried to my lungs (see "pulmonary arteries" above) where they were forming blockages (embolisms) to my normal breathing. Barring drastic measures, these embolisms could not be removed. However my body's normal processes, over a time scale of several months, would remove them naturally.

The obvious next step was to determine the source (or sources) of the blood clots. The usual suspects are wounds to the lower legs.

Before I had had a chance to sleep, I was probed by a new series of Star-Trek-like machines. Wheeled into a room where an enthusiastic redhead named "Melody", applied a combination of ultrasound and deep Esalen massage to my bare legs. She would locate a vein on her imaging device, then press down till that image disappeared. If the vein's image failed to disappear no matter how hard she pushed, then the probable cause was the presence of a blood clot inside the vein. The best part was that I could watch all this on the screen while it was happening. Melody conscientiously probed both my legs with her sonic massage tool but found only one blood clot--inside my left knee. She and her machine found no probable cause for my bilateral pulmonary embolisms.

Back in Room 1222, I was given "blood thinners" both oral (xarelto?) and via shots in my stomach (lovenox?) to prevent the further formation of clots. Six electrodes were placed on my chest and hooked via an electrode harness to a heart-lung monitor over my bed which was in turn linked to the nurse's station in Overflow. Suffering from lack of sleep, isolated in an unfamiliar, high-tech couch, hooked to an electro-sensing machine, I felt (except for the high gravity and good air) that I was floating inside Space Station Dominic high above the Earth.

After breakfast (pancakes and bacon), a nice dark-haired lady arrived with an echo-cardiogram machine. With this device we both could see into my living heart (!!!). From many angles. I was fascinated. On the screen of nice lady's echo machine, my heart looked less like the pictures in an anatomy book, and more like the cross-section of some intricate marine creature pulsing with the rhythm of the sea. Via this method of imaging, my heart did not appear tough and robust, but delicate and vulnerable, able to be swept away at any moment into the depths.

After viewing my heart from many directions, both in black-and-white and color (Doppler-imaging), the echo tech informed me that she found no serious abnormalities. Most notably she saw no blood clots inside the little sea creature that moves Nick's blood.

I spent the rest of the day (Tuesday) having blood drawn and vital signs taken, being interviewed by a doctor from India and finally getting my first night's sleep in two days.

After breakfast (omelet) and more tests of blood and vitals, I was visited by a nurse's aide around noon who tested my vital signs while we briskly walked the hospital's halls. This test suggested that despite my embolisms I could function normally without stressing my system. Later that day I was given a prescription for a blood thinner (xarelto by Bayer) and discharged around 6 PM.

Although I was happy to exit Space Station Dominic, I was pleased with the careful attention of the staff and their cheerful and friendly attitude under stressful conditions. In my haste to get back home as soon as possible I neglected to obtain a copy of my CAT scan. Instead I am posting an image from a website that publishes nothing but pictures of cats cavorting on flat-bed scanners.

From "thecatscan.tumblr.com"