Archive for January 29th, 2020

THE FOUR PART DAY, COURTESY OF MIDAZOLAM.

January 29, 2020

It was really all my fault: it was I who suggested to my cardiologist about a year ago that maybe I should be screened for abdominal aortic aneurysm.  I didn’t think I had one, but I’m old, male, and have a waist size that is borderline large for my height.  I don’t think the cardiologist agreed that I had any risk factors, but he scheduled me for a CT Angiogram in a year. He was in no hurry.  He  first wanted to get a CT of my heart, looking for calcium in the vessels, 

That exam showed almost no calcium, good news, but a small hiatal hernia, a fairly common finding, but which I could have done without.  A year passed, I had the angiogram, and the aorta was normal.  That was the good news.  The bad news was that I had diffuse esophageal thickening, which is always abnormal, and which required evaluation. The likely possibility was reflux esophagitis;  maybe I had Barrett’s esophagus, where the lower esophageal lining changes and appears more like the stomach’s, Esophageal carcinoma was a fortunately more remote possibility.  

I initially didn’t think I had significant reflux, but three years earlier, I had a nagging cough that went away dramatically when I started an H2-blocker for acid reflux, again confirming what we know about one cause of chronic cough: reflux.  And when I started thinking about it, I did have some symptoms of reflux, especially if I did some bending over activity when working trail.  I had such reflux up the Aufderheide last August in the Waldo Lake Wilderness that I upchucked, fortunately with nobody else on the crew’s noticing.  Barfing on the crosscut saw would have upset everybody.  Anyway, It’s like my body is trying to tell me that my heart Is doing OK, deal with my esophagus.  

So that is how I found myself one dark morning in the GI lab, about to get an upper endoscopy (EGD), at least with half my clothes still on me, including my shoes.  I was hoping I would only have to ditch the shirt for the study. Given what was going to happen later, I could have walked out of the hospital nude and not been aware of it.

The nurse told me what medicines I would be given, and I heard something I wasn’t sure I heard right, and I didn’t really want to hear it, but I asked her to repeat what she said.

“Versed.”

“Oh,” I replied. “I did have that in 2001 for a colonoscopy, and afterwards, the nurse asked me how I felt, and I said fine, so they let me leave the lab.  Unfortunately, they didn’t ask me if I knew where I was, because the next thing I knew, I was wandering around the hospital parking lot, fortunate enough that my wife, in the car, found me before someone ran me over.” I had no recollection of walking out of the GI Lab, leaving the hospital, and ending up in the parking lot. The hospital later heard about my experience and promptly changed the system to require all patients to leave in a wheelchair, accompanied by a staff member.  The next two colonoscopies I had were done with Propofol, and I did just fine. I actually woke up in the GI lab, rather than leaving the hospital without a clue as to what county I was in. Such a relief.

Just sayin’ be careful with that stuff with me, and don’t believe much I say when I come out of it.  The nurse laughed.  I was serious.

The last thing I remember before the procedure was telling the Indian-born doctor that I really liked the birding at Bhartapur in India, when I was there in 1995.  Incredible place.  Saw 30 species that day.

The next thing I vaguely remember was trying to read the report and understand the pictures from my study, but as I tried to turn the pages, I couldn’t do it. The feeling was like one has in a dream where simple things just can’t be done, and words don’t quite make sense.  The next thing I remember in this induced dream/reality was making my breakfast at home, hearing my wife saying that the bag of blueberries I had picked and frozen last summer had a hole in it. I then remember eating, reading the paper online, and doing some writing.  I even read my report.  I looked at the clock and was surprised it was 1050. The last time I had seen was 0800. Nothing else surprising happened for the next hour, when I had lunch and then let the heater service man in the house to take care of the annual servicing. The gap in my morning was still a gap, and I still wasn’t aware of it.

That afternoon, 5 hours after I got Versed, I took a walk.  I felt fine, but only then did I realize I hadn’t a clue what happened earlier that day.  There were four parts to this particular day, and so far, I had only been aware of two: right now, and before I had the procedure and acting normal at home.  The third part was being at home, eating two meals, and having lunch, but not being aware I had had a deficit. That deficit itself was part four, when I was able to remember anything.  I did not remember the doctor’s talking to me after the procedure, my getting dressed, walking out of the hospital, to the car, riding home, getting out of the car, and going inside.  None of it.  

I walked for nearly an hour, came home, to where my wife had some concern that my note “Took a walk” didn’t include the needed comment, “I really know who I am now.”

This loss of memory is known with Midazolam (Versed), and a friend of mine had a similar problem after a colonoscopy, although hers was more like Transient Global Amnesia, a disorder of unknown cause, that typically lasts about 12 hours, or Global Amnestic Syndrome, which typically follows a significant head injury.  The way I would test for these two disorders was to tell the patient my name, then leave the room, and come back in a minute later (or even after 30 seconds) and ask if they knew me.  With the above conditions, they would not know me.  

Once again, we are fortunate in our house to have medical knowledge. I don’t know what an older couple would do if they suddenly heard their partner ask over and over again where they were.  My wife knew that I would eventually return to the world of memory, but she didn’t know exactly when. 

I didn’t turn in my smiley evaluation to the GI lab, because I when I left the lab, didn’t know who I was, let alone where the box was to turn in the evaluation. I felt like the man in Blazing Saddles, who woke up in jail, so maybe I need an “in jail” smiley. My review will be the one of my favorite lines in response to the black sheriff’s asking, “Are we awake?”

“We are not sure. Are we black?”

“Yes, we are.”

“Then we are awake.  But we are very puzzled.”