Aneurysm Schmaneurysm

I intended to write a quick blurb last night about one of my peculiar traits. Note that I quantified that as “one of” them. As I was drifting off to sleep, I had a brain bolt regarding my irreverence. However, I was not inclined, nor was I able, to leap nimbly out of bed, rush to the Broad Cave and record my revelations.

The gist of the blog-to-be was this: I am an irreverent person. I often think that people don’t appreciate my brand of humor as much as they should. This can be mildly annoying. My approach to life frequently requires a certain offbeat viewpoint. I can either try to find the humor in situations that would terrify the rational human or I can wrap my bad self even further around the axle of angst and hasten my demise. I choose humor. Although when I voice it, it is neither always appreciated nor even recognized. I have come to accept that the lack of recognition is not my problem. Please note that I don’t mean to offend with my flagrant irreverence. When I want to be snarky, I’ll do so deliberately…and you’ll know it.

There have been numerous occasions in the past four months where my ability to see humor in very dark situations has been evident. Take, for example, the life-threatening motorcycle accident in November 2015. More on that later. Suffice it to say that the EMTs and other medical personnel who helped me from the moment they encountered my prone body in the middle of a remote road, to the ER staffed by the Keystone medics, to the crew on the helicopter flight, and on to the trauma center staff…they all received a double-barrel dose of “Full Mari.” While I was being wheeled to pre-op, twelve hours after the accident happened, my sense of humor abruptly stopped. Dead in its tracks. I even told Hunky Hubby to stop joking because I could no longer endure it. The fact that I was a stubborn moron who refused narcotics probably caused the sudden humorectomy.

Guess what? I digress. Quelle surprise! This is not about the accident nor the injuries suffered during that mishap. I’ll meander back to that subject at a later date. This is about something that was detected in the Keystone ER (Keystone, as in Keystone Cops, not a real location). The backwoods ER to which I was transported was less-than-confidence-inspiring. They did, however, manage finally to complete a full body CT scan. Which, naturally, they could not interpret. They had to send the images to somewhere in Maryland. Really? There isn’t a facility in the entire state of West Virginia with the technology and expertise to read CTs and X-rays? That, my friends, is a rhetorical question, to which you know the answer.

When they finally cleared me off the back-board, they completed the CT scan. Then, I was shuffled back to the ER to wait for something. A decision. Godot. I’m not sure what. At this point, they were still discussing where they would drive me. I just wanted them to pick an acceptable location and get me the hell out of there. It should be no surprise that I vigorously declined being transported anywhere other than to a Virginia facility. I think I even told them the clock was a-ticking and I wasn’t healing spontaneously on my own. Finally, the doctor raced back in and paid the attention to me that I believed (as the only occupant of the freaking ER) was my due. “How long have you had an abdominal aortic aneurysm?,” he inquired. After HH pried me off the ceiling and we determined that I was having a panic, not heart, attack, I replied that, to the best of my knowledge, I didn’t have one of those things. Nor did I want one.

The radiologist in Maryland did a thorough job in reading the images sent to him. Yes, it was a him; I saw the bill. At the time, I was aghast at how much it cost for some dude in another state to look at a few images. He must have been having a slow day; how else could he devote time to pore over my scans? Whether or not I wanted an aneurysm, I was the proud owner of one. As you can probably surmise, I was not amused. The conversation went thusly:

Dingbat ER Doc (DERD) – “Yes, aneurysm. How long have you had it?” [Isn’t this like asking when you stopped beating your dog?]

Worried Mari (WM) – “How the hell should I know. I don’t even know what that means. What does that mean?”

DERD – “The radiologist detected an abdominal aortic aneurysm (Triple-A). I really don’t know what that means, or even if you sustained it during your accident.” [THAT was helpful, so I shared my opinion with him.]

WM – “Well, you know Doctor, that’s not entirely comforting. I really don’t want the Triple-A, so can we just send it back?”

I said that last bit to the retreating back of the doctor, as he rushed out of the ER. He returned. Much to my chagrin.

DERD – “I have further news from the radiologist. Apparently this is a pre-existing condition, so we can focus on your injuries.”

WM – “How the hell does he know it’s pre-existing? Is it like a tree with age rings? Holy crap, you’re not making me feel better. But, certainly, great idea, focus the hell on my current injuries. When do I get to leave?”

At this point, DERD whipped out an ultrasound device. I informed him that I wasn’t pregnant. He did not laugh. He waved it over my left foot and rushed out of the room again. I remarked to HH that I had that effect on men until he arrived in my life. Someone came in and offered me morphine. I declined. He insisted. I told him he’d need to give me Benadryl and anti-nausea meds, or I’d go all Linda Blair in “The Exorcist” on him. Morphine, at that point, didn’t work. I guess I should give him props for trying. I think it was a diversionary tactic.

DERD raced back in, and said that he had just called for a helicopter.  He couldn’t find the pulse in my foot. Driving me anywhere was off the table. Great. Six hours after I splatted onto the pavement, they decided to airlift me. I was told that the Triple-A was small and not immediately life-threatening, and off I went to the Winchester, VA Trauma Center. As if that nitwit would know what small or life-threatening really meant. In retrospect, he was correct. I’m still here. Happy coincidence, not proof of medical acumen.

Fast forward four months. I’m finally mobile enough that I thought I should probably deal with this Triple-A thingy. I did convince my foot surgeon to prescribe valium for those nights I woke up in a cold sweat, feeling my heart beat through my chest, wondering if this was the night the aneurysm would burst. I thought about wearing full makeup, with jewelry and a tiara, to bed so that I would be presentable should I croak during the night. I decided that was too much work. I screwed up my courage instead and made an appointment with a vascular surgeon. The Winchester Trauma Team told me that the aneurysm was small enough that I could tend to it after I got my other injuries under control, as long as I kept my blood pressure low (you try doing that with a ticking time bomb in, you think, your abdomen).

Today was the day. I met with the vascular surgeon. What a great guy, in addition to routinely being named one of the Top Docs in Northern VA. As opposed to one of the white-coated quacks in WV.

Dr. F, the surgeon, listened to my explanation and relieved me of the CD containing all the CT scans and X-Rays. Thankfully, I had procured a CD from the ER. He took it to another room, then popped his head back in for clarification:

Great Vascular Surgeon (GVS) – “What did they tell you about the aneurysm? Where did they say it was?”

Irreverent Mari (IM) – “They said it was small and in my abdomen.”

GVS – “What do they mean by small?”

IM – “Beats the hell out of me. I guess it’s not at the “you’re dead now” size.”

GVS – [huge eye roll] “You’ve characterized it as “you’re not dead now” in size? That’s a novel interpretation.”

IM – “As of now, it’s a correct interpretation.”

Dr. F left again to peer at the images, then came back to the exam room.

GVS – “The aneurysm isn’t in your abdomen.” [I had a fleeting moment of hope where I imagined that it wasn’t anywhere in my zip code]. “It’s in your chest. It is what we call an Ascending Aortic Aneurysm.”

IM – “HOLY SHIT.” [Direct quote. No kidding. Exclaimed loudly and with purpose, in fact]. “That sounds decidedly not good.”

After Dr. F looked sideways at me, and after I apologized for my sailor mouth, he offered to let me look at the images. There it was, not clear as day to me, but clear as a bell to him. And crystal clear to the wonderful radiologist in Maryland who spent enough time on a Sunday afternoon in November to give my scans more than a cursory glance. I don’t think he was a football fan, otherwise he’d not have looked so carefully. I think he should have charged the insurance company more, though at the time I saw the bill, I thought it was highway robbery. Funny how one’s perspective can change. Oh, and he provided a written report. I didn’t see it until today, as it was included on the CD. I presume, though, that the WV ER staff saw it. On the report was written clearly: “ascending aortic aneurysm,” along with a lot of other pertinent medical  jibber-jabber.

I may have to name the aneurysm-that-isn’t-a-Triple-A. Although, it too has three As, the notorious AAA is in the abdomen. Apparently, the ascending variety can be a little bigger than the abdominal one without causing medical personnel to go to General Quarters. I have an appointment for another CT scan in May, so Dr. F can see if there is any change. We’ll take it from there. I’m not in a Monty Python movie – no need to walk around me exclaiming “Bring out your dead.” I am, emphatically, not dead yet.

The not so good news is that, should surgery be required, Dr. F won’t be able to do it. He knows some excellent surgeons who specialize in this. But, we’re not there yet. This is me being serious, not irreverent. The other news is that there are three hospitals in a 100-mile radius that have the facilities to handle surgeries of this nature. I deduce, therefore, that it isn’t out-patient surgery. I fearfully deduce that, should surgery become necessary (and it will not), they’ll have to crack me open like a walnut to place the stent / mesh / replacement-aorta-thingy at the top of my heart. It would be so much less complicated if I had aortic loops, as does a worm. Actually, I’ve claimed that for years. Turns out I was lying.

Dr. F also told me to get a Primary Care Physician. No, I don’t have one right now. I’ve been preoccupied with other things. So, I did that. I see her next week. Since low blood pressure is the best way to ensure that aneurysms don’t do bad things, I need to ensure mine is under control. Dr. F asked if I had high blood pressure. I told him I didn’t, until now. He snickered. Really. He asked if I smoke. I told him I quit over 20 years ago. He told me that, in my case, smoking likely wasn’t the cause, but, then, who knows. [Smokers: STOP NOW while you’re ahead. One of the leading causes of aneurysms (abdominal or otherwise) is smoking.] I may very well have had this thingy since birth. I likely would never have known, were it not for my accident in November. This proves HH’s assertion that I am just a defective human whose warranty has expired. Thankfully, he does not want to trade me in for a younger model, if only because a younger model would be too difficult to train. Yes, I let him think I’m trained. We all really know that I’m untrainable.

So…aneurysm, schmaneurysm. I’ve got one, yet I don’t want one. I probably can’t sell it on Craig’s List. Therefore, I’ll just deal with it. I’m confident that the annoying thingy will just remain its current size and not bother me in the slightest. Since I’ll be monitoring it very closely, with the help of Dr. F and other competent medical professionals, I’ll know if it becomes problematic. For now, I’ll come up with some appropriate name, make inappropriate jokes about it (and everything else) and use it as an excuse when HH wants me to mow the lawn.

Once again, the adage “getting old is not for sissies” comes to mind. Turns out I’m no longer ten feet tall and bulletproof. Confronting one’s own mortality is unnerving. Pass the wine. I’m off valium!

23 March 2016

1 thought on “Aneurysm Schmaneurysm”

  • Dear Mari
    Thank God you are ok.
    My email is joycesteingass13@gmail.com.
    Sorry I have been out of touch.
    Not trying to compete, but a family member just got cleared to return home after brain surgery. We laughed on the way to the operating room with inappropriate jokes. “Your surgeon is excellent”. Imagine the retort to that comment….
    Sending you prayers and positive energy that your sense of humor remains intact while communicating with medical folks!

    Love
    Joyce

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