When the Water Crisis Is Very Personal
Oct. 15th, 2022 07:20 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
elfsWhen I was hospitalized and declared NPO (nil per os, “nothing by mouth”), they hooked me up to a feeding machine that supplied 1500kCals of low-residue pap.
Early Thursday morning, they switched me from intravenous hydration to hydration through the feeding tube, which delivers nutrition past the constriction in my upper intestine, and I could already tell it wasn’t enough. I complained about it. I told them about it. The nurses were sympathetic, and they said, “We’ll talk to the dietician, but this is the amount of water a 56 year old man of your weight and profile should be getting.”
On Tuesday, I was able to walk four laps around the floor. On Wednesday, the same. On Thursday, Omaha was escorting me around the floor for my laps, and I made it halfway around the floor before I collapsed to the ground, exhausted. I knew these symptoms. I was dehydrated. I told them.
The dietician came and assured me I was getting enough. “No, I’m not. I am not a couch potato. I am an amateur athlete with a strong hydration game. I need more water.” My blood pressure was dropping fast and my heart rate was sky high. I demanded a lab draw for dehydration and hypovolemia. She consented.
“Oh, she also ordered 1500ccs of water, double rate, immediately,” like it was the most casual thing in the world to admit that they had pushed me into hypovolemia by a liter and a half.
About two hours later, the nurse comes in and casually says, “So, the dietician says we need to double the amount of water we’re giving you.” And she plays with the feeding machine to set it. Then she starts futzing with my intravenous line. I ask her what that’s for. “Oh, she also ordered 1500ccs of water, double rate, immediately,” like it was the most casual thing in the world to admit that they had pushed me into hypovolemia (not enough fluid in my body) by a liter and a half.
One thing I later learned was that my condition had not been correctly explained to the dietician. She understood that I had an intestinal blockage, but it had not been clearly explained in my chart that meant I had bile reflux disease, and that the stomach pump was removing one to two liters of digestive fluid that had nowhere else to go. Her water recommendation had not accounted for that artificial removal.
The intravenous water was chilly. When you go to sleep, your body’s core temperature drops to preserve metabolic resources during the cool hours of the night, and apparently deliberately lowering your core temperature signals your body that you’re sleepy. I fell asleep quickly and napped for three hours.
When I came to, I was feeling much better. I finally had enough water in me. I was partially human again. My blood pressure immediately returned to a very normal 120/80 and my waking heart rate dropped below 100 for the first time in three days. As one of my mutuals on Twitter put it, “Doctor, you’re a valuable and appreciated consultant, but as the sole occupant of this particular body for the last 50+ years, I happen to have a little bit of accumulated expertise on it myself. Heed me.” Indeed.
Now I look forward to being well-watered every two hours. I feel a little queasy when it’s done– it’s a lot of water in a short period of time– but it lets me stay conscious, and today I was able to complete one lap around the floor twice in the same day.
Now, to be fair, they had a valid concern. Most men my age would develop swelling and edema in their calves, because their calves are weak and underpowered, with that much water in them. But my calves are built out of years of hiking and bicycling, and I will start developing that risk if I don’t get out of here soon and get back on the bike and the calf lifts and all that. But grief, it shouldn’t have taking friggin’ begging and a dramatic collapse in the hallway to convince them the problem was real.
Early Thursday morning, they switched me from intravenous hydration to hydration through the feeding tube, which delivers nutrition past the constriction in my upper intestine, and I could already tell it wasn’t enough. I complained about it. I told them about it. The nurses were sympathetic, and they said, “We’ll talk to the dietician, but this is the amount of water a 56 year old man of your weight and profile should be getting.”
On Tuesday, I was able to walk four laps around the floor. On Wednesday, the same. On Thursday, Omaha was escorting me around the floor for my laps, and I made it halfway around the floor before I collapsed to the ground, exhausted. I knew these symptoms. I was dehydrated. I told them.
The dietician came and assured me I was getting enough. “No, I’m not. I am not a couch potato. I am an amateur athlete with a strong hydration game. I need more water.” My blood pressure was dropping fast and my heart rate was sky high. I demanded a lab draw for dehydration and hypovolemia. She consented.
“Oh, she also ordered 1500ccs of water, double rate, immediately,” like it was the most casual thing in the world to admit that they had pushed me into hypovolemia by a liter and a half.
About two hours later, the nurse comes in and casually says, “So, the dietician says we need to double the amount of water we’re giving you.” And she plays with the feeding machine to set it. Then she starts futzing with my intravenous line. I ask her what that’s for. “Oh, she also ordered 1500ccs of water, double rate, immediately,” like it was the most casual thing in the world to admit that they had pushed me into hypovolemia (not enough fluid in my body) by a liter and a half.
One thing I later learned was that my condition had not been correctly explained to the dietician. She understood that I had an intestinal blockage, but it had not been clearly explained in my chart that meant I had bile reflux disease, and that the stomach pump was removing one to two liters of digestive fluid that had nowhere else to go. Her water recommendation had not accounted for that artificial removal.
The intravenous water was chilly. When you go to sleep, your body’s core temperature drops to preserve metabolic resources during the cool hours of the night, and apparently deliberately lowering your core temperature signals your body that you’re sleepy. I fell asleep quickly and napped for three hours.
When I came to, I was feeling much better. I finally had enough water in me. I was partially human again. My blood pressure immediately returned to a very normal 120/80 and my waking heart rate dropped below 100 for the first time in three days. As one of my mutuals on Twitter put it, “Doctor, you’re a valuable and appreciated consultant, but as the sole occupant of this particular body for the last 50+ years, I happen to have a little bit of accumulated expertise on it myself. Heed me.” Indeed.
Now I look forward to being well-watered every two hours. I feel a little queasy when it’s done– it’s a lot of water in a short period of time– but it lets me stay conscious, and today I was able to complete one lap around the floor twice in the same day.
Now, to be fair, they had a valid concern. Most men my age would develop swelling and edema in their calves, because their calves are weak and underpowered, with that much water in them. But my calves are built out of years of hiking and bicycling, and I will start developing that risk if I don’t get out of here soon and get back on the bike and the calf lifts and all that. But grief, it shouldn’t have taking friggin’ begging and a dramatic collapse in the hallway to convince them the problem was real.
