#infarction

O lado amargo dos ADOÇANTES ARTIFICIAIS – Dr Lair Ribeiro

http://bit.ly/2EHrSSD O lado amargo dos ADOÇANTES ARTIFICIAIS – Dr. Lair Ribeiro

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O lado amargo dos ADOÇANTES ARTIFICIAIS – Dr. Lair Ribeiro

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Yes, she violated House’s bodily autonomy.

At the same time, it was pretty clear House was going to die if she didn’t.

Whatever your opinion on her choice, this is one of the fascinating moral points of the show. Although she couldn’t have known the full fallout of her decision, she made a choice that she knew he would see as betrayal. She did this a fully rational actor who decided she was okay with him hating her as long as he lived through it. It was an intense time, and maybe if she’d tried to talk him through it, he’d have found a way to pursue his own harsh ideas regardless. Maybe he’d have died while they were still discussing.

She saved his life. She violated his consent.

Was it right? If you say no, then you’re arguing that people have no right to intervene with suicidality - and in this case, suicidality mixed up in internalized ableism (I would rather die than be disabled). If you say yes, then you’re advocating for violations of consent (it’s okay not to talk to someone, not to try to make them see, not to at least inform them that you recognize they’re in no state to make their own decisions).

One amazing part of House is how often the show explores areas of grey morality, and I think this is a prime example. If it makes you feel a little icky to consider all the different angles of it - and by contrast, of the implied unrelated circumstances? I think that happens sometimes when things aren’t bright and clear.

If she had talked him through it, then we don’t have a conversation about right and wrong anymore. We don’t have to grapple with it as an audience.

World Health Organization (WHO): Cardiovascular disease EURO. (2024). Accessed October 2024 Timmis, A., Vardas, P., Townsend, N., Torbica, A., Katus, H., De Smedt, D., et al.: European Society of Cardiology: Cardiovascular Disease Statistics 2021. Eur. mind. J. (2022). https://doi.org/10.1093/eurheartj/ehab892 Tiemann, O.: Changes in hospitalization costs for acute myocardial infarction – a…

I have always suffered from what I thought was a sensitive stomach and digestive tract. My sensitivity got to be so much to where I was only eating bland foods and fish as my main source of protein. That all changed on day I had a horrible pain at home. The pain was so bad I started to recognize that I was going into shock. I was cold to the touch, sweating, began to get tunnel vision, auditory exclusion, and felt myself struggling to stay conscience. All I could do is moan in pain while doubled over. Jen called 911 for an ambulance who arrived in less than 3 minutes if I had to guess.

The EMT's assessed my vitals, placed me on a gurney, rushed into the ambulance I was on my way to the ER. Some may ask "Why are you taking photos?!” Well, when you're in that much pain you tend to do anything to divert your mind from the pain. On the way, I remember being given 3 “units” of pain relief before we landed at the ER door steps. The EMT's were surprised at how much it took. The EMT's handed me off to the doctor and ER staff on duty who immediately ordered medical imagery.

I specifically remember the doctor questioning and kind of reprimanding the EMT's for their liberal dosing of what turned out to be Fentanyl. After my imagery came back, It turned out I had a bowel obstruction that perforated. The ER team decided I needed emergency surgery.

When the surgical team got in to see what was going on, they decided to perform a total colectomy. They removed most of the large and all of my of the small intestines. They were riddled with severe diverticulitis. This is when your intestines develop weak portions that formed sacs. As the attending physician put it “looked like 10lbs of chewed bubble gum!” I was given an ileostomy which is where they connect your stomach to a hole on the side of your belly where a bag is fitted and collects your waste. After they briefed my wife and I signed off, the procedure was performed.

During the procedure I suffered a heart attack and had to be revived on the table. After I was revived, I was rushed to the Cardiac ICU for emergency heart surgery. A stent was placed and I recovered in CICU for about a week before being downgraded to a regular ICU bed. I spent another few weeks there where I had a number of difficulties such as pain management, ostomy fittings and a fistula that developed in my abdomen as a result of my emergency surgery. My incision was from my pubic bone up to my sternum. For those curious, I DO have photos of the incision. I know a lot of people in the medical field and if they wish to see them, I'd be happy to show. I won't post here because they're *very graphic*.

I had a very difficult time with IV's and blood draws. My veins were very hard to find and when they did find them, they blew out. I ended up getting "Midline" (IV in arm/shoulder) , "Central line" (IV in check/nest) , and eventually PICC line (for me, side of bicep) catheters.

Even with the "Best stick" in the hospital, Infared Vein finder and even a NIC-U (baby doc) nurse came to try. All failed. I eventually had to have them inserted via Sonogram via a specialist that had to be called in.

Once stabilized, I was in recovery for a long time (3-4 weeks) due to the nature of the procedure and difficulties. With lots of help from a team of doctors (neurologist, nutritionist, surgeons, nephrologist, hematologist, infectious disease, cardiologist, pulmonologist etc.). A recovery plan was developed and executed.

There was A LOT Of pain involved. I was on a "nocro+dilaudid+Morphine" rotation. Norco was great, but with any pill, it took a while to take effect. The Dilauded was amazing because it was I.V. and instant, but it only lasted bout 15-20 mins. I tried to stay away from morphine because it constipates you and is very addictive.

While in recovery I suffered a pulmonary embolism while getting a "Washout procedure". Since I had been bed-bound for so long, I developed a clot in my leg that traveled to my lung. Once that was treated and taken care of, I remained in ICU for a bit before being downgraded to a regular hospital bed until an LTAC (Long Term Acute Care) facility was found and admitted me.

While in the LTAC unit, one of the things I'll never forget is one of the surgeons came by (Dr. Mark Cheek) and had a crowd of students/residents/fellows, whatever doctors in training are called). He decided he would be the one to demonstrate a dressing change on my surgical site. With NO WARNING, NO ADHESIVE REMOVER, he literally peeled off the surgical tape, gauze and dressing all in one fell swoop. I let out one of the loudest screams I'd ever uttered, immediately began to tear up and try and keep myself from passing out from the pain. Even with the Dilauded drip I had, the pain was so sharp and so deep, I had never felt a pain before or since.

He quickly patched things up, offered a half-ass apology and scurried out the room. I immediately asked for the hospitalist/duty nurse and filed a complaint. I asked that he not perform anything on me other than observations and non invasive tests.

I had a couple of drains placed that would extract fluids and help keep my wounds healthy and happy. I was supposed to have a "wound vac" placed, but in the process, the nurse team was not able to put it on due to my sever pain so other methods were employed.

One of the other things that was tough to deal with was not being able to eat or drink. I was "NPO" which means "Nothing By Mouth" for 8 weeks straight. All of my nutrition came in the form of an IV bag. This was probably the second most difficult thing to overcome and deal with. All I could have were sips of water and ice-chips. I went in at 260lbs and came out at 190lbs.

Regardless, my wounds were recovering so quickly, it was to the point to where the surgeons came by to check in with me and they would comment about how they were very surprised at the rate of recovery. I was up and around, lucid and while in pain, it was managed.

My only REAL setback was that once I was well enough to get out of bed for short walks, I wanted to brush my teeth and hair. The nurses helped me to the sink and in the process I felt something wet on my belly and I looked down to find a nice pool of blood on the floor. I got really dizzy and the next thing I knew, I was in bed. I had passed out but the nurses caught me.

I HAVE to shout-out he head nurse Vernoica. She took a liking to me. What can I say, I'm a jokester and always try to make light of the worst things. She appreciated that.

She ended up transferring me to an amazing room with a view. I believe it was for ladies that give birth. It was HUGE, had plenty of space for people to stay and visit. There was a couch and 2 recliners in addition to the bed. The room had it's own fancy sink and mirror/vanity and the bathroom had interesting tile. Best of all, it was private and of much better quality than the other rooms I was in. I've never seen a room with a bath room that had hardware like this "Moen". It was nice!

Catheters are no joke. Here is some "forbidden Hawaiian Punch" I had. I couldn't believe some of the stuff that the body produces and can do without. I was literally urinating a lot of blood until things began to heal more.

I had A LOT of trouble with finding a suitable solution for my ostomy. Bags kept leaking and as a result, I developed a HORRIBLE case of "Diaper Dermatitis" which is basically a RAGING case of diaper rash. The fluid (which consisted of stomach acid) would irritate ANYTHING it touched in the matter of just an hour or two. Since I was "Nothing By Mouth", all I had was liquid, no solids.

My skin was red, raw and "weepy" secreting plasma-like fluid. It was like a large scrape that had the scab removed). I wasn't able to get an ostomy bag to stick since the skin was not dry. We had to wait for it to heal a bit before trying again. That was some of the roughest sleep I ever had over the course of those few days.

Veronica (one of the head nurses @ the LTAC I was in) took the time to help me find a solution and offered lots of tips to help with the ostomy. Pictured above was an ostomy bag with some "ostomy sealant" to help prevent leaks. The other photo is the bag attached and a glove with very warm water to help the adhesives bond to the skin better.

I'll be forever grateful for everything, Veronica did. She spent a lot of time and attention with me. I'll never forget her. Through her care and recovery tweaks, I recovered much quicker than I could have without her. found my correct ostomy equipment fit and wound care was finally making real progress. Before leaving the facility she made sure I had ANY and ALL supplies needed to get through until I was able to order my own. Bags, gloves, adhesives, tapes, covers, gauze, lotions, washes, EVERYTHING!!

Needless to say, once I was well enough, Jennifer and I bought her a case of cookies for her floor/area and some flowers for her as a small gesture of gratitude

Here's my "bug-out-bag" I made. I always kept it with me when out of the house. Leaks and emergency bag-changes can happen at any time. The last thing you want to do is be caught without one. I packed it with everything I need to complete a bag change "in the field". Flange, Bag, medical grade no-water soap, adhesive remover, tattoo tape (to seal the flange in case a leak occurs, it would contain it), medical shears, a small portable fan to dry off, alcohol swabs and a towel.

Once I was back home, I began to research and call ostomy supply companies. Most took my information and sent "sample packages" with various bags, seals, flanges, adhesives, etc.

I ended up going with Convatec. They sent me the hangable bag pictured above. It had lots of pockets, pouches and and a hook where you can hang it from a coat hook in the bathroom stalls.

Here's my "rolling battle station" of stuff for the house. This holds all my equipment and could be easily wheeled from room to room. Gauze, gloves, tapes, marathon skin protectant, moisturizing cream, absorbing powder, deodorizing drops, waterproofing film for when I shower (covers ostomy site in a waterproof film), and tons of other stuff.

I had to wear this silly hat for protection since I passed out in the LTAC. In the event I fell again, the doctors (and Jen) wanted to be sure I wouldn't hurt my head/brain.

I was finally well enough not to have to wear it and I was able to cut my hair and get a beard trim (pictured on the right) Boy that felt good. That little "bib" I'm wearing held a heart monitor device since I am/was a "high risk cardiac patient".

It is amazing what a bit of personal grooming can do to your spirits after being laid up for so long. I literally felt like a hobo festtering in a den of sickness and uncleanliness.

Brushing your teeth, combing your hair, just being able to get up and do things on your own are all things a lot of us take for granted until you're not able to do them on your own.

Just before being released, they put me in physical rehab to develop whatever muscle I lost due to my 9 week bed-stay. Atrophy is a real thing!

Additionally, they wanted to be sure my heart could handle physical activity. This was in the rehab room on the "bike" machine.

I quickly progressed which allowed me to get up and around more often. Before I knew it, the staff at the nursing station would cheer me on and even clap. It was truly inspiring to know that people cared enough to take time out and encourage me with words and clapping.

They were cheering me on and recognized me and my "try to be cheerful" demeanor. The entire team (minus one nurse) were amazing. I did have a nurse that claimed "It shouldn't hurt" as he was working on my freshly incised stomach. I reported him and asked that he not be assigned to me.

After about 9 weeks in various medical facilities - Here I am at home getting ready to go on my first outing. I was so happy and excited.

This was the first time I was able to fit into my Mark Grace Cubs jersey in years! I was so happy to be out and about.