my thrombophlebitis (DVT) scare

“Hi!” I call out as I wave jauntily to the two male nurses as I walk down the driveway on my way to the radiology department at Big City Regional Hospital this morning. They are two of the three male nurses who attended me last night when I got admitted to the ER.

“Good morning Sunshine!” The older and beefier of the two nurses calls out to me. “I am feeling much better this morning!” I inform them both, only slightly more enthusiastically than I actually feel. “Good for you!” says the first one warmly. Followed by “Good, good,” from the other, narrowly built, but equally bald nurse.

As I pass the EKG, CAT and X-ray rooms, I am looking for a specific department. I’ve obviously shown up during a shift change but oddly, instead of the place having twice as much staff coming and going, it seems deserted. Coming around the corner I encounter a desk staffed by a short woman with apparent mixed-Pacific Islander ancestry.

“Are you here for an exam?” she inquires.

“I am here for an ultrasound,” I answer, smiling.

She shifts through some paperwork and asks me if I am Plastic Girl and as I nod my head she advises, “Have a seat over there Plastic Girl, someone will take you into ultrasound shortly. “Thank you.” I reply and I do exactly that.

The beefy nurse had suggested I get here as early as I could. “The later you come, the longer you will wait,” he advised me. “But if you get here early, sometimes there is only a few people ahead of you.” Well, I am here early and the ultrasound tech isn’t here yet, nor anyone else aside from that female nurse. No biggie. I am really quite used to waiting for things and they are playing 80s hits over the speakers in the waiting room so I am okay.

But I don’t actually know that I am okay. Yet. Which is why I am here in the first place.

The ultrasound tech arrives and like the female nurse, is some mixed heritage that I can’t discern but his overall appearance suggest Asian-plus-something and like the nurse he is considerably shorter than I am. There is so much cultural diversity in the city I live in.

“What are you experiencing?” he asks me as we enter the lab. My answer after so many repetitions is succinct.

“Intermittent flashing heat and pain spikes which originate from deep inside my right inner ankle. The spikes wrap around and shoot up my calf and terminate around the back of my knee, here.” And I trace the path the pain takes with my fingertips.

The tech then gives me a rundown on what he is going to scan. He doesn’t actually read the scan, he explains to me, he just runs the scanner and pushes buttons on the ultrasound console, and that’s more or less it.

Soon enough I am reclining on a nursing bed with a sheet covering me from the waist down. After positioning my right leg with my knee facing him and very slightly bent, he turns for a white bottle, and then back to me.

“Oh my god it’s warm,” I exclaim as he applies the contact gel. “I totally did not expect that.” I explain, “I had braced myself for it to be cold.” “I can get the cold stuff if you like,” he jokes with a smile. His eyes flick back and forth from my leg to the ultrasound monitor. He adjusts something on the console. After scanning my upper thigh and hip, he moves on to my lower leg.

“How much to have you keep doing that for a while?” I ask as he applies more contact gel to my calf, and we both laugh.

The atmosphere in the ultrasound room is surprisingly pleasant. I’ve had quite a few medical procedures done to me in the past, what with me being Plastic and all. I have to say, I would take an ultrasound over the others any day.

The room is dark, but for work lighting. I can’t stand bright artificial lighting and strangers being near me when I am not feeling well, which describes most emergency rooms and waiting rooms fairly accurately. The small, dimly lit and cool room is composed of just me, the bed, the tech, his sonic scanner and the quiet whir of fans coming from the ultrasound machine.

This is how medical care should be. Simple, efficient, compact, quiet and private without being overwhelming with bodies and light and sounds and the voices of unseen strangers talking about what antipsychotic they are going to use the treat the delirious patient in the next stall over. Like it was last night.

I can’t feel the sonic waves passing through my leg at all, and I am surprised. I am very sensitive to my body’s feelings, and to things like sound, heat, electricity, the energy of other people. I thought I would sense something and I ask him about it. He tells me that there are times when stronger settings are used and can be felt but most of the time, it’s just like this.

Time now to image my left hip. We are almost done. And then, it’s over. Twenty minutes was about how long it took from the moment I got up on the bed.

The ultrasound tech steps out for a moment and when he returns he places several white towels next to my knees. “Take your time Plastic Girl,” he instructs. “There is still no one else here, come out when you are ready and I’ll take you over to the ER waiting room for discharge, pending.

Discharge pending means, if my ultrasound is clean. That ‘if’ has been troubling me all morning, which is why I feigned a little more enthusiasm than I actually felt in my greeting to the two nurses I passed as they left to go home from the night shift.

Last night had been a different scene altogether. I spent all day and most of the evening thinking I could drop dead any second. My significant other noticed how subdued I was when she came in from the office.

“What’s wrong?” she asked as she started kicking off her flats and removing her coat.

“I think I may be in serious trouble.” And I proceed to tell her about how my right calf and ankle had been having transitory pulsing pain since last night. My SO is also a plastic girl and she immediately comes to the same conclusion I have.

“Why did you wait all day?” she asks as she fishes her Iphone out of her bag to call a cab. I wanted to see if it would clear up on its own. I didn’t want to cost us an unnecessary ER visit I explain softly. “I was planning on going tomorrow if it got worse overnight.”

“We have insurance. It’s okay.” she says. But having health insurance is new for Plastic Girl, who went most of her adult life without it.

I grab a Trader Joe’s bag and start putting things in it without any plan or logic. I have been stricken with fear all day and my attention span is unusually spotty. I am having trouble thinking in straight lines. But that might have something to do with the half glass of red wine I chased a 325mg tablet of aspirin with on an empty stomach in a panicky attempt to start thinning my blood a half hour before my spouse had come through the door.

I am going to the hospital so I don’t worry about taking valuables. I’ve got my ID, insurance card, extra panties, socks, my hormones, my stainless-steel water bottle and house keys. I toss a striped scarf in to cover the lot of it and we head downstairs to wait for the cab.

All the way to the ER my spouse is rocking back and forth in the cab with nerves. I keep mouthing the words, “I’m sorry,” every time she glances worriedly at me, and give her hand another squeeze. Every time she says, “Don’t Be.” and squeezes back.

It’s nervousness wave propagation. I am worried about me. She is worried about me. I am feeling bad because of her worry. It’s my fault my spouse is not relaxing at home right now after a day at work. My fault her eyes are wet. I can’t help but blame myself for my injury and for making her worry, even though I know intellectually, it isn’t my fault.

Finally we arrive and walk into the ER. And I can walk just fine. The pain is intermittent. It throbs and then fades. About three or four twinges an hour. But then sometimes an hour will pass with no twinge. Then it starts again, with another following that one within minutes. It’s just too odd and unlike anything I’ve ever experienced. Given what it could be, I am very scared.

For ten years I’ve had to deal with the possibility of having Deep Vein Thrombosis as a consequence of going on hormone replacement therapy. Deep Vein Thrombosis is the condition of developing blood clots deep in your veins. Your body is always dissolving clots on it’s own, but if a big clot relocates to your lungs, heart or brain, it can cause major problems.

The human mind is a shifty thing. Differing concepts can seem associated and run around in your head holding each other’s hands. In this case, the idea of a blood clot moving towards my heart or brain gets conflated with other concepts, like embolism and aneurysm. The imagination can be a bastion of terror in the face of the unknown.

People who have aneurysms can simply drop dead, quietly, without much fanfare. All day long I had been unable to get those ideas to stop moving in my mind. Blood Clot. Brain. Stroke. Aneurysm. Death.

Thinking I might just die any second changed my entire day around. I literally started to put my affairs in order, which aren’t really too many. I don’t have children and my spouse would get all my stuff.

I didn’t know what to do. As the day went on and the twinges continued, I felt very positive that I might end up spending the night or several nights in the hospital, depending on how severe the problem was.

So what did I do? I cleaned the house. My last act before either A: dying or B: being hospitalized for a while, would be to make sure the house was clean and in order. I made the bed, did the dishes and took out the compost. I vacuumed and picked up my spouse’s things and put them away.

After registering and sitting through a not unbearably long wait in the ER waiting room, a staff comes out and puts on my plastic intake bracelet. “You will be seen shortly, Plastic Girl,” she tells me.”

As she is walking back I notice the place seems to be in a shift change. The number of medical staff seems to have swelled to near-crowded at the triage station. Then, as if on cue, the entire group of female nurses that had been on shift when I got admitted, walked out as one, all chatting amongst themselves. I turned back to glance over at triage and my heart sank. All but one of the remaining nurses was male and the female nurse was in motion tending to other patients.

“Plastic Girl?” I smile and stand up and head over to intake.

It’s then that I realize with total clarity that this nurse is gay. This might not be bad after all I think to myself.

“What seems to be the trouble this evening?” asks the tall, thin nurse.

“I think I may be DVTing.” I state with false calm.

“Why do you think that?” he asks, tone of skepticism in his voice. “Is this something you read on the internet?”

“No, well I mean yes, but..”

“Have you ever had DVT before?” he asks.

“No,” I answer.

Then he is asking me about the pain I am having. He starts with the one to ten pain scale and I am trying to explain that my pain is not a particularly intense pain. It’s not even a seven or an eight. It not sharp, it’s spiky. It’s not intense, it’s throbbing. But everything about it feels wrong and that because of certain factors, I am at risk for DVTs. The symptoms I am having are very similar.

In the last week I had turned my ankle pretty bad when my right foot was sprained. I was wearing boots and I stepped into a deep crack in the pavement as I was crossing the street, which in turn caused my foot to roll and twist.

Consequently  I had been staying off my feet more than usual, and I spent that time doing, what else? Blogging at Plastic Girl and reading about feminism among other things. Among other factors was that for whatever reasons my primary care physician had switched me from two 1mg tablets of estradiol daily, to one 2mg tablet of Estrace and so I was wondering if I might be having a reaction from switching from one type of synthetic estrogen to another.

So between having a lower limb injury, prolonged inactivity and a recent change in my HRT, I had reason to believe the pulsing heat pain coming from my leg (which did not come from the ankle-twist pain site) might be a blood clot going on. It could also be a mild sciatica or other neuropathy from sitting so long. But because of my unique risk of blood clots from HRT we needed to rule out Deep Vein Thrombosis first, and then work our way down. The nurse agreed and things went a little faster after that.

In no time I was in a hospital gown on a bed with curtains drawn closed, my spouse on a chair with her head in her hands, still rocking with nerves.

I do not like to be in hospitals if I can avoid it. A long time ago Plastic Girl had a very traumatic experience in a hospital. Bad things can happen to people in hospitals. People sometimes come out of them with diseases they didn’t have going in. Medical staff are people. And people are people.

Drug doses can get screwed up, operations can be done at incorrect sites. Blood work can get messed up. People can get the wrong meds or be misdiagnosed and treated for that misdiagnosis, which then goes even more downhill from there. All this is going on in my head as I wait to be treated, wondering if the next pulse coming from my calf is another blood clot breaking off to head towards my heart or head.

The way I handle medical events is, I subjugate my ego. I release it. When I walk into a clinic or hospital I give up vanity, modesty, privacy. I surrender. It’s the only way I can just let people do things to me.

I have to reach this headspace where I can sit passively and let people manipulate my plastic limbs, stick things into me, draw things out of me, and just permit it without freaking out. I just don’t resist. As long as I wear a patient gown, I am subject to people who come to do things to my body.

At this point I’d like to mention just how skilled and competent these night shift staff were.

The first thing they did was draw blood for clotting analysis. Then I was seen by my doctor. I had to give him a rundown on everything I had just told the last two nurses and the intake nurse. That’s just how it goes in hospitals.

Lo and behold, my attending physician was gay! He immediately recognized my medical situation as a transsexual woman who is on estrogen replacement therapy for life. He measured my calves with a tape and found them symmetrical. He then gave me another rundown on what Deep Vein Thrombosis is and its complications and treatments. If you are prone to clotting they can insert a filter catheter into your vein to catch them.

This doctor was super kind and empathetic. He was busy and rushed, as doctors often are, but he answered every question and reassured both me and my spouse immensely. He told me that the ultrasound clinic was closed at this hour (by this time it was 10pm), and so I would have to come down in the morning. He told me they were going to treat me as though I was having DVT, and then he left for other patients.

Then I was seen by yet another nurse. This was the big bald beefy guy and he also was gay! I was seen by three nurses and one doctor and all but one of them was queer. He gave me a shot of a bloodthinner called Lovonox with a gun-like syringe in my belly a few inches to the right of my navel.

These guys, all four of them, were pro. I can not express how impressed I am with the care I got from all of them. From the intake nurse who listened to me and understood the potential dangers of supplemental estrogen therapy and made sure this was the first thing we ruled out. To my doctor who was also understood my situation. To the two nurses who stuck me.

Normally, I am a bruiser. When I get blood drawn I invariably end up with a giant black and blue over the draw site. Then to have a blood thinner injected which can also increase bruising. Ten hours later, I have exactly zero subcutaneous bruising on my arm and only a little tiny bit on my tummy. They may very well have been the most professional needle sticks I have ever received, and when you are a plastic girl, you can get them a lot.

“Plastic Girl?” I hear my name being called at the desk. It’s the morning shift attending physician, and he is from what I can tell, not gay. “Your ultrasound was negative. Your clotting factor is normal. You are all set.”

“Thank you so much! I am going to go cry now. Thanks again!” He smiles as he heads back onto Emergency. The automatic hospital doors open for me as I head outside into a beautiful March morning.

I really do feel like crying. I am actively looking for a place to sit down for a second, but the only places are the emergency room seating, or the benches outside, where there is a patient or staff having a cigarette. So I head down the sidewalk in the general direction of a bus line. I also feel like laughing.

Both the crying and laughing are colliding in my heart and because I am smack in the middle of urban sprawl, there really is no place to be private and vent emotions without using a bathroom. For the next few hours I walk around and ride random buses and that feeling of wanting to collapse into laughter and tears of relief slowly begins to subside.

I get off the bus when I decide want to treat myself to a mocha at a Peet’s Coffee and Tea I can see about a block away. The barista, a young white man in his twenties with some kind of Easter Island earlobe thing going on asks me:

“How are you today?”

“I am wonderful!” I answer with genuine sincerity. “I just found out I am not going to die.”

But I was seriously scared for a while there. I don’t want to die. I love being Plastic Girl, not to mention it pains me greatly to think of dying on my spouse and leaving her alone (who incidentally, was overjoyed and relieved to hear my ultrasound was clear).

I am so grateful that I do not have DVTs. I don’t know what I would have done if I had been forced to stop taking estrogen due to clots in my legs. I would love to name the hospital where I received such wonderful care, but given the nature of my blog, I am going to pass on that.