Over the handlebars.

Those familiar with the Tour de France know it holds surprises, and can be transformed completely in a moment.

All it takes is a moment of inattention after days of fatiguing racing, or the slightest bad timing on an aggressive move by an ambitious rider, or some other random twist in a peleton moving at high speed, and in the blink of an eye the race leader finds himself upended in the ditch and a pile of riders and broken bicycles appears where just a moment before all was smoothness and speed.

Last night was one of those surprises.

How did it happen? Well, it was kind of late in the day. When I thought about whether to try pumping another can of formula through the stomach tube, I probably should have passed on the idea. But I didn’t eat well over the weekend, and I felt like I was “behind” on my calories.

And, despite the fact that my gut had been very well behaved all day, I probably should have followed my usual rule of thumb, and selected a slower feed rate since it was late in the day. But, as I said, it was late, and if I went slower, I’d have to stay up later, and so I didn’t turn the rate down until later, and it was getting pretty late.

Which is how I suddenly found myself upside down in the ditch.

Pumping formula through a stomach tube is NOT a natural way to get nutrition. As a result, there are some ways in which the body doesn’t handle it well – the body has some very fine and long-evolved autonomic responses for normal eating, and it can get quite bewildered by tube feeding.

They tell you that it’s important to remain vertical, or at least with your upper body inclined, during tube feedings and for some time afterward. This helps move the formula down the gut, and helps prevent it from burbling up through the top of the stomach and trying to come UP the pipe food normally goes down. This is particularly important when the stomach is full, because, say, you’ve just rapidly pumped a bottle of food, even if it is 11:30 at night and you are feeling very sleepy.

I fell asleep. I rolled over onto my side. I woke as food was not creeping, but shooting up the wrong way, and managed to rush to the sink before it came out. But at just the wrong moment, I unconsciously breathed in, and aspirated a bit of formula, ending up coughing over and over and over. (On the slow-motion race video, this is where you see the rider flying head first over the handlebars.)

The rest of the night was a long, semi-sleepless process of sitting up and trying to let my body sort itself out. What made it worse was that, after a couple of hours, I started experiencing chills and shaking. That was when I woke up Kimberly, and we called the on-call resident for advice.

The good news is that a trip to the ER was not required, and eventually everything worked itself out. By dawn, I was mostly back to normal, (except of course for the fact that I hadn’t slept very much, what sleep I’d gotten was sitting up, and I’d spent a lot of those “extra” calories on shivering.)

So I took it slow and easy today. I did make it to my morning and afternoon radiation, and following the second dose, got Dr. Liao’s new resident, Dr. Dhami, to check my lung sounds and vitals so that Kimberly won’t worry tonight. So now I only have two sessions (one day!) left. But last night was a lesson in not getting cocky, and remembering that it isn’t over ’til it’s over.

10 thoughts on “Over the handlebars.

  1. This is a lesson I will be learning over & over my whole life — that some things should not or can not be rushed, no matter how much you want them to be over & done with.

  2. I must add, y’all are going through this whole process with a whole hell of a lot more grace & caring & faith than I could have mustered. Much admiration for you & Kim.

  3. Oh my goodness! And we all thought it was (mostly) a coast downhill from here. Glad you got it sorted out and CONGRATULATIONS on tomorrow being the last last long day.

  4. I was just thinking what Alison wrote – that some things can’t be rushed. They say after a chemo, you need to drink a gallon of water/fluid to flush the system. Of course, this is insane. My mom would fight to get it down. The first few weeks, if she felt she could swallow she would try and get down a whole BigSlurpee-sized cup. Well, we learned the hard way this was counter-productive. *sigh* I am so sorry you lost a precious night’s sleep to this craziness :(

  5. Paul, your writing brings this vividly to life in all its horror and we’re all rooting for you here. Endure these next few weeks and it will get better.

  6. Your composure under tube feeder fire is beyond words. Turtle speed full ahead and win the race my friend.

  7. Just one last drop of prednisolone in the right eye…Dr. Eninger believes in tapering off…was all I had to do this morning, but was thinking of your last day of treatment…probably the most important or it wouldn’t be there?…and feeling proud of your wisdom and strength. Then this the unscheduled extra challenge. You will prevail.

  8. Paul, Fantastic narrative — completely unexpected dramatic twist! Never saw this one coming!

    Well written. But so sorry this happened – sounds awful & scary. You & Kimberlly have to be so focused all the time to get through every little medical/personal process you do so many times a day. It’s impressive that this has only happened one time. I think your track record is still intact.

  9. Ugh! Glad you’re hanging in there. Sorry about the lost sleep, it’s SO precious. Thinking of, I should call it a night right now…

Comments are closed.