Guess what I did yesterday? I had a life-threatening attack of Angioedema. My tongue swelled to the point where I couldn’t talk. The left side of my tongue was severely effected, the right side less so. I could still breathe through my nose, thankfully.
It came on rather suddenly, as I was sitting on my deck watching a comely young man hauling fish after fish out of the river, taking the hook out, and holding it up in the direction of the East. He then put the fish back into the river. Imagine the experience of the fish!
And as I was watching this curious fish ritual, I became aware that my tongue hurt. I looked at it in the mirror and it just looked a little swollen, and thickly coated. I use oral inhaled steroids for asthma, and thrush is always a concern.
But I know how to handle thrush, so I went for my baggie of medical grade myrrh resin that I bought at Manny’s homeopathic pharmacy on Yaffo Street in Jerusalem. I picked a nice clear chunk and lodged it between teeth and gum, and went about my business.
But it quickly became apparent that this was not thrush. The left side of my tongue was jammed against the roof of my mouth. The right side was starting to swell too.
I pondered what to do.
Would you believe, one of the things I was pondering was that this was the death ordained for me on Rosh Ha’Shanah, the Jewish New Year where everyone’s fate is decided, who shall live and who shall die, and if you are condemned to die then there are different ways to die, and one of them is by strangling. Maybe this was it, and I should just sit down in my recliner and let the decree take me away.
Then I thought, who will take care of Noga if I die somewhat suddenly?
I went to the medicine cupboard and got out the Benedryl, and took the proper 50 milligrams. Then I got Noga’s Predisone (she has allergies) and took a couple of the 5 mg tablets. I silently (since I could no longer produce understandable speech sounds) cursed that I did not have any epinephrine. I used to keep a whole emergency formulary at home, but now I don’t even have a prescription pad, even though I still hold my license.
Should I call 911? Well, if I definitely wanted to die, then yes. First of all, I wouldn’t be able to talk to the dispatcher except in grunts, and she would probably think I was a prank caller and hang up on me.
Even if I managed to give her my address, the Keystone Cops that they call the EMS here would never find it. It’s not on any map, being a mile and a half down an “unimproved” road and up a dirt driveway that looks like it goes to nowhere in particular. Giving directions in my present state was definitely not a possibility.
Not only that, but the last several times that Dad has fallen and needed emergency medical services to put him on a backboard and take him the the skunkworks they call a hospital here, the EMS has not showed up any sooner than 30 minutes after being called, even when he was unconscious. Calling the EMS was a quick ticket to the next life.
So I hopped in my car and drove the 15 minutes to the hospital. I remembered to say Shma Yisrael, the prayer we Jews are supposed to say before we die, and asked the Creator if s/he would please spare other people when I passed out from lack of oxygen and ran off the road. I was pretty sure that I got a positive answer. That made me feel better, because if I was destined to die along the road I really didn’t want to take anyone with me, although it also occurred to me that they, too, might be destined to die right now and I would simply be the agent of their death by sudden impact, which is the equivalent of the punishment of stoning.
Miraculously, I made it to the hospital, parked in the wrong lot, amazed myself by navigating the path to the Emergency Room, and walked to the Registration cubicle. The young clerk was sitting there chatting with her friends. I approached and put out my tongue, hoping that she would see that I was walking wounded and get me inside quick. She gestured for me to take a seat. I did no such thing, but made urgent guttural sounds, like some sort of primate. This time she said, “OK, I’ve called the nurse. She’ll be here soon.” I felt sort of better. At least when I passed out, someone qualified would find me.
The nurse appeared right quick, and I put out my tongue for her. She exclaimed and whisked me away to a monitored room. The air conditioning ate through my fleece jacket, fleece vest, and two layers of silk turtlenecks. This thing had made me really cold. So she holds up this thin hospital gown and says cheerfully, “Everything off, now, and put this on.”
I pantomimed freezing, hugging myself and jumping up and down a bit, to make it clear I was not about to abandon my layers of warm clothing for a barely-there schmatta. She turned the thermostat up, the air went off, and she brought me some warm blankets. Monitors of all kinds were applied, and a wave of panic washed over me. Trapped. Tied down. Wanna run, but probably would die, and I had decided not to die this time.
An aide came in and sat down at the computer and asked me a question. “Uuuh!” I answered. This reiterated several times before she got the clue that I could not talk.
A pair of nurses appeared, carrying the tools of the Intravenous Line trade. Panic attack. I have a disease that has destroyed my veins, making them very fragile. They often bleed for no reason at all. Last time I was hospitalized I went through seven IVs in one day.
But they got it on the first try, even though one of them had to hold the vein down to keep it from rolling. I’ve done that. Works pretty well.
The doctor brisked through the door, asking questions as she came. Must be busy, I thought. She’s in hyperdrive.
I tried to talk and that told her what she wanted to know. She asked me a series of intelligent questions to which one could nod or shake one’s head. She rose in my esteem.
Medicines went into the IV. A respiratory therapist came and gave me a breathing treatment to prevent spasms of the bronchial tubes.
The doctor popped in from time to time, and when the medicines started working and I could speak after a fashion, we of course started exchanging war stories. Doctors are incorrigible when it comes to war stories. I am certain that if there were two physicians and one of them was on their death bed, the two of them would be talking about this or that horrendous case, and trying to one-up each other, just for the fun of it.
Little by little my tongue went down, but the left side was being a bit stubborn.
The doctor came in and announced that they were going to admit me for overnight observation.
I secretly thought that was a good idea, but there were several factors that argued against it. One was that my little Noga was home all by herself and would not have enough water or food to keep her in good shape. Another is that I take exotic medicines that hospitals usually don’t have, and I must have them. Third, although I am something of a heretic and no good at all at certain things, I am still an observant Jew and I cannot eat anything from that hospital. The joy of being hospitalized in Israel is that the hospital food is kosher and served in accordance with Jewish law.
But this hospital is Baptist, and Baptists love their pork. Three times a day, pork. It’s amazing. But I wouldn’t even be able to eat green beans here, because they are seasoned with pork fat, and the mashed potatoes are served with utensils that have also served pork. In summary, the place is non-Kosher and I would not be able to eat anything there.
So we negotiated that I would stay 6 hours in the ER for observation. That was all right with me.
It was a very boring 6 hours, since I had no reading material, and the medicines they gave me made me too wired to sleep. So I amused myself by trying to count the slats in a Venetian blind that covered a window in the room.
Seven o’clock arrived and so did “change of shift.” I was impressed how smoothly the nurses navigated the change. Usually change of shift means you don’t have a nurse while they are in “Report,” and you could lie there and die in the meantime. I soon discovered that the reason the change happened so swiftly is that they had pretty much dispensed with Report, because my new nurse didn’t know anything about me. That was too bad because she had no idea how desperate my case was when I came in, and said I “didn’t look so bad.” I thanked her.
Likewise the doctor, whom I happen to know both from my old doctoring days, and because she has taken care of my dad during his last two hospitalizations. She was very hassled, and rightly so, since she had to run from room to room taking histories and doing physicals. And I came to understand that there were many cases more serious than mine. I should say so; it is an Emergency Room.
She of course had not seen my tongue in its supersized phase, but the first doctor had briefed her on my case, and suddenly the 6 hour observation turned into an 8 hour observation, and she said she would not let me go even then if my tongue had not returned entirely to normal dimensions.
She roared out of the room, and I really hoped she was using the waterless hand cleanser units that lined the walls in the ER, because she sure did not stop to wash her hands before exiting my room. I am a stickler about washing hands, especially in places where sick people come on purpose.
At that moment I realized I have a Tikun Klalli booklet in my wallet. I always have a Tikun Klalli on me. The Tikun Klalli is a set of 10 Psalms selected by Rebbi Nachman of Breslev, and is said to be the Universal Cure. So I got it out and settled down to read the introduction, which I had never read before. I didn’t actually read the Tikun itself, because once you start it you shouldn’t stop, and there was a big risk of interruption, of course, where I was.
The time flew past as I crawled through the easy yet esoteric Hebrew of the Introduction. Often the Introduction of Kabbalistic books is the key to understanding the book itself. So it was gratifying to be using my time in a productive way. And my tongue went entirely back to normal, except for a huge blood blister on the bottom of my tongue where it had been stuck on my teeth.
The doctor flew in, looked at my tongue, asked me how I felt, and announced that she would indeed let me go, and only had to do the requisite paperwork. I would have jumped up and down if I wasn’t attached to so many monitoring gadgets. It was now after one o’clock in the morning. I was sorely feeling the absence of my evening meds.
So what had provoked this gruesome tongue-swelling? The consensus was that my blood pressure med was the culprit. Seems that any blood pressure med ending in -pril, such as Captopril, Ramapril (which is what I was taking) and others, have a small but present chance of causing angioedema.
At last I was released and drove home. Noga turned herself inside out with joy. I was pretty happy myself.
But. I was filled with apprehension: what if it came back? I made a plan. If it came back, that meant that I was destined to die. I would somehow get plenty of my sleep meds down, so I might be able to pass out pretty quick and not feel the minute or two of choking before lack of oxygen shut down the brainwaves. I took a large syringe full of insulin (my dad’s) and prepared it to inject, just in case I couldn’t get the sleepers down. I found a manilla folder and wrote a note explaining what had happened, saying goodbye to all, how to find my will, what to do with Noga. And between every line I wrote DO NOT RESUSCITATE. I took a black marker and wrote it on my chest. It’s still there: DNR. That’s what I want.
I filled three large bowls with water for Noga in case it took a long time to find me. I put her bag of food on the floor where she could get it.
Then I went to bed, choking down all my usual pills plus an extra clonazepam to ensure sleep.
And as you can see, I also woke up.