Search

Top 60 Oracle Blogs

Recent comments

Philosophy – Treating Illness As A Performance Issue

Firstly, I’m on the mend. This is not a post about “oh woe is me, I am so ill”. But I have been rather ill.  I’ll just give you the highlights: The highs of UKOUG Techfest19 at the start of the month were followed very quickly by me developing full-blown influenza (Type A). After about 5 days of being ill in bed I realised I was fighting for breath just laying there. I analysed the problem and came to the conclusion “something else is very wrong and paracetamol is not the answer”. I was taken into hospital and put on increasingly powerful ventilating machines until they could get enough oxygen into me to keep me (sort of) functioning. I’d developed secondary infections & pneumonia, seriously reducing my lungs’ capacity to exchange oxygen & carbon dioxide. {Update – no, I was not an early, uncrecognised COVID-19 case. If that was so my type of influenza would have almost certainly come up as unknown – the two viruses are quite different}.

A normal oxygen (O2) blood saturation level is 100. Below 90 is a cause for concern. A constant level below 85% is medically deeply worrying as 80% and less is harmful to several organs and confusion/unconsciousness are likely. Below 75% and you are almost certainly unconscious. I do know that when I first got to hospital they could not get me up to 85% and they could not understand how I could still talk and be (mostly) rational. I went from nasal O2 to a face mask to a machine that blew damp, warm O2 up my nose and finally a pressurised face mask. Next step was sedation and full mechanical ventilation – but they did not want to do that. My blood O2 became my main metric and I followed it like a hawk.

So I’m in hospital, very unwell (but not dying {update – at least they didn’t tell me at the time. They told Sue I was seriously ill and would probably be put into a medical coma} ), under excellent care. And I’m almost, but not quite, totally incapacitated. To me it was a bit like I was a computer system with a serious deficiency of CPU power. Or a toy robot with failing batteries. Energy conservation is paramount. So what do you do in this extreme situation? Turn off everything you don’t need turned on, and save energy for things you have to do.

Turning things off was relatively easy. After all, I was connected to a load of monitoring technology and breathing kit so I was not going wandering about. I didn’t move much. If I needed to sit up I was not going to use those stomach muscles, the bed was powered and would move me about. If I wanted something from the table besides me (like a drink) I’d relax, breath deep, get my Blood O2 up –  and then get it. A little rest and then I’d e.g drink or look at the phone.

Some things I had to do (or insisted on doing) and I realised how much energy they took:

Having a poo

It takes a lot more energy to have a poo than you think. I was just about mobile so I was allowed to look after my toilet needs. They would bring me a commode, position it so I could get there still attached to the ventilator keeping me going, remove some of the monitoring (but not all, heart monitor and blood 02 had to stay on) and get me ready to swap to the commode. And then leave me alone for 10 mins. I think at first they hung about by the door listening for a thud, and I had a call button. Getting onto the commode was OK (breath-breath-breath, move, pant for a minute like you just sprinted 100m… relax), but the actual job itself uses more abdominal muscles than you probably every realised. Tiring.

All the monitoring kit was on one arm. The one I normally use to “tidy up” with. Using the other hand was very odd. And again, tiring, I had to take it in stages!

Post event I would need to rest and let the blood O2 lift back above 90% and then I could shuffle back to the bed and press my button. The nurse would come in, congratulate me, and attach any removed monitoring. I’d lay there and wait for the O2 to get back above 90% and the bloody monitoring machine would stop pinging.

For 3 days this was the hardest thing I did, it was my main exercise…

Eating

Actually chewing & swallowing was easy. But to do that you have to get the food into your mouth. Holding your arms up to eat is hard work! I took to cutting up what I had (if it needed cutting up), having a rest, then eating with one arm, mostly balanced on the table with brief bouts of effort to ferry morsels to my mouth. I was incapable of lifting a pint. Even more incredible – I had no desire to lift a pint!

I’d have a little rest after eating and I found I had to listen carefully to my body about how much to eat. Anything more than about what you would feed a cat in one sitting, and I would lay there, 2 or 3 hours later, conscious of the need to move that food out my stomach and into my gut. Who knew the mechanical side of digesting needed effort.

Washing

You can’t have a shower if you are attached to breathing machines. And I was not able to leave my room anyway as I was an infection risk to other patients (I had ‘flu remember). Plus, at first, no way could I do all that waving arms, applying shower gel and the rest of the business. So it was washing with a bowl, cloths, and lots of towels. If I took it steady I could do this myself, except my back and, oddly enough, my legs. lifting them up was exhausting! Nice nurses did those bits.

Weeing

I’m a man, weeing was not an issue. They give you an endless supply of little bottles with a hole towards the top. So long as you tuck the relevant part into the hole (having sat up using the bed) you just “let go” and pressure does the rest. No energy. The first time is worrying – “what if I miss, what if I fill the bottle”. The bottles are designed to be bigger than a human bladder.

However, if you do what I did and then drop the bottle of wee on yourself, do not attempt to sort it out! I did, I stared trying to use a towel and get out the wet spot and I nearly went unconscious as my O2 plummeted from the effort.

What you do do is call the nurse and say “Nurse, I just poured my own wee over myself and I’m wet”. Nurse will remove your wee-covered clothing (a hospital smock), un-plumb you from some machines, move you to a chair, plumb you back in, and then clean up the bed, bedding, floor etc. They don’t either laugh at you or grumble. You just sit there feeling like a pillock.

Nurse will then ask how much you had wee’d. Why? I’m on a high dependency ward, they measure everything. A key thing is fluid in (via saline drips and drinks) and fluid out – blood taken for observations and weeing. I knew I was getting better when the weeing increased compared to drinking. This is because my lungs had swollen with fluid and, as they recovered, they released the fluid. A pair of swollen lungs hold a lot of fluid!

It had been a good wee, I guessed 350ml. It certainly was enough to make me and the bed very wet.

Coughing

Having a good cough (which I did a lot of, of course, what with all the lung issues) would send my blood oxygen plummeting. Again, lots of abdominal muscles and the diaphragm (the sheet of muscle between your lungs and stomach) are used in coughing. If I could, I would build up to a good cough, conserving my strength and getting my O2 up in preparation for a real good go. But if it caught me by surprise, it could drop the blood O2 dramatically. But the good thing was, coughing helped expand the lungs and I recovered quickly and was “better” for half an hour.

Thinking

At rest, your brain uses about 20% of your total energy. This is true even for stupid people like Donald Trump :-). Biologically it’s very interesting that humans have such large brains and put so much energy into it – far more than any other animal (in relation to body size). Our brains makes us different to all other animals, ie “intelligent”, but at a significant energy and nutrients cost.

If my blood O2 dropped too low I would start shutting down. This is why people with breathing difficulties pass out, once blood O2 goes below a certain level, your higher brain functions stop to reduce demand and protect the rest, unconsciousness comes quickly.

Thinking was hard. I’ve never been one for just sitting there “thinking of nothing” but I did an awful lot of that in hospital. It was my brain saving energy.

Socialising was a real drain. I could do the 2 or 3 mins with the nurses or docs when they came to do observations (oh, so many observations in a high dependency ward!) or put drugs in me, take out my bood (Oi! I wanted that blood! I was using it to ship the small amount of O2 I can absorb!). I had to be really on my game when the docs popped in once or twice a day as this was my opportunity to try and ask smart questions like “so we have a diagnosis, what is the prognosis?”. Don’t worry what it means, medics live by it so asking them makes them think you know some of the secrets… Docs don’t tend to tell you much in my experience, unless you can ask pertinent questions and show you understand the answers. They seem to think ignorance (on the part of the patient) is bliss. If I knew when the docs were going to be in, I’d try and have a pre-visit snooze so I was at the top of my game.

Where it was hard was dealing with Mrs Widlake. Mrs Widlake was wonderful, she would ask me what I wanted and the next day she would bring it in, let me know what was going on, if people had been in touch, who was annoying her. And kept me company. It was very important to me.  But after about 1/2 an hour I would start shutting down, the thinking (and talking) reduced my low energy levels. We worked out a solution. She would come in, give me my new book and the bizarre, random items I asked for and chat to me. After 1/2 an hour she would go have a cup of tea in the visitor’s room whilst I zoned out, then came back for more chat. Resource management and time sharing! Sue did not want to leave me alone but after a few days we both accepted that a daily visit in sections, kept to maybe 3 hours, made the best use of the resources available. It was a bit like my batch processing window!

Monitoring

So I was managing my resources and finding out which ones took effort. But like any good system, you need monitoring, real-time feedback. And boy was I monitored! I was on a high dependency/close observation ward. Every hour, every single damned hour all night too, they would come and do blood pressure, record my heart rate and O2, measure my wee, what I had eaten, temperature etc, steal blood.

But the main thing was the machines I was attached up to. They constantly monitored. And pinged. Oh god, did they all bloody Ping. If a chest sensor fell off or I sat on the connector, that machine would ping. If a drip (drug or fluids) ran out, it would Ping. Breathing machine ran out of water? Ping Ping Ping! The ventilator had to up pressure or I moved too much (I duuno why) – Ping Ping Ping.

But the worst, my nemesis (and also my KPI) was the blood O2 monitor. If I dropped below X, usually 86 or 88, it pinged & pinged & pinged. If I dropped below 85 it would up the volume and multi-ping: “ping-Ping-PING! ping-Ping-PING! ping-Ping-PING!”. You could not even cheat it by taking the monitor off, as then it went ping-bloody-crazy. All those tasks I mentioned above that took effort? They all made this blasted machine ping or ping-Ping-PING!

The one biggest challenge to me during my stay was not boredom, not pain (I was lucky, no pain other than what they inflicted on me putting in drains etc, or headaches due to low O2), not fear – it was trying not to go crazy due to the the pinging. I did everything I could to stop the pinging. The only time I really lost it with the nurses was one night as I improved and they changed the warning levels up to 90 and every time, every time I started to fall asleep it bloody ping-Ping-PING’d. I told the nurse to turn the levels back down else I would rip the damn thing off the wall. She said she could not, as she was not qualified to make the decision. “Well find someone who can as, if it does not let me sleep, I will lose my shit”.  It’s the only time I swore at any of the people looking after me. It got turned down.

This is exactly like having OEM monitoring a database and alerting on a KPI such as CPU usage when usage spikes and is actually OK. Just endless, endless false alarms. What the damn things should have done (in my opinion, for me) was only Ping if I was below a limit for over a minute, or went down to critical. Then it should go absolutely crazy.

And it was not just my machines. Other people in the ward had their own pinging machines. They. All. Pinged.

I’m back home now and recovering. I can breath unaided and slowly, slowly I am able to do more without running out of breath. Like have a shower or make my own cup of tea. Give me a month (I’ve been told it’ll take a month) and I should be back to sort-of normal. I won’t be running marathons or using the axe in the garden for a while. I’m still treating myself like an under-resourced computer and dolling out effort where best used. But each day another core comes on line and I can expand the extra effort. I think it’s called getting better.