January 9, 2014

The Thief of Time

Post-tx day 29, pulmonary rehab #10:  The Thief of Time

Walking 30 minutes in rehab can be mind-numbing; your mind will wander.  Today, I found myself thinking about stasis and sedation. 

I've been reading a serial in Analog over the last few months called Lockstep.  Even if the name itself didn't already resonate with the frame of activity at rehab, the core sci-fi concept of the story certainly has begun to resonate.  A family invents a way to put people into stasis.  By being asleep 30 years and awake one month in endless repetition, and by having sub-light starfaring technology, mankind finds 70,000 worlds "next door" and sets up a vast empire.  In which people pass THIRTY YEARS in the course of "one night's sleep". Astonishing, when you think of it.  Eerily, the last issue of the magazine features two more stories dependent upon stasis issues for the plot.  In one, a crewman on a ship that will take 90 years to reach man's next homeworld finds he won't survive his turn in stasis.  So he lives, from age 8 to 80 on board the ship, managing to survive to see the new world, but losing all his friends, lovers, and family along the way - not to death, but to TIME. To stasis.

I begin to mesh this idea with the reality I'm living.  As I've told many, many transplant patients as they're about to go in, the hardest part of the whole process - the operation itself - is the easiest part for you; because it passes in a blink.  Your mind is suspended - again, stasis.  Sedation not only keeps you asleep, but erases a good part of any memory on either side of that sleep as well.  ICU time becomes compressed because you spend most of it sedated.

And the same is true of other procedures I've experienced.  Every time I go to Interventional Radiology, the procedure invariably takes longer than I remember, even when they're not putting me under, but rather just "making me comfortable."  Although, my last trip to IR, they had to have put me under.  For what I do remember are the clock times at the start and the end.  What was subjectively 15 minutes took about 2.5 hours!  Luckily, I was awake enough at the end to get the doctor to show me the 3" of catheter he retrieved from inside my jugular. 

But that time is lost.  And not in the way you lose time when you regularly sleep.  When you sleep, your brain still tracks time - hence people's ability to wake up 5 minutes before the alarm.  No, this time is LOST.  When I say the interval passes in a blink, I mean it.  To the mind, this is the stasis of sci-fi.

My latest example - and one where I now know sedation can last too long - is yesterday's bronch.  When inpatient, they do bronchs unsedated, but they're only looking at sutures and sucking out excretions.  When outpatient, the bronch also takes biopsies, so it is much longer and they want the patient sedated.  I talked to the doctor pre-procedure about strategies for numbing my reactive airway (nebulized lidocaine, which seems to have worked well) and he mentioned that CF patients are usually resistant to sedation and they go a little heavier with us.  So it went. 

Problem is, though he had a hard time getting me fully asleep (told me by phone today that I was attempting to text and trying to call Walgreens about my IVs), he finally did and got the bronch done.  What I could then tell him was that I think the sedation needs to be halted sooner and made lighter in general, for I lost THE ENTIRE EVENING.  Even though I went to dinner with friends (Mom driving, of course), I remember only snippets and Mom has told me of other events of which I have no memory.  I do NOT want to leave the bronch suite in that kind of mental suspension again!  In this case, I feel I've actually been robbed of time.  So we made notes and next month, we'll try going lighter, perhaps get me in earlier and keep me in recovery longer.  I'd rather be somewhat awake mid-procedure than be that deep again - for a bronch.  (Side note, it's apparently entirely normal to cough up blood clots the day after a bronch.)

My loss of time is minimal, of course, compared to Denise's.  She has spent seven days now in ICU, most of it completely sedated.  How much she'll remember is anyone's guess right now, but likely not more than a few minutes of it total.  It will be a shock to her to find out how much time has passed when they can finally wake her up fully and keep her there.  And given her racing heartrate when they try to bring her up, who knows how much time will be stolen from her mind, ultimately?  [Next day edit: To be honest, I awoke this morning with a certain gut feeling - I think they'll be successful in getting her off the vent today.]

And so I keep an eye on the clock as I walk laps. Today, I am reminded that while time may be passing slowly during this boring activity, it is at least passing perceived, rather than being slipped away by the stasis of sedation.

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