Homecoming

On Andy's 2019 hospital stay

This photo popped up on Facebook today. It was taken six years ago just after Andy was released from an error-ridden stay at Cedars-Sinai for a mystery infection.

The crisis started when Andy came home from a recording session complaining that he was in pain; and he was clearly feverish and disoriented. I called his neurologist, thinking it was related to myasthenia gravis, which he’d been diagnosed with about six months earlier.

I told her his symptoms.

“That is not myasthenia,” she told me. “He has an infection. You need to go to the hospital now.”

“I’ll need to call someone to take care of our kids first.”

“You need to leave right away,” she responded. “Find someone quickly.”

We called a friend who made it to our house in ten minutes to pick up the boys and then we headed to Cedars.

The receptionist was unimpressed when I told her that Andy’s neurologist had called ahead to say his case was urgent, as was every other Cedars employee we told.

After six hours in a standing-room-only waiting room, much of that next to a man who reeked of urine and close to a woman who puked on the floor several times, Andy was admitted to the ER. The admitting physician hand-wrote “likely sepsis: high risk of death” in his chart. She’d gone to my alma mater, so we’d exchanged niceties about St. Louis, yet for some reason she forgot to mention her note. She told us he had an infection, likely a UTI, and that he needed to be admitted, and hours later, at 5:30 am, he was. But in the ER, her tone was casual and reassuring with no indication she thought my husband was likely to die. I discovered her note months later, after I dug through medical records trying to figure out what the fuck had happened.

I sped home as soon as Andy was in a room in the Neuro ICU. The friend who picked the boys up as we rushed to the hospital had passed the boys off to Miss Patty, the boys’ former preschool teacher and favorite babysitter. She had spent the night, but I wanted to be back before they woke up to take them to school. They easily accepted my assurances that Andy was doing okay – he seemed to be okay at the time – and I told them I’d see them later that night. Then I headed back to the hospital. I’d been awake for over twenty-four hours.

Back at the hospital, I unfolded a chair that turned into a bed-like object but lacked all comforts of an actual bed. I tried to sleep on it between medical providers stopping by and friends and family calling. As the days wore on, I slept rarely and only when my exhaustion outweighed my discomfort.

I had early indications there were problems with Andy’s care. For a full day I kept telling different medical providers that Andy had a fever. When he wasn’t drenching the thin sheets and blankets with sweat, he was cold and shivering. They kept taking his temperature and assuring me he was fine. Many hours later they realized their thermometer was broken and he had a high fever.

As the days went on, every new provider opened with, “so I hear he has a UTI,” and I would have to politely tell them that no, that had been ruled out after about forty-eight hours, now he just had some mystery illness that the million dollar workup (that’s what the doctor called it) hadn’t identified, and the three antibiotic IV cocktail wasn’t slowing down.

Later, when Andy got his own room out of the ICU, the room had a shower and Andy was thrilled to be able to take one. As the nurse prepped him, I mentioned that he’d just had a spinal tap and I thought showers weren’t allowed. The nurse said that was true, that he had forgotten about the spinal tap.

The mistakes, big and small, were endless. I couldn’t imagine how anyone without an advocate survived a hospital stay.

Day 4 was the worst day.

I had gone home to spend an hour or two with Jackson and Charlie after they were finished with school for the day. Miss Patty was there again. As I’d done every day, I reassured the boys that doctors were continuing to rule out things Andy didn’t have, so they were getting closer to figuring out what he did have to make him better. On the advice of a doctor friend, I knew not to promise he would be fine but I was treading close to it, in large part because I had no idea how sick he was. Just as I was reassuring the boys, the doctors kept reassuring me and I believed them.

While I was with the boys, Andy’s brother Jonathan was at the hospital with Andy, plus Andy’s friends Ned and Andy Kindler. I was glad they were all there. Jonathan is a nurse, Andy Kindler is Andy’s favorite comedian and Ned is a good straight man. Andy had daily visitors and most kept his spirits up with jokes and clowning around and stand-up routines.

Just as I was about to leave the house, Jonathan called me.

“You need to get back here,” he said, “they’re about to intubate him.”

I had watched enough ER in my lifetime to know that was bad. I asked if they would wait. He said probably not, and to hurry.

I drove like a maniac from Los Feliz to Cedars, dodging in and out of traffic while crying to my mom on the phone. I made the usual forty minute drive in twenty minutes. I pulled into the parking garage just as Jonathan called me to let me know they didn’t have to intubate after all.

I was still scared and hurried to the room. I saw Ned and Andy Kindler first when I walked in. Their faces told me it was worse than I thought. Then I saw Andy: pale, barely conscious and drenched in sweat. I was quickly getting up to speed on parameters for heart rate and blood pressure and I could tell from the monitors that his heart rate was way too fast and his blood pressure too low. Jonathan was next door – I could see him through a window in the hallway, where I was still standing – grilling a guy in a white coat I’d never seen, and I was getting to know everyone around here. I later learned the guy was Miguel, a nurse practitioner. I didn’t really understand all the different medical roles and who was where in the pecking order. Later I’d learn that was important to know.

I went to Andy and held his hand, though he didn’t seem to notice I was there. Jonathan came in and assured me that Andy was stable now and that was a positive sign after the near-intubation incident. He was sleeping and probably would be for a while.

Ned and Andy Kindler said their goodbyes shortly after I arrived and said they’d be back in the morning. Jonathan stayed for a while, updating me on the notes from Miguel, saying that the guy knew what he was doing and we’d be in good hands with him for the night.

There was a new nurse, Kareem, on the floor too – not just new to me, but to the rest of the medical staff. Kareem usually worked in another part of the hospital and was a floater for the night. He reminded me of a young Boris Karloff, both in appearance and demeanor. It was not comforting.

Just as Jonathan was leaving, my best friend Elizabeth showed up. Since my mom was in Kansas she’d sent Elizabeth as her proxy. I was so happy to see her. I hugged her and cried and begged her to stay as long as she could.

And then Kareem told me that only one visitor was allowed at a time. I was the visitor.

I knew that wasn’t true because we’d had multiple visitors, day and night, since Andy had arrived. I pushed back on Kareem’s made-up rule but he wouldn’t budge, and he seemed to be in charge. He finally said Elizabeth and I could sit together in the waiting room, but I didn’t want Andy to wake up alone. I knew Kareem was wrong about the policy but there was no one else to appeal to – the ICU was a ghost town except for Kareem - so Elizabeth had to go.

After she left, Kareem started telling me that Andy wasn’t getting good care on this floor and Kareem was going to call his old boss and try to get Andy transferred.

I don’t know what his old floor was, why he wasn’t there anymore, or who his old boss was. But this did not make me feel comfortable about the hospital or Kareem.

Shortly after that a guy came up with a gurney to take Andy downstairs for a procedure – I can’t remember what it was. MRI? X-ray? Kareem said I couldn’t go with them, then walked out of the room for a minute and the gurney guy said, “that’s not true. I see people go down with the patients all the time.”

I didn’t know who to trust. I knew Jonathan thought Miguel was capable, but I hadn’t seen him since shortly after Jonathan left.

They brought Andy back a half hour or so later, and he was still too out of it to even know I was there.

As midnight approached, Andy continued sleeping with labored breathing. I noticed his blood pressure kept dropping. Earlier Miguel had assured me that someone was always monitoring the vitals from the nurse’s station, but I was getting nervous. Finally when the reading hit 77/54, I walked to the nurse’s station to check in, only to discover no one there. I walked quickly through the hallways, then began running, searching frantically for anyone and eventually found Kareem down the hall. I told him that Andy’s blood pressure was too low. He followed me to the room and looked worried once he saw the vital signs. He started texting someone. He went back to the nurse’s station. He came back again, said “he needs pressers,” texted someone again, and then said, “the doctor on this floor isn’t very responsive.”

He left the room and came back with a couple of IV bags and started trying to put an IV into Andy, who woke up, startled, and began resisting Kareem’s attempts to hook up the IV.

“Sir, you have to let me do this,” said Kareem.

“Why?” Andy yelled, drenched in sweat, clammy, wild-eyed.

“You’re a very sick man,” Kareem replied.

“How sick?”

“You’re septic and have a bad case of pneumonia.”

This is when I decided I couldn’t trust Kareem. Andy didn’t have sepsis. Someone would have told us.

“Am I going to die?” Andy asked.

“You might,” said Kareem.

This couldn’t be right. Sure, hospital staff had asked for Andy’s advanced directive, but that was just a normal precaution in an ICU. Not one medical provider had indicated death was a realistic outcome. Possible, yes. We were in the ICU after all. But no one had indicated it was that serious.

I was sure that Kareem was exaggerating because this was so far afield from what I’d been told by the doctors. And I knew that Andy panics and that he always expects the worst. And so I was terrified that by telling Andy he might die, that Andy would believe him and give up hope when I needed him to fight.

Immediately after Kareem told Andy he might die, and just as he hooked Andy up to the IV, Miguel – who had been absent for an hour or so - walked in and said, “What are you doing? You’re giving a patient meds without authorization. Do you even have a medical license? I’m going to report you.”

And then he walked out. Then he came back in and said to me, “I’m sorry you had to see that,” before leaving again and taking Kareem with him.

I was sorry I had to see that too.

Then I was alone in the room, with Andy on an IV that had been given to him by someone who may or may not have a medical license, and Miguel and Kareem were in the hallway arguing about all of this. It was 1 AM. I crawled into the bed with Andy and held him and cried.

I didn’t know what was going on. I didn’t know if I could trust any of the medical providers.

Andy’s blood pressure started creeping back up. A nurse or someone peeked in at one point, didn’t speak to me, but checked Andy’s vitals and left again.

Eventually I moved from the bed to the bed-chair. I cried some more. I was afraid Andy was going to die in what was supposed to be one of the best hospitals in the country.

Then I decided to go back out there and let them have it.

I walked into the hallway, where it looked like the entire on-duty staff were huddled around the nurse’s station, oblivious to my existence, and presumably, Andy’s. They were having a loud argument with multiple people talking and yelling at once.

I walked closer and stopped within a few feet of them. They didn’t even notice. I had to yell “hey” a few times, louder each time, just to get their attention. Finally they realized I was there.

I asked who was in charge.

“I am,” said Miguel.

“No,” I said. “Not you. Someone above you. I want you to find the most senior person who is in the hospital right now and I want you to bring them to me.”

I also demanded that they keep Kareem out of our room because he had lied about Andy having sepsis.

No one contradicted me.

I think I also yelled some more, about how my husband could die because of all their bullshit.

Then I went back to Andy’s room and cried some more.

I didn’t know what else to do. It was too late to call anyone.

Eventually I fell asleep, only to have a woman wake me up to talk to me. Apparently she was the most senior person in the hospital. I lost her card and I was so tired and sleep-deprived and traumatized that I couldn’t remember her name later. She was useless, telling me that Kareem was a good nurse but that they had reassigned him for the night. She reassured me that Andy was in good hands which had clearly been proven wrong earlier. She apologized for the behavior of Miguel and Kareem but didn’t seem as outraged as I felt she should have been about Kareem telling Andy he might die. I tried to explain that hearing that would make him lose hope but they didn’t seem to care. It was an infuriating conversation.

Later I had a long talk with the head nurse, who tried to calm me down by telling me what a great nurse Kareem was, and then how survival rates for sepsis were better than they used to be. Now there was only a 40% mortality rate! As if those were good odds. And I thought it was a moot point. I didn’t care about the survival rate for sepsis since I was sure that Andy didn’t have it.

In hindsight the entire conversation was modeled on the classic misunderstanding trope in comedy, where we thought we were having a conversation about the same thing but in reality were each working with different facts – except whoever wrote our script had written it as a tragedy instead.

Months later, when I reviewed Andy’s medical file and found the note about sepsis, I started talking to friends in the medical field about what happened and we pieced together the likely scenario: Andy went into septic shock in front of me because nobody was paying attention his rapidly dropping blood pressure, and Kareem broke protocol to give Andy life-saving drugs without approval from Miguel because Miguel was MIA. Kareem probably got in trouble for it.

In the end, Andy was okay. The doctors never figured out what caused the infection. Eventually he just got better. He didn’t remember most of the horrible stuff – he was too drugged up.

I was traumatized. I still re-live seeing him in septic shock. It replays in my head like a movie trailer, a horrible prequel to his next and last hospital stay, and his death.

That photo of the boys and Andy the day he returned from Cedars always made me smile in the years since then. It made me grateful that he survived Cedars despite the multiple mistakes the staff made.

Today I tried to be grateful again– that he did survive Cedars, and that he had six more years after that. But I couldn’t muster gratitude today. I could only find sadness and anger and grief.

Today was a day I cried a lot.