by S. Mina
ENTRIES:
1. "Tales from the Georgetown Hospital Surgical Ward (and Beyond)"
2. "The Iraq War: A Soldier's Story"
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Tales from the Georgetown Hospital Surgical Ward (and Beyond)
by Samantha Mina, 2008
Chapters:
* Introduction
* 2008: My Year In A New World
* 01 - 02/08: Stories from the Surgical Center
* 12/07 - 1/08: Recollections from Reston Radiology
* 03/08: Post-Surgical Update
* 01/09 (1-Year Anniversary of Diagnosis): Final Note
Cutting-edge medical researchers now believe that life and death begin in the digestive tract."
— Jordan Rubin, N.M.D., Ph.D., in The Maker's Diet
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Introduction:
For all of 2008, I went on leave from the University of Virginia due to Superior Mesenteric Artery (SMA) Syndrome. (Click to read the Wikipedia article I wrote. Also, watch the YouTube video posted on the "World Rare Disease Day" profile that describes my personal struggle with SMAS). On January 31st, 2008, I had a fairly major surgery (open duodenojejunostomy). For months thereafter, every day was a struggle, as every bite still hit my stomach like broken glass. I may not have "looked sick" to passerby, but having the blood-cell count of a cancer patient, the weight of a ten-year-old, and the digestion capacity of a senior citizen made it hard to attempt normal life. It changes you, to have been diagnosed with a life-threatening condition with a demographic of only 0.013%, making it one of the rarest gastrointestinal disorders known to medical science. I've learned first-hand that I honestly do not fear death, because I trust in Christ. In January 2008, my cardiologist told me I was only a few pounds away from heart failure. According to the World Health Organization, a body mass index (BMI) under 18.5 is considered underweight, under 16 is starvation and under 15 indicates a danger of organ failure and cardiac arrest. My BMI, just below 70 pounds, was an 11.5. People in the street stopped me to say that my "super-skinny body is to die for." They didn't know just how frighteningly true their words were. Yet, throughout this entire ordeal, my faith in the Lord has only strengthened. :)
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2008: My Year in a New World
It all began with a case of pneumonia near the end of my sophomore year of college, when I was nineteen. For ten days, I couldn’t leave my bed, let alone walk to the dining hall. Naturally, my weight was in the mid-90s, but by the end of that week, I was down to the upper 80s. (SMA generally happens to people who are already naturally lean, with the majority of cases occurring in young women.) I began to get awful stomach pains, unrelated to the pneumonia. Only a week later, I developed sinusitis. And then the flu. I didn't understand it at the time, but this was the slow breakdown of my immune system that comes with being underweight. Summer came, and I found that I could barely swallow a bite without feeling sick - and I don’t mean that figuratively. I was always freezing, though it was hot, and I caught colds every other week. One night, my mom caught me crying on the floor with my stomach hard and distended, like an apple. School was starting in a week, so of course there was no time to wait for a specialist or to begin testing at a hospital. So, I just saw my general practitioner.
I stepped on the scale in her office and found that, at a height of nearly 5'5", I had hit 75 pounds. The doctor couldn’t diagnose me without running any tests, but she did explain to me the Body Mass Index Scale: Under 18.5 is underweight; under 15 indicates danger of organ failure and cardiac arrest. My BMI was 12.5.
The next week, I returned to UVA for the spring semester, despite warnings from my physician. (I just loved school so much, I was blind to the dangers I faced). By then, I’d become so weak, the physical aspect of college life had become almost impossible. I lived in a building that was a forty-minute walk from central campus and more than twelve flights of stairs up from the street, with no elevators. I couldn't go anywhere without taking rests on the curb. I stopped bringing half the required books to class because I couldn’t lift them. I grew faint and dizzy when sitting in lecture. I was always so cold, I wore leggings under my pants and turtlenecks under my sweaters, even in early September. Sometimes, I wore a winter coat and gloves indoors. I skipped half my extracurriculars out of exhaustion. Every night, I had tremors and palpitations that made it difficult to breathe and impossible to fall asleep.
But, worst of all was the stabbing in my stomach. Often, I’d have to lie face-down after a meal from pain, even if that meant stretching out on the chairs in the dining halls.
One November day, I tried to jog after a bus that was about to leave without me, and a debilitating pain struck me in the center of my chest - I'd never felt anything like it before. I stumbled to the ground, dropping my backpack, hands numb, chest heaving, unable to breathe. The bus stopped and the next thing I knew, someone onboard had called an ambulance, falsely reporting that I was having a heart attack. That upset me because I’d always considered doctors and medicines as coddling; growing up, I even refrained from taking Tylenol for colds. But, this time, I let myself be taken to the University Hospital. There, while I was given an EKG, I mentioned my continual stomach pain, and the doctor told me I probably had IBS—a very common, incurable intestinal condition. I faced myself with the prospect of feeling like this every day for the rest of my life. The idea was unbearable. I was convinced that it had to be something more serious. Something treatable.
When I went home for Christmas break, I began intensive testing at Reston and Georgetown Hospitals. The tests were grueling, some even barbaric. I was scanned, biopsied, scoped, prodded, poked, injected, infused, dehydrated, starved, x-rayed, strapped to a tilt-table and turned upside down, fed literal liters of radioactive chemicals, and was even landed in the ER twice from allergic reactions to the IV and oral fluids. The holiday season passed with nonstop tests, but no diagnosis. By then, the pain had forced me into an all-liquid diet.
And, by New Years, I hovered around seventy pounds. My BMI was 11.5.
I saw a gastroenterologist who wouldn’t take me seriously because he was convinced I was anorexic. I saw a hematologist who told me I had the blood-cell-count of a cancer patient. I saw a cardiologist who told me that I was only a couple pounds away from heart failure. And I saw a rheumatologist who estimated I had six weeks left to live.
I was scheduled for a very invasive test on January 3, 2008. The night before the prep, I researched what exactly that test is used to diagnose and found that I lacked all the conditions’ symptoms. So, I called and canceled, researching for alternates. I stumbled upon a resource that described “CT with PO contrast” which would image twice the surface area. So I called my doctor and asked for it. Four days after the CT, the results were in: I was diagnosed with SMA Syndrome. I was told that the diagnosis would’ve been missed if I’d only done the test the doctor ordered.
The following week, I met with a surgeon at Georgetown Hospital. He was the first to truly explain SMA Syndrome to me. He said that it used to be terminal, but now 1 in 3 patients die of the condition either by: catabolysis (advanced malnutrition in which the body begins to digest organs), acute gastric rupture (in which the SM artery slices through the intestines), aspiration pneumonia (when food spasms from the stomach to the lungs), spontaneous upper gastrointestinal bleeding, hypovolemic shock, or sudden collapse of the entire cardiovascular system. I was confronted with the fact that my life could only be saved by a major bypass surgery called open duodenojejunostomy. What he didn’t tell me is that laparascopic (as opposed to open) duodenojejunostomy is an alternative operation for SMAS, meaning that the three-inch scar on my upper belly wasn’t actually necessary. (Laparoscopy does not leave scars because it is done with 5mm-punctures).
I went on medical leave from college not only for the surgery, but to recover from SMAS in general. By the grace of God, as of September 2009, I have gained about 15 pounds from my lowest weight and have successfully returned to school, now in my final year at UVA with law school lined up next. The Lord carried me through all this, and I know now that no matter what comes my way, I’m always shielded, armed and ready - not by my own strength, but His. :)
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01 - 02/08:
Stories from the Surgical Center:
Prepare to enter the world of my hilariously horrific hospital stay (January 31st - February 6th). Get ready to laugh/cringe.
#1:
My nurse wanted to give me my daily hebburn shot either in my stomach or my arm. She didn't know where I had my surgery, and, anatomically, the stomach is the best place to give that specific kind of shot, as the medicine requires a certain amount of fat at the site of the injection for proper absorption. She could obviously see that my twig-arms didn't qualify (but, then again, she said she believed no part of my body could qualify, including my concave stomach). In any case, I told her to give to my arm, since my abdomen was the site of the surgical incision. She said, "Oh, I'm sure there's some room next to the incision." Was she kidding!? My stomach hurt so badly, I couldn't even stand the feeling of my gown touching it. Yes, I actually sat there holding my gown up all day for the first three days after the surgery, so it wouldn't even brush into my tummy. And she wanted to stick it with a needle.
#2:
At 4:00AM on Saturday, February 2nd, a technician thought it was a fabulous time to give me a chest X-ray. You know that heavy pad that's used to shield body parts that don't need to be imaged? The technician woke me up that morning by dropping that pad on my stomach. No exaggeration - he actually dropped it from a couple feet up, smack dab onto my stomach. It was all I could do not to scream at the top of my lungs and wake up the whole ward.
#3:
My roommate used to defecate on the floor of the bathroom. Not just once or twice, but multiple times a day, every day. Nearly half a week passed and no one cleaned the diarrhea - more just kept piling up. I was stunned the staff at Georgetown would actually leave things that way. So, I made a special request to have it cleaned. After another twenty-four hours, it appeared as though my inquiry was ignored. It turned out they had sent the housekeepers to the wrong room. When it finally did get cleaned, I didn't even get to use the bathroom before my roommate went back in there and... well, you can guess the rest.
#4:
My surgeon, said to my mom, dad and I that our behavior is a "testimony to the strength of this family." He obviously has no idea that my parents are divorced…
#5:
For the first four days after my surgery, I was put on a morphine drip. I could push the button every eight minutes for pain relief. (Imagine a fork jabbing and twisting your intestines like noodles - that was how the internal stitches felt, even with the drip). Well, I turned out to be allergic to the morphine; it made me itch like I had mosquito bites all over my body. So, the nurse decided to give me a second IV with hydroxyzine to make the itch stop. The combination of medicines was too much for my 70-pound body to handle - I fell unconscious. When I finally woke up hours later (not on my own, but with help), she asked me, "how much did you say you weighed again?" When I told her, she exclaimed "Oh, if I'd known, I wouldn't have given you that much medicine!" I was shocked: Nurses are supposed to have the patient's records on hand. And, even if she didn't have my records, couldn't she see me with her own two eyes and know to ask? Of course I didn't think to tell her myself - I trusted that she, as a heathcare professional, would know how to measure a safe dose.
#6
One afternoon, when my surgeon visited my room, he told me, "I know you well, inside and out."
#7 - 10:
There's a few more incidents I can think of, like the time the nurses delivered my pain meds ninety minutes late despite my incessant pushing of the call button; the hour-long needle torture sessions by nurses who didn't even know how to properly stick an IV or a catheter; the afternoons my parents spent watching America's Funniest Home Videos on the room TV when I couldn't laugh without my stomach feeling as though it were about to split apart; and the evening when the nurses took away my dinner when I said I was intolerant to one ingredient in it, ultimately forgetting to provide any replacement meal at all...
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12/07 - 01/08:
Recollections from Reston Radiology:
#1:
The Friday before my surgery, I spent nearly the entire day (from 10AM to 4:30PM) doing an Upper Gastrointestinal Series (UGI) at the Imaging Center. I had to fast both the night before and as long as the test was in progress; this made me quite dizzy, achy and cold by the end of the day (body-heat and muscle function requires energy, and it's not like my body had a reserve to draw from!) The test began with swallowing a handful of dry Alka-Seltzer crystals (ouch) in order to create a pocket of air in my stomach (ouch), then downing two sixteen-ounce bottles of barium sulphate (gag) so my organs could show up on the X-Ray. The technician took images every half hour until the barium hit my colon. He exclaimed, "For a young, healthy individual, this should've only taken two hours, not all day!" I didn't really know what to say to that. I mean, if my digestive system was "healthy," I wouldn't have been taking the exam in the first place, now would I!?
#2:
Well, overall the UGI was a less intense experience than the Computed Tomography (CT) scan I had in late December, though the CT scan took far less time. The chemicals from the CT IV caused some serious hot flashes. Hot flashes, plus the sensation your throat is closing, heat in the bladder area, headaches, metallic taste in the mouth, numbness in the hands and feet... The nurse who hooked the IV told me, "The solution is flowing into your veins at the slowest possible rate it can be set, but even that is faster than your own blood flow. So, this may feel a bit intense." As the solution coursed, my veins protruded all the way up my arm like a black net.
However, I am very glad I did the CT scan, because that was what ended up leading to a diagnosis. All 93812091859 other tests I took beforehand yielded nothing. The interesting part is, I wasn't even supposed to have the CT scan done. I was the one who requested it, not the doctors.
Here's the full story: I was scheduled for a fairly invasive test on January 3rd. The night before the prep, I decided to do some online research to determine what exactly that test is used to diagnose. I found that all the syndromes and diseases on the list didn't pertain to me, because I didn't have their symptoms. So, the next day, I called my GI's office and said that I didn't want to have to go through something so intense if it wasn't going to help point to a diagnosis. I was told that normal results were indeed anticipated, but the doctor figured we should do it anyway because it is "routine." I was baffled, and a little angered. Routine? Routine what? I cancelled it on the spot, and researched online for comparative tests. That's when I first read about "CT scan with PO contrast." I figured it would do even better, because it images twice the surface area So I called my GI and asked him to write a prescription for one. He agreed. I took the test and a week later the results came out: I was diagnosed with SMA Syndrome - a condition affecting an area that would not have been imaged by the doctor's originally ordered procedure!
I believe that God is responsible for this development: It was the night before the prep when I suddenly began to feel an urge to search for alternate tests. I believe God was guiding my actions. He spared me a procedure and led me to the exam that would end this wild goose chase and yield a concrete diagnosis.
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03/08:
Post-Surgical Update:
I saw a new gastroenterologist at Georgetown Hospital for my post-surgical follow-up: Dr. Stanley Benjamin, who is on the "Top Doctors in America" list. He costs the same as any other GI (thanks to insurance) and he works at the hospital at which I've been receiving treatment thus far, so I figured why not see him instead of my original GI? The only drawback is that he is crazy-busy (not just seeing patients, but attending/holding conferences, traveling to his fellowships in other hospitals, writing and publishing research papers, teaching med classes--basically, doing far more that your average GI). This means that his secretaries practically have secretaries of their own, and that his appointment waiting-list goes on for a mile. But, I didn't have to get on the month-long list for my visit because I am a post-surgical patient from the hospital. I was seen within two weeks of calling!
My appointment on March 24th was interesting. Dr. Benjamin told me that my UGI and CT images were reviewed in a large conference throughout the Georgetown Gastroenterology and GI-Surgical departments after my operation in January. The topic of discussion? The existence of SMA Syndrome. Apparently, the condition is so rare, some people in the medical community at large doubt its existence entirely. Dr. Benjamin said he was a skeptic himself, though he's now more willing to consider it, for my images are a "most compelling example" (which truly is something coming from a doctor so experienced!)
This may sound odd, but it felt like a bit of a slap when such a prestigious doctor told me of his skepticism, straight to my face. How can someone doubt a condition that disrupts (and, in more than enough cases, destroys and ends) lives? Untreated SMA Syndrome is fatal. Many have actually died from it before. A few weeks ago, I was contacted via YouTube by a fifteen-year-old girl who was diagnosed with SMA Syndrome when she was eight. Unlike me, she never had a duodenojejunostomy, so she has never recovered. Instead, she's being fed for 20 hours a day via jejunal feeding tube. All she can eat by mouth is chicken broth, and even that does not always stay down. Her story makes me want to cry. It makes me really wonder how some medical professionals can look at her and deny that her condition is real.
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01/09 (1-Year Anniversary of Diagnosis):
Final Note:
God has humbled me a lot throughout 2008; He temporarily revoked my comfort-zone of the university, forcing me to slow down and straighten my priorities so that He always comes first, before grades and performance and extracurriculars. I've also gained a better perspective of the limits of human medical science and technology. Most people think doctors can fix anything. But, the truth is, only God can, through whatever means He chooses.
I think it's the "glass half full" mentality that has gotten me through it all, and that mindset has truly been a blessing from God. Not to say I didn't have my fair share of private whiny and mopey moments, of course ;) . But I figured that the suffering would only intensify if dwelt upon. For example, instead of groaning about how little sleep I'd get because of my abdominal pain, I thought: "Hey, I just had five whole hours, which is one more than yesterday!" And so forth. Also, if something was looming over my head, like a surgery or particularly invasive test, I tried not to think about it at all, except when in prayer or at a doctor's appointment. I figured, if I was going to have to go through with it anyway, why "pre-live" it hundreds of times and multiply the suffering? This has saved me a lot of fear and stress.
My priorities have definitely changed in the last year, mainly because God has shown me the consequences of putting Him second. When I gave my novel-writing almost all of my free time, God gave me a massive computer crash that deleted hundreds of pages. When I channeled all my energy into obtaining a 4.0 GPA and performing in as many extracurriculars as possible (cutting into time that I should have spent with Him), God responded by taking the University of Virginia from my life for all of 2008. God used that time to sharpen me, and make me cling to Him. I see these trials as revivals. When my parents split when I was twelve, my relationship with God took a leap forward. Same with this health saga I just endured. So, I now figure, how could I be too sad or upset that these "bad" things happened when they ultimately lead to something as good as spiritual revival?
Now for the much-anticipated college update: After twelve full months on leave, I will not be returning to UVA until the 2009 - 2010 academic year... but not for medical reasons, this time! I have been accepted into Georgetown University's highly-selective "Semester in Washington" Program for the spring 2009 semester, which, in my case, includes a Congressional internship on Capitol Hill alongside a full schedule of politics classes.
January 2009 marks the one-year anniversary of my diagnosis of SMA Syndrome and consequent life-saving duodenojejunostomy. 2008 has been an incredible year in every sense of the word. The Lord has taught me much as He captained my spirit through storm after storm. God continues to hold my hand wherever I go, showing me now that I can still enjoy a "normal life" despite any past physical trial. :)
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The Iraq War: A Soldier's Story
by Samantha Mina, 2005
At first, I only told this story to a couple of my close friends. But when one responded with "The more all of us know about it, the sooner we can make it stop," I realized that I should spread this to as many people as possible in order to increase awareness.
As a freshman at the University of Virginia, I am a pen-pal of a US soldier serving in Iraq. The college's "Help Our Troops Club" received two letters in response: One from each of the leaders of the platoon we were sponsoring.
Oh
My
Goodness.
I don't know where to begin. One of the officers, Tom (name changed to protect privacy), claims that "the platoon has high morale" and is "in good spirits" but I honestly find that hard to believe when considering all the horror that the other officer, John (name changed to protect privacy), relayed to us. Well, to start off, sixteen soldiers serving alongside the two in their "square of Iraq" have already died, many more wounded. John and a few of his men went on a night raid and accidentally wound up badly wounding / slaughtering a group of four to ten-year-old Iraqi children. John described this all in detail, how visible chunks of the little kids' legs got blown off and how some of them were bleeding to death before the marines could transport them to their hospital units...
There's also the story about how John's unit fired at the enemy, missed by 500 feet and wound up shooting a fellow soldier right through the hip while giving another a concussion. Others fell into a ditch when their structure had collapsed, and they became buried beneath giant boulders. Many suffered broken bones and concussions. All had to be rescued.
Then, there's the time where they had to travel one-hundred-fifty miles (which is only a little more than the distance between my hometown, Reston, and my college town, Charlottesville. It is a two-and-a-half-hour car trip, to give you an idea) across an Iraqi desert at night, accept that it took them nineteen hours instead of three due to their dilapidated vehicles and tanks that keep breaking down. John's description of the nineteen-hour voyage and all the troubles it involved goes on for pages. He says "travel in the military world sure isn't the nice, neat, two-hour trip in the Lexus back home."
John details how his platoon conducts attack after attack, travel after travel, raid after raid, strategy session after session, all without sleep. They asked us to send them white socks and protein supplements like Nitro Tech and "ripped fuel."
There's a part in my Fire & Ice novel series in which a military commander says something along the lines of: "The state of the war was becoming so desperate, we were receiving batches of untrained rookies at an alarming rate, and they were dying as fast a they were arriving." Indeed, that actually mirrors real life. So many "green" recruits, as John calls them, are being sent over to Iraq before they learned how to properly drive a Hummvee. The result? Two seven-ton hummvees overturned (driver error), three more crashed (driver error again), two more collided on the road (driver error the third), and three more took incorrect routes - that is to say, routes that were rigged with mines. Those hummvees exploded.
Then, there's the time where they witnessed an insurgent's firebomb kill 160 civilians. All John had to say about that was "it could have been worse."
And there's the story about the mortar fire that took the men by surprise - with neither helmets nor flak, they huddled together for protection, which of course did nothing. Officer John is angry at them for behaving like a "flock of geese, or something," and huddling when they should have been mobilizing.
So, what is John's reaction to all the horror he so meticulously relayed? He said he is "tempted" to feel sad, but he refuses to because "as leaders we can't afford to dwell on the ugliness, and the tragedies. We have to accept it as an unfortunate reality of war. To dwell on it would be counterproductive. The military is a destructive force by nature, what this is called is collateral damage, and we have to accept it and move on to the future." John goes on and on about how he can't let this affect him, and how he has to move towards the future. John is only a junior at my university (merely two years older than me) and he's already talking like that. Yeah.
Tom, on the other hand, claims that the morale of his platoon is, in fact, "very high" and that they are "definitely bringing the fight to the insurgency... lead[ing] many successful operations." Tom emailed Erin, the president of our club here at my university, a picture of himself and a few of his comrades, which she printed out and showed to us today at our club-officers meeting. It was unspeakably difficult to look into their eyes, to behold their young, smiling faces.
Overall, John's tragic letter trumped Tom's cheeriness in the eyes of our club. As I write this, I myself am still working on absorbing everything he conveyed. But, alas, I suppose I should have expected this.
These letters have made writing to my own penpal tougher. Erin warned us sternly to "BE UPBEAT" and avoid mentioning their tragedies, as they are not supposed to dwell on them, and the purpose of our club is to offer encouragement. Yeah, I thought, like I can just ignore everything John wrote and scribble down a bubbly "Hi! I had a lovely day in sunny, safe Charlottesville while you were out there in the desert, dealing with all that #&^%@!"
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Life: 11/05/09 | Posted By: RedViolin | 0 comments
