Playing the game: another hospital appointment

Going to a hospital consultation, in a country where I only speak a little of the language, is not dissimilar to my time spent as a child playing adventure games such as Monkey Island, on my old Amiga computer. Yet instead of following the misfortunes of the hapless Guybrush Threepwood as he struggles to become the most infamous pirate in the Caribbean, the focus is on me, an English girl; half-deaf and with limited Spanish, trying to fathom her way around a Spanish hospital system. Yeah, it doesn’t sound as interesting, and it’s not, but it presents a puzzle in itself nonetheless. As in such adventure games there are questions, feelings of apprehension, and puzzles that must be solved before progressing with the story and moving forward in the game.

My game begins with the intense feeling of nervousness whilst sitting in the waiting room. I sit asking myself various questions: Will the specialist speak English? Will they listen to my Spanish and take me seriously, even though I’m obviously not fluent? Will they slow their speech down so I can understand some of the words? Will they be OK with writing down the names of any necessary tests, so that I can go home and Google them? Will I even hear them when they call my name!  My main hope is that they will be patient with me.

The next part of the adventure is the actual consultation. If I am not fortunate enough to meet a specialist who speaks English, I feel the difficulty level increase immediately, and uneasiness starts to claw at me. Trying to make sense of what a specialist is saying, involves me grasping at the words of which I know the meaning of, and putting them together as quickly as I can. Sometimes I find myself listening and trying to concentrate so hard, that I actually end up not concentrating at all. Sometimes I succeed in listening carefully and I manage to understand some words. However, in the time it takes me to make sense of the words, I end up missing the rest of what has been said. On occasions I am handed papers and may be told to take them to another department or area of the hospital, or to use them to inform another member of staff as to the nature of a follow up appointment. The next level follows my journey as I walk around the hospital following signs, and then coming to the realization that I have no idea where I’m going, or why I’m even walking around clutching my paperwork in the first place!

Four weeks after my appointment with the new ENT specialist, I went to the hospital for my referral with the maxillofacial doctor. The upper jaw is referred to as the ‘maxilla’, and the type of doctor I would be seeing, specializes in treating problems related to the hard and soft tissues of the face, mouth, and jaws. I went to the hospital by myself. As usual, my game began with me sitting and waiting anxiously in the waiting room. A mixture of questions were eagerly pushing themselves forward; fighting to be at the forefront of my mind. I scanned the faces in the room. There were people here of all ages. I had found myself sat next to an old man, who kept coughing loudly into a crumpled handkerchief. Whilst battling to ignore the interrogation of persistent questions in my mind, I couldn’t help but glance at a few individuals around me; studying their faces, and wondering why they were here. I’d focus for a while on someone’s features; looking at the shape of their jaw, and assessing the symmetry of their face, until I felt they had sensed my stare, and were about to look back at me. I’d then quickly move my eyes away from my subject.

My name was called, and I walked into a small room. Immediately the specialist started speaking in Spanish. Difficulty level up! I started to answer her questions, and I apologized that my Spanish wasn’t good. She reassured me by saying it was OK. The doctor had a young face, dark hair and radiated compassion. She listened to me as I explained how I had suddenly lost my hearing. She was writing everything down. Then she examined my jaw. She asked me to open my mouth as wide as possible and she felt the joint. She then asked me to close it. I repeated this a few times and she asked if I had any pain in the joints. She placed a tiny piece of card with measurements on, next to my front teeth, and told me my teeth were 3mm to the left, off centre. Then she told me that I was going to do a test. If the results of the test were negative, the treatment would be physiotherapy and wearing a night-time mouth guard. But, if the test showed that I have…then…Oh dear, my skills of following the Spanish conversation were dwindling. I had missed some important information. I told her I didn’t quite understand. She told me not to worry, and the main thing was that first I would need to do the test. I asked her to write down the name of the test and condition she was referring to, so I would be able to research it later at home. Then I was handed some papers and told to go to the receptionist.

Next I went around the corner to the receptionist. As she was speaking to me there was also another woman in the small room, speaking very loudly on the phone. I couldn’t hear my next instructions.  I apologized to the receptionist and said that I didn’t understand and that I couldn’t hear very well. She kindly accompanied me out of the door, handed me some more papers, and directed me to take them to a window down the passage. I thanked her.

Next level. I then walked forwards as far as I could go – which is the direction I was given, and wandered around for a bit. Then it hit me, the moment of realization that I didn’t know what I was doing or where I was supposed to go, or why! I spoke to a nurse who was talking to another nurse in the corridor. She directed me and told me I needed to get a ticket and then go to a window. I walked again in the direction she told me, but didn’t find a ticket machine. Hmm puzzling…I spoke to a man who was sitting at the Information desk in the entrance, and he printed me a ticket. Oh, there wasn’t a ticket machine – this man was in charge of tickets! Then he pointed to the first window and told me I was next. Next for what, I wasn’t sure! I handed the woman behind the glass screen my papers, and she was very patient as she spoke to me. I had to put my ear into the small opening of the glass, so I could hear some of what she was saying. I managed to make appointments for the test and also a follow up appointment. Then I went back to the receptionist in the maxillofacial area, and showed her my papers. She checked them. She seemed happy with my accomplishments and we said our goodbyes.

When I returned home I Googled the words the doctor had written down for me. The ‘gammagrafíatest was a ‘bone scintigraphy‘.  I would be having an injection of a dye of radioactive material. This dye would then travel around my body and emit radiation. Then a camera would take pictures of how much of the dye accumulated in my jaw bones. It was a test to rule out a condition called ‘condylar hyperplasia‘ which is a rare bone disease that affects the jaw bone, and causes asymmetry in the jaw amongst other things.

Anyway…Game over, for this day at least!

Testing testing

Eight weeks after experiencing sudden hearing loss in my left ear, I was back at the hospital to have a test called a Brainstem Auditory Evoked Potential (BAEP). I had read that this test involves monitoring responses to a series of ‘clicks’ using electrodes positioned on the scalp. In my case the BAEP could be used to assess conduction through the brainstem and auditory nerve pathways that are not as accessible to other testing procedures. In other words; the results could give the specialists more of an idea as to why I couldn’t hear anything in my left ear.

I arrived at the hospital early in the morning, slightly before the time of my appointment. I was on my own, and feeling somewhat nervous about what was going to happen. I watched as people went into the room where they do the hearing tests. I watched people who arrived after me, go in before me. I guess that due to the amount of time the test was going to take, they saw the people first who were going to have the, less time consuming, routine hearing tests.

My name was called, and a man explained to me what was going to happen. He cleaned my forehead and behind my ears with what I assumed was alcohol, and then used what felt like a small piece of sandpaper to rub the same areas in order to help the electrode pads stick to my skin. Then he stuck two pads in the middle of my forehead, one above the other, and also one behind each ear. My face stung slightly as the alcohol permeated my newly exfoliated skin. The electrode pads were white circles of thin plastic with a silver metal circle and raised bit in the middle; where wires would be attached. They looked like small targets on my head. I asked one of the staff members who, after my many hospital visits, I was now well acquainted with, and who always greeted everyone with a smile and a joke, for something to tie my hair up with. He shortly emerged from one of the rooms and handed me an elastic band. So there I was, on my own; hair roughly tied up with an elastic band and white targets on my head. I waited for the next step of the process. I was sitting in a doorway. Nurses and hospital staff kept passing by, taking a look at me and making little comments such as, “Pobre!” or “Pobrecita!” –  Literally translated as “Poor person!” or “Poor dear!” Every time someone came in or out of the room of the doorway in which I was sitting, the people in the waiting room opposite were presented with me, the ‘pobrecita’, with the electrodes stuck to her head. When the doors slid open, there I was for all to see! I waited for over an hour. They were carrying out the test that I would be having, on a young child, and it must have been taking longer than they had planned for.

When it was my turn, I was shown to a small room with white walls, two chairs, a desk and a computer. I was asked to sit on a chair that was covered with a white sheet. Wires were then connected to pads on my head and behind my ears. I put on a pair of headphones and I was told to relax and listen to the ‘clicks’. My brain was going to do the work for me; I just had to sit there. I was also told that sometimes people fall asleep during the test. Throughout the process I could hear lots of ‘clicks’. Some that were played into my good ear were almost painfully loud. I have no idea how anyone could possibly fall asleep; sitting in a small room with a stranger, with electrodes attached to their head with clicks being randomly played at loud volumes! I had the thought that, what if my brain was picking up the signals from me hearing my tinnitus noises and confusing them with the real sounds that were being played into my ears. Would this show on the results? I’m sure this isn’t the case, as most people with hearing loss also have tinnitus. But it was a thought that intrigued me. The test took about an hour. The electrode pads were removed and I was free to go home.

Three weeks later I was back at the hospital, with my boyfriend, for a consultation with an Ears Nose and Throat specialist. We were there to talk about the results of the BAEP test; whether the steroid tablets and steroid injections had helped me; whether my hearing had improved; and how I was feeling in general. My boyfriend and I had unintentionally placed a lot of hope in this appointment. We hoped the specialist would be able to tell us some more information, or give us a plan of what to try next. We walked into the specialist’s office with all of our questions written down, so I wouldn’t forget to ask them. Things always feel a bit rushed in the hospital, and they are always so busy. My heart sank when I realized it was a specialist whom I hadn’t previously met. I had hoped to see one of the many specialists who were familiar with my story. I had done a hearing test before I went into the consultation room, and the specialist explained that the test results were the same as when I first lost my hearing. He told us that the MRI results were normal: I already knew this as I had received these results weeks ago from my GP. He also told us that the BAEP test had shown the same as the hearing test – that I couldn’t hear. The test results weren’t explained in any more detail.  He said that sometimes there are cases of sudden hearing loss where, within a 6 month period, a patient’s hearing comes back naturally. He told me to wait for three more months and then come back for another consultation. Maybe a hearing aid could help me if there was no change in my condition.

Deflated, we went outside of the hospital and sat down on a bench in a park across the road.  I cried. They hadn’t told me anything I didn’t expect or already know.  I didn’t really expect them to have any more answers to tell us. But I couldn’t help but raise my hopes for a solution. I didn’t want to stop trying things that could help my situation.

We needed to put our minds at rest. We decided to seek a second opinion.

 

Frustration

The next few weeks after leaving the hospital, blended into months. I finished taking the corticosteroids and I had 4 injections of steroids into my ear, each a week apart. Yet there was still no improvement in my condition.

Friends and family were keen to ask me how I was feeling. They saw that I was out of hospital and assumed that everything was OK. But it wasn’t. I was struggling through every day with deafness and other related issues: sensitivity to noise, light-headedness, tinnitus and the ever-present pressure in my ear and head. I almost felt like I was letting people down; telling them that I was not feeling any better. I looked like my usual self, but was feeling awful. There was no visual evidence of the discomfort and frustration I was feeling. My problem was completely invisible. If I had a visible scar, maybe people would be able to empathize with my situation a little easier. I wanted to tell them something positive, and I didn’t want to upset anyone, by responding honestly. I didn’t feel any better. Nothing had changed since the day in the auditorium when this all began.

Everyone seemed to have a story about an ear problem. There were stories about ear infections and tinnitus, and about ears feeling clogged when flying. Many people also turned into specialists; asking me if I had recently been swimming or if I had been on an aeroplane? Did the hospital specialists check for ear wax? People didn’t really know what to say to me. I know that they wanted to sound positive, helpful, sympathetic…I did appreciate their support. People just wanted to show they were thinking of me. I would have done the same, if one of my friends or family were in my position. I would have wanted to help solve the mystery and for everything to be better. I didn’t want to sound negative, but I didn’t want to lie to people. Sometimes the truth is difficult to share, and it can also be difficult for others to hear; especially when they have feelings invested in the person sharing the news.

I couldn’t go to work. Being an Early Years teacher demands having energy; being able to tolerate high levels of noise, being able to go up and down stairs without feeling lightheaded, being able to hear in background noise, being able to sing and dance without feeling dizzy. The children in my class were only 4 years old. They needed a teacher who could give them the care and attention they deserved. I missed being in a classroom. I only briefly met my new class, who I instantly loved, and who I felt like I’d abandoned. It was so frustrating. I could walk and talk and breathe and see. I looked the same. But to be able to do my job properly I needed to feel better.

I was having meetings every two weeks with my doctor to inform her of any updates. She also seemed to be getting frustrated with the absence of any change in my situation. Every time I met with her I would tell her that I felt the same. One time she explained to me that it was difficult for her also. Usually she can give her patients some form of hope. Usually she can give her patients a diagnosis, or prescribe some medication, and then with time, symptoms will improve. Usually people show some form of recovery and this gives them hope. However, in my case there had been no change in 10, 11, 12 weeks, and she knew it was difficult for me. She told me to take comfort in the knowledge that my hearing loss wasn’t a result of a more sinister problem, such as stroke or a tumour.

There was still hope. 12 weeks after the day of my sudden hearing loss, I went to see a specialist at the hospital. He told me that sometimes hearing can come back spontaneously within the first 6 months after the occurrence of hearing loss. I was told to wait and see if my hearing would improve naturally. I would go back to see the specialist in 3 months, and if there were no changes in my condition, they said a hearing aid might help me.

Taking corticosteroids

When I left the hospital, I was given a prescription for Prednisone tablets, which are a type of corticosteroid. I was to take them for four weeks, each week decreasing the dose. As I have mentioned before, corticosteroids are different to the type of steroids that you hear about athletes abusing.  They mimic the effects of hormones that your body produces in your adrenal glands, which are just above the kidneys. If they are taken in doses that exceed your body’s usual levels, corticosteroids can suppress inflammation. They also inhibit your immune system, which can help control conditions in which your immune system mistakenly attacks its own tissues. If you stop taking Prednisone abruptly or taper off too quickly, some people can express withdrawal symptoms such as severe tiredness or body aches. Another reason for gradually coming off corticosteroids is that this gives your adrenal glands time to resume their normal function.

With taking corticosteroids can come many different side effects. For me there were 4 main ones. The most noticeable effect for me was the loss of my muscle tone; very quickly I lost the definition in my arms and my legs. It was nearly autumn-time in Madrid, but the days were still often warm. I would enjoy going for short walks with my boyfriend, and in the warm weather I would sometimes have bare legs. Every day, when I looked down at my legs, they seemed to get thinner and thinner. I called them my Bambi legs. At first the sensation when walking, was as though my body was really light and I felt like I was almost gliding. Later, my legs started to become achy and wobbly, and I would become tired much more easily. Next were the hamster cheeks. I had read that people who take steroids can have a redistribution of fat. As the days went on, my cheeks seemed to get fuller. This side effect however, didn’t bother me too much. My face has always been very slim, and slightly puffy cheeks actually didn’t look too bad. I felt lucky, for the first time in my life, to have such a thin face, as I know that this is a side effect that can really upset takers of Prednisone who start off with more rounded faces. Similarly, another side effect was the little tummy bump that seemed to be growing with every tablet I took. It wasn’t that the tablets were making me fat, in fact my arms and legs were getting thinner, but that I had a little distribution of fat around my tummy that didn’t seem to be a result of how much I ate. Then there was the crying; this started when I was in hospital. At first I put my teary outbursts down to my situation: I was scared and tired and felt helpless. However, I realized that I didn’t seem to have any control over my emotions and would randomly start crying. These emotional eruptions continued during my weeks of taking the Prednisone at home. I would find myself thinking about my situation, about possible causes for my hearing loss, and about a future with unilateral hearing, and I would break into a mess of tears. I guess that when thinking about my condition, it was quite a normal reaction to become upset. However, there were times when tears were just unwarranted; sometimes my boyfriend would come back from work and I would be happy to see him, so I would cry. He would get me a cup of tea, and I would cry. I ended up telling him to ignore me when I was crying, especially when I was in the hospital and he had enough to worry about, than me bursting into tears at regular intervals. After taking corticosteroids for only a few weeks, I have so much sympathy for people who have to take this kind of medicine for longer periods of time. I know corticosteroids can save lives, but it is with the risk of some nasty side effects.

Every week, on a Tuesday, I would go to the hospital for steroid injections in my ear. There was about an hour each time, immediately after having the injections, that my ear felt more ‘open’, like there was slightly less pressure. But after that hour usually followed a headache and some pain deep inside my ear, with any small improvement diminishing to nothing.

It took a few weeks to get the results from my MRI scan. My doctor printed off the information, and told me that everything was ‘normal’. Although I was happy that there was nothing sinister on the scan such as an acoustic neuroma, I also felt somewhat frustrated, as we were still no closer to knowing what had caused my hearing loss. I found myself constantly searching on the internet for an answer, because it seemed like nobody else had one to give me.

Time to go home

It was Friday and what I was hoping would be my last day in the hospital. My roommate had also been told that she may be able to go home on this day, and when we awoke that morning we greeted each other with optimistic smiles and crossed our fingers.

During my week in the new room, friends came and visited me nearly every day; visitors who all came with stories and who were all bearing gifts. One day, my friend who was heavily pregnant at the time, came to visit. She shuffled radiantly in to my room, carrying an enormous and beautiful tropical-looking plant. She is only a small lady, and I could barely see her behind the long green leaves, and the red cellophane wrap which surrounded the plant. She made me giggle with stories about her pregnancy. She was only a couple of weeks away from her due date, and she told me how she felt like her hands and feet were so swollen that they resembled pig’s trotters! She also spoke about the various methods she had been trying in order to go into labor, and how she was going to start drinking some special herbal tea that she hoped would lead to a successful result.  After chatting for a long time, we said goodbye; both wishing the other well with the new challenges life was going to bring. Another friend, who I have worked closely with for around 2 years, came to see me with her husband. This friend is much taller than me, and she gives the best hugs. When she entered the room, she enveloped me in her comforting embrace. She lives outside of the city, and she brought me figs from her garden and told me all about what had been going on at the school I work at. On the Thursday evening, two other colleagues came to visit; one Italian and the other Spanish. They brought me a big card with drawings from all the children in my class, and it made me feel sad to not be able to be there with them. Again these friends told me about more news from my school, and updated me on how the children in my class were doing.

Whilst in hospital I had been desperately looking forward to normal everyday life. My boyfriend and I had talked about what I would do when I got home: take a long shower, put on clean pyjamas, eat spaghetti, go for a walk in the sunshine, watch a film together, have a cup of tea, eat Marmite on toast, sleep in my own bed… The normal seemed so exotic to me now!

My roommate showered promptly that morning. Her doctor visited the room early and I could hear him making preparations for her departure. I felt so happy for her. After the doctor had gone, she went to our cupboard and took out some clothes. Shortly she emerged from our bathroom, in a fitted flowery dress, and looking revitalized. I had to wait to be disconnected from the IV machine, and then I went to have a consultation with a specialist. It was the same specialist I had seen on the Monday. There had been no improvement in my situation. I still couldn’t hear in my left ear, and I was also finding loud noises uncomfortable, and was experiencing tinnitus and fullness of pressure in my ear. I was told that I would need to take Prednisone (a type of corticosteroid) for four weeks, in decreasing doses each week. I would also continue with the intratympanic steroid treatment of having injections in my ear, every Tuesday for three more weeks, and I would need to make an appointment for an MRI scan. I was still hopeful that the medicine would start to work in tablet form, and the thought of being able to properly relax and rest in my own home also made me optimistic for a recovery. When I got back to the room, I quickly showered and put on the grey dress that I had worn a week ago when I was admitted. It felt great to be wearing normal clothes. Soon after, I was again attached to the IV medication and I waited, sitting on my bed, for my paperwork to arrive and to indicate my time to go home. I waited a few hours. I said goodbye to my roommate and we gave each other a hug and wished each other a quick recovery.  It wasn’t too long before I was walking to a taxi, holding on to my boyfriend with relief. It seemed so bright outside. Very soon I was home.

Two weeks later it was the day of my MRI appointment and I received a message from my friend. She wrote that today we would both be in hospital. Beneath her message was a photo of my friend with a joyful smile, in a hospital gown, waiting for her baby to arrive.

Injections and a bit of love

The next morning, after seeing another specialist, I had a visit from the doctor who I had initially seen when I was first admitted to hospital, 4 days ago. She told me that there was another treatment called Intratympanic Steroid Treatment which would involve injecting steroids into my ear, once a week for four weeks. I told her that I was willing to try anything, and very soon I was lying on my bed as she tipped drops of anesthetic into my ear. She went away, after telling me to lie still and let the anesthetic numb my ear drum. After about half an hour the doctor came back and took me to a room just down the corridor. I was asked to lie down on a cushioned bench and to stay very still. I couldn’t see what was happening, but the doctor talked me through her actions. First she used a little vacuum-like tube to suck the anesthetic drops out of my ear. Then I felt a needle pierce my ear drum and travel through my ear, to what felt like deep inside my head. I could feel the needle somewhere between the bone of my jaw and side of my throat and was experiencing a scratchy pain in this place. I was desperately trying to stay still. My eyes were watering with nervousness and discomfort. After the steroids had been injected, I then continued to lie in the same position for about another half an hour to allow the steroids to infuse into my inner ear. I was so tired and lying there on the doctor’s bench in my hospital gown, I felt extremely vulnerable. I closed my eyes.

When I got back to my room, I was given a handful of cotton wool to soak up the mixture of liquid and blood that had started to drip out of my ear. Whilst feeling sorry for myself, and gently dabbing my ear, my boyfriend entered the room.

When I was in hospital my boyfriend was always by my side. Every day he would appear in the hospital room doorway with a smile. He’d bring pastries for breakfast, which we’d enjoy together in the mornings. When I was fed up of the cold milky hospital coffee, he brought me peppermint tea in a takeaway cup from a café outside the hospital. Every day he asked me for a list of things he could bring me from home that would make me feel more comfortable. He’d sit by my bedside doing work on his laptop while I slept. He would hug me tightly when I was upset or scared, and would always manage to calm me with positive words. One day, when the intravenous was uncomfortable, he washed my hair for me – I joked with him, that it was the most intimate I’d ever been with anyone! .

One day I was desperate for some fresh air, and my boyfriend and I decided to escape for a bit. I put my denim jacket over my shoulders and put my plimsolls on. Dragging my IV stand with two swinging glass bottles, we scurried to the lift. Once on the ground floor, my boyfriend carried my IV stand down the ramp to some exit doors, with me following behind. When we got outside we sat on the wall where the hospital staff usually gathered on their smoking breaks. There was a slight chill in the air as summer was moving into autumn; though the sky was a lively blue. I was longing to go home.

Before my sudden hearing loss happened, I would often rush through my days and routines, and everyday life would pass by, without time to pause or appreciate it. It was when I was in hospital I had time to reflect. I had moments of intense emotion, where I felt so thankful and fortunate for the love and care my boyfriend was showing me. I could see he was scared, and that he needed someone to talk to as well. I know it was hard for him, especially going back to an empty apartment with a mind full of worries and questions.

New medication

My first night in the room was an upsetting one and I felt like I was also imposing my distress on my roommate. In the early evening a nurse entered our room with a small, cubic-shaped machine and an intravenous stand; which looked like a cheap metal, unembellished hat stand. What I understood from what she told me in Spanish, and what her actions were telling me, was that she would be giving me some medication which involved the machine. The medication I’d previously been given had not required a machine, so I was puzzled at its presence. She proceeded to attach the machine to the stand, tightening a clamp at the back, and then clumsily secured an IV line to my arm; passing this thin plastic tube through a gap in the machine. She attached a small brown glass bottle of corticosteroid liquid to the top of the stand, and told me to press the emergency call button to alert her if the machine made a beeping sound. Within a few minutes the beeping started. As instructed, I pressed the red button that was attached to a cord next to my bed. ‘Beep Beep Beep…’ With each Beep I felt more and more awkward as I was certain I was disturbing my roommate. The nurse came back to the room to see what the problem was. She had short brown wavy hair and wore red glasses. Her glasses were on a string around her neck that she kept taking on and off in order to look at the machine, scrunching her face into an unnerving expression. She straightened out the IV line and then fed it back through the machine, pressed a button, and again told me to call her if the machine beeped. A few minutes later, ‘Beep Beep Beep’. Again I pressed the little red button, and again I felt concerned about disturbing the calmness in the room. This time the nurse took longer to return, and my roommate asked me if I had pressed the call button. I reassured her that I had. Back came the nurse, looking even more frustrated. Fumbling with her glasses again, she straightened out the IV line and then fed it back through the machine, pressed a button, and yet again told me to call her if the machine beeped. The third time it beeped, the nurse entered the room looking puzzled and exasperated, and this time she decided that it was a problem with the intravenous line in my arm. She then proceeded to check my arm for more suitable veins; taking her glasses off and putting them back on, to be certain of her choice. She decided on a rather uncomfortable location where my wrist meets my hand, just down from my left thumb. I turned my head so as not to watch her make the initial puncture in my skin, and tensed my face as I felt her awkwardly insert the IV line. She taped the tube to my arm, and again straightened out the line and then fed it back through the machine, pressed a button, and yet again told me to call her if the machine beeped. Once she had left the room, and the machine had been quiet for a few minutes, I lay back on my bed and tried to relax. Since the medication bottle was small, I naively expected its contents to have been transferred into my body quite quickly, and then I assumed it would be unattached from my arm and I would be able to sleep comfortably. However, I soon realized that every few minutes when the machine made a mechanical clicking sound, only the tiniest of drops was released into the tube, and into my arm. I fell asleep, thinking that I would call a nurse when the bottle had finished, so they could disconnect me. An hour or so later, I awoke with an acidic stinging sensation in my arm. My arm had started to become swollen just above the line entrance, where the unpleasant liquid was entering my body. With every tiny drop, came more pain. I lay there, drifting in and out of uncomfortable sleep, until around 4am, when the machine finally beeped to signal the bottles emptiness. After only a couple of beeps, in came another nurse. This time it was a short, middle aged man, with a calm and friendly nature, and who entered the room with a torch in his mouth, so as not to disturb us with the room lights. I told him I was in pain, and his demeanor seemed to suggest that this was normal, although I was very tired by this point, and could not focus on what he was telling me in Spanish. As he removed the tube from the bottle, I heaved a sigh of relief. But a second later, to my dismay, he attached another identical bottle to the line, straightened out the line and then fed it back through the machine and pressed the button to turn it back on.

By the second night, my arm was so swollen from the excruciating buildup of medication that the nurses had to try two more IV locations in my other arm, and I also finally ended up getting a different machine.