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Over the Counter OD 

A pseudoephedrine trip through the health care system

The story I'm about to tell you is shocking.

And true.

It'll make you question the state of our country's health care system, your faith and your own mortality.

My story starts like this:

It's the second week in April in the Piedmontthat's the central part of the state for all you non-Tar Heels out there--and spring is getting off to a good start. The oak, birch and pine trees, along with a gaggle of flowers, are all starting to bloom.

Which means pollen is in the air. Lots of it.

Pollen is my worst enemy. For several years now I have been battling chronic sinus infections brought on by the onslaught of pollen soot dished out by the pine trees. You can't leave your car windows open--or the windows to your house--during this period unless you want to have everything you hold good and dear to your heart covered with a greenish, yellow dust.

Remember that word: heart.

"I'm takin' you outta my pillbox/ I should report you to the FDA."

-- The Joneses

So the pine comes a-knockin' on my sinuses and I resort to the ol' habit of chowing down liberal amounts of Sudafed (90 mgs of pseudoephedrine sulfate, or three tablets, every six hours) and going through a few boxes of Kleenex. Suddenly, the weather takes a turn and drops from the mid-70s to a balmy 50 degrees and brings with it some rain.

Rain is good.

Rain washes away the pollen.

I am feeling happy that the end is near. But the rest of the family isn't doing so well. Both of my sons (11-month-old Cole and 4-year-old Spencer) come down with raging ear infections complete with snotty noses and nasty coughs. Just a couple of weeks earlier, both my wife and Spencer battled a 24-hour stomach flu that made its rounds through the schools and offices. Apparently, Spencer didn't get back to full strength before he got hit again with the ear infection (probably from his little brother). Sleep is a precious commodity that neither my wife nor I see much of during this time. But outside of the generally miserable feelings associated with head congestion, I'm feeling fine and somewhat surprised that I haven't been laid up with anything the rest of the family has had to face.

In literature, they'd call this foreshadowing.

By April 15, I'm in the throes of the busiest weekend for my part-time job--as a stay-at-home-dad, I supplement the family income by working catered events. Usually I bartend and help with the set-up and break-down of wedding receptions, graduation parties and the like. For three straight days you can see the yellow pollen misting through the air like a fine spring rain. It coats everything. I take lots of Sudafed, work my ass off, then come home to two miserable kids who wake several times during the night with complaints of earaches. Well, the baby just cries and thrashes about like a possessed demon while his older brother is actually fairly articulate: "My ear hurts!" he screams. "Make it stop."

By Saturday afternoon the head congestion has sunk into my chest and midway through my shift I'm thinking there's no way I'm going to be able to work the next day's gig. I'm beginning to feel like ass. Hell, not even a beer sounds good, and I know that's a surefire sign of the infectious hellstorm that is about to sweep through my body. The Sudafed has not helped. By Sunday morning, I am right about my suspicions. The hellstorm has arrived. I've called off on my shift and have managed to convince the family to let me sleep. My wife is gracious enough to concede to this even though it's a beautiful day, because she knows I'll need a recharged battery to get through the week as stay-at-home-dad. She suggests Clartin-D, which has worked for me in the past. By midday, I swallow a 24-hour Clartin-D (loratadine 10mg/pseudoephedrine sulfate 240 mgs), get horizontal and stare at bad TV.

When I wake up Monday, I look at my wife and tell her that I still feel like ass and a trip to the doctor is a must. The doctor's office promises a long wait--it's 8 a.m. and I won't be seen until 11 a.m. Unbeknownst to me, the Family Practice Center where my doctor practices has no walk-in hours. Plus, I find out that my primary care doctor no longer works there. "He hasn't been here in a long time," says the older administrative assistant in her southern drawl as she checks me in. I mull over going to the emergency room but I reason this office is more cost effective. An hour later, I throw caution to the wind and tell the check-in lady that I'm bailing and headed to the ER.

"Wait," she says. "Let me check and see." Dare I say "miraculously," she comes and says a doctor can now see me. After the prerequisite blood pressure, weight and temperature checks, I'm slapped into a holding room and wait. Ever notice how there's no clocks in these rooms?

A female doctor comes in and I tell her my saga. She looks vaguely familiar and I believe I've been treated by her before. I mention that I can deal with the head congestion for the most part but the cough is killing my chest and beginning to strain my lower back and testicles. I tell her I'm coughing up lung oysters and she asks me if there's blood in the phlegm. I once again tell her they look like raw oysters.

I get a blank-faced look from her.

Finally I point to a brown paper towel and say, "They look that color." It occurs to me later that she most likely has never seen a raw oyster. She prescribes me an antibiotic (doxycycline), something for allergies (Zyrtec) and then a pill--which contains the main ingredient in Robitussin (guaifenex plus 240 mg of pseudoephedrine)--for my cough. I go home and take the meds. I feel incredibly tired. Can't keep my eyes open. I decide to rent Kill Bill Vol. 1 and rest. By 7:30 p.m. I can fight off sleep no more. I gobble down the meds and it's off to bed.

I have weird dreams.

I wake up around 1:15 a.m. in a cold sweat with chest pains and a tingling sensation in my fingertips. I've had the tingling sensation in my hands a few times before from Sudafed so I'm not that alarmed, but the chest pain is new to me. I feel like there's a knot under my sternum or that my heart is experiencing some sort of cramping. "Maybe all the coughing has caused some tenderness there," I think and wander to the kitchen to take some ibuprofen.

Try to lay back down.

Not working.

Feel too weird.

Decide to look at side effects of meds I got today. The guaifenex says chest pains are a common side effect.

I call the nurse line.

Nurse says call 911.

I call 911.

And here's where the fun begins.

The EMTs arrive and take my vitals. The heavy-set man, who is obviously in charge, says it doesn't look like I'm having a heart attack but recommends they take me to the hospital.

"You can refuse treatment if you like," he says.

"I think I'll take a drive with you," I say.

He tells me to stick my tongue up and touch my top teeth with it. He pulls a canister out of his pants pocket, shakes it a few times and says, "This is nitro. I'm going to spray it under your tongue."

Then he tells me it might give me a headache and instructs me to chew down four aspirin.

"Did the nitro make your chest feel any better?" he asks.

The tightness in my chest does seem to have subsided but I can't figure out if it indeed was the nitroglycerin or the fact that a half dozen Durham County emergency medical technicians are hovering over me in the comfort of my own home. I walk up the driveway with the two EMTs toward the ambulance, since the others had been dismissed earlier when the big guy bellows out a directive: "Y'all can leave now. This guy's gonna walk out."

Fifteen minutes later, I arrive at the emergency room of UNC Hospitals in Chapel Hill.

Ten minutes after arriving, I once again explain what has happened while having my blood pressure and temperature taken. Pressure OK; no fever. A young woman comes in to give me an EKG. She has a series of scars on her forearm. The ones on the back of her forearm are faint and thin. But there's three fresh, thick pink scars on her inner forearm. I want to ask her if she's a cutter. Like Frankie on the Real World. Or Tracie from the movie 13. Or my wife's friend's sister. I'm not an expert on the signs of self-mutilation--but she sure looks like someone I've seen in a Joe Christ movie. Christ flicks are filled with blood. In Communion In Room 410, a 400-pound goth chick cuts herself as another girl drinks her blood, while Sex, Blood & Mutilation focuses on former Throbbing Gristle/Psychic TV frontman Genesis P. Orridge lounging about while his girlfriend cuts him with a scalpel.

I guess an emergency room would be a good place to get your hands on scalpels.

I'm surprised she doesn't cover up her arms and wear long sleeves like a junkie. Then again, at 3 a.m. in the emergency room, nothing is surprising. Not even the gentleman next to me, who is huffing and puffing, calling out for the nurse and vomiting. His gurgling expulsions are my only company and, quite frankly, not much of a distraction.

An attending resident comes in and asks me if anyone in my family has a history of heart disease. "Has anyone in your family had a heart attack," he pauses and I'm about to spit out that my father had one years ago but then he finishes his sentence, "this young." It's the first time it occurs to me that these people honestly think I'm having a heart attack. I'm asked about my recreational drug use and I begin to sound like a Queens Of The Stoneage song: marijuana, ecstasy, cocaine, Percocet, valium, alcohol, LSD... I'm honest as all bloody hell about what I've consumed over the last 20 years. Did I mention that I took a bunch of Sudafed over the last few days? This seems to fly over their heads. But the mention of coke doesn't.

"I haven't used cocaine recently," I say. "Trust me, I'd tell you."

"Because cocaine can cause a heart attack," says one doctor. No shit. I remember Len Bias very well, thank you. The pride and joy of the University of Maryland's basketball team in '86. To the Terps, Bias was like a god. And after being drafted No. 1 in the NBA by the Boston Celtics and signing a lucrative shoe deal, Lenny went and smoked and snorted himself into the graveyard.

They say he had over a gram of cocaine in his system.

They say when those with him told him to chill out a bit, he said, "I'm a horse, I can take it."

So the constant barrage of questions about coke starts to chap my ass. Check my blood I'm thinking. That'll give you your definitive answer, you bastards.

Silly me. In the next 48 hours I'll have my blood tested more times than I'd care to count.

But my original blood test is going to take a couple of hours anyway, so now it's time for the sit-and-wait game. My wife opts to go home and try to get some sleep and relieve the friend of the family who is overseeing our sleeping boys.

Then suddenly, I'm moved to another spot in the ER. I've got a front row seat at the ER desk... and a clock. I'm officially now a clockwatcher. Sleep for me isn't going to come anytime soon.

Shortly after being relocated, and after another bout of EKG checks, a young male resident from cardiology comes in to assess the situation. Doogie Howser's theory is that my sinus infection has sunk down to my heart. The virus, he explains, could cause swelling in the sac around your heart and hence cause pressure. He's 90 percent sure this is the case with me (he would be 100 percent wrong). "But..." (there would be lots of "buts") "we'll need to send you upstairs for some more tests."

No one tells me that "upstairs" is the Coronary Care Unit or CCU. Ostensibly, the ICU for heart patients. Upstairs is where the shit goes down.

"You're kind of young to have a heart attack," says the orderly as he wheels my gurney through a series of hallways--the bowels of UNC Hospital--and I don't have the nerve at the present moment to give him my long, drawn-out explanation nor care to make some snarky comment like "Sudafed O.D."

He wheels me through the CCU ward to a corner room where I'm greeted by a tall woman named Michele. "I'll be your nurse until 7 a.m. Then there's a shift change." A short, young woman comes in to help; she's trying to get out of giving some old geezer a sponge bath before her shift ends.

I get up off the gurney and step over to the bed, sit on the edge and slide my legs onto it without unhooking any of the various tubes attached to me (oxygen, EKG nodes, IV) and lay prone on the bed.

They both look at each other.

Michele says, "That's the first time I've had a patient make that transfer unassisted. "

I make an offhand comment about how much more comfortable this bed is--it comes across as nervous as it sounds. She adds some vial of drugs to my IV and says she has to ask me some questions.

"Who's your next of kin?"

"In case of an emergency who should we notify?"

"Do you have a last will and testament?"

"Um, geez, I don't know. I guess so," I say. "Maybe not."

"Well, social services can come up here and help you draft one up," she explains. Somebody else calls her and she tells me she'll be right back. I realize now that I could die. Or at least that's the way these people are acting. I begin to feel clammy. Last will? Next of kin? Who should we notify? I can't shake these phrases and they start to loop over and over in my head. A new group of folks walks in shortly after 7 a.m. The phone rings but I can't answer it. Doogie Howser is back and explains to me that I'll be getting an ultrasound of my heart and catheterization, aka a cath.

"Do you understand what this means?" he says. Well the ultrasound is self-explanatory and I'm vaguely familiar with the heart cath as I recall both my father and father-in-law have had one. But I ask him to tell me anyway.

"We'll shave a spot down in your groin area and they enter an artery where we'll slide a catheter into it and put some dye in your bloodstream to check your arteries."

"How long does it take?" I ask.

"About 40 minutes... if there's no complications," he says.

"What kind of time frame are we on for all of this," I ask.

"This should all take place within the next hour," he says.

Kind of quick, I'm thinking, considering I sat down in ER for a solid four hours. Michele's replacement rereads the same questions to me about wills, next of kin, etc., except she throws in the things-that-can-go-wrong addendum to the cath: "There's a possibly of stroke, heart attack or death."

Death.

"I ain't going out like that."

--Cypress Hill

Somebody said the D word. It's official now, my mortality is being called into question. I think of my boys and tears well up in the corner of my eyes. The phone rings. It's my wife. She says she'll be back at the hospital after she drops Spencer off at play school at 9 a.m.

"Am I all right?" she asks.

"Yeah, but they've got to do this heart catheterization and an ultrasound of my heart," I say.

She starts to tear up. "When are they going to do that?" she asks.

"Um, right now."

"Do you need me there?" she says.

"Not much you can do right now, just take care of the boys," I say. "I'll see you when I'm done." I try as hard as I can to push out the thought that I may never see my family again.

A cluster of medical personnel barge in, one lady with the ultrasound machine. My chest is gooped up and she's off to the races. I'm instructed to turn away from her but I can see the ultrasound monitor in the mirror. All I can think of are puckering fish lips and "boy is this going to cost a fortune."

A tall man with an accent (that I make out as African because his name is Julius--I can read it on his shirt--but it sounds like he's saying Judas) comes in and tells me he's the cath lab guy and takes a couple looks at the ultrasound. Fucking everybody here is a specialist. He goes over the whole cath lab procedure finishing it off with, "You know there's a chance of stroke or even heart attack with this procedure," then glances at me.

I glance back and say, "Or even death."

"Yes," he says. "Or even death."

Michele's replacement, a short, spunky redhead from Boston greets me by saying, "I hear you're from New York?" (where the fuck she got that from is beyond me, and once again, quite frankly, it scares me where these people are getting their information) and instructs me to take a handful of potassium pills and a valium for the cath procedure. She lightheartedly mocks me that it takes two 8-ounce plastic cups of water to swallow these pills.

I'm an anomaly in the CCU. I'm 36 and can't swallow pills without water.

"I'm used to the old folks who gobble those down like it was breakfast," she says with half a smile. And then before you know it, two middle-aged orderlies are wheeling me down to the cath lab. "We should cover that up," one says as she turns my hospital gown back and covers my penis. "That might scare the old ladies on the floor."

Another orderly makes some comment to me as I go by to "watch out for those ladies."

For all the hype about the cath lab, it's pretty uneventful. I get my groin area shaved. They add some nice high-grade drugs to my IV, and cover me with a blanket with nothing but a small hole where the incision is going to be. They make the cut and slide the catheter up the artery and then release some dye. The dye allows them to closely look at the arteries and capillaries around my heart. I witness the entire procedure on the monitor, occasionally seeing a masked attendee point toward the monitor at my heart. The drugs have me feeling a bit detached and it's as if I'm watching some show on The Learning Channel. I pass with flying colors and within no time, I'm back out in the on-deck area on the cath lab. Now the African doctor informs me that he has to put pressure on the incision for 10 minutes in order to close it.

"In de next 10 days," he says, "do no heavy lifting, or you may rupture de opening and cause massive bleeding." Then he hollers off a number: "7 minutes, tirty five seconds." I take this brief moment to interrogate the man.

"So doc, what's the verdict?" I say. "What did the cath tell you?"

"Everyt'ing looks good," he says still looking down at his hands which are clasped together on my groin, his tricep muscles flexing from the applied pressure. "But you should refrain from smoking de cocaine."

I'm appalled by his comment but still too shell-shocked from the day's events to even care to comment. I toy between commenting on my desire to freebase the moment I leave the hospital or making some wise-ass remark about how few Sudafed overdoses they must see in these parts.

Pseudoephedrine, after all, is one of the key ingredients in making methamphetamines. One look at drugfreeamerica.org will tell you so. But meth isn't big in Chapel Hill or Durham, not as big as it is in the western part of the state--the mountain towns--where people can conceal meth labs a little better. Or like Tujunga, Calif., where bikers still run speed like yesterday's Hell Angels crews.

"This is the weeping song/for those who wish to weep."

--Nick Cave and The Bad Seeds

The two female orderlies wheel me back up to the CCU where I'm greeted by yet another nurse who is there to "take care of my every need." It's the first time in several hours where I get a chance to reconvene with myself; to take some mental stock in what the fuck has been going on. I am alone.

I feel like crying. No scratch that, I feel like weeping. Like just letting the dam burst and wail. The weepiness subsides when I turn on the television and try to focus on some inane show to take my mind off things. But channel after channel offers no respite from the gnawing emotional breakdown I'm on the verge of having.

And then suddenly I find it: Champions League futbol. Monaco vs. Chelsea. I confess I'm not the biggest soccer fan, but I am addicted to Playstation 2's FIFA soccer game. Enough to know the basics of the game and even recognize a player or two. For the first time, I manage to focus on something else besides my current state of health. That is until I need to blow my nose again. But I don't feel like getting up. So I buzz the nurse and ask her for some tissues.

"Sure," she says, "I'll be right back."

She comes back and says that the male orderly says there's no crying allowed up here. I want to tell her to tell him to shut the fuck up, that I've already beaten the weeping demons back, but instead I follow up my tissue request with one for water. Smart lady that she is, she returns with a pitcher of ice water. She's obviously waited tables before I say to myself.

The good doctor, the one with a last name that sounds like a sneeze, comes back in with his flock of residents in tow and talks.

"You're a bit of a mystery to us Greg," he says.

"Your ultrasound says your heart is fine.

"Your cath lab says your heart is fine.

"But there's the appearance of some enzymes in your blood that tells us that there has been some damage to your heart.

"So we're just going to keep you here overnight, monitor you, keep checking your EKGs and blood and see if the enzymes go down."

He makes some comment to the affect of, "If I didn't know better, I'd say there was a mix up at the blood lab."

I tell him I feel bad I've ever made fun of the television show ER, because my life is starting to mimic a bad episode of it. In sweeps week no less: Young, white male, 36, with some tell tale signs of heart damage but no hard evidence to back it up.

WWAED (What Would Anthony Edwards Do).

"Born a rocker/ die a rocker."

--UK Subs

They move me down the hall out of my own precious room into a suite with a roommate. Lee, my new friend, is 84 years old. He's wrapped up like a mummy on his bed. His arm is in a sling and he's got a gash on his forehead.

"Hey partner, what are you here for?" he asks.

"Why, heart attack!" I say. I can't help myself. I'm feeling a little punchy from lack of sleep and must have a dash of post-traumatic stress disorder or something. I mean, this is the cardiology department after all.

At least I'm mobile. That's more than I can say about most of the patients here. Thanks to this nifty, portable EKG contraption they affix around my neck, I can freely get up out of bed and piss. No more getting interrupted pissing into a plastic container midway by a pesky orderly.

At 6 p.m., my wife and two boys arrive and I'm happy to see them, but they don't stay long because the baby is melting down; it's close to bedtime for him. Spencer tells me: "Dad, you're the man!" and says that we'll "rock out" when I get back home.

They brought with them a magazine, a request I made earlier to help stave off the boredom. I asked for a music magazine with the caveat that it not be Spin or Rolling Stone. It's Revolver, a hard-rock magazine from the publishers of Guitar World that a good friend of mine, Dan Epstein, writes for. It started out as an American version of Mojo before grasping at nu-metal and now is firmly affixed in post-hardcore, Swedish metal, emo and wispy nostalgia pieces on aging metal veterans. This issue features the Readers' Poll results--Slayer and Bam Magera are on the cover. After a few reads, I begin to formulate a hypothesis that Revolver quite possibly could be the RIP of today (Or would that be Circus?) Needless to say, Epstein's the best thing in there, even if he does have to write about Drowning Pool's new vocalist. If it means he gets to interview Black Sabbath's Tony Iommi, Iron Maiden's Bruce Dickinson, hang out in the studio with Metallica or drink with Motorhead's Lemmy Kilmister, then I guess it's all worth it.

Shift change at 7 p.m. brings in Derek, an older Scottish gent with a cockney accent straight out of an Irvine Welsh novel. I'm still congested and coughing. The coughing is aggravating my cath lab incision. "Derek, "I say. "What can I do about this situation? Can you get me something for the cough or something for the pain?" I say.

"Joist grabbed yer towl an a hold in rite der at yer groin," he says.

That's not the answer I was looking for.

I opt to read sans lights because the eye strain will surely make me tired. And it does. Shortly after a ghoulish Eddie Munster look-alike comes by to take blood, I pass out almost upright. In what seems like 10 minutes but turns out to be two hours, a nurse barges into the room and says, "Okay, Mr. Barbera, we need to take some blood."

"Sweet Jesus!" I yell as I snap awake, "can't anybody get any rest around here?"

"Sir," she says, "We're required to check your blood every six to eight hours."

"Well, Eddie Munster came by at 8 p.m. and that was only two hours ago," I say.

"I hope I don't see you again until 5 a.m."

I've become another curmudgeon in a floor full of curmudgeons. But between being bored and sleep deprived, can you blame anyone?

Sleep comes. As do more blood tests and yet another shift change that brings a new nurse. Breakfast comes and I vaguely remember filling out a request form for wheat toast, raisin bran and orange juice. I don't have my hopes up, as dinner--described as pork medallions in a cream sauce--was less than appetizing. It was more like Southern-style pork chops with watered-down apple sauce.

There's a knock on the door, followed by, "Dietary!" and in walks a woman with my breakfast. The first thing I noticed is that there's no milk for my cereal. Then I open up the lid and peer at the main course: One slice of wheat bread and tiny wedge of orange. I can't help but laugh out loud. Twice. Almost three times... but I curbed that one for fear that'd wake my roomie Lee-with-the-pace-maker. But soon the nurses wake him anyway and wheel him off to X-ray.

Then his son arrives. He's bald, probably in his late 40s/early 50s. He walks past my bed and past the curtain that separates the two of us--our privacy curtain--although it doesn't stop sound from traveling. I've heard him peeing, snoring, talking on the phone and consulting with his doctors.

"He's gone to X-ray," I say to his son. "He should be back soon."

"Oh, thanks," he says.

It's a door I should have never opened. After some lengthy phone calls regarding his father's estate, his attention is directed towards me. I'm not laying in bed after all, like most of the old folks on this floor. I'm sitting in a chair, holding my groin when I cough and conjuring up a mirage of taking a long, hot shower.

"Want to see my honey in a bikini?" he asks as he takes out his billfold.

He pulls out a picture of one of those bear-shaped honey jars that has had a plaid, pink bikini fashioned onto it.

"Isn't she sweet?" he says.

So bad I have to laugh. Laughing sparks a coughing attack and I get up to spit in the trash can.

"I'm sorry," he says. "I didn't mean to make you laugh, but you see I used to be a clown."

Maybe I did die, I think. This is my existential hell. Like principals in Sartre's No Exit, I'm eternally stuck in a hospital ward with septuagenarians, their endless barrage of visitors, and a bunch of bumbling doctors who can't find a cure for what ails me.

Dr. Gezundheit finally makes his rounds and tells me that I'm good to go, that I will soon be able to resume my normal life.

"Can a run a marathon?" I ask.

"Yes, but not anytime soon," he says.

"Can I eat a bacon cheeseburger guilt free?" I ask

"Well, yes," he says.

"So what do you advise good doctor?" I ask

"Stay away from Sudafed," he says.

"When's check out?" I ask.

"In a couple of hours," he says.

"Yeah, need to rack up a few more EKGs," I say.

He cracks a wry smile. The half-dozen residents follow him out like newborn ducklings.

"Your discharge papers are in," says my nurse.

"You can make arrangements to be picked up."

"Just out of curiosity," I ask.

"What was I diagnosed with?"

"They didn't tell you?" she says.

"No. What does it say on your paperwork?"

"It doesn't say anything," she tells me. "Just that you've been to the cath lab."

She hands me the papers, calls for transportation (i.e. a wheelchair) and sends me on my way.

When I get home and look at my paperwork, the name on it reads:

Lee [blank] [blank] 01/01/1919.

Maybe I am dead.

Maybe this is hell. EndBlock

Greg Barbera has since had a follow-up appointment with his doctor. He was officially diagnosed with a heart cramp brought on by constricting blood vessels due to pseudoephedrine consumption, but is assured that he is 99.9 percent risk-free of having another attack. He has returned to exercising and eating cheeseburgers at his own discretion. He will no longer take any medicine containing pseudoephedrine.

  • A pseudoephedrine trip through the health care system

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