Sunday, September 26, 2021

Live, from Port Washington, NY: The Arrhythmics

We are anchored in a familiar spot in Manhasset Bay (map), near the village of Port Washington, NY. As of today we have been here just over a week, and therein lies a tale. Let me catch you up from where we left off, at Truman Beach, our first stop in Long Island Sound.

We had a very calm and pleasant night there off the beach, but in the morning seas were starting to pick up. Nevertheless, we waited until the tide was favorable for westing, weighing anchor just before 11. Even with the favorable tide, winds and seas slowed us down and we arrived at the next safe harbor, Port Jefferson, nearly seven hours later, just a little before 6pm, for a speed made good of just 5.1 knots. Winds were high enough that we dropped the hook in a new spot, off the powerplant on the other side of the harbor (map).

Getting ashore in Port Jeff is something of a challenge, with the dock we normally use closing, sometimes by locked gate, at sunset. So instead we tendered ashore to Danford's hotel and marina and ate at their on-site restaurant, Waves, on the lovely outdoor patio. They do also have a day rate of $10 for the dinghy if we wanted to walk into town.

My constant companion for the past week: a Philips IntelliVue Patient Monitor

We were now in a part of the tide cycle where the current would not be westbound until well into the afternoon, and so we had a relaxing morning in the harbor and I tendered ashore just to get in some walking. Our favored dock now seems to be completely occupied full-time by a schooner and a pair of dragon boats, and there was no place for me to squeeze in, so instead I landed at the boat ramp, which nominally has a ten minute limit. I checked in with the attendant, who allowed that it was not busy so I did not have to rush too much. I got in a walk of about 15 minutes before heading back to Vector.

Fortunately, the harbors get much closer together west of Port Jeff, and after weighing anchor at 2pm we made a very short hop to Huntington Harbor and the village of Northport, New York, a new stop for us, where we dropped the hook just outside the mooring field, off Bluff Point in Northport Bay (map). We splashed the tender and made our way to the free town dock, which provides easy access to the quaint business district with several restaurants and other shops. We strolled until we found a nice patio with available tables, at the Feed and Grain restaurant, which was quite good.

On my morning walk I experienced some pain in my upper sternum when my breathing got deep, something I attributed to having man-handled our heavy anchor on deck back at Truman to effect repairs to the roller. I had to take it slowly on our evening walk for the same reason, and on our way home from dinner I was starting to become concerned that it was something more serious than muscle pain.

Throwback to our bus days: doing all the laundry at once.

We knew we'd be pinned down in Northport for a couple of days with high winds, and after seeing the village just briefly at dinner time, I was looking forward to returning ashore stag in the morning to explore on foot, and trying one of the numerous other restaurants for dinner. But by Friday morning my breathing had become painful enough that I immediately started spinning my wheels imagining that I had contracted COVID-19, which is, after all, a respiratory disease. I spent the day obsessively checking my pulse oximetry, which was always perfect, and researching whether this sort of inspiratory problem was a possible symptom. In consideration of the possibility that I could be contagious, we refrained from landing ashore at all and had a nice dinner on board.

Among the many things that I researched was exactly where I could walk in and get a test. As we learned when we were in Maine, the vast majority of testing sites are "drive through" -- you must remain in your car and there is no option to walk inside. I did find an urgent care facility run by Northwell Health just a few minutes outside of town that would let me schedule an appointment, but transportation would be a challenge.

In the course of weighing anchor after dragging across Manhasset Harbor, the anchor brought up this pipe. Louise knocked if off with the boat pole. Photo: Stacey Guth

In the process of looking up Northwell Health, we learned they also have a location literally right across the street from the dinghy dock here in Port Washington. We had vaguely remembered seeing it before, as it's next door to the grocery store we use on every visit. I made an online appointment for Sunday afternoon, the first available.

Saturday we had excellent travel weather, and by this time the tide schedule had advanced to where an early start was favorable. We weighed anchor first thing for Port Washington. I was feeling crappy enough on the way out of the harbor that we had a little spat about driving while under the weather, and Louise took the conn for most of the trip. En route I called the clinic to see if an earlier appointment might be available. They told me I could come in any time and sign up at the lobby kiosk for a first-available slot.

We dropped the hook here just after noon. Knowing that even going out to dinner was off the table until I had been seen, we immediately tendered ashore. Louise went into Home Goods and then the grocery store to stock up on provisions, while I walked into the urgent care to get myself on the waiting list. Before I could even get my details into the kiosk, the intake desk asked me  my symptoms and they stopped me in the middle and whisked me immediately into a treatment room.

The sailboat that Vector came close to tangling with, in the calm aftermath. This trio of swans visits all the boats in the harbor, looking for handouts. They woke Louise in the middle of the night, pecking the growth off the hull.

The doctor was very good and very efficient, and within a very short time of her initial exam they were breaking out the portable EKG. My strip showed normal sinus rhythm, but with a couple of blips in the signal that gave her some concern. She felt I should get an immediate blood workup and further testing, both beyond the capabilities of the little clinic. The good news? One of the best heart hospitals in the country was just ten minutes away. She wanted to put me in an ambulance, but I declined, choosing an Uber instead.

I had texted Louise when they first brought out the EKG, and she abandoned her half-loaded cart of groceries at the Stop and Shop to come to the clinic. We're both nervous about hospitals during the pandemic, and so we asked the doctor what other alternatives we had. On a Saturday that was more or less none, and she felt very strongly that it was an immediate and urgent need. After a quick pow-wow we agreed to head there directly via Uber.

The hospital is modern but has been here a very long time. This old fa├žade now faces an inner courtyard.

As promised it was just a ten minute car ride to St. Francis Hospital & Heart Center, where the EKG and referral I was carrying expedited me through triage to an exam room. A few minutes later I was on a gurney with a heart monitor, getting blood drawn and a chest X-ray. Within an hour of walking through the door, the ER doctor had an initial diagnosis: pericarditis. This is an inflammation of the pericardium, the lining around the heart. Needing more tests for a more definitive diagnosis, they decided to keep me overnight, and after what seemed like an interminable wait in the hallway of the ER I was moved to a room in the observation ward.

Louise, in the meantime, was booted out of the hospital as soon as they put me on a gurney in the ER. Visitors are not allowed in the ER, which is overcrowded and divided up to keep the COVID cases separated from other medical emergencies. And let me just say here that the selfish boors refusing to be vaccinated are literally killing the rest of us -- time-critical resources are delayed or unavailable due to the influx, and the extra precautions slow everything down. We may never know how many non-COVID deaths have been directly or indirectly attributable to these trickle-down effects. On several occasions we heard PA announcements that there was "high census in the ER." In any event, Louise waited outside on the hospital grounds until I texted her that they were keeping me, when she got an Uber back to the dock.

Current state of many ERs. We're lined up on gurneys down the hall.

As it turned out, I would remain in the hospital an entire week, a possibility we had not deliberately prepared for when we dropped anchor. Louise found herself thrust into the role of primary dinghy driver (her skills have increased markedly in a week) and also suddenly in charge of making electricity and managing all of the other demands the boat makes of us on a daily basis. We had arrived in the harbor with only a few days' supply of water left, expecting to whiz through Hell Gate and the East River the very next day, just ahead of the closure of the river for the United Nations General Assembly, and top up the water at 79th street before anchoring there for a couple of weeks. Instead, she would have to make do on what she had left in the tank.

By 9pm my heart rate was through the roof and I was in atrial fibrillation, and I was very glad to be on a heart monitor tied to a nurse station down the hall. We had arrived at Port Washington not a moment too soon, and were just incredibly lucky to be a stone's throw from a major heart center. They put me on rate control and anti-clotting meds and scheduled another battery of tests, including an echocardiogram and an MRI. I joked with Louise that heart problems "take machines many, money more."

Philips has a lock on the heart market. They wheeled this echocardiogram machine up next to my bed.

I will not bore you with the blow-by-blow on diagnosis and treatment over the next six days, but will skip to the result: I had not just pericarditis, but a pericardial effusion, which is a buildup of fluid between the heart the pericardium. In my case it is idiopathic, which means of unknown origin, although we tested for hundreds of possible causes from bacterial infections to cancers to viruses. It is an acute rather than chronic condition, and idiopathic pericarditis is typically transitory and does not return.

The effusion was quite large and was thus stressing the heart, causing both the inspiratory chest pain and the arrhythmia. The simple solution was to go into the pericardium surgically in a procedure known as a pericardial window, drain the fluid, and insert a post-operative drainage tube to make sure there was not a constant inflow of additional fluid. Both the fluid and a small piece of pericardium were sent for testing and culture, which thus far has been negative for everything. The surgeon drained 500cc of fluid and an additional 100cc eventually made its way through the drain. To put this in perspective, imagine having a half-liter water bottle implanted in your chest.

In one of the more amusing twists of this story, Louise and I had been briefing pretty much every nurse and doctor, and there were over a dozen in all, that we live on a boat and how that impacts how we will receive meds and follow-up care and so forth. Most were wide-eyed and either incredulous or envious, but the one doctor who grokked it right away turned out to be the cardio-thoracic surgeon, who is himself a sailor and used to keep a boat right here in Manhasset Bay, and nowadays crews on other racing boats. While he was laying out for us the procedure and follow-up, he allowed that we could do follow-up on the phone and the "office visit" to remove the surgical sutures could easily be handled by us on board without any assistance. A few minutes ago he passed Vector on a fast racing sailboat (it's race day), called out to me, and we exchanged a few words as he zipped on by.

Distant shot of my cardio-thoracic surgeon zipping past on a race boat.

Wednesday afternoon our good friends and fellow boaters Stacey and Dave arrived in the harbor, en route, like us, to points south. Knowing I was in the hospital, they very generously offered to stay a few days and help Louise with any boat issues. One possibility this raised was for Dave to help Louise get Vector to the dock to load up on water, or. alternatively, to deliver some water to Vector using their own tanks, to be refilled at the dock. I think it was also just a huge emotional relief for Louise to have some friendly faces with her in the harbor.

Visiting hours were noon to eight every day, and Louise made the trek each and every day by dinghy and Uber to be with me, which was an enormous boost. The surgery took place Thursday morning at 7:30, and special exemptions for surgery meant she could come early and be with me during recovery. She left Vector early and was at the hospital by 9am. As it turns out, Thursday was also the day the winds in the harbor picked up to 30 knots.

30-knot winds had not been in the forecast when we dropped anchor last Saturday, and we scoped for more normal conditions.  And in all of the emotion and logistics of dealing with me being in critical care and undergoing heart surgery, neither one of us was particularly thinking about this situation or the need to add scope. And in 30 knots of wind and a soft mud bottom, Vector very gently swung back and forth in a series of successive arcs, plowing her anchor some 500' through the mud.

We started at center bottom, making a nice semicircle until the SE winds picked up. Vector slowly sawed for 500', ending up in the semicircle at upper left. The grey circle with the boat icon in it is where they re-anchored Friday morning and where we still are today.

At some point in this process our unattended boat passed an anchored sailboat that got very concerned about a collision, and they called the harbormaster. Louise had checked in with the harbormaster and the marine patrol and given them the details of our situation (they were very understanding and helpful), and around 2pm he tried to call her to inform her of the issue. As it turned out, neither one of us had any cell signal at all inside the hospital, although my calls were coming through over WiFi. Louise never got the message until she left the hospital at the end of visiting hours, 8pm.

Suffice it to say that she arrived home to quite the mess, at first wondering why the boat was not exactly where she left it. The sailors flagged her down with a flashlight and explained the situation. They were thoroughly convinced that Vector had ensnared their ground tackle and all would need to be untangled, and they had deployed a second anchor. With winds not forecast to shift further overnight, Louise put out more chain to add distance from the sailboat, and had a fitful night of sleep. All I could do from my hospital bed with a tube sticking out of my chest was wish her well.

The good ship Stinkpot rafted to Vector, preparing to transfer water. Captain Dave is on our side deck. Photo: Stacey Guth

The following morning Dave and Stacey tendered over to Vector first thing to assist with the supposed disentanglement. In fact there was no tangling at all and likely neither boat, through sheer luck, had ever been in jeopardy. Vector's impromptu crew moved a short distance to a new spot and re-set the anchor, on storm scope this time. All's well that ends well, and we were fortunate that there was plenty of room downwind and we could have dragged a very long time. After the dust settled, Louise tendered over to the sailors with a friendly bottle of wine, in recognition of the few hours of nervous watchfulness we had put them through, and they seemed appreciative.

I would very likely have been released Friday after the drain was removed, were it not for the fact that one of the numerous IV catheters inserted in me over the course of a week had gone bad, creating a thrombus in my elbow. It was hot, swollen, and hard when they wheeled me into the OR, and the medical team became nervous enough about it that they sent me for an ultrasound. That determined it was superficial and not a deep vein thrombus that could dislodge and cause problems. My arm is still swollen and tender four days later.

In my room I watched "A Tour of Manhasset Bay with the Port Washington Water Taxi" on the community channel. Sort of a boatman's holiday.

The discharge orders came so late yesterday afternoon that we arrived at the Walgreens near the dock, where we had the scripts sent, after the pharmacy had already closed. Louise returned this morning, across heavy seas, when they opened at 10, only to find they were out of stock on all the important heart meds. Fortunately the Stop and Shop pharmacy in the grocery store had everything we needed and we called the hospital and had the scripts re-sent.

It was good to finally sleep in my own bed last night, after a full week away. I'm improving rapidly, with the biggest issue being pain from a 3cm incision below my xiphoid process from the surgery and a separate stab incision for the tube. Between the six or so IV catheters and over a dozen blood draws, my arms look a bit like a junkie's, and of course one arm is swollen, but I am expected to make a full recovery with no long-term effects.

I am extremely grateful to the doctors, nurses, and other staff at St. Francis. I had a great team and everyone was not only knowledgeable, but also pleasant and accommodating. I am also grateful to Stacey and Dave for their assistance, and of course to Louise who had to do my job every day and still managed to spend every visiting hour with me. And the outpouring of love and support from our friends and families all over the country.

The hospital was fantastic, but there were some hiccups. You got your three squares a day by picking up the phone and calling "room service" just like a hotel, and placing an order. Here I ordered Raisin Bran but ended up with... raisins.

As it stands now I am in no shape to drive the boat, and so we will remain anchored right here in Port Washington until such time as we both feel it is safe to get under way. Our mail and several other packages are already at the 79th Street Boat Basin, and we hope to still find them there when we arrive. Amazon has extended my Manhattan package locker to the middle of the week and I will see if they will extend it some more. Dave and Stacey brought us enough water to get by for another week, and Louise ran all the laundry ashore to the laundromat for the first time since we moved aboard.

Whenever we do leave here, there is no opportunity on the cruise to Manhattan to update the blog. The next time you hear from me will likely be when we depart New York Harbor for points south, sometime next month.

Everybody listen to me
And return me my ship
I'm your captain, I'm your captain
Though I'm feeling mighty sick
 -- Grand Funk Railroad
 

23 comments:

  1. Thanks for keeping us informed! So glad it turned out so well!!!

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  2. Oh,my! What an unexpected adventure you had. So glad you are on the mend and both of you are ok.
    I know you appreciate the support of your friends who so willingly helped Louise out during your hospital stay. I know you two would return the favor to them or others when needed. True friends make us so thankful!
    Take care of yourselves! Will look forward to your updates.
    Erica

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  3. Well goodness gracious! There are enough intense experiences in this one entry for a couple of decades at least. Please take care of yourselves and smooth sailing!

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  4. I am so glad this seems to be a one and done treatment! You should have seen the bravery in your wife's face the first time she tendered over to us. I was so proud of her.

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  5. Thank you Sean. So glad to hear you are feeling better.

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  6. Good grief,thank goodness you were close by such a great medical facility plus a life partner that more than rose to the challenges.
    Perhaps more passive solar capability/ lithium batteries + small water maker for those infrequent long anchorages.All the very best in your recovery; looking forward to your onward journeys.

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  7. Thank you for this post! Having been in a similar situation stuck in a hospital while out boat was at anchor - I certainly feel the pain you experienced. But its a good reminder that although we may plan for everything possible, some things are out of our control. Great to hear everything worked out and you are on your way to recovery.

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  8. An unfortunately riveting post! Thank goodness your on the mend. And extra special thanks to Louise for working extra hard to keep the ship floating and your spirits high.

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  9. Geez! I just echo everyone else's comments and I'm so glad it all turned out OK. I've always known Louise is a hero, and you both have many good friends. Stay well.

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  10. I've been following your adventures since the early days in the bus. I'm so glad things worked out and you'll be OK. I did want to say that I work in a hospital and since you are both vaxed, don't fear Covid so much. Yes, take precautions but for example in my hospital of the Covid cases in the ICU and MCU, only 7% of the patients are vaxed, the rest are not. Of the 7%, almost all have comorbidities. So, if you are having chest pain or any health issue do NOT worry about Covid and get yourself to the doctors.

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  11. Hi, Sean!

    So glad to hear that you are back on Vector and on the mend. Us folks on land were kept well informed and we closely followed your progress.

    I do hope your recovery continues rapidly, and that in just a month or so all this is merely a memory.

    take care, stay safe, I am thinking of you,

    ----alfred

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  12. Ouch, a painful and serious issue. I lived in LI for 40 years, you were fortunate to be treated at St. Francis - Northwell. A top-notch facility.

    Hope you recover quickly and are on your way. Kudos to Louise for coping so well.

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  13. Wow! Always something new around each bend, isn't there? Pleased you were close to great med facilities when you needed them, and that they had staff and space to treat you. Glad you're on the mend!

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  14. What a harrowing experience you have had. So glad you were near a top-notch hospital that took care of your needs. Sounds like you are in good hands with Louise on deck & I know she's learned a lot more about boating just because of this incidence. Praying for a quick recovering for you with no further issues.

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  15. Very glad you are ok and Louise was able to handle everything solo (way to go Louise!) Here's to your quick recovery!

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  16. Oh, my goodness! You've had quite an adventure. Here's hoping for a speedy recovery. I was trying to subscribe at the bottom of your blog but the link is to some HTML which I don't understand. Is there another place to subscribe on your blog?

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  17. Hi Sean! All of us at Infinity Coach are happy to hear you are on the mend!!! Take Care! Michelle and Jimmy

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  18. Surrounding you and Louise with Light.

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  19. Louise texted me once you were out, but it's nice to read your perspective. I had to laugh about the hospital food. I always tell my patients, "we aim for ok". If we can hit 'ok' it's pretty good. I'm glad you had good caretakers and were diagnosed and treated promptly! Being in good shape will help you recover quickly, and I'm sure Louise can handle taking those stitches out!

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  20. Thank you for posting in your condition hope all goes well best of luck

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  21. Glad you're resting up, was concerned when you hadn't posted. Glad your physician understood your situation and was able to work with you.

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  22. i am so damn glad to hear you are okay.

    that is all.

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  23. Glad you are on the mend. Louise is a hero.

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