Michael Birchenall: LIFE WORK

WELCOME

Here we go ... for me it's been a journey that began August 20, 2012 when I asked a physician assistant about a small mass I had found on my elbow and a cough that had persisted over two years. At different visits to the primary care office I had been told it might be allergies (I tried all the OTC meds with varying degrees of success and to no lasting effect), perhaps a shrinking of the esophagus and once I was told that maybe I was just getting old. Traci D. was action driven, caring and got me in to see people who could find out definitively what was going on. I wanted to thank her later for getting this all into a forward motion, but I found she was no longer there on my next visit. 

I call the first part of this journey ... Room With a View and I wrote about it on my website last November after my lung biopsy at Washington Adventist October 19, 2012. I share it again in the next post as it takes me through that stage up until I met Dr. Steven Nathan at INOVA Fairfax on November 20 2012. This is when I got my diagnosis for Idiopathic Pulmonary Fibrosis. On October 27, I got the call offering me the gift of a left lung, now. I am doing all I can to nurture this miracle of life.

Onward.

Mis En Place

I've spent so much time around chefs and in restaurants that most of the world looks like a dining room or a kitchen to me. After getting my degree in English, I worked my way through the back of the house of hotels, eventually popping onto the front of the house stage as a food and beverage manager. Now I write about the industry for the foodservice professional. 

Having had my lung transplant 37 days ago, I have been occupied with recovering, taking the time to be sick; managing my ever changing cocktail of medicines; visiting INOVA Fairfax three times a week for clinic and pulmonary rehab; accepting the absolutely powerful prayers, love and concern from so many wonderful friends, fellow travelers, associates and family and be a part of a joyous expression of love from my wife Acqua as she embraced the role of caretaker during the trip to the hospital that Sunday morning and then shared with all through an innocent but ever expanding email thread the timeline of my operation and hospital recovery through ICU, CTU and discharge in eight days.

A week later I was back in the hospital after a bronchoscopy found fluid that could bring on infection ... so three days later of intense antibiotic treatment I was sent home with a nebulizer and an order for a home antibiotic IV setup. Whoa ... from a company called InfuScience I was getting a 11-day delivery of medicine that Friday night (I was sprung at 10 p.m.) and a Saturday morning visit from a home nurse to train me in giving myself an IV treatment every eight hours. Before I left the hospital, I had a mid-line placed into a vein in my left upper arm that allowed an easy connector without a needle to let the good stuff flow and attack any of the bad guy germs.

Saturday morning, Laurent came to give me my lesson. After we both washed hands, he took paper towel sheets and laid them out on the table and proceeded to line up the medical materials from left to right. Ding ... medical mis en place. My food friends know what I'm talking about ... the essential laying out of all the ingredients in adavance so the building of a recipe follows a reasoned order without having to back track for ingredients ... you gather, measure and assemble. 

Here Laurent laid out the line flush (clean out any residue in line), the alcohol wipes to sanitize the connector at each step, the actual vacuum container of antibiotic, another flush and a final heparin flush. After I administered the dose, I reset the table for the next dose in eight hours. 

That day I was making oatmeal, raisin, walnut cookies ... and I proudly placed my mis en place for baking next to my mis en place for medicine.

It all works!

Today, Taking a Step … 1156 of them

The story may drive you crazy as I go back and forth in time, but it all makes sense to me ... scary, but if you're reading this, you probably already know me.

At all my consulations, clinics, hospital visits, medical related phone calls ... the consistent inquiry is about whether I am staying active at home. Yes, I am. I credit a vigorous commitment to pulmonary rehab to be an important part of my success so far. The paradox is that you're also recovering and need to take the time to get well. If you lead an active life, it's hard to slow down to learn how to go from seriously ill to well.

Today, I walked 1/2 mile. That's a step or 1156 toward another deep breath. 

Hope your day had a moment that pushed today into the good category. I did.

Let's Go Back To October 27

[all of my recollections of what happened to and around me is not founded in pure medicine fact ... I am not a doctor ...  this is my interpretation based on what I saw, understood and felt ... my life with idiopathic pulmonary fibrosis over the last 11 months of diagnosis, education, consultations and clinic visits with some wonderful medical professionals at the INOVA Transplant Center at INOVA Fairfax Hospital...]

Stayin' Alive: The Medicine Tree

I made the last post as I was headed to INOVA to report to Room 303 in the Cardiac Telemetry Unit. I also sent out an email to a list of family, friends, associates ... folks that basically said they would like to know when I got the call. At the same time, my operating team was headed to the donor location to examine and accept/reject the donor lung. I knew the travel could be up to 1,200 miles away ... but would not know exactly where. My doctors went to make absolutely sure this gift is right for me. This also means that as I am being prepped for surgery, that it could be called off at any time ... that's a "dry run." Throughout the lung transplant process, you know there are no guarantees that you will ever get a lung ... or a pair ... I needed one. In this case one person saved two lives, the right lung went to my "lung buddy."

I was listed for 13 days. It's Go Time!

We arrived at 5:20 a.m. and were greeted by Allison, a CTU nurse. Again, as I go through this recounting of my story, more people than I can ever remember by name have worked to make this a story to tell. So while I will use a name when I can, it doesn't take away from my appreciation of all the people along the way who helped me. I was prepped by CTU nurse Derly and others ... sanitizing, setting two IV lines and waiting. It was around 11:30 a.m. that I was rolled to the Operating Room with drugs to knock down my immune system already flowing in my body. I can remember a few of the surgical team in the room ... signed one more document for the anesthesiologist and that's about it for operating memories. Probably just as well. Paul Massimiano, MD was the lead surgeon for my transplant ... thank you. 

My first waking memory is seeing a blurry clock on a wall that say 9:00 ... and some sensation of people talking to me. I start to wake up, painless, alert to listen and do as told. I have a breathing tube and cannot talk. I am in the Intensive Care Unit 208. I have a new left lung. I am alive.

Now, when can I get this tube out. 

I have to pass medical milestones before the tube can come out. There is one device that beeps when I breathe too fast. Keep setting off the alarm and the tube won't come out. My arms are strapped to prevent me from talking any steps on my own. I don't have the urge to do that but I do know I am ready for it to come out. I can see light outside; it must me Monday morning.

At 10:30 Jenny tells me if I continue to breathe slowly a doctor will approve its removal at 11 a.m. That was the longest wait. 11:00, 11:01, 11:03 ... the doctor is outside my room talking to another about patients etc. I am becoming more anxious by the moment. The approval is given and the tube removed. At last I am breathing on my own. Later I realize I am breathing on room air ... no supplemental oxygen. I have a new left lung and it is working. 

Acqua tells me that the transplant started at 1 p.m. and ended around 5 p.m. 

By mid-afternoon I was sitting in a chair. Tuesday afternoon I was moved from ICU 208 to CTU 308. I think I'm feeling pretty darn good for a lung transplant dude. 

 

 

 

 

 

 

It's Go Time

At 3:42 a.m. INOVA called and said they would like to offer me a lung ... I accepted.

I am on the way to the hospital ... see you in two weeks.

Love 

Michael

Room With a View

 

Room 1504

 

[the post first appeared at foodservicemonthly.com on November 11 2012]

OK, I confess. I took a little staycation recently. Some of you noticed and asked about my absence from the scene … so here’s the scoop. For the weekend of October 19, I had a corner suite reserved … a room with a view in the Intensive Care Unit (ICU) of Washington Adventist Hospital (WAH).

The Details

Let’s get the messy details out of the way first, so I can get on with my “sauce on the side” storytelling. The deets: I’ve had a cough for quite some time and it had to be dealt with … now. Fast forward through my doctor referrals and I found myself in the care of an eminent pulmonologist Alfred Munzer (and former president of the American Lung Association), a leading thoracic surgeon Marc Margolis and soon to be my new best friend Steven Nathan (he’s the guy that’s going to make me well with a treatment program).

All of this tells you that I was in WAH from October 19 – 21 where I had a lung biopsy performed by Dr. Margolis with the WAH team.

Reality Check

I had never had any form of surgery before … never ever.

WOW!

My experience at WAH was one successful episode after another. And by the time I was discharged, I had cataloged in my head the parallels of service between restaurants, hospitals, and hotels. After all these years in the food world, it’s the way my head is wired now. Each step at WAH was clearly defined, explained and executed from the pre-op blood work and interview the day before, to the pre-op nurse Hazel the morning of surgery to the operating nurse Essie (who stepped out and called my wife one hour into surgery to let her know things were going well and in her personal life is a leader of a “wine divas” group of friends) to Ruth my post-anesthesia care unit (PACU) nurse who was the first person I saw when I awoke from surgery. I will never forget her smiling face and her words telling that all had gone well. How do I know/remember their names? Ruth gave me a thank you card signed by them all as I was getting ready to leave PACU to go to my room with a view in ICU.

Many of you have commented to me how you like the Bob Brown insider columns on service. Well, his principles apply here … you develop your service strategy, you hire good folks who are comfortable with the public, you train them and you give them the freedom to bring their personality to the job. Then they execute the plan with great skill and verve. And thanking your guest at the end is a bonus that can reap big rewards down the road.

ICU

I have a notebook in which I record the events of my medical experience. A special friend (a breast cancer survivor) had suggested I keep it – a kind of diary that records every appointment … each day in the hospital … each insurance document … each medicine … you know – everything. You are constantly asked for this information as you travel along this journey and the brain gets frazzled with all these details. My notebook has it all.

By 1 p.m. on the 19th, I am in my room 1504 and now I am totally dependent on others for everything. I can drink water and feed myself, hit the button for assistance and change the channel on the television. That’s it. Nursing shifts are 12 hours and either begin or end at 7 p.m. or 7 a.m. Each shift a nurse comes on who is assigned to you – to make sure you are progressing as you should. Susan is my first nurse. I know all their names … the nurses who kept me on a solid recovery path in timeline order after Susan: Alena, Anastasia, Jeanette, Jackie, Jeanette (again) and Doreen.

Like a server, each had their own style and way of dealing with the guest, I mean patient. Each was a professional of the highest degree … an angel in my mind. Alena and I talked restaurants and I know she and her husband like to go out and explore the area’s eateries. Even better she treated me to a fresh, morning coffee from their staff-stash … a serious improvement over the patient breakfast java. At some point the word spread about my food writing job and soon I was suggesting restaurants from DC to Baltimore to Silver Spring to the ICU staffers checking in on me. I gave them my email address for future reference. Hey, why not. They were keeping me comfortable and … alive.

Empty Tables In a Dining Room

You know how sometimes, you have empty tables but you don’t seat them because you don’t have the staff to service them properly . That happened at WAH … as in 36 hours I had recovered enough that I could have been moved into the main hospital population. But from what I overheard from my sedentary position, there either weren’t beds available or not enough nurses to take care of the patients. I stayed where I was in the ICU unit. The same thing happened the next night and once again I stayed in ICU. As I was getting better (and more aware of my surroundings) I clearly realized the magnitude of the care given in ICU … highly professional, superbly trained and caring. I couldn’t have been in a better place.

From housekeeping to the 4 a.m. blood work technicians to the portable x-ray guy to the other staffers who cheered me on as I made my walks around the unit for my daily exercise with my nurse and many monitoring attachments … I didn’t meet a single grumpy person or face a single frown or one heavy sigh.

I understand the rigors of service in foodservice and retail and how the constant contact with a demanding public can test us all. Those of us that love to succeed and thrive on the energy of pleasing … survive. But I will never forget these same principles I found at WAH, but there the service equation also has critical (read: life and death) patient care at the forefront.

Thank You

I’ve never been treated so well in a room with a view, yet I was so happy to leave. I was more than ready to leave my empty bed for the next person to be cared for by the Washington Adventist Hospital team. I was well enough to go home … thank you!

One More Thing

I was so happy to be home I did make a few strategic mistakes. One, I thought I could use cooking as a physical therapy and one more way to be active during my recovery. I knew I couldn’t be sedentary … pneumonia was a real threat if I chose to only stay in bed.

David’s Smoked Chicken Soup

 

David's Chicken Soup

On the first day, I walked one-half mile and increased that by a quarter mile each day until I finally reached two miles. That was a good thing (and now I am up to 45 minutes and will reach 3 miles tomorrow). What didn’t work out so well was the standing in my kitchen … cooking. Oh, I tweeted I was going to make chicken soup, but I was really too tired to tackle it. I got a quick response back from writer, peer and friend David Hagedorn who said he was bringing chicken soup to my house.

 

The next morning was October 24 … the day of the monumental chef event he conceived and organized for the Human Rights Campaign (HRC): a Chefs for Equality fundraiser (and YES Issue 6 did pass in Maryland!). I don’t think DC has seen a finer collection of culinary talent in one place … ever. He texts me that Wednesday morning he is on his way to the Ritz-Carlton Washington where it is being held. As soon as he was dropped off, his partner Michael headed my way to Bowie with a freshly made smoked chicken soup. Indeed the delivery was made (and I did send Michael back with some of my fresh oatmeal raisin cookies) and David’s four containers kept me nurtured over the next few days full of great fresh ingredients and the love that went into its preparation. I will never forget the gesture … it’s a great world to live in when you have good friends.

After this post appeared, I did get a note from the president of Washington Adventist in the comment section:

Dear Mr. Birchenall,

Thank you so much for taking the time to give us such valuable feedback. Your kind words and appreciation have meant more to our staff than you could ever know. They are truly wonderful people, dedicated to taking excellent care of each and every patient, and it means the world that you would recognize them for their special brand of caring. I will be sharing your post widely throughout our hospital so that each person can be encouraged and is inspired to ALWAYS provide extraordinary experiences for every patient, every time. Thank you again!

Joyce Newmyer, President, Washington Adventist Hospital

It is now a year later and my memories are still just as wonderful, just as appreciative and the quality of their care for me will always be with me as a beautiful experience.