Hospitalization – Page 2 – Tale of Two Parents

A good day in the ICU gets Dad one step closer to a room on the patient floor

Published on December 18, 2018December 18, 2018 by mellowdee55Leave a comment

August 27, 2018. Mom and I arrived at Dad’s room around 8:30 A.M. Dad was a little confused about where he was and why he was there, and I spent a lot of time trying to explain his situation to him.

At 9:50 A.M., Adan arrived at Dad’s room with Emily, his trainee, to conduct a swallow assessment. I was relieved to see him and knew that Adan would conduct a proper assessment that wouldn’t adversely impact Dad. Before he started, Adan left the room to review Dad’s chart. Within moments of his return, the doctor and his entourage of residents and other providers stopped by Dad’s room for morning rounds, which meant that Adan had to postpone his assessment. After conferring with his associates for a few minutes, the doctor told me that Dad’s hemoglobin and platelets were low. It seemed counterintuitive to me, but the doctor said that he’d probably order blood thinner for Dad to address both problems. Because Dad’s fistula had clogged during his last dialysis session, the nephrologist had entered an order for Dad to go to interventional radiology (IR) to have his fistula checked out. If Dad was lucky, clearing out the clog would be a simple process. If the interventional radiologist could not clear the clog, he would need to insert a dialysis catheter in Dad’s neck. I said a silent prayer for Dad’s good luck.

Shortly after the doctors left, Adan and Emily returned. In case a patient aspirates fluid during a swallow study, it’s important to have a clean mouth so that a minimal amount of bacteria goes into the lungs. Because Dad had not brushed his teeth since he arrived five days ago, Adan had him brush his teeth before starting the test. After observing Dad drink some water, Adan said that he had a productive cough and a good swallow. They then had Dad drink some cranberry juice, followed by some pudding. I was thrilled when Adan said that he had not observed any sign of dysphagia, and would order a menu for him. He warned us that food trays get a low priority in the ICU, so he couldn’t guarantee when Dad would get a meal. As Adan left the room, he said that Dad was probably the healthiest person on the floor, which was the best news that we had heard since Dad entered the hospital.

At 10:15 A.M., I saw a familiar face walk by the door. I quickly left the room and was able to stop Dr. Heath White. We had had quite a history with Dr. White in 2015. He had tended to Mom after her stroke and then had periodically been Dad’s attending physician for a couple of months. We chatted in the hall for a few minutes, and he said that he was surprised that it had been three years since he had seen Dad. While we were talking, he pulled out his phone to peruse Dad’s charts to see when he had last added a note to Dad’s chart. As he left, he told me to contact him if we ever had any pulmonary problems. It was good to see a familiar face, and I regretted that he had not had an opportunity to see Dad last year when he looked and felt so well. As much as I liked Dr. White, he had often had negative predictions about Dad’s prognosis.

At 11:00 A.M., Leslie removed Dad’s feeding tube. She then told me that she had started Dad on a new blood thinner to prevent clotting. Because his hemoglobin was low, he might receive a blood transfusion. We had been down this low hemoglobin path three years ago, and I hoped that one unit of blood would do the trick.

Now that Dad was more alert, he talked a blue streak. Not everything that he said was based on reality, and he was still confused about where he was. He thought that he would be going to a hotel and that he would be coming home with us tonight. However, when he and Stan talked about sports or chores that Stan could do around the house, Dad was as lucid as the rest of us. I couldn’t wait until he was moved out of ICU, an environment that often contributed to confusion and delirium.

Shortly before noon, an aide from food service brought Dad his lunch tray. His first meal in five days consisted of puréed chicken noodle soup, milk, iced tea, and orange sherbet. Because he thought that the consistency of the soup was like a milkshake, he decided to use a straw to eat it, which proved to be very messy. While holding the bowl, he tipped it, and half of the soup ended up on the bed. He was able to consume some of it before he devoured the sherbet. Eating again was an important milestone. Although it had been a messy meal, I was practically giddy with relief that he had been able to eat.

After Dad was cleaned up from his lunch, Mom, Stan, and I went home for our lunch. Stan then left Temple around 1:30 P.M., hoping to beat Houston’s afternoon rush-hour traffic. Shortly after he left, I received a text message from Pastor Tom. He indicated that he had spoken with Dad, but he wasn’t sure what was going on and asked me to call him to clarify Dad’s status. Dad was pretty lucid when it came to talking about yard maintenance or sports, but he was pretty confused about his status and what was happening to him. I could understand how Tom would also be confused following a conversation with Dad.

When Mom and I returned to Dad’s room shortly before 3:00 P.M., Dad was sleeping. He woke up to let us know that he would be receiving some blood and platelets. Leslie came in a few minutes later and confirmed that he had been typed and matched and was ready to receive the transfusion when the blood arrived. I was pleased that Dad could accurately relay some information to us about his status.

Dad’s status had improved dramatically. He no longer required medication to elevate his blood pressure, and now he was eating. He was still a sick puppy, but not sick enough to warrant ICU care. I had hoped that Dad would be moved from ICU to a patient room, but now that move seemed doubtful for today. The hospital generally does not like to move patients from ICU while they’re receiving blood. It was getting late, so we were not sure if the IR schedule could accommodate Dad.

As we were preparing to leave the hospital at 5:30 P.M., Leslie told us that Dad should be moved from ICU to 634 North before the shift change. If his food tray arrived after the shift change, she said that she would take his dinner tray to him. Although the 6th floor had a higher patient-to-nurse ratio, she said that they had many more aides and that one of the aides would assist Dad with dinner. When I asked about the blood transfusion, Leslie said that he should be able to receive blood overnight.

When I returned to my parents’ house, I wrote an enthusiastic email message to my sister-in-law, telling her about the turnaround in my father’s health in the past couple of days. Today had been a great day. Dad hadn’t had his fistula checked out, but it felt like he had turned a corner. Mom and I both felt optimistic about Dad’s prognosis.

Are we about ready to leave the ICU?

Published on December 11, 2018 by mellowdee55Leave a comment

August 26, 2018. After having spent an enjoyable evening in Johnson City, Stan and I left for Temple at 7:35 A.M. We arrived at my parents’ home at 9:40 A.M., unloaded the car, and headed to the hospital. Unfortunately, we just missed seeing the doctor during rounds. Dad was on dialysis, which had started at 6:00 A.M. Rachel, the dialysis tech, stopped by shortly after 10:00 A.M. to check on Dad, and said that he hadn’t put up any fuss when she started the SCUF dialysis session. I was glad that he was having more fluid removed and was encouraged that he could withstand the loss of the fluid while still maintaining adequate blood pressure. I had hoped that Natalie would be back as Dad’s nurse and was a little disappointed to see that the name Leslie had replaced hers.

Dad had slipped down the bed, and I used the call button to summon a nurse to reposition him. Instead of Leslie, a male nurse and a female aide entered the room. I immediately recognized the nurse as Fred and said that the last time that I had seen him, his wife had just had a child. He recognized me but said that he didn’t think that I was correct because his youngest daughter was three years old. When I told him that Dad had been a patient here in 2015, he said that he hadn’t realized that that much time had elapsed. It seemed like a mini-homecoming in some alternate life.

Dad talked a lot this morning, and most of what he had to say was pretty depressing. He said that he thought that he and Mom had changed mentally, and he implied that his life wasn’t worth saving. Today was the first day that he’d been talking since the surgery, and I asked him to wait another day before we discussed these serious topics. This talk was also upsetting Mom, and I wanted to redirect the conversation.

Because we had missed the morning rounds with the doctors, Leslie provided us with an update. They had changed his antibiotic, but his white blood cell count was still trending upward. I told her that I had fed Dad some gruel on Thursday morning and was wondering if he could begin eating again. She said that she would try a bedside swallow test to see if he could swallow a pill. I told her that with his history of aspiration, we would prefer to have Speech involved in any swallow test. If she did do the bedside swallow test, I asked that she not use a straw, which changes the shape of the mouth during swallowing and can affect the test.

The nephrologist and his resident stopped by shortly after 11:00 A.M. The doctor asked Dad how he was doing, which was a mistake on his part because Dad started complaining about the hospital, beginning with his stay in 2015. When the doctor explained that Dad was having dialysis to remove fluid, Dad started to give him some attitude about having dialysis. While I was explaining to Dad about the stress that the excess fluid had on his organs and why he needed dialysis, the doctor left. I was certainly glad that Dad was awake and somewhat alert, but he was not the greatest patient in the world and was a bit challenging to control. When Dad asked me what we were going to do for the rest of the day, he got a little annoyed when I said that he was going to stay in bed. By 11:45 A.M., the cold of the hospital was beginning to bother Mom, so she and I went home for lunch.

When we returned to the hospital at 1:30 P.M., I was surprised to see that Dad was off of dialysis. Leslie said that because his fistula had clogged, they had stopped his session 90 minutes early. Still, they were able to remove 2,225 ml. During the past two days, just over 4 liters of fluid had been removed, and Mom and I saw a noticeable difference in the size and weight of his legs.

At 2:50 P.M., Dad had slid down in the bed, and I called for a nurse to reposition him. While the nurses were preparing to move him, they noticed that he was bleeding slightly from his fistula in his left arm. The moment that they moved him, it was like a dam broke and the fistula started bleeding—a lot. The nurses called for some assistance, and Angel, one of the hospital’s top 25 nurses, entered the room. When Angel called down to the dialysis center for advice on how to stop the bleeding, he was told to keep applying pressure until the bleeding stopped. When Rachel, the dialysis nurse, showed up at 3:05 P.M., she said that his fistula had seeped just slightly yesterday, but she saw no real bleeding. By 3:25 P.M. the bleeding had stopped, enabling the nurses to replace his bandages and change his gown and bed linens. About 30 minutes later, Christina, the dialysis resident, stopped by with Rachel to check the fistula.

At 4:30 P.M., Leslie stopped the Levophed drip, which had been keeping his blood pressure at a safe level. She had already reduced it to the lowest dosage earlier, and Dad had been maintaining a MAP of 79 (80 being perfect). Some 15 minutes later, his MAP had dropped to 68. As we left for the day, I hoped that Dad’s blood pressure would stabilize on its own and not dip below a MAP of 68.

As tired as we were when we left at 5:00 P.M., I dreaded leaving him alone. Historically, most of his problems developed when we weren’t there to watch over him. I was so anxious when I wasn’t with him that I was starting to rely on sleeping pills to sleep.

Holding steady in the ICU

Published on December 4, 2018December 2, 2018 by mellowdee55Leave a comment

August 25, 2018. When Dad had been hospitalized in 2015, extended time without eating had left him unable to swallow food without aspirating. Against all the odds and the prognostications of the naysayers, he had regained his ability to swallow again. The fear that he could suffer again from dysphagia gripped me, probably irrationally. Before Mom and I left home for the hospital this morning, I texted Adan, our friend and speech pathologist at Scott & White, for his advice. He told me to ask the attending physician for a speech consultation. Adan added that he was off work until Monday, but that he would alert Holly, the speech pathologist who was working this weekend. Holly was another Scott & White employee I really liked. Even if she couldn’t help Dad this weekend, just seeing her would provide calming relief to Mom and me.

Mom and I arrived at the hospital shortly before 8:30 A.M. When we entered Dad’s room, I checked the board to see the names of the nurses and aides who were assigned to him today. When I saw that Natalie was his nurse, I wondered if it could be the Natalie that we knew in 2015. Less than a minute later, I got my answer when she walked into the room. I was so thrilled and relieved to see her again that I ran to her and hugged her. In retrospect, I probably picked up all sorts of germs when I hugged her, but I didn’t care and would do it again. Not only was she an angel in blue scrubs, but she was also familiar with Dad’s medical history. Natalie, whom we had referred to as Daytime Natalie, usually worked in the Cardiothoracic Intensive Care Unit (CTICU) and was helping out in the Medical Intensive Care Unit (MICU) for a few days. Dad had also been in the MICU unit for about a month in 2015, and another nurse came by to say hello, saying that she thought that we looked familiar.

Shortly after our reunion with the nursing staff, the nephrology resident stopped by and said that she didn’t think that Dad needed to be dialyzed today. However, she added that the nephrologist would stop by later during nephrology rounds, and he would make the final decision after seeing Dad.

At 9:45 A.M., the doctor and his entourage of fellows and residents entered Dad’s room. He reiterated that Dad was very sick. His low blood pressure, which they were keeping in the safe range with Levophed, was affecting his liver, kidneys, and lungs. When I asked about a speech consultation, he said that Dad’s blood pressure would need to increase before they could consider letting him swallow food. He went on to say that as it was, Dad was in danger of aspirating his own saliva. When I mentioned that Dad’s face and extremities seemed very puffy from excess fluid, the doctor said that dialyzing him could have unintended consequences. Although Dad needed to have some of his excess fluid removed, removing the fluid could cause his blood pressure to drop, so dialyzing him today seemed out of the question.

The doctor asked me about whether we would consent to using a ventilator. I told him that I would view using a ventilator as a last resort. When I asked if we could use CPAP or BiPap for oxygen instead of a ventilator, he said that CPAP had some risks, but inserting the ventilator also carried risks because you had to anesthetize the patient. I was so frustrated with Dad’s situation, and it seemed that everything hinged on our ability to increase his blood pressure. I hoped that Mom and I would not be faced with this decision.

Just when we thought that we understood Dad’s plan for the day, the dialysis nurse entered the room. By 11:30 A.M. she was finished with Dad’s setup, and his eight-hour session had begun. She told us that the nephrologist wanted to see if they could safely remove 300 ml/hour. Over an 8-hour period, he could have as much as 2,400 ml removed, which would be great if he could tolerate it. They had given him a liter of saline the other day to increase his blood pressure, so I was not overly optimistic that they could reach their goal. The dialysis machine monitored Dad’s blood pressure and would alarm if Dad’s blood pressure dropped. Dr. Idoux, the nephrologist, said that Dad might need to be dialyzed every day for a while if he could tolerate it. I prayed that we could safely remove all of the excess fluid that he had accumulated over the past 7 to 8 months.

Because I knew that she would be honest with me, I spoke with Natalie about the wisdom of my leaving Dad for about 20 hours. She said that he seemed to be trending in the right direction, although during her time as a nurse, she had seen patients die who were about to be discharged. On that happy note, I posted my mobile phone number in the room and ensured that the nurses would contact me if I needed to come home. Johnson City was only a two-hour drive from Temple, and we would return if she or another medical provider thought that Dad was in jeopardy.

After taking a short lunch break, Mom, Stan, and I returned to Dad’s room at 12:45 P.M. Dad was still on dialysis, and his blood pressure was still holding steady. Levophed was supporting his blood pressure, but they had not needed to increase the dosage to compensate for the loss of fluid. Dad seemed a bit more aware, but he still faded in and out. I prayed that he would not wake up, notice that he was on dialysis, and pull out the lines.

I hugged my parents goodbye, and Stan and I left for Johnson City at 2:35 P.M., hoping and praying that both of my parents would be OK until I returned home tomorrow morning.

ICU room transfers and road trips

Published on November 27, 2018 by mellowdee55Leave a comment

. I didn’t sleep well, and I got up around 3:00 A.M. and started the coffee maker. One of my photographs was in an art gallery exhibition in Johnson City, Texas, and the opening reception was tomorrow evening. I had made a hotel reservation in Fredericksburg, about 30 miles from the gallery. I now thought that I should cancel this reservation and book a room in a hotel closer to both the gallery and to my parents’ home in Temple. When I logged on to the hotel’s website, I learned that the deadline for canceling without a 100% cancellation fee had passed at midnight, three hours ago. I was too frugal to pay for two rooms, so I kept the reservation in Fredericksburg. Barring any emergencies, we would be gone for only 20 hours.

I had texted Pastor Tom several times yesterday and he finally responded shortly before 5:15 A.M. Unfortunately, his message said that he was out of town. He said that he would notify Pastor Brian about Dad. Although Mom and I would welcome a visit from Pastor Brian, Dad did not have a relationship with him. In addition to comforting us, Pastor Tom could often get a response from Dad.

Mom woke up shortly after 6:00 A.M., and we arrived at the hospital during the shift change at 7:15 A.M. I found a nurse sitting outside of Dad’s room charting, and I asked him if he knew where I could find Dr. Yawn, the doctor who had called me last night. He replied that that was a good question, and set off to locate him. I had only spoken with Dr. Yawn on the phone and didn’t know what he looked like.

While I was waiting, I saw that Dad was restrained with soft restraints. I also noticed that he no longer had the a-line in his right arm. When Dr. Yawn entered Dad’s room, he had a long list of updates to share with me. During the night, Dad had pulled out his a-line and his IV lines. Dr. Yawn and another doctor had tried to find another vein using ultrasound but without success. Dr. Yawn was able to start the central line. He had not yet used it for administering medication but was keeping it open with saline. While we were talking, a transportation person appeared outside of Dad’s room. The doctor told me that Dad was scheduled for a VQ scan at 8:00 A.M., which would test for the presence of a pulmonary embolism. He had had this test before his hip surgery in March. The doctor reiterated Dad’s problems with his liver enzymes and ammonia.

I couldn’t believe that Dad had pulled out the venous and arterial lines; it had to have hurt. I was in pain just thinking about it. While we were talking at the foot of Dad’s bed, I told the doctor that I was surprised that Dad had pulled out all of these important lines, yet left the feeding tube in place. Many patients, including Dad, accidentally pull out the feeding tube because it irritates their nose. The doctor agreed and said that the feeding tube would have been preferable.

I spoke with Dad for a few moments and told him that I was going home to Houston but would return later this evening with Stan so that he could beat Stan at cribbage. He smiled and kissed me good-bye. I hugged Mom goodbye, introduced myself to Jennifer, Dad’s nurse, and I left the building at 7:45 A.M. When I stopped for gas in Somerville, I noticed that I had received a text from my friend Rhoda, who wanted an update on Dad’s condition. The nice thing about Stan’s new car, which I was driving, is that I can make hands-free calls. I called my friend and gave her a quick update on Dad’s fragile condition.

When I got home at 10:30 A.M., I texted Stan to tell him that I was home. I tried to call my mother but all of my calls to Mom were directed to voicemail. Hoping that she might also have Dad’s phone with her, I called his number too, but with the same result. I finally gave up and called the SICU nurses’ station and asked Dad’s nurse to tell Mom that her phone was off.

At 1:30 P.M., I received a call from my parents’ landline. It seemed that Mom’s phone hadn’t been off; its battery was dead, so instead of eating the sandwich that I had prepared for her, she decided to eat her lunch at home and charge the two phones.

Mom said that Dad wasn’t doing very well and that he was having a difficult time getting enough oxygen. However, she said that the nurse had told her that they were going to ensure that he got more oxygen. I didn’t know what that meant, and I hoped that it didn’t mean intubation.

I kept hoping that he’d rally again, but I was becoming concerned. Besides attending the exhibition reception in Johnson City, we were meeting with another couple from Houston. We had been planning this trip for quite some time, and I didn’t want to cancel it. Mom also didn’t want me to cancel the trip, but I told her that I would not go if Dad’s passing seemed imminent. I planned to be gone less than 24 hours, but I didn’t want to take any chances on being gone if he and Mom needed me.

Stan had arrived home from work a little after 1:00 P.M. and by 2:00 P.M., we were on the road back to Temple. Thankfully, Stan said that he would drive. We usually shared the driving, but I had not had a chance to rest and was very tired. Stan hadn’t slept well last night either, so we stopped at Buc-ee’s for some coffee.

During the time that I was away from the hospital, the hospital chaplain, a woman from palliative care, Pastor Brian, and my parents’ neighbor, Sharon, stopped by to visit Mom. Sharon stayed for almost three hours. I was grateful for the pastor and Sharon, but Mom couldn’t tell me much about the visit from palliative care. I didn’t know why, but I was suspicious about this visitor.

Stan and I arrived at the hospital at 5:15 P.M., and we were greeted with the news that the SICU doctors thought that Dad should be moved to the Medical ICU (MICU). At 5:40 P.M., Jennifer said that his room was ready and that he would be transferred to room 246 South in MICU right after the shift change.

Mom and I returned to the hospital at 7:30 P.M. to see Dad in room 246 South, but the room was empty. We walked to the north tower to his room in SICU. He was still there, but they were preparing him for his transfer. We walked with the nurse as Dad was transported to his room in the south tower. The two nurses who were getting him situated in MICU said that we could see him when they were finished—in about 15 to 30 minutes. When we told them that we just wanted to say good night, they stepped away from his bed so that we could kiss him goodnight.

We left the hospital shortly after 8:00 P.M., hoping for a better day tomorrow.

Remembering that recovery can be the worst part of surgery

Published on November 20, 2018 by mellowdee551 Comment

August 23, 2018. Mom and I arrived at Dad’s room shortly after 8:30 A.M. Following earlier surgeries, he had suffered from post-surgery delirium, and I wondered how confused he would be about his surroundings and his situation. Dad was still sleeping when we arrived, and his breakfast tray sat untouched on his bedside table. I was pleased that his breakfast included Cream of Wheat, which he called gruel and which he could easily swallow. Because of his aspiration history and the weeks of swallow rehabilitation therapy required to recover from this disorder, I was always nervous about letting him go too long without eating, and almost 40 hours had elapsed since his last meal. I was able to wake him without much difficulty and coaxed him to swallow two or three spoonfuls of the now-cold cereal and a couple of sips of orange juice before he drifted back to sleep.

A few minutes later, Lisa, his nurse, came into his room. I could tell from the monitors that his blood pressure and pulse were trending downward, and Lisa started making some phone calls. Dr. Christopher Sartin, the orthopedic surgery fellow, stopped by and ordered a blood test to check Dad’s potassium level. The lab tech was unable to find a vein, and eventually had the nurse pause Dad’s IV so that she could draw blood from the IV line. I had inherited Dad’s stubborn veins and understood the torture this activity could be, and I hated to watch him endure it.

When the lab tech left, an aide checked Dad’s blood sugar, which was down to 54, which is very low. His temperature was also low, and his blood pressure was 90/58. A couple of minutes later, Lisa called the doctor again, and I overheard her say something about calling for a rapid. Moments later, I heard an announcement that Mom and I had heard numerous times during Dad’s previous hospital stays but never for him: Rapid response medical alert; in-patient room 546 South.

Dad had been assigned to an unusually large room, which suddenly became very crowded. In addition to his nurse, the room was now being filled with the rapid-response nurse, the charge nurse, the other nurses assigned to 5 South, therapists, doctors, the pharmacist, and the chaplain. In case Dad needed to be moved, someone from the Transportation department waited in the hall outside of his door. Because they kept moving around, I lost count of the number of people in the room after I counted 12 of them. One of the nurses was one who we knew from Dad’s 2015 stay in the hospital, and she continually updated us on what the team was doing and what they were considering. As she disseminated information to me, I relayed it to Mom, who was now very nervous. I overheard them say something about giving Dad Narcan to rid him of any opioids that he had received during surgery.

Thinking that the blood pressure equipment might not be correctly recording, they tried two different machines and then tried the manual process, but all of the readings were similar. To elevate his blood sugar, they gave him dextrose. Myriad devices were ushered in and out of the room. I supposed that there was some bodily function that they didn’t measure, but I couldn’t imagine what it was.

To increase his blood pressure, they started giving him a bolus dose of saline. Although I prefer saline over Lopressor alternatives, I thought that I should tell our friendly nurse about Dad’s fluid overload condition, although at this point, they were fighting to stabilize him. They could address his fluid situation later.

After 30 minutes, Dad’s blood pressure was 104/71 and his blood sugar had increased to a safer 85. The rapid-response team finally decided to move him from the orthopedic surgical floor to surgical ICU (SICU). Fortunately, a room was available, and the transportation tech and the nurses started preparing Dad for the move.

Mom and I followed Dad’s bed through the halls and elevators to room 202 North. As he was being resituated in his room, a nurse walked in and started talking with the doctor. As soon as I heard her voice, I knew that Dad was in good hands. I immediately said, “Hi, Ursula! Do you remember us?” It took her about a nanosecond to remember us. I had to remind Mom that Ursula (from Transylvania) was Dad’s first nurse when he was brought to the Cardiothoracic Intensive Care Unit (CTICU) following his aortic valve replacement surgery on May 6, 2015. She said that she was the SICU charge nurse and would get him situated, and that Debra would be his nurse.

Dad’s temperature was still low, so the doctor ordered a Bier Hugger to warm him. Because he wouldn’t be getting out of bed anytime soon, Ursula also started a Foley catheter. It was now 11:50 A.M., and we still hadn’t had a coherent conversation with him since he was wheeled to surgery yesterday morning.

I started having unsettling feelings of déjà vu when the nurse inserted a feeding tube at 12:15 P.M. I knew that it was necessary, but it seemed like a big step backward. A few minutes later, Dr. Jonathan Curley, the resident SICU doctor, asked us to leave the room because he wanted to start an a-line in Dad’s arm, which required a sterile environment. The a-line would enable the doctors to monitor Dad’s blood gases and continuously monitor his blood pressure. Because you cannot insert IVs, draw blood, or take blood pressure from an arm that has a fistula, starting IVs and a-lines was more difficult now that he had a fistula in his left arm.

When Mom and I returned to the room at 1:00 P.M., the doctor was trying unsuccessfully to start another IV line. About an hour later, Patricia, a tech from the cardiac unit, administered a cardiac ultrasound. She couldn’t tell me what the test would show, but I assumed the doctor wanted to see if his heart function had improved.

Around 3:00 P.M., Dad’s first IV infiltrated and they needed to start another IV. Unfortunately, his body wasn’t giving up veins without a fight. Dr. Curly called in another resident, whom I nicknamed the vein hunter. He also used ultrasound and he eventually found a vein on Dad’s upper right arm. Dad’s MAP was still very low, hovering between 54 and 58, but he was receiving more albumin to raise his blood pressure. I kept hoping that the albumin would start working. His MAP needed to increase to at least 60 (ideally 65).

By 4:15 P.M., Dad had finished receiving his dosage of albumin, but his MAP had only inched up to 59-60. However, his glucose level had increased to a more normal level of 92.

Although Dad was awake for much of the afternoon, he wasn’t making much sense. At 4:45 P.M., Mom and I were exhausted from this emotionally draining day, and I was concerned about the emotional strain on Mom. We decided to go home for the evening. As we walked out to the parking lot, I received a text message from Sharon, one of Mom’s dear neighbors, saying that she and her husband would provide us with dinner. After we arrived home, I walked across the street to their house to tell them about the day and to accept their offer of dinner. They said that they would bring the meal over in about 30 minutes.

I had been back in the house for only a few minutes when my phone rang at 6:06 P.M. It was Dr. Yawn from the hospital. He started by saying that Dad was stable but followed that statement by asking if my mother or I had medical power of attorney. He said that although Dad was stable now, he was pretty sure that he wouldn’t stay that way. He said that Dad’s heart was not doing well. They had performed an echocardiogram yesterday, and the side of the heart that pumps blood to the lungs was strained. He also said that Dad’s ammonia level was elevated, which was causing much of his confusion. The doctor said that the elevated ammonia level was the result of his elevated liver enzymes and depressed clotting. He said that they were giving him medication to address the elevated ammonia. He seemed to think that Dad had more confusion than from just anesthesia, but I told him that I had been anticipating 3-4 days of confusion, which had become normal for him after surgery. He had no response, and I felt that he discounted what I said.

He went on to say that Dad had been slowly responding to some medication to elevate his low blood pressure, but that IVs cannot be used to administer most of the Lopressor class of drugs, which would require a central line. Dr. Yawn needed permission from us to insert the line so that they could administer these drugs. I reluctantly gave him permission to proceed with the procedure, which would require an interventional radiologist.

Dad seemed to be making urine, but because of his liver situation, the doctor said that he would not be able to be dialized if his kidney function failed. The organs have a pecking order of importance, and it seemed that the liver trumped the kidneys, so that anything that might help the kidneys but compromise the liver would be off limits. The Doctor went on to say that Dad had the potential for severe liver problems, which would yield a severe outcome. He asked if Dad had a history of liver ailments. I told the doctor that the only problem that he had had was when he was very ill in 2015 and his liver was in shock for a few days.

The conversation continued to get worse when Dr. Yawn started asking about any extreme measures that we would want to hospital personnel to take should Dad’s heart stop beating. I didn’t want chest compressions, but I felt that I should discuss this issue with Mom, and then call him with our decision.

Mom and I had a long and heartbreaking conversation about this question. In the end, because Dad had signed a DNR for his surgery in 2015, I felt certain that he would not want the chest compressions, and I pleaded with Mom to agree. During the past 30 years, Dad and I had had several conversations about procedures that he would not want at a later stage in his life. I now prayed that he would have stuck with those declarations, had he been able to speak. Although we watch TV and movie doctors give chest compressions, in reality, the act is violent. Mom reluctantly agreed to forgo extreme measures, and I called Dr. Yawn. When I told him the reasons for our decision about not administering chest compressions, he agreed and used the word gruesome to describe the process.

I asked the doctor to call us during the night if any event occurred so that we could go to the hospital to be with Dad.

As I ended the call, the doorbell rang. Sharon, and her husband, Jim, were on the front porch holding our hot dinner, which they had just finished preparing for us. I thanked them profusely for their kindness and quickly told them about our phone call. After they left, I put most of the meal in the refrigerator. During the past 30 minutes, Mom and I had lost our appetite.

I didn’t sleep well, but at least my sleep was not interrupted by a ringing telephone.

Replacing the crumbled hip

Published on November 13, 2018November 13, 2018 by mellowdee55Leave a comment

August 21, 2018. Once again, Dad objected to my plan to come to Temple to sit with my mother in the surgery waiting room. I told him that I had to be there for Mom, but truth be told, if something went wrong, I’d never forgive myself later for not having been there to give him a hug and kiss before his surgery.

I had a full schedule today and didn’t leave Houston until 7:15 P.M. Houston traffic was still a bear, and I was thankful that I was able to bypass most of it with my EZ Tag toll tag.

I didn’t arrive at my parents’ home until after 10:00 P.M. I had a house key, but Mom had insisted that she would wait up for me until I arrived. As I expected, Dad had been in bed since 8:00 P.M. and was asleep when I arrived. Mom told me that we would be getting up very early tomorrow because Dad had to be at the hospital by 5:30 A.M. for his 7:30 A.M. surgery. At least one of us would be well rested.

August 22. We all woke up earlier than necessary, and we were ready and in the car by 5:00 A.M. Needless to say, the streets of Temple were all but deserted at that time, and we were in the day surgery waiting room by 5:15 A.M. Dad’s name was called a few minutes later, and we rode the elevator to the second floor and located our surgical bay. We were greeted by Richard, one of Dad’s nurses, who handed Dad his surgical wardrobe. While Mom helped Dad to change into his surgical attire, I waited outside of the bay curtain.

After Dad had donned his surgical gown and cap and was situated on the gurney, Allison started his IV. Shortly after 7:00 A.M., the anesthesiologist arrived to address any questions that we might have. I mentioned our experiences of Dad’s challenges with extreme confusion following surgery. His not-so-comforting response was that as we age, anesthesia becomes more problematic, so today would be no better (and could be worse) than Dad’s surgery in March.

Moments after the anesthesiologist left, Dr. Daniel Stahl, the orthopedic surgeon arrived. He described the surgical procedure, and while talking, he lifted the portion of the sheet that covered Dad’s legs. Dr. Stahl seemed somewhat alarmed when he saw the many sores on Dad’s legs. The doctor then told us that because of Dad’s age, his kidney issues, and the sores on his legs, the hip-replacement surgery was very risky. When he offered Dad a chance to cancel the surgery, Dad said that it was too late to back out now, to which the surgeon replied that until he made the incision, it was not too late to back out. I asked the doctor why he didn’t perform the hip replacement surgery in March. Evidently, the earlier surgery of mending the hip with pins was a lot less invasive and often sufficed. I, on the other hand, wasn’t feeling great about more surgery and starting over with rehab.

After hearing from Dad that he wanted to proceed with the surgery, the doctor told Mom and me that he would meet with us after the surgery, and then he left. At 7:25 A.M., Shasta, another one of the OR nurses, wheeled Dad to the operating room. As Mom and I proceeded downstairs to the surgery waiting room, she was noticeably upset. She said that during the pre-op visit on Monday, she had not heard that the hip replacement would be a high-risk surgery for Dad.

While we waited, I mentioned to Mom that Dad would probably require rehab. She said that after their previous experience with Cornerstone, she didn’t want him to go to a rehab facility. I reminded her about how weak he was after the last surgery and that we should be open to rehab, even if we went someplace other than Cornerstone.

Dad’s surgery was over at 9:30 A.M, and the surgeon stopped by to speak with us a few minutes later. He said that Dad came through the surgery fine and explained a bit about the condition of the hip from the earlier surgery. When I asked if we would bring Dad home from the hospital, he said that Dad should go to rehab for a couple of weeks. Before he left, he told us that we would be notified when Dad was ready to leave recovery. After the doctor’s disturbing comments prior to surgery, Mom and I were very relieved and eager to see Dad.

An hour later, Mom and I were becoming concerned that we hadn’t heard anything about Dad. We were also starting to turn blue from the temperature in the waiting room, which must have been set to 65 degrees. We had seen several people leave the waiting room to see their loved ones and we were curious about our long wait. When I approached the waiting-room clerk to check on Dad’s status, she told me that “they” would call her when he had a room. At 11:15 A.M., almost two hours after his surgery, his recovery nurse, Karly, called us to tell us that he was still in recovery because there were no available beds on the orthopedic floor. I gave Karly my mobile phone number and Mom and I went home for lunch and to change into warmer clothes.

About an hour later, Karly called and told me that a room on the orthopedic floor was being cleaned. When I asked her for the room number, she said that to avoid problems caused by last-minute changes, she could not give me the room number until he was in the room. At 1:15 P.M., as we were backing out of the garage, she called me again and told me that Dad was in room 546 South. We arrived at Dad’s room at 2:00 P.M., and Pastor Tom from my parents’ church entered the room about five minutes later. During his visit, he told us that quite a few of his church members had had hip replacements and recovered quickly. After a short visit and a prayer, Tom left at 2:15 P.M.

Dad’s nurse, Brittany, was very nice and spent a significant part of the day monitoring his vitals. His oxygen saturation level was low because he sometimes stopped breathing, but it eventually leveled out between 98 and 99%. She asked if he had any history of sleep apnea. We said that he didn’t, but I mentioned that we had seen similar breathing patterns after earlier surgeries.

With Dad sleeping soundly, I was able to give the nurse an update on his meds. I also told her that he had a bit of fluid overload, and that his face was usually puffy in the morning, although the fluid usually dissipated by mid-morning. Unfortunately, as the day progressed his legs became swollen from sitting in the wheelchair all day. A couple of hours later, she said that Dad’s face seemed swollen from lying down all day, and she elevated his head.

Around 3:00 P.M., a millennial in red scrubs and many tattoos entered the room with a heart monitor, and hooked it up to Dad. When I asked her if she worked in the war room, she said yes. I had seen the war room employees in one of Dad’s earlier stays in the hospital and was relieved that his heart would be monitored. The color of employees’ scrubs identified their role at the hospital, and the red scrubs stood out among all of the others.

Dad’s oxygen saturation and blood pressure levels looked good for most of the day, but his heart rate hovered around 109, which seemed high to me. When I asked Brittany about it, she said that as long as it wasn’t fluctuating between the 60s and 90s, he should be all right. She reminded me that because of his AFIB, he was being closely monitored by the heart team in the war room, and they would keep an eye on his heart rate.

Try as we might, Mom and I could not get Dad to open his eyes for more than two seconds, and he only grunted like a bear when we asked him questions. At 4:45 P.M., his condition had not changed, and we decided to go home for the day. Mom and I were sleep deprived, had been here for the better part of 12 hours, were starting to get hungry, and Dad would probably sleep for the remainder of the day.

We were relieved that the surgery had seemed to go well and that his condition seemed stable. I didn’t know how well Dad’s new hip would work with all of his excess fluid. I hoped that he might have some dialysis during his stay, which I hoped might improve his mobility.

Because of his history of delirium and confusion caused by the anesthesia, the next three to four days would be important for him, and probably a little challenging for the three of us.

Maybe rehab won’t be so bad after all

Published on July 24, 2018July 23, 2018 by mellowdee55Leave a comment

March 29, 2018. Mom left home for the hospital shortly after 8:30 AM., and I followed her in my car about 15 minutes later. By the time that Mom arrived at Dad’s room, he had been visited by Mike (today’s physical therapist) and a nephrologist. According to Dad, Mike had had him walk around the bed. He seemed to like Mike and was eager to have another session with him.

When I arrived, Dad was finishing his breakfast of hot cereal, pancakes, eggs, and a few cups of apple juice. Dad looked much better today and had a healthy appetite. He was still a little confused about the dreams and hallucinations that had occurred during the night, but he seemed to be in a good mood. Unlike Dad’s previous surgeries, I had been able to warn him about the potential for hallucinations and confusion after this surgery. I was encouraged that he shared his events with me so that we could sort out what was real. During the day, he asked me about a cat that was sitting in the corner of the room. Although it seemed real to him, he believed me when I told him that there was no cat in the room, although he could still see it.

The morning’s happy mood took a nose dive when Alisa, the nurse, tried to give him a doxycycline capsule. He insisted that he would not take this pill because it had made him vomit. Alisha said that she would give him a Zofran for nausea to take with the antibiotic. I reminded him that he had had problems with this antibiotic when he took it on an empty stomach, but he had just eaten breakfast. He eventually calmed down and agreed to take it, but I was not hopeful that he would take the second pill after dinner.

Sara, today’s physician’s assistant, stopped by at 10:15 A.M. to tell Mom and me that Dad could be discharged to Cornerstone as early as today. Mom told her that we wanted to meet with a Cornerstone representative and tour the facility before Dad was discharged. Sara thought that our request was reasonable and would relay our request to the case manager. When I asked her if we were responsible for Dad’s meds, she said that the hospital would send Dad’s list of medications to Cornerstone and that they would obtain them through their pharmacy.

At 10:30 A.M., I went to the cafeteria to get some coffee for Mom and me. When I returned, Dad was in the bathroom. Being able to get out of bed to use the bathroom was a significant and welcome milestone after hip surgery. With his movement at glacial-speed, the short trip took quite a bit of time, but Carrie, the aide, eventually got him back into the bed at 11:10 A.M. After watching the process that was required to get Dad from the bathroom to the bed, Mom was convinced that we had made the right decision to have Dad discharged to a rehab facility. Dad had insisted that he could have out-patient therapy, but Mom and I together could not have safely transferred him from home to the rehab facility.

Shortly after Dad was settled back into his bed, Dr. Bolanos and Dr. Duran, the nephrologist, and her entourage arrived. Dr. Duran said that Dad’s kidneys were back to where they were before this surgery, whatever that meant. Dad hadn’t seen a nephrologist or had a blood test since early December, so I wasn’t convinced that his kidneys had been in great shape when he entered the hospital. I knew several of the Scott & White nephrologists and was disappointed that one of them was not working at the hospital this week.

When the nephrologists left, Dr. Bolanos spoke with Dad again about rehab, and he was still very resistant to her recommendation and dismissed her reasons why he should have in-patient therapy, insisting that Mom needed him at home. After a few minutes of unsuccessfully trying to change his mind, she left the room.

After the doctor left, Dad started talking about how he wanted to extend his hospital stay so that he could get the physical therapy here that he needed before he went home. I explained to him that his insurance didn’t allow patients to extend their hospital stays for physical therapy. I also reminded him that hospitals were germy places and that he didn’t want to stay any longer than necessary. I added that the hospital wanted to discharge him either this afternoon or tomorrow morning and that there was no way that Mom could take care of him. Because Mom seemed to be Dad’s primary concern and his stated reason for not going to rehab, I had told her that it was up to her to convince him to go to rehab. When she started telling him about her appointment at Cornerstone this afternoon, I excused myself and went to the waiting room so that they could talk in private.

Shortly after I returned to his room at 11:45 A.M., Brenda, the occupational therapist, and Carrie, the aide, arrived for a therapy session with Dad. The goal of an occupational therapist is to prepare the patient to become independent in the job of daily living, and today she wanted to get him into the bathroom. Brenda and Carrie had him practice sitting on and standing up from the commode. She also had him stand at the sink and brush his teeth.

During Dad’s therapy session, Mom told me that he had agreed to go to Cornerstone and complete his therapy as fast as he could. The doctor and therapists had estimated that he would require two weeks, but he planned to be ready to come home in half that time. I was thankful and encouraged by his change in attitude. I left the room to find Dr. Bolanos to let her know that we were all on board with his rehab plan at Cornerstone.

I needed to return to Houston today, but Mom wanted me to join her for her appointment with Marie at Cornerstone. Because we wanted to spend as much time with Dad as possible, I picked up a soggy sandwich from the cafeteria for us to split and eat in Dad’s room. At 1:00 P.M., I woke Dad from a nap to tell him goodbye. It was a good goodbye, and I felt optimistic about his prospects. Mom and I left the hospital together and drove in separate cars to Cornerstone for our 1:30 P.M. appointment. After Mom signed a huge stack of papers, Marie provided us with a tour of the facility that ended at what would be Dad’s semi-private room. The current occupant was due to be discharged tomorrow morning, which meant that Dad would have the room to himself for some time. Everybody was very nice, and it seemed like a nice place. I hoped that Dad would do well here.

After our meeting, Mom returned to the hospital and I drove to my parents’ home, where I worked for another hour before driving to my home in Houston. Five days ago, Mom called me with news of Dad’s fall. Because of his severe osteoporosis, I feared the worst for him. With Dad seeming to be inspired to get back on his feet, I now felt optimism that I hadn’t thought possible.

They say that he has to go to rehab, but he says No.

Published on July 17, 2018July 17, 2018 by mellowdee55Leave a comment

March 27, 2018. Because I was concerned about how Dad fared during his first night after surgery, I didn’t sleep well and woke up just before 2:00 A.M. I hoped that he had slept well and that he had not tried to get out of bed during the night. Mom and I didn’t have much of an opportunity to visit with Dad yesterday after his surgery, but I had warned him that he might experience some confusion after his surgery. I knew that I would be spending a few hours at the hospital today, so I set up my computer shortly before 5:00 A.M. and worked for about four hours. Thirty minutes later, Mom and I arrived at the hospital.

When we entered Dad’s room, we found that a nurse and a couple of nursing students were turning Dad in his bed. Until patients can get out of the bed, they must be turned every few hours so that they don’t develop bed sores. After Dad was resituated in his bed, Dr. Bolanos entered the room. Within moments, the two of them were arguing about Dad’s antibiotic suppressant drug. He insisted that the doxycycline gave him an upset stomach and that he hadn’t taken the pill in six months. She suggested that he take the antibiotic with food or with Zofran, which would prevent any nausea. He agreed but said that he would take only one pill a day and not the prescribed two pills. Fortunately, she avoided the subject of rehab during this visit.

Although Dr. Bolanos had steered clear of the contentious subject of rehab, Kim, the physician’s assistant, took the bull by the horns when she stopped by Dad’s room. While she was there, she described the different types of physical therapy available to patients and the patient requirements for each option. For Dad, she reinforced Dr. Bolanos’s recommendation for in-patient therapy at a rehab facility. As before, Dad insisted that he had to go home and take care of his garden and wife.

Shortly after lunch, Amy, the occupational therapist arrived and had Dad stand with the walker. Before Amy left the room, Brooke and Lisa, the physical therapist and her assistant, arrived. They had Dad stand up and sit down and then sit in a chair. While he was enjoying being out of bed, Pastor Tom entered the room. While Tom was there, he spoke of the many benefits of rehab. The pastors in that church always seemed to answer my prayers. Before Tom left, he urged Dad to get well quick because he needed a Christian in the church, which was a running joke between them. Tom had a very busy schedule this week, and Mom and I greatly appreciated his taking the time for a visit.

At 3:00 P.M. I returned to the house so that I could get in a couple more hours of work. I was feeling the effects of my sleepless night and drank coffee to keep myself awake until 5:00 P.M., which was when I logged off for the day. While I was working, my parents’ neighbor, Jane, dropped off a Cobb salad that she had purchased for us while she was in Austin. Mom and I devoured this much-appreciated gift for dinner.

March 28. Dr. Bolanos stopped us in the hall as we approached Dad’s room. She told us that Dad was very confused. He thought that he was at home and he was also having hallucinations. Also, during the night, he had gotten out of bed, and the nurses had found him on the floor when they responded to the bed alarm. To help prevent him from injuring himself, they exchanged his bed for one that could be lowered within inches of the floor. As if this news wasn’t enough, she added that Dad was argumentative and was still fighting the notion of going to rehab.

When we entered Dad’s room, we encountered chaos. Dad was eating breakfast and arguing with Alisha, an aide who was trying to take his blood pressure, which was required before he could have his morning meds. He insisted that he would not take the meds, and wanted her to leave. Steve, the electrical technician, was also in the room, trying to repair a problem with a spastic call light and oversensitive bed alarm. It didn’t help matters any that Steve and a nurse were discussing the problems with the system.

I asked Alisha if she could leave so that Dad could finish his breakfast, and she agreed to come back later. As soon as she left the room, another woman entered the room. She introduced herself as Lisa, the nurse manager, and asked if we were having problems. I told her that the room had been like a sea of chaos when we arrived, which was not helping my father’s anesthesia-induced confusion or his mood. She took control of the situation and orchestrated the activities of the nurses, aides, and Steve until a relative calm settled over the room. The only challenge, which remained for a few hours, was the bed alarm and call light. Dad’s new bed did not have a built-in bed alarm and an attached call light. The nurses were using a chair alarm and the rigged-up system was somewhat faulty. I finally had Steve turn off the maddening bed alarm, promising to have the nurse turn it on when Mom and I left.

Adding to the parade of people who dropped by was the case manager, who asked whether she should start looking for a rehab facility for Dad. Dad didn’t hear her question, and I quickly ushered her out of the room. Rehab was still a touchy subject, and I didn’t want us to launch into another argument in front of the case manager. I returned to the room and told Mom that she needed to see the case manager in the hall. While Mom was gone, she signed the appropriate paperwork to set the discharge process in motion. While Dad had been in surgery, I had asked Pastor Tom about Cornerstone, and he said that he thought (based on his visits to many rehab facilities) that it seemed like a good facility. We hoped that Cornerstone, which was within a couple of miles from my parents’ home, could accommodate Dad.

Mom and I had hoped to be with Dad during his next physical therapy session, but we hadn’t heard anything about today’s schedule. To ensure that we didn’t miss the session, I went to the cafeteria to buy lunch for Mom and me. While Dad enjoyed a lunch of pork chops, Mom and I ate yogurt and fruit. Dad admitted that his lunch was pretty good, which was practically an enthusiastic endorsement of the hospital food. We finally asked the nurse about Dad’s schedule, but she said that there was nothing on his chart today about him having physical therapy. With that disappointing news, Mom drove me back to the house so that I could get back to work.

Shortly after Mom returned to the hospital, Pastor Tom returned for another visit. Tom told Dad how rehab had made a difference in his recovery when he broke his ankle after jumping from a plane while he was in the army. Although Tom’s words probably fell on deaf ears, I felt like we should have baked Tom a pie for trying to sell Dad on the notion of a rehab facility.

Shortly before I logged off from work, I answered a phone call from Cornerstone. Marie was calling to inform us that Dad had been accepted and that she wanted to make an appointment with Mom so that they could finalize the arrangements for his two-week stay.

Now, all we had to do was get Dad to agree to the transfer from the hospital to the Cornerstone facility.

Back at Scott & White Hospital. Oh, joy.

Published on July 10, 2018July 16, 2018 by mellowdee552 Comments

March 25, 2018. After last night’s disturbing phone call from Mom about Dad’s fall, I wanted to get an early start to Temple so that I could be there during Dad’s surgery. I was up by 5:30 A.M., called Mom 45 minutes later to let her know that I was coming, and left home at 7:40 A.M. Because of my early departure, and some good highway luck, I arrived at my parents’ home at 10:15 A.M. I quickly unpacked my car, drove to Scott & White Hospital, and made my way to room 566 in the south tower.

I had just missed the surgeon, who had stopped by to tell my parents that barring any emergency surgeries, Dad’s surgery was scheduled for that afternoon at 1:20 P.M. Shortly after I arrived, Dr. Karla Bolanos, Dad’s attending physician for the week, stopped by to visit with Dad. Dad was very charming and witty, giving her the impression that he was a cooperative patient. At this stage of the process, he actually was very cooperative because he had no idea what was in store for him.

The doctor said that Dad would have his first physical therapy session and evaluation the day after his surgery. Following the surgery, he would remain in the hospital for 2-3 days and then move to a rehab facility for two weeks of rehab. It was at this point in the conversation that Dad balked and said that this plan didn’t work for him. He had no intention of going to rehab; he was needed at home. Unfortunately, Mom seemed to agree with Dad. In an attempt to sell my parents on the notion of rehab, I related the story of their friend Sally and her experience with rehab after her hip-replacement surgery, but my parents were not swayed.

Shortly after Dr. Bolanos left us, I left the room to call Stan and my friend Rhoda, both of whom wanted an update on Dad’s condition. On the way to the lobby, I saw the doctor at the nurse’s station and spoke with her about Dad’s diuretics, his swollen legs, and I requested that she order an infectious diseases specialist to check Dad to see if he still needed the antibiotics to suppress infection in his lungs. She appreciated knowing about the diuretics but said that Dad would need to take suppression antibiotics for the rest of his life. Furthermore, she said that he needed the antibiotics because of his new heart valve. It seemed to me that he needed the antibiotics for a couple of good reasons. Because antibiotics can affect the kidneys, I had hoped that he could quit taking them, but the doctor dashed that hope.

When I finished making my phone calls, I returned to Dad’s room. Dr. Bolanos returned to the room a few minutes later and told us that they had noticed a spot on Dad’s heart that looked like a clot. Before they could operate on Dad’s hip, they would need to run some tests, which were scheduled for tomorrow. By now it was 12:30 P.M., and Mom and I were hungry and decided that we would leave Dad for an hour and go home for lunch. When we returned to Dad’s room, because his surgery was rescheduled for tomorrow, his NPO restriction had been lifted, and he was eating lunch and complaining about the food. Some things never changed.

At 3:30 P.M., an imaging tech arrived with an ultrasound machine to scan Dad’s legs for blood clots. She couldn’t tell us anything, and we assumed that we’d hear something soon from the doctor.

Shortly before 5:00 P.M., Mom and I left the hospital for home, having not seen any medical providers after the imaging tech left the room.

March 26. Mom and I arrived at Dad’s room shortly after 9:00 A.M. Dad said that he had been told that his surgery was scheduled for 1:20 P.M. Dr. Bolanos stopped by the room and told us that Dad was scheduled for a VQ scan at 10:30 A.M. I had never heard of a VQ scan, but I learned that it evaluates the circulation of air and blood within a patient’s lungs. The transportation tech arrived 10 minutes before the scheduled time and transported Dad to the procedure location. Not knowing how long he would be gone, Mom and I started getting antsy when he hadn’t returned by noon—especially because he was scheduled for surgery at 1:20 P.M. We didn’t want the surgery rescheduled for tomorrow. We also didn’t want to leave the room for lunch and risk missing the doctor.

Dad was returned to his room at 12:15 P.M., and a couple of minutes later, we were told that he was still scheduled for surgery today. Less than 30 minutes later, another transportation tech arrived to take Dad to the OR prep area. Mom and I were both allowed to accompany him. Dad wasn’t in favor of my coming, but I wanted to speak with the anesthesiologist. Dr. Daniel Stahl, the surgeon, stopped by to tell us about the surgery. He said that Dad would need three pins and that unless they found something different from what they had seen on the x-rays, the procedure should take less than two hours.

I told the anesthesiologist that following Dad’s previous two surgeries, he had had a heck of a time dealing with the anesthesia. For three to four days, he had been very confused and had had hallucinations of animals, insects, and water in the room. The anesthesiologist said that he had Dad for his second surgery in May 2015. He said that if this surgery lasted no more than 90 minutes, he could use a spinal tap. Dad would be aware of what was happening, but he wouldn’t have any pain, and he would not suffer the after-effects of the anesthesia. He said that he would confer with the surgeon and try using a spinal tap if we agreed that was the route that we wanted to take. He thanked me for the update on Dad’s history, and Mom and I hoped that we had found a solution to Dad’s post-op dramas. While we were speaking with the anesthesiologist, the nurses were having a heck of a time finding a vein so that they could type and screen Dad’s blood.

When the nurses had finished drawing Dad’s blood, Mom and I made our way to the OR waiting room. After waiting for about an hour in the freezing-cold room, we were pleasantly surprised to see Tom, my parents’ pastor. I don’t know how he found us, but pastors seem to know their way around hospitals. We had a nice visit with him, and during our discussion, I mentioned my concern about Dad’s reluctance to go to rehab. I hoped that Pastor Tom would be able to have a guy-to-guy talk with Dad sometime before he was discharged from the hospital. After talking with Mom, I learned that part of her reluctance to send Dad to rehab was because of the promise that my parents had made years ago to not put the other in a nursing home. I explained to her that he would be admitted to the temporary resident section of the skilled nursing facility, not the permanent resident section, commonly referred to as a nursing home. I think that she felt somewhat better about rehab after our discussion.

Just a few minutes after Pastor Tom left us, the surgeon arrived to tell us that the surgery had gone well. Unfortunately, because of Dad’s spinal compression, the anesthesiologist was not able to use a spinal tap and had to use a general anesthetic after all.

Oh, joy.

Thank goodness for the (relative) calm after the surgery

Published on April 3, 2018April 9, 2018 by mellowdee55Leave a comment

April 2, 2016. After staying up last night until after 11:00 P.M. following Dad’s fistula fiasco, the 4:30 A.M. alarm seemed to come just moments after I placed my head on my pillow. By the time that I had dressed and started the coffee, the light was on in my parent’s room. Dad’s incision site had bled only slightly during the night. After eating breakfast and administering meds, Mom and I took Dad to dialysis. When we arrived, he weighed 153.34 lbs., which was about 3 lbs. more than his dry weight. After getting him settled in for his three-hour session, Mom and I left for home around 7:30 A.M. When we returned to pick him up, his RN, Melissa, showed him how to find the thrill in his arm. Following fistula surgery, when you place your fingers over the fistula, instead of feeling a pulse, you feel a whooshing that feels almost like a cat’s purr. This whooshing vibration is the thrill. His post-dialysis weight was 150.92 lb.

Dad’s fistula would need to cure for a couple of months before he could use it for hemodialysis. Dad’s surgeon, Dr. Jaffers, had told him that he should check his thrill on a daily basis. If he could not feel it, he should contact his doctor, and he’d probably need surgery to repair the fistula.

While my husband, Stan, was in town, he mowed the lawn and sprayed weeds. After lunch, Dad took a nap, and Stan and I drove to the Miller Springs Nature Center near Lake Belton to find some accessible trails that Dad might be able to walk. The trails seemed a bit less than optimal and appeared to be a little damaged. I was pretty certain that Dad would have a difficult time navigating them with a cane or a wheelchair.

My lack of sleep was starting to take its toll on me, and when we returned home, I needed a nap. Fortunately, I woke up in time for happy hour. After dinner, dad was feeling well enough to play cards, and I won.

April 3. According to Mom, Dad’s incision seeped a bit more during the night. While Mom and I went to church, Dad and Stan stayed home and played cribbage. As Mom and I were walking into the church, my phone rang. It was the home-care nurse, Paula, and she wanted to come by and admit Dad into Scott & White Home Care. When our friend and nurse practitioner, Sue, heard about Dad’s ordeal with the fistula surgery, she was more than a little exercised, and she could not believe that the incision was still seeping blood. She said that “bleeding wasn’t supposed to happen.” I told her that I have hundreds of pages of documentation full of things that “shouldn’t have happened” to my father.

Because Sue had been so worried about Dad’s continued bleeding, we checked Dad’s dressing as soon as we returned home. Paula arrived at 1:00 P.M., shortly after we had finished replacing the adhesive on the dressing. Paula offered to change his dressing, but we decided to wait until we heard from Dr. Jaffers. Because she was part of the Scott & White network, she was able to email Dr. Jaffers to see how soon we could have the dressing changed.

It was comforting to have my nursing lifeline back.

April 4. I logged on to Dad’s MyChart account at Scott & White and saw that Dad’s appointment with Dr. Jaffers had been rescheduled to a later date. At the start of his office hours, I called Patsy, Dr. Jaffers’s secretary, to see why our appointment had changed. Her phone number had been one of the numbers that I had called in response to Dad’s bleeding after the surgery. When she heard that it was me calling, she said that she was getting ready to return my call from Friday evening. I also told her about the drainage of Dad’s dressing and thought that it should be changed. When I told her that I had photographed it with my phone, she asked me to text the photo to her cell. She soon returned my call and told me to take Dad to the dialysis center and have the nurses change his dressing. To ensure that we wouldn’t encounter a problem there, I called the charge nurse to let her know that the doctor had instructed us to drop by. Dad and Mom left a few minutes later and had no problem getting Renee, one of the nurses, to change the dressing. She and some of the others there were a little disturbed about the problems that he had encountered. Unbelievably, it seems that he was the first person ever to have problems of this nature. Of course.

This afternoon while I was working, I looked out the window and saw Dad holding the cane with his right hand and dragging a garden hose with the arm that had just had surgery. I immediately ran outside to help him. My major concern was that he might fall, but he also seemed out of breath, and then there was the issue with his arm. I got him to rest for a minute before he headed out to the garden to see my mother, who was planting cucumber seeds. It was pretty warm out, so I wasn’t wild about either them being in the direct sun.

At 4:00 P.M. I ended work so that I could download some bank statements and transaction statements for Dad. We finished at 4:30 P.M., and then I took a short walk to stretch my legs. We had a nice happy hour and watched the news before eating a tender chicken that had been stewing in a crock pot. We played cards after dinner, and my mother won. We hit the hay a little early. I did a little packing and gathering for my trip home on Wednesday, two days from now.

April 5. I was up early and had to wake Mom and Dad with the “good morning” song. They were moving a little slow but they were up and out of the house by 6:15 A.M. When Mom returned from dropping off Dad at the dialysis center, she said that they planned to remove 3,300 ml of fluid today, but they would also add fluid, so the net amount removed would be closer to 2,000 ml. I’m no nephrologist, but I wasn’t sure why they didn’t just remove 2,000 ml.

After lunch, Dad took a nap. He was sleeping soundly, and I had a difficult time waking him. He finally got up at 2:45 P.M., 45 minutes after I started trying to wake him. The rest of the day went well. He and I talked about dinner plans for Saturday, and I went to the store to buy him a battery and some food. After dinner, we played cards, and Mom won.

It was after dinner when the day went to Hell. It seemed to me like Dad was out of breath. Concerned, I checked his oxygen level, and it was fine, but his heart rate was 132. I had been hoping that he would start weaning himself from the wheelchair, but the more we talked, the more apparent it became that he wasn’t getting rid of the wheelchair. According to Dad, the wheelchair was the only comfort that he had. Furthermore, he didn’t trust Dr. Pfanner and thought that he’d keep coming up with excuses for not pulling Dad’s PEG tube. Dad then shared a bucketful of excuses for not walking or getting rid of the wheelchair and not exercising. When our discussion turned into a heated argument, Mom came into the room and asked what we were arguing about.

Dad seemed to be in the midst of a terrible pity party, and he couldn’t seem to see his way out. I was a little concerned because he seemed depressed. I’m no expert, but I knew that he was in pain, which probably contributed to his attitude and outlook on life.

I was too tired to continue the fruitless conversation, and I went upstairs to bed. I could hear the television, and it was on for quite a while. Evidently, Dad went to bed late after watching Ted Cruz give his victory speech in Wisconsin. By the time he went to bed, he didn’t like Ted Cruz.

April 6. I dragged myself out of bed at 3:45 A.M. and was logged on to work 15 minutes later. Mom and Dad were up by 6:00 A.M., and I stopped work at 7:30 A.M. so that the three of us could eat Mom’s homemade banana muffins for breakfast.

At 10:00 A.M., I took a brief break from work when Kathleen arrived to administer a physical therapy assessment for Dad. Following her assessment, she said that she would put him on an aggressive rehab plan so that he could walk with or without a cane. Kristen, the speech therapist, also called this morning and scheduled a session time with Dad on Friday afternoon. I would be in Houston on Friday and was disappointed that I wouldn’t get to see her.

I called Dr. Pfanner’s office and tried to get a straight answer from his nurse about whether or not Dad needed to take another MBSS before he could have the PEG tube removed. After not getting a straight answer, I emailed her again and restated my question in writing.

I left Temple for my home in Houston at 12:43 P.M. and arrived home shortly after 3:30 P.M. I was pretty tired for the last 40 minutes of the drive and forced myself to stay awake. Stan got home from work about an hour later.

It seemed like I had been gone for quite a while, and it was good to be home again with Stan and our cats. Stan fixed us a nice dinner of turkey breast, and it was moist and yummy. After dinner, we made reservations for our trip to Wisconsin this September. My friends had surprised me with a girlfriend trip to Wisconsin to celebrate a milestone birthday last year, but my father’s situation had required a postponement of our plans, and this trip was our time to get together at last.

April 7. Because I would be working from home today, I was able to sleep in until 4:00 A.M., and lounge around and watch the news until 5:30 A.M. I finally got to my home office above my garage at 6:00 A.M., close to the time that Mom and Dad were on their way to the dialysis center back in Temple.

Back in Temple, Dad had 1,800 ml of fluid removed during dialysis and his nurse also removed his dressing. Sue, the dialysis nurse practitioner and our friend, had been very concerned about Dad’s progress and stopped by to ensure that his fistula was healing well.

I worked until 5:00 P.M. and then called Mom for a quick update on their day. After Dad’s nap, they spent quite a bit of time outdoors in their garden, planning a drip line. When I called them, they were watching the news and enjoying happy hour.

After I spoke with Mom, I set up an account with WordPress so that I could begin sharing Dad’s story, a story that I hoped would be ending soon.