hip replacement – Tale of Two Parents

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.

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.

Tag: hip replacement

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

Replacing the crumbled hip