FRIDAY contrasts

Nancy was doing fine today and from Noon to about 2 o’clock we visited and looked at Christmas cards and she wrote short notes on the bottom of letters I’ll mail to family and friends for whom I haven’t found e-mail addresses.  One procedure, done before I arrived, was the withdrawal of 800 ml of fluid from her lungs via a needle through the back.  Ouch!  The issue is they want her lungs to get better as fast as possible so the valve replacement operation can be done.  Taking out the fluid is the fastest way of helping that problem along.  Her heart seems to be strong enough – as a muscle – but the leaking parts need fixed real soon.

I am in awe of modern medicine.

I am less respectful (rant alert) of some of the ‘stuff’ that happens.

Nancy has had “procedures” in the Catheterization Lab twice.  One and one-half days after the first she was on life-support and fully sedated in the ICU within the same building (I think the former is one floor above the later).  Within two days she received (at home) a letter and survey form wanting her to confirm their high regard for their services.  I sent it back suggesting – to the Director – that their protocol include finding out the whereabouts and health status of the intended recipient.  Her second visit to the Cath-Lab was the night time attachment of the external pacemaker and she is back in the ICU again.  The letter and questionnaire almost beat me home from the hospital.

But wait, there’s more.  The dear patient (or Nancy as we call her) gets a second letter.  This one advises her that she is pre-scheduled (what’s the purpose of the “pre” here) for a ‘pacemaker check’ at 2 PM on January 6th 2010 and failure to appear could cost her $100.  Okay, they provide a number to call to alter this.  Hello, hospital!  She is in the ICU.  She is going to get a permanent pacemaker on Monday.  The one this letter is about – we’ll send it back in a plastic bag for you to check.  (Rant off.)

Finally – if you are still with me – the ICU discourages visitors.  In Nancy’s case she is quite able to have visitors but people in nearby rooms are very seriously ill.  If it were not for potential problems with the heart valve they would likely move her out and if they need the room, they will.  So, no visits, please, as requested by the ICU nurses.

There was heavy fog today.  They closed I-82 for a time but I apparently passed the exit they were to set up at before the police got there.  When I came down off the last ridge into our valley I could see the flashing police car lights blocking the south-bound lanes.  There was only one short stretch where the cars and trucks slowed to about 60 mph, and keeping a respectable distance between us, we sailed on through without a glitch.

THURSDAY — timing is important

The timing of the beating of one’s heart is an important and complicated process involving chemical and electrical signals and best left to someone else to explain.  Nancy’s heart has been irregular and a bit fast at times and so she gets a pill to slow it down.  As that chemical waxes and wanes so might her own internal controls and if the two combine just so – sometimes her heart rate slows.  It did that last night.

The doctor in charge of the evening crew thought Nancy’s heart was being less than true and sent her downstairs to have a temporary pacemaker attached.  For closer monitoring purposes they than moved her back into the ICU rather than into the room on the 4th floor where she had been.  I talked with her and the nurse at about 1 AM, then went down in mid-morning.

In the ‘temp’ setup the power source is outside the body with a lead to the heart and then initiates the impulse for contraction of the heart muscle.  [Look up the ‘sino-atrial node’ if you really want to know more.]  The plan was to insert the lead up through a vein in the crotch area.  Those veins either had a problem because of having been used earlier for the balloon angioplasty, or perhaps has some blood clots from weeks of inactivity.  In any case, those trying this entry point had no luck and after some considerable period of time decided on a new route through the side of the neck.  That was quickly done.  Nancy compared their antics to The Three Stooges.  I don’t know if she told them so but she did tell some of us at mid-morning.  I don’t think the decision has been made to implant a permanent pacemaker although that is a possibility.  Meanwhile the pulse is steady now.

When I arrived this morning a crew was doing an exam of veins to check for the aforementioned problems suspected when the ‘stooges’ [I’m sure they are skilled and nice people.  They just irritated Nancy.] could not get the heart lead inserted. I think the machine is the same as used for an echocardiogram but used differently or with additional chemical tracers and software (I missed all but the last minute – poor timing.) and falls under the category of ‘vascular ultrsonography’ – I think that’s what they said.

They wheeled the machine out.  Nancy, the doctor, the nurse, and I visited off and on for an hour and the machine was brought back in – with a different operator (but one we knew) and he started to set up for an echocardiogram to be followed by lunch and then, who knows?

I went to fill the car with gas and came home.  I’ll call later but don’t plan on going down again today.  We have patches of dense fog and as darkness comes driving is difficult.  Besides, I haven’t been to the grocery store in more than a week.  It is now 3:30 – I’ll post this and go.

WEDNESDAY another fine day

It was a good day for Nancy and the snow/rain/ice forecast by the local office of the weather service never showed up.  I talked to Nancy in the early morning – they wake her about 5:30 – and told her I might not come down.  But as the morning progressed I could find nothing on the internet suggesting the storm was about to arrive.  So I went.

I was there for a visit from a lung specialist – he didn’t do much but the cardiologists asked for him to stop by and report for their meeting tomorrow.  Another chest x-ray was taken later in the afternoon and some other test too but I didn’t catch exactly what Nancy said and didn’t have her repeat it.  With the collected information from the last few days the doctors will consider having her move to a skilled care facility.

I stopped by one of the possible places for her to go to and came away with a packet of material to show her, and I learned of some of the things available there and some of the rules.  I also bought a $1 chance on a large Christmas-goodies basket.  I forgot to ask where my dollar will go!

I came home to find our long driveway cleared of the 10 inches of snow accumulated over the last three days.  That unexpected gift is from a neighbor with a farm tractor with a wide blade.

That’s all for now.

TUESDAY — well within . . .

. . . the time frame for holiday music as there are just 10 days to go.   Yakima’s First Presbyterian Church is a block from the hospital and their Carillon Bell Tower (or a loudspeaker with recorded sound) provides a nice touch for a minute as I arrive or leave.  Nancy would enjoy this but the only outside sound to enter her room is from the helipad on the top of the next building.  Anyway, it was a snowy-wet day in Yakima but warm enough that I could pause and listen for a few moments.  Nice touch.

At about 2 A.M., Nancy woke from a dream (or not quite woke) and decided she had the wrong clothes on for whatever it was she thought she was doing.  She claims to have just about gotten out of bed and was removing the sensor-sending units stuck to her body which triggered the arrival of the night crew.  When I arrived at Noon those folks were long gone and I don’t know what, if anything, got recorded regarding the incident.  Maybe there wasn’t an incident.  Nancy says so, and had on a new clean open backed hospital gown provided after the sensors units were restored.  Her story and she’s sticking to it.

The team of doctors is scheduled to meet on Thursday of this week to decide if she is ready to transition to a skilled care facility. One of the team visited with her mid-afternoon. If this means a few tests on Wednesday they haven’t informed her as of 6 PM.  They may be getting what they need from the on-body sensors.  This is yet another mystery to the uninitiated.  In her two day stay in this unit Fri/Sat after Thanksgiving they wheeled equipment into the room and did a chest X-ray and an echocardiogram; maybe more.  So, I think such may be done now either in-room or elsewhere.

I got a list of the local skilled care facilities from the Social Services person.  I used Google Earth to locate them and in addition to “where they are” I could get a sense of the neighborhood.  One is directly across the street from Yakima’s largest high school.  Another is just off a main street in a neighborhood one would not consider idyllic or serene.  They all come highly recommended (tight regulation and control here in WA State) so location and ambiance can be considered.  We are wondering if such places have high-speed internet connections.  A question for tomorrow.

MONDAY late afternoon

Nancy is still tracking smoothly today.  I managed to get there today shortly after a rep from the rehab unit arrived.  It didn’t take long to determine that would be an inappropriate place for her.  They expect a person to do 3 hours of physical activity each day.  At the moment Nancy tires after getting out of bed and into a chair.  About when that person left an occupational therapist arrived.  These folks seem to be the ones that assess your ability to function with regard to chores such as dressing, bathing, eating, or some other number of things.  I really have read this list but that was about 7 years ago.  Anyway, this lady went and found toothbrush, paste, cup, water, paper towels – and then let Nancy brush her teeth.  I don’t remember ‘teeth brushing’ on the list I read.  After watching Nancy and some input from both of us, I think we convinced her that Nancy would be able to take care of herself as soon as her strength returned from 3 weeks of total inactivity.   The problem is that when that happens Nancy will have open heart surgery and we hit the ‘replay’ button.

We did get this person to call the hospital social worker’s desk and they sent a lady who was a bit more helpful.  We expect that within a day or two or three that the doctors involved will have a get-to-gather and decide when to turn Nancy loose – to a skilled nursing facility.  There are several choices, including a couple of places here in E-burg but, at least initially, I think closer to the heart center is better.  The ridge tops on the way from E-burg to Yakima top out close to 2,400 feet and can get freezing rain in the Winter.  That makes for nasty roads.

I have 3 inches of snow here at home.  3 miles south there is no snow and that holds all the way to Yakima.  But the weather folks think there will be about 5-7 inches of snow tonight maybe changing to rain during the early morning.  The winds are shifting, to come more out of the SE –and upslope.  Thus the precipitation in this near-desert country.  So, I’m going back down now and if the roads are too bad I won’t go tomorrow.  Nancy’s talker isn’t working well but her ears are fine so I could call if I decide not to make the trip.  All for today!

SUNDAY a snowy eve at home

Not a lot new with Nancy.  Oxygen is still set on the lowest level of one liter per hour although it is now being trickled through water to add a little humidity to the flow.  They did take the catheter out (for urine) and shortly after paid the price!  That part of her isn’t working any better than her voice.  Maybe they should have stopped the Lasix (furosemide) a few hours sooner.

Monday she will have a meeting with the ‘rehab’ folks to see about getting her up and moving.  This will be done with monitors in place and two attendants.  She has moved very little for over two weeks and so her muscle tone (or whatever one calls it) is close to nothing.

The rehab unit sent a packet for us to read.  All the material makes the assumption that the person has heart problems because of poor diet and smoking and so on.  Not one mention of a valve problem.  There is nothing to be done about that except to replace it.  At the moment a successful rehabilitation means getting to the operation.  I’ll write more on this as we go thru it.

Here’s a thought Nancy and I talked about today.  A couple of people have asked about the hospital she is in and the RM.# with the idea of sending cards and flowers.  She is going to try to add a note to a pre-printed message I will write in response to Christmas cards for folks we do not have an e-mail address for.  If you are reading this you have an internet connection so just send a message via e-mail.  I will print these for her to read now and save them in digital format too  so she can respond later in like manner.  You can use this e-mail address:  nancyh@ellensburg.com

The hospital does have an in-house web based card service.  I think it is free but there may be a fee.  Please consider using it and, if you like, use the money you save on flowers, cards, candy, or whatever on your local food bank.  Here is the link:

http://www.yakimaregional.net/Patients/eCard/default.aspx

The card is printed in color on 8.5 X 11 inch paper and they bring them to the room and tape them where she can see them.  Works great.  However, the e-mail to  –   nancyh@ellensburg.com   –    is the best thing to do.

SATURDAY 7 P.M.

Still doing well.  The medicines are being adjusted just a little as tests indicate but nothing major.  The doctors did reduce the oxygen flow from 3 to 2 liters – I didn’t get to ask about the ‘time’ used in that measurement.  However, they would like to get her off the supplemental oxygen and today’s change went okay – so that’s progress.  All this past week the oxygen level was at or near 100 and the nurse took an in-room reading for us at about 5:30 and it was 95 +/- 1 over a period of about 30 seconds.  These things are also being monitored continuously at a computer screen at a central station just down the hall but the nurse wheeled the real-deal in and tested it for us to see.

It is now about 7 and I just got home from the hospital.  Not much to report from this morning’s visit.  I left at about 11.  Nancy had visitors to help with lunch and I returned to help with dinner.  Weather and roads are still great for traveling.  By Monday evening they expect snow.  We’ll see.  The rain shadow effect still works when the snow storms come from the west but an upslope flow from the east can be big time trouble.  I’ve been too busy to check the reasoning for the current forecast.

FRIDAY a long day

Nancy continues to improve.  I visited this morning and late afternoon.  I think her voice is stronger in the morning and by 4 PM it is more difficult for her to project.  This morning we talked about visitors again and this time she seemed agreeable.

I called a Yakima couple.  The lady of the house still works – he’s retired.  She works about 5 minutes away from the Hospital so she came during her lunch hour and brought a gift and a card.  Later a nice arrangement of cut flowers was delivered – compliments of students from CWU.  The colors were wonderful in this cold record-setting drab Yakima December.

Mid-day when I got home I called a family (she’s a nurse and the daughter who just happens to be home was a student at CWU a few years back.)

Only the daughter could go with me on the afternoon trip.  We arrived just before Yakima’s rush hour, stayed to see what Nancy got for supper, helped her cut it all up, and then left.  If I am there, or today with two of us, she will occupy herself with thinking about what I should do next and either telling me or writing it down.  If I leave, she eats better.  Today was grilled fish, rice, carrots, and angle food cake.

The blood thinner she is on interacts with several foods, especially dark green veggies and cranberries.  I’m told this would not be too much of a problem if one eats about the same amount of these things daily.  Then the amount given could be set to match.  With Nancy and veggies it is a good bet she won’t eat much of any of the boiled green ones.  If they fixed something in a different manner and she ate it, there goes the balance.

They started her off shortly after 5 AM with a chest x-ray.  Had her out of bed three times.  About supper time a helicopter landed on the roof across the courtyard.  It reminded me of a MASH episode. She might sleep well tonight.

While we are going to allow visitors, all need to be aware that she is frail and the nurses will likely limit the time to short, and the number at any one time to 2.  None under age 14.  If you visit, be prepared to wait a bit if something is going on or if someone else is already in the room.  Don’t wake her if she is sleeping.  Include a trip to the hospital along with some other purpose for going to Yakima.  There is no schedule, as yet, that we can plan around.  She is not ready for phone calls.

THURSDAY

Nancy was moved upstairs to the fourth floor today to the Advanced Care Unit (ACU).  That was twelve days in the ICU.  I visited in the morning in the ICU where they were in preparation for Nancy’s departure and the arrival of two new patients.  They could not get her moved yesterday because of the lack of appropriate space upstairs.

When I returned at 4:30 the move had been accomplished although (in Nancy’s mind) with less than a smooth handoff to the team in the ACU.  The crew that brought her up were needed back in the ICU, she was in good shape and properly taken care of, and the ACU is, by definition, a little less intensive – care wise.

Luckily (I think) an acquaintance stopped in to see her at just that time and took on some of the welcoming function she seemed to want.  Nancy and I had talked about visitors or no and she wanted to put it off for at least one more day.

Her voice is just strong enough now that she can be heard and understood.  I don’t think she is ready for her cell phone yet.  The in-room phone triggers long distance charges so she will soon demand her cell phone back.  In anticipation of that I spent an hour in the AT&T store buying one of the darn things and switching her account (it would have expired on 12/18) to my new one.  They have to do a credit check and want both people there because they have to call an AT&T center someplace for such a transfer.  So we had to wait on another female clerk and have her ready “to be Nancy” if need be.  Being my first cell phone my homework for tonight is to figure out how it works.

I did not encounter any of the doctors today and the ACU nurses were not yet really acquainted with Nancy so they didn’t provide any new information.  I expected that, so no problem.

It is cold but there is no snow – that’s good with the driving I’m doing.

My sister lives south of Cleveland OH and they had 60 mph winds but the big snow is farther east.  I’ll post this and then check and see how it is progressing.

WEDNESDAY – a better day

Mid-morning and late afternoon visits and discussions with doctors and nurses, left me feeling a lot better than yesterday.  That’s because Nancy was much better than on Tuesday and surpassed the Monday status. She was sleeping better and eating more today.  When I got there about 4:20 this afternoon she was sleeping soundly.  I stood and watched a silent television for 15 minutes before she woke up. I learned that the mid west was being slammed with a blizzard unlike any since Nancy and I lived there in the 1970s.  Also Yakima broke a record low.  With the sound off that’s about all I learned.

She needs to breathe  more deeply.  When she went to the ER last spring she had fluid in her lungs from the cell damage the bacteria were doing (I think) and the X-ray was first interpreted as her having a “piece of pneumonia.”   Not so as it turned out.  Then this latest episode caused some more lung damage (now healing) but laying in bed doesn’t get you much lung exercise. So she gets to blow into one thing and suck on another.  That’s boring after about 30 seconds.

So, …

I told them she played fiddle and visited nursing homes and such with a group of  ‘old-time-music’ friends and that she started singing in a church youth choir when she was about 3.  So they brought in a music player and tried to get her to sing along with some Christmas music.  We both think Christmas music ought not to be allowed on the airwaves until 12 days before Christmas (not close enough yet).  She was a good sport about it but when David (ICU nurse) left the room she had me turn it off.

If they had had the Virginia Reel, she probably would have known lyrics and been happier.  The rest of us would have been clueless.

So we are looking forward to Thursday.