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I arrived today to find Nancy in a chair.  It is not an easy task just yet for that to happen.  She is still connected to a couple of drip lines, an oxygen line, and the chest cavity drain.  She also has a suction line such as the one dental assistants use to clear your mouth.  This is a great advance over having to cough and spit into tissue.

Some body chemistry is still marginal.   Fluids are an issue partly because she is drinking a lot and not eating much solid food.  Getting rid of the fluids takes out some of the desirable chemicals, such as calcium.  While these things are easily correctable they do require monitoring, injections, and pills.  They are also (and have been for awhile) giving her low doses of insulin, as in being diabetic.  We think this may just be because of all the things that have happened and that it will not remain a long term issue.

Nancy is right handed and moves the right arm and hand more than the left.  This shows in the degree of puffy-versus-normal in the appearance of her left hand. [The puffy or swollen aspect is referred to medically as edema, caused when fluid is retained in the spaces between body cells.]

Her lower legs are likewise swollen.  This is her 37^th day of being in bed, many with almost no movement.  With the open heart surgery behind her it is a sign of progress that edema is the concern of the day.

Today, there was also the issue of the bed.  I guess she has used it so much it needed to be replaced.  So, before moving her from the chair with the Robin’s egg-blue “float” (a canvas like sling), the broken bed was moved out and a new one in.  These things may not roast the Christmas turkey or fly you to your Hawaiian vacation but they are marvels of engineering and construction.  They also cost about 50 grand.

Nancy continues to do well.  We’d like her to eat more real food but at the moment she is not much inclined to do that.

She got a big red heart-shaped pillow for her new year.  I didn’t know about these things until last night.  The gentleman homeowner who hosted the potluck last night asked if Nancy had gotten her pillow?  He had multiple by-pass surgery in the same hospital a few years back.  When I said I had no idea what he meant, his wife brought out a large red pillow in the shape of a heart.  This had an image of a heart on it and over that someone had drawn each of the by-passes that had been done inside his chest.  Also, about a dozen people had signed it – doctors, nurses, and family.

I got home to find an e-mail asking the same question?  “Did Nancy get her special pillow?”  I’m I the only one that didn’t know of these?

Well it seems that when your chest is split open and then closed again that in the weeks to follow you have an urge to cough frequently.  So as to keep it from opening again when you cough, you are told to hold a pillow tightly against your chest.  A stuffed teddy bear is sometimes given but any pillow would do.  It seems the red heart-shaped ones are the “special” ones – it could be considered a badge of courage and a statement that one survived.

Much of the very high-tech equipment was gone from Nancy’s room today.  There remained a gizmo on the floor at the foot of her bed making the sounds of a little stream tumbling over rocks.  This is part of a ‘chest drain’ and its purpose is to allow any fluid, blood, or pus to exit the ‘pleural’ cavity by way of a long tube.  Translated into English this means ‘from the hole in your body where they were working.’   Seems to me the original meaning (now said to be side or rib) has gotten lost somewhere along the path from Greek to Latin to Middle English to the World Wide Web.  A wine maker would recognize this as a “water sealed fermentation lock” with a vacuum assist through the water causing the bubbling sound.

Each of the two doctors on the floor visited briefly today and listened to her heart and lungs and pronounced her in good shape – for the shape she is in.  Many times a heart patient in the ICU will only encounter one or two doctors during a stay of a few days.  Today was Nancy’s 36^th day there and she is on their (the doctor’s) third or fourth rotation.  Somewhat uncommon we were informed.

I’ve heard that the first day after heart surgery is the most painful for the patient.  Although Nancy was awake today she was being given several drugs of one sort or another and still was experiencing pain.   When I arrived she still had an intra-aorta balloon pump going and was still on the ventilator.  She was frustrated that she could not yet speak and her nurse was not happy that my presence was causing that frustration.

The surgeon was there and showed to me 2×3 inch pictures of Nancy’s mitral valve – both old and new.  Quite interesting but I would like to see them full screen on my monitor at home along with one from a healthy human.  No such luck.  As part of the operation he also did two by-passes but I didn’t learn anything about that.

There was too much going on in the ICU today –and not just with Nancy.

Based on the readings they were getting from her heart they felt it was time to take out the post-operative balloon pump, so shortly after 1 P.M. they chased me from the area while they did that.  By the time they allowed me back in I felt compelled to leave for home because they were wanting to shut down the ventilator and remove that also and I didn’t have the inclination to set in the waiting room watching the Weather Channel for a second hour.  I already know that the atmosphere over the Northern Pacific is about to clobber the west coast of North America.  Washington State is in between the two major thrusts, one south and one north of us.  We get a mash-up of snow, rain, and freezing rain beginning sometime tonight.

I told Nancy I would come back at 7 P.M. but the driving conditions are suggesting otherwise.  Fog is really thick in the low places and the tops of the ridges are at or below freezing.  I drove through patches of thick fog on the way back north and at home I can see only a short distance.  At dusk, while I was feeding and running water for the horses, I noticed a ‘silver frost’ had formed, and was still forming, on the trees.

I have plenty of pictures of such trees. This is not my picture but it is a rather nice image: http://www.flickr.com/photos/joka2000/2258434451/

“Silver frost” seems to be a Pacific Northwest term for this ice. . .

I did not find it here: http://en.wikipedia.org/wiki/Frost

I apologize for all the weather stuff.  I don’t have anything else.

————— One: waiting

Nancy is still in the operating room as of 2:15 P. M.  Because of the allergy to heparin other anticoagulation chemicals are being used and these apparently prolong the time needed.

Yesterday I wrote that the operation was scheduled for 7 A. M. but that is the time they began preparations with her.  They wheeled her out of the ICU at about 9 A. M. and at this point I do not know exactly when the doctors actually started.

—————  Two: news

The news is good.  An operating room nurse called about 3:30 to say the surgeons were in the process of finishing the ‘closing’ and Nancy would soon be back in the ICU.  They do not expect to have her off the ventilator and awake until Wednesday morning.

The nurse has promised to write a short English-language version of the operation for me to adapt and post here.  That may take a day or so.  A general idea of such operations can be found on the Web, and so, in case you are curious — below are two of the many pages I have looked at.

The Texas Heart Institute has web pages that provide descriptions of heart surgery.  This first is an overview:

http://www.texasheartinstitute.org/hic/topics/proced/

About half way down in this long page you can find a link to “Valve Repair or Replacement Surgery” (just below where “stenosis” and “regurgitation” are explained.  Nancy’s problem was regurgitation.  It is easier to click on the link on the page, but below is the page you are going to:

http://www.texasheartinstitute.org/HIC/Topics/Proced/vsurg.cfm

Here’s to a good tomorrow.

The last couple of postings indicated the remarkable change in Nancy with the insertion of the intra-aortic balloon pump.  This was the hoped for result because it shows that improved heart function will likely bring adequate oxygenated blood flow to Nancy’s body.

The nature of this artificial assist is such that it cannot be continued indefinitely – although it can be in place for more than a few days.  The issue is that while Nancy needs open heart surgery she is in poor health.  A few days with the balloon pump assist and good nutrition makes sense but a prolonged delay provides additional time for more complications from the already compromised heart.

The surgeon who will perform Nancy’s operation had reviewed her case and visited her yesterday while she was sleeping.  During my mid-day visit today, he met with the two of us.  This was a general discussion about the issue of valve leakage and the effects on heart and body health.  A few months ago we obtained a book on heart valve surgery and I’ve taken a lot of material off of the Web, and so we are not unaware of the material discussed today with the surgeon.  For someone in Nancy’s state of health, open heart surgery is dangerous.  There isn’t an alternative.

The team of doctors includes the surgeon, a cardiologist, hematologist, pulmonologist, and anesthesiologist – maybe more. These folks will meet early next week to consider the pending surgery.  As of Noon today neither the meeting of “The Team” nor the surgery have been scheduled.

After our meeting with the surgeon Nancy had another ‘high nutrition’ drink and went to sleep.

The improvement Nancy has shown in the past 24 hours is astonishing.

She was talking and joking with us and scarffing down high protein power chocolate and vanilla shakes – 4 of the 8 oz. size by 2 PM.  That’s more than a day’s supply of a couple of dozen nutrients and, I think, more than she has gotten except when she was on the brown-drip-food or the intravenous stuff.

Except for a slight tilt to her upper body she is prone.  Critical parts of the apparatus have to be at the same elevation as her heart for everything to work and record properly.  All the high-tech equipment comes with a meter (or yard) stick and a carpenter’s level.  I thought someone was going to hang a picture frame when I saw those two items!

I don’t know what is next but “The Team” hit the ball out of the park with the Thursday afternoon insertion of the intra-aortic balloon pump (IABP).   The doctor that performed the insertion visited Nancy this morning but before I arrived.