Category: Post Visit

Today Nancy asked for me to bring her something to read.  That’s new.  I guess she has healed enough to bet bored.  To bad they can’t shift her a little more into the center of the area and let her keep track of all that is going on in the ICU.

She had visits from the surgeon, a cardiologist, and a physical therapist (the only one that actually did anything).  She seems to be eating better each day, something she has been told is necessary for healing.

She is still very weak but improving and that is now the focus.

There was not a room on the fourth floor so she gets to spend tonight in the ICU.  Tomorrow may be the day but who knows?

The chest drain is gone and the hole sutured shut.  That is a sort of milestone, I suppose, indicating the reduction of danger from open heart surgery.  However, the sutures will have to come out in about two weeks and so – in my mind – when that happens I will think of the heart surgery episode as having closed.  I’m thinking here in terms of danger level because I know there is still a long healing processes.  It will be a major step down in terms of stress – not actually an end.

Today also marked the beginning of a more aggressive plan to get Nancy moving and back on her feet.  A physical therapist arrived about 2:15 P.M. and I left for home.  Such folks have been coming daily but the doctor and the operating room nurse were both in today to indicate the stepped up activity.

The Advanced Care Unit (ACU) has been asked to make a room available and to insert an extra nurse into the schedule.  ACU did not have an empty room today but Nancy will be kicked upstairs (4^th floor) soon, possibly as early as tomorrow.

The fourth floor rooms are directly off the hallway and visitation is easier in contrast to the 2^nd floor ICU rooms which are configured on the periphery of a central personnel station.  Thus to get to an ICU patient you have to ask over a phone to be allowed in and you walk through the work space of the doctors, technicians, and nurses.  Once inside that space there may be a security guard when required, patients may be wheeled in or out, coming from or going to operations, or, in fact, if there is a lot going on you won’t be allowed to enter.

I suspect some such thing happened recently because Nancy woke to find a balloon and candy “Get Well” package in her room.  This seems to have been purchased at the downstairs gift shop but the clerks there this afternoon don’t recall selling it and have no way of determining to whom it was sold.  So, ‘thanks’ to the person or persons responsible.  Nancy will thank you in person if the mystery guest signs in, please.

(If you are under a certain age you probably won’t recognize the television connection to this last phrase.)

The only news today is that there may be news tomorrow.  It is quite likely the chest drain will come out tomorrow.  That will be followed by a move out of the ICU and up to the fourth floor.  The move could be on Tuesday or Wednesday.  Plans are not set yet.

It is increasing clear that Nancy is having no problem recovering from the surgery.  I wonder “what might have been” had she gone into the hospital for an elective operation that relied on heparin?  The initial use of heparin was with the Friday after Thanksgiving heart attack – not a seriously invasive procedure such as cutting one’s chest and heart open.  I wonder if she would have survived both the surgery and the heparin allergic reaction?

Having gotten the explanation of the operation posted last night I’ll not do any more now but hope to have something to report on Tuesday.

I’ve mentioned the drainage coming from Nancy’s chest.  From just after her operation until today the rate of discharge has steadily decreased and is now just half of what it was.  It still seems a lot to me but the surgeon thinks that it will soon be time to remove the tubes.

The pleural space is the space between the inner lining and the outer lining of the lung.  A drawing can be found here:

http://www.nlm.nih.gov/medlineplus/ency/imagepages/9968.htm

A tube, usually about as big around as a small finger is inserted in the pleural space. This tube is sutured into place and the skin around the tube is sutured. This tube can be hooked to suction to facilitate drainage.  The function of this set up is to help get the serum or fluid out of the body without allowing fluid, air, or organisms to enter.

You can learn a bit more about this by visiting the following site.

http://web.mac.com/kieran.mcmanus/Chest_drains/Chest_drainage_systems.html

There is a simple drawing showing three bottles and the basic set up.  Scroll down to see the 3-chamber plastic unit such as is being used for Nancy.  This is not shown in use here but continue scrolling down and there is a photo of a plastic unit (a Portex bag) showing the color of the initial fluid being drained from Nancy.  Over time this color has become more pink and transparent.

The pleural fluid allows the pleurae or membranes to slide effortlessly against each other during the breathing process.  The fluid is produced and reabsorbed continuously.  The decrease in volume and the change in color indicate the improvement taking place within Nancy’s body, especially the chest cavity.

Soon the sutures holding the tubes in place can be removed, the tubes pulled, and the holes closed – then her lymphatic system will have to take over the absorption of any excess fluid.

Everyone seems to be in agreement that as Nancy consumes better food and starts to move more (as in physical therapy) she will speed her recovery.  The doctor is pushing the food aspect and indicated he is currently keeping the chest drains in especially to prevent any pressure on her lungs.  When I arrived today the physical therapy team was completing a session with her and then later the nurse brought a padded chair and propped Nancy’s feet up to lessen the pressure in her legs.

Her heart rate, breathing, and oxygen saturation (without supplementation) were all in good range today.  All signs that the repair of her heart has worked as planned.

A few days ago the ICU was a bit quiet.  Not so last night and today.  We never know who is there or why but it is easy to tell when patients in serious need are there.

One of Nancy’s new “friends” following along suggested a tattoo on Nancy saying “No Heparin” and seems like a good idea.  The question is where to put it.  A medical bracelet was/is a good idea also.

I’ve thought of getting a sweatshirt listing all the things she has endured in the last year – something like

“2009 was a great year –

I survived

and then the list”

We’ll need a big sweatshirt or tiny print.

Yup.  That is all that is new today.  At a time when many open heart surgery patients would be home Nancy still has a chest drain and holding excess fluid, mostly in the lower body.  As her arms have been freed up and she has been able to move them and exercise her hands, these have taken on a normal look.

The surgeon requested of the ICU nurses that they record what part of her meals Nancy actually eats.  Then the nutritionists can calculate the nutrients she is ingesting.  The nurses just love to do this!  Yeah, right!  Having enough of the proper nutrients is essential to cell recovery and lessening the edema.  With her refurbished heart doing well they feel it is time to focus on this other problem.

At 2 P.M. a crew of two from the physical therapy staff showed up to work on Nancy.  I left.

Nancy seems to have had very little trouble from the open heart surgery.  Rather, her entire body has suffered from the allergic reaction to heparin – the anticoagulant.  Over the weekend she will stay in the ICU, then on Monday she will likely have the chest drain removed (or maybe not) and move to the fourth floor.  There they can be more active about getting to work on the lower body therapy which she badly needs.

While we are now counting nutrients we are not yet counting down the days to the end of the hospital stay.  It does seem that we will soon be doing that too.

After I arrived today two nurses came with a wheel chair for Nancy.  Then Nancy, a nurse, and I left the ICU, went down the elevator one floor to the main level and went to the front entrance.  We told Nancy we were going to escape!

Actually, on either side of the main entrance there are large windows and one can look off toward the hills east of downtown Yakima.  The temperature was cold outside and it wasn’t a really pretty day but it was the first view of the world outside of hospital rooms Nancy has had since Thanksgiving.  For four of those days her rooms had windows but there was nothing to see and she was not in shape to care.  The ICU room has a tall, thin window that lets in fuzzy light and looks at another section of the building.  That one is behind the bed so it isn’t useful either.  This was the first chance Nancy has had to become orientated – both where the ICU is within the building and where she is relative to the city.

She will stay in the ICU over the weekend it seems.  She talked to the surgery team’s nurse about not wanting to be moved because she is so weak and because there is less constant and immediate care in the Advanced Care Unit (ACU) where she was for the two 2-day periods when she was not in the ICU.    Nancy thinks a move just before a weekend is a bad idea.  I surely don’t know, while she might.

Her refurbished heart seems to be doing fine.  She is not up and around but by the time she is, about two weeks will have gone by since the surgery.  Currently she indicates there is no pain associated with the upper chest area but neither is she coughing with a pillow held closely as we were told to expect.  Her lungs are being helped to clear without that.  I think if she were more vertical then coughing might be more normal.  Nothing is normal about this though – not only is her heart healing but damaged lungs, kidneys, and liver (and her whole body) are also along for this ride.  That is why hers is a special case and why she is still in the ICU.

Nancy was getting doses of Robitussin© today with emphasis on the expectorant potential.  It seems to be working.  She is still in the ICU.

This is post-op day 8.  A regular (if there is such a thing) open heart surgery patient would likely be out of the hospital on day 5 or 6.  Nancy’s back road’s way of getting to this stage included heart attack and cardiopulmonary collapse from heparin-induced thrombocytopenia (HIT).

http://en.wikipedia.org/wiki/Heparin-induced_thrombocytopenia

I now have a single-spaced 3 page transcription of the operation as dictated by the surgeon.  I’ll work to summarize it and post that later this week.  Given my lack of medical knowledge, such a summary would not be possible without the resources on the internet (or WEB or Cloud, or whatever it is called this week) and a relatively fast connection (DSL via phone company for us out in the county), nor would this manner of providing updates on Nancy’s progress.

Nancy is slowly being transformed into a bionic woman.  Some years ago she had intraocular lenses inserted to replace the natural lenses of her eyes.    Now she has a porcine valve in her heart and, using her own donated tissue, some new plumbing for her blood.

Today the team decided she need no longer have the external pacemaker that has been with her for some time.  It has been turned off for a couple of days and she wasn’t needing it for a time before that.  So the wires were clipped and the ends leading into her heart were given a few gentle tugs.  One came out very nicely.  The other one seemed more securely anchored and so it got to stay.  It was stretched out ever so gently, clipped off, and allowed to retreat beneath the skin.  Truly, a spare part.

Otherwise, for Nancy, this was an uneventful day.  We are again talking about (but not having) a timeline for leaving the ICU and going to a skilled care facility.  A comment was made today that “there is light at the end of the tunnel.”  True, but it has turned out to be a very long tunnel.

New today is a ‘midline catheter’.  I wonder why they don’t call it an MLC?  Almost everything is known by acronym.  It’s maddening.  And I think it should be a mid-length catheter – but I didn’t get to name it.

Catheters are short or long tubes that can be inserted into the body, in this case Nancy’s, for the injection of fluids.  Thus, she gets one poke that will do for many days rather than multiple pokes.  The down side is that you have the end sticking out and taped to your skin – often in an awkward place.

The midline catheter usually goes in on the arm near the elbow joint and runs up into the area just short of the axilla or near where the arm connects to the shoulder.  I’ll get a look tomorrow.

Nancy had a PICC line (peripherally inserted central catheter) inserted last summer.  That story began in April and you can search for endocarditis to catch up.  Nancy had four different bacteria in her blood and the protocol was for 28 days of injections of about 30 minutes.  That line went from about the same location near the elbow into the artery near her heart and so the medicine was released close to where it was needed.

Today, I was there for lunch and visits by a nutritionist and a social services case manager. The case manager gave us a large 3-ring binder with reading material designed to guide us through the recovery period, especially that time after Nancy leaves the hospital.  There is also a section on pre-operation instructions and one on how to quit smoking.  I’m thinking of buying a parakeet so I’ll have something to do with those pages.