karenulijohn

It seems that the excitement of homecoming set Harvey’s heart all a’flutter: literally.  He had a restless night on Friday, tossing and turning, coughing, but no pain.  I went to my aerobics class at 8:00 AM and left a little early in order to be home when the visiting nurse was scheduled to arrive at 9:00 AM.  Trina settled in and began by having Harvey sign all of the usual “permission to treat” papers.  She then described all of the services available to him including Physical Therapy, and a Registered Dietician.  All of this took the better part of an hour.  Finally, she took his vital signs, and his heart rate exceeded 120 bpm.  Yes, his heart was in Atrial Fibrillation (Afib).  He took his Amiodarone, but the rate did not change over a couple of hours.  Trina telephoned Dr. Yadlapali’s office and was put through to the On Call Dr. Ebeneezer.  He was to call her back, and she remained here until about 11:30 AM with no call back.  She suggested that Dr. Ebeneezer would say one of two things; either go to the ER or pickup a prescription.  By 3:00 PM, we had still heard nothing, so Harvey called 911 and told the dispatcher that he needed a ride to the ER because he had “a little Afib.”

The ambulance and fire truck arrived within minutes, but, thankfully, no forestry service.  They hooked him up to the heart monitor, saw his heart rate, and began to get him ready to transport.  By the time I got to the ER in Carrrlo, he was in a cubicle and had another IV line in his poor, bruised arm.  Amber was his nurse during his stay, and Dr. Worth checked him over.  In consultation with Dr. Ebeneezer, they decided to “shock” his heart back into rhythm since he had not been in Afib for more than 24 hours.  I was happy to leave the area for this procedure, so I can only describe what I was told and then what I observed after it was over.  They put Harvey into a ‘twilight sleep” similar to that which is given for colonoscopy.  The drug has a very short half life, so it leaves the system fairly quickly.  He was unconscious for only about five minutes.  They shocked him three times, first with 100 joules, then 150 joules, and finally 200 joules.  Unfortunately, it was to no avail.  Dr. Worth came to get me and said that Harvey’s heart was being stubborn, and that the shock did not bring his heart into rhythm.  When first I saw him after the procedure, his eyes were open, but he was still not conscious. He started talking to the technician, but no sound was coming out.  Gradually he returned to himself, and was disappointed to find that he was still in Afib.  I think the doctors were at a loss as to what to do at this point, so they prescribed a Beta Blocker to slow his heart rate down, and hope that the rhythm would correct itself.  They sent us home at about 7:30 PM.

Having not eaten since early morning, to say that I was a “mean, hungry bitch” would be an understatement.  As we were driving down our street, Harvey suggested we stop and get the mail.  I told him that I didn’t give a crap about the mail (only not “crap”).  Obviously, he was happy to be home, having feared they would admit him to the hospital.  While I was happy to be home, the responsibility for all of this was once again placed on my shoulders.

I was assured that the prescription for Metoprolol had been called in to the Walgreen’s Pharmacy on Twelve Bridges.  Of course, it was closed last night, so I waited until 10:00 AM this morning to pick it up.  They had no record of the prescription at all.  He was to have taken the tablet by 8:00 AM this morning to fall into the every 12 hours cycle.  It was then up to me to track down the prescription.  Well, it had been called in to the Walmart here in Lincoln.  After several phone calls between Walgreen’s and me and Walmart and me, the pharmacist at Walmart said that he would fill the prescription, and register us there when I came to pick it up.  If I had been there, I would have kissed him on both cheeks.

Funnily  enough, when I finally got everything sorted out, I felt Harvey’s pulse, and then counted it for one minute (using a stopwatch).  Believe it or not, the rate was down to 77 bpm.  While it is still a little irregular, it seems to have slowed to a more normal rate.  Maybe having his “looney tune” wife out of the house for an hour made all of the difference.  I am happy to say that, as of now, 12:00 Noon, he is resting comfortably.

Years ago, when Harvey was traveling a lot for work, he would be gone for two or three weeks at a time.  Upon his return, I would be so excited and happy to see him.  Shortly after, a day or two, I would experience something of a letdown as he became introspective, quiet, and preoccupied.  I would try to engage him in conversation about the trip, asking who he had come in contact with, what were the outcomes, and did he manage to sell anything.  Invariably, weeks later, I would hear references to the trip that I had never heard before.  Similarly, today at the hospital, all of the discharge instructions were given to him before I got there.  He was given some paperwork which described his medication schedule, description of side effects, telephone numbers,  etc.  However, there was no information about diet.  I know that he had been given liquids, yogurt, juice, ice cream and pureed soups at the hospital.  I assumed that I would continue that, but for how long?  Should I begin introducing more solid foods?  When?  It wasn’t until late this afternoon that, out of the blue, Harvey said that he was told he should continue the liquid diet for two weeks.  I lost it!  “Thank you for letting me know,” I said.  “Why didn’t you tell me that when I asked earlier?”  His only reply was, “I’ve been sick!”  Ugh!!!

Yesterday, the chest tube was removed and all but one of the IV’s.  This morning at 7:00 AM, Dr. Meyers, the latest “Docling,” came in to remove the remaining drain.  Nurse Shastika, a lovely woman from Fiji, and Alisa, who sounded Swedish, removed the staples from both wounds.  Harvey said that it was a little uncomfortable, but not painful.  They placed tape strips over the wounds, and he is to let them fall off on their own.  Dr. Graves visited a couple of times this morning and told Harvey that he had recovered very well, and he was very happy with his progress.  He had told Harvey he would arrange for his discharge at 11:00 AM, and within a few minutes, that is what occurred.  On my visit yesterday, I had taken a duffel bag with all of the clothing he would need, including his Rotary pin on the collar of his shirt.  The Murdocks again came to our aid, and kindly volunteered to help me get Harvey home.  When we arrived at the hospital, Harvey was dressed and waiting for the wheelchair to transport him to the parking lot.  We were home just before Noon.

I will be adding another activity to my nursing experience.  Harvey will require an injection of Lovenox, a blood thinner, twice a day for the next thirty days.  Fortunately, they taught him how to give the injection as well, so the responsibility doesn’t fall solely on me.  I am happy to say that a Home Nurse has been assigned to Harvey’s case, and she has already contacted us to make an appointment.  She said that her first visit usually takes approximately two hours.  I will definitely be asking for nutrition advice.

Harvey’s sister, Hilma, emailed us to say that she had sent two quilted lap robes made by the women of her church.  As she and her husband, George, are snuggled under their quilts while watching Jeopardy, she will  be able to picture us sitting in our respective, side by side recliners, snuggling under our lap robes while watching Jeopardy.  Maybe we can send each other the answers through telepathy.  Thank you, Hilma.  They arrived today, and they are beautiful.  When Dawn is here on Wednesday, we will have her take a photo.

Not much has changed for Harvey since I reported this morning, except that he feels a little depressed.  Per our agreement yesterday, I did not go to visit him today, but we did speak over the phone.  According to him, not much is happening, certainly compared to the past couple of days.  That’s a good thing!  Compared to his room in the ICU, the room he currently occupies is very small, old, and dark.  It is a double room, and he is not on the window side.  He did have a roommate for a while last night, but the man was released early in the afternoon.  While Harvey still has the chest tube, he is not as tethered as he was in ICU, so he is able to get up on his own and walk around.  Dr. Graves visited with Harvey late this afternoon and told him that he was amazing in his recovery.  The chest tube will be removed tomorrow, but he will have to continue with the blood thinner, coumadin, at least until the blood clot has dissolved.  Dr. Graves did not seem to think he would need to take it for the rest of his life.  That is good news.  In other words, he is on target for discharge of Friday.

I enjoyed my own Recovery Day today with a little retail therapy.  My friend, Debbie, and I went to the Galleria for some shopping and lunch at Land and Ocean.  Early in the summer, I cleaned out my closet leaving me with a lot of empty hangers.  I needed to replace some of my tops with some that are warmer and have long sleeves.  At lunch, we chose the Halibut in a lemon caper sauce with rice and asparagus.  It was delicious.

As I consider all that has happened, health wise, in the past few years, I feel as though there should be some designation or certification that acknowledges all of the medical knowledge and experience I have gained.  RN, CNA, LVN, LPN, NP, all indicate a certain level of nursing training.  I propose a new designation: CWN, Certifiable Wife Nurse, or in order to remain politically correct, CSN, Certifiable Spouse Nurse.  I know there are a lot of us out there!

What a difference a day makes!  I arrived at the hospital yesterday at about 2:00 PM and was surprised to see Harvey sitting up in the bed reading a book on his iPad.  The nasogastric tube had been removed, but he still had the nasal cannula for oxygen.  He gave me a big smile and said that he had a very busy morning.  Clearly, he did.

His nurse, Rose, had him up walking at about 7:30 AM.  I commented that she must be a miracle worker.  He doesn’t get up much before 9:00 AM when he is at home.  Upon returning to his room, Dr. Graves appeared with a “brace of doclings” in tow.  He commented that all of Harvey’s vital signs were very good, and said the  nasogastric tube was to be removed.  He challenged Harvey with the goal of going home on Friday.  Whoopee!!  Harvey was then given the contrast drink to check for leaks in the esophagus, and happily, none were detected.  Rose brought him some chicken broth, applesauce, and jello, and while he tried each one, he said he really wasn’t that hungry.  I noticed that one of the bags hanging on “Howard” was glucose.  It seems that he has only lost one pound since being admitted, but that may be due to all of the fluids they are giving him.

He doesn’t seem to be suffering much pain even though the epidural catheter has been removed.  He did tell the doctors that he thought the PCA pump was really a placebo; “Just give the old boy a button to push and a flashing light, and he’ll think he is well medicated.”  Truly, he hasn’t bothered with it much.  By the way, I counted 20 staples on his chest, the incision he refers to as “the zipper.”  They have not removed the dressing on the incision on his back, so I don’t know about that one.

Another surprise for me was the mustache and beard that Harvey is cultivating.  It is very dark in comparison to the white hair on his head.  I wanted to take a photo, but he wouldn’t let me.  In fact, he asked me to bring in his razor, and he plans to shave it off before he comes home.  Even his nurse, Rose, commented on it.  Speaking of Rose, she told us that she is from the Placerville area and has two sons, five and one and a half.  She showed us a couple of pictures of two very handsome little boys.  She said she liked having Harvey as a patient, and she hoped they wouldn’t move him to “the floor” until her shift change.

Last night, he called to let me know that he has been moved out if ICU and into a semi-private room in the older part of the hospital.  We agreed that I would not visit today because I’m not sleeping very well, and I’m just exhausted.  He has promised to call me a couple of times during the day to let me know how he is doing.  I’m sure they will have him up and walking, maybe more than he wants.  I told him to do everything they tell him and then a little more.  I want him home on Friday!

In addition to the Afib yesterday which carried over into today and was finally controlled with IV amiodarone, the monitors showed that Harvey’s oxygen saturation had dropped to 80 percent. This is the fraction of oxygen-saturated hemoglobin relative to total hemoglobin  in the blood.  Normal blood oxygen levels in humans are considered 95-100 percent.  In addition, the nurses were hearing crackling in the lungs which is a sign of fluid collecting, and that can lead to pneumonia.  All of these things put together raised some red flags, and he was whisked to radiology for a CT Scan.  The scan showed a small blood clot in the lung.

Dr. Gregory Rossellini, a pulmonary specialist, recommended that Harvey be placed on a blood thinner such as Heparin.  The anesthesiologist disagreed because Harvey still has the epidural catheter.  In addition, the suggestion was made that they insert an IVC (Inferior Vena Cava) filter to capture any further blood clots that he may produce.  Fortunately, Dr. Graves has the final say on any treatment, and he arrived shortly after I left today.  Harvey called me a short time ago to let me know that, in the end, they removed the epidural catheter and are controlling his pain with a PCA (Patient Controlled Analgesia) Pump in which the patient presses a button to self-administer doses of pain relieving drugs.  He will be given blood thinner medication after twelve hours when the epidural drugs have cleared his system.  Best of all, absolutely no IVC filter.   Apparently, Dr. Graves was quite adamant about that.  His nurse today is Steve, and Harvey said that Steve got him up and had him walking around quite a bit.  He really sounded so much better this evening.

Tomorrow the nasogastric tube will be removed and the contrast drink will be administered to determine how well the internal stitches are holding the anastomosis.  I had planned to stay home tomorrow, but given the events today, I determined I just need to be with him.  When I told him I would be coming, he said he was secretly delighted.

I have to give special thanks to Bob and Carol Murdock, who drove me to the hospital today and stayed with me through all of the unsettling events and discussions.  I was so glad they were there, not only for moral support, but also to backup my understanding of the discourse.  I was sorry that I was not able to introduce them to Dr. Graves and Dr. Becker.  However, I did find out that Dr. Becker has moved on and a new “docling” (as Dr. Graves’ Residents are called) is working with him.  I wonder if he is as cute as Dr. Becker?

Everything I am reporting today came second hand, but from a very reliable source.  Dawn and her son, Cole, drove up from San Mateo this morning to visit Harvey, and to give me a day to restore my energy.  Fortunately, Dawn has a good balance of my desire for details and Harvey’s unflappable composure.  Cole’s role is to verify her conclusions.

Harvey did not have a very good night.  He experienced a bout of Atrial Fibrillation (Afib), although the nurse reassured Dawn that this is often the case after chest surgery.  He has some fluid in his lungs, but it is not due to pneumonia.  Apparently, after this kind of surgery, the body produces a lot of fluids in general.  Both surgeons have been in to see him and have assured Dawn that everything is under control.  They prescribed Lasix, which is a diuretic to treat fluid retention.  Though I don’t know what drug, I am sure they have given him something to slow him down because his speech is very slurred, and he reports that he is unable to pull his thoughts together.  Of course, he also still has the nasogastric tube down his throat, making it very hard for him to speak.  Using Dawn’s mobile phone, I was able to talk to him, and believe me, he does not sound like himself.  He even admits that the minute his eyes close, he is asleep.  He did have a walk down the hall and back today.  His nurse is Gretchen, and she is amazed at how straight he is and how good his balance is.  So, the news today is mixed.  He will spend another day and night in ICU, but he is hoping to have nasogastric tube removed tomorrow.  I hope so too, for his sake.

I will be going to the hospital tomorrow, and will, hopefully, have only good news to report.  It turns out that his room does have a phone, and he telephoned me just moments ago.  It is difficult for him to have a conversation, but it was wonderful just to feel connected.

Since Dawn went home yesterday, I found myself really alone in a strange hotel in Sacramento anticipating all of the things that might happen on my way to the hospital this morning.  So, at 4:00 AM, I began to think about my route, which street would take me directly to the parking lot, and when it was time to leave the lot, which way must I turn to find my way to J Street and the freeway entrance.  I had been given complimentary parking tickets for Lot B, next to the hospital, so I proceeded to worry about how they were to be used, and if I had to pay in advance and then get reimbursed at the exit.  I checked my phone and found there were no emergency calls from the hospital, which was another worry.  Happily, all of the worst scenarios never came to fruition.  I found my way to the parking lot, found a perfect spot next to the exit, and when it was time to come home, four right turns and a left put me on the freeway. Whew!

Harvey was waiting for me when I arrived at 9:00 AM.  Again, I got there in time to see Dr. Graves, who was genuinely impressed by Harvey’s progress.  He had the nurse remove the bandage on his chest.  The incision is longer than I expected, but the stitches are very neat, and there is no sign of redness, heat, infection, or seepage.  These are all good signs.  He also had the urinary catheter removed.  Harvey is nothing if not persistent as he asked Dr. Graves if he could go home today.  Dr. Graves said that would be kind of unprecedented, and maybe he should wait a few more days.  Harvey then asked about the nasogastric tube.  Again, Dr. Graves didn’t promise anything, but suggested it might come out tomorrow.  He is still in ICU but will likely be moved in the next day or two depending on room availability on the prescribed floor.  A couple of hours later, Dr. Becker came in and checked all of the tubes, etc.  He is so cute!  Anyway, he said that on the fifth day after surgery, Harvey would be given a “contrast drink.”  This is used to determine if the Anastomosis is leaking or not.  The consequences of it leaking are somewhat dire, so we are praying for the sutures to hold fast.

Once the doctor visits were completed, Nurse Elise got Harvey unhooked so that he could get out of bed and sit on the chair.  I began reading email greetings and comments from friends and loved ones, and showed him photos of our grandson’s heroic football moments.  However, I could tell that he was getting tired.  He dozed in the chair for about half an hour, woke up, and said he wanted to go for his walk.  Not waiting for the nurse, he started to stand.  I panicked.  “Wait, wait for the nurse,” I said.  “I don’t know how to unhook all of these things.”  Fortunately, Elise walked in at that moment and sorted him out.  A short walk ensued after which he lay on the bed and went fast asleep.  It was a busy morning.  He was exhausted.  Sleep is the best thing for him now.

Dawn will visit tomorrow, and possibly Cole.  I will stay home and catch up on a few things here before going back on Monday.  As always, your thoughts and prayers are so much appreciated.  Our hearts are full to overflowing.

I am writing this as I sit in the ICU watching Harvey sleep.  Dawn just left and is on her way home to be with Cole for a special awards ceremony in which both will participate.  It is just past 1:30 PM and all is well.  We arrived at the hospital this morning at about 9:00 AM after finding ourselves dressed and ready to go at 7:15 AM.  Dawn doesn’t eat in the morning, but unlike her, I have to eat almost the minute I arise.  So, we stopped at Starbuck’s and I had an Original Oatmeal, and she had a grande coffee.

Harvey was wide awake when we walked into his room, and about the same time, his nurse, Melissa, came in to let us know that Dr. Graves was just down the hall and would be coming in soon.  What a stroke of luck to get to see him and hear what he had to say about Harvey’s progress.  He, and that cute Dr. Becker, looked Harvey over and asked him how he was feeling.  Harvey countered with “How do you think I’m doing?”  Dr. Graves said “You are doing phenomenally well.”  They bantered back and forth while Dr. Graves inspected all of the tubes and wounds, suggested removing one of the lines, and ordered the suction turned off for the nasogastric tube.  He then turned to the nurse and said “Get him out of bed and on his feet today!”  Wow, really?  In the end, she got him to swing his legs out of the bed, pivot to a chair and sit there for about 35 minutes.  She had pity on him when he fell asleep in the chair and returned him to the bed.  That really tired the big guy out!  When he got back into bed, he looked up at the monitor and commented that his blood pressure made him look like he was in hibernation.  At that moment she was asking him to “roll over please.”  Even at the best of times, Harvey’s hearing is not the greatest, but he thought she said she was “looking for fleas.”  We all had a good laugh over that.

By the way, Nurse Melissa was born and raised in Lincoln, CA.  Her father owned a chicken farm (maybe turkey) and she attended Lincoln High School.  A true Lincoln High Zebra.  She knows Kris Wyatt and Elizabeth Jansen, and a few other long time Lincoln residents.  She is a lovely woman, and a wonderful, caring nurse.  Last night before she went off shift, she introduced us to Nurse Chelsea who would be looking after Harvey overnight.  She was very attentive, but I told her that he can be overly stoic sometimes and not say anything when he is cold or in pain.  She went straight to the bed, leaned in, looked Harvey in the eye and told him she wanted him to be her most whiny patient ever.  She rattled off a litany of reasons why he might call on her including if he was cold, awake, in pain, not in pain, lonesome, etc.  Another “Angel of Mercy.”

My plan for updates did not work out.  Easiest way to keep up to date is to go to karenulijohn.com and click on the blog entitled “Surgery Day Diary.”  I am posting regular updates to that same blog, but automatic notifications are not going out to let you know.

8:45 PM:  It has been a long day, and Dawn and I are now resting at the hotel for the rest of the night.  Harvey was moved into the ICU around 4:00 PM by which time we had left the hospital to find a good place to eat dinner.  We walked across Capitol Park to K Street and found Ella, a very popular restaurant.  We arrived at about 4:30 PM and they do not start serving dinner until 5:30 PM.  However, they have a very well attended Happy Hour.  Dawn introduced me to Poke which is a raw yellowtail tuna in a spicy ginger sauce, served with tarot wonton crisps.  We also ordered lamb meatballs and a small caesar salad.  It was such a lovely afternoon that we ate outdoors.  A delicious meal.  After dinner, we returned to the hospital and found Harvey in the fourth floor ICU.  The room is “Huge” and Harvey, ever the comedian, asked if there was a bathroom, sauna or a hot tub.  We thought maybe he was a little over medicated, but he then went on to say, the room was so big, “there should be some other amenities.”  He has about 10 tubes sprouting from his poor body and he is uncomfortable to say the least.  But he is surprisingly alert and mobile.  He moves around in the bed pretty well, but he is receiving strong pain maintenance.  We stayed for about an hour and half, and were able to observe the nurses as they checked his wounds.  He is pretty beat up, but the incisions don’t appear to be as big as I had anticipated.  We will return to the hospital tomorrow morning to visit before Dawn heads back home to San Mateo.  I will continue to update you on Harvey’s condition.  Thank you all for your comments, prayers and well wishes.  We have felt your love throughout this whole ordeal, and we are so very grateful.

2:05 PM:  I just visited with Harvey in the Recovery Room.  He is still groggy, but coherent, and very glad to see me.  They would only allow us go to in one at a time, so Dawn is with him now.  He was very happy to see me and told me that he did not think he could go through this again.  He is in some pain despite the epidural, probably a level 3-5.  When the nurse said that she would give him a little bit of extra pain medication, he said his level was really 7-8.  They are trying to get him moved into ICU and they do have a bed, but nursing staff is at a premium.  It will probably be another hour or so before they move him.

12:57 PM:  Harvey is out of surgery and in the Recovery Room, awake and talking!  Dr. Graves and Dr. Becker came to see us in the waiting room and moved us to a small conference room where Dr. Graves told us that Harvey did very well.  They had hoped to perform the excision through the incision in his chest, but the tumor was still fairly large and he had to go higher than anticipated.  This required a second incision on his right side between the ribs.  There they were able to remove the affected portion of the esophagus and all of the surrounding lymph nodes, and reattached the esophagus and stomach.  Pathology will take approximately seven days, so don’t stop praying.  He has a lot of tubes including chest tube, bladder catheter, nasogastric tube, a drain and the epidural catheter.  He will undoubtedly be very uncomfortable until all of these tubes can be removed, but that will be when it will be.  He will be in Recovery for another hour or so.  We are going to take a break and go to the cafeteria for an appetite killer before we return to see him.

12:00 PM:  We are still waiting and the color code is still showing “In Procedure.”  We are assuming that the 8:30 AM start was delayed.  More news to come as soon as we have something to share.

9:30 AM:  Harvey was wheeled into the operating room at approximately 8:30 AM.  We arrived at the hospital at 6:30 AM and were directed to Patient Registration.  We had to smile because over the past two days, we have had numerous “Pre-Registration” phone calls asking, essentially, the same questions that he was asked here at the hospital.  But, he did get a bracelet, a lovely deep blue one.  We were directed to a waiting room on the third floor, and he was immediately whisked away to the pre-op area.  Dawn arrived about 5 minutes later and we sat and waited to be called in after he was prepped and on the gurney.  We sat with him, trying to keep things light, but when it came time for him to be wheeled to the theatre, Dawn and I both noted that he looked frightened.  I am sure I triggered it, because I started to cry.  We asked God’s blessing, waved him off, and walked over to Starbucks.  At registration, I was given a card with an ID number and color coded instructions.  These coincide with what looks like an “Arrivals” board at the airport.  It identifies the patient by number and is color coded to let you know at what stage the patient is in the process.  Right now, Harvey is “In Procedure.”

While we waited in pre-op, Harvey’s nurse was named Karen.  I quipped that he would be able to remember that since he dated two Karens before he got to me.  He was then visited by Dr. Jim Becker, Dr. Graves’ assistant.  He was very cute and personable and, hopefully, an excellent up and coming surgeon.  Next came Dr. Kandra, the anesthesiologist.  It was her responsibility to let Harvey know what she was going to do and how she was going to do it.  Then she needed to tell him all of the risks of anesthesia and surgery.  Finally, she asked him if he knew what they were going to be doing to him today.  Of course, Harvey, always ready with a dry remark, said that he hoped they knew, but he thought they were going to “rip out” part of his esophagus and then sew him back together.  That put a smile on Dr. Kandra’s face, and she seemed to lighten up a little after that.  Dr. Graves made an appearance, telling Harvey that he was going to do very well, and then looked at Dawn and me and said that we need to make sure Harvey breathes very deeply and coughs regularly to keep his lungs clear.  According to him, Harvey is to keep a positive attitude throughout this whole process, including recovery, no matter what.  Finally, his OR nurse came in and made the final preparations to move him to the OR.

I will update this post when Harvey is out of surgery and we have spoken to Dr. Graves around 11:30 AM.