Tuesday, February 23, 2010

Quadruple Bypass

Just to try and keep track of what was going on, I kept a log of what was happening with my Dad, so here's the long story.

After feeling cruddy all winter, Dad had a doctors appointment with a complete physical in January. He was given stuff to combat the sinus etc. stuff he'd been dealing with. He was given a good bill of health and told he was "young for his age" which is 70.

About mid January Dad started having breathing problems and just didn't feel good. Saturday and Sunday, February 6th and 7th he was really feeling it. That didn't stop him from doing some overhead sanding on Saturday, and Sunday he was 5 minutes from going to church when he decided he better stay home. Monday he went to work but was still feeling awful so he called his doctor. He complained of breathing problems and pain under his right arm. They said he could come in Tuesday at 10:45am but maybe he should go to the ER. Being the man he is, he waited for the appointment.

Tuesday Feb. 9th. At his morning appointment they took an EKG and did not like what they saw. He was transported to Deaconess hospital where they agreed they definitely didn't like it, called Mom at work and told her to come to the hospital. She didn't find out until she got there that he needed a quadruple bypass right now. They thought he had a major heart attack on Sunday. They were already prepping for surgery when Mom got there so there was no time for a blessing first. They took him away at 2pm and called from the OR at 3pm to tell Mom everything was going well. She didn't hear anything else until after 8pm when the surgeon came to see her. Originally they said they wouldn't fix the leaky aortic valve along with the quadruple bypass because it would be too much for him to handle. In surgery they decided to do it anyway. In surgery, they determined that the major heart attack occurred Saturday instead. His heart suffered serious damage.

Wednesday Feb. 10th. That morning the doctor said on a scale of 1 to 10, Dad was a 12. Good news. He was really thirsty all day, but ended up in horrible pain because everything he drank wouldn't leave his stomach and it ended up horribly distended. He had a fever. He got MRSA (methicillin-resistant Staphylococcus aureus). Not exciting.

Thursday Feb. 11th. Dad was beyond done laying on his back (he's not a back person anyway). His coloring was better. He was urinating more, but not as much as they would like. Early afternoon they remove the balloon pump. They promised to try sitting him up at 5pm. He sat for an hour, but then was exhausted. They get a nephrologist, Dr. Chow, involved in Dad's case because they were worried about his kidney function and were considering dialysis. He still had a fever.

Friday Feb. 12th. 6:45-7am Dad goes into cardiac arrest. He codes for about 10 minutes during which they shock him 6 or 7 times. He is intubated. He responds positively to requests for hand movement. He is sedated. Nurse Harry gave me the full rundown on the phone on that when I get called at 7:30. Just before 9:30am he has another, short attack requiring one shock. I called shortly after it happened and spoke on the phone with his cardiologist, Dr. Stucky. He needs an implanted defibrillator. Dr. Stucky also tells me that the anti-arrhythmic medication, amiodarone, which they pretty much use for everyone, obviously is not working for Dad. They've switched him to a "really ancient" anti-arrhythmic that they "never use" anymore. Apparently lidocaine does more than numb your mouth at the dentist! It's a different percent and administration of course, but apparently it seems to be working for Dad. We hear that he has pretty aggressive vascular disease for his age which he inherited from his Dad and all his kids need to be aware of to as it's hereditary. At 10am he is responsive (nodding) to questions from the cardiac surgeon, Dr. Vishwanath (Dr. Vish). Because of the CPR they had to do on his incision, they had to check that it didn't compromise the surgery.
Travis is in CPR renewal at 10, so I have to wait for him to get home, but then I leave for Spokane at 2pm. I arrive after 8pm and find Dad doing well. His heart rhythm is good, his coloring is good, he's talking. Normally bipass patients aren't given a little button to push that automatically injects pain meds into the central line, but because the CPR is rather traumatizing to the chest they gave Dad one. Dad's central line is in his neck and we call it his "bling." By the time I get home with my Mom it seems like forever since the events of the morning.

Saturday Feb. 13th. Mom and I arrive early and hear he's had a good night. Later in the morning Dad's older kids, my half brother Gordon and 2 half sisters, Jen and Liz, visit. Jen lives in Spokane, but the other two don't and it was wonderful for my Dad to have them there. He had a great day visiting with them. Because he can't stay on lidocaine forever, they try weaning him off. There was talk of moving him out of the Cardiac ICU the following day. At one point the nurse asks if he'd like to try the built in massage the bed has. Dad gave him a look that could kill and said, "You're just now telling me this?!" Which he says because he was in such misery on his back for so long.

Sunday Feb. 14th. That morning we got a phone call that Dad had two heart attacks at 2:30 in the night. One episode of v-fib with one shock to get him out and then 12 seconds later an episode of v-tach with one shock to get him out. He wouldn't let them call us in the night, but then he was asking for us in the morning and they called then. Considering the night's events, there was no more talk of moving him out of the CICU and he's put back on the lidocaine. They're going to have to puzzle out what to do about that. He went on to have a great day. More excellent visiting with his older kids, and they took out his chest tubes (those are for draining internal bleeding around the surgery site). He said goodbye to Gordon and Liz that night. Before we left that evening the nurse told us that his heart rhythm was very stable all day which was good news. That same nurse told Mom some time that day that one of his jobs is to study those that code and the outcomes. From what Mom recalls, he said only about 18% of people who have a major code like Dad did after a bypass actually go on and live life for a while. With every code after that you can take off about 18%. Dad has had 3 codes after the major one. The point is that we're still very much in the woods, but Dad is doing amazingly well. That keeps getting said over and over - considering what he's gone through, he's doing so well.
As for it being Valentine's Day, Mom brought Dad gel hearts and the word "Love" to stick on the big sliding glass doors of the room and a bag of dark chocolate Hershey's kisses. Later in the afternoon a couple guys from Mom and Dad's ward brought the sacrament for us to take. After they left Dad put a card on his knee for Mom. Since the writing wasn't Dad's standard, Mom asked who it was from.
"I'm sorry I can't write very well, I don't know why."
So Mom takes the card and after going to use a tissue comes back teary eyed and ask sort of crankily "Is this going to make me cry?"
Dad, tearily, says, "I hope so! I sure love you."
I scooted out of there quickly.
How did Dad contrive to get that card for Mom? I don't know the whole of it, but apparently he said something to Bishop Tanner the day before when he was visiting, then Barbara Crump showed up at church with a card, gave it to bishop who passed it along the those bringing the sacrament and they slipped it to Dad. Crafty.

Monday Feb. 15th. We arrived to find that his rhythm was not as stable any more. He had pretty constant bigeminy (an extra ventricular pump) interspersed with runs of PVCs (a PVC being a ventricular pump) or more which are basically little spurts of v-tach. I didn't like how he was also having episodes of almost gasping deep breaths. Then I noticed he wasn't breathing for a time before the gasping. Great, now he has apnea. Not just sleep apnea, he does it while he's conscious too. I point this out and they bring in a CPAP machine which basically just makes sure a certain number of breaths happen per minute in case a person isn't spontaneously breathing. Dad tries it, hates it, and rips it off. Dr. Vish comes by and immediately listens to Dad's lungs, then orders a chest x-ray to make sure the apnea isn't causing too much fluid retention in Dad's lungs. After that Dad's heart rhythm went back to normal. The nurse joked that it looked like all Dad needed was for Dr. Vish to take an interest and the heart jumped back to attention. I said lets wait until we get him from the chair back to bed and then see since exertion had been exacerbating the arrhythmia. We were happy to see it stayed stable. Additionally, when his heart rhythm is stable, the apnea seems much less prevalent. Monday night before we left we were told they scheduled Dad for his ICD (Implantable cardioverter-defibrillator) at 8am.

Tuesday Feb. 16th. One week from his emergent bipass surgery, Dad got his ICD. We arrived at the hospital a little before 7am so we could see him before surgery. We found out then that Dad decided to try the CPAP again so he could sleep in the night and that, while he hates it, it definitely helped him a ton and he was able to get a good nights rest. Before the surgery his heart rhythm was pretty crazy. Afterward I thought it was pathetic that I was just glad to see mostly bigeminy instead of so many crazy runs of PVC's like he had pre-surgery. For the surgery we were told to go wait on the 4th floor. After a while Mom went to the restroom and on the way back a door opened, she peeked in and said, hey, I recognize that head! It was Dad in the actual surgery room. How strange that there's a door that just opens onto this main hallway. They were done and Dr. Chilson had already left. Apparently we couldn't be found for him to speak to because we were in the general surgery waiting room instead of the cardiac surgery waiting room. Thanks for no directions people. Dad was awake then and talking.
It wasn't long before he was completely exhausted so we went home, had some lunch and visited with Morgan and my little niece and nephew for a bit. Actually, I wasn't much company as I was exhausted having gone five nights at that point with between less than five and just over six hours of sleep a night. When we returned to the hospital Dad had only just woken up from an excellent nap - with help from the CPAP - and was feeling great. We were happy to see his heart rhythm was back to normal and it remained so the rest of the day. We also got to "fire" the nephrologist. Dad's kidneys had failed, but before dialysis became necessary they began to get better and at that point they were back to normal and Dr. Chow was no longer necessary.

Wednesday Feb. 17th. That morning he was back into bigeminy and had been since about 4am. Also, he didn't sleep well at all due to vivid nightmares. Later, Dr. Vish showed up and was very upset at the state Dad was in. "My patients do not look like this, and you are shaved and look nice, so you must be my patient, and this is unacceptable! This man needs a new gown! What is with all this leaking? Ah, who did this?! I want 1 inch steri strips! I want to talk to the nurse in charge! I have asked for them to do it this way for the last ten thousand surgeries!" And on and on. I would like to point out that the leaking wasn't there the night before, so it's not like he'd been neglected, and one of the areas Dr. Vish didn't like had been redressed 4 times the day before because it just didn't want to stay but apparently the 4th redressing that did stay put was not the way the Dr. wanted it done. In other words, I don't feel for an instant that my Dad was being neglected by the nurses, but I definitely like Dr. Vish. His exacting, all-business attitude is great and he obviously takes an interest in his patients and pride in his surgical work and nobody better mess that up! Turns out there weren't even 1 inch steri strips on the floor at the time and there was a bustle to find some fast!
After the hubbub we had normal time with the Dr., including questions and answers. I'd heard a couple of references to Dad's ejection fracture (the percent of blood the ventricles push out with each beat, normal being ~60%) and different numbers at this point. Dad wanted to know about the condition of his heart when Dr. Vish operated. He brought up the ejection fracture and said that 30% is an optimistic estimate.
Also, Dad was still retaining more water than Dr. Vish liked and since Dad's kidneys were back to normal he ordered Lasix (a diuretic) to start flushing Dad out. Shortly thereafter they moved Dad out of the Cardiac ICU and up to the therapy floor. With Dad doing so well, his ICD in and moved out of CICU, it was time for me to say goodbye and head back to Salem.

Thursday Feb. 18th. They take Dad off the lidocaine but don't yet replace it with anything. With no heart monitor in the room anymore, Mom doesn't know whether or when his heart rhythm is stable or funky. They want to see Dad take a walk around the loop of that wing three times in a day. He did one lap each time.

Friday Feb. 19th. Dad does one and a half laps each time of his walks. With every exertion, be it walking, showering, etc. Dad has to then rest for an hour before doing anything else. Also, he can't eat right before an exertion. It's basically the "don't eat before you swim" message but with his weakened heart it really is true that he can't afford any blood sent to focus on digestion.

Saturday Feb. 20th. Dad did two laps per walk and he gets unhooked from everything but his little pocket heart monitor. Mom said his steps on Friday were still small, Saturdays were much more of a regular stride. He's supposed to rank on a scale of 1 to 10 his exertion with each walk. The first one of the day ranks around a 4 but the next two of each day he's ranked around a 1 to 2. If all continues to go well, he could be going home Monday!

Monday Feb. 22nd. After two weeks in the hospital it's Moving Day! Dad gets to go home! He had to do stairs before they let him go, but he did fine.

Lots of recovery, therapy, doctor visits and a sleep study are now in his future.

And because I like pictures in my posts, here's a couple. On the 16th Mom and I got home and found a plastic bag full of old pictures on the doorstep. An old friend my Dad knew growing up (who didn't know what was going on) had been cleaning and dropped them by. She came later in the evening to make sure we got them. Here's Mom and Dad looking through them.

One in the bunch was my Dad's senior picture.


Mindy said...

Great sr. photo!
Your notes remind me exactly of what I went through with my dad one year ago. My dad was born in 1942.
At one point, the lasix wasn't doing enough so they brought in a machine that looked like dialysis...it pulled the plasma out to decrease the amt of fluid and put the blood back in.
Scary! I'm glad your dad made it through it all.

Bill and Maggie said...

Laurie - thanks so much for sharing what went on with your dad. I'm glad to hear that recovery is happening. I love you guys!

Alex Benjamin said...

Hey, Laurie. It's Cousin Alex. Thanks for giving us the update on your dad. Jennifer and I have been praying for him. Our church (Mt. View Baptist) has him in long-term prayer as well. I hope things are going well with you and Travis and the boys. Be careful and keep in touch with me on Facebook.

Aaron and Kristel said...

You don't know how happy it makes me knowing you Papa is on the mend.. and doing great! It is so hard when you hear something like this and live so far away and feel like you can't do anything to help your friend. I'm so glad you live closer to home so you could be there for your Mom too. :)