Tuesday, May 23, 2006

Good Little Car

I made it back to Ohio in one piece. We ended up taking the red eye...and I think my eyes are true to form. Of course there were problems with my tickets, just like every time I've flown over the past few months. It will ba amazing if airlines get my tickets right at one point. For now I just pay the change fees and let out a big sigh. Oh well.

It is strange being back here. I left in such a hurry that I feel like I just snuck out the back door and didn't say anything to anyone. Part of me wanted to leave things like that. It is harder to say goodbyes in person. Just hard to say goodbyes period.

I had my last therapy and psychiatrist sessions here this afternoon. It would have been nice to be all better by the time these wrap up here, but no such luck. Today there were new things to talk about...and not nearly enough time to sort them out. So I guess I will be seeing someone in San Diego if I have the time.

Dr. L. has been great; he related to me on a personal note today which was sort of different...said that he reacts to things much the same way I have and that what I really needed to focus on was figuring out what I really wanted...not what was going to please or dissapoint someone else, but what I want deep down...for me. Easier said than done for someone who has spend a lifetime learning how to make other happy.

The session with Dr. D. started out fairly light (compared to other sessions at least) but got into me talking about my not thinking that I deserve somone who will treat me very well. Yeah, big problem, right...came out with about five minutes left to talk. He asked me if I thought anyone deserved what had happened to me. "No. I wouldn't wish this on anyone," I said. Then feeling like I have to compensate with the good parts of me for what I perceive as the bad parts. And that men just "put up" with me when they are with me and are really happier on their own. Ugh.

Anyway, graduation is on Sunday. Wow. I picked up my cap and gown today. Bright red. Have a ton of family coming in for the big day. Found out yesterday that I will be getting an award from the Ohio Council on Aging so that was a nice surprise. I have to work one more day tomorrow at the adolescent clinic. And hopefully will be able to finish up getting the credits for helping with Pop at home. Keep your fingers crossed. With the rest of my time, I have to pack, pack, pack. I'm only taking what will fit in my car. But can send some home on the plane with my family. That reminds me that I'd better get boxes while I'm out today. My car started right up after sitting for a month. I love my car. Pop wants to get me new tires for graduation so I will get those sometime this week, too...before the big trek across the country.

Wednesday, May 10, 2006

Creek Passage

The other day a couple kids came by asking if they could cross our field to return from the creek after tubing down to our property.

We have had trouble with this in past years. Sometimes kids leave the gates open, or leave trash, or take the rope that we used to leave tied to the tree down there. Sometimes they are very good and repectful, but it's hard to tell the difference from a one time meeting.

It got better when my brothers got older and were frieds with most of the boys in town (more boys than girls by far would spend time in the creek--some sort of macho thing maybe--or survivor instinct or something). Then the kids knew my brothers and knew us and knew that the town was small enough that word would get back to us if anything went wrong.

But I didn't recognize the two sophomores when I opened the door. I don't spend a ton of time here anymore. In fact, most of the neighbors don't recognize me on the street. And some of my youngest brothers' friends don't even know he has an older sister.

So I go to ask dad if it's okay to let them cross the property. He agrees, "It's probably Ryan. He lives down the street." So I deliver the message. They look like nice enough kids. I would have let them cross, too.

A half hour or so later I'm down at the creek with the dogs as Ryan (it did end up being him) and his friend come walking down. They have "tubed" down on a log which they lost just before they got to our place and walked the rest of the way. They are covered with goosebumps and bubbling with stories of their adventure as I start to talk with them once they've swam over to our side.

I remember when my brothers and I used to tube the creek several times a summer. Sometimes even a couple times in one day. The crisp snowmelt water felt so good on those 100+ degree days of dry heat. When B. was really small, mom wouldn't let him go by himself so he and I would have to share a tube. I wasn't always happy about this, but it usually turned out okay. He is now 6'5" and sharing a tube with him would be impossible.

When we got back to our familiar rock bed wall at the creek we'd stop by grabbing rocks as the current pushed us past. Depending on the level of the water it was sometimes tricky to catch the rocks and haul yourself and your tube out--especially if you had a little brother or inexperienced tuber with you that day.

I'd ushered many of my friends down the creek over the years. And those who didn't get to tube with us usually at least went for a dip with us and our happy labradors fetching sticks from the shore. In later years, I'd go down there with my boyfriends for some time away from the brothers and parents. These days I go down there with the dogs so they can cool off. It's too early in the year yet for me to swim--too cold--althought the days are warming up and I'm sure I'll be back in the creek soon.

The creek changes every few years when we have a big winter flood. When I was little there used to be a stand of trees with a small sandy beach at the other side. We would swim the cold water across and sun and play on the beach for hours at a time. Building tiny rivers of our own or just feeling the sand between our toes. The beach is gone now. I doubt if my youngest brother even remebers it very well now. The other side is now rock and the course of some of the water runs over it. The trees that were there have been washed out and smaller other trees grow out of the water now in their place.

Today we had another knock at the door. This time I recognized the visitor; it was D. G. from the corner house down the street. Many of the neighbors have changed over the 28 years my parents have lived here, but the G. were here before we were. I grew up playing with Danny's niece. Danny himself is probably in his 40s now. He is sunburned and red from a lifetime in the sun. He had driven up in his white truck with a fishing pole and tackle box in the back.

He has come to ask the same question the young boys were asking. And the same questions he himself has been asking for years, "Can I walk across your field to get to the creek?" Somethings never change.

Monday, May 08, 2006

Wine Tasting

This past weekend I traveled to Hopland for a wine tasting event that my brother's girlfriends brother's girlfriend organized...say that five times fast! It was tons of fun and will have to become a regular outing as my future schedule affords. I definitely recommend it!

Everyday's Most Quiet Need

"I love thee with a love I seemed to lose with my lost Saints."
--Elizabeth Barret Browning, Sonnets from the Portuguese

Why this line suddenly came to me now, I don't know. It is from the famous "How do I love thee?" sonnet she wrote for her husband to be. They are titled sonnets from the portugues because she had to pretend that she was translating them instead of writing them due to her father's disapproval of her writing.

I had to memorize it at one point. The whole sonnet. We were in British Literature at Santa Cruz and we all met at our professor's house on the hillside in his beautiful rose garden and recieted the poems we had memorized. It was something of a magical day. Something of a magical moment in time that can be remembered, but not recreated or recaptured.

"How do I love thee?
Let me count the ways.

I love thee to the breadth
And depth and height
My soul can reach...

I love thee to the ends of being
And ideal grace...

And if God so choose
I shall but love thee better after death."

i don't even remember the whole thing now but I bet I could find it on the internet...it's not the same as having the beauty float around in my head and surface at random moments. At least I have the scraps of it left...it has not drowned among the medical facts.

"How do I love thee? Let me count the ways.
I love thee to the depth and breadth and height
My soul can reach, when feeling out of sight
For the ends of Being and ideal Grace.
I love thee to the level of everyday's
Most quiet need, by sun and candle-light.
I love thee freely, as men strive for Right;
I love thee purely, as they turn from Praise.
I love thee with a passion put to use
In my old griefs, and with my childhood's faith.
I love thee with a love I seemed to lose
With my lost saints, --- I love thee with the breath,
Smiles, tears, of all my life! --- and, if God choose,
I shall but love thee better after death."


Today I heard from my program at school and it looks promising that I will get the credit for taking care of Pop here at home...it is not a done deal so I'm not going to get too excited yet, but they are very supportive and I think they liked the proposal and idea. If that doesn't work out then I have to dissect two limbs when I get back into town. Not my favorite thing to do since I prefer my patients alive.

Everything else is pretty much going well. Pop is doing great. We had his first post-surgery appointment with his doctor today and the doctor agreed tha the is doing well and will see him again in a month. He also got us an appointment with a dermatologist for a facial lesion that has been growing a bit.

Friday, May 05, 2006

Primary Care Giver

I'm trying to see if I can get credit for working with my grandfather at home...since I still need two more weeks of credit to graduate...the following is a proposal to the hoped for end. It is probably more information that you ever wanted to know...if anyone actually reads it that is :-)...

Home Study Geriatric Rotation with an Ill Older Relative
Proposal for two weeks of senior elective credit

This proposal is written with the hopes of earning two weeks of senior elective credit while I am home taking care of my grandfather before, during, and after his heart attack and CABGx5. I will outline my time spent, work performed, and perceptions below. Though I would never have chosen for this to happen—ever—it has been fortunate that it occurred during my senior year when I am able to be home to help. And as I have moved through the medical system from this side, I found myself thinking that every medical student should have an experience such as this. Of course it is not something that one would wish for or be able to design, but it is a situation from which to gain perspective and wisdom.

Some Background:
My grandfather, Robert Jackson, has lived with my family since before I was born. He helped my parents buy the small farm in Northern California where I was raised. While my parents worked to raise the child that had come too early, they sent me off to daycare when I was four months old. Reportedly I screamed every time I had to go and hated leaving. I was the first born of my parents, grandparents, and all of their friends, so I was used to being the center of attention; looking back, my theory is that the daycare just l didn’t cut it. After a while “Pop,” as we all called him since he was my mom’s step-father but raised her since she was six, refused to let me go back to that daycare, “She’s not going back there.” And he insisted on keeping me home with him.

As I grew older Pop would strap me into the little blue backpack on his back as he cut the grass in our hay field or fed the animals or fixed the fence. He probably walked miles and miles with me on his back.

Once he saw a velvet dress that he thought I would like and couldn’t decide whether he should get the blue or purple one…so he got them both.

When I started being able to conceptualize death around age 10, the thought struck me that Pop would die one day. I hated the thought and would have nightmares about it. I cried myself to sleep about once a month thinking about him being gone. He was getting older and slowly starting to do less around the house. I rationalized that he was just taking an extended break and would be back to it eventually.

Days when I had to stay home sick from school were a treat because that meant I got to hang out with Pop all to myself for a whole day. He brought me crackers and soda to ease my stomach. We watched his favorite game shows together (“The Price is Right”). He made sure I had my pillow and blanket. I never stayed sick long under such care.

When I went away to college, Pop would send me letters and the Sunday comics every week. Sometimes that was by far the highlight of the week. It would see me through the exams and stresses and homesickness.

I moved to Cincinnati for medical school two years after I graduated from college. I didn’t want to be that far from home. I knew Pop was getting older—he was 80 when I left for medical school—and I was afraid that his health would fail while I was away. Yet when I looked into myself and thought about it, I realized that I couldn’t put my life on hold to simply wait around home…nor would Pop want me to. I knew he loved me; he knew I loved him. We had no regrets.

Before I drove across the country, he bought me a new set of tires for my car. He always thought of details. He always took care of all of us.

April 18th, 2006-April 23th, 2006
Mom texts me around 11am saying that Pop is having chest pain, what should she do. “Go to the hospital,” I say.

This is not the first time this has happened. Last time it was my brother who called me when Pop had chest pain; that time they went to the hospital and he had multiple pulmonary emboli post op. I was in touch with his doctors every other day. He was in good hands at the hospital 30 miles down the road from our home.

This time he is having left-sided chest pains, numbness, tingling down the left arm. It is women and diabetics who have atypical MIs—not men. Not my grandfather. His symptoms are classic…and I am worried. It is much easier to read about such things. Even much easier to have a stranger/patient come into the ER with these symptoms and order enzymes, ECG, pain management, etc. With my grandfather I was 2500 miles away trying to figure out what was going on over the phone. I spent hours on the phone with my family and his care team. When mom gave me the cardiologist cell phone number, the call was dropped. I wasn’t together enough to call him back. I asked one of my friends to call and get the details. I hadn’t done a cards rotation…and I was too emotional to really think much or ask any of the right questions. I sat next to my friend as he sketched/jotted the details, “90% occlusion” “70% occlusion” “Positive enzymes to 40” “no pain” “no CHF” etc.

The cardiologist and cardiac surgeon went back and forth between medical and surgical management. They ended up doing a cardiac cathaterization (which showed disease too diffuse to be amendable to stents), CT, ECHO, and a stress test. The stress test was the last one to come through. It showed that, though he was 85, he was actually a low risk for surgery (a “young 85”) and that it was his best options—without it, the surgeon thought, he would last maybe a couple months more.

We heard late Friday that he would have the surgery. On Saturday I decided that I needed to come home. I felt scared and far from home. And if anything happened, I wanted to be there. I needed to say goodbye if that’s what was going to happen. I didn’t have any regrets about Pop. Like I said, he knew I loved him, but I needed to come home.

He came home the few days in between that hospital stay and his surgery so he was home when I got home on Sunday. Mom picked me up at the airport two hours south of our house so we had time to talk about everything. Pop had gotten out his will and papers so she knew where they were. He wasn’t worried, and didn’t want us to be either. He said he had no regrets. He’d lived a long happy life. He thought he’d be fine, but just in case he wasn’t…

I talked with mom about something I’d read about letting loved ones go. The person dying often was at peace with their passing. It was the relatives who made it hard—the hardest part for the dying person was worrying about the pain and sadness felt by those he left behind. Pop needed to know that we were fine. That we would be okay without him. Mom started crying then. She thought he knew us kids (my two brothers and I) would be okay without him, but he would still worry about her. He still took care of her…of all the little details that she didn’t remember or didn’t have time for or that he could help her with.

Pop was very glad to have me home. That first day he grilled me about the details of the surgery. I’d watched one on my surgery rotation so knew sort of how it worked. “Would they take out the disease?” “Will my heart keep beating?” “What will it feel like afterwards?” I knew some but not all of the answers. We usually didn’t follow patients after surgery, or after they left the hospital. I didn’t really know what things would be like after. In the back of my mind I was still hoping there would be an “after.”

One of my friends in Cincinnati told me I had to be strong for my family. “They will be counting on you.” He said as I cried, “You have to be strong for them.” Once I got home I was strong. I was reasonable. I asked all the questions. I was there. I was still worried, though, privately I was still very worried.

Clinical Activity Time Spent (hours)
Long distance phone consultation with family and doctors 4
Research of condition, procedures, tests 2
Figuring out situation once I was in California 2
Talking to Pop about procedure 2
Total 10
Running Total 10

April 25th, 2006
This is the day that Pop has to go in for his pre-op consultation which consists of meeting with the cardiac nurse, the respiratory therapist, the pre-op nurses, the physical therapist. He gets a carotid doppler, another chest x-ray, blood drawn, and ECG. We spend hours learning more about the procedure and meeting some of the people who will help us after he’s finished. They even give Pop guided imagery tapes (and a tape player) because people who are relaxed do better after surgery. They are also doing a study on post-op pain and anxiety management with acupuncture, but the practitioner is not available to do the eval so Pop doesn’t get the acupuncture this time around.

I learn a ton, though. The pre-op labs to order, the medications to not take the morning of surgery, the wound care that I will need to do afterwards, the therapy that will help speed his recovery, the proper use of the inspiration spirometer (IS) that will decrease the risk of pneumonia, how deep he should be able to go with the IS, how to manage his pain, and to tell if he is in pain, how guided imagery helps, how acupuncture helps, how to make sure you have a good surgeon, how an effective recovery team functions, etc. They are mostly talking to him, but he’s very hard of hearing so I am there to be his ears. And he told everyone, at least once, that I was almost finished with medical school, “She’s going to be a doctor.” I guess I hadn’t realized quite how proud of me he was.

They ask the normal health history questions about 10 times. They also ask a few more interesting questions, “What are your goals for this surgery?” “To live to be 100.” He replies. “Why didn’t you remarry?” My grandmother died before I was born and there were lots of women after Pop soon after. “I always told them I’d remarry if I found one like the one I just lost.” I guess he never did. It makes me with I’d known my grandmother, too. She was smart to marry Pop (course it was her third marriage but it’s the one that stuck).

After our time at the hospital we had a prescription to pick up. The surgeon has his patients take allopurinol to decrease the inflammation of the vessels. He also likes them to take 2000 mg of Vitamin C for the antioxidant properties. Interesting, I thought. I hadn’t heard of those before, but I knew this surgeon had “impressive outcomes” and that other surgeons traveled from all over the world to observe his bypass and ablation operations. He would have the heart/lung machine on standby, but hoped not to have to use it during Pop’s bypass procedure.

We also went out to lunch at our favorite restaurant in town. He was going to have the steak sandwich but when I said I was having the chicken pesto, he had that, too. We both had dessert. He has always had a sweet tooth. He had cheesecake. I had panna cotta. I told him he was the best date. I’m sure the whole restaurant heard everything I said since I had to scream it so he could hear me, but I didn’t care. I just wanted him to hear. I knew cheesecake wasn’t great for him, but I wasn’t about to say he couldn’t have it. I still didn’t know what was going to happen the next day. Everything that day had made the surgery, and the risk, even more real for me.

We also went to the grocery store to pick up a few things that mom wanted. Pop leaned on the cart and was winded. He’d had a big day and was tired, but said he was okay to still go to the store. When we got to the check out the woman there took one look at him and kindly ushered him over to a bench and got him a bottle of water from the store cases and just gave it to him. I told her what he was having done tomorrow. “Oh, wow,” she said, “What’s his name?” “Robert.” “Okay Robert, I’ll add you to my prayers!” With random kindness like that, I felt reassured that everything would be okay the following day. But I held onto my mental preparation in case it wasn’t.

Clinical Activity Time Spent (hours)
Pre-op visit at hospital (see details above) 6
Prescription pick-up/education 1
Visiting with Pop over lunch, talking about WWII, life, etc 2
Total 9
Running Total 19

April 26, 2006
Surgery Day. Pop had been scheduled for the first surgery of the day, which meant we had to be there at 4:45 am—that is earlier than the medical students rounding on surgery patients in Cincinnati—but that wasn’t what I was thinking that morning. Pop had to register again first. He’d taken a Hibicleanse shower the night before, and he would take another one that morning after he was shaved from neck to toes. This was new to me, too. I’m sure it helps cut down on skin bacteria; good idea, really. The more I saw this surgeon’s methods the more impressed and reassured I was about Pop’s surgery. He had to have his iv started, he had more blood drawn, he had to sign a bunch of papers. They let us stay with him in the pre-op area. And he would go straight to the ICU after surgery. The plan was to have him spend a night there, then head to the CCU until he could go home.

The nurses started an arterial line in his left wrist. She put a warm towel on it to draw the vessels up to make the stick easier. She also used lidocaine so it wouldn’t hurt. And it worked. He didn’t feel a thing except the lidocaine stick. They went over his records with me and answered all the questions they could.

Once he was physically prepared for surgery (he was always mentally prepared—we should all take a lesson from him really—he takes everything in stride—“don’t let things bother you” he would tell me), they let us accompany him to the door of the OR suite. It was 6:30 am. In there the anesthesiologist would talk with him and the doctor would get to work by 7:00 I figured. He seemed very well respected by the staff. I think he is very particular about the care of his patients and the staff he chooses to work with.

When we said goodbye to Pop at the door, I started to get a little teary for the first time since I’d been home. I hid it well. Pop handed us his glasses, kissed us and said he’d see us soon.

And then we waited.

The cardiac nurse, Robyn who had run the Boston marathon the weekend before, would be out to talk to us between 8:30 and 9 am. Dr. Poa had her check in on the surgery and then keep the family informed as things were progressing. I didn’t think most surgeons did that, but from the family end, I certainly appreciated the extra efforts.

Mom and I were both there and Dad was planning on coming down later. I’d brought things to read and do, but all I could handle was curling up in the chairs and turning on my music and trying to not think about what might go wrong. What I’d seen go wrong in surgeries before. What the anesthesiologists had said about the concerns with older adults and surgery, especially in cardiac cases. I didn’t think I’d been that worried, but I guess I was. I was on the other side of the coin now. I was the one waiting anxiously for any word from the doctor. I was the one in the waiting room looking eagerly up every time a new person walked down the hall in the hopes that it might be someone bringing word about Pop.

My brothers were also anxious, even my calm brother Colin was freaking out that day. He had gone to work, but could not concentrate. He told mom that he kept having to go outside for walks to calm himself down. He had started really thinking about it the night before after he said good night to Pop—that he might not see him again. He was a wreck. And Bryce, who was in New York, texted us every few minutes to see if there was any news. He was having a really hard time being so far from home. We texted them and my dad and our neighbors and friends with the news that he was in the OR now.

Finally we saw the nurse walking down the hallways just before 9 am. She started with some pleasantries but could see we were in no mood for small talk, “Everything is going well,” she said. “He is working on the third bypass now. He tests the patency of them with special equipment and doppler while he is still on the table to make sure they work. So far these three work. He is also planning to do an ablation because of his history of afib—while he’s in there. There is very little risk to that, but it will add 20 minutes to the procedure. It cures about 86% of afib.” We asked a few questions and she gave us a few more answers and information. Bottom line, he was doing fine. His heart was tolerating the procedure well. He was doing fine.

I felt a HUGE weight that I had not even taken the time to acknowledge, lift from my shoulders. I felt that for the first time since I’d heard about his heart attack, I could breathe. My mood suddenly lightened. He was going to be fine now. I could sing. I could joke.

I knew we were not out of the woods, but so far everything looked good. That was a good start.

It was a sunny day as mom and I decided to wait out the next stretch outside. We told the volunteers where we were incase the nurse came back to talk to us. I re-explained everything the nurse had said to mom and then translated it into abbreviated phone text language to send to my brothers and friends who were anxiously awaiting any news. I would rather have shouted it from the roof tops.

Our next visit with the nurse went just as well. He continued to do well with the surgery. They had done five bypasses and decided against doing the ablation. She wasn’t sure why but Dr. Poa would talk to us about it after when he came to see us himself.

By about 10:15 am, the surgery was over and we waited this time for Dr. Poa to come out. He came out in his gown, shoe covers, full head cover, leg covers. I knew that any surgeon who took the extra time to put all that extra sterile material on was usually very good—usually cared a lot about how his patients did. I felt again that Pop’s heart was in good hands.

He said everything had gone very well. He’d decided not to do the ablation because he could not find any real definite history of afib in his chart and rhythm strips for the past two years. I was impressed that he looked that carefully. Pop’s history of afib had been questionable. It was only seen once and they didn’t evaluate it very carefully at the time since. It was thought that it might be rare and intermittent if anything. We told Dr. Poa this and he was reassured with his intraop decision.

When mom told him I was finishing medical school he explained a little more in detail to me and asked who I had worked with in Cincinnati. Apparently some of his classmates are there now.

We could see Pop in about an hour up in the ICU for a little bit. He would be groggy and foggy, so we couldn’t stay long, but we could come back in the afternoon to see him again. He would still have his chest tube and catheter in until the following day or whenever he was moved to the CCU.

We sat and waited for the hour to be up and then went upstairs to the second floor ICU to see Pop. He was pretty doped up still from the anesthesia and pain medication he’d received. He kept saying he hurt, “Oh my neck hurts. My back!” I massaged his neck for nearly the whole hour we were there. The nurse was close by and he seemed to be in good hands. When we left and told Pop we would be back later, he was sad to see us go. He was not yet at all himself, but he was alive and going to heal.

After we left, Mom was so exhausted she slept in the car for over two hours while dad and I walked around town. We lived too far away from the hospital to make it worth it to drive home then back.

When we got back later that evening, Pop was up in his chair and looked much better. He was talking more like himself and his pain was finally under control. The nurses gave me the update and I peaked at his labs. He was still anemic and might get blood eventually.

While we were there, my brother Colin showed up with food from Taco Bell to eat while Pop ate his dinner, too. Colin is quite easy going, but even he had been very worried and unable to concentrate all day. He came in and was sighing and rubbing his forehead and just smiling and staring at Pop, “Boy Pop, am I glad to see you.” He was suddenly back to his happy joking self. It really made it hit home to see my brother react that way, too.

Eventually we had to leave that night, but I would be back the following day.

Clinical Activities Time Spent (hours)
At the hospital during Pop’s CABGx5 10
Running Total 29

April 27, 2006
The next day Dad and I drove down to the hospital around noon. Pop had been moved to the CCU around 11 am. His chest tube and catheter were out but he still had the central line in his neck. It was bothering him, but at least he didn’t have to have a fresh stick for every blood draw. He was still anemic at H/H: 9/27 and they would probably give him a unit of blood later. He was understandably very tired and slept for the most of the afternoon while I was there. Nurses came by to check his vitals. Nutrition came to get his dinner and breakfast orders. Respiratory came by to check his lungs and give him percussion treatments. Physical therapy came by to take him for walks. It was exhausting just to watch. He just wanted to sleep peacefully for a while. After a time I started asking people if they could come back later. It’s good to have an advocate there in the hospital. Someone who has a vested interest and can keep track of all the comings and going and keep everyone on the same page.

For instance, I knew from his orders that he was supposed to be on an 1800 ml fluid restriction. Nutrition knew about it but nursing didn’t. And he didn’t like the Ensure they kept bringing him to drink so he wouldn’t drink it then would have nothing to drink with his meal. I had to tell them a couple times over the next few days to get him something else. He liked the milk much better. Even after they changed his orders the next day, I kept having to correct them.

Pop did end up getting one unit of blood that afternoon. His temperature went up a couple degrees but other than that his vitals remained stable and the transfusion went well. He felt better afterwards. Especially since he was able to get up and get another walk with the physical therapist in before I left. It was good for me to be there while they got him warmed up and ready with leg exercise then showed me the correct technique to help him out of the bed and chair. He was unable to use his arms due to sternal precautions that Dr. Poa wanted to keep him on for another three months.

They also showed me how to put on his Ted hose properly, how to clean and dress his wounds, etc. Social work came by to set up his home health benefit from Medicare (which pays 100% as long as he is home bound) and physical therapy visits. We probably wouldn’t be seeing respiratory therapy once we left the hospital, but he would take his IS home and use it once an hour while he was awake. There continued to be a lot for me to learn and remember.

His urine was dark and there wasn’t much of it. He wasn’t anywhere near his limit of fluid restriction so I asked if I could encourage him to drink during the times when he was awake and gave them my reasons. They agreed and told me to just record the cups on the I/O sheet. 200 ml if the cup wasn’t too full and 240 ml if it was almost full to the brim. I stayed through Pop’s dinner that night until my Mom, brother and his girlfriend came down to get me around 8 pm. I think Pop was tired again; he was ready to have us go so he could get the intermittent hospital rest that is never really restful enough. But he wasn’t yet ready to come home.

Clinical Activities Time Spent (hours)
At the hospital POD #1 8
Running Total 37

April 28, 2006
The next day I got to the hospital around 1:30. He had been having some trouble urinating which the nurses said was a common post-op complication from the anesthesia—you were unable to feel the urge to urinate. They had to straight cath him once during the morning and again in the afternoon. Their criteria consisted of the fact that he had been unable to go on his own for more than six hours. They did numb him up first and he said it didn’t bother him too much. I still thought it was better than having the indwelling catheter, due to the limit in mobility and the risk of infection.

The rest of the day progressed much as the previous one had, except that he did not get another transfusion that day. His H/H had not come up appropriately, but the doctor was waiting to see if he started to recover on his own before transfusing him again.

He was also coughing more that day—they were very focused on the color of the sputum (which was greenish yellow at that point) even though I’d read that the color didn’t matter that much and had a low sensitivity and specificity for pulmonary infections. His lungs continued to sound clear and he was using his IS and taking walks.

His color looked better than it had in months and I kept thinking he was flushed and asked them to check his temperature in between the regular vitals checks, but it was fine. I guess we just weren’t used to seeing him with such rosy cheeks.

That night I stayed again until mom came down after work to get me. For the first half of my stay he was still very tired, but by the time we left, he was back to watching his favorite evening television programming and looked almost good enough to take home. I still thought one more day would do him good, though, and Dr. Poa agreed with me. So that plan was to take him home the following day.

Clinical Activities Time Spent (hours)
At the hospital POD #2 7
Running Total 45

April 29, 2006

In preparation for Pop’s homecoming Mom and I did a lot of meal-planning and scouring of the binder they’d given us for diet recommendations. We would eat less red meat. We would look for salt alternatives for Pop. They’d recommended that if he needed extra calories that Carnation Instant Breakfast was often preferred over the Ensure that Pop didn’t like. He had to get plenty of protein so we would get fish and chicken and yogurt and cottage cheese. I planned to make chicken pot pies and had found a low fat low salt recipe in one of my old Cooking Light Magazines. I still wasn’t happy with the fat content in the crust, however, so I chose to use phylo dough instead. Mom planned to make Pop’s favorite bread pudding—without the salt this time.

We planned the menus, made a list, and visited three grocery stores to find everything before we got to the hospital. It was one of the hottest days of the Spring so far and we had to take an ice chest to keep the food cool or frozen.

Pop had his cell phone in the hospital (our solution to Lifeline for him) and he’d said he would be ready around 3 pm. But as we got there shortly after three we found that he’d been given two more units of blood and that he had just finished the second unit.

When we got there he still had to get his central line out. They had to lay Pop flat for 30 minutes, then up for another 30 minutes in a chair. Then get his discharge paperwork done. Plus they’d called in a prescription for Darvocet for us to pick up. We divided forces and mom went to get the prescription while I waited with Pop. We stayed so long that they brought Pop his dinner, but he wanted to eat at home. I even told him that we could save our planed dinner for another day. He was anxious to get home and eat dinner there, though, “No, I don’t want dinner here. I’ll eat at home.” His favorite part of the hospital was leaving it.

And eventually we did. Now I would be the nurse, respiratory therapist, physical therapist, doctor, social worker, home health aid, nutrition consultant, pharmacist, cardiac nurse, companion, and granddaughter all in one.

Clinical Activities Time Spent (hours)
At the hospital POD #3 4
Getting thing set up for homecoming (bed, bathroom, food) 4
Total 8
Running Total 53

April 30, 2006

Pop felt good on Sunday. We took four or five walks even as far as the barn a couple times. I carried a chair so he could stop and rest as he needed to. His pulse was not supposed to get 20 beats above his baseline. He has a baseline of around 70 so was not supposed to go above 90 or so. Of course I thought this was helped by his atenolol and Altace which he was taking agin. He was also back to taking his levothyroxine, statin, baby asperin, Metamucil and multivitamin. He didn’t feel like he needed his pain medicine.

My biggest worry that day came later when he said he had some dark black stools. I knew that he had not responded appropriately to the first unit of blood. And he was still low the morning before we took him home. They also had not rechecked his H/H after he’d received the two units the previous day. I felt like we still didn’t have a good answer for where the blood was going. They kept saying that he was still recovering from surgery. He was still feeling okay and I knew the home health nurse was coming out tomorrow. We’d see how things went overnight and talk with the nurse about it the next day.

Clinical Activities Time Spent (hours)
Physical therapy (helping up, walk, exercises) 2
Respiratory therapy 1
Meal preparation 3
Nursing (wound care, ted hose, monitor weight, monitor pulse) 2
Total 8
Running Total 61

May 1, 2006

Monday he was a little more pale and didn’t have as much energy for walks and getting up around the house I was still helping him out of all the chairs, walking him around, making sure he used his IS, getting meals, checking daily morning weights and playing dominoes with him. But he was definitely more tired that day. He had one more episode of melena that morning, but since then the stool in his colonostomy pouch has started to lighten up a bit.

When Marilyn, the home health nurse, got there around noon she spent a long time getting all of his initial intake information and going over mountains of paperwork. Fortunately he was pretty perky through the whole visit and I was there to help him hear and get the information. Although most of the time I was quiet and there to listen and just in case he needed anything. I thought it was better for them to get to know each other.

She called Dr. Poa about the melena but his office referred us to Pop’s GI surgeon’s office. We called them but never heard back. They needed an order from the doctor to draw blood or check a hemocult.

Clinical Activities Time Spent (hours)
Visit from Home Health Nurse 2
Physical therapy 2
Respiratory therapy 1
Meal Preparation 2
Nursing 2
Total 9
Running Total 70

May 2, 2006

Pop was still draggy on Tuesday, but he melena was resolving. I thought he might need a little extra iron so planned to have lean red meat, potatoes, and greens for dinner. I knew Pop liked lemon desserts, too, so made some lemon bars for after dinner.

We still went for our walks, but not quite as far that day.

Clinical Activities Time Spent (hours)
Physical therapy 2
Respiratory therapy 1
Meal Preparation 2
Nursing 2
Total 7
Running Total 77

May 3, 2006

Marilyn was back that day, but this visit was shorter. His vitals still looked good but his energy was about the same. The nurse said that he was doing great and we could expect some good and some less good days.

The other thing I was learning about being the primary care giver was the importance of taking at least a little time for myself. Fortunatley Dad was home most of the time and could help Pop with transferring so I could get away long enough to get to the gym sometimes.

I also usually had all of the animals to feed. Cats and horses in the morning. Birds sometime during the day. Dogs in the afternoon. Making sure everyone had water. Catching my brother’s goats when they would escape. Taking the dogs out so they didn’t bark at everyone. These were short trips away from Pop so I could usually squeeze them in sometime during the day before I had to start dinner.

Pop also got to take his first shower since the operation that day; he wanted to do it on his own but we put a chair in his bathroom in case he needed to take a break and mom and I sort of hovered around the door incase he needed anything or hollered. He just took it slow and did great, though.

Clinical Activities Time Spent (hours)
Visit from Home Health Nurse 1
Physical therapy 1
Respiratory therapy 1
Meal Preparation 2
Nursing 2
Total 7
Running Total 84

May 4, 2006

Thursday we had a visit from Martha, the physical therapist. Pop was sitting in the recliner in our TV room finishing the Price is Right when she got there. It is the lowest chair in which he sits and the one that we have the most trouble getting him up from. He does fine with my help, but I didn’t think he could do that one on his own. She pointed out that when he scoots to the edge to stand up the recliner rocks forward and makes his knees bend at less than a 90 degree angle. She said that we could build a 4 inch lift that might help him get out of it on his own. She also gave me some tips on keeping my body mechanics correct in helping him. And told me that if he fell down to call 911 or get someone else to help since she didn’t think I could get him up safely on my own.

She tested his leg strength and said he was “strong as an ox” and that there was no reason he couldn’t get out of the other chairs on his own. He just had to work on his stamina and getting his gluteal muscles a little stronger and recruited to help him stand up. She gave us a couple exercises to do about three times a day in addition to his walking. This was helpful for me to learn and see since now he would be able to get up on his own and I wouldn’t have to be there all the time to help him transfer. I think it also boosted his confidence, too.

In addition, his energy was returning a bit and his appetite continued to be better. His daily weights were looking okay. We were mostly watching for fluid retention but between the fluid restriction and the ted hose he seemed to be doing well on that front. He had no peripheral edema and was actually losing a little weight, which is what he wanted to do. I had told him this was not a good time to lose weight as his body was healing and was encouraging him to eat well. He’d usually have oats or toast and peanut butter for breakfast, fruit for snacks. I made smoothies with the yogurt. Mom had gotten some unsalted peanuts and he’d usually have a glass of milk with a snack or with lunch. He wasn’t eating as much as he usually did, but he was eating healthy. I was making sure of that. His appetite would return eventually. In the meantime I just encouraged him to eat as much as he could.

Clinical Activities Time Spent (hours)
Visit from Physical therapist 1
Physical therapy 1
Respiratory therapy 1
Meal Preparation 2
Nursing 1
Work on this proposal 3
Total 9
Running Total 93

May 5, 2006

Cinco de Mayo and Pop was having a good day. He can walk to the barn and back with increased ease. And then sit on the lawn to relax for a while and visit with the neighbors. A different Home Health nurse comes out today since Marilyn in on her way to San Francisco for a little vacation. Joanne was the nurse for that day. She tried to check a pulse ox on exertion but her machine wasn’t working. Martha had checked it the day before and it was 92% with walking and 96% at rest so I thought he was doing fine.

Clinical Activities Time Spent (hours)
Visit from Home Health Nurse 1
Physical therapy 1
Respiratory therapy 0.5
Meal Preparation 2
Nursing 1
Work on this proposal 3
Total 8.5
Running Total 101.5

“I don’t know what I’d do without her here.”
“She’s one in million.”
“She’s been a lifesaver”
“You’ve taken care of her a lot during her lifetime”
“That’s alright, she’s well worth it”

Wednesday, May 03, 2006

late night update

I have been having a lot of trouble getting online so wanted to post this as an update. My grandfather came through the heart surgery well. He ended up with five bypass grafts. I came home to be with him and my family during the surgery and help during recovery so that is where I am now. He is tired, but doing fine.

I am mostly hanging around the house, feeding animals, taking care of Pop, playing dominoes with him, filling bird feeders, working out, playing with dogs, watering everyone, making dinners, doing dishes, reading, talking on the phone, texting, planning, etc.

I had a therapy appt via phone today; it went well. No tisses. No big issues. I still have lots to think about, but it's not bad necessarily. I am just trying to enjoy being home and being helpful and everything. So far so good.