Monday, January 17
It's been a somewhat difficult two days for Dad. He had his surgery yesterday morning, and they did succeed in getting the stomach tube in place. But he woke up in significant pain from the surgery, and the doctor had only authorized one dose of morphine, which did virtually no good. His nurse yesterday was unhelpful to say the least -- she seemed to have no interest in helping to find alternate ways of easing the pain, nor even in contacting the doctor; she really didn't check on Dad the whole time she was on duty, unless we insisted, and then only in the most surly manner possible. So she made a difficult day even worse.
When I arrived back in town yesterday afternoon, he was still wincing from the pain every now and then, but he was thrilled to see his grandchildren (heck, nobody stopped us on the way in, so in we went) and he didn't seem to let them see his pain. Mary and Alexander were equally thrilled to see him, with only a bit of hesitation when they first entered (the room was full of strange things, he was laid up in a hospital bed, and he had a mustache!). He was unable to talk, even with the block on his trache; it just required too much effort from his very sore diaphragm, so we had to give up on that. But Katie, who was there all day, was amazing with him -- she understood the vast majority of his soundless speech, and she knew all his signs. She was extremely attentive to him and he was obviously very grateful.
A doctor from the surgical team came in during the late afternoon and was surprised to find Dad in such pain -- he said of course he could have more pain relief, and they'd get him a PCA (a self-administered pain killer pump, for which he only needs to hit a switch to get relief) as soon as he could communicate it to his medical team. "Soon" is not at ALL soon on the sixth floor, however, so it was very late yesterday evening before they got it to him.
Sarah spent the night with Dad and said he had a rough night -- the PCA didn't help him all that much, and he rated his pain a 5 to 10 out of 10. She learned that a small percentage of patients who have this stomach surgery have stomachs which try to reject the pin that's put in place, and that causes stomach muscle spasms. This is what seems to be happening to Dad.
Katie came in this morning and spent most of the day there again (also again acting as his main means of communication). She reported to us this morning that Dad was having some fibrillation, but the machines to monitor this were on the second floor, not the sixth, so he would need a room change. They finally got him shifted downstairs after two o'clock, about the time that the kids and I arrived again, into a much smaller room, but in a place where he could get better attention. His heart rate at that point was about 170. Dr. Hiatt was there and identified his heart pattern as something very familiar (maybe SVT?) to which a standard medication could be applied. However, after first a single dose and then a double dose of the medication, his heart rate remained unchanged, so they elected to move him into the Cardiac Care Unit (one step removed from CICU, so full of very competent, attentive nurses). There they tried him on a blood pressure medication which also had no effect. I'm not sure what other measures they attempted, but they were beginning to get frustrated when Mom sneezed and Dr. Hiatt left the room to get tissues, and at that point Dad's heart rate abruptly went back to normal. So we don't know if the medication, the sneeze, or some kind of Dr. Hiatt magic finally did the trick, but we're just relieved that he's back to normal. He is still in a fair amount pain (though outwardly it seems to have diminished) and he can't talk yet, so that's not quite the normal we had a couple of days ago, but it's better than this morning.
Dad had some nausea and vomiting this morning (they gave him a vitamin solution that he tried to refuse, since it has made him sick before, but they didn't believe him, and whaddya know, he was right) and his stomach was still off this afternoon, but I hope that will go away for good soon as well.
They did let the kids back into the CCU today -- it seemed so high-fallutin' that we thought they might not, and some of the nurses were uncertain about the status of his C. diff (but we were told by an internist it's gone), but his nurse and Dr. Hiatt were both more than willing to have them back there, and it seems to cheer him up so much that no one likes to refuse to allow them!
I had hoped to see Dad in much better shape this trip than he has been in the past, and to a great extent he is, but I'm sorry he's in pain and that his communication is so limited! So we're hoping he'll have a much better day tomorrow, and I'm planning to get back here soon. One thing that does seem better this week than reports have suggested is his motor control with his right hand -- he drew a very convincing picture of a washcloth yesterday (but Amy and I were too obtuse to recognize it) and he has been able to talk to us by spelling things out on a printed alphabet. One of his messages late today, after Katie left, was "Katie has been very helpful. She has been here for many important decisions." That's pretty effusive praise from a guy who can barely move his hand!
When I arrived back in town yesterday afternoon, he was still wincing from the pain every now and then, but he was thrilled to see his grandchildren (heck, nobody stopped us on the way in, so in we went) and he didn't seem to let them see his pain. Mary and Alexander were equally thrilled to see him, with only a bit of hesitation when they first entered (the room was full of strange things, he was laid up in a hospital bed, and he had a mustache!). He was unable to talk, even with the block on his trache; it just required too much effort from his very sore diaphragm, so we had to give up on that. But Katie, who was there all day, was amazing with him -- she understood the vast majority of his soundless speech, and she knew all his signs. She was extremely attentive to him and he was obviously very grateful.
A doctor from the surgical team came in during the late afternoon and was surprised to find Dad in such pain -- he said of course he could have more pain relief, and they'd get him a PCA (a self-administered pain killer pump, for which he only needs to hit a switch to get relief) as soon as he could communicate it to his medical team. "Soon" is not at ALL soon on the sixth floor, however, so it was very late yesterday evening before they got it to him.
Sarah spent the night with Dad and said he had a rough night -- the PCA didn't help him all that much, and he rated his pain a 5 to 10 out of 10. She learned that a small percentage of patients who have this stomach surgery have stomachs which try to reject the pin that's put in place, and that causes stomach muscle spasms. This is what seems to be happening to Dad.
Katie came in this morning and spent most of the day there again (also again acting as his main means of communication). She reported to us this morning that Dad was having some fibrillation, but the machines to monitor this were on the second floor, not the sixth, so he would need a room change. They finally got him shifted downstairs after two o'clock, about the time that the kids and I arrived again, into a much smaller room, but in a place where he could get better attention. His heart rate at that point was about 170. Dr. Hiatt was there and identified his heart pattern as something very familiar (maybe SVT?) to which a standard medication could be applied. However, after first a single dose and then a double dose of the medication, his heart rate remained unchanged, so they elected to move him into the Cardiac Care Unit (one step removed from CICU, so full of very competent, attentive nurses). There they tried him on a blood pressure medication which also had no effect. I'm not sure what other measures they attempted, but they were beginning to get frustrated when Mom sneezed and Dr. Hiatt left the room to get tissues, and at that point Dad's heart rate abruptly went back to normal. So we don't know if the medication, the sneeze, or some kind of Dr. Hiatt magic finally did the trick, but we're just relieved that he's back to normal. He is still in a fair amount pain (though outwardly it seems to have diminished) and he can't talk yet, so that's not quite the normal we had a couple of days ago, but it's better than this morning.
Dad had some nausea and vomiting this morning (they gave him a vitamin solution that he tried to refuse, since it has made him sick before, but they didn't believe him, and whaddya know, he was right) and his stomach was still off this afternoon, but I hope that will go away for good soon as well.
They did let the kids back into the CCU today -- it seemed so high-fallutin' that we thought they might not, and some of the nurses were uncertain about the status of his C. diff (but we were told by an internist it's gone), but his nurse and Dr. Hiatt were both more than willing to have them back there, and it seems to cheer him up so much that no one likes to refuse to allow them!
I had hoped to see Dad in much better shape this trip than he has been in the past, and to a great extent he is, but I'm sorry he's in pain and that his communication is so limited! So we're hoping he'll have a much better day tomorrow, and I'm planning to get back here soon. One thing that does seem better this week than reports have suggested is his motor control with his right hand -- he drew a very convincing picture of a washcloth yesterday (but Amy and I were too obtuse to recognize it) and he has been able to talk to us by spelling things out on a printed alphabet. One of his messages late today, after Katie left, was "Katie has been very helpful. She has been here for many important decisions." That's pretty effusive praise from a guy who can barely move his hand!
posted by Emily @ 7:28 PM
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