OK, so it's decidedly been a while since any of us have posted on this blog--largely because things have been going pretty well, for the most part. Over the past two years Dad has really made a remarkable recovery from the dire situation we were in in December of 2004, but there was this one nagging problem. He had developed a fistula where they had put in his feeding tube, and it had never fully closed. This meant that he was leaking stomach acid and fluids fairly consistently for two years. This had become little more than a nuisance, slowing to only a small amount of seepage, until it became dramatically worse early this year (2007). After much discussion and consultation with any number of doctors, Mom and Dad (with consult from Amy) decided to put off the trip they had planned to Italy and instead go in for ELECTIVE surgery to close up the fistula.
So, last Wednesday, March 7, Dad went BACK to Sinai (what on EARTH were we thinking?) to close the fistula. He had consulted with his cardiologist, Dr. Sher, who said his heart was stable (the wonderful Dr. Hiatt has left the practice to move instead to practice in Annapolis, I believe) enough to handle the surgery, and his GI doctor, Dr. Shear (really, truly--the two, Sher and Shear, should NOT be allowed to work together with such similar names)
performed the surgery. On Wednesday afternoon Amy called me to tell me that Dad's surgery had gone well, to which I replied, "his surgery?" THAT'S how much of a non-event this was supposed to be. Mom hadn't even told me they had definitely decided to go ahead with the surgery, and it was really nothing to be concerned with. He apparently went through the surgery just fine and was going to stay in the hospital until he had passed something (anything, really) to show that his GI tract was working nicely.
AND THEN..
Monday morning I talked to Mom, who said that Dad had managed to fart, but they decided to keep him until he pooped, instead. But still, all was well.
AND THEN...
Flash forward to about 1:00 Monday afternoon when Amy sent me a text to call her when I get a chance. Then she called me again at about 2 and left voice mail stating that Dad had had an episode of heart failure. I'm a bit fuzzy on these details, because I was teaching 30 first graders at the time, and trying not to freak out, so instead, I'm going to simply copy the email Mom sent to Dad's siblings on Monday night detailing our experiences thus far.
"Dick called me this morning and told me that Dr. Shear had decided to keep him in until his GI tract was completely back to normal. I went in a while later, and he was feeling unwell and said he had vomited some more this morning. He was also feeling quite chilly, so I piled on another blanket. When the tech came in to take his "vitals" we noticed that his ozygen rate was way too low. She upped his little oxygen tubes back into his nose, and went to get the nurse. While she was gone his breathing became quite shallow. The nurse came in and shooed me out for a while, and when I got back about ten minutes later, his room was full of personnel. I recognized a respiration therapist from our first stay, the nurse supervisor was in there and a couple more nurses. They also had sent for an x-ray technician to x-ray his chest, and an electrocardiogram machine. Then a pulmonary doctor showed up. I mentioned to them that he did have congestive heart failure--somehow, none of them was aware of that. They decided to send him to the ICU and entubate him. I trailed along down to the fourth floor on the elevator with them, and the nurse practictioner walked me to the waiting room. Meanwhile, I called the girls--after a while the NP came in and told me they had sedated him and entubated him, and he said he had called Dr. Shear, the surgeon, and Dr. Sher, his cadiologist. We were marvelling at how fast things can change!A while later Dr. Shear came in to see me and said, "He's going to be all right." He told me Dick had suffered an episode of heart failure, but his blood work and ekg showed no signs of a heart attack, He had ordered heparin in case he had a blood clot, but he thought that was unlikely because he had been up walking around earlier. He said all his numbers were back to normal, but that he had sedated him a little further because he was coughing around the tubes and, maybe, fighting them. He said in the morning he will order a CAT scan to make sure there were no clots around, and an upper GI to see if they can pinpoint the problem with getting his intestines moving. He said his fistula had originated right next to his pyloris, the narrow area of the stomach that leads to the small intestine, and that the surgery narrowed it a little, and the stomach was probably a little swollen, causing the back up. He says it will straighten itself out eventually.Sarah came by and she and I went back to the ICU until they kicked us out. The nurse told me that Dick's watch and wedding ring had been put in a bag and sent down to security, and there was a to do about getting them back for me. Later the social worker went down with me to get them, and they hemmed and hawed and said only after Dick gives written authorization! A different social worker had sent me a bag with his hearing aid, glasses, and some other possessions. My coat was still in the closet in his room, so after a while I went up to get it. In that short time they had cleaned and mopped the room and changed the bed and the bouquet of flowers Amy had brought him had disappeared, as well as our unread newspaper. (When you want housekeeping,you usually have to wait.)After Sarah and I visited, we went to the waiting room and Katie joined us. We all went back for the 4:30 visit, and then Sarah and I left, and Katie waited for Amy and they were going to go in for the next visiting period. He is very out of it, so I don't know how much he realizes that we were even there.Dr. Shear said that by morning they can probably remove the tubes. I certainly hope so, and I hope they can get him fixed up and able to come home. That standing over his bed in ICU was deja vu all over again!Prayers again, please!Mary"
Unfortunately (and really, needless to say) they were not able to remove the tubes today. After Mom left last night, Dad's blood pressure continued to drop, really quite low, and so they tried giving him a saline line to rehydrate him and hopefully raise his blood pressure. When this didn't work, they started him on a Dopamine line. Sarah called late last night and I called first thing this morning and we found out that the dopamine had worked and his blood pressure had remained stable and at an acceptable level throughout the night. He was responding nicely to stimuli, and they were not giving him the propofol (sedative) anymore. Sounds good, right?
Yeah, right. This afternoon at 2:30, Amy and Mom went back for the visiting time and were shooed out because Dad was having a "little cardiac something." Or, well, that was the translation. Basically, his heart rate had jumped dramatically and they were doing an EKG. His blood was also a little too thin, so they stopped the heparin and started him on metoprol. They were also wanting to do CAT scans on his chest and abdomen. They did a blood culture on him and discovered at this time that he was "a little bit septic." (is that like "a little bit pregnant?") They had already started him on an antibiotic, which they are continuing, to fight the infection. PLUS, they inserted an arterial line so they wouldn't have to keep sticking him every time they needed blood.
In spite all this, he really, truly seems to be doing ok. He was somewhat awake this afternoon, and he was, of course, uncomfortable and in pain, but he was able to respond and he seemed to have some of his good humor still, so I still have a certain degree of hope in me. So as of 9:00 this evening, when Amy and I left, Dad was still in ICU on 70% oxygen. The metoporol had done the trick and his heart rate was stable, and they had kept him off the sedative. He had had some pain medicine earlier in the night, so he was asleep from that. They had stopped the metoporol and restarted a low level of the heparin, and inserted ANOTHER line in him (they called Mom at home for permission for that one). Unfortunately, his blood pressure was lowering at this point, so who knows what tomorrow may bring.
I realize I probably missed a bunch of stuff here, but it's late and I'm tired, and I'll have to come back to edit this at a later time.
Please, please do keep up the prayers and positive thoughts!
