Sunday, January 29, 2006

Second dispatch (from John) covering surgery and post-op

Well, after a couple of days in which I could not reach my email server
(through which this is passing on its way to you) I'm finally able to
communicate again. Let me start by saying that Tod is doing very well,
and Pat and I are beginning to feel as if life might someday return to

Tod returned to the hospital on Wednesday at 10:00 for a second try for
the surgery. Again nothing at all happened for quite a while. Pat and
I arrived at about 10:30 and sat with them. At about 11:45 Tod and
Danesha went "into the back" to prep for the operation. A few minutes
later their very good friend Las arrived. At about 1:00 a nurse came
out to tell the three of us that Tod would be going any minute, and it
was time to go back for hugs and kisses. About 1:30 a nurse-
anesthetist named Jimmie came by; he explained what sort of anesthesia
Tod would be getting, and answered a lot of questions. Very nice guy.
Then he disappeared to find out if the OR was ready for him yet. Ten or
fifteen minutes later a nurse stuck her head in and asked "What are you
doing still here?" We all kinda wondered the same thing. Finally,
finally, just when Tod was about to go completely nuts, they came for
him at 2:05. All they'd done in the previous four hours was get him out
of his street clothes and onto an IV. Although actually there'd been
more; by the time we went back to see him his arms were bandaged in
several places where they'd been unsuccessful in finding a vein for the
IV. Tod was getting very, very tired of being poked.

Anyway, at last, off he went. We knew no word would be forthcoming for
at least a couple of hours, so the four of us went out for lunch to a
Thai restaurant Danesha loves, but we got there after it had closed to
prepare for dinner. We eventually got sandwiches and soup at Panera,
and then went back to the hospital. They have a large "critical care
waiting area", full of chairs in gangs of 3 that can be arranged into
little family "cabins". If one threw a blanket or two over the top, it
could be just like being kids again. All over the room families were
clustered, each in its own style. At the middle of the room was a large
desk, staffed by some wonderful and sympathetic volunteers. When there
was word from the OR they'd announce that a member of the [name] family
had a phone call, and then they'd route a call from one of the surgical
nurses to a phone where you could get a progress report.

Our first progress report came at 4:42 PM. A nurse we'd met before (and
who had, along with Jimmie the nurse- anesthetist had been driving the
gurney when we'd last seen Tod) called to say things were going fine.
Tod was on the bypass machine and Dr. L was working away.

More waiting. Adjacent to the waiting area were some vending machines,
but nothing very palatable. The ladies (Pat, Danesha, and Laz) played
Uno while I read human studies.

The next word came at 7:05. A different nurse called to say that they'd
successfully repaired Tod's valves, and were closing up. Everything had
gone very well.

At about 7:30 Jimmie came by on his way home to tell us Tod had done
very well, and to wish us all well. As I said, he was a really nice

At 7:50 Dr. L came to see us. He said Tod had had a great deal
of "redundant" tissue, and a very "floppy valve". Sometime when I have
the ability to draw I'll reproduce for you the drawings he did for us to
show what he'd done. In addition to clipping tissue out of the middle
of both the anterior and posterior leaflets of the valve, and pulling
the sides of each leaflet together in the middle and sewing them up, he
installed a reinforcing ring around the base of the valve. By removing
tissue in the middle of each leaflet he removed as well the longest of
the reinforcing cords; by pulling the sides of each leaflet to the
center he retensioned the remaining cords. He said that the result of
the surgery was a reduction in atrial regurgitation from +4 to between 0
and +1. He said further that with someone Tod's age one would hope to
make it perfect (i.e., zero regurgitation), but this was at least a
great improvement, and should last for 5-10-15 years. That was
something of a shocker--I'd hoped for a much longer run. Finally he
said that while Tod might eventually need a valve replacement, he was
not a candidate for a "tissue valve"--i.e., a pig valve. So we'll just
have to keep an eye on developments in the artificial valve department,
and hope for the best.

At 8:00 Tod arrived in the Cardio-Thoracic Surgery Unit--the post-op
ICU--but we didn't know that until later.

We kept waiting until at 9:00 we were allowed to go back to see him.
The first thing I noticed was the sickly yellow color of his skin. (It
was hours later before I realized this was not evidence of liver failure
but of thorough pre-op scrubbing with betadiene.) He still had a
breathing tube, and the tape holding it in place distorted his face.
The attending nurse said he wasn't in pain. He was conscious, and could
communicate. His grip was strong, although he'd accummulated a lot of
fluid in his hands and legs/feet. He could nod and shake his head;
shook when asked if he were in pain; nodded with all the vigor he could
manage when the nurse said she'd ask Dr. L if she could start
taking tubes out so he could sit up. He gave us a thumbs-up, and a
private "smile" signal he'd worked out with Danesha. He made a lot of
hand gestures which we all tried to figure out, without much success.
He gestured for the means to write; the nurse brought him a clipboard
and pen, but he couldn't control his hand to write. After a few
minutes we had to leave, to return to the waiting room.

9:30 PM is normally the last visit of the day permitted for patients in
the post-op ICU. But moments before they announced visiting hours we
were called to the desk and told "your bed is on hold". We gradually
figured out that this meant we would not be permitted to go back to see
Tod, because they were doing something for him. But we were told we
could see him after a few minutes.

At 10:00 they let us all go back to see him again. The nurse said he'd
had some drainage--more than they liked--and they'd given him some blood
products. He was still conscious, still bedecked with tubes, still
gradually recovering from all the various kinds of anesthesia. (He'd
had, of course, pain meds, but also paralytics, to stop his heart and
lungs, and amnesics. All in all, quite a load of stuff--a little of it
was still in his system 24 hours later.) At about 10:10 Pat and I left
for our hotel. Danesha and Laz stayed a few minutes longer.

At midnight Danesha called and spoke to Tod's nurse, who reassured her
all was well.

At about 2:00 AM, we learned later, they started removing tubes. Tod
was immensely relieved and much more comfortable. He got some sleep.

At 8:30 Thursday morning, the time of the first CTSU visiting period of
the day, Danesha and Pat and I went back to see Tod. He looked vastly
better for having the tubes out, but still had a nasty looking rig stuck
into his neck, through which they could pump him full of any number of
things. His bed had been made chair-like. He was wrapped in those
thin, towel-like hospital blankets, and with his nearly shaved head (his
choice; he figured he wouldn't feel much like either washing or fussing
with his hair for a while, so he chopped it all off--both head and chin)
he looked a little like a Buddhist monk sitting on a throne. His
spirits were good; the nurse said he was doing great.

After the 8:30 visit we took Danesha out for a good breakfast. Then
back to the Critical Care Waiting Area, our home away from home, to wait
for the 10:30 visit. At about 10:25 we were notified that they'd moved
him from the CTSU to a regular room. Great news!

So we waited a few minutes for him to settle in and then went to see
him. Still shaky, still swaddled in blankets, still sitting in a
throne-like chair, but no longer with the nasty rig stuck in his neck,
and much more himself. He was wearing a wireless four-lead EKG monitor,
and the nurses could keep an eye on him all the time. After a while
Danesha left to run some errands; Pat and I stayed on. At 2:00 Tod got
up for his first walk around the area. At first he was very
stiff--moved his feet, but held his trunk absolutely rigid. But after
one lap of the area and a quick pee he set out immediately on another
lap, punctuated by his pausing for a few experimental standings on one
foot and simple yoga stretches. Then there was a third lap, and more
stretching. He quickly loosened up and started resembling his usual
lithe and flexible self. But he did tire, and after half an hour or so
he was ready to rest.

In mid-afternoon Danesha came back, bearing many wonderful viands
lovingly prepared by friend Phil for Tod, as well as jammies and a
couple of dress shirts! Tod so didn't like wearing a hospital gown, and
decided that what he had that was least like a hospital gown was dress
shirts, so there you have it.

Pat and I went to T&Ds house at suppertime, where we found friend Phil
still cooking--he'd spent his entire day off making one thing after
another, and tucking them away in the fridge or freezer. We had a very
good supper with him of pinto beans and [can't think of the name of
it--Italian corn pone] and beer. Very tasty. Excellent conversation.
Phil is a prince among men, and a very good friend to both T & D.
Danesha stayed at the hospital pretty late--she didn't get home until
after we'd left.

This morning I left Pat sleeping in and went to the hospital at about
8:00, where I found Tod wearing pajama pants that were cut as if for the
street--i.e., with pockets--and a white dress shirt. Stunning. He was
just getting his breakfast, of scrambled egg-beaters, nasty ham, grits,
and OJ. Because he had options (thanks to Phil) he had instead a pear
and some of Phil's puree of roasted red pepper soup and some
decaffeinated tea. He was still swollen from excess fluid, and I
massaged his legs while he scrubbed at the residual yellow streaks from
the betadiene. He scrubbed so hard on one shin he broke the skin. But
after he finished he looked worlds better.

A checker-upper came by to see if the staff had been telling him in
advance what was on the menu for the next meal, and offering him
options. He said no. So a few minutes later here come the menu guy.
Tod settled on alternate meals for lunch and dinner today, and asked for
a bagel with tomorrow's breakfast. I told the menu guy that this should
be a New York style bagel, specifically a toasted onion bagel with a
schmear. He asked if Tod would like capers? Yes. Onions? Yes. A
little lox? Yes. And a bloody mary or a mimosa? At that point a nurse
intervened. But I think it might result in a little better attention.
In general, Tod's been getting very good attention--the staff isn't used
to having a fit 29-year-old to deal with, and some of them seem to find
him quite attractive.

Another nurse came by to announce that at 10:00 there would be a
mandatory pre-release training session. I allowed my hopes for an early
release to soar, and left to fetch Pat from the hotel. Tod had noticed
and envied the crisp press on my shirt, so I took one of his back to the
hotel to press it. When Pat and I and the shirt got back the training
had begun already, so we sneaked in. A nurse talked through what to be
alert for after release, what not to do, what was OK to do, etc.; then a
dietician talked at great length about the elements of a heart- healthy
diet. At one point Tod chimed in to say that his wife, who is a plant
pathologist, recommends against organic peanut butter because it's too
likely to contain aflatoxins. The dietician said she didn't like it
either, because it was gray.

When the training session ended we all returned to Tod's room, where we
found Dr. L making his rounds. Tod asked if he could wander
farther afield than the 3B wing on his walks; Dr. L said no--they had
observed some irregularities, and didn't want him to go outside monitor
range. Dr. L said they were also concerned that the heart was enlarged,
but he wasn't sure why--it could have been mechanical, as a response to
the catheter they'd run up into his heart from his femoral artery, or it
could be physiological. Anyway, bottom line was a prediction from Dr. L
that Tod would be able to go home on Monday. So my soaring hopes
returned to earth; we'll have to leave town before I see him back home,
with the dogs and cats and video games he loves.

This afternoon Pat and I took some time off to rest. I had a long talk
with my office, and learned to my great relief that the human studies
rule did, after all, get signed yesterday, and has made very little
impact in the press. That's good.

In a few minutes we'll leave to meet Danesha and her
just-arrived-from-West-by-God-Virginia mom for dinner. (Notwithstanding
what it may say at the top of this message, the time is actually 5:30
PM.) We're gonna try Thai again-- same place that was closed a couple
of days ago. We'll pass the parental baton to Linda. A bunch of Tod's
friends are going to come to see him tonight, and we'll let them have
him to themselves. We'll go again in the morning, and then head for
home. Sunday I'll go see the P's, and tell them all about it.

Thanks for all your support.

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