Voices. Soft female voices. Now some movemnt.
I hear Kim's voice.....
"Mark, it's me Kim. My sister Terri's with me. Mark everything went great. Dr. Landreneau did not have to mess with the nerve or the artery!!! He got all of the tumor out and everything looks great!" I was pretty sure I was gaining some focus at the foot of my bed----pretty sure that's Kim....
"Honey, don't try to talk," Kim said, "you have a breathing tube in and they say you may hurt your throat if you try to talk. They say they are going to take the tube out after we leave and you will feel a thousand times better!"
I could not believe how cognitive I was. I tapped my wrist for the time and Kim said it was three pm and I just got here into my ICU room about half an hour ago. She said surgery started a bit late and lasted about two hours. I was in post op while they fixed dressings, tubes, clothes, bandages. I asked Kim to get me something to write with. First I scribbled I loved her. Then I scribbled that my throat hurt a bit. She reassured me that it would be better after the breathing tube was out and that the bronchioscope may have tore things up a bit. I tried to scribble something else but I just drifted off into the glory that is surgical drugs.
The next morning has me awake with the respiratory specialists at my bed ready to take the breathing tube out. I was scared before surgery that I would panic as I awoke with something in my throat, but the nurses said I didn't...Thank God. Now the respiratory guy was kind of vacuuming out my throat tube. I think he squirted something in my throat, and had me turn my head and cough. As I did, two things happened, first I found out it really hurts bad to cough after lung surgery. Second that foot plus long tube comes out in about two seconds with no pain, no gagging.....you know, those unknown things you fear so much...
Time distortion was rearing it's ugly head. I thought it was Monday afternoon but it was really Tuesday. Kim could not see me yet as they wanted to clean me up from the blood stained gowns and a good wipe down from all of the orange betadine that covered me. I was trying to take a quick assessment of what was working on the spacecraft. It seemed that I had a catheter in place, something new for me, but could see a use for in those insufferrable lines at the supermarket. I also had a large bandage covering most all of my left shoulder, which itself was covered with some large white elastic/velcro affair.
I also had a chest tube exiting about two inches left of my left nipple. It was running as about a 6-8 foot tube to a measuring vessel at the foot of my bed. No apparent pain involved here, but there was a lot of pink water in there. I then took the chance to rotate my left arm. Hmmmmm, seemed a little stiff but there seemed to be no limit of motion. I did feel a bit of numbness but not anywhere near as bad as before surgery.
Then I coughed.
Good Lord. That hurt. That hurt alot. My nurse handed me a Kleenex and asked me to spit the sputum into the Kleenex. Out came about a tablespoon of thick dark colored bloody goo. "Oh that's great Mark, good job! Good job? I still had not allowed the pain to subside enough to not be afraid to breathe.
"Mark, that stuff in the Kleenex is a good thing to have come up. You want to clear your lungs from this post op bloody stuff as it will keep you from getting pneumonia" When you feel like you want to cough, just grab a pillow and hug it tightly against your bad side and it will cushion the pain."
Kim was finally allowed to come see me about dinner time (fluids for me) and she was really pissed. Somewhere between the waiting room and my room, it seemed that there were some staff members running interference. By rights, there were no adult visiting hours in either the ICU (unless procedures are being done)or the cancer floors. I could see she was upset and I figured, "Kimmy, let's try and do this again tomorrow....go home, eat something real, and you and Bailey crash in the bed...you guys deserve it." She had been waiting to see me for over three hours but was denied for no real reason.
Let's see what Wednesday brings.
Wednesday does bring a much happier Kim, and her sister Terri. It also brings me ICURN Lauren Robbins.
Lauren is in charge here. There is no doubt. Mark and his family, their needs and desires come first. In her late twenties, Lauren is an attractive, strong, and very knowledgeable nurse. She is going to try and get rid of the catheter today, as well as get some solid food. We are also going to get out of this room and walk around. That shoulder is going to get worked out a bit, and she is going to show Kim and Terri how to change and clean the dressings involving my shoulder. She's also going to let Kim do the sponge bath I should have had the previous day. I heard that and the trumpets were sounding. Explaining what "Let the indignities begin" meant just cracked her up.
Not to criticize the other staff members since I got there, it was obvious that Lauren had a lot on the ball. What a difference this made in this room, amongst everyone. The bathing went well, lunch went well, chatting was great. Lauren was leaving at 4pm and I was getting Zach at Midnight, and Donna
during the 3-11. She was delightfully old school and brought that compassion with her. She removed the catheter after dinner and it went very uneventfully and painless...what a gem she was!
Zach was a cool break in care as I have never had a male nurse assigned to me. Lotsa stuff in common and great conversation. Very early Dr. rounds found Dr. Landreneau's Kim and her entourage stopping by to check my chest tube. The volume had dropped to about nothing over the last day or so, so she decided it would mean more comfort for me. I was shocked to see he drop her tunic showing really nice dress clothes much more suited for dinner that making rounds. On went a sterile smock, snap--snap went the rubber gloves and she said "OK Mark, just relax it won't hurt....we'll go on three...take a breath and hold it..One....YANK!" and out it painlessly came!! I laughed so hard thinking of the Danny Glover/Mel Gibson "We'll go on three" running gag.....
She packed the wound, virtually the size of a pencil point and said "How's that feel, better????" "Oh you bet! Thanks so much!" Stripping away the gown she said that she would see if I could get out of the ICU to the regular Med-Surg floor to get ready to go Home!!!
An hour later or so, Zach showed me how the hide away toilet built into the cabinetry. As I stood up, I felt an awful lot of body warmth water flowing all over me from about the waist down. I yelled out to Zach...."Hey Zach, I think my water just broke..." He came in and just started laughing. It seems that I must have hd some trapped liquid in my chest cavity that just came out because of a way I moved. Well, that gallon of nice pink goo saturated my sweatpants, my gown, my under wear, my socks, and anywhere I had come close to on the bed.
At least Zach had a great attitude while we cleaned up the entire room, the patient, and all the clothes. I thought I had seen everything at this point.
I would be wrong.....
Throughout my stay in the ICU an Epiphany came upon me....
An ICU specifically, and hospitals in general, are the last place you want to be in an effort to get rest or to recuperate. It's kind of like being in Las Vegas. No windows, no clocks, no easy ties to the time of day. Well that worked OK for me on Monday and Tuesday when I was in the land of OZ awash in surgical anesthesia/pain killers.
But now, having my vitals taken at 1:30 am followed up by 2-3 tubes of blood at 4am, all the while being offered respiratory mist treatments 5-6 times a day. And we cannot forget the automatic blood pressure cuff that would measure my BP every half hour or so. So this started me into some math....It was starting to look like I was getting about 45 minutes of sleep at a time throughout the night time hours. Daylight hours were tougher to determine with DR, Nurses, Family, therapists, my 5am X Ray technician (actually someone I liked to chat up and was just in general one of those cool people you run into throughout life-----for all I know, he may not have even worked there.)
One of the Drs. this day told me I had a very low grade fever of about 100.5. Blood work showed my red count to be below the 8.5 they wanted and was at 7.7. Neither of these numbers were of great concern but since they followed the placement of that plastic mesh with the radioactive seeds, they would have to watch things.
For now I would be moving back to a regular Med Surg room, most likely this next morning. This day brought back Nurse Lauren, Yea for us! Kim and her got all my gear together, got me into real clothes----you know, we call them lounge wear, I would call them soft sweat pants and shirts, and everyone else in the world would call them PJs. Then I could go to the sink and wash up, brush my teeth, and, Thank God, shave. Turned out it would be early Friday morning as there were no beds available. One more night in the ICU....
It went well until the night coverage RN had to try and take my 4am blood sample. Oh God. How I had come to love all of these wonderful staffers, but this poor women had either forgotten her glasses or just could not see the vein. After her second stick and miss I wanted to just reach down and guide her hand a little to the left to get the vein. She just stopped, loosened the arm wrap and apologized so much I felt bad for her. She was going to call a charge nurse she knew from the next dept as "She was so good at it.
About 10 minutes later I met Charge Nurse Candee Houk. She moved from my right arm to my left arm. "Your veins have just taken a beaten over the past weeks and it's really hard to find a strong one." She did find a "huge" 6-8mm vein on the underside of my forearm. "Most men have these big veins but you don't really see them unless they lift weights" What a relief!
So now it's 5am and we started to chat up a bit and I find out I went to High School with some of her family and that we just lived across town from each other in our hometown of Ellwood City. We shared love of Golden Retrievers and all those things barky and furry. It's amazing how fast friends you can become under such adverse conditions. She said that she would check back with me before I would be moved.
An hour or so later Candee returned to tell me that she had looked over my records and it seemed that all my surgery went really well, all the marginal tissue and whatever came out clean and things looked very good as far as the biopsy reports went. Wow was that great news....
So, very early into our sunrise I was moving up to the regular room. Goodbye to all my ICU friends.
My new room was the one right next door to the one i had stayed in back in July. I had a nice view of the helo-pad and the deer path on the wooded hillside. No more auto BP readings every hour or so, repiration aides dropped visit fro 6 a day to 4 a day. I had my own real bathroom and the ability to really bathe and shave. Things were looking up.
I did notice that my comfort level had gone up without a lot of the bandages, tubes, fittings, catheters, on and on. I do have to admit that my left side was very very sore. The required breathing exercises to make me cough up the sputum and prevent pneumonia were necessary and still unbelieveably painful. The bloodiness was less heavy each time so that was good. Trying to find some comfortable position in the adjustable bed was really hard. I was finding the recliner to be my best bet.
Well, vitals were still being taken, just by hand this time and just at the beginning of the shift.
My 4am blood draw was going to be different though. They wanted me to fill up little bottles about the size of Red Hot sauces. They also needed a pee test and a "sputum" collection.
After thinking this one out, I asked for the IV team to come by and hook up my Power Port on the right side of my chest. For the surgery it could not be used because it was actually part of the sterile field they were operating out of. The IV nurse....another Ellwood City neighbor no less....comes in and has my port hooked up with just the slightest pinch. Looking down at my right arm I see that it was totaly black and blue from my wrist to my elbow. No more....Thank God!
Now my nurse could just come in, load up her couple of tubes, flush the port with some saline/Heparin and be done in two minutes.
My temperature that they were watching seemed to top out at about 101.5 on Thursday, and had been dropping each day about a half degree on average. Saturday morning's Dr. visit might spell my going home..........
So one of Dr, Landereneau's many assistants dropped by around 8am to give me a rundown of where I stood. They were still concerned about a low grade fever that could mean some kind of infections. I knew they were concerned about the radioactive mesh that they had sewn into the place left by the tumor...Oh by the way had I not mentioned it before, the chemo and radiation prior to the surgery going back to August, well it did shrink the tumor by about 60%. down to about 1cm X 2cm, or about the size of your thumbnail or a quarter. Anyhow, introducing any foreign body into your body opens the cahnce for your body rejecting it or an infection arising, and that is what they were worried about. The fever had dropped an average of about .75 degrees to around 100.5 to 100.7, a move in the right direction. My red blood count had also dropped from a good number of 8.5 to a low and some unacceptable 7.5. In my case they would like to see it above 8.0. If it does not rise throughout the day today (Sat), the 4am blood samples may indicate that they would want me to get a unit of red blood. I questioned that as I was told that I may have had to receive (and signed off on a waiver) up to two units of blood during the surgery. The Dr. told me that they decided my blood loss was much less than they though or planned on as I did not have to get that artery involved, moved, bypassed, or so on.
"Welp, I quess that takes care of Saturday's chances of going home...."
"Mark", he said. "we just don't want to send you home with two things borderline, or give an infection a chance to take hold when we can treat it all so much easier throught your IVs." He said if the numbers improved with the IVs overnight or with some added blood. I could still be released Sunday...
I was a little disappointed, but then again I think it was time to be reasonable since only the previous Monday my chest was wide open for the world to see....
I called Kim and gave her the somewhat dissappointing news that came as no surprise to her. I told her to take a break from all of this, drop by her Mom and Dad's with Bailey, let him decompress and frolic with her Dad in their huge acre+ yard, and otherwise burn off some of this tension. Maybe she could bring me some MickeyD's for dinner after 7 or so. She resisted at first but I insisted all the more and I think she found some appeal to it all.
She showed up right about 7pm., food bag in hand, just as they were giving me a respiratory treatment. The IV team then came in to flush my IV port and I was told that I had to go for a chest Xray, then give another blood sample. I saw the tears of frustration building in her eyes and I just pulled her over to my bed and kissed her "You know what honey, I bet Bailey's just beat and could sure use some butt to butt time in bed with you and a bowi of ice cubes..." That got me both a tear and a knowing smile. She hugged me and flipped an unseen glare towards the medical types gathering in the hall at my door. "They're saving me Kim...it's a small price to pay."
As Kim left, my evening nurse, Ranji, a beautiful woman from the far east, Indian or Pakistani, maybe Nepalese heritage came to my bedside and told me that she thought it was rude for these techs to all want to descend on Kim and I without consideration to any of our private time. She said that she thought that a lot of my discomfort came from being overly tired as well. She would check with one of the on call residents to see if she could increase or add something to my 10pm "Medication Time" to help me sleep.
I was so taken by her demeanor and her compassion, all wrapped around so much professionalism. She was so attractive and youthful looking I was hard pressed to think it all came with years of experience, although she could be into her 40's with 20+ years of experience and maturity. I really think it was more cultural and the compassion and work ethic came from that background. In any regards, Ranji, you're Aces in my book...
So the 4am bloodwork came and went, followed by the Stat Angel helicopter stopping by at 5am ensuring I would be getting a bright and cheery outlook on the beautiful Sunday morning. Didn't matter though as I was going to be on my way home. Yea for me!
Dr. Abbas, one of the higher up Drs. looking after me stopped by around 8 am. He said that he was hopeful that they mya be able to send me home today. The temperature issue had pretty much become normal over the past 24 hours. The red blood count number was about 1/2 of 1 point below where they would like to see it. His game plan was this: While he was waiting to see if anything was developing in my cultured samples, he may call for 1 unit of red cells for me to see if that would have me hit the number they were looking at...
I couldn't resist at that point. I had to ask.
"Dr., what would happen to a patient if you took him from the day after lung surgery and allowed him to sleep about 45 mins at a time, say three or four times a day. Interrupt those times with breathing exercises, maybe a trip to xray, and of course take blood 2 to 3 times a day. Continue this for three days and where do you think the patient would be?"
He gave it a thought for a minute or two, kinda smiled, and said "It sounds like something the CIA would do to Terrorists! Actually, there is a term for this, 'institutional anemia' It happens when we take so many tests that the numbers are skewed because of the amount taken for the tests and just how close the numbers are. Here's what we're going to do. No more blood draws today, we'll get you up and moving around. and later today we'll give you a unit of red blood cells and then see where you are with the last draw we'll take. You may still get to go home today but let's make it tomorrow to be sure."
Wow! The testing was causing the numbers to stay in a range where they needed to do more testing. Go figure!
Later tht day, Ranji brought m my little red bag of Vampire's delight! I had pretty nice visit with Kim as we both knew that it was really going to be Monday. She had brought Bailey so I got permission to "escape" the unit and go down to the entrance area and get a big bunch of lucious Golden Retriever fur and kisses. Oh what a glorious bunch of canine love he is.
I got to watch the beginning of the end of the Steeler's Dynasty with the first of three inexplicable losses to Kansas City, then to come Oakland, and worst yet, Cleveland.
Monday was now just hours away!
Monday's bloodwoork came back +.2 above where they wanted it to be. Temperature was normal for the second day in the row. Dr. Abbas told me that I was going to be leaving for sure today sometime after lunch. That led to a tentatively happy phone call to Kim to tell her that they said around lunch, I told her make it more like 2pm and expect 4pm.
Sure enough, after breathing tests, walking tests, lunch, removal of bandages and IVs and the end of classes that would allow my primary nurse to sign off on me, it was just about 4pm before I was leaving.
The trip home in the Toyota Corolla reminded me that post op pain and Pennsylvania potholes were made for each other.
Once home I made it up stairs to see my beautiful bed waiting for me, complete with a heated throw to warm my forever chilled hospital bones, and a great stack of pillows to cushion my damaged left side.
Into my "lounge wear" and into bed I slid. It took me some very tenuous moving around to find a less painful position. Hmmmmmmm maybe those IV pain killers were helping back at the hospital????
And now for Bailey. My "little" 70 lb bundle of blonde fur lept up on my bed and immediately went for the left side of my chest with those paws and all of those kisses. It took Kim and I a good five minutes to get him calmed down to a point where he would be satisfied just making some kind of bodily contact with me.....which ended up being just a rear leg to my right hip. I could pet him, and he could touch me....
The next day had me descovering new depths of soreness, not really pain, but some real intense muscle/bone kind of soreness I had not experienced before. I was doing my part to stick to the pain killers, and supplement them with hot showers for relief. I would find myslf rolled over into a position that I was not able to extract myself from. With an almost panic stricken intensity I found myself yelling for Kim to help pull me up from the pickle I had twisted myself into. The pain was great and it hurt to breathe, and I mean really hurt. As soon as I would change my position the pain would go away almost instantly. I had to find a way to help myself out of these perdictements on my own.
By day three or four I was finding myself getting just a bit winded by the steps or by small tasks. There was no doubt that I had my lungs operated on. Kim and I decided that we were going to go find some kind of recliner for the bedroom to help me past these panic stricken moments. another three or four days till I went in with follow ups with my surgeon, Dr. Landreneau and my Oncologist, Dr. Osborne.