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The Unkindest Cut of All: Carotid Artery Surgery

 Myths about Hospitals that we have picked up from the movies:

  1. Hospitals are quiet havens of caring and healing where people speak in hushed tones.  In reality, there are few quiet places in a hospital.
  2. Hospital rooms are spacious enough for your loved one, all the equipment, the doctor and the pack of interns who travel with him and you to sit without being in anyone's way.  In reality, they are more like the stateroom scene in the Marx Brothers' classic, Night at the Opera.
  3. Hospitals have chairs that don't require you being a human pretzel to be comfortable.  If comfortable furniture in a hospital exists, please let me know where!

On July 16th, we returned to Valley Hospital so that Dad could have his carotid arteries cleaned out.  Dr. Holland had determined that both were 95% clogged and once cleaned out, Dad would start to feel better.

Following the instructions that we received from the Hospital, we are there at 10:00 am.  We quickly find out they have no record of Dad coming to the hospital but do have his surgery scheduled.

So, rather than pull up his admitting papers from last week, the young woman opts to start fresh from the beginning.  I'm not joking.  We must have looked quite the sight.  My dad on a gurney on one side of the desk, the admitting officer on the other side of the glass, taking in his information.

The surgery is scheduled for 1:00 pm.  After we get through the admitting process , we head for Pre-Op.  They, unlike Admitting,  are ready for us and get Dad ready for his surgery.   The anesthesiologist comes by.  He and Dad get along and Dad is feeling more relaxed.  My niece, Serena, and my mom, Laura,  come in and we begin the countdown to Surgery.

The plan is to do the left carotid artery today and in a few days, likely Thursday, they will do the right carotid artery and Dad will be home within the week.  That's the plan at least.

The surgery is supposed to take about an hour.  Dr. Holland comes in and reassures us that everything will be fine.  They take Dad off for surgery.  Serena and mom have to go to work.  Someone has to be there in case something goes awry so I go to the waiting room.

The Surgical Waiting Room is filled with people talking on cell phones and watching CNN.  Why do all waiting rooms have a dearth of good magazines to read?  At least the people watching is good.

An hour goes by and still no Dr. Holland.  I begin to feel a tad worried.  Finally, he comes in and tells me that everything went fine but that there was more plaque than the CT Scan had indicated.  He had to make the incision further up my Dad's neck to just behind ear.  He says it will heal and Dad will be just fine.  After recovery, Dad will go to Surgical ICU for the night and be transferred to a new room on the 3rd floor in the morning.  That's the plan at least.

The Surgical ICU is around the corner from the Surgical Waiting Room.  He is resting comfortably when I get there.  His neck looks very swollen.  The nurse, Aimee, tells me that is due to the incision.  The  incision looks scary.  We pack it with ice.  It still looks scary.  Everyone assures us it will look better in a few week.  They are right.

The next day, Dad's neck is the size of a medium balloon.  He can have ice chips but nothing more.  The last time he ate was dinner on Sunday evening.  He is getting hungry.  By Wednesday, they are talking about putting a PICC line so that they can give Dad food intravenously.  Like everything else, it takes time for the order to be processed.

On Thursday morning, they move Dad to the 3rd floor.  There we wait for the PICC line specialist to come and put the line in.  She arrives a little after the lunch hour.  The smell of wafting food, even hospital food, reminds my Dad that he is hungry.  She gets the PICC line in.  Then we have to wait for Radiology to come and take a X-Ray so they can be sure the PICC line is in properly.  Finally about 4:30 pm they confirm that all is good with the PICC line.

How about getting Dad some nourishment?  It has now been almost four days since he had anything to eat.  Well, we have to wait for the Pharmacist to make the TPN (the intravenous food) bag up.  By 7:00, we are still waiting.  Finally, we learn that the TPN bags are delivered about 9:00 pm after the shift change.  I wonder if they would take so long if they had gone 4 DAYS without food or water.

On Friday morning I ask Dad how he likes is "food" and he tells me that he has had better meals including those cooked by my mom. Hee! 

Saturday, July 21st,  passes uneventfully and that evening my mom and I sit down to watch The Godfather Saga.  This is the version that debuted years ago on NBC and puts the story in chronological order.  Despite the commercials, my mom enjoys it.

About 11:45 pm the phone rings.  It is my Dad, calling from the hospital.  He is having chest pains and can't get anyone to respond to his call light.  Will I please call the Nurse's Station and have them send someone in?  I am not making this up. 

I call the hospital, get the Nurse's Station, explain the situation and tell them I am on my way.

When I get there I have to enter from the Emergency side of the building.  This means I have to walk quite a distance to the elevators.  I pass the Telemetry Room.  This room is for monitoring all the Telemetry devices (they monitor patient's heart rates and rhythms) that are hooked up to patients.  My Dad is on one.  There is no one in the room

You would think that given that they monitor important vital signs and are supposed to alert the Nurses Stations in case there is a change, they would use the Buddy System.  That way, one person is there to monitor while the other takes a bathroom break, goes for coffee or to get the paper.  The room is empty.

I get upstairs and they have given Dad some nitro and ordered an EKG.  The nurse apologizes, the charge nurse apologizes, everyone apologizes.  I don't even have to raise my voice.  I just calmly remind them that he is a cardiac patient and this sort of mistake can cost him his life.

By Wednesday, July 25th, the swelling has started to go down. Dad is able to eat on his own and having passed the swallow test, can have liquids on his own.   They schedule the surgery for the right carotid artery for Friday, July 28thDr. Holland is not available.  It is summertime in Las Vegas and those who can go somewhere cooler do.  His associate, Dr. Daugherty, will do the surgery.  All goes well.  This artery, while 95% clogged,  is not as difficult  as the other so the surgery is done in about an hour.

The good news, Dad's neck does not swell up.  No need for TPNDad can eat and drink! Bring on the good food and liquids!

On Monday, July 30th, they tell me that Dad has developed a blood clot in his right arm due to the PICC line.  They tell me it is no big deal, they will put Dad on blood thinners when they send him home in a few days and that will take care of the blood clot. 

They release Dad on Wednesday, August 1st.  While in the hospital, they had him on Coumadin, a strong blood thinner.  They prescribe both Coumadin and Plavix, another blood thinner, for him at home.  We can leave the hospital.

Pat, the Case Worker (not the one from two weeks ago),  arranges for Medi-Car to come and pick my dad up and take him home.  The two girls who show up to get Dad on the gurney are hardly able to handle a 6'1, 225 lb mountain of a man.  But they manage.  They get him home. 

Getting him from the gurney to his wheelchair is a comedy of errors and they nearly drop dad more than once.  Luckily, he has a lot of upper body strength and he manages to overcome their weaknesses.

That evening we sit outside in the cool of the night, watch the dog run around the yard and are grateful to have him home.

If this were a John Ford or an early Sam Peckinpah movie, there would have been storm clouds on the horizon and we would have heard thunder in the distance.  But, this is real life and we are grateful for the tender mercies that we have.

We have no idea that in less than six hours our world will be forever changed and that we are about to experience the most harrowing month of our lives. 

Next Five Things I learned from Healthcare in America, Las Vegas Style:

1.  Everything takes more time than you think it should.  I had no idea that it would take almost 24 hours to get a PICC line ordered, put in, X-Rayed, the TPN ordered and finally have the intravenous food arrive but it did.

2.  A PICC line needs to be flushed any time they use the ports.  This is very important.  The PICC line my dad had had three ports.  One for the continual intravenous food, the other two for blood draws and IVs.  Any time they use those ports, they must be flushed.  Be sure this happens. 

3.  "You are yelling at me and you want my help".  This is probably the most important piece of advice I can stress.  Do not yell unless it is absolutely necessary.  A slow, cold burn is much more effective.  I can not stress this enough.  If they know they screwed up, don't rub it in.  Just let them know, you know they screwed up.

4.  There will be complications that will throw the best plans off schedule.  Be able to roll with it.

5.  The amount of time spent waiting for doctors to come through and give you an update can be numbing.  But it is essential that you establish contact with them and the nurses so that you get the flow of information.  We chose to be there every day waiting for the doctors to come through and give us updates because we felt it was the best way to ensure that Dad was getting the best treatment possible. 

6.  As you will see, the above lesson will come in handy when a medical problem turns into a medical crisis.  Ours will be in lesson in how a medical situation turns into a crisis that almost costs my Dad his life and alters our family forever.  If we can help even one family learn from our journey, we feel some good will come from our experience.

Posted on Sunday, September 30, 2007 at 7:26PM by Registered CommenterLasVegasLynn in | Comments2 Comments

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Reader Comments (2)

I had Carotid Artery surgery 1/13/10 I needed both to be done.1 so they said was something like left side 92% clogged and the right is like 88%. So they Dr. said the left had to be done very soon.I had it done the next day.When the surgery was finished Dr. came in the waiting room and said oh when I went in Artery it was 100% clogged! So he could not do anything about that side. I went through all the test that I was suppose to do. My question is how accurate are theses test I did have the nuclear test.
P.S. my Dr. Is a MAJOR ASS and thinks he is god.
February 10, 2010 | Unregistered CommenterPatty
My father, 81, is scheduled to have this surgery on 7/12. I am scared to death. So afraid he will have a stroke during surgery. Glad to know that your father didn't. Was wondering how he was after surgery. Did it improve his health? Was he able to resume normal activity? At 81 my dad is still very active and is very young for his age. He lives his life, doesn't just exist.
July 2, 2010 | Unregistered CommenterGloria

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