Blog - Healthcare in America, Las Vegas Style

I had gotten home the night before just before midnight. I had called Jon on the way home to give him an update. My mom and I stayed up for awhile talking. I took a phone to bed with me, thinking I would not need it. Just in case.

The call came at 5:50 am. It was the night time charge nurse. She was calling about my Dad. Something had happened. I was scared he was dead. She said that he had been stable since I had left just after 11:00 pm. That is, until about an hour ago when his blood pressure and heart rate crashed. Was he okay? Yes, he was okay but they had to put him on ventilator.

I woke my mom up and gave her the update, throw some clothes on and head down to the hospital.

He was, in fact, on a ventilator and he was still bleeding. Not nearly as much as yesterday but he was still losing blood. The shift change hadn't happened yet and his nurse said that one minute he was doing fine, waving at her and talking with her. She went to check on another patient and when she got back 15 minutes later he was in duress.

As we wait for the doctors to come through, the two respiratory techs answer our questions about the ventilator. One by one, throughout the day, the doctors come in and evaluate him.

The kidney doctor, Dr. Takiyudden, tells us that Dad's kidneys are in shock due to the blood loss and the fact that donor blood is high in potassium. They will start dialysis in the morning.

The gastro doctor wants to run a series of tests to see if they can pinpoint the bleed.

The respiratory doctor, Dr. Stuart, understands our concerns about the ventilator and wants to ween Dad off as soon as he is stable and ready.

Dad's previous primary doctor is on vacation and we meet Dr. Ibarheem, the doctor who will be the primary doctor for the next ten days.

It's not easy seeing Dad on a ventilator. He can't talk except through eye signals and hand squeezes. He is scared. It is his worst nightmare come to pass.

On Saturday, we think the bleeding has almost stopped. The catheter bag is not filling with any blood. The Dialysis tech comes. Dialysis takes about 3 hours. It is late in the day when we discover a kink in the catheter line. Dad is still bleeding, though it has slowed down considerably from Thursday.

Saturday night, he spits up blood. Serena and I sit with him all night, praying and holding his hands.

The ICU staff is getting to know us, partly because we are there so much. I take the day shift and Serena takes the evening and night shift. She is often there until midnight. We talk to him, explain what is going on, tell him that we love him.

We become familiar with the other families in the ICU. A father and daughter from Australia stop by whenever they are going for coffee or food to see if we need anything. The wife had a heart attack while they were visiting Las Vegas. I refuse to leave because I am afraid I will miss a doctor or something will happen while I take a break. They bring me food and Diet Coke and I am grateful for their kindness.

On Monday, the begin taking x-rays and I begin signing consents for exploratory procedures. Dad, hating the ventilator, takes the situation into his own hands and excubates himself. This is not the usual way to be taken off a ventilator. However, Dad is able to breath on his own and they put an oxygen tube in his nose.

Over the next few days they will do an endoscopy, the longer endoscopy, a colonoscopy and a myriad of x-rays trying to discover where the bleed is coming from. In the process, they discover that Dad has eight, previously undiagnosed, ulcers in his stomach, dueduodum and colon.

But by Wednesday evening, he is still bleeding and they don't know why.

Things I learned:

Ventilators are scary. You are not prepared for the first time you see your loved one hooked up to one. But, DON'T be intimidated by them. Ask the Respiratory techs to explain the numbers so that you can tell how many breaths your loved one is taking vs how many breaths the machine has to give them. This ratio is important. The more breathing your loved one does vs the machine is good.
Get to know the ICU nurses and staff. Get to know the Charge nurses. This is very important. Most work 4 day, twelve hour shifts (with time off for lunch) so the nurse you have, you will likely have for four days at any given time.
Not all nurses are created equal. The sad truth is that in today's modern medicine, not all nurses are there because it is a calling. To some, unfortunately, it is just a profession. For others, they may be having a bad day and their attention may not be on the patient. You need a nurse who knows to leave their private live on the other side of the ICU doors.
Don't be afraid to ask for another nurse. This is very important. If you don't feel the nurse is giving your loved one the care and attention he needs, speak to the Charge Nurse and ask for another nurse. Don't be shy about speaking up. Your loved one's life depends upon it.
Be kind. Say thank-you. Alot. Every time someone comes in take a reading, do an x-ray, whatever, be polite, ask how they are and be sure to say thank you. Courtesy goes along way and you have no idea how long you will be in ICU and dependent upon these people. We had no idea we would be there for a month but we tried to be as polite as possible to everyone.

A note to Charge Nurses, Nurse Managers and Nurses everywhere:

When calling the patient's family:

If our loved one has not died, please lead off the conversation with the fact they are still alive and then proceed to tell us why you are calling. Any call we get from the hospital, our first reaction is Oh my God, he/she's dead! even if we don't say it out loud. You can help everybody's anxiety level by letting us know if they are still with us!