My Dad is dying.
It is Saturday morning, Aug. 11th and the little bleeder that could has become an engine that won't stop. My conversation with Judith, the Charge Nurse, spooks me enough to race to the hospital. Serena meets me there. My Dad's catheter bags are filled with blood. As quickly as they transfuse him with blood, just as quickly it seems to pour out of him.
His nurse, Annabel, answers our questions. Another nurse is pushing us to give Dad some morphine to make him more comfortable. Annabel tells us that morphine will lower his already too-low blood pressure. We are in a race to get his blood pressure up. We say no morphine.
We are scared. Dr. Ibraheem explains how difficult it can be to detect a bleed in the bowel The Radiologist, Dr. Batiste, took his time and tried to find it, to no avail. It must be a tiny, but, potent bleed. We ask what can be done as we realize that he is bleeding out and if the bleed is not slowed or staunched, he will die.
Dr. Ibarheem explains to us about vaso-suppressors. These are strong drugs that will constrict the blood vessels in his legs and feet as the blood is sent to his chest cavity and his blood pressure can stabilize. As my Dad is diabetic, there is a very real likelihood that the vaso-suppressors will damage the circulation in my Dad's feet. We are between a rock and hard place with no real alternative but to make the devil's agreement and concentrate on keeping him alive.
Doctors come through and evaluate him. The Gastro-Intestinal doctor evaluates my Dad. We step out into the hallway, Dr. Ibarheem, the Gastro doctor, Serena and me. The Gastro doctor tells us it looks grim. My Dad is not a candidate for surgery so they can't find the bleed that way. The Gastro doctor tells us he can do nothing more and walks away and out the door of ICU. We turn to Dr. Ibarheem. Without blinking, he calls for a second opinion. Luckily, we never see that particular GI doctor again.
By now, my mom has arrived. Serena's husband, Rob, went to pick her up. She uses one of those small four wheeled carts to help her keep her balance while she walks. She looks at Dad and the shock registers on her face. However, she quickly regains her composure and starts to talk to him.
By now Dad has lost 3,000 cc's of blood in one hour and has had 12 units transfused. Even without medical backgrounds, we realize this is not the norm.
Within 15 minutes, the other Gastro-Intestinal doctor, Dr. Banich, has arrived. While he evaluates Dad, we explain the situation to my mom. If they cannot find the bleed, her husband, of forty-four years, will die.
Dr. Banich comes out and tells us what we already know. Dad is not a candidate for exploratory surgery. We ask what else can be done. He asks if an angiogram has been done. Dr. Ibarheem explains that two have been done with no luck. Dr. Banich says "Do another angiogram". It is our only hope. Before he leaves, he takes me aside. He wants to be sure that I understand what an outside chance it is to find the bleed. I tell him I do but that we have no alternative. I tell him Dad is one tough hombre. He agrees and says that he will keep Dad in his prayers.
Dr. Ibarheem makes the call to the two Radiologists that have performed the angiograms. The first one refuses to do another, quipping "I've been in there, didn't find it, probably won't find it this time". The second one, Dr. Batiste, agrees to assemble his team and give it another go.
The problem: it is Saturday so it will take sometime to assemble his team. We start praying.
I call Jon and tell him that Dad is dying. He asks if he should come. I tell him 'not yet', afraid if I tell him to come, Dad will die. Jon says that Mary and Arlyn from work are praying for Dad and Arlyn has said a rosary. I start to cry. Afterwards, I call a few friends and ask them to pray for Dad.
The vaso-suppressors have helped stabilize his blood pressure and the bleeding has slowed. Annabel explains to us how difficult it is to try to find a bleeding blood vessel or artery in the bowel. We wait for them to come from Radiology. It is the longest afternoon of my life.
Dr. Ibarheem waits with us, checking Dad's vitals every 15 minutes. The ICU staff and nurses, even the people in the hallway and in the waiting area are wishing us luck.
Finally about 4:00, they come from Radiology to take Dad downstairs for his last angiogram. We follow him down, tell him we love him and go to the small, quiet waiting room. Dr. Batiste comes out and tells us that the test will take some time. As he did the angiogram the night before, he feels he knows Dad's insides a little better today and says he will do all he can. We tell him that he is our only hope.
We wait. An original Star Trek episode comes on. The one with John Fiedler. It makes good background noise. Serena, Rob and I talk, we try to take our minds off what seems like the inevitable. Through it all, Dad has not given up. He could have slipped away when so much blood was oozing out of him. But, as we say, he is one tough hombre. We pray he will be one again.
An hour passes and we are still waiting, convincing ourselves that this is a good sign though I don't know that we actually believed it at the time. I turn the channel looking for anything to take my mind off the waiting.
Suddenly, there is Jack Bauer. 24 is Dad's favorite show. He got me hooked on it last season (season 5). Tonight is a rerun of Season 5. There is psycho President Logan, the great Gregory Itzin and his humane wife, Martha (the wondeful Jean Smart) but most of all, there is Jack. I take it as a sign that things might not be so bad. If Jack Bauer is here, surely there is hope.
About 20 minutes later, Dr. Batiste comes out. He looks tired but he tells us he did find the bleed. It was a small bleed as everyone suspected and it was only by luck that he found it. It took 8 coils to cauterize it. He explains that 8 coils are alot. We hug him and thank him with tears streaming down our faces.
He says the team will take Dad back upstairs to ICU. He cautions that Dad has lost a great deal of blood and is not out of the woods by a long stretch. We go back upstairs. Dr. Ibarheem is waiting for us. We hug him and tell him thank you for everything.
I turn the channel to 24. When they wheel Dad back in from Radiology, there is Jack Bauer on screen. Jack becomes my talisman and will, in the weeks ahead, prove to be a worthy one.
By now, Dad is resting comfortably as possible. We have been at the hospital for almost 12 hours and all of us are exhausted. We tell him that we love him and that we will see him in the morning.
As I head back to my mom's house, I stop at the light at Jones and W Charleston Blvd. Our old church, United Methodist has a modern LED/LCD sign. All it says is "Practise Hope".
I burst into tears.
"Is that a man?" asks the young driver
"Yeah, that's a man" Ridley replies
Monday morning after the worst weekend of my life.
Dad is still there and we are still standing. The only thing different is that Dr. Ibarheem is not there. As the day goes on, I realize that he has not come through and ask about him. I am told that Dr. Ahmad, the original primary doctor, is back from vacation so he is taking over.
We will miss Dr. Ibarheem. He was like our guardian angel willing to step out on the limb and do what was necessary to keep Dad alive. He sensed that Dad was a fighter and was not going to let him down. If we had had a doctor that was not willing to go the extra miles that Dr. Ibarheem was willing, Dad would probably not be with us today.
Which makes me think about faith. Many people I know live with faith in their every day lives. Faith was never a big component in our family when I was growing up. Though for a few years we did attend United Methodist Church. When my brother was younger, my family also explored the Church of Latter Day Saints but to say that we are a faith based family would be pushing it.
I found my faith that Saturday afternoon that Dad was bleeding out. Losing 3,000 ccs of blood in one hour will do that. I prayed from the top of my head to my toes. I went to the Quiet Room, what passes for a Chapel at Valley Hospital, and prayed. It was one of the most non-descript rooms I have ever been in. No furniture, the walls were painted white sans one that had a scene of the ocean as if painted from a Greek window sill. Not my idea of a Chapel or a Quiet Room but at that moment it didn't matter.
There I prayed and bargained with God like I have never done before. And there I learned that you do not need to bargain with God. All you need is to believe and pray. I don't know that it was an epiphany but I do know that Dad overcame tremendous odds and remained alive. Many people were praying for him in various cities around the country. They all contributed to Dad beating the odds and the doctors and staff that had written him off hours before.
That Monday morning, his vas cath (dialysis catheter) clogged and they had to put in a new one.
As the week progressed, the various doctors made their rounds each day and each day I was there asking questions about how well he was doing. There was good news and bad news.
The good news, they are able to begin weaning him off the vaso-suppressors.
The bad news, his right foot does not look good. As we were told, the vaso-suppressors constricted the blood vessels in his legs and his feet as they sent all the blood there to his chest cavity to keep him alive. To complicate matters, he is diabetic.
His left leg and foot look alright but his right foot continues to go downhill. We are told they might have to amputate.
On Aug. 15th, he pulls out the PICC Line. Annabel thinks that it was not deliberate but that it causing him to scratch and in his sleep he pulled it out. His oxygen mask is replaced by nose tube. He is alert, asking questions, beginning to remember. He wants an Orange drink, a ginger ale, and a 7-Up. He is thirsty.
I walk in to see two unfamiliar nurses prepping his right arm (the one with the Blood clot). I ask them what they are doing. They tell me they have to put in a new PICC Line. I ask them why they are trying to put it in the right arm. They tell me it is because the previous PICC Line was in his left arm.
I tell them he can't have a PICC Line in his arm because he has a blood clot in it!
The nurse says "What blood clot"
"The one in his right arm".
"What's that from"
"The first PICC line"
"How long ago? A long time?"
"Three weeks ago"
They stop prepping his right arm and move to other side of the bed and begin prepping his left arm. If I had not walked in at that moment, they would have put a PICC line in his right arm. The problem with the blood clot in that arm is that it can break free and move towards to his heart causing him to have stroke. The right arm should not be used for blood pressure readings, IVs, PICC lines or anything that can cause the clot to break free.
Which makes me wonder why people do not read his chart before attempting procedures? But the sad truth is they don't. They are too busy, too many patients to treat, you name it there is a reason. Never mind that it might cause the patient more harm than good.
As the week progresses, we learn that his right foot cannot be saved. The cardiologist, Dr. Holland tells me this on Friday afternoon. I ask what do we do next. He says he will ask Dr. Morris, an orthopedic surgeon, to come take a look but he his almost certain the foot will not able to be saved.
My Dad is sleeping. I cannot tell this wonderful man myself that he will lose his foot. It is one of his worst nightmares come to life. He knows he is diabetic and has had trouble with infections and sores on that foot for years. But every time, he has been able to beat the odds.
Today, his luck runs out in that regard.
Dr. Holland offers to come back in the morning and tell Dad the news. I thank him and tell him we will be here as well.
I go home to tell my mom the bad news.
Things I learned from this:
1) As hard as it is, you have to be there as much as possible.
A) To talk to the doctors and chart your loved one's progress. Leaving notes in the chart for the doctor's to call you
and give you an update is most likely not going to happen in timely manner.
B) You have to be there to make sure that anyone that comes in to do a procedure, change a PICC line, do anything
has a full understanding of your loved one's condition and problems. One wrong move can have catastrophic consequences.
2) Never underestimate the power of prayer and the power of faith. It can provide you with a sense of calm and help
ease the sense of helplessness.
3) Listen closely when they tell you side affects of medication they are giving your loved one. We were prepared for
what the vaso-suppressors could do because Annabel and Dr. Ibarheem took the time to explain it to us. If they
hadn't this next part of our journey would have been much more difficult.
4) Healthcare in America today demands that you be as hands-on in the situation as you can afford to be. Sacrifices
will have to be made if you want to ensure that your loved one is getting the proper care. Having someone there at
their bedside during the day to talk to the doctors is a financial, but necessary sacrifice, because of the information
you learn will help to you to make the tough decisions. It is one that I felt I had to make during all this to help keep Dad alive.
The next morning, Dad is still with us. No late night phone call, no frantic rushing, a peaceful night instead. Today he is doing much better. He is awake, alert and though still fuzzy on some of the details, very aware of what has been going on.
For the first time in a month, we are hopeful. We have been in the same room (the one nearest the automatic door) for almost a month. The nursing staff has all but adopted us, it seems. Now that Dad seems to be doing better we ask if it is possible to move him to another room away from the door. Every time the door opens or closes he wakes him up or commands his attention. There is a room on the other end from where we are. The Charge Nurse, Tessie, and the Nurse Manager, Michelle, both agree it is a good idea. We all wonder why didn't think of it sooner.
He gets set up in his new room. He even comments on how much quieter it is. Go figure. The things you don't necessarily think about when you are surrounded by medical crisises.
On Monday, the doctors start to come through and talk about moving Dad down to MICU, which at Valley Hospital, is considered step down ICU. It is on the third floor. We have been there before after his stent replacement and after his carotid surgeries. The Doctors say if all goes well they should be able to move him by the end of the week.
We finally begin to believe that we have caught that long hoped for break. Dr. Takiyudden, his Kidney doctor, believes that Dad's kidneys will recover. He is the only Kidney doctor willing to say that and we respect him for that.
I call Jon and tell him I am planning on coming home for Labor Day weekend. I haven't been home since my trip home for a weekend in June. I will have to come back right after the holiday because of an event I have at the Las Vegas Springs Preserve but I think I will be home for good right after that.
Life, of course, will have different plans for us. But for now, Dad does get moved to MICU and begins to recover. We say goodbye to the nurses in ICU who have treated us with kindness and who have worked so hard to keep Dad alive. We owe some of them a debt of thanks that we can never repay except with kindness. Dad is awake, alert and talking to us. His memory is still quite foggy but considering all the medication he has been on, we take this in stride.
For a few days, I am able to return home to my husband. The first night home, I sleep with the phone at my side, praying it never rings. I get up in the night and in my grogginess think to myself "Why is it so dark? Where are all the nurses?". It takes me a few minutes to realize that I am home and not in the hospital. I tell Jon about it the next morning and we have a laugh together.
I talk to Mom and Serena and the news is good. If Dad continues to do so well, they will move him to the Harmon Rehab Hospital by the end of the week. There he will get his physical therapy, fitted for his prosthetics and begin his journey to coming home.
We wallow in the good news not realizing that it is too good to be true.