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

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 28th.  Dr. 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 TPN!  Dad 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.

All my life I have had dreams while I sleep.  Some in color, some in black and white. Sometimes I am flying, others seem to portend events that might come to pass, still others are just fun.  I cannot recall a time when I haven't  dreamt.

On the night of August 1st, in anticipation of being able to return to my home in Los Angeles,  I dreamt of my husband Jon, our baby turtle, the Mighty Z and of his parents, Miss Dale and Stumpy.  To date, it is the last time I have any recollection of dreaming.

My parent's house is not large.  It is an early 1970s Ranch House with three bedrooms.  If you cough in one room, you can be heard throughout the house.  As we had just gotten Dad home from the hospital, I was sleeping with the bedroom open in case there was an emergency.

He was home from the hospital, joking with us and in good spirits.  I thought I was prepared for any emergency.  I was wrong. 

About 5:30 am I woke up.  He was calling for me.  At first I thought it was dream.  I have never been an early riser and  am hardly what anyone would call a morning person.  But that morning, realizing it wasn't a dream, I shot out of bed.

I hurried into my parents room.  My Dad was sitting up in bed, complaining that he felt sick.  I remember asking him where he felt bad. He said he had a lot of blood in his colostomy bag.  I took a look.  Not only was it full of blood but he was still bleeding, badly.  I asked him how long this bleeding had been going on.  He said he wasn't sure.  I looked down in trash can next to his bed and there was a bag filled with blood.  The first thing I thought of was:  This is not good.

I told him we should call 911.  He said no, go get some ziplock bags.  He thought perhaps there was a problem with the colostomy.  I ran to the kitchen and got some gallon size ziplock bags.  We had to drain the colostomy bag before it burst.  It wasn't easy.  The smell alone would do you in.  But, we worked together and got it drained.

By now it  was a little after 6:00 am.  I told him that this was serious and we had to call 911.  By now my Mother was awake and scared.  My dad agreed and I called 911.  I told them that my Dad was bleeding out and to please send an ambulance.  American Medical Response and the EMT Paramedics from the local Fire Station were soon knocking on our door.  They assessed the situation and loaded Dad on a gurney.  I told them that he had just been released from Valley Hospital the evening before.  It was the closest hospital where both his heart doctor and his cardiac doctor had privileges.  We were going back to Valley.

I followed the ambulance to Valley and into the Emergency Room.  Dad is still bleeding out.  I tell them he should still be their system as he was just released the day before.  I give them a quick medical history.  They try to get him stabilized.  I call my niece, Serena and she rushes down to join me.  Thus, begins our crash course in vital signs stabilization. 

They begin to order blood transfusions for my Dad.  As quickly as they put the blood into him, the blood flows out.  His blood pressure is in the 70s and 80s and we learn this is not good.  The ER team continues to try to get him stabilized.  Dad, to his credit, is alert and talking with us.  We hold his hands, try to reassure him and watch as the ER team does their jobs.  The doctors are running tests trying to figure out what is causing the bleed out.  The machine takes his blood pressure every 15 minutes.  We begin to clock our day around those 15 minutes.

I call Jon and tell him I won't be coming home and why.  Twelve hours fly by.  You'd be surprised how quickly time flies in situations like this.  They finally have him stablized and we are waiting for a bed in ICU. 

Finally about 10:00 pm that night, a bed is available in ICU.  We transfer him up there.  They have an air bed for him and try to make him comfortable.  He is hungry and thirsty.  Only able to have ice chips.  The doctors will run a number of tests, I am  told, in the morning to see if they can figure out what happened.

I talk to his nurse, a wonderful woman from the South, who tries to make Dad as comfortable as possible.  I leave the hospital finally around 11:00 pm.  It has been a long day.  I think the worst is over.

I am wrong.  It is only just beginning. 

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:

1. 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.
2. 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.
3. 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.
   
4. 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.
5. 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! 

Limbo.

Dad is slowly oozing away as the blood continues to leave his body.  The nurses continue to give him transfusions and plasma (looks like frozen orange juice) but still the bleeding won't stop and they are all at loss to explain it.

Finally, the radiologists are called in.  This is a special team that specializes at finding bleeds like this.  On Thursday, I sign the consent for the radiologist to go in and try to find the bleed.  We are hopeful.  After all, this is the A-Team. 

They will do an angiogram.  They will inject a "dye" through a thin, flexible tube. It will then be threaded nto the bowel  from an access point.  This "dye",  properly called contrast, will make the bleeder inside the bowel visible on an x-ray.  It is intricate work and with 20 feet of bowel, the odds are not on our side that the bleeder will be seen.

I call down to the hospital late that evening and ask about the results.  They could not find the bleed.

The next day, Friday, Dad is slowing bleeding away.  I call Jon and tell him he should prepare for coming home as I don't know if Dad will make it.

Dr. Ibarheem calls in another radiologist to take another look.  We hold our breath.  He, too, cannot find the bleed.

The blood keeps oozing out but Dad refuses to give up.

We are in limbo not knowing what will happen next . 

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.