Wednesday, February 20, 2013
Sobered and scared is the best way to describe the beginning of my dear husband’s day. This was hard for me because this is not how he has approached surgery in the past. Even though he said he knew everything would be fine, I believe he really knew the seriousness of the proposed procedure he was about to undergo and deep down was not sure what the outcome would be. He talked about his kids, his grandkids and me in a reflective sort of way remembering good times in the past almost as if time had run out and he would no longer make additional memories. I’m thankful God gave me peace and although I was nervous, I never once thought, “what if...”
As we drove down Pima Road making the right hand turn at Thompson Peak and then onto the 101 and Mayo Clinic Hospital, we both had a sense of deja vu. There have been so many other early morning rides to the hospital to have a surgical procedure. But this time was different and we both felt the gravity and weight of his upcoming procedure. Yes, in the past as there is with any surgery, there are the risks, but this time, his heart was going to stop beating while a mere mortal touched that stilled heart and did his work.
At 5:45 AM Andy passed the first registration point in the main lobby and then up to the second floor where he signed in at the surgical waiting area. He was called immediately and was taken back to the pre-operative areas where he was prepped for the upcoming procedure. Medical history was reviewed, consents were signed, IV’s were started, and his chest was scrubbed and shaved. At 6:30 AM daughter Barbara arrived and we were both allowed to go back to his pre-op bay. His shaved chest was a shock to me...not that I didn’t know they would do this, but after 20 plus years, it was strange to me to see him truly bare chested! It was hard for Barbara to see her strong “Poppo” in such a vulnerable state and the tears flowed, BUT she had tissues covered with red hearts and her Dad took her tissue and wiped his own eyes with the “love Kleenex.”
Andy also had a Bair Paws gown on which is a special gown with a forced-air warming system as part of the gown that helps patients avoid hypothermia during surgery. Most surgical patients lose the majority of their body heat during the first hour under anesthesia. This is not good as unintended hypothermia is associated with surgical site infections. Back in the mid-1990’s I used a very antiquated version of this system when I was recovering ambulatory surgical patients.
I was very relieved and happy to see Patti Certified Registered Nurse Anesthetist, who I worked with when I started at Mayo in Ambulatory Surgery in 1996. Under the direction of the anesthesiologist she would be putting Andy to sleep, monitoring him AND waking him up. The anesthesiologist visited and I was reassured when he told me they would be monitoring the oxygen supply to his brain with specialized equipment.
They took Andy to a procedure room where the anesthesiologist placed an arterial line which is a thin catheter inserted into an artery for the purpose of measuring blood pressure real time rather than by intermittent measurement. It is also used to obtain arterial blood gases throughout the surgery and then during the first few days of recovery. A Swan–Ganz catheter was inserted into the subclavian vein, passed through two heart chambers and then into the pulmonary artery for the purpose of measuring heart function during the surgery.
A quick chest x-ray to check placement of the lines was done and then he was ready to be rolled through those doors at the end of the hall with Restricted Area in big, bold letters written above. The time was 8:05 AM. We never know if the simple acts we do each day will be the last time and so as I kissed him and told him I loved him, I couldn’t help but wonder if this would be the last kiss. Patti looked me straight in the eye and told me, “I’ll take good care of him” and I knew she would.
This would NOT be the last kiss and with Patti’s reassurance, Barbara and I left the hospital. Back at home I watched mindless TV, cleaned out a closet, walked around the house aimlessly and did everything except directly think about my husband, but underneath it all were my prayers asking for God’s blessing on the surgical team.
At 12:30 PM Barbara and I were back in the surgical waiting area where now minutes became hours as we waited and waited and waited. At 2:10 PM we were called into a small conference room in the surgical area and Dr. D appeared. He looked tired and I thought this was a good thing. The responsibility of literally holding someone’s heart in your hands should make you tired. Everything went perfectly, his brain was well oxygenated, and once removed from the heart lung bypass machine, his heart re-started on its own and continued to beat in a normal rhythm. Isn’t that just truly amazing that medicine and God’s will allow this to happen?
He was moved from the operating room to his critical care bed where we were told we could see him at 3:00 PM. I was starting to feel a little anxiety when at 4:00 PM we were still waiting to see him. So at 4:40 PM when allowed to enter the critical care area I couldn’t get into his room fast enough. Sure enough, there he was, a little dot on the bed amongst hundreds of wires, cables, tubes, pumps, machines, monitors all flashing and beeping their messages to his nurse Allison who along with Patricia would be at his bedside continuously.
His eyes were closed, the endotracheal tube connected to a ventilator protruded from his mouth as well as a tube through his mouth and into his stomach. He had the Foley catheter in his bladder, three chest tubes draining excess blood and fluid from the cavity where his lungs reside. All of this expected, but yet it all contributed to how small he looked amongst all this technology. When I was a critical care and recovery room nurse for inpatient surgical patients in the early 1970’s, I probably used about one third of the technology now available.
I held his hand and I felt an almost imperceptible squeeze. I told him he was okay, he made it, surgery was over, he was okay, I loved him, he was alright, I loved him, he was okay. I asked him if he was cold as his feet and hands were freezing to my touch and he was able to nod his head yes. Warmed blankets were brought in to cover him. Thank-you Lord for getting him this far.
Then I started looking at all of the lines, the equipment, the drugs, the monitors, and the ventilator that was breathing for him. We were delayed in going back to see him because at one point the ability of his heart to produce strong contractions lessened to the point where he was given serious medication (dobutamine, and epinephrine) to make his heart contractions stronger and more efficient. I could see on the monitor the exact point where the dobutamine had been given and the spike it caused in the strength of his heart contraction. This was all noted because his NURSE was at the bedside constantly monitoring what his heart was doing. Dr. D was there through out because Andy’s NURSE called him and at the same time she had already prepared the necessary medications for infusion and once infused his heart responded immediately. God bless Dr. D, his brilliance, his skilled hands, his judgment, his absolute focus, his obsessiveness with his patients. Because of Dr. D, we can say the operation was a success, but God bless Allison his nurse because she’s the one who can say the operation was a success AND THE PATIENT LIVED.
I talked to the cardiology fellow who would be with Andy through the night and he was very reassuring all was going well. I didn’t know cardiac surgery is such an insult to the body that blood glucose levels and temperature rise during and immediately after the surgery. Andy who is not diabetic and whose fasting blood sugar was 93 (70-100 is normal) prior to surgery had a rise to 200 after surgery. He was on IV insulin with his nurse monitoring and adjusting the rate according to his blood glucose level. His temperature was 100.3, but as Patricia (his 7 PM to 7 AM nurse) told me, this was of no concern and was expected and would go back to normal as he recovered.
Barbara and I went to dinner at Pita Jungle. I had intended to go home after dinner, but decided to go back to see him one more time. He was more awake, nodding his head, sweating because now he was too hot, feeling like he needed to urinate (this is a common sensation with a catheter in the bladder), feeling the irritation of the tube in his throat, wanting to talk but unable to do so because of the endotracheal tube. Think about this folks, Andy unable to talk...
The next hurdle to cross was getting him to breathe well enough on his own, so the mechanical ventilator could be removed. Patricia called me at midnight to tell me he had been extubated (tube removed), was breathing on his own with 4 liters of O2 and maintaining his blood oxygenation at 96%. Once the tube was removed, he responded with his name and date of birth when asked. This is all good, very good.
I am so humbled by the absolutely amazing outpouring of love and support from all of our friends and family. Andy has read every one of the e-mails, cards, text messages and we both are so grateful. I’m especially thankful for the messages that came while he was in surgery. Thank-you seems so inadequate, but believe me; it is very heartfelt from both of us. We are blessed to have so many friends and family who have reached out to us.