Baby steps

All is good here! Dad's doing really well. He is getting frustrated and irritated, which I take to be a great sign of improvement. It's pretty easy to understand why he's feeling that way:

1. He's had open heart surgery, which multiple sources have informed us "feels like an elephant sat on your chest."

2. He's been stuck lying in a bed for weeks, so he's achy and his muscles are tight and he wants to get up and move around way more than the nurses and doctors will allow.

3. He still has the trach in, which his nurse - who had one in her younger years - called "your best friend and worst enemy." She says it's weirdly uncomfortable, and makes you feel like you have to cough at all times.

4. He can't drink or eat because of the trach. He's getting nutrition and fluid through his G-tube, but still.

5. It's difficult for him to communicate. He can't talk with the trach, unless they put a speaking valve in, which they tried to do yesterday but it was too uncomfortable in his throat. (They'll try again today). We've since discovered that we are all really bad at reading lips. He can write and point to alphabet letters, but his hands are still wobbly and don't always do what he wants them to. (They tell us that this will greatly improve over the next few weeks.)

6. He just wants to go home.

I think it's hard for him to see the amazing improvements that he's making every day: yesterday he could hardly hold the pen, today he could. Two days ago he couldn't make a thumbs-up sign, today he did. And cognitively he really seems to be "all-there." He gets my dumb jokes, he can answer any question the nurses throw at him, his memory is good. He seems like himself. Tempest-tossed, but himself nonetheless.

Well Geez Dad, it's about time!

Dad woke up!

This morning I drove back to Reno. As I was checking into the hotel, I got a phone message from Kathy, which went something like, "Sara, this is Kathleen, I'm on my way up to Tahoe to get Gene's hearing aids and glasses, and I have wonderful news - your dad was awake for a solid hour while I was there this morning! He knew who I was, he wanted to know where he was, and he had so many smiles: when I told him you were on your way, when I told him I loved him, when I told him about all of the people who were asking about him and thinking of him, when I told him that Jana and Brian had been here. He even mouthed the word 'wow.'"

I sprinted up to my room, threw my stuff down, and made a beeline for the hospital. Sure enough, when I walked in, dad gave me a big smile. He grabbed my hand and brought it to his mouth to kiss it. When I told him he was in the hospital, he gave me a "what am I, some kind of idiot?" eye roll. Through an elaborate series of charades (he still has the ventilator going, and speech therapy hasn't yet come to evaluate him and give him a speaking valve, so he can't talk yet) I determined that he: (1) did not want water, (2) wanted his wrist restraints off, (3) was not particularly excited that his birthday was tomorrow, (4) wanted to leave the hospital for a warm sandy beach where one might find tan girls in bikinis, and (4) needed to go to the bathroom and could I get the nurse because he did not need my help with that thankyouverymuch.

I suppose there's more to say, but I'm so happy about this sudden turn of events that I can't really think of anything else. So I'll try to post again later tonight.

And hey, thanks for those positive thoughts, good vibes, prayers, buddhist meditations, wiccan chants, etc. It looks like they're doing the job!

Post-Christmas update

The biggest news is that dad's doctors want to remove all sedation, as they are growing more concerned about dad's neuro status and these tremors he's been having (he'll shake his hand back and forth for a while, then his leg, then his other hand, etc.) The doctors stated that the nurses "won't like it" because dad will probably get really agitated, but they think it's necessary in order to properly assess his neurological condition and determine what's triggering the tremors. They gave him his last dose of sedative at noon today, and Kathy was surprised that dad didn't get as squirrely as she thought he might. He was opening his eyes a lot more throughout the day, but was otherwise unresponsive.

The respiratory therapist turned off dad's ventilator today for the first time and had him do 4 hours of breathing on his own. This is good! Kathy says that he seemed like he was gasping, but the therapist said the issue was that dad was only using his lungs, and neglecting his diaphragm and rib muscles. This is not so good, and is another reason why the doctors really want him off the sedative.

The anti-arrhythmia drugs are no longer being given to him via drip. His heart rhythm seems stable, so they are now only giving him those medications orally, on an as-needed basis.

The results from his ultrasound show that his liver is "fatty" and his gallbladder is "sludgy." I'm assuming this has something to do with the massive amount of meds that have been coursing through his system the last few weeks. The doctors don't seem overly concerned, and think it is likely to resolve itself over time.

Finally, dad had some stitches in his throat that were put in with the trach to hold everything in place. They were able to remove those today.

Jana, Brian, Gina and Ken all left yesterday. I'm so grateful that they were all there while I was. Someone once said, "Grief can't be shared. Everyone carries it alone. His own burden in his own way." While I think that's true to an extent, it makes a HUGE difference to know that there are people around who feel for you and with you, who empathize and understand you, and who can hold down the fort when you just can't deal with reality for that minute/hour/day/week. So - thanks you guys.

(By the way, I am no literary genius - I had to Google that quote to remember it exactly. It was Anne Morrow Lindbergh who said it. And she knew a little something about grief... and resilience.)

Vicki and Frank are now in Reno with Kathy, and I'll be going back on Monday.

I hope everyone had a lovely Christmas!

Christmas Eve

Nothing much new to report. Dad's condition seems to be almost exactly the same: heart rate and blood pressure look good, he's on CPAP on the ventilator (meaning he's initiating his own breaths), but he's still very agitated and unresponsive.

He moves around so much, he's starting to get cuts and bruises on his arms and legs from hitting them against things. And he's looking pretty skinny - he's expending so much energy with his constant motion, yet he's not able to take in that much nutrition through his G-tube.

They're going to take him for an ultrasound some time today - his skin is still yellow and his bilirubin is elevated. So they just want to take another look at his gallbladder and liver.

I've been feeling pretty depressed the last few days. Something about the move to the new facility, the apparent stall in progress, and the approach of Christmas is making me want to crawl into a hole. Tonight we're all (Kathy, Ken, Gina, Jana, Brian, me, Ron, Desmond, Lynne) going out to dinner together at the Circus Circus Steakhouse - I'm hoping that will pull me out of my funk.

Tomorrow morning I'm leaving town, but I'll be back Sunday or Monday. I'll be sure to get daily updates from Kathy and post them here.

Happy Christmas Eve everybody. Hope your hearts are light, your Yule-tide is gay, and your troubles are miles away.

One Old, One New

Gene, 1951

Gene, 2008

A New Home

Yesterday they moved dad to Tahoe Pacific Hospital West. They transferred him by ambulance (and I got to ride along, which was neat). His condition is about the same, and they're just trying to find the right mix of medications to keep him comfortable and keep his blood pressure and heart rate down, while at the same time have him be with-it enough to wean him from the ventilator and be more responsive.

Kathy, Jana and I are now staying at the Circus Circus, which is 2 blocks from this new hospital. It's nice to be back in the real world - if that's what you can call the casino-during-the-holidays crowd. At least it provides some diversion. As in: "Look at that girl! How can she walk in those heels?! Why is there an enormous reproduction of an oil derrick in here - what does that have to do with a circus? Wow, could that guy have doused himself with any more cologne?!" etc. etc.

Back to dad. Here's a nice story: the gentleman currently sharing a room with dad had a very similar cardiac incident, and he was also very agitated and unresponsive for quite a while. But today when I walked into the room he was sitting on the edge of his bed, off ventilator, giving his nurse the A-OK sign. His wife was so happy.

Reason to hope!

Monday Night Notes

The G-tube (feeding tube) seems to be working well, and the trach is really clean and well done, so the nurses tell me.

Dad's been on a lot less sedative today, and he is definitely more agitated. Just tonight he's pulled the IV out of his neck and the ventilator tube out of his trach 3 times! But he also seems more alert, and perhaps a bit more responsive. And that's a good thing. It's just hard to watch him struggle.

His blood pressure's been pretty high this evening, probably due to his agitation. But they're keeping an eye on it and trying to manage it with blood pressure meds, as opposed to just sedating him. Another good thing.

Finally, they are talking about moving dad to Tahoe Pacific Hospital West, an "Acute Care Hospital for the Medically Complex Patient." It's located at St. Mary's hospital in downtown Reno, and after touring it today we think it would probably be a good idea to get him over there ASAP. They specialize in post-surgical care, ventilator weaning, and respiratory management, so it seems like a good fit. He may move as early as tomorrow. I'll keep you posted.

Nothing new to report, so I thought I'd share dad's favorite joke. Prepare yourself.

A guy walks into a saloon and goes up to the bartender and begs him for a free drink as he is so thirsty he can barely stand it. The bartender replies, "I'm sorry sir, but I can't give you a free drink otherwise I'd be giving away drinks to everyone."

The thirsty patron replies, "C'mon, I'm really thirsty, you gotta give me a drink!"

The bartender says, "No, sir, I'm sorry, can't do it."

The thirsty patron spies a spittoon sitting in the corner and says, "Well, how 'bout I take a drink outta that spittoon? Then wouldya gimme a drink?"

The bartender, assuming he's pulling his leg, says, "Yeah, sure buddy, whatever."

So, the thirsty patron walks over to this heavy brass spittoon, hoists it up to his mouth and starts chugging the contents noisily.

Alarmed, the bartender exclaims, "Put that down, that's disgusting!"

The patron continues noisily chugging away. The rest of the patrons start getting sick watching him.

The bartender yells, "Put that down, I'll give you your free drink!"

The patron, struggling to keep holding up the spittoon, continues swallowing.

The bartender, now beside himself, yells, "I'll give you 2 free drinks, for the love of God, just put it down!"

The patron continues chugging away. Finally, he lowers the spittoon to the ground and wipes his mouth off.

The bartender yells at him, "What are you, crazy? Why didn't you stop? I said I was going to give you a free drink!"

And the patron replies: "I couldn't. It was one long string."

Blech. Thanks dad.

Notes from Sunday morning

The surgeon's assistant came by, and Kathy asked her about permanent heart damage - she said they would perform an ultrasound to determine the extent of the damage in 4-6 weeks.

Cardiology says his heart looks good and is pumping strongly -at this stage - for what he's gone through. They are still concerned about his slow digestion and his cognitive function, though Dr. Fuller feels like "everything is moving in the right direction."

Dr. Louie - the neurologist - says he "has a feeling that he's in there," it's just going to take a while.

He's still on sedative - whenever they lower it he gets agitated and restless. He has been opening his eyes a bit more, but still is not responding to commands.

Out of surgery

Dad is out of surgery and resting in his room. Everything went smoothly. He's very calm now, as he's still feeling the effects of the anesthesia, which should start to wear off sometime this evening.

It's really nice to see him with all the tubes out of his mouth! He looks so much more like himself. Hopefully he'll be feeling better too.

Surgery

Dad will be taken down to an operating room any minute now to have the tracheostomy done and feeding tube inserted.

Dr. Linkus is very hopeful that this will make a "big difference." He also said that, after looking over neurology's notes, he feels optimistic about dad's neuro status.

The surgery should take 1-2 hours.

Changing of the guard

Ken G., Kathy's brother, is leaving this morning. He has been wonderful and helpful and steady and just... a rock. I know Kathy is so thankful that he came - and so are the rest of us. Thank you Ken.

Gina and Ken M., Kathy's sister and brother-in-law, arrived last night.

It's such a relief and a comfort to know that we've got support coming in from all sides.

Late Night Edition

Dad's pretty agitated tonight - left to his own devices, I imagine he could wriggle right off the bed. His morphine and sedation have been increased as a result.

We were informed late this evening that dad will indeed be getting a tracheotomy tomorrow, as well as a gastric feeding tube (a feeding tube inserted directly into his stomach via an incision in his abdomen). Currently his ventilator and feeding tube both go through his mouth and down his throat, and they seem to be really bothering him.

The doctor who will be doing it said that he's seen it make a big difference in some patients. Let's hope?

Update

Dr. Linkus, the surgeon, came in and told Kathy that the head CT scan looked good and showed no evidence of bad things (like a stroke). The EEG results are, amazingly, still not back. Or at least no one has told us about them.

Heart rate and blood pressure are looking good. The heart rate jumped up into the low 100s for a while earlier today, but is now stable in the 60s.

Dad's currently on full ventilator support and a medium level of sedation. He seems restful.

His lungs are looking a little funky, and they're thinking he might be getting pneumonia. Not uncommon for someone who's not moving and on a ventilator, but not great news. Depending on tests and tomorrow's chest x-ray, they may soon put him on some antibiotics, and Dr. Linkus thinks this is another good reason to give him a tracheotomy.

Picture from the Carmodys

"Attached is a picture taken at the public works department a year or so ago. After being fortified with a good breakfast, we all dropped in to take care of a billing overcharge which Gene had received. Needless to say, Gene prevailed and no charge was made. Who could win against that calm, assurred, handsome, kind man?"

- Jan & Tom Carmody

Story from Alan

Alan: "Ask him if he remembers when we were kids and pee'd in a bucket instead of going in the house. We put the bucket on a shelf and to make a long story short, it spilled all over me. Gene thought that was very funny............ I didn't................................."

Sara: He definitely remembers this story Alan, as he's told it to all of us many, many times. It cracks him up to this day. Personally, I love imagining two little boys having so much fun playing outside that they would rather pee in a bucket than go indoors. If we remember the story correctly, the bucket had lots and lots and LOTS of pee in it, and had been sitting on that shelf for some time. Dad told us that you "shrieked" when the pee rained down on you - not that I blame you - but it's just like my dad to bring the details to life. ; )

Waiting Game

No news yet from the neurologist - we're still waiting to hear the results of his CT scan and EEG.

The cardiologist is "very, very pleased" with his heart rate and blood pressure stats.

We are continually reminded by nurses and doctors that dad had a very serious, very massive heart attack and that he is still "a very, very sick man" (duh).

He was quite agitated this morning, really squirming, coughing, grimacing and thrashing around. Still not following commands though, so they can't extubate him. So they put him back on full ventilator support and reintroduced some sedation, just to give his heart a rest. They'll try to back those things off again later, and see how he tolerates it.

I told our nurse that I was really concerned about the lack of consciousness/interaction/response/whateveryouwanttocallit, and it was explained to me that, due to the severity of what happened to him, it could possibly take a month or more for him to really start responding and interacting with us, but even given that he could eventually recover full cognitive function. (The nurse mentioned possible hypoxic brain injury, but said people can and do recover from that.) It's exhausting to think that it could take that long, but it gives me some more hope than I had yesterday, when I was feeling really concerned about his lack of with-it-ness.

More later...

Brain scans

The pulmonologist had dad's ventilator turned down to CPAP, meaning he's initiating his own breaths, and just getting a little help from the machine. His sedation has been weaned back completely, but he's still not responsive. He was given an EEG (which measures brain activity) and a head CT this afternoon, and we're just waiting for the results. We might have to wait until tomorrow - if that's the case, it's going to be a long night.

The surgeon

Dr. Linkus, the surgeon, just came by. He says:

Dad's bilirubin is elevated - which is a little curious - it could be from the transfusion of blood products, bleeding during surgery, or it could be a gallbladder issue. They're going to keep an eye on it.

An arrhythmia is pretty common in right ventricular infarction patients; it's controlled right now, and his heart rate and blood pressure look great. Sometimes the arrhythmia can recur a couple of times until the heart becomes less irritated. Rarely, the arrhythmia sticks around, and people have to take meds to keep it under control.

The amount of sedatives in his system is such that he's going to be some sort of sedated for 2 weeks to a month. So we shouldn't necessarily expect the Versed to wear off quickly. However, his neuro status is still a big question; one that can't be answered until he wakes up enough to respond to commands.

The surgeon wants dad off the ventilator soon, even if it means a tracheotomy. The pulmonologists seem more comfortable keeping him on the ventilator for longer, until he is appropriately responsive. I wonder how that's going to play out.

Decreasing the sedation

This morning they started dialing back on the Versed (the sedation). It had been at a 5 ml/hr since Saturday, and now it's at 2. We're hoping this means we'll see him respond to us soon, but he hasn't yet.

They've still got the ventilator going full-blast - our understanding was that they would lower the ventilator assistance as they lowered the sedation, but I guess the pulmonologist has to give that order, and he hasn't yet been by today.

We're all feeling very anxious this morning.

Stable sinus rhythm!

A few hours ago dad's heart rate suddenly plopped down into a normal

sinus rhythm. As Jana and I were talking, we glanced at the monitor

(something we do instinctively every few seconds at this point) and

realized that his heart rate was at 69. This is a good thing, and means

that the Digoxin is doing it's job and dad is responding to the medicine.

As I type, his heart rate is holding steady at 63.

Keep up the good work dad!

2 recent photos from Ken and Gina

Holding Steady

Dad's heart rate is currently stuck on the high side - it should be in the 70-80 range, but it's hovering around 105-120 instead. So they don't want to fiddle with him too much, as changing things can create stress, and stress could further elevate his heart rate.

He is still on the Amiodarone, and they've added Digoxin to try to bring the heart rate down. They've scaled back on the ventilator slightly - it's now doing a bit less work and he's having to do more of his own breathing. Soon they might take his sedation down a bit and see how he tolerates it. I'm really anxious for them to lower the sedation, as we haven't had a chance to interact with him at all, and ever since a nurse mentioned his "unknown neuro status" I've been fretting about it. So let's hope that his heart rate stabilizes soon and they can start decreasing his sedation and ventilator dependence.

Yesterday they told us that they were considering (1) sticking a needle into him to draw off some fluid that had accumulated around his lungs, and (2) giving him a tracheotomy so that he can start moving around but still have ventilator assistance. Today they are telling us that they are not planning to do either of those things, as it would premature at this point, and again, they don't want to do anything to tax his heart and increase his heart rate. So... I suppose that's good?

The last 24 hours have been relatively calm; no major oh-no-that-number-on-the-monitor-is-going-crazy-here-come-the-nurses-rushing-in moments. So we're hoping his body is just trying to come out of the shock of it all and heal itself. We've all had a good night's sleep (finally!), so today feels like a pretty good day. Hoping for more of those.

Pictures, stories, and other incriminating evidence

Do you have a picture of Gene you could pass along? A sordid tale

you'd like to share? I know that lots of you have all sorts of dirt on

dad, so - spill it! Fond remembrances are acceptable too...

though not nearly as fun.

You can e-mail photos, stories, and memories to me at

sarasama@gmail.com. My plan is to show it all to him when he

wakes up, and get the warm fuzzy feelings and laughs going.

Gosh knows we need 'em.

Arrhythmia

Last night and this morning dad had a few episodes of a arrhythmia

(of the atrial tachycardia variety, for anyone who's interested in such

things), due to his "irritable" heart. They've given him Amiodarone -

a medication with some gnarly potential side effects - to help control

it. There isn't really any other choice.

Because of the arrhythmias, they won't scale back the sedation or

ventilator today - they don't want to do that until everything else is

stable. Since he won't be coming off the ventilator today, they are

planning to start tube feeding him so he starts to get some nutrition.

Goodbye to the heart pump

They're about to remove the heart pump, which is a good thing. They don't think he needs it anymore, and once it's out, they can start to think about lowering his sedative and removing the ventilator.

What's Going On (the long version)

Here's what I've been able to put together. If I get something wrong, I'm sure Kathy or Jana will correct me!

On Friday dad had a backache, but he just thought he had slept wrong. On Saturday, his back still hurt in the morning, and in the shower he started experiencing chest pains and shortness of breath. He got out of the shower and Kathy called 911. They instructed her to give him an aspirin, which she did. Paramedics got there quickly and transported him to Barton Memorial, where he was given a "clot buster" and some diagnostic tests that suggested he was having a heart attack. Due to weather they decided to ground-transport him to Renown Medical Center in Reno, which has a "state-of-the-art chest pain center." The paramedics called Kathy as they arrived, and said that they thought the clot-buster was helping, as dad seemed to be feeling better. Dad had been chatting with them about sailboats and the like. Kathy got to talk to him on the phone and said he sounded almost chipper.

Upon arrival at the hospital dad was taken to the cath lab to get a catheter+balloon+stint, as that was all they thought he needed at the time. In the cath lab his blood pressure started to bottom out, and the doctors realized his situation was more critical than previously thought. They had to do immediate open heart surgery, and he received a triple bypass. The vessel leading into his right ventricle was completely blocked, another was 95% blocked.

It was a pretty shocking sight - tubes and wires and machines all over the place. He was heavily sedated, and eventually placed on a paralytic to stop him from moving around too much and taxing his heart. In other words, since surgery he's not been awake or alert, and we've not yet been able to talk with him (we do talk to him though). That night Kathy and I took turns staying with him. They had a hard time keeping him stable - there were 4 or 5 people in his room almost all night long - fiddling with machines, adding meds, checking vitals, etc. At around 5:30 in the morning he received his 4th liter of blood via transfusion and that seemed to finally level out his blood pressure. The frenetic activity in the room went down a few notches, which I took to be a good thing - it meant he was beginning to stabilize.

On Sunday things stayed pretty much the same. Again, a good thing - he was staying more or less stable.

Sunday night they started removing certain medications, as he had stabilized enough to no longer need them. This morning (Monday morning) they took him off the paralytic, and he's started to move and fidget again. He's still heavily sedated, on ventilator and heart pump, but they're hoping to be able to remove those things in the next day or two.

The major concerns at this point are: (1) once removed from the heart pump, will his heart muscle be strong enough to do its job, and (2) will he have any cognitive impairment. We're hoping for the best, and so far, things have gone our way. We should know more in the next few days, and I'll try to post updates here as quickly as possible.

Thanks to everyone for their support and good wishes. And keep 'em coming! They make us feel a whole lot better.

Love,

Sara

What's Going On (the short version)

On Saturday, my dad (I call him dad, some call him Gene, others know him as Leonard) had a heart attack. It started at home in Tahoe, he was taken by ambulance to Barton Memorial, then ground-transported to Renown Medical Center in Reno, where he had an emergency triple-bypass. It's now Monday and he is still in critical condition, but he seems to be moving in the right direction. It's all still very much touch-and-go.

I am here, as well as Ron and Desmond, Kathy, my sister Jana, her son Brian, and Kathy's siblings Ken and Terry. We're holding out hope that everything's going to turn out well.

I don't know when I'll be home - not for another week at least. Ron and Desmond will probably be going home on Wednesday.

I will post updates here as I can, and I'll post the long-version of what happened soon.

Please send positive thoughts, good vibes, prayers, or whatever works for you. We all really appreciate it.

Much love,

Sara