A Tearful Day

I’m sorry that last post was so grim; it was a rough night. I couldn’t have been funny or quippy about anything; I just didn’t have it in me. The wake-up to Amanda choking and vomiting was startling. I just laid in bed and prayed as I saw the nurse trying to help her. They thought it might be constipation since they’d started the feeding tube. I’m not sure she’s been on a feeding tube, but maybe once before. I feel they started it a little too early. She typically won’t eat for days after a surgery. I know some lean toward the idea that you need protein to heal, while others say you should not waste energy on digestion and let your body heal that way. I’m a big fan of fasting, so I lean towards that side; it has worked for her every other surgery she’s had. Is tube feeding worth the nausea and issues? Amanda would tell you no, because she’s done once she vomits. The nausea finally died down, and she got settled. I was feeling rough and a couple of days out on a shower, so I took care of that. After I sat through shift change with the nurses, then went to get a latte. I walked the halls like so many I’ve seen before, beaten and torn down, on my way to get coffee in the neighboring building.

The cardio fellow came in first. He wasn’t much help, and if I were mean, I would have shooed him off! The real, big girl, doc came in, the petite one I like, and was much more helpful. She didn’t know about the rate issues, and when she asked how it was going, I laid it all out. She was still perplexed by the rate, saying she wondered if it was really V tach, since that was uncommon in transplant patients. 

Amanda was almost impossible to wake up, and even harder to get her to follow commands. Then she’d just pop out of it and be awake and squeeze fingers and wiggle toes. The IV pain meds were cut in hopes of getting her extubated. It’s just a crappy spot to be in. She was flailing with her knees up in pain. I mentioned it to the nurse, and she gave her the oral pain meds. Then, about 5 minutes later, the PA came in, and Amanda was unresponsive. Some of her responses came after a question or two, and she was not even given time to wake up. She had a rough night, give her a hot minute, I thought. The PA then wanted to ask why the nurse had given her pain medication. She wanted to know if Amanda asked for it or if she was going on the restlessness. I guess she knew I was questioning her line of questioning. This isn’t my first rodeo; I know when she’s in pain. Plus, the oral med given 5 minutes before the PA walked in, that didn’t zonk her; I didn’t need a degree to know that. It wasn’t the morning to butt heads with me, my triger was pretty touchy.

Rounds followed not long after the PA came by. There was all kinds of talk, well above my head, on the high rate. One said it was a pacemaker issue, another said it was V tach, and then the cardiologist thought it was atrial flutter. None really agreed; the only thing they all agreed on was that they needed an EP, a heart electrician, to consult. They looked over the monitor screenshots and the EKG. He was ok with not treating it like they were planning. It was debatable even when the EP showed up. He mentioned something that the ICU attending rolled his eyes at, and something else the pharmacist rolled her eyes at, too. They looked like they wanted to shoo him off! The heavy diuretics may have also been a cause. She’s been negative 2 liters for a couple of days, peeing out 2 liters more than what she brings in, and she’s still super puffy. Once she’s up, she’ll be devastated by her puffiness; the last transplant she gained nearly 50 pounds of fluid. They stopped the antiarrhythmia drip and lowered the inotropes like dopamine, beginning to wean them off.

The plan was to intubate as soon as she was irritated with the tube. The PA was speaking to her cognitive ability to be awake enough to be in discomfort. I wanted to be smart and say that was two days ago! The vent was turned down, and she was initiating her own breaths with minimal help from the machine. She was getting ready. I was prepping her to be prepared to squeeze fingers and wiggle toes. Telling her she needed to follow their commands if she wanted the tube out. She must have gotten the hint, she squeezed the crap out of my fingers and wiggled her toes for 5 minutes or so!

The ICU doc came in and did an assessment. He wasn’t being deliberate in waking her, but was just being loud. She was delayed in responses, especially on her right side. I mentioned she was following commands from me. He looked at me and asked, ‘Where are you going?” I gave him a firm right here, and he said, “Well, we have family by the bedside to help, let’s extubate.”

After RT pulled the tube and she was out like a light, scarcely out of it. They were trying to get her to stay awake and respond, but she wouldn’t. I tried and could only get her to open her eyes, but she really wasn’t looking at anything. I just kept trying to get her to stay awake, but she wouldn’t. Last transplant, I was only allowed to stay 15 minutes a few times a day. I didn’t ride these rough times out like this. It’s been rough. 

I’ve had to beat a few close friends away from coming. I’m not going anywhere but Amanda’s side (insert the look I gave the ICU doc when he asked where I was going)! Besides that, I don’t want anyone else to see Amanda like this. I know she wouldn’t want that, either. I feel that my job as a husband is to be right here by her side, and nowhere else. Sooner or later, I may need a distraction, I may need to get away, or I may need help to take better care of myself, but now is not the time. I’ve flown solo on these too many times, I’ve got a groove and I’m in it. If I start missing making posts, y’all can send help then! These are therapeutic for me.

She still hasn’t had any pain meds since this morning, and she really doesn’t seem to be uncomfortable. Of course, she is mostly asleep, too. I was working hard to get her to breathe right, saying “slow, deep breath” over and over to her. I was getting scared with her respiration rate close to 30, normal is 12-20. I was shaking her to get her to respond. She would have her eyes open, but was unresponsive. She finally opened them wider and fixed on me. I kept asking her to speak, and she dozed off. Then she would shake her head yes; I kept telling her, ‘Well, then say something,’ but nothing. All of a sudden, she popped her eyes open, focused on me with a half smile, and said, “Hi.” It was all I had not to burst out crying in front of her.

Physical therapy came by with occupational therapy in tow. I wondered what they were going to do; she could barely stay awake! They went over the intake questions with me. After they were done, the PT guy asked, ‘Did your husband get it all right?’ She shook her head yes. When they asked what she did for fun, I left out shopping but mentioned that we traveled and said she also loved her job. He asked what she did, and I told him. He said, ‘Well, that explains,’ and pointed to the TV, which was playing worship music. The OT lady commented on Amanda’s pretty pink nails, and I proudly told her that those were “hospital” nails, which she’d done herself in the hospital. She was talking to Amanda, who wasn’t going to answer anything, asking what kind they were. I told her they gel and that she used to do the dip. She and the PT nearly fell out because I knew the specifics of her nails! 

They started with just getting Amanda to try to wipe her forehead. She needed a lot of help to make that happen. They then took 10 minutes just to get the double chest tube drain buckets, catheter, and all the IV lines moved so that she could sit up. They spun her around and hung her feet off the bed. It got low enough for her feet to touch the ground. She was surprisingly able to hold herself up with the PT’s hand, only there for support. She even got a few leg kicks in, done together, no less. We’re still learning the arms, though. She had an issue with coordination and was unable to move them much at all. After they got her back down, the OT wanted to fix her hair; she was asking for a comb. I was to the rescue with her brush close by in the bathroom. Amanda was getting all the compliments on her nails and hair! She and the OT would probably be friends.

She was still shallow breathing a little; she needed to take deeper breaths. Her first post-extubation blood gases came back good. So, respiratory therapy was okay with things for now. She was super sleepy, though. She, out of the blue, raised her arm to scratch her neck. I asked for a high five and got a baby one. So we were moving in the right direction. She’ll be punching me in no time!

I know I said sorry about the sad post, but my sinuses are killing me from crying today, mainly after what I’m about to tell you here took place. So, y’all can just join in. Amanda had been moving her arms a lot. I was confused about what she was doing. I was thinking she was dreaming. Then I realized it was certain songs. I’m listening to worship music in the background. She was lifting her hands to the songs. Maybe it’s not that, but that’s what I’m choosing to believe. The one I noticed it on was I Speak Jesus.