All About Perspective 

Well, my recliner got stolen again! I woke to 5 nurses standing around Amanda. A little PTSD kicked in from yesterday morning’s events. I rubbed my eyes, got my glasses, and saw they were helping her stand up and sit in the recliner. I’ll allow it! I would have gone to bed a little earlier if I’d known they were going to get her out of bed at 5:30 am! That post-midnight bedtime is kicking me right about now. 

While sitting, Amanda’s rate was 105, on her own, no pacing. That didn’t last for long. While I was in the bathroom taking a shower, I heard the nurse call out, “She’s in V-Tach at 160.” It’s a good thing I already had britches on, otherwise someone might have gotten a show, as I quickly popped out of the bathroom! I wondered why there was no rush of people; I had misunderstood. SV Tach is what he said, SVT, a rapid rate out of the upper chamber of the heart. A concern, but not a defibrillator pad ready to shock you, screaming take it off auto, kind of concern. Did I mention PTSD? There was confusion when people did arrive; SVT, AFib, and atrial flutter were all thrown out. They ordered a bag of Amio, the anti-arrhythmic, like last time, and then started a drip and also ran a bag of Mag.

With the shift change done but pre-rounds pending, I had a quick opportunity to grab a coffee. It was the 4th, I guess the coffee shop had banker’s hours and was closed. I went to the cafeteria with little hope the pseudo StarBs would be open; I was right. Being halfway to the parking garage, I figured I would grab a pullover. The thin one I carry in my man satchel wasn’t cutting it. I needed a thick one. When I got to the car, I was like, well, I’m here, it’s not that busy, I’ll drive to the real deal, I hadn’t had our regular honey oatmilk flat white from StarBs since I was up here last time. It was a four-shot morning. I never park in handicap parking unless Amanda is with me, I mean never. I really dislike it when people do that. Confession time, there are a ton of handicap spots, so many that on some floors they are blocking off every other one for extra van space. One of the only hospitals I’ve ever been to that has ample handicap spaces. You think that the one place they have enough spaces is hosptials and clinic. So, yes, I’m that guy who parked in a handicap spot to make it easier to get to and from our big beast and in and out of. Go ahead, call the authorities! Well, maybe not, they already think I’m staff parking in a visitor’s space! On the way back, I saw a care partner from the 7 East, I sitll call it “the floor” like back home, where Amanda was before the transplant. She immediately said How is she? I gave a report, as if I were on rounds, in the elevator lobby.

The cardiologist, the tiny pocket-sized doctor I like, and the ICU attending overlapped doing their pre-rounds. It was pre-pre-rounds then, as they did a differential talking about how when two attending in a patient’s room at the same time meet they’d be having rounds before rounds! Since Amanda was still above 150, they both agreed to run another bag of Amio and continue the drip. The ICU doc mentioned how they could use the pacer to try to get the heart back into a normal rhythm, but he’d rather wait and see. The other ICU doc came by and spoke with me about the rate. He said he was thinking it was because her heart was healing and working better. Thus, not needing as much medication, and maybe some of the meds were the culprit. After the second bolus of Amio was run, her rate dropped to around the 130s. 

A few stacked up for rounds, but the lead, who wrangles everyone, is the PA, and she was running a little late, as they all do. They are also the ones who put in all the orders and order all the meds, per the doctor’s orders during rounds. I went to the door to listen in, but it was water-cooler talk till the PA arrived. I farted around the room and acted like I was on my phone trying not to be the 5th wheel or 11th in this case. My team partner is incapacitated at the moment. When all else fails in a hospital room, you can also look at the monitor to avoid looking suspicious. Then walk really close and stare, total doctor moves right there. I could fake my way on rounds for a while before I was found out not to be a team member!

They are still holding all pain meds because of the lethargy. She’s really not in that bad of pain to only be on Tylenol and lidocaine patches. This has to be the least painful open heart she’s had. That may come to an end when she is more lucid, but I hope not. They decided against the IVIG and will do Thymo or Thymoglobulin, an antirejection medication. 

After rounds, I tried to get Amanda to use her incentive spirometer. She hates those things! It’s a meter that helps you take slow, deep breaths. Which is what Amanda can’t do right now at all. I tried but couldn’t get her to do much or even move the needle. The problem is she’s in pain and can’t breathe deeply because it hurts, but they can’t give her any since she’ll get too lethargic. All of her other numbers look great in terms of the lungs, so no one seems concerned about the high respiratory rate.

She does have some involuntary head movements. It looks like she’s shaking her head no really fast. I can wake her up while it’s happening, and she will look at me, but it still continues. The nurse said she’d seen it on other transplant patients before. She was hurting the move to the chair, and a high rate didn’t help things. They called the PA, but nothing was given. The head movements got worse, and I mentioned it to the nurse, and she did a neuro check, which was fine. She was moving her hands out front and shaking her head while the nurse was in the room. So, she akedv Are you hearing or seeing anything? She said she saw, but I think Amanda confused it with can you see because when I asked her later, she said no.

The ICU doc came in and we spoke a bit about the rate. He was going to try to up the pacemaker to get her out of the funky rate. He turned it up, and the pacer spikes on the EKG line were wild. I’d never seen a pacer fire like that. I got my phone out to take a picture, and he laughed. I told him Amanda used to have a pacemaker, and we had friends with pacers, and they’d want to see that! The picture I got doesn’t do it justice because it was fast firing all the way across, not just a short snap that I got a picture of. I know it won’t mean much to others, but our heart friends or healthcare professionals will enjoy it. The white spikes are the pacemaker firing. It didn’t do the job for Amanda; her rate still stayed the same after. Surprisingly, she felt ok during it, she’s too out of it, I guess. The doc said since they’re not endocardial, inside the heart, leads, she wouldn’t feel it as much; not sure how true that is. The temporary epicardial, outside the heart, leads always freak me out. When she doesn’t need them, they just grab the wires and rip them out. There’s really not much more to it than that, either. It just scares me every time they do it! I asked the doctor if he thought it was a junctional rhythm. He said no, and wanted to know if I was in healthcare. Nope, just Amanda’s healthcare, I said.

The EP, the heart electrician, came by next. The team called in a consultation on the new rate. It was a fellow, barely a real doc yet. She wasn’t as advanced as some fellows. I guess she didn’t even look at Amanda’s chart. She was talking to her like she was a decrepit old grandma. She’s had like six pacemakers, she knows what an electrophysiologist is, I thought when she introduced herself as a heart rhythm doctor. She spoke to us like we were children, really dumbing things down. I asked a few questions, but was annoyed with her quickly and wanted to see the real EP. She thought it was an SVT. I asked about the medication to see if it could have induced it. She said yes, and rejection could as well.

Beverly had planned to come by and wanted to bring me some food. I told her I wasn’t that hungry and asked for a tea. She texted back, “You are GOING to eat,” and sent me a menu for a place. I took the all-caps as a threat and sent her my order. She and her husband, Sam, both came. She also had Amanda’s clothes and my undies, which she’d washed. There can only be two people in at a time, so she came back first. Amanda was happy to see her and talked a little bit. We chatted for a while, and then she swapped out with Sam, and he came back for a bit. She’d only met Sam once on our first trip to Nashville. He walked around when I woke her and said, Hi Sam. I had to think of this name really quickly as I walked to greet them, so cognitively, she’s doing great, since she remembered his name after only one face-to-face meeting. He is actually a physician with Vandrbitl but works at different outlying clinics. So he was familiar with the numbers on the monitor, more than most. He commented on how much more these monitors had than there are in the clinic. He prayed a nice prayer over Amanda and I and then swapped back out with Bev. They were getting Amanda set up to get in the chair, so she didn’t stay long, just goodbyes, and then left.

I hadn’t eaten since Tuesday night at the burger joint, and that’s all I had that day. So, I guess it was time to eat. I joked with Beverly that I’d just tell her I ate even if I didn’t. Later, when I was done, I texted her back a pic of the empty bowls and a salute emoji! She sent back a GIF of Samuel L Jackson from Pulp Fiction that said, “I thought so.” I think I’ll eat if she brings more food again, she low-key scares me! 

They gave premeds, steroids, Benydrl, and something else I can’t remember before they ran the 6-hour bag of Thymo. Not long after the premeds were given, Amanda was out, dug in like a tick. She didn’t want to wake at all, and didn’t wake. It scared me, and when the nurse walked in, I said something. She mentioned the premeds, Amanda is just so sensitive to meds right now. The reintubation really took a toll on her body. I guess it’s just going to take a while to wake up from.

Amanda has been pretty demanding as the evening went on. She was tired after getting back into bed. She had been sleeping and then demanded handholds when she’d wake up. Hitting the rail when I wasn’t paying attention! Her rates went way up after she moved to bed, but eventually leveled out to the 130s, where they’d been staying. I’m praying that the high rate will come down and isn’t rejection, that’s just too scary to think about or write about right now. Just as I was about to push publish for this post, I looked up and the PA was in the room. Then I noticed the pacer box in her hand. Amanda’s rate was in the 80s, back to sinus rhythm, normal again. She bumped the pacer to 100 saying it would help with pressures and we’d reasses in the morning. Answered prayer!

Amanda had my recliner all day, and you know what, my legs haven’t even hurt that bad. I guess it’s all about perspective. I was really mad and sour about the recliner theft the first time, but the second thief is pretty cute, maybe that made a difference! It really is all in the perspective. Amanda and I are polar opposites in so many ways. I don’t stress about big decisions, but I can get road-rage mad at the flip of a switch about traffic on the interstate. We balance each other out well. Yinging and Yanging our way through life together. It’s a good thing, too, because if I had encouragement on I-10, I’d likely run someone off the road every time I drove it! I’m going to bed, friends, the cute recliner there comes like the tooth fairy, early in the morning, but is much louder!