The Knee

Ok, I have a lot of notes from yesterday, but I’m going to hit the high points cause a lot has gone on. A lot happened while Amanda was at dialysis. While I was gone, of course, the orthopedic fellow showed up to aspirate Amanda’s knee and get a sample of the fluid around the joint. Amanda said the pain from the two sticks was excruciating. I’m pretty sure she caused a stir down there, so much so that the neurologist got in trouble with the charge nurse for allowing it! The infectious disease doc showed up down there also. I try to make the most of the dialysis time. I’d prefer the later time because that gives me more time off and allows me to go to bed early. Or the morning if I know about it and don’t show up when she’s headed back!

This time I went to the apartment to get some work done. I got to drill a hole through the wall and vanity cabinet, so that was therapeutic in itself! Story time, even though I may be too much for some of you. I needed a laugh after a tough day yesterday and this provided some comic relief. I couldn’t make this up if I tried; I was routing the line for the dehumidifier drain. I drilled a hole in the dining room wall through the vanity cabinets to the sink drain in the bathroom. I just couldn’t get the PEX drain line to go through the hole on the other side. I tried and tried and was frustrated. Then a song comes on out of nowhere on my phone; This Is for the Lover In You by Shalamar! I just let it play, took my time, and finally got it. It just needed some slow soft music playing, I guess! My setup did turn out professional-looking, and it was nice to have a break to do something normal for once and get a good laugh too! 

We’d been waiting for a Stat CT since the morning, but dialysis took priority. It was a while after she got back before they came to get her. Everyone showed up at once: the ultrasound tech for an echocardiogram, CT transport, and the IV team to place a new IV since she had no access because her last IV had blown. The echo tech wanted to come in and asked the CT transport to wait. I chimed in and told her we’d been waiting all day for the CT and it was stat. The ultrasound machine is mobile and can come back, but the CT is not so much. Turns out the CT transport was early, so they got to do the echo. The IV team was shooed off to come back later since the CT wasn’t with constant, they didn’t need an IV. I got home later than I wanted, but didn’t want to leave Amanda too early with the day we’d just had. I need some sleep, though, I’m running on fumes. At least I am sleeping well in a real bed. I wish we’d gotten a place closer to the hospital, but I had no clue we’d still be in the hospital at nearly 7 weeks out, and I couldn’t find anything close that checked all the boxes and was within our budget.

I needed a coffee this morning and since I was early, I got one from the coffee shop that’s in the small lobby I enter through. I like it better than pseudo StarBs and I’m not as picky as Amanda, so I can settle for their honey oat milk latte. I’ve frequented the place a good bit and would have been more if it were open on the weekends. It’s always the same two girls working there; they swap back and forth between cashier and barista every hour. I ordered my regular. I rarely even have to tell them my order, as the barista grabs the cup, she said, “Extra shot?” I said yes and told her thanks for reminding me. She replied, “You were just testing us!”

An orthopedic doc came by around 6 am. He said preliminary results didn’t necessarily show infection in the knee, but her red cell count was off the roof, and that led them to suspect infection. It likely traveled from another infection, or the blood just dropped something off that made it grow the infection on the replacement. They wanted to wait a few days to see what grows on the cultures, then possibly replace the poly fillers. Amanda was NPO; we figured for the biopsy that they just hadn’t canceled yet. The nurse came in this morning after the shift change and said they are doing the knee surgery after lunch! The ortho fellow followed and just came by to get consent. I grilled him with questions. The transplant team still had to approve, but it seems to be planned for the afternoon. When Amanda had to have the redo on the knee, it was frustrating, but today, having the different type where they can easily swap out the fillers makes this surgery so much less invasive than if she’d still had the traditional replacement. God was working even in that.

The team passed us up this morning, and later, I heard scuttlebutt in the hallway. Their rounding order was off; usually, we are first, but they skipped around today. I recognized McChicken’s voice and heard him say, “Simmons is in dialysis.” I popped my head out and said We’re here. He wanted something written on, so they rounded a few doors down next to some supply chests. I invited myself to join and was asked to join by the pharmacist as I walked up. Not many families join in with the hallway rounds on this floor, but I do! Heck, he invited me to round with them the first time we saw him after I gave a rundown on Amadna’s history.

He got quite talking about the infection, as if I couldn’t hear him, I already invited myself in, no need to whisper, I thought! He spoke a bit about things, thinking of one thing in particular, saying that they could come off one med, usually it wouldn’t be a problem. Then he said she was a problem with the unusual. I rarely say anything besides the occasional correction if needed, but I popped off “She’s a unicorn!” He sighed, hung his head, and said, “I’ve got a lot of unicorns!” He deals with many cases of congenital heart disease outside of his advanced heart failure role. I did end up telling him I called him McChicken, he took it in stride and laughed, saying he’d been called worse and that he liked a McChicken every once in a while!

The big boy ortho came by, it was a lot better talking with him compared to the fellow! He said there’s a 30% chance this won’t work, and they may have to do a complete redo. Also, being the third time going into her knee, they’ll keep her knee straight for two weeks. This is to let the incision heal. Then they’ll let PT start to bend it a little. She will be bearing weight and able to take breaks from the brace to bend it a little for relief. I text out an update to my regulars and said we needed to pray that 30% down. Brittany responded with “We prayed off the trach – I have hope we will get through this too.” Amen sis!

ID was the longest of all the visits with the docs today. After all, we are fighting off an infectious disease, so why wouldn’t their list be lengthy? The culprit is the same as when she had the pneumonia. Like the old cranky uncle you can’t get rid of at reunions or holiday parties, our old friend Pseudomonas is back—likely traveling into the bloodstream via the dialysis catheter, which may need to be removed and redone. Once in the blood, it traveled around like one of our road trips, driving everywhere, even the back roads of the knee replacement, where it found a camping spot. The ID doc didn’t give off a 70% success vibe as the ortho doc did. She seemed worried and not as hopeful that a washout and plastic parts replacement would do the trick. I’m hopeful we can pray a redo away, though. She did a thorough examination of Amanda, checking for any spots with a foreign body in it, her toe with a single tiny screw, her leg where the stent is, but wasn’t too concerned about the recent IVC filter. Next, she checked every joint and asked about any pain anywhere. I liked her thorough approach.

They finally got Amanda and took her down to the general surgery pre-op room. I was able to tag along. It wasn’t a long wait, but they did kill a little time to make sure it was 6 hours since she’d eaten anything since she did take her pills with apple sauce. Then she was off to surgery. I went to grab some lunch from Hop; a burger sounded good. I hadn’t had one in a while. I knew Hana would be bartending; she’s always nice to talk to. She has a mean dog named Happy and a cat named Miller Lite! These are the non-hospital things we talk about when I’m there, besides the front of house, back of house water cooler talk. I’d taken my Mac with me to work on this post and got a little done. Jackson came over to talk, but as he often does, he got hollered at for talking to me too long on the clock. After he clocked out, he talked my ear off for about 45 minutes. So, I didn’t get much typed while after all! The OR nurse was good to call me and update as the surgery went along, from the They’ve started call to the They’re done call, it was only about 45 minutes.

I came back to the room and promptly grabbed my My Pillow, curled up in the recliner, took my glasses off (that means it’s serious nap time), pulled my cap over my eyes, and got a proper nap! It was a while before Amanda showed up, I probably slept about an hour and a half or more. After she heard the transport nurse and me talking, she woke up and was alert but in a fair amount of pain in her knee, but not wincing. I helped the nurse and care partner get her all settled. She has three drain lines out of the knee, a couple of bulb-type suctions, and a small mechanical suction machine that won’t stop beeping. I rummaged through a bag they sent and found the charger cable, which I plugged in. That didn’t fix it, so I got the manual out and started to read why it was beeping. The nurse had never seen one, so I figured I might as well try to figure it out. Amanda is out of it; she needs to take her meds. I’m going to stay till she does, then head out to the apartment.

I made sure the nurse knew she should call the team to get some more pain meds on board, at least something IV, so they can stay on top of it. Once all the sedation and IV pain meds wear off from the recovery area, I imagine it’s going to get bad. The leg needs to stay straight, but I hope they get her up and walking tomorrow. She’s already so weak we don’t need to fall back anymore. The PT on this floor is inadequate if you ask me. After they get her up and I see how they handle the straight leg and all the drains, I’ll be on her case though!