On Friday, Jack had his follow-up appointment with his surgeon, Dr M. In the meantime, Jack has been faithfully taking two walks a day: one in the morning, usually with Stephen, exploring new coffee shops; the second walk in the afternoon after his nap and his wake-up espresso. All the while he's wearing a pedometer, tracking his steps up hill and dale, up and down stairs, in and out of cafes. And he's posting good numbers indeed! The previous Tuesday included his first Warriors game since his surgery, which meant parking in one of the last rows of the parking lot and walking up a seriously long flight of stairs to the entrance of Oracle Arena. He reached 10,000 steps, which is a pretty good haul even for a healthy person!
Meeting with the his nurse practitioner before our consultation with Dr M, I think we surprised her. "You're driving?!!!!"
Ooopsie. I guess most folk wait for the formal blessings from the surgeon before they step behind the wheel. But Jack looks great, his heart sounds great, and is -- for the most part -- off the pain meds. She looks at me. "How's his driving?" Can't lie. Lots of times I'm white-knuckling it. The man drives like a crazed cabbie. But for him that's normal.
Dr M steps in and confirms: Jack looks great, the incisions are healing well. He sounds great, his heart is sounding like it should. All systems go! Dr M's work with him is done. Jack is released to the care of his primary care physician and his cardiologist.
We think Jack looks pretty good, but it was time for a professional opinion.
Jack's three weeks out of surgery. Though he still tires, he's stronger every day. He takes walks twice a day. Hills and long runs of stairs are still challenging and can leave him gasping for a bit. But he recovers quickly and covers up the pause with at thoughtful gaze at the scenery.
Since there's little flat ground in the immediate vicinity of our house, Jack usually has to take a ride out to somewhere with more appropriate terrain for a walk. As I've gone back to work (the experiment of work at home plus caretaking was an epic failure), Jack says that he better understands the plight of dogs left at home while their owners are at work. When I reappear, he's anxious to get out of the house. He's barking, but politely.
Recently Jack's been able to tackle some of the nearby slopes to piece together a good neighborhood walk. It's not as wide ranging as the hikes through the hills he used to do with Ryan, but they get him out and about. I gave him my favorite old pedometer and he's posting some pretty impressive numbers. He's also been posting some pretty impressive naptime. Sleep is one of the best healing tools.
The visit with the cardiologist went well. Though there's still some soreness, the incisions are healing and his heartbeat is strong and regular. He still needs his pain meds, but the interval between doses is lengthening.
I've heard from others who've gone through heart valve surgery that they started feeling better almost immediately after the operation. That really hasn't been the case for Jack. He was active and feeling relatively well prior to surgery, but pre-surgery, his energy was noticeably decreasing and he began experiencing a racing heart more and more frequently which got pretty frightening. He's observed that before surgery he wasn't able to sleep on his left side without his heart starting to feel like it was about to go into overdrive. Now he says he can lie on that side fairly comfortably.
Jack has been occasionally experiencing shadows one eye which had us concerned. But Dr. Gee is suspicious that it's an optical issue since the vision problem is consistently in one eye. Jack hasn't seen an optometrist in many years. It's probably time.
Dr. Gee wasn't quite ready to say that Jack can drive again. Permission to drive, he says, is up to the surgeon. When we got home, we checked some of the surgery papers and found a letter from the surgeon that documented the amount of time off from work he was authorizing. The letter also said that Jack couldn't drive for three weeks -- but it didn't say when that three weeks starts and ends. We decided that a reasonable interpretation was three weeks from surgery.
We've been home for the last few days. Jack's been scaling the stairs pretty well. You wouldn't know from looking at him that he had major surgery a week and change ago.
We've never been very good at it -- being home. And probably a good thing too. Jack's recovery instructions suggest that he should take walks, but avoid hills. We live in the hills. There is about 75 feet of flat sidewalk on our street and that's not enough for a decent stroll. So a couple-three times a day I fold up Mr. Daisy into the back seat of the car and we take off in search of a nice walk. We're rediscovering old neighborhoods we've loved, but we need to be careful about overdoing it. Sunshine, sentimentality and curiosity sometime spur us on a little farther than we should. Luckily we can usually find a café or bakery for a short break, or combine the outing with lunch -- I can't put together a decent lunch at home anyway.
In general, Jack is improving, but mornings have been rough. Typical wisdom would have it that one would feel better in the morning after a good night's rest, but it's been the most difficult time of the day for him. Hopefully this will level off in time.
Because airbag deployment could be really damaging since his wounds haven't yet healed, Jack can't sit in the front seat of the car. He has to sit in the back. Though the passenger seat in my Mini Cooper has a ton of legroom for Jack, the same can't be said for the Mini's back seat. So when we need to go from Point A to Point B, I need to drive what I call Jack' s "old man car", with him tucked away in the back seat. He's trying hard not to be a true back seat driver, but we argue about the radio's volume.
Jack's been doing well with the stairs. I've made sure that there's a strategically placed chair at any stretch stairs that's more than 4 steps. He hasn't needed to rest at the turn but once that I've noticed.
Morning to evening I see him getting stronger. His stride is getting longer, his pace is getting quicker, and his appetite is returning. He still reaches for the pain meds regularly though. I need to remind myself that it hasn't even been a week since his surgery. He's doing really well.
It's recommended that someone is with him for 10 days after surgery. And he can't drive himself for another couple of weeks. I've always said, "Have laptop, can work anywhere, anytime". The digital tether can be a curse -- too easy access tips the work-life balance too far toward work -- but in this case it's a blessing. I can work at home and stay connected to the office and still be available for Jack.
Jack checked out of the hospital a little later than the recommended 11 AM checkout time, but I think everyone needed the extra time.
Jack's brother-in-law Stephen accompanied me on the Jack-repatriation trip. And a handy thing too, as they were able to amuse each other while I dealt with the discharge process, retrieved the take-home meds, and fetched the car. Seemed like lots of folks were checking out. I was double-parked for what seemed like forever waiting for a place in the loading zone.
Kaiser sent us home with practically a grocery-sized goodie-bag. More slipper-socks (I think Jack goes into surgery just to get another pair of those -- and this time he got 2!), miscellaneous toiletries in a hospital-issue kidney shaped dish, breath torture device, and vial after vial of meds. I had to scoot out to get more daily meds boxes just to organize all the pills while we still remembered the instructions, rewriting them into a checklist to make sure we don't miss or overdo anything.
It's hard to tell if Jack's feeling better from the valve repair. Over the last few days I think we were really dealing with all the side-effects of the surgery itself. He's still got pain to manage, and we're monitoring healing of the wounds in his side and at his groin. When he's back in his old activities, he should notice an improvement in his energy and stamina.
Jack's now checked in to Chateau Ritz-Gray/Laws. The accommodations are more spacious, food is better (I'd like to think so at least), but the staff will probably prove to be a bit grumpier.
The smart money says that Jack should be going home on Tuesday.
The Physical Therapist was pleased with Jack's progress. He's been cleared for solo takeoff. Not only does he not need a walker, but he can toddle off on his walking exercise without an escort. I hear that they spent 5 minutes at the stairs. I think that 5 minutes is probably enough time to verify that he still recognizes what stairs are. The PT seemed to be satisfied with Jack's ability to demonstrate that he could climb one flight.
Depending on the results of morning blood tests, Jack could be released Tuesday. The attending physician says that for Jack's procedure, they don't even send out home care nurses to check on the patient. Mostly we'll need to check for signs of infection.
All of the resting places that Jack's been given have their own charms. The window of Jack's ICU room had the occasional hummingbird visiting the plants in the lightwell. Here at 1107, his window looks out at the Geary traffic, a patch of green on a hill called Lafayette Park,and ritzy Presidio Heights beyond. I'm sure the traffic on the busy boulevard below provides the right white noise touch to help sleep. But it's too bad he can't hear the lively music from the Hamilton Memorial Church on the corner. Tomorrow I'm bringing him binoculars so that he can check out the mansions on the hill.
Take away the machinery and the articulated bed, and juge up the decor just a little bit, and Jack's room compares to hotel rooms I've had in New York and London. That probably says more about hotel accomodations in London and New York than it does about private hospital rooms at Kaiser.
Jack's blood pressure is coming up closer to where is should be, and they took out the chest drainage tube this morning. He's been taking his strolls without the help of a walker. After a bit of a rough early morning, he's close to pain-free.
The physical therapist met with him today and says that he gets the stairs tomorrow. Bwa ha ha ....
We're guessing that he may be making his escape on Tuesday. In the meantime, we're looking out at the passing cars, keeping up snarky commentary on the drivers' skills on display.
... but not to the East Side. The nursing wing is actually downstairs and to the north -- "1 North". Yup, after a few false starts, Jack's finally moved out of the ICU.
1107 is in a small group of private rooms right by the nursing station. He's now got a door that closes, a real bathroom, real walls instead of flimsy curtains, and no roommate. The only beeping and gurgling will be from his own machinery. That said, that door is right next to the nursing station, but it's got to be a lot quieter than the ICU. I'm sure the nurses will do their share of poking and prodding at inconvenient times, but Jack will have a better chance at a good night's sleep.
He's still on pain meds. It has been major surgery after all. But I am a bit surprised to hear from Jack that the morphine he's still taking is actually supposed to be a step down from some of the other drugs he's been given. Yikes!
I'm hoping that now that he's moved downstairs, the physical therapists will start torturing him soon. He told me that this morning he did 5 laps around the ICU before I got there. Can he do 5 stair steps? There are 3 stair steps just to get to the bathroom in our bedroom;18 to get to the front door of our house.
He's got a ways to go yet, but he's definitely starting to look more himself. He's still tiring fairly quickly, and I suspect that he was actually glad to see me go today. It was a big day!
I won't say that the party's on in room 1107, but if you're thinking of coming by, the door's open. Just remember that he's still fairly weak and frequently in discomfort. A true stoic Midwesterner, he hides it pretty well. Don't feel like you have to visit. He's truly been touched by all the kind notes and wishes -- they've all meant so much. And he's not at all bored yet. He's enjoying his sleep too much.
When I got to Kaiser today Jack was already sitting up and looking almost normal. They've removed a bunch of the tubes out of his neck and other fun places, so even despite the new oxygen tube he's a lot less Borg-like this morning.
The machines are pretty mysterious. There are lots of them. I have been able to figure out the graph on the monitor that tracks his heartbeat. When he's still, the lines are a steady, regular pattern -- so steady that the cursor just looks like a shadow passing by the screen.
The attending ICU physician says that he's doing well. He would have been transferred out of ICU but there weren't any beds available. Like a fine hotel, checkout's at 11. As soon as a bed's available downstairs, he's outta here -- the ICU, at least.
Whirr, gurgle, drip, beep! Another night in the ICU
Journal posted on February 14, 2014
Jack's blood pressure still too low to transfer him from the ICU. Day shift has ended and the swing shift crew has come in. Can't see that they'd transfer him during the night. Maybe tomorrow.
At least Jack was feeling well enough to take a stroll around the ward after lunch. Next time, Maybe I'll have the presence of mind to count the steps with my Fitbit. But today his stride would be much smaller than mine. Usually he leaves me in the dust with those 7-league boots of his. On this first journey out of his bed, he performed not just one, but two laps around the ICU. Show-off!
When I get in Jack's still in the ICU. He's hooked up to what seems to be a million and one things. Little tubes and stuff coming out of his neck, wrists, fingers and lord knows what else. He looks like a member of the Borg.
He had just gotten a dose of morphine before I got there, and it hadn't quite kicked in yet. This was the first time I'd seen him conscious, and perhaps not the best introduction. Within a few minutes though, he seemed more himself, and I was able to read him messages from his fan base, and articles from the paper.
He has a pillow to help him when he coughs.
He's not yet feeling springy enough to read on his own, so his little iPad will probably be staying with me for a while yet.
His blood pressure is a bit low yet. When it gets into better range, they'll transfer him out of iCU. It is a symphony of sound here with things gurgling and dinging. Those earplugs could prove to be handy later.
He is eating solid food - omelette and fruit for breakfast this morning. No macchiato though.
Despite starting on Jack a couple of hours later than scheduled, the cellphone on the table starts a-vibrating at 1:20. It's the surgery secretary. They can't find you, and Jack's being transferred to the ICU already. I heard that Dr M was fast, but dang!
I scarf down the last of the zazhang, and scoot back to the hospital. When I return the pager to Prissila it's sparkling.
She directs me to the CVICU waiting room and after a time Dr M comes by, gently chiding me a bit for being caught AWOL.
The procedure sent well, he said. They were able to complete the repair as expected, through an incision on Jack's side. Barring any complications, Jack could be out of here in 3 or 4 days. He shouldn't need too much extra care. Hmmmmmm, do they know how many stairs we have in our house?
Jack's nurse came by and brought me in to see him. So many machines! The technology brought to bear on him is pretty stunning.
Lynn is encouraging me to go home. After surgery, patients go in and out of consciousness. It will be 4 or 5 hours before he really comes to. He'll be in the ICU overnight and will likely be transferred to recovery on the 1st floor tomorrow. She can't say when. It depends on when beds are available.
Somehow it seems odd not to stay and be here when he wakes up.
Jack and I got into the hospital early, early, early. A foggy morning 6:30 start but got there even earlier than that. Always amazed that there are people up and functional at these hours.
Jack got poked, prodded and manscaped again. I shuttle from one waiting room to another; from one bedside chair to the next. With Jack sedated and drowsy, Dr Melikian appears and tells me that the surgery should take about 5 hours. It's about 8:40, right about the time they said surgery was scheduled for. I should see Dr M again some time between 1 and 2 PM.
In solidarity with Jack who wasn't allowed any food or water, I've been fasting as well. I'm on the hunt for breakfast. Surgery reception has my cellphone number and has given me a pager because cellular reception is so poor in the hospital. According to the info sheet, the pager isn't supposed to be taken off the hospital grounds. I ignore that and take off for a meal and what turns into a long walk.
Because the waiting room on the surgery floor is small and crowded, there's a secondary "family" waiting room on the 1st floor. When I get back from breakfast at 11, I have it all to myself. It's practically a suite, with its own bathroom and coffee station. I'm there long enough to pour myself a cup of coffee when the phone on the desk in the corner rings. It's Prissilla from surgery. Uh oh, does the pager 'phone home' when it returns and I'm about to get scolded for taking it AWOL? No. Par for the course, Jack's surgery was delayed, and they've just started working on him. They're letting me know that I'll be waiting a bit longer. Things are going fine. No need to rush back from lunch. It will be a while.
That's the news for now. What follows is my therapy - mini travelogue and restaurant review. Hey, who you talkin' to? That's who I am!
On my way to the cafe that I researched, a passing tour bus on Divisidero hints at a Site of Interest that's nearby. I recall seeing on the map Alamo Square nearby. Ah, it's the famous Painted Ladies! Sign of a true local, in my umpty-ump years in the Bay, I've never seen them in the flesh -- only in coffee table books and postcards. I head uphill and there they are, bordering a lovely green park. In a few hours the Victorian sisters will match their portraits, but in this light they look a bit drab. Over their shoulders though, you can see downtown and the Pyramid, where my office is, and I am not.
Breakfast was found in a diner called Eddie's Cafe, a joint calling itself a Soul Food restaurant run by a Korean family. It's a small place, and when I arrive a little after 9 only two tables are occupied, and I'm motioned to a small 2-top instead of my choice of a booth. Really? But by 9:15 all the tables are occupied, and the u-shaped counter is full. The meticulously coiffed Korean ladies "of a certain age" seem a little incongruous with the notion of "Soul Food" (hey though, us Asians do have soul!) Nonetheless, the clientele, ambiance, and food are indeed soulful.
Eddie's is known for their coffee mug collection. No two are alike. As I look around the cafe, I wonder if they purposely select the mug to match the diner, or just grab the nearest one. "Mr. Right" seems to be an appropriate match for the guy of the young couple next to me, and the "Far Side" cartoon mug fit the gentleman of the long-married couple on my other side. Mine is festooned with hearts. Dealt to me because tomorrow is Valentine's Day? A generic woman's cup? Or did they somehow know that I'm waiting for someone in cardiac surgery?
We're now about a day and a half from surgery. Still can't get Jack to slow down. Last night he went straight to bed when he got home from the Warriors game. He was afraid he was starting to catch a cold and he might delay surgery if he got sick. He so wants this over with, and the waiting has been excruciating.
It still seems like there are a million and one things to get done before he takes off. But this isn't just "taking off" -- this is major surgery, dude! If he works any harder, there may not be anything left to operate on! But maybe being caught up in work keeps him from worrying about that major surgery, dude.
I'm hoping to at least get him out of the office early on Wednesday to allow a little separation from the work frenzy. Wish Ryan was home -- a personalized yoga class and some mindless basketball chatter might at least get his mind off work. The Winter Olympics will have to do.
In the meantime, i'm mentally preparing his "Go" bag (thanks for the tips, MikeZ). I added some new apps to his iPad so he'll have his little amusement machine while he's in the hospital.
Pre-op Consultation - It's getting real-er by the minute
Journal posted on February 6, 2014
Jack and I spent the morning following the "treasure map" all over Kaiser hospital, doing all the prepwork by talking to admitting, getting him poked and prodded for labwork, pharmacy, x-ray, and another EKG. And finally we ended up in a very cold office on a rainy day experiencing the personalized What to Expect When You're Getting a Mitral Valve Repair.
His surgery is scheduled for Thursday the 13th at 8:40, which means that we need to show up at 6:30 AM that morning. He'll be expected to be in surgery for 4-6 hours. Typically the repair procedure is a relatively small proportion of the time. Most of the time spent in surgery is preparation -- checking and re-checking the condition of his organs and then putting things back where they found them.
We confirmed that Jack will be having a "port access mitral valve repair". (Sailors, no, there isn't a "starboard access mitral valve repair".) Port access means that they'll go in between a couple of ribs to perform the repair. Assuming things go as planned, this is supposed to be relatively minimally invasive surgery. It is a pretty dang important organ however, so it's still major surgery!
After surgery, he'll be transferred to the CV ICU, and he'll likely stay there overnight. In the CV ICU visits are all of 5 minutes, once an hour.
After the ICU he'll be transferred to a hospital recovery room for 5 to 7 days. The hospital is a concrete behemoth -- not always kind to modern communications technologies. Their IT folk have been able to will the wireless such that it's accessible for most patient rooms. But apparently cellular transmission is pretty unreliable. While he's in the hospital, email and old-school land-line may be the best way to reach Jack. Hospital operators should be standing by and able to literally hook you up.
I took pictures of all the stairs in our house. I'm keeping them to show Jack's physical therapists so that they know what he's coming home to.
Both the nurse practitioner and the anesthesiologist listened to Jack's heart and lungs. The murmur is pretty apparent to the naked stethoscope. Apparently the regurgitation can be pretty easily heard to the point where the anesthesiologist remarked that he was surprised that Jack looked as good as he does. I guess it's about time for that surgery!
Jack's not a high tech kinda guy -- not that blogging is all that high tech -- but it is a means of easily communicating with a number of people. He probably doesn't realize how many people will want to know how he's doing. So I figure I'll start it up and get it going and eventually he'll join in -- or at least make a guest appearance or two. Such is our typical MO.
We're now at Surgery - 10 days or so. Pre-op tests and discussions are in a couple of days. So here's the initial post.
For those that need exact dates and locations, surgery is scheduled for Thursday, Feb 13 (that's right, the day before Valentine's Day) at Kaiser SF.
It's a repair vs a replacement, and the surgery is supposed to be fairly non-invasive, entering through his side rather than full open-heart surgery. They ran what seems to have been an endless battery of tests, checking for other blockages and heart disease. He passed with flying colors. No obvious complications were found. Except for the regurgitation, he's in pretty good health. Folks seem to think he should do well.
All the poking and prodding and waiting have been pretty rough on him and he's been anxious to get this over with. I think he's been way too busy to really think about things and get scared. We'll see he he fares as the time ticks closer.