So begins Pride and Prejudice. In the BBC mini-series Lost in Austen, the female lead begins the story with the same phrase…. It is a truth, universally acknowledged…
But, being obsessed with all things P&P, finds herself in what she calls a post-modern moment and in many ways, it disturbs her. She is to try to keep the story going as Austen wrote despite the fact that she seems to have switched places in time with Elizabeth but as herself and her very modern presence sends the various story lines spinning off in unforeseen and unwritten directions. New truths develop.
We’re finding unforeseen circumstances and truths following us on our current journey.
And the last few days, truths have been coming at us a little more strongly than one would like. As Rich and I walk the halls between specialist visits, we overhear the PCA telling a nurse “… but you aren’t going through what SHE is going through. That’s the difference.”
When we’re in these rooms in these halls in this hospital, it’s very easy to forget, or ignore, the journey that others are on. And that their outcomes may be very different from what we are experiencing. Or they are your possible future. The remarks of this one PCA strike home. None of us knows what the other is going through. There are similarities, there are strengths and weaknesses that affect outcomes. There is the way each situation is approached that can impact one’s stay. Or one’s leaving.
The reminder of compassion and patience is one that is needed right now as well.
This is a hospitalization of waiting. While the leads taped to Rich’s chest are gathering data, Rich himself has little to do. As the v-tach leaves no blips of pain, no stumble of the feet, no dizziness in its wake, the wait seems pointless. But it’s necessary. It is a truth. We must have patience. As Rich feels nothing during the v-tach, there is a truth to his health that we have not, til now, acknowledged. There is a danger there. We have to recognize that it exists. Waiting. Lurking.
Day two and our Heart Failure doctor brings us more truths. Entresto, a medication that did not sit well with Rich and stopped after a few days, is to be started again. We’re hesitant. We’re not convinced. And then she hits us with a solid truth. Humor has left her eyes. Those eyes bore into Rich’s. They will not be ignored.
“People DIE from the heart condition you have. They DIE. Not YOU. Not on my watch. We will find a way for this medication and we will find it NOW. Waiting until you return from Ireland is not an option. We can’t wait that long. This is your LIFE.”
She is not to be denied! Her truth, our truth, cannot be denied.
Having had issues with this drug, we uncharacteristically agree to stay overnight so that Rich can be monitored and his reaction gauged so that dosage intervals and the timing of other parts of his CHF cocktails can be modified to bring the best possible optimization of all meds. That is our goal. Once we reach that optimization, Rich will need to be on these doses, yet to be reached, for three months. At that point, more tests, measuring heart function and ejection fraction, will determine if the internal cardiac defibrillator will be needed. For now it is too soon. Despite the v-tach, it is too soon in the process.
That we have chosen to stay rather than self-monitor at home, is unusual for us. The truth is, this medication scares us. The side effects hit Rich hard. They don’t afford good quality of life as they were taken before. Our ability to take this home and travel through it on our own doesn’t sit well with us, though it is offered to us as an option. Our doctors know us well. But we feel this truth that they have so eloquently urged on us… We need to be here now. The timing of when this medication is to be taken and when the others should be dispensed is modified. We need to follow this protocol as much as possible. No longer will Rich be able to tip a handful of meds into his palm and take them en masse. Patience. Your truth now guides this new process… we need to stagger meds and avoid overlap for optimization.
We give in to the sleep that is so needed. But as in all hospitals, the time to wake will come soon. And repeatedly. There is a price to allowing others to carry your burden. It is a price we gladly pay this night. The truth, our truth, is that we gladly hand this burden to those who do have our best interests in mind, although their plan isn’t always what we wished. They don’t know what we are going through, but take on the responsibility so that we can rest. For now.
The morning’s tests and data will give us a new truth. We hope it is one we can swallow!
Every two weeks, Rich visits the office of the heart failure doctor and has blood drawn and vitals taken. The powers that be take the data, swirl it into their magic ball and modify his medications to bring them to where they need to be. Care has to be taken to protect his heart from sudden bursts of meds but at the same time optimize them. Last time we were at this office, the doctor was nearly giddy with Rich’s progress.
And now, three days a week into the month of October, Rich carefully places the color-coded leads, following the diagram posted, that will allow the staff to monitor his heart rate while he follows the protocol that was carefully set up based on his stress test results. The first day he starts by stretching and is immediately asked to stop. It had set his heart to racing. As he continues, he’s advised to add some salt to his diet… his blood pressure is too low. We walk a fine line to find our balance.
Even the days scheduled are carefully calculated: days of rest and days of exercise. The rest is needed. Moving his body for extended periods like this are not easy. Energy can be in short supply.
It is not only the EKG reports that are so carefully checked, stress levels are another part of the equation to find the balance we need. It’s hard to quantify stressors in life and, as is Rich’s way, he uses humor to lighten what stress sometimes falls too hard on his shoulders.
Such has been our pattern since he was released from NSUH in June. Until yesterday. Following a fun weekend upstate with cousins, Rich went to his cardiac rehab, popped on the monitoring leads and began his routine. While on the treadmill, he was asked to stop… he was in v-tach… his heart going out of rhythm. EMS were called and Rich transported to the ER where I met up with him.
Blood work and vitals taken… history told over and over again. And then the waiting began. The plan is to be monitored and data gathered on what his heart was up to. To see how the electrical pulses that make the heart beat are doing. Rich feels none of the changes. The day drags. We’re admitted to a room for the night… monitors and AED pads stuck all over Rich.
The nurses here are concerned with Rich’s blood pressure, the results of his bloodwork and any other number of tests. In some ways we feel like we’re taking a giant step backwards. Meds withheld and additional tests done. The wonderful work of the last two months seems to be suddenly dismantled. We’re disappointed that none of our doctors have stopped by with information.
Based on bits and pieces of conversations in the ER, we’re thinking they are leaning towards the installation of an internal defibrillator. Since Rich doesn’t feel the v-tach happening, it would give us comfort to have that done.
Now we wait for the doctor’s rounds to find out which way the wind blows. If our stay is longer than today, we’re hoping it includes progress forward.
In the meantime, we keep walking the hallways, trying to keep moving while we wait for answers.
On Facebook there is a group of scouters that have wonderful memories of a special Boy Scout camp called Treasure Island. Truly a set of two small islands, situated on the Delaware River, it is indeed a treasure that lives in the hearts of anyone who has camped there. As the home of the Order of the Arrow and amongst the oldest of the scout camps, it was always well steeped in the traditions of summer camps. The dining hall the most quintessential we’ve ever been in. On the wall there was a brass marker showing the height of the water level during a flood. We first went there as leaders from Carle Place Troop 305 in the summer of 2004. Rich had just completed six cycles of RCHOP…. our experience with cancer our first time around. He had mourned during that time the trips and events he was unable as Scoutmaster to attend. We were thrilled to once again be sleeping out of doors. This camp revitalized Rich and confirmed the healing taking place.
TI abandoned. Too many times has the Delaware risen to flood the buildings and grounds. The financial decision by the council was to close it down. Also found on this fb page if you search back, are photos of times past… a camp filled with boys from all over the country, counselors from all over the world. But lately and sadly, the true present. Abandoned.
This past weekend, a group of scouters made their way to TI. The new series of photos being posted are now of the result of a weekend of what the OA calls “Cheerful Service.” One by one, the buildings are being cleaned of the detritus of what was left behind and what nature brought in. Trails are being cleared. A rebirth.
His numbers are all improving, and like TI, Rich is once again being reborn. The swan catheter in his neck is removed. IV fluids are stopped. All meds are by mouth. We’re moved to the step-down unit. We walk the halls, each lap trying for better speed.
Like TI, we’re ready to be what we once were; perhaps with a few slight changes. There is always a time in the hospital when everything is done that can be done. You’re too well to be there any longer. Everyone admits you look great. Your numbers are great. But always doctors prefer that one more day to make sure, to be certain. You fight against it. An internal switch is flipped and it’s time to go home. You’re no longer content to be here. The next few hours will confirm for us which way the doctors will decide.
We have been walking the halls, proving our fitness. We find that may have become a problem. Rich challenges himself to walk a quick pace. He does well and his breathing keeps up with him. The walking does raise his heart rate… will this be problematic for our release? The ups and downs and questions continue. A new med was added last night. We hope the monitoring this morning will be enough. Before we can get ourselves nervous, the nurse stops to ask about inhalers and nebulizers. They still appear in the computer but the truth is, Rich hasn’t used them since his first full day in the hospital. These are now in our past. We need to remember how many answers we’ve gotten and much improvement has been had since we were admitted here… in truth since this past March. The final piece of the four-year puzzle of continued health issues seems to be in place now. And that is something to celebrate. Adventures await!
To get to TI itself was an adventure. Along a roadside was a small clearing with a sign announcing the camp. All our gear would need to be humped down the embankment’s steps. There we’d load it, and ourselves, into the waiting flat bottom barge boats that would take us to the island. Once across, we would hump ourselves and our gear up to our home for the next week. Magical from start to finish.
In 2007, after another flood, our troop spent a week again at TI. Then it was a mere shell of its former self. The following year was the final summer camp season. The property has now been sold and will be turned into a family camp. Scout volunteers work to keep the buildings in a condition that may allow them to be used once again. One day we hope to cross that river in those flat bottom barges as we did before and enjoy its new incarnation.
Of the TI camp song, our favorite verse was the second:
We have known the woods that grace thee, Trace thy meadows o’er. Learned the flowers that bloom upon thee, Watched the birds that soar. Often have thy waters blessed us, Off the sun’s bright smile, Brought the touch of health and gladness, Dear Ole Treasure Isle
But for now, in a little more than a month, we expect Rich to pack light and pack smart and travel upstate to spend a few days Cub Scout camping with our oldest grandson. There won’t be the uniqueness of a camp straddling two states in the middle of a river, but it will still be magical.
When we were pregnant with our third child, we were told to attend a refresher Lamaze class as ten years had passed since our last pregnancy. Figuring a free tote bag and some diaper coupons would be worth it, we dutifully went. In the middle of the class, the nurse leading the group told us about a new doctor in the practice. Fresh off the obstetrics assembly line, no one wanted to give birth on his watch. They encouraged us, however, to make at least one appointment with him as we neared our respective due dates. Meet the man in case he is on duty when your water breaks.
We did and as we walked out of the office, we said to each other, if this was our first pregnancy, we’d be scared shitless! This guy gave us every worst-case scenario, told us to get every test in the book. He had new knowledge and he wanted to share it…he couldn’t help but share it. By the time we left, there was the potential for a real freak-out. He led with disaster.
As fate would have it, he was the doctor in the practice that was on call and ultimately, the guy we were glad to have by our side when an emergency c-section was needed. His gentle yet sure manner was a perfect counterpoint to this new development.
Today we have seen more specialists and had more procedures than one would think possible in one day.
After a full afternoon of waiting for the angiogram to be done Wednesday, it was finally our turn. The expectation the doctors (and we) had was that the pesky left bundle branch blockage would show to be a pesky nuisance, the root of all discomfort. They’d clear up the blockage, pop a stent in place, and voila! Our ejection fraction would adjust itself from its normal 40-45% from the early chemo days to a healthy and normal 65% and we’d be running marathons in no time, despite the fact that we don’t run marathons.
We do, however, have one of Rich’s original goals in place… we’ve booked a trip to Ireland in September. In three short months we’d be, with friends, experiencing the often wild and awe-inspiring island country from top to bottom and round again. Waterfalls, rivers, mountains, ocean cliffs, ancient ruins, pubs, villages… the stuff of literature and dreams. With Arlene and Kevin doing the driving and, as before, our support and companions, we’d see our goal come to life. We find we’re telling everyone so they understand our personal goals… This little tune up of ours, is merely a tune up to complete our preparations before we’re flying off to the land of my fore-father’s birth. And one of Rich’s dreams. Will the results of this hospitalization affect those plans?
Rich came out of that operating room and, test not quite complete, we’re admitted for a stay in the cardiac unit. Our tune up is not so quickly done. Rich’s heart has had since March a mere 15-20% ejection fraction. Time has not improved it. There is fluid in the pericardium which is the congestive heart failure that was suspected. But not only the left side of his heart is weakened. The doctors are dismayed to find the right side is weakened as well. The low blood pressures he has been experiencing, this angiogram and the tests that are to come will show that heart failure is the right description of what he has been experiencing. His blood hasn’t got the oomph to make the circulation effective… the pump is broken. Our own cardio doctor is recommending that we be seen here by the cardiomyopathy group.
Rich has been given a double dose of Lasix and admitted to the cardiac ICU floor; the CCU. Once more, he in a hospital bed, me in the standard vinyl recliner, and we settle in for the night, looking forward to the morning rounds where we’ll get some answers. As always when in crisis, we’re glad to be where we are.
One of our first doctors to stop in is from the cardiomyopathy group. She gives us a brief rundown on Rich’s condition and how it applies to her specialty. She applauds and approves the ketogenic way of eating we do. She will stop in later in the day.
When we do see her again, her demeanor has changed. She begins discussing what our options for treatment will be for the heart failure Rich is experiencing. Her opening is about heart transplants. Wait, what?! We went from expecting a quick stent procedure to ripping out his heart? She discusses the benefits of having the transplant assessment done in conjunction with the other evaluative testing Rich is undergoing in order to have that all in place.
While it makes a certain sense, it reminds us of that obstetrician 26 years ago who felt the need to give us all the doomsday possibilities, so eager was he to impart his new-found knowledge. Instead here we are listening to grant money, no cost to us thanks to a grant and adding to the growing prestige of the heart program in this hospital. Wow, we hit the jackpot! She ends with “but of course, our goal is to leave you with the heart you were born with and find other solutions first.” Alrighty then. Better. Because a groupon for a transplant is just too bizarre.
We listen to the rest of the options including a heart pump which would entail another four week hospital stay or simple medications… the last being the treatment of choice. Visions of Ireland begin to fade.
In between that first and second conversation are the tests, procedures and consults. His ejection fraction still at 15% is confirmed. Next, they stop his current heart meds and begin with Milrinone which is to help the contractions of his heart so the flow of blood will be stronger. After a few hours to let the meds begin to do their work, they feed a swan catheter into the artery in his neck. They will use this, while it is all hooked up to a monitor, to measure his heart output or how well the pumping action is improving. Improvement being our person preference! Twice they try and fail. His room, set up as a sterile operating room, looks like a crime scene. It’s decided that they will go to the cath lab to use some radiography to guide them along. Turns out some scar tissue from his chemo port needed to be cleaned up and then they were set. We thought what he was getting would look similar to the triple lumen that was used in the stem cell unit. Discreet. What he now sports looks like an array of medals on epaulets; his shoulders dripping with access points off a slew of IV tubing. And the catheter’s end, coming out of his neck, forms a swan neck type curve and connects to all these medals of honor.
There are x-rays, sonograms, attempts to insert an A (arterial) line in Rich’s arms for additional monitoring. His veins are too compromised due to his condition. The odds are they will plump up when the pulses are improved. It’s decided to wait 24 hours and try again.
With all the invasive procedures and contrasts used for helping us to find answers, as well as mentally processing the unexpected diagnoses and possible treatments, the night is uncomfortable on a number of levels. Sleep eludes us. But there are signs that these new meds are working. Belly bloat way down and breathing eased. It’s a busy night and we hope we’ll have time for rest in the coming day.
The good news comes early in the cardiac care unit. An x-ray is needed daily to check the placement of the catheter. The readings that are coming from the monitor hooked up to the swan catheter are more than we could have hoped for. The Milrinone is helping Rich’s heart and besides the expected changes that will bring, we’re thrilled that his oxygen levels, which had been anywhere from 80 to 100 are found to be a full on 100% O2 saturation without any supplemental oxygen. This truly proves that so much of what our pulmo doctors have suspected.
Finally, the daily weigh-in. In 48 hours, Rich has lost twenty pounds of water weight. The fluid around the heart in the pericardium and in his belly is lessened. Hydralazine is added to help open the veins to let the improved output flow.
The downside to these meds are that they give his creatinine levels a slight rise. All tests have shown that his kidneys are clear of any issues other than damage that is also chemo induced. Our nephrologist feels that the steady elevated numbers have been stable since his cancer treatment so our patient’s higher than the norm numbers is something we’ll monitor but will not interfere with. This added blip from the new meds is explained by her in a way that proves her compassion. “Our main concern is Rich’s cardiac health and his personal well-being. If his comfort and daily life as well as his cardiac health needs these medications, we can be comfortable with this new number for his kidneys.”
It’s also felt that, like his pulmo function, his kidney function will ultimately head in a healing direction and thus better numbers as his cardiac function improves. That this doctor is looking at the whole picture of living life confirms so much for us. This team of caring health professionals have blessed us with their knowledge and persistence.
The plan now is to tweak medications to optimum levels, currently adding in and create the balance Rich needs. Once those are set up using IV infusions, we’ll then transition to oral meds for home use. Making sure heart and lung function maintain improvement and reach the goals we need to go home is the next step. Monitoring and less and less invasively through the weekend, we expect optimistically to be here til mid-week.
Lastly, our cardiomyopathy doctor, the one with the heart transplant conversation stops by again. She’s thrilled with the turn-around that has occurred. Before she leaves, she enthusiastically said “Remember that horror we talked about yesterday? Forget it. Forget it all. Those needs are good and gone!”
The rain has ended and the night is quiet. The sound of the soft breeze in the leaves of the birch is the only accompaniment outside. Our windows are open.
We are once again sleeping in the little bedroom on the first floor. Stairs are near to impossible and small tasks leave Rich gasping. Oxygen levels are all over the place. Balance is a thing of the past. Thankfully, infections are not with us this night. But breathing is shallow, difficult, and noisy.
Rich attempts sleep in his recliner; laying flat it’s impossible to breathe. As the night moves on, the recliner isn’t working any longer. His breathing is labored. The night sounds are no longer quiet although his usual snoring doesn’t exist. Once again, doses are checked, timing discussed and more medications are considered. Days and nights are upside down. We settle into that now familiar routine. As Tolkien’s quote that gives a title to this post, we’re in the shadows.
Since Rich was discharged in March, we experienced a brief and very slight uptick and then a steady downhill trend.
We met with our specialists shortly after we left NSUH as the discharge instructions required. An additional follow-up with our immune doctor shows that Rich’s body does produce new B cells… however they don’t mature which means they do not protect him from infections as they should. They do not produce the antibodies needed. Immunotherapy is suggested since his infusions in the hospital have protected him well. But we do need to also take into consideration the side effects that concerned our stem cell guru when she discussed immunotherapy as a possibility with us in March while Rich and I strolled the hallways on 7 Monti.
As the kidneys are most affected, we’ve added a nephrologist to the specialist mix. Creatinine level has shown to be elevated throughout our journey but with some thorough research on the doctor’s part, it’s concluded that the elevated number has been for the most part stable since his stem cell transplant. Probably a new normal from the intense chemo. We have a renal ultrasound scheduled to document and confirm no other issues, but are otherwise approved for immunotherapy and ketamine treatments as long as the dosages remain as they were before.
And here we are. Most answers are as we have hoped them to be or what we expected. And yet the breathing issues remain and continue their slow but steady downward trend. Our cardiologist had advised us to see him three months post hospitalization to give what he called the insult, the injury, time to heal. In two weeks we’re scheduled to see him. But our concerns peak and we contact him to let him know where we are.
Again, we are blessed with the health team we have. They listen and understand our concerns. This doctor, our cardio guru, understood our fears four years ago when we first went to see him. Our oncologist recommended we see a cardiologist given the doses of chemo Rich had his first go-around in 2004, particularly since the MUGA scan showed some areas of abnormality that were not there in 2003 as part of that pre-chemo testing. When our guru told us in 2014 that we should consider an angiogram, we asked if we could refuse. Rich had been through so much with bone marrow biopsies and radioactive goop and port installations… the invasions to his body went on and on. At that point, to consider an allowing a catheter to be threaded from his groin to his heart was the tipping point for him. Our cardio doctor agreed it didn’t have to happen. He would get EKG records from our GP, and we’d come in for the followup tests between each cycle. We could get by that way. We were relieved.
Four years have passed and thanks to the doctor’s diligence, we’ve been able to avoid the cardio catheterization. But now it’s recommended once more. This time without hesitation we say yes. We need these answers. Our doctor explained that this will allow him to fully see the function of Rich’s heart, arteries and veins, as well as take a look at his lungs and how they are interacting with the heart. Answers. It will give us the answers he needs to diagnose any heart disease instead of the “probably” we have now. Therapy, meds and lifestyle changes will be clear. We agree. The time has come. Let’s fix this!
It has been a long week waiting for the insurance approval. On June 6th, instead of the cardio rehab we had been scheduled for, we’ll be at NSUH for the angiogram and the answers we seek. In the meantime, I watch this very odd rhythm…the rise and fall of his chest with a hiccup in between … and I know that watching is not as difficult as this breathing is to him, but it feels awfully close.
We look forward to those answers, we look forward to the solutions, we look forward to us both being able to take a deep breath and the night sounds to once more be just the night. With Rich’s snoring… ya know… normal.
In the month since Rich’s hospital discharge, we’ve met again with all our specialists; this time in an outpatient setting. The appointments set up prior to our trip to the ER …set up by chance… become perfectly aligned for follow-up. One by one, each one gives us their opinion on where we are and what direction we should go.
First up is our PET/CT scan. Once more Rich is drinking radioactive goop and getting injected with a lead protected syringe that is delivered in a lead box. Biohazards galore. We’re thankful that this test has been approved. For the first fourteen years living with cancer, our insurance has never denied a single test or procedure. Then last year we were thrown for a loop… No PET scan. We were informed that, despite a peer-to-peer review with our stem cell guru, Rich was eligible for a CT scan only. The near to continuous pneumonia bouts that have been our life since the holidays four months ago is the blessing that has brought this change. It is only a few days after coming home from the latest stay in the hospital hospital that we have the PET/CT scan. It is sure to light up the lungs a bit as there is still a lingering pneumonia, but the gurus all determine that it’s ok to have the test.
We have also brought new specialists into our world. In December, we visited, at our pulmonologist’s request, an allergist/immunologist. We thought that perhaps, like his childhood vaccines, the stem cell may have reset and lost the efficacy of the allergy shots he received in the 1980’s. The test showed those shots were still doing their job. These infections were not allergy related. As an immunologist, the doctor also ran a panel to check Rich’s immunology levels. Antibodies that are known as immunoglobulin, are proteins that are used by a well-functioning immune system to ward off bacteria and viruses. You know, all those that we’ve been having difficulties with for so long. She said, in January, that Rich’s antibodies are where you would expect them to be. No worries.
But now, a week after our hospital departure, as we’re in consult once again in her office, we know from the recent hospital tests and the accompanying Immunoglobulin (IgA) he received in the hospital that his levels at the time of admittance last month were low. This latest panel she takes will help us determine Rich’s reaction to the recent IgA infusion and the worth of therapy. IgA, is, not coincidentally, the antibodies that help protect the body’s mucosa. It’s no wonder that infections manifest in the lungs. She suggests we wait three months and see her again to check the IgA levels again. The infusions as therapy might be an option. She says “You are a mystery!”
Directly from the immunologist, we go to see our pulmonologist. We first were introduced to this practice in the summer of 2014… four years ago. Rich was in the middle of his pre-transplant chemo and we found ourselves in the hospital with a pneumonia diagnosis. Dr Kz introduced himself to us and over the course of our journey, we’ve welcomed his advice as he is not one to limit his concerns regarding a patient’s health to his specialty. He looks at the overall patient and can see gains and losses when he walks into the room.
One of our favorite memories of him came about a year after the transplant… 2015 being the year of pulmonology. It seemed like we were in the hospital every month with some kind of lung infection… PCP, RSV , hMPV as well as the generic viral, fungal, or bacterial pneumonias and infections. Rich was not progressing well. Our Dr Kz, at one point in a hospitalization, advised to be patient. In a rather long discourse, he advised sticking with the Robitussin instead of opting for the cough med with codeine. He admonished us that the codeine would slow the lungs from clearing. “Use codeine only when the pain is unbearable.” He explained the why of it in intense detail. We agreed.
Trying to stick to his plan, we found we had to resort to codeine in the middle of the night. Knowing we would have to wait for the pharmacy to fill the prescription and that at night could take a significant time, Rich asked me to give him a dose of the meds from my bag. Seeing the pain in his face as he coughed, I gave him the dose. His conscience must have been on duty… no sooner did I get into my recliner than a team rushed into our room. Apparently, his guilt manifested as wonky readings on all the leads sticky taped to his body!
Come morning, the codeine unrecorded, Dr Kz comes checks Rich and finds him much improved. He credits the Robitussin protocol and launches once again into his speech on its benefits and the why of it.
Finally at the end, he says to Rich, “You only had Robitussin right?”
Dr Kz: Bastard.
It had been two years since we had seen him… he had sprung us from the ER when Rich was about to be admitted for the flu. Now he walked into Rich’s hospital room a month ago, looked at Rich with a smile and shook his head. “You look better than I expected from reading the ER reports. I don’t understand you!”
The directness of this doctor gives us strength. His compassion and willingness to work with us is a common trait with his office partner Dr J-R. She tells us, when we see here, that Dr Kz joked with her, “I gave him to you two years ago. What did you do to him?!”
I mention to her that he was supportive of us going home as soon as advisable but, when it came time for us to leave, he seemed skeptical. “Dr Kz was scared with this admittance. He wanted you home, but at the same time, the reports from the ER and Rich’s numbers were extreme. He hoped we were all making the right decision for you to leave, to come off the vancomycin.” The first few days, we wondered if it was the right decision, too!
She also advises that, as we know she suspected, this appears to be infection by way of cardiac issues. Congestive Heart Failure. Of all the reasons for the continual infections, she says this would be the most treatable and could be considered curable. Her explanation is that the congestion… brought on by his heart issues which were in turn brought on by chemo… builds up and it is then that the fluid builds up in amd around his lungs where an opportunistic bug makes its home. The fluid also bloats Rich’s belly which restricts the amount of room his lungs have to take a deep breath. Treat the CHF and the rest will take care of itself. Lasix as needed is prescribed.
Part of that is in direct contradiction to the immunologist, but it makes us think perhaps this is a combined issue.
Another week goes by and we’re meeting up with the cardiologist. While we were in the hospital, the ejection fraction of Rich’s heart was further depressed… lower than his average. Both doctors seen last week brought up that problem, so we’re anxious to see his take on things. We’re first scheduled for an echocardiogram followed by an EKG. Surprisingly, our consult is short. The tests indicate Rich’s heart function is indeed not exactly status quo to where it has been throughout this journey, but is what he would expect given the recent events. He tells us that he wants to reconvene after three months, that Rich’s heart needs to “recover from this insult.” There has been an injury and it needs to resolve. We ask to be more proactive, we ask that Rich be prescribed cardiac rehab. Approved. Continue with the Lasix as needed, he says. Further tweaking of meds will be reviewed when we meet again. We always have to keep his liver and kidney function, particularly with CHF, in mind. Patience.
One week more and we see our stem cell guru. By now we have as many answers as we could have wished for. Blood work is taken and vitals checked. As we have been told by each of the doctors during these weeks, the PET scan not only shows no evidence of disease but a few spots that everyone was watching for inflammation have resolved. We breathe a sigh of relief. So many symptoms this year are part of the list of NHL. We’re glad to have a recurrance off our list of concerns.
At this point in our journey, this is the shortest stem cell consult of all. In many ways, we have moved forward into the realm of other specialists for the issues chemo have brought. We will meet for only for 6-month follow-ups and testing. The consult ends with hugs and a reminder of the Celebration of Life dinner. It will be good to see our fellow HSCT patients and the angels in scrubs who guided us through an incredible month in August of 2014 and celebrate living our new lives.
With one month down from our date in the ER, we have two more to go to see where we stand. But we’ve been contacted by the rehab group and this next month will see the start of evaluation and rehabilitation with a staff that has experience and certification for working with cardiac and pulmonary patients.
The recovery from this latest insult, this injury, this one worse than any before, has been understandably slow. Rich says it feels like he’s taken a jump back three years. Pneumonia in and of itself is not a quick bounce-back. Rich’s condition in the ER was not like any ER admittance before. Three years ago, Rich had his doubts about coming through one of his infection hospitalizations. This time it was my turn to have my doubts while he was in the ER. We’re blessed that deep down is a strength that pulls him through. We’re blessed with our family and our friends who are family to us that support us and are with us along the way and especially there when we need them most. We’re blessed that those who partner with us in the health care system are indeed partners and listen and voice their truth and guide us well.
Two days have passed since the Sunday we entered the chaos of the ER. Rich has been, the most part, reclining in his hospital bed, and it is amazing how busy one can be while motionless in a hospital bed. The long night in the ER gave us very little time for sleep and morning came too early. A virtual revolving door brought on a Q&A marathon with each specialty having their own focus. In many ways, this is a boon for the mystery we hoped to solve before our unplanned detour. Throughout the day the new doctors that have come on board since we’ve last been here have us repeat our history as well as what has brought us here this time. As well as the floor staff, our main gurus from each division that has been part of our journey have stopped in, ordered tests and discussed their differential diagnoses. More and more are we partners in this journey; having been managing Rich’s health outside of the hospital for the last two years. There is a comfort to the coordination that happens inside. This coordination also allows for the tests’ results to be further analyzed and lead to additional tests. Conclusions can be made quicker than on our own.
What seemed to be a huge step backwards is proving to be a blessing. Answers are coming fast and furiously during this admittance.
As always, once we reach a certain level of health, each consult ends with us requesting release. Yesterday was too soon but we did let our wishes be known. And we are heard. Our nurse advises us that for the most part, our intravenous meds are being discontinued… a sign of prepping for discharge. We are told that our pulmonologist is in the deciding vote… and we know his views on getting us out of here.
We work subliminally on our team. Rich is no longer in his bed, but we have breakfast sitting in the chairs with the hospital table between us. IV removed, he wears a t-shirt. We create a vignette of health; looking out of place in this hospital room. All indicators of illness are removed from view as much as is possible. Our plan is to take a stroll or two so the staff will see us up and about, as we do every day. It shows our determination to take our care back into our own hands.
This has worked for us before. We look forward to getting back into our own routine. Our own home. We know that once Rich’s health reaches a certain point, we need to be in our own space for the best healing.
We look forward as well to seeing the doctors this morning. We look forward to seeing them in the appointments made last week for the end of the month. We’re pleased that tests that we had anticipated for those appointments have happened already thanks to this admittance. Only the PET/CT scan remains; it’s scheduled for just days away. A delay may be needed as we do not want the pneumonia to give false readings. We consider making a second appointment for the following week just in case.
Twelve hours ago, Rich was given a three-hour infusion of Immunoglobulin. Amongst the tests administered since our admittance, we’re told that his immunology is off balance. We’ve always known the blood counts need to be on our radar and this one, as we’ve indicated before is the one we’ve been watching closely. It has been on a slow rise but never quite reaches the level we need. This infection brought it down by 100 since our last in depth bloodwork. We’re told that this indicates that he could have developed, since the transplant, an autoimmune disorder that creates that imbalance. And that a simple, periodic treatment of Immunoglobulin could be the answer we’re looking for. It’s something to keep in mind. We don’t need more side effects so it’s not a quick jump onto the bandwagon.
And now we do know that we will be going home today. Our determination for best impressions has paid off. Cardio came in and cleared us for discharge. Next was Infectious diseases. They are the kingpins this go-around… it is this group’s determination if the antibiotic that is only available by IV can be discontinued. We agree that we’ll contact them if there is any degradation at home. We laugh that we had plan B in place to convince him just in case and he feels, with the other antibiotics we’ll be supported by orally, we’ll be fine. Besides, we give him little choice.
The rounds by the other doctors will now be to discuss post-hospital plan for care. As we have appointments scheduled with them already, it will be more protocol than a necessity.
It’s just a matter of time and paperwork. Every hour, another confirmation of our leaving or another step closer.
We’ll be home by dinner. Sprung!
And in honor of today’s date 3/14/18 as well as the title of this blog post, credited to Yogi Berra as we enter baseball season, we’re prepared.