Monday, June 18, 2012

On the Mend

          My husband has been home from the hospital for about two weeks now and thus far, no major issues. It's almost always a bad idea for me to say that, because past experience has taught me that nearly every time I do, badness follows quickly behind. I'm going to take a chance anyway and throw caution to the wind, since we're nearly fourteen days removed from medical incarceration and doing alright. No more tiny strokes, no severe back pain, nothing that's sent us running for the emergency room. The nice thing is, I don't feel like this is the calm before the storm, a sensation I've often experienced before. This time, it feels like we may actually be reaching calmer seas after fighting to keep afloat in a months-long hurricane.

       I spoke last time of my husband being admitted to the hospital after I took him to the ER to be treated for severe back pain. We both assumed that he would be given his standard round of IV-administered painkillers and sent home with a prescription for more, which is the typical outcome of those visits. What I wasn't expecting was a 3:30 am phone call from him telling me that he was being admitted in the wake of the previous week's neurological scare. I can only assume that the doctors were nervous about letting him go home again after so recently being seen for a T.I.A. Then, too, there was also the small matter of his INR levels being all wrong.

     After the mini-stroke scare, my husband had been sent home with orders to complete a round of Lovenox injections over the course of the next seven days. Lovenox is a type of blood thinner which can work alongside warfarin, his daily dose of which my husband was supposed to continue to take. Mind you, all this was after he'd spent roughly twenty-four hours on a heparin drip in the hospital. So after all that, to show back up in the emergency room less than a week later, I would say the doctors were right to be a little overly cautious and re-admit him for observation, especially since his INR was STILL only at 1.4 (it's supposed to be between 2.5 and 3.5). That definitely registered pretty high on my oh-what-the-hell?! meter.

     I had to go to work that day, but I went over the hospital as soon as I got off to assess the situation. It wasn't quite the same set-up as usual, because he was in there for lingering issues from a previous incident and I can't think of another instance where that's been the case. Besides that, there was the fact that at this point, his stomach was bruised and bloody from all the Lovenox injections that he'd been given and yet his INR was apparently refusing to budge. Day two of his hospitalization came and went and the blood was still too thick, registering at 1.7. I was at work during the days, of course, but my husband would call me from the phone in his hospital room whenever the nurse or one of the army of doctors would give him some new bit of information.

     At first, I was more than a little concerned he was going to suffer another, possibly more debilitating, stroke while he was chilling in the hospital, waiting for his blood to thin out to the appropriate levels. When I mentioned this to my husband during one of his updates, he assured me that the whole point of the Lovenox was to ensure that this didn't happen. As I understand it, the way the drug works is by preventing the proteins in the blood which are responsible for clotting from allowing them to do that in the first place. Those same proteins are the ones being measured whenever his INR is checked and since the Lovenox doesn't actually thin their ranks, but rather just prevents the ones that are there from clotting up, that seemed to me to be the answer as to why his blood wasn't registering as any thinner, despite the abundance of blood thinners coursing through my husband's system.

     I've had to do this once before while writing this blog and I find myself compelled to do it again, because I just spit out a bunch of medical nonsense. I'm sure everyone is well aware, but I'm nothing even close to a reliable source of medical information. I regurgitate, as best I can, what the doctors tell me with regards to my husband's specific situation and I try to do it as accurately as possible, even going so far as to use that infallible research tool, Google, to try and deepen my understanding of things. My ramblings should not, under any circumstance you can think of, be construed as medical advice or knowledge. It's not and I would never in a thousand and two years purport to be able to do something like that. Just throwing that out there before we continue on with the actual important part of the saga...

     My husband called me on the fourth morning of his hospitalization and told me that he was, barring any unforeseen complications, being released that day. I was at my parents' house when the call came in, as I'd gone there after class the previous evening to spend the night since I was off work the next day. I paid particular attention to the part of the conversation in which my husband said he was being released "today", not "right this minute". As anyone who's familiar with oft-hospitalized people know, the process of actually being released can easily be an hours-long ordeal. I never go get my husband until he tells me the paperwork is being drawn up, and even then I usually have to cool my heels for half an hour or so.

     Knowing this, I finished up whatever it was I'd been doing at that moment and lounged around a bit longer before I headed out. It's nearly an hour-long drive from my parents' house to the hospital in the city, so there was a good three-hour gap in between when I first got the call and when I got to the hospital. I figured that surely the paperwork would be in process by then, if not completed. Yeah, about that. Whatever, the delay just meant we could get some quality Food Network time in before we were finally able to go home three hours later. By that point, I was so happy to have my husband home and not have to sleep alone again that I would've waited another six hours if that's what had been needed.

     My husband's condition since then has been so far, so good, with a few minor hiccups which will be related at a later date. Overall, though, I'm feeling pretty good about the fact that we seem to have left the whole stroke issue behind us. His blood is actually a little too thin at the moment, which is part of the thing, that will be related in a future post, but that's not a huge issue. It makes him overly bleedy, which is annoying, but not overly dangerous. Also, he's super-tired because of it, but that should resolve itself as his blood gets itself balanced out again. We both feel as though we're headed into a better place now; a new chapter, if you will. This T.I.A was one of the most serious things that's yet happened to us with regards to his Marfan's and we've come out of it relatively unscathed. That has to count for something.


    

Monday, June 11, 2012

Time to Get Ill

     I forget sometimes that people actually do read this blog with a certain amount of regularity, people who are not me and are not my husband. I think because I keep it like I keep my paper journal, I tend to believe that the whole business is solely for record-keeping purposes, something that my husband and I can go back and visit when we need to remember the chronology of something. That, or an easy way to get information about my husband's health to the people who love him on the other side of the country. As I've said before, I prefer this method because I can update our loved ones with what's going on without having to bug them with phone calls every time something happens. Every so often, though, someone I don't know will email me to tell me that they're following my writing. That makes me so happy to read, and even happier when those people send well-wishes my way because they know something bad has happened with my husband's health. Thanks for that, more than you know.

     My end of that bargain is to keep this blog updated as much as possible and as the aforementioned emailer (is that a word?) kindly pointed out, I've been lacking a bit in that area of late. True, I'm still in school, but my homework is much less this semester, as I'm only taking one class instead of four. I've got much more time to write now; I just need a kick every so often to get my lazy ass off Pinterest and over to my blog. What followed in the days after my husband's mini-stroke was really nothing that would raise any alarms, with maybe the exception of the fact that his blood wasn't thinning out quite as quickly as we'd assumed it would. When he went back to his doctor on the Friday following his hospitalization, his INR levels were still nowhere near where they needed to be.

     The number were slowing edging their way to the appropriate levels, though, so nobody thought much of it. And as it turns out, that wasn't even the reason I had to take him to the emergency room (again) last Tuesday. When I came home after my workout that night, I walked into the living room to find my husband curled up on the floor on top of his heating pad. That's never a good thing, but it was made worse by the fact that he was trying really hard not to move at all, which is a sure sign that the pain is becoming unbearable, if it's not there already. I asked him if it was time to go to the hospital and got an answer in the negative. I knew that was bullshit, but I let it lie and went to take a shower. I was pretty damn sure that he'd still be in the same place when I came back.

     For a girl who hates being wrong as much as I do, I really wish I was sometimes when it comes to my husband's health. Sure enough, there he was, curled in a ball in the same spot, trying to pretend it wasn't as bad as it so clearly was. While I have no desire to portray myself as less than pleasant, the truth of the matter is that there are times when my husband, for various reasons, refuses to acknowledge just how bad the given situation is and will NOT request that I take him to the hospital. This was one of those times. Lucky for him, I have absolutely zero qualms about pulling out the Unpleasant Wife card when I think he's in need of medical assistance, so I got down on the floor and I got in his face and I told him that we were going to the hospital.

      It was one of those times when the pain in his back was so bad that I had to prop him up while I put his shoes on, because there was no way he could do it. As soon as I had them on and he was ready to go, I grabbed his cane from the kitchen, as he needed it to get out to the car. What we really needed was his walker, but that lives at my in-laws' house in North Carolina, so we made do with what we had. I know how much he hates having to use his cane, but there wasn't really another option, seeing as how he was having a hard time staying upright long enough to get to the car.

     The ER was packed when we got there, as it so often is. I mean, it was so crowded I couldn't even stop at the front doors to get a wheelchair for him to be taken in with. I just continued on to the underground parking and, with the assistance of a kind stranger who saw me struggling to get him out of the car, got my husband into the elevator and checked in at the triage desk. And let me tell you, that right there, the getting him checked in at the triage desk? That was a feat and a half that night, as there was some little jackass with a sense of entitlement who thought it was a-ok to speak to the nurse as though she were beneath him, using every variation of the word "fuck" that he could think of in the process. This continued until the security guard simply wheeled him out the front doors, profanities streaming behind him. As soon as he was gone, damned if another one didn't start arguing with the same beleaguered nurse. Sigh...

     It was at this point that I decided to leave my husband in the nurses' capable hands, because there was no room for me there anyway. I told him to text me when they took him back to the treatment rooms and I would come back to pass the time with him until they let him go. At this point, we both assumed the usual battery of tests would be run while he was hooked up to an IV of Dilaudid and when nothing out of the ordinary was found, he would be released with a prescription for painkillers and instructions to come back if it got worse. That's how it always goes, that's how it's gone all 6,732 times we've done this before. I ran to get food from the nearest twenty-four hour drive-thru, figuring I'd get a text message before I'd even eaten.

      I didn't, though, nor did I get one after settling down in bed to watch an episode or two of Friends to kill time until I could go back to the hospital. It was past midnight by this point and still no news from my husband. Finally, sometime after I'd drifted off, the opening distortion of White Zombie's "Electric Head, Pt.2" rocking out of my BlackBerry jarred me awake. It was three in the morning by this point and my husband was being admitted. Not because of the back pain, but because his blood was still too thick and the doctors were not comfortable letting him go home so soon after he'd just had a fairly significant neurological event. Um. Something just wasn't adding up for me.

     Maybe it was because it was the wee hours of the morning, maybe it was because I was running on nothing more than broken patches of sleep at this point and I had to be at work at nine, or maybe it was because I just couldn't get my brain to function properly, but I did NOT understand what the hell my husband's stroke-like adventures from the previous week had anything to do with this visit. When I voiced this to him, he wasn't able to give me much information, as the doctors hadn't been super-forthcoming on their end as of yet. All we had to go on was that they weren't comfortable letting him go home and that he was being admitted for observation. And thus began an almost week-long hospital stay that was a bit different from those he'd had before...

Tuesday, June 5, 2012

Aftermath

     I know, I left the small band of you who kindly take the time to read my ramblings hanging after that last post. It wasn't intentional; there's just been so damn much going on around here in the past two weeks that I haven't been able to find the time to sit down at my computer. Well, that and the fact that my husband hasn't been home for the better part of a week and the basement, which is where my computer lives, creeps me right the hell out if I'm by myself at night. I wish I could say he's been away from home for some cool reason, like that he was interviewing for a fantastic job in another state, but it's not nearly so good a reason - he was in the damned hospital again. Before I get into that adventure, I really should finish recounting the last one, yes?

     As it turns out, the paramedics took my husband to the trauma section of the emergency room, which was the last part of the ER that we hadn't yet explored. I must have been a bit quicker than the nurse at the registration desk's information was updated, because when I walked in to inquire as to which room my husband had been taken to, I was told "Trauma 22, right" and given a name tag with my surname on it. Armed with this information, I pushed through the heavy double doors that separate the ER waiting room from the treatment area to find my husband. When I reached the correct room, I glanced in to see a rather small figure huddled under a blanket where I was told my husband should be. I hesitated, because while he's skinny, I knew he wasn't that damn skinny. Sure enough, when I worked up the nerve to walk up to the foot of the stretcher on which the patient was laying, I could see that it was clearly a youngish girl with hot pink running shoes. Definitely not my husband.

     I backed out quickly, before she woke up to find me creeping on her, and as I did, I saw the paramedics wheeling my husband around the corner down the hall. I didn't dare move to go to him, as the trauma unit is worlds away from the regular ER and I was doing my best to blend in with the wall. I personally have no experience in the medical world, but one of my best friends is a nurse and if I've learned anything from hanging around him, it's to get the hell out of the nurses' way when they're working. There weren't any rooms available at that moment, so my husband's stretcher was parked unceremoniously in the hallway right in front of where I was standing. He was immediately swarmed by no less than three nurses and a doctor, who started in with the questions right away.

     I recognized that the questions being asked were designed to evaluate how bad the damage suffered during what we assumed to be a tiny stroke was. I stood there, listening and watching, making sure that my husband didn't leave out any pertinent details, until the social worker-type person figured out that I was the wife and asked if I would sign the paperwork consenting to treatment on my husband's behalf. Of course I signed, but I felt weird about it. Even though we've talked about it more than the average couple probably does and I know that, as his legal spouse, I've got the final word when it comes to his medical care, should he become incapacitated, I've never actually had to exercise that power. I didn't like it.

     As the little Irish doctor doing the evaluation was able to eventually ascertain, the damage was virtually nonexistent. He was able to say with a pretty good amount of confidence that my husband had suffered a transient ischemic attack, or T.I.A. Basically, it's a tiny stroke that's usually the final warning shot before the big, potentially debilitating stroke. As soon as he said that, my husband and I looked at each other and knew right away what had probably happened. Remember when I said my husband was going off his blood thinners for a week in order to receive steroid injections in his spine? Yeah, about that. When they took his INR in the emergency room, he was sitting at 1.4. Normally, he needs to be between 2.5 and 3.5 to make everything work with his artificial valve, so that reading was less than good.

     Once the ER doctor had the full story about how my husband had been off his warfarin for the previous week and had only just picked it back up a few days before, he quickly put two and two together and told us that most likely, a blood clot had formed somewhere around that titanium valve and a tiny piece had broken off and made its way to my husband's brain, momentarily obstructing the blood flow. It was seriously only for the briefest moment in time, which is why there was no lasting damage. My husband had by this time regained about eighty percent of the use of his left side and his speech was normal again.

     Eventually, we moved out of the hallway and into a trauma room, where the same cognitive tests were performed on my husband every thirty minutes or so. There was no question that he was going to be admitted, but the staff wanted to make damn sure he was stable and not going to suffer another "neurological event" before moving him into a regular hospital room. Somewhere in all of this, the fire alarm went off and a prerecorded voice told us repeatedly to follow our nurse to the nearest escape route. No. Just no. Nobody else seemed excited about this, either, and one of the nurses came back to assure that the fire doors had been closed as a precaution, but that hospital security had assured her we were in no danger. By that point in the evening, I doubt very seriously if we'd be phased by something as random as dragons crashing through the ceiling.

      Once the battery of testing was finished for the time being, the small nurse released the brake on my husband's stretcher (no, really, those things have brakes, like a car, only it's a bed) and we started the trip to the eleventh floor. Can I just pause for a moment and say that I never really thought about how strong those nurses have to be just to do their jobs? I'm not talking about emotionally strong, though God knows they have to be, but physically strong. Those beds are huge and not light, especially with someone in them, but damned if she didn't maneuver him through the hallways and up a couple of ramps like it was nothing. Impressive.

     After my husband was settled on the floor, it was pretty standard procedure from that point on, really nothing we hadn't encountered before. The one exception was that every nurse and doctor who came in gave him the same "smile for me, BIG SMILE" test that I knew they were using to test for facial paralysis. Hell, we even settled in to watch the same show that we always watch in the hospital - "Chopped", on the Food Network. It's kind of become our ritual, one that relaxes us, as much as anyone can relax in that place. I eventually left, sometime after midnight, as I had to work the next day and begin the usual round of phone calls to Jean, my sister-in-law and Adam, my brother-in-law.

     I was able to take my husband home the next day, after he'd been inspected by what seemed like every neuro doctor in the place and pumped full of heparin to get his blood thinned out. We stopped at the nurses' station on the way out to thank them, because they really are wonderful people and we see them an awful lot. That night, laying next to him in our bed, I was just happy to have him home. I wasn't even thinking about the bullet we'd just dodged, though I probably should have, since the lingering complications from said dodged bullet would seriously ruin my day just a week later.