Daisy gets a sister from the gift shop.
I had made the comment to Mom and Dad’s PCP last week when she mentioned that she was just worried about all of this for them, for us— that we hadn’t even gotten a chance to start the recovery race. We hadn’t even gotten to the starting line. Covid prevented respite care from coming, we had issues with the VAC dressing and stoma emergencies. We never got to a pattern. But on Thursday morning we saw mom’s surgeon and he gave us a timeline to reversal– early January should all go well, a study after Thanksgiving to evaluate the anastomosis of the colon where the resection had occurred- where the re hook up was healing.
But of course this is not how things go.
On Sunday evening I was out with a friend when I saw a missed call and a silenced text. “Mom is on the ground and I cannot get her up.” Followed by “if I don’t hear from you I might call 911.”
Certainly the thinking would be — of course, CALL. But Mom had a tough time at the hospital, mom didn’t want to go to the hospital. And Dad knows that her mental status is FAR worse as a patient. And she hadn’t fallen, she had slid to the ground and she was awake. So off we went to their house (I was the passenger), calling a friend and neighbor and MD to join us with a stethoscope AND blood pressure cuff. There are so many reasons a patient can slide down and we knew that another hospitalization would bring a degree of trauma– getting details and data would be key.
I found her on the ground next to the bed, cool extremities, increased heart rate and low BP. Knowing that it seemed to always take longer for EMS to get to their neighborhood– Susan and I carried mom to the car. As I looked across at Susan, appreciating that she just knew this was what we had to do– I commented that this was yet another reason that we kept training/swimming. Swimming with the Flying Fish Heads kept us fit enough to carry parents out of the house to the car.
To the ED. Mom’s BP was so low that she really couldn’t stay awake by the time that we were in the waiting room, immediately onto a gurney with a bag of IVFs running— and housed in the hallway– because it is 2022 and we don’t have staff. Blood work and CT scans showed massive (clinically they called it submassive) pulmonary embolisms– right heart strain– and a showering of clot throughout all of the lung fields. Risk factors? Surgery. Decreased mobility. Covid (just because she was basically asymptomatic does not decrease the clot risk).
I have now explained to my parents the physiology (each time I explain mom tells me that it makes so much sense)-- that the veins bring blood back to the heart. Their pipes gets larger into the right atrium of the heart and then finally the right ventricle which pumps deoxygenated blood into the lungs. As the blood travels through the lungs the vessels get smaller until the capillaries in the alveoli where the oxygen is exchanged from the air into the bloodstream. A clot traveling from the calf has clear sailing until it gets jammed in the smaller vessels in the lungs– and then things get blocked off. Air exchange doesn’t happen as it had and in mom’s case if the “clot burden” as they refer to the number, size and location of the clots is enough– right sided heart strain. And when the muscle fibers in the heart are strained– troponin is released by the cardiac cells. Her troponin levels were elevated. She started to have chest pains, she needed some oxygen. Her heart was pumping faster to try to get the blood its oxygen and her blood pressure was dropping. Within an hour of being in the ED, they had hung a heparin drip. The heparin doesn’t clot bust as a mechanism, it decreases the ability to clot. They admitted mom to the ICU. A bedside echo, a call to the system PE team, and off to the ICU we went.
Monday am she was oriented to June 1972. She told me that the smartest thing that she did was encourage me to go into medicine. We again discussed that the only surgery she ever wanted to have again was the one when Dr L reversed her ileostomy (now delayed for a few months more). It is an amazing place to sit in with her– her complete disorientation to the setting but complete grasp of the big picture goals/plot (until she forgets it).
Beauties of the ICU. Quieter rooms, larger rooms, better staff ratios. So I stayed Sunday night and awaited team rounding in the morning. Mom’s comments to me were that she had never been so sick in her life— Her pains were vague but she had a feeling of doom. She asked if I thought she would make it through this and I honestly answered- “I am not sure mom. But your heart and lungs are perfectly healthy. Your brain and bones were your problem areas– and now your gut. But your heart and lungs have always been fine. No high blood pressure, no lipid issues, no weird arrhythmias; nor asthma or smoking. This is when that pays off.” Dad came in Monday morning with a stuffed cat that looked much like their newest kitten Daisy and mom hugged her. That stuffed animal made a difference. It comforted mom and softened everyone who came into her room, as it does me. Its presence suggests the need for the skills of pediatricians, their warmth.
And 36 hours after her admission to the ICU– she was off of oxygen, walking around the ICU with a walker (slowly and much more weakly). Therapeutic on heparin, able to sit up and ambulate with a walker. Home was safest. The thought was to get her home before she sundowned (she had pulled her IV out the second night and dad’s hopes of going home to sleep were crushed). And Dad and I got her into their car at 5:30 pm.
So I am now typing from their guest room. She is much weaker. We have a new pill that brings a new risk of bleeding. A slide to the floor, a fall will take far less to cause a bleed in the brain. But she got in the door with her walker and then sat, pale and tired until it was time for bed. She ate her dinner and we watched Notting Hill and reminded her of its plots many times as we meandered through it. She introduced her stuffed cat to her real ones.
We will have home care, wound care, ileostomy care, follow up cardiac echos, and a CT in a few weeks. There is room for many more complications in her story. But one cannot live life waiting for complications to happen, we acknowledge their possibility and move forward a step at a time. I almost think of it as honoring their existence and continuing to walk, a form of bowing to their being. And as I have told her a gazillion times. “Your brain is F&^*&^#* with you, you have Alzheimer’s. We are doing this one day at a time.”
And Lolly comes in on Thursday night.
