We may have a new record!

As if we didn't have enough to deal with, we managed to hit an all time high for Caren's INR, which is the blood test to see what her clotting factors are. A normal INR is between 1 and 2. They started her on anticoagulants last week in an attempt to decrease her ability to clot, thereby reducing the size of the clot in her liver. It may not actually make it smaller, but it sure shouldn't get any bigger. A therapeutic INR, meaning the anticoagulant drugs are doing what they want them to, is, I think, between 2 and 3 (I'll double check that and correct if necessary. I hate being the harbinger of bad information!).

Caren's INR is currently 4.2. That means she's somewhere between, "Way Too High" and "Leaking Cool-Aid from Every Orifice". So, we skip the Lovenox injections (BTW, injecting drugs into your wife's belly twice a day is NOT fun) and reduce the dose of oral Coumadin, and recheck on Friday. In the meantime, we keep Caren away from sharp objects. A paper cut could be a huge problem for us.

We still can't find a reasonable explanation for her hot & cold spells either. I thought it was related to the thin blood, but the surgeon said it wasn't. She goes from sweating bullets to freezing cold in the span of minutes. This would be annoying under normal circumstances, but when adding and removing clothing and blankets requires a half-time respite, it's damn near impossible. I'll walk in and find her half undressed, taking a breather, just un-fun (if that's even a word. The hyphen makes it look good though right?).

She's got a small appetite back. Her carrying capacity is about 5 tablespoons though. Half a turkey sandwich will fill her up for hours. But she is eating. I should research how long it takes malnourished people to return to normal energy levels. There's got to be a case study out there on a crash victim who was trapped for 10-days, or a lost hunter that didn't eat for two weeks. Actually, a lost hunter that didn't eat for 2 weeks has got to be the WORST hunter on the face of the Earth! Maybe a lost hiker. Anyway, there has to be a way to gauge if she's progressing normally, or stagnating terribly. I just hate seeing her so weak. The next few days will probably tell the story.

So weak.

Caren is so unbelievably weak. She's eating and drinking, but just can't seem to generate any energy. Brushing her teeth requires a two hour nap to recover. I'm really hoping that it's just the residual effects of not eating for 11-days. Eventually she has to catch back up, but by eating a few tablespoons at a time, it's going to take a while.

We'll nurse her back to health slowly, very slowly. Thank you for all the best wishes, every little bit helps! I'm on waffle duty. More to come later.

Monday Morning

It's Monday and we're finally home. Yesterday afternoon got a little hectic, I never got a chance to write. Although we did get out of there, finally, it wasn't without it's ups and downs. For some reason, the team of residents thought it was perfectly reasonable to see Caren to arrange her discharge AFTER they saw the roughly 50 other patients they had on two floors. If they had started their rounds at 6am this might (andI stress might) have been acceptable. Unfortunately for them, the scorn of being the last to be seen to have her NG tube removed was still fresh from Saturday and our patience had run out.

Caren had the nurse start paging the residents at 9am and asked her to page them 2-3 times an hour until they finally arrived at 11am. They obviously weren't very happy with her. We had given up on making friends and influencing people four days earlier, so no great loss. When they finally arrived, he two of them played a good cop-bad cop game with us. Little did they know, Caren had the bad cop-psycho-ninja, doctor killer roles all wrapped up into one. After some fairly tense moments, we got the discharge plan ironed out. Then the waiting started all over again.

The Team had to see the rest of the patients before they updated anyone's orders in the "system" or wrote discharge notes. It seemed ludicrous to me that the "system" would be so slow to evolve. What if there was a drastic change in a patient's treatment plan and they were the first patient to be seen? We've already established that the nurses will not deviate from the treatment plan in the "system". That patient could receive inappropriate treatment in the window of time that the Team is updating the "system". What complicates the "system" even more is the sheer number of doctors on the Team and the lack of communication therein. Caren's Lovenox (a blood thinner) therapy started a half day later than it should have because a Team-member didn't enter the order to start it. They didn't catch it until the next set of rounds later that day, then debated in the hallway outside the room who the guilty party was. In my mind, the simple solution is, enter the orders immediately after seeing the patient, then move on. Or, jump into the 21st Century, and use a bedside tablet or computer to enter the orders real-time, as you see the patient. I'm sure some hotshot accountant can find a decent return on investment for the initial cost of implementation. There has to be some way to calculate the value of increased efficiency in the "system".

Since I'm on the topic of efficiency, the fact that they wait so long to discharge patients (we finally got out around 2pm) creates huge logistical issues for the facility. I'm not sure how often the hospital runs at capacity, but I seriously doubt that Caren's bed was scheduled to sit empty for any length of time. If there are patients coming out of surgery or waiting to be admitted form the emergency Department, they wait and wait until the beds are empty upstairs. The sooner they can get the outgoing patients out, the smoother the "system" will run. There's really no reason why they couldn't see the patient's to be discharged first, maybe after any critical cases in ICU, and get them on their way. Just my thoughts. Sometime this week I plan on outlining my vision of the perfect hospital, what it NEEDS, what it should really have, and anything that should be ever-absent from inside it's walls.

This entire experience was extremely eye opening for both Caren and me. Some of our assumptions about a large, teaching hospital in NYC were completely absurd. We also came to see our local, community hospitals in a different light. Yes, they are smaller, and lack some fo the fancy specialties, but they are doing some things very good. The big guys could stand to learn something from the small-town approach.

Caren is resting uncomfortably right now. It was a long night. Getting the pain managed without our friendly neighborhood PCA pump is proving a little complicated. I'm sure we'll figure it out and she'll be sleeping most of the day. Off to eat something before the boys and I get to playing!

Home Bound!

We have been told that we are going home today. We're expected to breakout around noon, but it could happen at any time. There's always the chance that the doctors could change their minds and decide she needs to spend another day here. I don't think they realize that they should have a SWAT team on standby if they even attempt that. Caren would summon the energy to go psycho-ninja doctor-killer on them! I think we're leaving today with or without their consent. I just hope I'm not high-tailing it up 1st Avenue with NYPD ESU in tow.

She's spent the morning cleaning herself up, even the Dilaudid can't suppress the OCD. Of course, the simple act of washing her face makes her so tired she needs a nap before putting on deodorant. I think the sheer excitement of going home is driving her forward. Right now she needs a shower (those are her words, not my assessment of her level of cleanliness - I'm brave, but not that brave), some comfy clothes, a good meal and her own bed.

I actually spent the night recovering from something. I don't know if it was just my sinuses, or I ate something bad or my body just released all the pent up pressure when we learned that she was going home, or a combination of all of the above, but I got ill yesterday afternoon. Headache, vertigo, nausea and I even threw up once. Fortunately, it didn't persist, so I don't think I'm harboring any contagions. My head is still a bit sore, but it feels like sinuses. The air down here just doesn't move. When we got the bad storm on Friday night, it must have stirred up everything laying around and sent my sinuses bonkers. It also didn't help that the beautiful flowers I brought Caren earlier in the week were growing a lovely strain of mold hidden deep inside the bouquet - looked OK on the outside, my worst nightmare on the inside.

So far, so good today. Tensions are a little high, just because we are anxious to get out ASAP. I'll post again if I can, but more than likely, the next post will be from home!!!!!!!

Her roomate

Actually, I say it went smoothly, but I almost forgot that Caren's roommate was almost assassinated at 3am! I know I'm only a lowly paramedic, but even I see the potential danger in giving a 60 units of insulin to a woman who has been NPO (no food or drink) in preparation for a colonoscopy and has a blood sugar of 99. Within a matter of minutes, her mental status declined to moaning and groaning, her blood sugar plummeted to 24 and the nurses were running in and out of the room like their clothes were on fire. I was awake and kept to myself. I was about to jump through the curtain when I heard them trying to administer oral glucose gel to her. We have pretty strict rules against giving oral medications to unconscious people! The last thing this little lady needs is an aspiration pneumonia added to her laundry list of troubles! I heard her start to mumble to them and decided she was probably awake enough to handle the glucose gel. Fortunately there was a single nurse on the floor that had a clue and ran the show. The got her some IV dextrose and got her sugar up enough that she could talk. The first thing she said, in her thick asian accents was, "That was no good!" Apparently referring to the near death experience she endured at the hands of her nurse. All the nurse said was that she had given her the same dose of insulin the night prior when her blood sugar was 107 and she did fine. What the good nurse did not realize, although she definitely should have known, was that the patient had been on an IV drip that contained dextrose the night prior. It was artificially maintaining her blood sugar level and allowed her to tolerate the insulin. They discontinued that drip earlier that morning...oops.

Here's to tube-free living!

The last of the dreaded tubes was removed about 20 minutes ago. No more NG Tube baby! The relief was instantaneous. They want to her to start eating a clear liquid diet today, and barring any issues, WE GO HOME TOMORROW!

I can't even begin to explain the sensation when they said "...go home tomorrow." I thought Caren was going to pass out, it's unclear when it was due to not eating for 11-days or the sheer joy of knowing we would be getting out of here soon.

She'll start eating at lunch and we go from there. For the first time, I feel like there might be an end in sight. We still have a long way to go, but getting home is the first step on that next part of the journey.

Other than a week and a half of our lives, 6 feet of colon and a gall bladder, the only other thing we lost was about 15 pounds of Caren and counting! I keep telling her this is not supposed to be a perk of the procedure, but she insists it's a good thing.

I'll be in touch soon.

A visit from McGuyver!

I had to throw this in here. For the last week, Caren's suction canister has be dangling from the wall connection via a 18 inch section of suction tubing. I noticed it as odd, normally there's a thing on the wall that holds the canister, but really didn't think much of it.

This morning, after changing out the full canister, our nurse proceeded to tape a canister holder to the wall unit to hold the canister higher. Apparently she noticed the missing holder and it was bothering her! She said they recently renovated this room and re-arranged the components on the wall and either forgot to, or discounted the importance of including a mount for the canister holder.

The nurse kept saying if the tape bothers us, just say so and she'll remove it. I just laughed. At a hospital where they can remove a colon, transplant a heart, and reconstruct a damaged face, we have a suction canister attached to the wall with medical tape! I mean, if we're gonna use tape, couldn't it at least be Duct Tape?

For the record, the tape in no way impedes functionality. In fact, I think it's working better with the canister closer to the wall connection! Just a little unsightly.