Mama's surgery

A few hours after my backyard fire, my mother called to tell me her surgeon finally scheduled her Aortic Aneurysm repair, after watching it for almost ten years. During her most recent scan, they found masses in her colon, so wouldn't go through with the surgery until a GI cleared her. Luckily the masses were benign polyps, so once the cardio-vascular surgeon heard she'd been cleared, he scheduled her for the aneurysm repair.

He was hoping to do it through her groin, similar to heart cath surgeries, but her groin arteries weren't big enough for the scope, so she ended up with an incision from her pubic bone to her rib cage!

Apparently almost all abdominal aortic aneurysm repairs recover in ICU, but I wonder if she spent a bit more time in ICU due to her smoking. Well, long-story-short, not once did she show signs of pneumonia, but she did puff on her incentive spirometer like a competitive athlete LOL

ICU can't have over-night guests, so I went home with Daddy and fixed him dinner. The next morning she looked good and no longer had her NG (nasal) tube - we were pleased, until we found out she yanked it out herself during a "delirious fit". It turns out her blood levels and potassium were very low, once they gave her two blood transfusions and a few potassium bags, she was no longer delirious. The doctors said they'd see how she tolerated being without her nasal tube, in the hopes of not having to put another one in while she was conscious. Luckily she tolerated things without the nasal tube.

She finally qualified for the regular floor, and made it six whole hours there before the floor nurses shipping her back to ICU. Looking back, I wonder if I might have contributed to her being sent back, if so, it was for the best:

Without the extra tubing of the ICU (nasal tube, EKG monitoring, just to name a few), she had more freedom to move around in bed. She kept tossing from side to side every thirty minutes or so. I told her to try to settle down a bit, because she had a lot of bruising after her minor gall bladder surgery from tossing around so much (but not enough to to to the ER - yea I did six years of post-0p on the floor). So I figure I should peek at her incision, since her tossing had caused problems in the past.

Not only was there bruising again, but the area directly around her incision was puffed up and hard! I found her nurse as quickly as I could, who was also concerned by this, so she used her pen to mark the puffy, hard area. I told the nurse about how Mama couldn't stop turning from side to side, so we decided her PRN Ativan might help her stop tossing and turning. Boy did it ever stop her from tossing and turning - Mama was gorked!

So maybe 30-60 minutes later I check her incision again and the puffy, hard area had grown considerably beyond the nurse's markings! I report this to the nurse again, who looked again, more concerned, so she wanted her vital signs. Another long-story-short, three RNs couldn't hear her blood pressure until they brought in a doppler (the hand-held machine normally associated with listening to a baby's heartbeat while in a pregnant belly). Between the increasing size of the puffy, hard area around her incision, combined with her weak blood pressure (most likely associated with the Ativan, looking back), Mama was brought back to ICU pretty fast.

Right after the nurses sent me down the public hallway to wait for the ICU nurse to call me in, I mean RIGHT AFTER, I hear a code being called in the ICU! I started crying in the ICU waiting room, and called Daddy, who's very hard of hearing, so he didn't answer. I called my hubby in Houston and cried to him until they called me into the ICU. Her room number wasn't the same room number as the code (I overheard the family of the room that had the code called, and their family member made it through the code!)

Well during the time I waited to be allowed back in, her surgeon's partner had already arrived and ordered a CT to rule out hemorrhage, since that seemed the most likely reason for the blood pressure and incision stuff, but the CT came back negative for hemorrhage, whew!

Three albumins and two more bags of potassium later, she wasn't gorked anymore, just groggy from the Ativan. She was borderline on her blood, but not quite enough to require more blood, but they'd watch closely until she was stable. Once the Ativan wore off, it was almost like nothing had happened, pretty much like the night before.

So even though my concerns about hemorrhaging were wrong, I'm glad it triggered us into action, for maybe her dropping blood pressure and potassium levels wouldn't have been caught so soon on the floor, with the higher nurse-to-patient ratios.

It was finally morning, so Daddy answered the phone (he has a thingee connected to his TV that says the phone is ringing). She wasn't stable at the time I told him about her being sent back to ICU, so his one hour trip back to the hospital was a rough one, especially all alone. She was coming out out of the Ativan while both of us were in the ICU with her, then we all went back to the floor once again.

Now that her blood and potassium had dropped to dangerous levels twice, they scheduled more frequent labs, so they were on top of it the third time it happened, and she got blood and potassium yet again while on the floor. She finally stabilized after that, so the only thing left in her recover was to move her bowels and do PT to regain a bit of strength.

That's when she and I butted heads - she has always hated exercise and being told what to do, and is the master of manipulation. She had the PT and CNA's all fooled about how much she could tolerate, and got mad at me when I'd remind her that not walking would slow down when her bowels would move. Instead of walking more, she started eating less solids! Apparently her Dr figured out something was up, and put her back on just water only until her bowels moved, and suggested in-patient rehab for the PT. He also ordered her Miralax until she moved her bowels, so it was off to in-patient rehab finally, yay, because they had one in their little town - in a nursing home!

Adjusting to the nursing home was a bit rough at first, but it was a pretty nice nursing home other than the loud raucous, because it was such a small nursing home, they didn't have enough wings to put similar patients into special wings like bigger nursing homes. Once Mama figured out she could request her meals in her room, things went a lot better, especially since they had scheduled smoking breaks every two hours during the day. And being in their home town also meant visitors from her retirement neighborhood, yay!

She tried the manipulation stuff again with the nursing home's PT crew, but since she was across the hall from the PT room, they allowed her to have many smaller PT sessions, instead of doing the entire hour in one session, so that was great as far as Mama was concerned, although I wished she had gotten enough rehab to rebuild some of her strength and endurance from being lazy and depressed from a few months of eczema that took many dermatologists to finally beat it. But since Mama could get around in the house with Daddy helping tend to her, that was enough for them. What can I say, it's Mama's decision to be inactive, and Daddy's decision to be an enabler because he loves her.

She's supposed to have Home Health PT, which was yet another drama due to the last time they had home health for Daddy's surgery, the home health nurse showed up twice with her family, once bringing her son into my parents home, asking if the minded! I'll call tomorrow afternoon to see if the Home Health service had got in touch with her yet, or if I need to call her poor doctor yet again.

All in all, I'm very relieved she no longer as a weak area in her aorta, for her blood pressure can get pretty high when she's not post-op. Hopefully having a break from me hovering will help keep her blood pressure in check, even if she did enjoy having someone cooking and cleaning for them for two weeks LOL

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