Archive for the ‘Nyel Stevens’ Category

In Through the Side Door

Tuesday, October 17th, 2017

Nyel’s View of the Passing Parade

Yesterday began as planned.  We headed out at 8:30 for a two o’clock appointment in Portland with Dr. God (whose offices are at Emanuel Hospital).  Although it was a ‘long-standing’ appointment, we had our backs packed on the likelihood that we’d go from Dr. God’s office directly to the hospital’s admitting desk.  Nyel’s situation had deteriorated considerably in the last two days and so, along about Cranguyma Farms, he called and gave a heads up to Dr. God’s nurse.

We proceeded to Ocean Beach Hospital (as planned) for blood work so that the doctor would have the results (by the miracle of FAX) by the time we arrived.  But, even as Nyel was waiting his turn in the lab, the call came from Portland – “Skip the appointment.  Go directly to the hospital.  Either to admitting or to the ER.  We’ll let you know.”

Ambulance Bays: Full

It ended up being the ER which is actually called the ED (Department not Room) these days.  This one, as is no doubt true in all big city hospitals, is considerably bigger than our entire Ocean Beach Hospital.  The triage went quick-as-a-wink, Nyel was placed in a room, the ER doctor gave a few orders for meds, Dr. God came in, and then… we waited.  I think the wait was five hours; the Cardio Care Unit was full and we were next in line for a bed.

While we were there, the ED filled up, too.  We could hear the ambulances arrive, and then a helicopter.  “All incoming bays are full,” someone said.  Outside Nyel’s room, the hallways began filling up with patients on cots – apparently having vacated their ED rooms (for incoming patients) while they awaited their own discharge.   We felt lucky that Nyel was safely tucked in a room, hooked up to monitors (never mind the constant beeping which, we were told was the result of his stopping breathing as he would drop off to sleep.)  Scary.

Helicopter Airspace- Busy!

Finally… back up to the fifth floor of the hospital.  Familiar territory.  Nurses we know.  Routines we know.  A menu we know (less happily).  And the beginnings of a plan to get Nyel into OSHU for a second opinion while we are here.  Our fingers are crossed that this will happen and that the various medical teams will move forward with something that will improve Nyel’s situation.  As ever, Nyel is non-complaining, but I’m feeling the need to beef up my cheerleading skills. Even the most patient patient is bound to get discouraged…

Learning the Rules, Regs, and Ropes

Friday, October 13th, 2017

It all seemed perfectly logical to us.  When Dr. God saw the results of Nyel’s bloodwork yesterday, his nurse called and said for Nyel to check into the ER (emergency room) at Ocean Beach Hospital.  He needed to be diuresed (given diuretics or ‘squeezed dry’ in hospital-talk) because his CHF (congestive heart failure) was making too many strides.

We got him there by 3:30 thinking that, like the last time this happened, they would check him into the ER and then he’d be admitted to the hospital, proper, by our local P.A. (physician’s assistant.) First problem:  the ER was full.  Second problem: his numbers were too high to admit him into the hospital.  Say what???

Well, it seems that CHF patients need more specialized care than normal hospitalization.  Or, at least Nyel does.  He would need a hospital with an ICU (intensive care unit).  And then the penny dropped.  The cardiac care unit is the CCU at Emanuel!  Same thing, said the E.R. doc.

In the end, a bed opened up and they kept him in the ER overnight, giving him several doses of an IV (intravenous) diuretic.  The unfortunate part for the patient – the bathroom in the ER is ‘down the hall.’  It made for a long night.  He called ‘to report’ about 5:00 this morning.  “Happy Friday the 13th!” he said.  “Wasn’t that yesterday?” was my response.

We compared notes.  Maybe three hours sleep between us!  I kept waiting for the call to come pick him up.  Little did I know that the ER doctor decided to keep him there at least through one more diuretic dose.  I needn’t have been poised to go get him after all.  And, come to think of it, it’s nearly seven ayem and I still haven’t gotten the word.  Nor do we know if we’ll be going on up to Portland.  New territory.  New rules and regs.  New ropes.  I hope this Friday the 13th is better than whatever yesterday was…

Lucky Thirteen!

Wednesday, September 27th, 2017

Ready!

Today marks the thirteenth day of Nyel’s hospital stay this time around.  We are hopeful that it is Going Home Day.  At least for a while.

Yesterday’s attempt at giving Nyel a new, improved pacemaker didn’t work out.  His heart has enlarged to the point that one of the leads could not be placed where it was needed.  So,  we head back to Oysterville with a tuned-up version of the same old pacemaker and as much optimism as we can muster.

Set!

The cardio-team here at Emanuel has already put wheels in motion for a second opinion from OHSU’s team so Portland isn’t quite through with us yet.  But we hope we’ll be giving them a break for a week or so.  Meanwhile… we have our fingers crossed that we will be on the road by early afternoon.  Thirteen seems a good number to head home on.

Though the day is yet young – in fact, our night nurse is still on duty – we have already been talking about all the things on that ever-growing to-do list.  Bills to pay – some late, already.  Appointments to reschedule.  To say nothing of laundry to do, groceries to get, prescriptions to refill and on and on.  How did it get so complicated to be away from home for a couple of weeks?

Go!

In the 1960s and ’70s, I used to travel every other summer.  For the entire summer.  Ten weeks away from home!  I have a clear memory of where we went and what we did but no recollection at all of how we managed all those mundane household things.  Was I less responsible in those days?  Or, perhaps more organized?  Or less encumbered with life’s nitty-gritty?

Actually, from my current perspective, enough is enough.  We miss our friends and neighbors to say nothing of the chickens and the bay and our dear old house.  Fingers crossed that we’ll be on the road before this day’s thirteenth hour!

…with Te cheering him on!

Saturday, September 23rd, 2017

Te-the-Hiker

Along the lines of ‘you never know who’s life you might be influencing,’ our friend Te comes to mind.  ‘Te’ is short for Terralene  and we met her years ago through our friend, the late Larry Weathers.  As we did our friend Linda.  They were all friends growing up in Raymond in the 60s (I think) and went on to lead separate, though intertwined, lives over the years.  Te (like Linda) lives in Seattle and we go year in and year out without actually seeing her face-to-face.  Even so, she is a presence in our lives, whether she knows it or not!

Take today, for instance.  I, as Nyel’s Head Cheerleader, have decided that we will ramp up his walking regime.  That thought immediately brought Te to mind.  She is a walker.  Years ago (maybe ten?) she embraced the 10,000-steps-a-day program and has followed it religiously ever since.  Often, she has those 10,000 steps accomplished before the rest of the world has had breakfast but, even so, she doesn’t slow her pace (so to speak.)  She is relentless.  She is also attractive, trim, slim, healthy, enthusiastic, and fun – the poster girl for that 10,000 Steps a Day idea.

All The Rage

Te’s enthusiasm is catching, and she soon had all of her friends using pedometers, checking their steps, trying to keep up with her numbers.  When I discovered that I average between five and six thousand steps a day just going about my usual day inside the house – not even venturing outdoors, mind you – I sort of gave up on my diligence.  Lately though, I’ve read that 15,000 steps are better but whether it’s ten or fifteen thou, it’s the intensity with which you walk that makes the difference.

Well… right now, that’s neither here nor there.  Nyel came into the hospital a week ago yesterday unable to walk more than five or six steps (and slowly, at that) without having to stop for a minute or so to breathe.  Now he can walk the length of this hallway and back with no problem at all – taking it slow, to be sure, but much like the proverbial tortoise, on his way to winning this race.

Outside Nyel’s Door

One round trip in this hallway equals 230 feet.  The little labeled hearts that are every five feet along the way tell us so.  Nyel says his stride is three feet.  So, for him, a round-trip  along this Unit 51 hallway is about 80 steps.  Reaching Te’s 10,000 step goal would take Nyel 125 round trips.  It would probably take every waking minute of his hospital day excluding mealtimes, meds-time, vital signs time, to say nothing of nap-time.  Maybe ten round trips today might be more realistic, stepping it up (so to speak) each day as he can.  I hope Te would approve.

No Tee-Hee About It!

Friday, September 22nd, 2017

The Doctor’s Diagram

They call the Transesophageal Echocardiography a TEE for short – not tee as in tee-hee but TEE as in the initials said one at a time.  Not much tee-hee about it!

According to the American Heart Association:  Transesophageal echocardiography (TEE) is a test that produces pictures of your heart. TEE uses high-frequency sound waves (ultrasound) to make detailed pictures of your heart and the arteries that lead to and from it. Unlike a standard echocardiogram, the echo transducer that produces the sound waves for TEE is  to a thin tube that passes through your mouth, down your throat and into your esophagus. Because the esophagus is so close to the upper chambers of the heart, very clear images of those heart structures and valves can be obtained.

The Magic School Bus – Inside The Human Body

According to me and my limited understanding:  Transesophageal echocardiography (TEE) borders on magic and is reminiscent of The Magic School Bus Inside the Human Body.  In Joanna Cole’s story, illustrator Bruce Degen takes Ms. Frizzle’s class on a visual tour of classmate Arnold’s body, where they flow up a blood vessel and into his heart – a healthy heart, of course.  The whole point of the TEE of Nyel’s heart was to show what the trouble is or, more specifically, how his troubles have improved since his TEE of five weeks ago.

Yesterday’s TEE procedure was the third one Nyel has had in the past few years.  From his point of view, the nurses and technicians set up the equipment at his bedside, right in his hospital room; the anesthesiologist prepares an IV, the doctor arrives, and the next thing he knows thirty minutes have elapsed, the doctor has disappeared, and the nurse and technicians are packing up.

Nyel and “Dr. God”

While Nyel was still ‘out,’ the doctor talked to me briefly about what he had learned and what his thoughts were concerning next steps.  Nyel’s blood clot has diminished by 60 to 70 percent.  The mitral valve regurge is also a bit less. Probably no valve repair or replacement at this time.  Perhaps an upgrade to his pacemaker or maybe just an adjustment.  He will get back to us after consultation with the cardiologist who is one of the Cardiac Electrophysiology specialists on the team.  It might be tomorrow in the time-honored fashion of hurry up and wait.  In any case, we’ll probably be here through most of the weekend while they back off one of the dicier meds…  Still not much tee-hee going on here, but things are looking better.

Ruts? Routines? Confusion?

Thursday, September 21st, 2017

Day Nurse, Holly

The older I get, the more I am noticing the many opportunities for confusion.  Not just the run-of-the-mill sorts of confusion like ‘Damn! Where did I leave the car?’ or ‘I remember leaving that rake right here!’  No, I’m talking about confusion of a much more basic sort.  It involves the wisdom of professionals and those who profess to have expertise in the important matters of life.  Like ageing.

Nestor, The Food Host

For instance, there is a lot of discussion by mental health professionals on the benefits of establishing (and sticking to) routines.  They say that routines give a structure and natural flow to the day.  On the other hand, there is lots of advice ‘out there’ cautioning us not to get into a rut.  “We’re all guilty of it… We do the same old things day in, day out, socialize with the same people, visit the same restaurants and even go on holiday to the same spot year-in, year-out” said one site I visited.

So, where is the line between ‘rut’ and ‘routine’?  I thought about that this morning as I woke up here in Nyel’s hospital room.  “Four ayem.  Time for Tanner-the-lab-technician to come for a blood draw.”  And so, the day begins.  Predictable almost down to the minute.  Shortly after that, vital signs – blood pressure, oxygen level, temperature – and the scale is wheeled in for weight. Seven ayem: the day nurse is introduced, although during this six-day period there hasn’t been a ‘new’ one so it’s been more of a renewal of acquaintance and update of symptoms.

Velma, The Housekeeper

Eight Ayem: vital signs again.  Nine Ayem: the nurse brings medications.  Nine-thirty:  housekeeping comes to tidy up.  Ten-thirty: food service host comes for lunch order.  Noon: vital signs again and arrival of lunch.  Four P.M.: vital signs again.  Four-thirty: food service host comes for dinner order and next day’s breakfast order.  Six P.M.: dinner arrives.  Seven P.M.: shift change and meet the new (not this visit) night nurse.  Eight P.M.: vital signs. Nine P.M..: meds. Twelve Midnight: vital signs.  And the next day begins.

It’s the routine here at Emanuel and, by my reckoning, it’s all good.  Perhaps that’s what distinguishes it from a rut.  Maybe the rut is that Nyel seems to be on an endless cycle of hospital visits – also all good, too, but with of goal of breaking the cycle.  As I say… it’s confusing.

Day Five, Stay Seven, Legacy Emanuel

Tuesday, September 19th, 2017

Nyel and Nurses

There don’t seem to be many new faces in Unit 53 this time.  Nyel (and I, by default) knows most of the nurses and they all seem delighted (in an apologetic way) to see him again.  He gets hugs and (maybe) special attention and I feel like I do, too.  For Nyel, it’s showing him pictures of their dogs; for me, it’s keeping me supplied with cups of decaf coffee – all above and beyond the call of duty.

Several of the doctors on the Legacy Medical Cardiology team have checked in, too – each with a warm handshake and a “remind me when we saw each other last.”  It’s reassuring to know that there are weighing in on Nyel’s situation.  Of the sixteen M.D.’s listed in Legacy’s cardiology provider group, nine have dealt with Nyel at one time or other!

Nyel on a Walk

The plan for this visit is to stabilize Nyel – get his exacerbated congestive heart failure under control – and then to decide whether or not he is ready for a mitral valve replacement or, in fact, if that is the direction to take at all.  With the data that’s been gathered so far. some team members feel one way; some another.  It will ultimately be a group decision, Nyel weighing in, as well – maybe as early as Friday with the possibility of the open-heart surgery in the next couple of weeks.

Meanwhile, we walk the halls, meet other patients and visitors on the same ‘exercise program,’ spend untold hours napping (Nyel) and trying to stay focused on various writing projects (me).  There are many pleasant distractions during the day.   Day before yesterday the sous chef even came up from the kitchen to straighten out a mix-up in our dinner order!  The housekeepers, meal service employees, and electrical technicians also stop to chat, welcoming us back as much as you can ‘welcome’ a frequent-flyer patient.

Another Visitor

Speaking of “frequent,” Nyel has even proposed a sort of rewards punch card – nine visits and the tenth one is free!  Everyone thinks that’s a fine plan – but no-one has offered to pitch it to the powers-that-be who are probably, (bottom line) Medicare.  Speaking of which… the loudspeaker announced early this morning that the “Joint Commission” is visiting today and “Please welcome them.”

We asked and were told it’s a sort of inspection team, here to see if this is a good place for people experiencing chest pain to be.  Can’t speak to that specifically – Nyel has not ever experienced chest pain, thank goodness!  But we can certainly attest to this being a great place to be if a hospital is in your future.  If the Commission asks us, we’ll give Legacy Emanuel high marks!

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Names and Numbers

Friday, August 18th, 2017

Nyel’s Door

The more time we spend around doctors and hospitals, the more we realize how little we know.  I sometimes think we should all be born with an instruction manual attached.  One with an up-to-date glossary and lots of diagrams.  It almost seems like a cruel joke that in all of the millennia of human existence, we still are breaking new ground with regard to our own care and repair and — very few of us know even the basics.

Right now, for instance, we are waiting for a decision by Nyel’s doctor which will be based on the numbers revealed by his 4:30 a.m. blood draw.  We were told, within an hour of the draw, that the results show a reduction in numbers for both his INR and creatinine but, until the doctor weighs in, no one knows whether those numbers (especially the INR) have reduced enough.

We feel “very much accomplished” at this point just knowing a tad about ‘creatinine’ and ‘INR.’   Creatinine – a waste product that comes from the normal wear and tear on muscles of the body and can be used as one indicator of kidney function.  INR – an abbreviation for reporting the results of blood coagulation tests.

The Most Important Meal of the Day

Terminology is a steep learning curve in itself – never mind the numbers, levels, and upward or downward trends involved.  Like every other niche in life, the medical profession has its own vocabulary – most of which we lay-persons learn about on a need-to-know basis.

Terminology and  complex definitions notwithstanding, though, what it all boils down to for Nyel (and the part that concerns him the most!) right now is that the sign outside his door says NPO.  Translation:  Nothing by Mouth.  Further translation: nothing to eat or drink after midnight last night because a ‘procedure’ is scheduled for one o’clock this afternoon.  The big question is, has that pesky INR level lowered enough so that it’s safe for the procedure to be done.  And, if not, can he get some breakfast?

Nyel is a great believer in the adage, “Breakfast is the most important meal of the day.”  He is remarkably accepting of the NPO designation when needed but is feeling a little anxious that perhaps the procedure will not take place today, after all.  In which case, presumably, he can eat until midnight tonight and precious meal time is being wasted as he waits!  One thing for sure – there is nothing wrong with the man’s appetite!

Hunches, Inklings, and Glimmers… Oh My!

Thursday, August 17th, 2017

Ready and Waiting

Of the two of us, Nyel is the ‘just the facts’ one.  He’s not much for surmising or second-guessing, or speculating.  So, yesterday morning when he said, “…and you probably should bring an overnight bag…” I didn’t question his judgement. Meds, cosmetics, toothbrush, a couple of changes of clothes and my trusty computer went along with us to his appointment with his cardiologist.  When Nyel has a hunch, I’ve found it best to listen.

It was a regularly scheduled appointment but…   as it turned out, Nyel was absolutely right.  After a brief meeting with the doctor, he arranged for a bed in the cardiac unit at Emanuel Hospital and here we are.  Again.  Probably until Tuesday.  I think it’s the seventh time since last Christmas.

Solar Eclpise 1999

This time, the plan is to bring in a team of specialists and to run a series of tests to find out why in the world Nyel has been on this revolving door plan between hospital and home.  At the end of each stay here, everything looks good; a few days at home and not good at all.  Perhaps, the doctor says, it’s because one of his key meds is being delivered by IV in the hospital and orally at home.  Perhaps his system is having trouble absorbing the oral delivery. That’s his hunch, anyway.  And that’s what he hopes to determine.  We aren’t sure what that might mean but, presumably, if they can find out the cause of the problem, then a more effective plan for treatment can be developed.  We feel a glimmer of hope.

Meanwhile, as we watched the news last night we suddenly realized that we may well be here in the big city for the eclipse on Monday.  Damn!  I was planning to do a little chicken research that day.  I had thought that I’d park myself out by the coop for an hour or so on either side of the magic two minutes of totality and see what our girls do.  Will they go to roost?  And will they ‘wake up’ when the light level returns?  I’m pretty sure they will… but it’s just an inkling.  I’ve asked them, but they don’t seem to have a plan.  Or even know what I’m talking about.  Not a glimmer.

Safety First!

In a way, though, we are hoping for a late rather than early discharge.  We are thinking that the traffic coming and going from Portland will be unmanageable for a while.  And it could be a serendipity that the hospital’s helicopter pad is just off the cardiac unit.  We have gone there many a-time on Nyel’s obligatory walks through the hallways.  If it’s not in use on Sunday, I wonder if it will be a gathering place for elipse viewingg by staff and mobile patients?  Will someone have the solar-eclipse-viewing glasses-franchise?  My pinhole camera is the one thing I didn’t think to pack!

Birthday Balancing Act

Saturday, August 5th, 2017

Birthday Baoy

Our long-planned birthday excursion for Nyel – a traditional August 4th event – took an unexpected turn yesterday when his destination suddenly became Ocean Beach Hospital.  The balancing act between medications for his CHF (congestive heart failure) needed fine-tuning… once again!  But this time, his cardiologist thought that his situation could be managed here, rather than in Portland.  In the grand scheme of things, that was a big plus and we are hoping for the best.

Meanwhile… our plans to meet for dinner with friends had to be put on hold.  Our plans for our usual overnight adventure at the Tokeland Hotel had to be put on hold.  And, once again we reminded one another that things could be worse.

Let him eat cake!

We also noted that this hospital thing on special days is beginning to be a habit.  Nyel spent Christmas at Good Samaritan in Portland, my birthday at Emanuel Hospital (also in Portland and now…this!  Our 30th anniversary is coming up and we’ve decided to avoid making plans…

As it turned out, Petra and Michael came over from Astoria for a visit – brought him two big pieces of dark chocolate cake, and diverted us with stories about Michael’s photographing ventures on the Columbia.  We laughed a lot – the best medicine, as they say, though Nyel might argue that dark chocolate is right up near the top of the list, no matter what the heart healthy diet may say!  Besides, a birthday is a birthday!!

Birthday Bird

Jeanne Bellinger dropped in, too, and brought Nyel one of her little bird mobiles with a sweet birthday note attached.  (There are a lot of perks to being at your ‘hometown’ hospital and knowing most of the folks who work there!)  The bird is flying around near his bedside, tethered to an IV pole which, fortunately, is not needed right now.

Birthday Visitors

It seemed odd to drive home in the gloaming, all alone.  On the other hand, asking for a cot for a sleepover (as I do in Portland) didn’t seem appropriate or necessary.  And, Farmer Nyel was concerned about the chickens.  As it turned out, there was one perfect egg in the nest box.  Considering that the girls have been on strike for five or six days (maybe a work slow-down during the heat) I was pretty sure it was a birthday present for the boss.  I called him to say so and I could feel the smile from seventeen miles away.

We count our blessings!