Archive for the ‘Nyel Stevens’ Category

Oysterville Never Looked So Good!

Monday, May 20th, 2019

Our Southeast Corner

There’s nothing like home when you’ve been away!  And if your home is Oysterville, Washington, and your return is in the merry month of May — it is lovely beyond belief!  Gigantic rhododendron “bouquets” nod at me from every direction.  They are early this year and the brisk wind is causing the blossoms to cascade to the ground in pools of bright pink and snowy white.  Only my beloved Nyel is missing to complete the perfection of Springtime in the village.

Tucker put the flags up in the churchyard this afternoon.  I didn’t realize how much I had missed them all winter.  I feel like they are my personal weather vanes.  Each time I look out our dining room and kitchen windows, I know just how the wind is blowing!

Flags Flying May 20, 2019

On my walk about the garden, I purposely avoided looking at the flower beds.  I doubt that I’ll ever be able to make up for this month of absence.  If only I could train those chickens to weed!  Never mind that the weeds must be forest-like to them, towering way above their heads.

I left Portland at first light — about 5:3o this morning — and arrived in Ilwaco in plenty of time for my early doctor’s appointment.  Then, the mail which revealed an overdue bill (and late fee) — wouldn’t you know? — but several nice notes for Nyel, too.  They are lined up on the table ready to take back with me tomorrow.

We had hoped that all Nyel’s “surprises” were over but… no such luck.  When the surgeon cleaned up his “wound” Saturday night, he sent in another blood sample for culturing.  We prayed that it would reveal nothing new.  But alas!  Nyel called with the news that it is another infection — a bad one — not what they thought it was yesterday.  Whatever it is, hospital personnel are all required to wear “hazmat regalia” so that they will not spread it around to other patients.  Nyel says visitors are not required to “suit up.”

Our Northwest Corner

So, talk of swing beds and rehab are tabled for this week, anyway.   Sorry if I offend anyone but… shit! shit! shit!  Worst of all, along with this new infection comes great pain.  He is getting morphine periodically.  I hate being here and not there; I return early tomorrow.  Yet I know I will feel helpless there, as well.

Complicated and Mysterious

Sunday, May 19th, 2019

Nyel – May 19, 2019

Day 24 — Ever since the swing bed facility at Ocean Beach Hospital refused to accept Nyel, he’s been known here at St. Vincent’s as “complicated.”  The term is used somewhat affectionately by the doctors and nurses who have worked with him over the last few weeks, dealing first with one issue and then with the next.  No one denies that he is, indeed, complicated, and they also have some understanding of the limited size and capability of our little hospital.  Even so, it would still be our first choice of places for Nyel to gather his strength for eventual homecoming.

But, we are also resigned.  His heart issues are complex enough and with no cardiologist on the staff of OBH, safety becomes a challenge.  Because of the removal of his entire hip joint and the ensuing need for a wound vac plus the additional evacuation of a hematoma  and shoring up of the wound site he has required orthopedic doctors and wound care specialists — also probably not available at Ocean Beach Hospital.  Complicated.

Add to that  the PICC line that goes from his right arm directly into his heart to deliver the antibiotics that are fighting his MSSA infection.  (To say nothing of today’s news that his recent surgery has revealed yet another infection.  Fortunately, this one not is not a staph infection and his antibiotic has been changed to one that will deal with both problems.  Very complicated.

Physical Therapy

I’m not sure if Ocean Beach hase an orthopedic doctor or an infectious disease doctor on staff, either; probably not.  And then there is the entire issue of physical therapy for a man with one seriously impaired leg who has been almost totally inactive since February 28th.  Yes.  Complicated to the max.

Now, added to the “complicated” descriptor is another, even more intriguing adjective:  mysterious.  That is one word that I’ve never really considered when thinking about Nyel.  The closest I might come to such a description is probably “the strong, silent type.”  I guess the silent part could indicate mysterious, although Nyel has always maintained, “what you see is what you get.”

Here at the hospital, his mysterious side has more to do with his reactions to certain medications.  Not only that, but his rather erratic reactions to certain medications that heretofore followed predictable patterns.  His blood pressure is one such mystery — it continues to plunge to unacceptable depths — but only in the mornings.  Each health care professional has a different explanation and, one by one, the obvious “fixes” have been tried and found lacking.  “You are a man of mystery,” they tell him.

Ultrasound

Another mystery seems to be why it’s his right leg (which is his good leg) that has swollen up to an abnormal degree, perhaps due to the fact that diuretics were withheld for some days before and after various surgeries.  “Probably.”  But his “bad” (left) leg has remained far less swollen.  “Hmmm,” said several of the doctors.  Finally, one of the cardiologists ordered an ultrasound to see if, possibly, he has developed a clot.  That mystery, however, will not be addressed until tomorrow (Monday.)  “You’re not supposed to get sick on weekends,” teased today’s nurse.  “Not in the hospital, anyway.”

Meanwhile, Nyel is feeling better than he did a few days ago.  His appetite is fairly good.  He is eager to work on some specific therapy goals — like transferring from bed to wheelchair to commode and back again on his own steam — without the use of Sara Stedy.  Those are things he will need to be able to do on a regular basis, once he gets home.  The hospital staff may consider him complicated and mysterious.  I say, he’s determined and forward-thinking.   Thank goodness!

 

 

 

 

 

Déjà vu At St. Vincent’s

Saturday, May 18th, 2019

Ready for Surgery #4

DAY 23 – Nyel got back to his room about 2:15 a.m. after yet another surgery – this time to clean out the site of his last surgery.  The surgeon evacuated the large hematoma that had formed, cleaned everything up “down to the bone” and took care to stitch him as tightly as possible, hopefully to prevent formation of another hematoma. During the initial surgery three weeks ago, they were unable to do such a great job because “things got very dicey” and the surgeon had to close him up very fast.  Nyel still has a wound vac but now, please god, it will be able to keep the wound free of excess blood…  His blood pressure is scary low and they’ve ordered two units of blood… But bottom line:  Nyel feels great and looks oh so much better.  And his appetite is back!  Yay!    So… I’m taking a bit of time to reflect on the last few days here at St. Vincent’s.

On Thursday, when Nyel agreed to the orthopedic surgeon reopening his surgical site, Nyel asked if a cardiologist would be involved.  He had a question about his blood thinners relative to the procedure and afterwards.  The nurse wrote his question on the white board.  By morning the question had been erased.  No cardiologist had seen or talked to Nyel so we put another question on the white board:  “Will cardio be involved in surgical decisions?”

Life-saving Fluids

About 10:30 a.m. an orthopedic P.A. came in to have Nyel sign the surgery consent form.  Nyel asked him if a cardiologist would be able to weigh in.  I wish I had tape recorded his gobbledygook answer.  The only part that is indelibly etched on my mind are these sentences:  “Well, even though you are on the cardiology floor, the orthopedics people check with you every day; the cardio doctors do not.”

So???? Nyel and I weren’t sure what that meant.  It sounded a little (no…make that a lot) too competitive to me.  The  P.A. had also mentioned that the cardiologist on duty today was on “the orange team.”  What the hell?  I wondered if Nyel is considered the football, the shuttlecock, the hockey puck or what.

As it turned out, the cardiologist was in surgery and did Nyel want to postpone his “procedure” in order to talk with him? That could mean, of course, the P.A. pointed out, that Nyel’s surgery would be postponed, perhaps until sometime next week…  I’m sure he was just stating the facts but it sounded a bit like a threat of some kind to me. “No,” said Nyel.  “Let’s get on with this.  But, if the doctor is out of surgery before I go in, I’d still like to see him…”  I knew he was thinking, as was I, for god’s sake, get me outta here!! Soon!”

Nyel Listens to Instructions

What is it about this hospital, anyway?  We are both totally convinced that the reason Nyel is here at all this time around is because we could NOT make ourselves heard back in February when we requested a consultation with a cardiologist.  And here we are again…

Postscript:  Nyel did not go to surgery until 8:00 p.m. last night.  The cardiologist did not show up.  It is now 10:15 the morning after.  The cardiologist has not shown up.  His assistant popped in a few minutes ago and said that “the doc” is still trying to get in here.  Yeah. Sure. You Betcha!

 

Nyel: NPO Again

Friday, May 17th, 2019

Day 22 at St, Vincent’s this time around — This was to be Transfer to Providence Seaside Swing Bed Day. Operable word: was.  Instead, it’s NPO day — NPO is hospital speak for nothing by mouth — a medical instruction meaning to withhold food and fluids. It is from the Latin phrase nil per os which, translated literally means “nothing through the mouth” and is usually the order given when surgery is anticipated.

By nine yesterday morning, Nyel’s discharge plan was in place.  He would be transferred to Providence Hospital, Seaside about two in the afternoon.  At tennish, one of the orthopedic PA’s came in to check his wound vac.  She had been in several times before and seemed efficient and clear about conveying information to us.  Before she left I asked her about the amount of blood being sucked into the wound vac cannister — “It seems to be increasing…”  and I asked about its color — “It seems lighter, not dark like we were told it would be.”

She reassured me on both counts (or tried to).  We had been told initially that there would be less and less blood except when he was moving and that the blood would be very dark (almost black) because it was “old blood” from the hematoma, not “new blood” fresh from the wound site.

Two hours later, she was back with a (new to us) orthopedic doctor who was seeking Nyel’s permission to do some more surgery.  “I thought about what you had asked me,” the PA said, “and I took a long look at Nyel’s charts and at the numbers.  I think your concerns were correct.  He may be bleeding from the wound site, itself, and not just from the hematoma.”

  

Apparently, there had then been a consultation among surgeons and other ortho doctors, the cardiac people had been consulted, and they were all recommending going back in and closing Nyel up more securely — doing what could not be done three weeks ago because he was in danger of dying on the table.  “There will be no bone involved this time,” the doctor said.  “Just tissue.  He should be fine and it will make a huge difference in his healing. Plus,” she reminded us, “he did fine when they removed the pacemaker after his initial surgery.  This one will be a similar sort of surgery — nothing like the initial one when they were removing hardware and infection from the bones.”

So… Nyel had to give up the swing bed situation.  At this point there is no projected discharge date — it all depends upon how it goes — when they can put him back on blood thinners and diuretics for his heart and any other meds they have put on hold until he recovers sufficiently from this latest surgery.  Then, and only then, will he be back to square one (or is it two or three?) in terms of getting out of here.  As always, Nyel is stoic — the most patient patient ever.

 

Twenty-one Days and Counting

Thursday, May 16th, 2019

The Hub

If I were clever like Mary Garvey or Wes Weddell or Larry Murante or Andrew Emlen or Cate or Fred or our neighbor Tucker… I’d write a song.  I don’t know if it would be a lament along the lines of “Danny Boy” or a ballad like “The Sloop John B” or more likely a nonsense song like “I’ve Got A Lovely Bunch of Coconuts.” Only the subject is clear in my mind — the trials and tribulations of the patients at St. Vincent’s.  Although, I’d probably call it St. V’s for the sake of the rhyme scheme.

I think there would be  a verse dedicated to each of the hospital hurdles we’ve encountered — the rules, the hierarchy of doctors, the inconsistency of nurses, the push and pull among therapists, the ever-changing dietary limitations for starters.  The chorus, of course, would be about mysteries of communication under this roof.  Perhaps the title should be something like “And Don’t Tell the Patient Anything at All.”

Command Center

I’m pretty sure it’s not just us.  Yesterday, as I waited for the elevator, a woman was pacing back and forth nearby talking on her cell phone.  “Thirteen people have been in to see her this morning.  They all said something different.  Two of them were doctors.  They said something still different –not what any of the other thirteen had said and they didn’t agree with each other, either.”

I was so tempted to weigh in with Nyel’s experiences.  But… none of my business.  If I’d already had my song written, I’d have broken into the rollicking chorus.  (I do think it needs to be rollicking, don’t you?)  Stay tuned, as they say.  A Hospital Hit is in the making!

 

My Aunt Mona and Sara-Stedy

Tuesday, May 14th, 2019

Mona, circa 1920

My Aunt Mona, whose full name was Ruth Muriel Espy, was the most different of my mother’s siblings — at least the most different of the ones I knew.  Albert, Medora, and Sue all died before I was born, but Mona lived until she was 68; I was 32.

Mona always thought of herself as the “ugly duckling” of the family, not because of her looks, but because she considered herself the least intellectual and the poorest student in a family that valued education above all else.  She was petite, scarcely five feet tall, with luxurious auburn hair, envied by every girl in the family.  Following high school, she attended Washington State College in Pullman where she studied nursing and worked as a practical nurse on and off throughout her life.

Mona spent much of her adult life in Southern California, was married and divorced twice, and had no children.  She became interested in politics and, like Papa, was a devoted Republican.  One of her prized possessions was a letter signed by President Eisenhower, himself, thanking her for her work as a committee chairman for his 1952 presidential campaign.  After Mama’s death in 1954, Mona moved to Oysterville to care for Papa.  Mona spoke of herself as “Papa’s girl” and, certainly she took after him in many respects.  She was loquacious, gregarious, and could readily to relate to folks from every background, every walk of life.  Her funeral in 1972 had the largest attendance in Oysterville’s history.

We (and by that I mean the family) thought of Mona as “a character” — but in a good way.  One of her passions was gadgets — especially kitchen gadgets — and, even though we moved into the family house more than twenty-five years after her death, there were still dozens of ‘reminders’ of her passion for every conceivable effort-saving (or spending) contraption.  I’m sure there are still melon ballers, jar openers, egg separators, and thermometers for cakes, meats, candies, etc. still lurking in the cracks and crannies of the house.

I thought of Mona-the-Nurse and Mona-the-Gadget-Lover when Nyel was introduced to Sara Stedy® the other day.  Says the website:  Sara Stedy® is a new enhanced standing aid, builds on the success of Stedy, a proven mobility-promoting support aid that encourages more mobile patients and residents to stand up independently. … The innovative pivoting seat improves transfer efficiency and patient stability.  It works slick as a whistle in getting someone with no hip (and therefore very little mobility) moving from one place to another.

Sara Stedy®

Out of curiosity, I looked on Amazon and found that Sara Stedy® and her many cousins are readily available for prices from sublime to ridiculous.  Fortunately, we think Nyel will be able to gain enough strength in his good leg and his arms and shoulders that he can manage from bed to wheelchair and back again by the time we get home two or three weeks from now.

Meanwhile…. we might be on our way back to the Ocean Beach Hospital swing bed situation as soon as tomorrow!  Cross your fingers for us!  It all depends upon bed availability!

The Comfort Zone

Sunday, May 12th, 2019

On A Scale of One to Ten

Well… it it ain’t one damned thing… Yesterday, Nyel spent the day in agony.  Not hip pain.  Belly pain! And, if you’ve been following along (bless you!) that’s what got us here in the first place.  Two months of pain meds for the hip repair equalled serious constipation despite all meds and efforts to the contrary.  Finally, in desperation, he went to the ER where an X-ray of the belly revealed that screw that had worked its way from the hip hardware through the bone… and he is still at St. Vincent’s in Portland seventeen days later.

Gradually, things are getting better.  As the Doctor-of-the-Day said to Nyel this morning, “Well, you’ve made it through.”  A little disconcerting to hear, in a way, but encouraging, too.  However, everyday brings something new.  Like yesterday’s pain.  Today, the pain is better although the problem has not been resolved, but his blood pressure plummeted to 72 over 39.  Scary.  It’s on it’s way up as we speak, thanks to IV liquids and holding off on his diuretics.  Another “balancing act” on the tightrope to stability.

I, on the other hand, have been leading the Life of Riley.  I have been staying at the Providence Guest House just across Barnes Road — a reasonably-priced, bare bones sort of motel.  There’s a microwave in which I can zap my evening meal and a TV upon which I have discovered an oldies-but-goodies channel.  Last night it was mac’n’cheese and three or four episodes of “Hazel.”(Remember Shirley Booth and that early 19e60s sitcom?).  Talk about an evening of complete (well, almost) relaxation.  Pretty close to  ‘Comfort Zone Heaven’!  Now, if we can just bust Nyel outta here…

Getting My Irish Up as in Trying Not To

Thursday, May 9th, 2019

I grew up thinking I was “Scotch, Irish, and English.”  Later I learned that scotch was something to imbibe and “Scottish” was perhaps a better choice of words.  Still later I learned that the Irish part was wrong, too.  When I visited Enniskillen in Northern Ireland in the 1960s, I not only found my “Irish” Little relatives, but was told in no uncertain terms that we were English, not Irish.

I don’t know about the Espy side — they, too, were from Northern Ireland and they, too, had arrived there from England during one of the potato famines of the 18th or 19th centuries.  As far as I can tell, they (like my Little forebears) were there for several generations but whether or not that qualified them as “Irish” I don’t know.  And, I don’t know if, perhaps, marrying a thoroughly vetted Irish colleen or perhaps an Irish crofter would count for anything.  I have the feeling that if you had a drop of English blood, you were never to be considered Irish.

It reminds me of the story a young man from Naselle told me.  His parents had moved there when he and his siblings were little.  After fifteen or twenty years, his mother asked an old-timer how long she and  her family would be considered “newcomers.”  After considerable thought, the answer was:  “Until the last person who remembers when you came here is dead.”

All of this flashed through my mind a bit when a caregiver came into Nyel’s room and said she wanted to talk to me about getting Nyel out of here — not this week, of course, but next.  She said that they would not consider sending him home yet (with which we heartily concur) but they were also not much in favor of sending him back to a small rehab place “on the coast.”  She went on to say, “We did that last time and, yet, here he is again!”  To say I was instantly furious is an understatement beyond comprehension.

My Irish was definitely up.  “That certainly wasn’t the fault of the facility where we were,” I said.  “That can be attributed directly to the care Nyel received, or actually, didn’t receive here in the first place.  Have you read his chart?”  I really wonder if I didn’t say all that with a very thick Irish brogue…  She backed down immediately.

I also said that I thought it was paramount to Nyel’s healing that I be nearby and that we also need to have our wonderful community to give him support.  She did not argue.  I assured her that we could get him back and forth to see the doctors here, as needed.  Perhaps she was convinced.

Our first choice is the swing bed situation at Ocean Beach Hospital.  We have our fingers crossed.  She said they had been trying to get another patient admitted there (Really!!  Who??? — but I knew better than to ask.) and, thus far, there was no availability.

“It’s early days yet,” I said.  “Perhaps something will open up.”

“Perhaps,” she said.  “If they will take him.”

“D’fheidhmigh siad go maith níos fearr!” say I!

Ins and Outs, Up and Downs

Monday, May 6th, 2019

Farmer Nyel – A Few Summers Ago

I was deep asleep in a real bed at the Providence Guest Inn last night when my cell phone rang.  1:26 the readout said.  The doctor on duty said she thought I should know that Nyel was experiencing some serious, unexplained bleeding…

Fifteen minutes and I was in his room.  They (four of them)were re-wrapping the “wound-site” (read: where his surgery had taken place a week ago), the bleeding had stopped, his vital signs looked good, they were working on pain control, and they were continuing to evaluate.  Nyel said I’d missed the “big show” — said there were a great many people in his room for a while.  He, of course, asked the doctor not to call me.  I’m so grateful she did (and, Nyel said with a big smile, “So am I.”)

Basking Nyel — A Summer or So Ago

“They just gave you a unit of blood earlier today,” I reminded him.  “Guess I didn’t really want it,” was his response.  The tension in the room dissipated somewhat…

Nyel slept for an hour or two.  So did I.  The cardio-mem technician came and got a reading on his heart pressures.  The ultrasound technician brought his portable machine and took a reading. Or a picture or whatever. As we speak ,the wound-specialist team is here looking and evaluating.  A surgeon (the one that did his first surgery in March) will come in when he can (between other surgeries) to weigh in.

For my part — lots of watching, listening, waiting.  Nyel is tired, dozes when he can, and is generally stoic, as always.  We both thank all of our “followers” for their interest and good thoughts and I, especially, apologize for not being in touch with each of you, individually.   Your concern and your messages have been a wonderful solace through all of this.

 

Coming to Consensus

Sunday, May 5th, 2019

They say “too many cooks spoil the broth.”  We hope to hell #1 that 20+ doctors are not too many and #2 that hospitals and kitchens are in no way comparable.  Now that Nyel’s care is being fine-tuned for possible discharge, we are eagerr for all of his caregiving teams to agree on next steps.

In general, everyone wants him back on the dosages and protocols that he was following before coming into the hospital.  But, of course, his body has undergone changes — loss of bone (and height!), increased degrees of heart failure and kidney dysfunction, etc. etc.  In addition, his blood pressure is not coming up as “they would want” and how to address that problem is one of many other “details” under discussion.

At best it is nuts-making.  At worst it is terrifying.  Who to listen to?  Who to believe?  Is it the doctor with the charming bedside manner who is most interested in Nyel’s comfort?  Is it the doctor who judges everything by the numbers (and believe me, there are dozens of them that they look at before and after every bit of input, output and putt-putt!)  Or is it the doctor who seems to feel experimental — sort of the do-this-and-wait-and-see approach?

And, of course, there is the most basic of all considerations — how does Nyel feel?  Today — not so good.  Not nearly as well as he felt yesterday.  Again, everyone weighs in with a different idea as to why.  Fortunately, opinions are somewhat limited as it’s Sunday and there don’t seem to be as many doctors on duty.  Or maybe they are out celebrating Cinco de Mayo.    I surely wish we were!