I had a 6pm date with Dr. Swanstrom in the OR Thursday evening.
I spent the entire day at deep peace, listening to some great music, catching up on reading some of my blogs, walking, doing deep breathing, and patiently waiting. It was such a calm, peaceful day.
About noon one of the IV nurses came by to change my PICC line dressing – you know, the new PICC in my right arm that had been placed on Tuesday. He changed the dressing, did the routine measurements (to determine how far the PICC goes into the heart), said things looked okay and left.
Shortly thereafter the nurse came in to test my blood sugar. When you’re on TPN they put dextrose in your mix, so they have to keep an eye on your blood sugars, and then give insulin on a sliding scale for certain readings. Well, my level was a tad high, and the nurse went ahead and gave my recommended amount of insulin.
At about 4:00pm the IV nurse came back. He had this look on his face. The one that says he’s the bearer of news I might not want to hear. “It looks like your PICC has backed out of the heart some. We need to take another x-ray to see for sure.”
What could I say?
So, a few minutes later the portable x-ray was brought in and they got said x-ray.
At 4:30 we heard the word. It had slipped – somehow! – how?! – and it would have to be pulled back to midline.
When I got back from surgery I’d have to get a new PICC line.
Cause I’m on TPN.
And you can’t do TPN on a midline.
So I had to get a new PICC line.
Yes, I asked if they could do it while I was still under.
At about 5:15 pm the new IV nurse arrived and backed the line out to midline and said she was sorry. They stopped the TPN, flushed my midlines, and it was time to wait some more.
It was about then that I realized I felt kinda weird. Shakey. Was having a hard time concentrating. My vision seemed – spotty? It reminded me of something… what was it? I wracked my fuzzier by the moment brain until I thought… “OH YEAH!” and pressed the button for the nurse.
She came in and I asked, “Could you test my blood sugar?”
“You okay?” she asked as she went to grab the glucometer.
“I’m not feeling so good.” My hands were really starting to shake.
She tested my blood – and looked up at me. “Yeah, it’s a little low! 52!” And she bustled off to get a straight dextrose boost.
“We should have planned this for earlier in the day when we had more time, huh?” I asked.
Moments later they came to take me to the OR.
Only I couldn’t go yet – we had to make sure my blood sugar was stable enough.
Oh no! Dr. Swanstrom was having to wait for me!
They finally got everything where it was supposed to be and off I went. It was about 6:30 pm.
I remember getting to the OR. I remember them telling me that if the procedure didn’t work they’d just call it a day and then we’d talk later. I remember saying that was a plan I felt comfortable with. I remember them giving me Versed, and I remember saying, “Night night.” And then I went to sleep.
I remember waking up in recovery. I remember thinking, “Shouldn’t I hurt?” My throat was dry and sore – to be expected after an endoscopic procedure. But I felt – remarkably just fine. You know, the normal shakes cause you’re cold, the normal post-anesthesia fog, the normal “take deep breaths” coaching when the pulse oximeter rats you out for shallow breathing. But no pain.
I wondered if they’d been able to do the procedure.
I wondered if they had, had it been successful.
The recovery nurses went through their check lists and I was eventually sent back up to my room. It was just shy of 11:00 pm.
John was there – he’d spoken with Dr. Swanstrom at 10:30 pm. They’d been able to do the repair. The procedure had been successful, they believed. The proof would be in the pudding. He told John that they’d start me sipping on clear liquids on Friday, then on to full liquids by later in the day. They’d eventually wean me off of the TPN, and they’d decide if I needed to be on antibiotics any more. He thought I might be discharged sometime over the weekend.
So John gave me a kiss – had to go pick up various kids at various locations – and go to work the next morning – and was on his way.
My nurse, Liz, was a gem. She got my vitals done. She took one look at me and said she’d be right back – and back she came with an emesis basin, and sure enough I started to dry heave. She quickly got zofran on board, and bathed my head with a cool washcloth. She got me up to go potty. She spoke soothingly to me. In short, she was an angel.
And then she said, “Now that you’re settled, I’ll call the IV nurse to come place your new PICC line.”
I asked if I could have some pain meds to go with that. She smiled and said, “Of course.” That was about 11:30 pm.
In just a few minutes a very nice IV nurse came and placed my new PICC line – back in my left arm, where it had just been a couple of days before, only up the arm just a tad so as to not bother the spot where the previous one had been. Yes, it hurt. But I was brave.
She left the guide wire in – as they always do – so x-ray could come and determine if it was placed appropriately. X-ray was called. That was about five to midnight.
Things take longer to get done in the middle of the night in the hospital, sometimes. Rather than there being teams of different specialists available, there are maybe one or two specialists for much larger portions of the hospital.
And so I waited.
About 45 minutes later x-ray still hadn’t gotten there.
Liz the fabulous nurse called to inquire why the heck not.
They arrived moments later, apologetically.
Duly x-rayed, and then off they went to find a doctor to interpret the results. That takes longer in the middle of the night, too.
By 2 am the news was back. The line wasn’t in far enough. But that was okay, they assured me – that’s why the guide wire was still in there – so that they could do just that very thing.
By 2:30 am the next IV nurse arrived. His name was Skip. He seemed like a pretty nice guy. He explained what would need to happen – it would have to be almost like getting a new PICC in setting up – cause it had to be sterile – only it wouldn’t hurt, it would take just a few minutes after quite a bit of set up to get the line advanced, and then there’d have to be another x-ray.
The line wouldn’t advance.
I knew before he even told me. They’d have to remove this not quite PICC and place another one.
Have I ever mentioned to you that I don’t really like needles or IV’s? That getting a PICC line kinda flips me out?
So Skip – in his very calming voice asked if I might need a little additional pain medicine.
Smart guy, that Skip.
I said yes.
They got me a hot blanket. Always give me a hot blanket if you want me to relax. J
And then Skip said, “I want you to know that I take my time – my goal is that this be a completely pain free procedure for you.” I was liking Skip more and more. By then it was about 3:30am.
Suffice it all to say that by 4:30 I had my very first completely pain-free PICC line placement – in exactly the right location according to X-ray.
I got to sleep! I remember glancing at the wall clock at 4:40 am just as I drifted off.
At 6am the nurses on the floor were doing vitals and woke me up.
At 6:15 am the docs started coming through. Lots of docs. They wanted to see how I was doing after this landmark repair. They asked lots of questions. And they started saying surprising things:
Start sipping clear fluids this morning.
Might discontinue antibiotics – all of them.
Might go home on the weekend.
Should do fuller liquids by afternoon or evening.
Consider trying a regular diet.
Taper off of TPN.
One set of doctors would say one thing, another a similar set of things. I would ask questions like, “Has anyone talked to infectious diseases yet? Dr. Crislip is my doctor. Will I go home with a PICC line? Shouldn’t I baby step back into foods? A week of simpler liquids, a week of fuller liquids, a week of soft food?”
They pretty much ignored me.
The two Fellows who work with Dr. Swanstrom came in last and actually sat down to talk WITH me instead off amongst themselves. They said…
- Let’s get you sipping clears this morning.
- You can have anything that’s clear, no carbonation. (I assured them that wouldn’t be a problem.)
- You can have lozenges. (Sore throat is my only discomfort.)
- You should have fuller liquids if you tolerate the clears fine.
- We’ll ask about the antibiotics.
- We’ll probably taper you off of the TPN and try to get you home by Sunday.
Yes, similar, but more definitive. They actually stopped to write orders, too.
So I started with herbal tea. And lozenges – which, honestly, I’d probably never normally do – but darn it all if they don’t help!
Can I confess that I feel like a bit of a weenie?!
I’m afraid to go to fast. Slow seems so much wiser to me – to give the gut time to heal and reinforce itself with the formation of some scar tissue. You know?
So all day Friday I worked on sipping slowly. (Teaspoon sized sips, spaced out about every 3 to 5 minutes.)
I learned that hot was way better than cold. My poor throat. It feels like they drove a Howitzer down there. Heat is definitely good.
I got broth with lunch – it went down fine.
I walked about once an hour.
I had some wonderful visits with friends who came by.
And I was tired. Really, really tired. I guess getting an hour and a half’s sleep really doesn’t cut it.
I tried to nap.
People (chaplain, cleaning lady, etc.) kept coming in and waking me up.
I finally gave up and decided to hold out for bedtime.
All the docs came around again in the afternoon. Still saying all the same stuff. There was an order given to discontinue all of my antibiotics – they figured it was a good way to see if everything was sealed off down there in my gut. If I spiked a fever again – back to the antibiotics I would go.
Everyone decided it was too soon for a CT scan – they didn’t think my gut would be ready for the contrast quite yet. But there would be one in my future – a couple of weeks down the road maybe.
They said, taper off the TPN, home by Sunday. But no one wrote the order.
Dr. Swanstrom’s Fellows came by and told me to try fuller liquids now – stuff like cream of soups, ice cream, that sort of stuff. They said fuller stuff was less likely to work its way through a leak or fistula, so fuller liquids and even soft foods would be a good thing.
So I tried cream of mushroom soup – other than being really bland and kind of disgusting straight out of a can, it was tolerated well. And then later on I tried orange sherbet ice cream – it was fine. No problems.
So here it is Saturday morning. I actually got some sleep last night. I definitely feel more rested.
They brought me a scrambled egg for breakfast. I ate one bite. Lord – the food is bad here. If they want me to eat food – couldn’t they send me GOOD food?! Prepared by someone who knows how to cook? Please?! So I’m sipping my horrible tasting apple juice, and fabulous tasting mint tea.
We’ll see what the day holds.
I’m cautiously optimistic.