My mother is ill

[Kaisu]

Hey all

Once again, I am writing to purge my experiences over the last week or so.

I live in Arizona - my mother lives in Thunder Bay in Northern Ontario. She is 80 years old and lives alone, but in a building full of people of her generation, and more importantly, ones that speak her language. After almost 50 years in Canada, she has never managed to learn English. Thunder Bay, at one time, had the largest concentration of Finns outside of Finland in the world. Her family physician speaks Finnish, as does her dentist, pharmacist, grocer, church, etc. etc.

I was visiting her last June and noticed a clear cardiac problem. Mild exertion left her short of breath, diaphoretic and grey. She has always avoided doctors but I convinced her that if she was my patient, we would be heading for the hospital. She never spoke a word about the chest pressure that often accompanied these symptoms. She consented to make an appointment with her family physician. I wrote a letter to her family physician, who set her up with a cardiologist.

At the beginning of December, my mother had an angiogram, which almost killed her. They had problems controlling the femoral bleeding, which necessitated a hospital stay as well as a return trip a couple of days after discharge due to pain, swelling and serious bruising.

The angiograph confirmed mitral valve regurgitation and a minor blockage in one of the smaller branches of the right coronary artery.

My mother is 80 years old, has been in controlled afib for about 5 years and with her decreasing cardiac capacity, has lost most of her muscle mass. She is malnourished (although obese), anemic (blood loss) with renal and hepatic insufficiency and relatively severe osteoporoses. Her measured ejection fraction was 38%. She has pulmonary hypertension and CHF. Just under a year ago, she almost died from an uncontrolled GI bleed, not calling for help until she just couldn't move anymore. On paper, she looked like a really bad surgical risk. In Ontario, the heart center is in Hamilton. The surgeon came up to Thunder Bay just before Christmas. He told me that he had decided against taking the case, but when he met her, he changed his mind. When I asked him later why, he couldn't articulate it. He said she had a "spark" and felt she deserved a shot.

I was on the second half of a 48 (with about 3 hours of sleep) when I received a phone call that her mitral valve replacement was in 3 days. I did not have time to go home and get to the airport in Vegas. When I got off shift at 8:00am on Saturday morning, my husband had driven the hour from where I live with some clothes and other travel essentials. He had booked and paid for a flight from Vegas to Minneapolis to Thunder Bay. I drove to Vegas, where I discovered they would not let me on the plane because I did not have a passport. (Thank you Al Qaida) I am a Canadian citizen and a legal US resident for 12 years. My expired Canadian passport is in Wisconsin (where I have a second home).

The would not allow me to fly to Minneapolis either. Apparently that is called "short-checking" and is against the rules. They did allow me to purchase a second full fare ticket from Vegas to Minneapolis but they had a heck of a time assigning me a seat on the full flight. I told them that they didn't need to assign me a seat as I would not ask myself to move from the seat I had been assigned to on the original ticket. The logic of this eluded them. Bottom line, I got on the plane. I was asleep in my seat before we even finished boarding.

In Minneapolis, I rented a car and drove the 7 1/2 hours to Thunder Bay. The customs officials on the Canadian side were more than accommodating, waving me through and even wishing me luck. (My husband had called them and explained the predicament.) I slept for a few hours, then accompanied my very ill mother on a flight from Thunder Bay to Toronto, where we spent the night, then drove to Hamilton, where my mother was admitted pending surgery the following afternoon. I contemplated the very good chance that she would not survive the surgery.

A three hour surgery stretched to five and a half hours. The mitral valve was replaced. The tricuspid needed to be repaired and my mother's heart was so enlarged that her fossa ovalis was patent. Her measured ejection fraction of 38% was in reality a functional fraction of approximately 20%. The surgeon repaired the septal defect. Mother had no veins in her legs that could be harvested for the by-pass. The surgeon decided to close her up and take what he could get.

I saw my mother an hour later in ICU. She had the ET tube, 4 chest tubes, a central line, a Foley, etc. etc. etc. I had her dentures in my purse and her tongue was lolling out of her mouth. I couldn't help myself - I burst into tears. I'm glad she was unconscious. (I told her the next day that she looked like a Chinese Crested Hairless)

My mother has had a lifetime of defying expectations. Her ET tube came out around midnight and her chest tubes were removed the next morning. I finally got in to see her around noon. She looked at me and said "When are they doing the operation? I've been waiting an awful long time." I laughed and told her the surgery had been done the day before. She was amazed. "Well no wonder there is blood on my chest" she said. She told me that she had expected to wake up in heaven. I told her "so sorry - you are in Hamilton" (if you've ever been to Hamilton, especially where the hospital is, you will get the joke).

That afternoon, I got news that a family member, 37 years old and the father of two young children, had been killed in a freak industrial accident. He is being buried today. I could only manage to briefly acknowledge my grief. I will deal with that when this mess is over. My husband, God bless him, is taking care of our responsibilities on that front.

In sinus after the surgery, I observed my mother's rhythm deteriorate over the next day and a half. She went to 1st degree AV block, then a junctional rhythm of about 60. Amiodarone and Milnarone were discontinued to no avail. She finally had to be paced with an underlying ventricular escape rhythm under 20. I was in the room when I noticed the pacemaker malfunctioning with repeated non-captured spikes. I also saw spikes landing on the T wave. My mother became nauseous. I had to drag an ICU nurse over to look as she would not accept that a patient's relative actually had a clue. The pacemaker was replaced. Mom is throwing the odd multifocal non-perfusing PVC (and once in a while a couplet) which throws the pacemaker off but overall the pacing situation is in hand. There was the possibility that as her post surgical cardiac edema subsided, her AV tissues would recover. They have not. Mother will be having a pacemaker implanted tomorrow morning.

I was looking over my mother's records. One of the nurses had noted positive for dementia. My mother is sharp as a tack. Just because she doesn't speak English and often misunderstands what is being asked of her does NOT mean she has dementia. When I challenged the nurse, she went crazy on me because I was not allowed to look at the records without a physician being present. I am bending over backwards to not challenge them and to make a small a nuisance of myself as possible. Some of the better RNs actually welcome my presence because I can translate and I help with her care. Others are threatened.

If you are still reading - thank you! You have no idea how much it helps me to publish these meanderings and get your input and comments. It keeps me sane. (and no smart ass comments about my sanity or lack there-of thank you very much)

[DwayneEMTP]

Yikes...it sounds like you certainly have your hands full. I'm sorry to hear of your troubles.

God's speed to you and those that you love. Keep your chin up girl...

Dwayne

[fireflymedic]

Hey gal -

Well wishes and prayers being sent your way for healing, protection, and comfort. Hang in there and vent whenever you need to !

[Eydawn]

Lots of love and prayers coming your way dear lady. I'm so sorry to hear about what a giant mess this has all been. Please, if there's *anything* I can do to help you out (and you know it's not idle talk from me) you just email me and let me know.

Stay strong, dear woman! God doesn't give us anything we can't handle.

Love,

Wendy

[joesph]

My father went threw 6 weeks in CICU after a unsuccessful bypass surgery and I can sympathize with your problem. I think once the nurses get use to the idea of you being there they will be a good allies. They were for me.

[WelshMedic]

Onnea äitisi!

Your presence is only a threat to those that don't really feel confident enough as a practitioner, the good people will see you as an asset.

Carry on the good work, and don't let the b*astards get you down!

WM

[Richard B the EMT]

You mentioned the femoral bleeding following the angiogram? I had it, too, following angioplasty (Cardiac Stent), resulting in me being hospitalized a week after the procedure, for a week. They called it an aneurysm/inbleed.

When I needed another angiogram, they had an alternative entry point, via my right radial artery (at the wrist). No problems with the second procedure.

My grandmother had an AMS from, amongst other things, a high fever. The staff at the ER thought she was an 80 year old with some form of dementia, until my brother in law, working as an X-Ray technician at that hospital, told them in no uncertain terms, that he knew her, and the AMS was NOT her regular mental status (Thanks, Michael). Then, she was evaluated, the cause of the fever discovered, and treated. She was successfully discharged a week later.

However, due to the tale you just told about getting back up to Thunder Bay, and all that happened, now I have a reasonable idea why you call yourself the "C-Magnet".

I wish your mom better health, and offer condolences to friends and family of the deseased family member.

[DwayneEMTP]

...I had it, too, following angioplasty (Cardiac Stent), resulting in me being hospitalized a week after the procedure, for a week. They called it an aneurysm/inbleed.

Damn it! I had my money on you being dropped on your head as a baby!

(Hopefully obvious that that was meant in fun...You're a gift here brother...)

Dwayne

[Richard B the EMT]

Could having been dropped on my head made me the person I am today?

[cynical_as_hell]

hey girl i was told to send you a messege from johnnie and it states: "You always crack me up. Always, Johnnie." Can't wait for you to get home. I've moped around the station commenting on how it's just not the same without you and other things like "well if kaisu was here that never would have happened" and so on and so on. When I heard you were coming home I was at work, ran into the dayroom, and started cheering and dancing singing Kaisu's coming home, kaisu's coming home!!!!! Gosh I miss you girl. Glad to hear things are working out for your mom.