God is always working to make His children aware of a dream
that remains alive beneath the rubble of every shattered dream,

a new dream that
when realized will release a new song, sung with tears,

till God wipes them away
and we sing with nothing but joy in our hearts

--Larry Crabb

Saturday, February 28, 2009

Devastated. That is the only word that comes even close to how I'm feeling. The internist came by this evening to tell us the preliminary MRI results. Kim has severe brain damage in all major areas of her brain.
Tomorrow we will get the final report from the neurologist and if things are reported the same as they were tonight Bob and Evelyn have made the decision to let her go.
Hearts are breaking, tears are flowing--no one is ready to think about saying goodbye, but we know and trust that God has this in his control.
I said the other day that the hardest part of all this is waiting for God to reveal his plans for us--but I'm not so sure that is true anymore. I now think that the hardest part is watching my fear in his plan turn to reality. Yet God has promised that "He knows the plans for us, Plans to prosper us and not to harm us. Plans to give us hope and a future." Jer 29:11
I'm clinging to that.
Until tomorrow,

Beauty Shop

Last night Kim's nurse spent some extra special time playing beauty shop. When we saw her again she was all freshened had her hair braided to keep it from getting all tangled. She had a third CAT scan this morning that showed that the fluid area had cleared, but there was evidence indicating that she has had a stroke. She is currently downstairs for an MRI to see what the level of injury is. We're still hoping to get her off of the vent today if possible and she may have dialysis later. Nothing more to report now, but I'll keep you all posted.

Friday, February 27, 2009

Friday evening

Kim was able to tolerate her entire dialysis session today. They removed 2 3/4 liters, which is good. The neurosurgeon came in again just a few minutes ago and said that the repeat CAT scan showed a little more fluid on her brain. They will repeat the scan again tomorrow to check for new changes. She was also started on a tube feeding this morning through the tube that is going into her stomach through her nose. She is tolerating that well, also.
This weekend they're hoping to be able to remove the breathing tube. Her breathing has been fine thus far...a litle too fast at times, but nothing that she shouldn't be able to handle on her own.
Please continue to pray for the best possible outcome for Kim. We know that God is holding her in His hands and will reveal His plan to all of us in His time, not ours. Please also pray for strength for Bob and Evelyn in dealing with all of the ups and downs. That emotional rollercoaster is so hard.
Kim is getting dialysis right now and tolerating it well. She will open her eyes at times but is not tracking at this point. The mucous removed from her lungs is less than what I earlier thought....that's a good thing. Hopefully there is no infection there. Her leg continues to look good.
Rob, Jeni, and Evelyn are in with Kim now and Craig is wandering the halls of the hospital denying how tired he is. He, being the structured A-personality engineer type, sets his alarm for early despite going to bed late.
Bob and I are in the waiting room, and Bob is entertaining ideas of how to reserve the only couch in the waiting room for himself tonight. The most resourceful option that he has found is to pour a little puddle of water on the middle cushion, sit on it, and get up only in front of unsuspecting couch space pilfering theives. Bob also felt the need to bring a small paint roller on an extension stick with him to the hospital this morning. He claims it is part of his exercise routine after his rotator cuff repair, but we're all pretty sure that it somehow plays into his delusions. It is entertaining (and slightly embarassing) to proudly march his paint roller into the CCU.
Hope everyone is well...I'll update more later.

Friday morning

Kim had another good night last night. Craig and I picked up Rob and Jeni at the airport about 1 AM and went to see her for a bit. She looked like she was resting comfortably. Bob stayed at the hospital with her, while Evelyn went home for some sleep.
Craig and I slept in this morning, so we haven't been to the hospital yet, but I just talked to Evelyn to get an update. The pulmonologists came in this morning to assess her lung function. They were able to suction a moderate amount of thick mucous from her lungs rising concern for pneumonia. I'm sure that some samples were sent for a culture to see what is going on there. They also removed the diprivan this morning, which should allow her to wake up. Evelyn said that she is opening her eyes but not doing alot of other purposeful movements right now. They're going to do dialysis this morning to get rid of all the fluid that has been accumulating. Her leg looks good and pulses are strong there. The incisions are draining nicely. The repeat CAT scan showed no change--the radiologists see a small amount of blood on the brain, but the neurosurgeons are debating whether or not it is really there.

OK...gotta go. We're heading off to grab some lunch and head to the hospital. Oh how great sleeping in a while this morning felt...

Thursday, February 26, 2009

Wishes granted

I asked Kim last night to try to keep today boring as yesterday had enough "excitement" to last for a few days. Today was boring indeed. Kim is down now (at 9 pm) for the repeat CAT scan. Neurosurgery came in today and said that what showed up on this morning's scan was pretty insignificant--Yay! Tonight's scan is just to make sure that the bleeding that showed up this morning was not just beginning.
There have been some positive signs. Kim has tried to open her eyes a little today. The neurosurgeon also checked all of her reflexes and they appear intact, although a complete assessment could not be done because she is sedated. She has been kept sedated because the docs don't want her blood pressure to get too high after yesterday's surgery, and it keeps her from breathing too fast over the vent.
The plan for tomorrow is to stop the sedation, let her try to wake up, and see what happens. She'll also have dialysis. That's all for now. Not much news today, but little news to report is good news!

GOOD morning, and nonobservent Craig.

What a difference a good nights rest makes...for everyone! Kim had a great night last night. This morning her leg looks swollen but the incisions are draining nicely. Pulses are strong in her foot. The CAT scan of the chest looked good. The CAT scan of the head showed a small brain bleed. They have stopped her blood thinner (argatroban), postponed dialysis, and are going to do another CAT scan later today. She is still not responding, but is on medication (diprivan) to keep her lightly sedated so that she doesn't work toohard to breathe.
That's all on Kim for now, I think.

On a less serious note, Craig saw me updating the blog last night. He looked at me, kind of puzzled, and said "Do YOU have a blog?" I confirmed that it was true, except it was "OUR" blog. I think he's a little scared to read back through the previous entries. :) It only took him 3 months to figure it out. Shows how little attention he pays to me and how neglected I am. Oh poor me.

Wednesday, February 25, 2009

She's Out!!

At 11:00 the vascular surgeon came out and said they were done. He did not make any attempts to sugarcoat how difficult this had been. He said that they originally thought that the clot in her leg originated from her heart, but found when they were operating that that was not the case. To have this make more sense, I'm going to give a very brief vascular anatomy lesson. Each leg has a large vein and a large artery that run through the groin. (if you put some pressure on the margin where your abdomen meets your leg, you should be able to feel a pulse--if you can't, please don't call me unless your foot is purple. Even if it is, call your doctor instead!). Central lines are placed in VEINS. What happened with Kim is that when she had her event on Tuesday she needed emergent large vessel access. Since her arms and chest have been ravaged by dialysis catheters, the groin was the next best place. With Kim's small size, the artery and vein lie especially close together, plus she has scar tissue that sandwiches things even more. When the doctor placed the Central line it completely penetrated THROUGH the artery and then cannulated into the vein. The catheter, therefore, partially interrupted the bloodflow through the artery to the lower leg and a blood clot formed. To fix this, they had to do a cut down to place a new Central line in her right groin, remove the damaged section of artery and connect the ends together, evacuate the clot, and form 3 small incisions to allow some of the swelling to weep out. The surgeon said that it was a VERY challenging surgery and if at any step along the way things did not go exactly as they did he would have felt that amputating her leg would have been the best option. We're all feeling that we truly saw the hand of God at work through this surgeon!
Kim returned to her room around midnight and Bob, Evelyn, Craig and I all saw her for a short time before leaving. Bob is spending the night in the hospital with her tonight.
Kim's social calendar for the rest of the night includes: a CT scan of the head and chest, about 50 billion more labs, turning every 2 hours, and trying to heal that ever-so-injured body.
Thanks for all the thoughts and prayers. It's 1:40 am. I haven't seen this time of day for a while and tomorrow is a new adventure. I asked Kim tonight to try to keep tomorrow a little less exciting. We're ready for a boring day!
Good Night~

Still same day, still waiting

This has been one very long day. Kim went into surgery at 5:45ish. It is now 10:00 and they are still not done. The OR nurse has come out and updated twice, both times saying that things were going well, but it was going to be a while yet. The last update was about 45 minutes ago and they said it would be at least another hour.
All of the other families have now left the waiting room one by one and we are the only ones left. To pass the time we've laughed, cried, and looked for a lost Jolly Rancher. Everyone's dumb joke supply is exhausted--except Bob's whose knows no limit. The epitome of exhaustion was realized when began quoting Shakesphere and Edgar Allen Poe. This surgery better be finished quickly or we may find ourselves thinking it is ok to impersonate medical staff and start visiting patients. I, for one, think it sounds like fun.

OK...so they just called again. They were able to remove the clot, BUT she'll be in surgery for at least ANOTHER hour. Things are going well, though. I've gotta go. I need to find me some scrubs....

Same day, different waiting room.

As I update now, we are sitting in the surgical waiting room. Kim is in surgery to extract the clot and remove some of the pressure on the artery. Without this, the only option would be to amputate her lower leg. Bob and Evelyn are here, as well as their pastor and a couple of Kim's friends. Craig is en route back from Des Moines with Madison, and Rob and Jeni are flying in tomorrow afternoon--it was the earliest flight that they could get.
Bob and Evelyn are exhausted, but holding strong. Evelyn "slept" in the waiting room at the hospital last night while Bob, Craig, and I went back to their house to try to get a good nights rest.
They were able to remove about 2 liters of extra fluid from Kim today, so she doesn't have quite the facial swelling that she had last night. She still has not regained any consciousness.
As of now, things are looking pretty bleak. The biggest concern is still that we know that her brain was without oxygen for some time, and that that kind of brain damage is permanant. We don't know the extent of that injury. The docs say that in the next couple of days as she stabalizes more they'll pursue more testing.
I think that's all for now. I'll keep updating new developments. Sorry if some of this is repetative. I've sat down to write so many times that I can't remember what made it to print. Oh the brain mush!
OK, so here's the latest. Kim's vitals remain stable. Her blood pressure is a little higher than the docs want it to be, so they are going to pull off a little more fluid with the CVVHD today to try to lower the pressure.
The nephrologist talked with Bob, Eve, and I this afternoon regarding his concerns about brain damage since they had to work so hard to get her back.
I'll have to finish this post quickly...Eve and I had just come back to the house for a bit so she could eat and get some rest, but Bob called and said that they need to make an incision in Kim's let to try to relieve pressure and extract a blood clot in an artery in her left calf. We don't know what this involves, but do know how her sick little body is tolerating any medications right now. I'll update again when we get back to the hospital...


Yesterday Craig's sister went to the hospital for what was supposed to be a same day surgery to place a new dialysis fistula, but things went horribly wrong. Just before the procedure started, she became very anxious and then went into cardiac arrest. The staff were able to revive her, but she was down for about 15 minutes before they could get her back. She is on a ventilator and is nonresponsive. They're running CVVHD to clear the anesthetic from her system. Her vitals are good. Her blood pressure was low yesterday, but the dopamine was off by the time we got here around 9 pm and she held it on her own through the night. Hopefully today we'll get some more answers, but with those answers tough decisions may have to be made. I'll update more later....we're off to the hospital again.

Monday, February 23, 2009

Winter Blues.

The sun'll come out TOMORROW! I heard it on the news. I can't wait. Acutally the sun is out now, but it is colder than (insert something REALLY cold here, like snow, or ice, or frozen peas). I thought earlier that, since it's sunny, I didn't need a coat when I went out to get the garbage and recycling bins, but boy was I wrong. Fresh air that doesn't freeze your lungs when you take a deep breath is really in order here. For the last few weeks I have been in a little of a funk, and I think what I really need is a nice long walk outside. Ahhh. The thought makes me smile a little inside.
During this long and rather chilly winter, I have accomplished a few things.
1. The basement has been downsized. Well, not the basement itsself, but everything in it. Craig and I drug a whole load of crap to the curb yesterday and my friend the garbage man took it to its new home. (actually when I said "Craig and I" here, I really meant just "Craig." I supervised, but you may have already assumed that).
2. I have organized a committee for a class reunion and tracked down all of my old classmates. It has been fun finding everyone and finding out what they've been up to. Thank God for facebook.
3. I cleaned my house. Yippee! It may not look like it now, but once this winter my house was truly clean. I think that the cat liked it too, because it didn't puke on the floor for like 2 days after the big clean.
4. I baked cookies for Craig to take to his office for his 5 year workiversary. 8 dozen of them. Chocolate chip and sugar. AND delivered them. yep. What a good wife.
5. #5 is a really exciting one but I cannot share it just yet. Maybe later. No, I'm not pregnant.
6. I've joined a couple more committees at work. Why? I'm asking myself the same thing.
7. I did laundry! One day I woke up and had to dig through the guest room closet for a clean uniform. Only the ones I don't like are in there. I also had to go through the mix-matched sock basket for a pair. I won't let it go that long again...I hope.
8. I matted and framed the print that Mom and Dad gave me for Christmas. I am proud that I didn't leave it between the sheets of cardboard behind the couch for more than a month. Yay!
9. I went on Prednisone for my ear condition, went absolutely crazy for a while, and bounced back. Not crazy in the way that you all may or may not have known me to be, but that kind of "happy one minute bawling the next I may just start going off on you for no reason" kind of crazy. It was not fun. Craig will back me up on that.
10. I stubbed my left pinky toe so hard that the end of my toe split open and the nail bent back on itsself...and I refrained from using words that shouldn't be in my vocabulary. I know that this is not exciting, and not necessarily an accomplishment, but I thought you should know.

Sunday, February 15, 2009

Meet Crabby

I've decided that I am going to be crabby all day long today...except for a few hours from about 1:45 to 3:45. I woke up this morning still tired--perhaps due to the fact that kitty declared me his pillow for the night. Knowing that I was meeting with some friends in Oskaloosa today to discuss plans for a class reunion made me rationalize that it was OK to skip church so I could get there earlier and maybe stop to see my nieces on the way. I asked Craig to return my library books. "The one in my purse and the one on the desk." He managed to find the ONE book in our entire house that I haven't read and couldn't wait to start. Now I have no books for the week. Grrrgggrrr. (yes, that was a double grr--the second was even a little more angry sounding).
On the way to Oskaloosa Craig returned my hasty call from the book incident. He called just as I was approaching my exit and I drove right by it. He just can't win today. I'm beginning to wonder if anyone around me can, either. Craig later, rather hesitantly, returned my call from the missing the exit incident. He offered to do laundry this afternoon. My mood lifted a bit. "OK...I need a uniform to wear to work tomorrow, and a long sleeve white shirt to go under it...and some socks...maybe a pair of underwear or two, I think I'm getting low." That should get me through the day tomorrow. "Don't forget to not lay any dirty clothes on the basement floor," lest kitty get another untamable urge to mark. ( a WHOLE 'nother issue!!). On a brighter note, I did successfully parallel park today!
Wow. What's with me? Needless to say there will be no autographs from this princess today.

Saturday, February 14, 2009

Memorable moments as a nurse.

In my 12 years of being a nurse I have found myself in many situations that make me say "That did NOT just happen." Here are some examples.
1. I was once urinated on by a deceased man. The funeral director and I were moving him from his hospital bed to a guerney. As we rolled him to his side to place the slider board under him I felt a little trickle down my leg. Hmmm that's weird...what is that? Why is the front of his gown wet? Oh. I always thought that hearing was the last thing to go when someone dies, but now I know it is the kidneys!
2. I once allowed a mental health patient to escape from a locked unit. Oops. Nor did I didn't have any keys on me to get myself out to go after her. As the other nurse rushed past and unlocked the door my patient stripped off her shirt. Nice. She wasn't hard to find...just follow the trail of clothes to, of all places, the pediatric unit! Stark naked and fighting with everything in her, she went back to Behavioral health. I don't remember working there after that.
3. I once completely lost a patient. He was elderly and had brain cancer...very unpredictable. He was in his bed on minute and the next thing I knew...gone!! After a few minutes of intense searching he was found--naked--in front of the fish tank. It still makes me laugh, remembering him standing there in his birthday suit just watching the fish.
4. This didn't happen to me, but to someone I was working with on an ortho floor. An elderly man had just had hip surgery, was gorked on pain meds and had underlying confusion. The nurse went in to give him some pills and offered him water but he didn't want to take them with water, he wanted to take them with the apple juice that was sitting on his bedside table. Can you see where this is going? It wasn't apple juice, it just looked like it. The patient drank the whole dang glass and didn't say a word. How someone could drink their own pee? Don't know.
5. I think that this has happened in some form to about every nurse I know but when it happens, one must still question how. My patient just had a prostate resection. He was set up with bladder irrigation where (for you non-nurses) there is a bag of fluid irrigating fluid into the bladder and a catheter removing it. Occasionally a patient will develop a clot that prevents the drainage catheter from working. I had noticed that the poor mister had a large amount of fluid in and barely anything out...obviously a clot. I get the supplies to fix it but the only thing that I could find was a crappy bulb syringe--not ideal but I've seen it work, so here we go. I squeezed most the fluid in with no problem, pulled back, got some fluid/blood/urine mix out, but no clot, and went to push it back in when the syringe became disconnected and sprayed the mix ALL over myself, him, and the walls. I eventually extracted a huge clot, but have changed my technique a bit!
6. Once a young man's telemetry monitor alarmed V-Tach (often a precurser to a heart attack). I learned that night that these alarms are sometimes sensitive to outside influences. This guy found out, too when his room filled with nurses during what was intended to be a personal moment. That's all I'm sayin'.
7. The Tin Man. A patient was admitted for cardiac reasons after huffing. His inhalation of choice? Silver spray paint. His face was completely discolored from the paint. He was dubbed The Tin Man...even by the docs.