Part Three: 55 Minutes (Mike’s Story)

April 17, 2011

Family, Health, Mike

On March 3 we traveled by ambulance across town to Good Shepherd Specialty Hospital.  Mike was installed in a private room…isolation was necessary due to the MRSA but I am pretty sure all Good Shepherd’s rooms are private. Transfer was uneventful and we were looking forward to the future.

Mike was marginally responsive during this time.  It was almost as if he was indifferent.  Daily I prayed for his healing…for a restoration to health.  To his former state…and to know what God’s plan was for us.  I have come to think that perhaps it is that I write about this.  I think God wants people to know he is out there…he does perform miracles, he hears and answers prayer in his way…and he wants people in the situation we faced to have hope and faith in him.  He has shown me tangible evidence of what faith can bring…my husband is alive, well and recovering.  For now, that is the part of the plan I think I see.  I don’t know what else he has in store, but I am listening and waiting. 

In spite of prayer, I wasn’t seeing much improvement and Mike had many ups and downs.  Though he had received huge amounts of blood in Open Heart, his hemoglobin count remained low.  And almost daily he had a low grade temperature of 100 or 101.  Blood, sputum and urine cultures were all negative, and he was still on huge amounts of multiple IV antibiotic therapies.  He remained on IV Heparin to treat the blood clots they had identified at OHU.  Both arms were loaded up with blood clots in superficial veins, there was one in his left jugular and there had been a deeper one in his left leg vein that had resolved before coming over to Good Shepherd.  He was bruised and battered everywhere.  His groin was purple, yellow, green across almost his entire abdomen from the hematoma that resulted from the bleeding at the site of the balloon pump.  I did feel confident enough that he was stable after a few days to stop sleeping in a chair and began to go home to sleep for a few hours before returning to his bedside.  The vigil dropped from 24 hours to about 16 a day.

Though I slept at home, I would awaken during the night to call his nurse and check on him.  After almost a week of awakening during the night he seemed to be holding his own and I relaxed.  I would not call until 4 or 5 am when I woke up from my 6 hours of sleep.  

On March 8th Mike’s nurse at Good Shepherd decided the foley catheter had been in him long enough.  I was there when it came out.  I remember saying “Uh Oh that doesn’t look good” to his nurse.  There was green pussy stuff at the tip and something crusty all around just below the tip.  He retained urine and needed to be straight cathed to void.  The next day he was a little off…and again needed to be straight cathed.  I went home to sleep the evening of the 9th about 11 pm.  I slept till 5:30 and called his nurse about 5:40 or 5:45 am on the 10th.  She told me he had a great night, no temps, no problems etc.  At 6:10 am I got a call from the Critical Care doc who said it’s kind of funny, less than half an hour ago you talked to his nurse and he was fine and now he is running a temp, he has infection and he’s very sick.  Because of everything he’s been through I think he should go to ICU.  I told him I was certain it was a UTI and why…and he concurred, assuring me he would hang a new IV antibiotic specifically for UTI immediately.  I said I’d meet them there. 

I got to ICU and was frantic.  They wouldn’t let me in until he was settled and assessed.  The charge nurse…and the admitting nurses were leaving and stopped to speak with me to tell me he was ok and things were under control.  I could go back shortly.  Soon they came to get me and I went back to find my husband packed in ice and with a temperature of 104 or higher.  He was not responsive.  He was very sick.  I kept thinking the antibiotic will control it, tylenol, ice…he’s fine.  I felt pretty confident.  His day nurse, Steph, an absolutely AWESOME nurse, in ICU that day was cautious.  She tried to impress on me how critically ill he was…and how fast a picture can change.  And change it did!

Mike suddenly began to decompensate.  His blood pressure dropped, his heart rate went up, his respirations went up.  His kidneys began to fail.  Frantically, the doctors worked over him.  I called the family to come to the hospital.  I called on God to intercede, to give the docs wisdom, to heal Mike, reasoning that he didn’t come this far to die now.  I pleaded with Mike to fight.  He barely squeezed my hand.  Dr. Stroble, the critical care attending and host of residents and nurses worked on Mike to keep him alive.  His blood chemistry went out of whack and his heart rhythms changed as he slipped from Urosepsis to Septic Shock.  Dr. Stroble asked me for a DNR at one point, telling me if he slipped into asystole he doubted they could bring him back.   Reluctantly I agreed, telling him that he wouldn’t need it.  Mike would not go into asystole…he was going to fight and he was going to beat this.  Dr. Stroble looked at me, frustrated with the situation, exhausted from the fight, incredulous at my confidence.  Mike rallied.  The worst was over.  He did not go into asystole.  And Dr Stroble pasted a huge grin on his face and once again looked incredulous as he announced…”He dodged the bullet again!”  Exhausted and overwhelmed I cried, held Mike, and thanked God.  For I knew it was God who had masterminded this.  Nobody else could have.

March 11 and 12 were like a honeymoon.  Mike was still pretty sick and not very responsive.  His hemoglobin remained low…7…and they gave him blood almost daily.  Still it remained at 7.  I kept asking where the blood was going.  I pointed out his swollen belly.  They told me it was not a surgical belly…the blood count might be due to chronic wasting from sickness and infection or it could be dilution from all the fluid.  Still, it was never getting better.  Not a bit.  It had been low since OHU.  Most people thought he would be relatively vegetative…but they continued to tell me to keep hope.  I didn’t need much hope…I was beyond hope.  I had faith.  God had shown us he would not let us down…and I believed.  More and more each day…I had a faith in something greater than this world.  Something I had never before experienced with such certainty.

March 13th was a different story and a test of faith.  Mike was deteriorating again.  Nobody was sure why but his blood pressure was low, he had high respirations and his heart rate was up.  Still, for all his instability, he seemed stable. Mike’s night shift nurse was an amazing guy named Ted.  He is an incredible nurse…was ready to graduate and do his internship as a nurse anesthetist.  I knew Mike was in excellent hands. I went home, exhausted, about 8 or 9.  The phone rang at 10 or 10:30.  It was one of the docs telling me Mike had decompensated, he was in respiratory arrest, shock, they thought one of the blood clots had moved and he had thrown a Pulmonary Embolism and that his condition was critically grave.  They wanted to take him to CT for a head and chest scan.  I gave permission and said I was on the way.  I flew to the hospital, praying, sobbing, calling friends to pray…screaming to the heavens begging to save my husband and to let me get there to him as quickly as possible.  My daughter Kristin called the rest of the family.  I called my girlfriend Debbie. 

I arrived just as a host of docs, nurses and respiratory technicians were getting ready to push his bed out the door.  He was not on the ventilator…they use an ambou bag and portable oxygen for transport…and he had not yet been bagged.  He was up off the bed, white…positively ashen, sweating profusely, wild eyed, absolutely gasping for air….I came up to the head of the bed from behind trying desperately to stay out of the way of the medical people.  I put my hands on his shoulder and said “Mike…it’s OK.  It’s Robbie…I’m here.  It’s OK honey.  I’m here”.  For the first time since February 18 I heard my husband’s voice.  Over the trach, loud and clear, he gasped “Please help me.  Please help me.  Please help me.”  I told him we were.  Ted kept yelling at him not to let his blood pressure drop.  They started to wheel the bed away and I tried to go along.  Somehow they made me understand I had to stay…and as they wheeled the bed out the door I remember saying please don’t you let him die….and then I started to collapse.  A nurse…a tiny thing…grabbed me and took me to a chair.  She got the chaplain.  My kids and my girlfriend Debbie began to arrive.  I have very little in the way of memories of this time as I waited to hear Mike’s fate.  I do recall that they asked for a DNR again…and knowing fully well what the neurologic and cardiac impact would be of further arrest, particularly without knowing what was wrong, I acquiesced but told them only if he arrested…otherwise it was full court press treatment.  My son asked questions about the DNR…and I recall dully explaining the medical situation and the rationale. I don’t know how I knew the medical situation and ramifications so thoroughly…but I did. The nurse told him that to know this, to say it and to be able to make this decision was truly heroic.  I didn’t feel heroic.  I felt gutted.  I felt bereft.   Still, on a very visceral level, I knew Mike would fight…and that God would know what was right to do for us.

In almost no time they came back.  He had neither a pulmonary embolism or a clot or bleed in his brain.  Unfortunately that meant they had no idea why he was in shock. He continued to be dangerously ill.  His kidneys went from failing to totally shutting down.  The docs fought to maintain his balances.  Jeff Marsh, one of the pulmonologists on his case and the doc in the box (the telemetry room that monitors and treats patients in all three ICU’s during the night) came over the monitor to talk to me.  I asked him all my questions…they were used to my questioning everything, processing it and making decisions.  They knew I wanted both big picture and details to analyze.  As big a pain in the neck as it was they were all very, very patient and forthcoming with all information I needed.  I remember asking him what other smart questions I should be asking that he would ask if it were his wife or mother or child.  He told me there were none.  I just had to wait.

About 6 am, as they were preparing to insert a guidewire into his central line so they could do dialysis (they would have preferred his groin but the hematoma precluded that and his arms were full of clots so they couldn’t do it in his arms) they got a call from radiology.  The plan to do bedside dialysis to reverse the kidney damage was waylaid…. the radiologist thought he saw fluid in the abdomen on the chest film from earlier.  He wanted an abdominal and pelvic CT.  Down Mike went to CT again.  His condition had deteriorated significantly and his blood pressure was almost non existent.  They told me later that Ted screamed at him the entire time he was in the CT to keep his blood pressure up and that he wasn’t permitted to die on his watch. 

In a flash they were back.  They flew into the room and a whole bunch of nurses showed up.  The CT showed Mike had a retro peritoneal bleed.  The small feeder arteries in his flank had hemmoraged…a result of the heparin therapy.  There was some belief the groin hematoma was also still leaking.  Mike was in hypovolemic shock and finally there was something to treat.  He was given vitamin K to clot the blood that they had so patiently thinned.  They gave him blood products.  Huge amounts of blood products.  (I just got the EOB for that stay…almost $12,000 of blood products!)  Frantic because of the blood clots, I was assured that this was the only way or he would surely die.  We proceeded…and I prayed. 

Mike’s kidney function continued to deteriorate and dialysis was necessary.  After almost two days of continuous dialysis they announced his kidney function had been restored and the damage reversed.  And Mike began to come out of the sickness induced lethargy and began to respond.  He also began to wean from the ventilator.  He was looking and acting great…neurologically he was bouncing back.  I told the docs again that he was a fighter…and they told me I didn’t have to convince them any more.  They told me he was going to be fine…and given his neuro progress they felt he was going to be fine all the way around.  Good Shepherd’s Brain Injury Program would help him tremendously.  I would have my husband back.  One of the docs, however, explained that such low blood pressure can create brain damage on its own…ischemic stroke like damage.  She wanted another CT.  On March 17th a new CT of his brain showed that Mike suffered additional stroke like damage to his brain, the result of the seriously reduced blood pressure depriving brain tissues of oxygen. However, he was not demonstrating a deterioration of his cognitive or physical functionality…they presumed it was small enough to resolve itself as many stroke patients do.  They told me there was no way to quantify or predict…only time, and proper brain rehab would tell what the ultimate outcome would be.    

We were ready to move on.  On March 24 they transferred Mike back to Good Shepherd Specialty to resume vent weaning and prepare for brain injury rehab. 

PART FOUR of Mike’s story coming up:

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