Wednesday, March 12, 2008
David's Heart Repair
The above image is the closure device in David's heart.
The heart repair went well, and David is recovering well. We were very impressed with all those who were working with us yesterday - from nursing student who asked permission to observe to aids to nurses to technicians to surgeons.
We found there were also a lot of surprises in store for us though. We had been told for months that David has an ASD (and possibly another hole) and that we were going to Sacramento to have the one hole they knew about closed, while at the same time looking for others. Yet one of the first things the surgeon said when he came in to talk with us before the repair was, "David, you are a conundrum! Even though I've never met you your ears must have been burning, because I've been talking about you since November. I don't think you have an ASD (um - this was the first time we'd heard that, and we were there for the purpose of having his ASD closed!!!). I thought I saw a VSD in one of the tests, but the rest of the tests did not bear that out." He went on to give us a long list of things it could be and said he wanted to spend about two hours testing David - via catheterization - to see what was actually going on, since it was not yet clear to him, and all the tests he'd been reading he'd been reading from a distance. That was all a bit confusing to us, but it was immediately clear that this surgeon was extremely good at what he did, and we felt very confident in his care.
(He'd also had a couple of chest x-rays, an EKG, and an echo when he first arrived. I was there when the technician was doing the echo, and she could not find a hole - but when we talked with the surgeon, he said, "We have a phrase: 'echo-schmecho.'")
They went in, did a lot of looking around, put catheters up both legs, did find a large hole - a centimeter in diameter - which was a bit of a surprise to the surgeon. He later told us they were happy to find they had a closure device large enough on hand of the specific type he wanted to use for what he found (which was something other than what he'd expected to find). Although David was out of it for the first couple of hours of the procedure (while they were testing) he regained his alertness during the time that they were putting the device in. He was not in pain, and they allowed him to remain alert and watch what was going on. He found it very interesting to watch the process of inserting the catheter through the hole, making a twist which made the one side of the device pop open kind of like an umbrella, giving a few tugs on the catheter to make sure it was secure, twisting again to make the portion on the other side pop open, and then twist again to release the catheter from the closure device.
We are still not clear on whether it was an ASD or a PFO that they found. When the doctors came to report to me they said he had a PFO. When I said, "Oh, so it wasn't an ASD?" One of them said, "Well, ASD/PFO." I thought it had to be one or the other . . . so I'm not sure whether his comment to me meant that they were so similar that it didn't matter what we called it or if he meant it was some sort of hybrid between the two. Whatever it is, it is successfully closed now. They are still not sure that that is the only problem with his heart, nor are they sure that that is DEFINITELY what caused his stroke. Regardless of that, this was there and needed to be closed. They'll continue to monitor him over the next weeks and months by doing a series of echocardiograms, and we'll go from there.
We are so pleased - so pleased to be at this point - to have had that go so well! It is certainly an answer to much prayer. I can't help but have a tiny bit of nervousness inside me that this might not be the whole story, but it is just a tiny bit of nervousness. We feel he is in VERY good hands - not only those of the doctors but also, of course, the hands of the Great Physician our Heavenly Father - Who created David's body before his birth (Psalm 139) and knows him inside and out better than any test can show. We trust that He is sovereign and that He has ordained all of David's days for him from before David's birth.
These last couple of days have really been quite an experience for us. It seems like we've been gone for a week rather than just two days!!
David is such a sweetie! Unbeknownst to me he looked up one of my favorite restaurants on the internet the night before we left so he could find one on the way up to Sacramento so that we could have a nice meal together before the big day. How sweet of him to be thinking of doing something special for me as he was anticipating going in for this heart repair. When we were at the hospital, once they finally let me in to see him again after his prep, he told me he was praying for me, for my peace. After they gave him his initial meds, which included a valium to relax him beforehand, he asked me if they had given me one too since I must be nervous! :-)
(On that last bit, I'm not sure if he was serious or joking or what, because I think the valium was already working on him!)
Here he was facing unknown findings and outcomes but thinking of me throughout.
I realized all over again that I should have internalized what I had learned from his earlier hospitalization, "I'll believe it when I see it." So much of what happened yesterday did not happen in the way we had expected it - which is certainly fine as all turned out well.
We were scheduled to meet with his surgeon at 7am, and the repair was scheduled for 9am. We'd been told he had an ASD that was going to be closed. We'd been told he'd be staying overnight. Those were the expectations we went in with.
We arrived at 6:50am. There was no talk of an appointment. They just kicked me out while they started prepping him, which I thought would take about 10 minutes but took about an hour. We had not yet met his surgeon and really wanted to at least see him and talk breifly before the surgery! We'd known for months he would be the one working on David, but we'd never seen him nor spoken with him. When they finally called me back in we asked about this, and they said, "Oh, would you like to see the doctor before surgery?" When we said, "yes," they said, "We'll page him to let him know you'd like to meet with him." Hmm . . . we thought that had been the plan all along! That's why we were there at 7 - for the appointment.
When we arrived the nurses spoke as if David would be going home that day. This surprised us, and we told them he's been told he'd be there overnight, which surprised them!
We finally got to see the surgeon. He was fantastic - clearly very knowledgable and also very personable - good bedside manner - nice guy. As noted above, we were extremely surprised by what he had to say and ended up kind of wondering what was up. Why had we been told one thing consistently for months only to travel to Sacramento for a very clear and specific reason but then be told by the surgeon that he wasn't at all sure what was going on and was certainly not convinced it was what we'd been told it was. That was a little unsettling. He'd been in contact with David's cardiologist for months; why hadn't we been given even a hint of this uncertainty? He listed about 5 different things that could actually be wrong with David's heart other than what we'd been told - some of which were hard to determine.
David's situation had already been called "unique" and "complicated" by his cardiologist; now here the surgeon was calling him a "conundrum" - not exactly things you want to hear from your heart specialists!
I'd checked online the night before to see how long to expect the procedure to be (assuming it was a closure) and got information that it would be 2 to 4 hours. We asked the nurses that morning and were told it would take only about an hour. Then, in talking with the surgeon, he said he wanted to spend 2 hours testing (checking O2 levels in the right chambers then checking some things in the left chambers then a third thing) and then, if he found a hole to close that he would be doing that. It ended up taking about 3 1/2 hours. He then had to lie flat on his back for 6 hours, which caused him FAR more discomfort than any aspect of the procedure.
Perhaps I have now internalized the "I'll believe it when it happens" philosophy I had mentioned last fall!
I was surprised at all the blood thinners they gave David during all this (since he'd been told to switch from Coumadin to Lovenox and then get off Lovenox the day before). He was given aspirin, Lovenox, Heparin, and Plavix. Somehow they made a mistake and ended up double dosing him on the Plavix, so he ended up with some bleeding problems. They almost ended up keeping him overnight afterall because of that, as it took some time to get it under control. As it turned out, they did release him at about 8pm, and it was so wonderful to be able to be in our own home last night.
David felt so good at being home that he was up too much that evening - wanting to read to the boys and kiss them goodnight and so on - regular bedtime routine - as well as just wanting to be up after having been on his back all day, but we both learned a lesson as he began bleeding again quite significantly last night. We got that under control, and he is REALLY taking it easy today - staying in the recliner or in bed other than just a few minutes up when necessary.
Although the boys never expressed any worry, it was evident that they were experiencing concern about all this. David shared with me that Jacob has been more "huggy" than usual with him for the last week, and it was really cool to see their eyes light up when Dad came home last night. Their hugs last night were so tender and wonderful. I think part of why David was up more than he should have been last night was not only his own sense of feeling good but also wanting to reassure the boys that all was well and normal in our home.
We are so very pleased to be at this point.
David still has his sights set on running the Sacramento marathon in December. Interestingly, the student nurse we met yesterday is a distance running and is a "pacer" for that marathon. They both agreed they'd be looking for each other in December. If that can happen, what an incredibly happy ending to the story that will be!