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SUSAN: The Story of a Miracle
By George White
iUniverse LLCCopyright © 2013 George White
All rights reserved.
In the Beginning
On Tuesday, January 24, 2012, I drove to Metairie, Louisiana from Pass Christian, Mississippi for a 10:30am eye exam with my eye doctor. He has been taking care of my eyes for a long time. I was home for lunch.
On Wednesday, January 25th, Susan felt fine. She and Karen Crawford (her good friend and bridge partner) and several of their card playing friends had lunch at a Mexican restaurant in Gulfport. Then they went to Biloxi, Mississippi to participate in a two day bridge tournament. Susan came home Wednesday evening, fixed dinner, watched TV, read some of her bridge books, and went to bed.
The next morning, January 26, 2012 (day 1 of her journey), around 7:00am, Susan got up, went to the bath room, threw up, told me she was in severe pain in her stomach, and we needed to go to the doctor right away. I was dressed, and she was in her night gown and robe, and off we went to Gulfport to see Dr. Francisco Camero, her physician. That drive took about 25 minutes. During the drive, Susan was in so much pain she could barely talk. When we got to Dr. Camero's office, he took a quick look at Susan and then sent her immediately to the emergency room ("ER") at Garden Park Medical Center in Gulfport, Mississippi ("Garden Park"), a trip of approximately 7.4 miles or about 13 minutes. While I was driving as fast as I could north on Highway 49 toward Garden Park, Dr. Camero called his son, Luis, who was the doctor in charge of the ER, and told him we were on our way. In the car, Susan was bent over in pain, moaning, saying "this may be the big one," and I was thinking to myself she was too old to be having a baby. All I could think to say was "Breathe."
We arrived at the Garden Park ER, and Susan went to a room where a team of doctors and nurses began an examination of the patient. I called our daughters Susie and Georgia (also known as the "Girls") and both of them left work and came right away. I forgot to call Karen Crawford to tell her Susan was not going to play bridge on Thursday. Susan had blood drawn, x-rays, other tests, throw ups, and meds administered to reduce the pain. Susan was given dilaudid for pain and nausea meds around 5:00pm, Ativan at 7:00pm to help her relax, more dilaudid at 10:20pm, and at 2:10am. Susan's ER nurse used green swabs to moisten Susan's mouth. We were told that gallstones had crept out of Susan's gallbladder and they had gotten stuck in the common bile duct. That caused the pancreas to go nuts. The pancreas was enlarged and inflamed. The gallbladder had numerous stones in it. The ultrasound of January 26, 2012, indicated there was no definite mass or pseudocyst but the findings suggested pancreatitis. I found out later that the pancreas was a gland located behind the stomach that most people do not know they have. The pancreas releases hormones such as insulin, glucagon, and enzymes that help with digestion. The pancreas will eat anything, including other organs and its own self, if given the opportunity. On Thursday, January 26, 2012, the radiologist found relatively advanced degenerative changes of the lumbar spine and mild scoliosis. Great, just what I needed! Susan had a bad back plus pancreatitis. On Thursday, January 26, 2012, I had a very sick wife on my hands. We were told by the doctor that the gallstones had to be removed. A procedure called an "ERCP" (Endoscopic Retrograde Cholangiopancreatography) would be used to do that. An ERCP was a complicated procedure, so please bear with me while I attempt an explanation. While the patient is under anesthesia, a flexible fiber optic scope is passed through the mouth, esophagus, and stomach into the duodenum (the place where the stomach meets the intestines). The opening into the common bile duct is located in the duodenum. A guide wire is advanced through a port in the endoscope into the common bile duct past the stones. A balloon is inflated. The catheter with the inflated balloon is then withdrawn into the duodenum pulling the stones out ahead of it. This procedure was repeated to clear the duct. Welcome to the world of endoscopy. Thursday evening, the Girls sent me home to get some sleep, and Susie spent the night with Susan in the ER.
The ERCP procedure was performed by Dr. Scott Michael Gioe on Friday, January 27th. At approximately 8:55am, Dr. Warren A. Hiatt, Jr., a very good gastroenterologist, told Susie that Susan's coumadin levels were still elevated and they needed to give more vitamin K to reverse the coumadin prior to proceeding with the ERCP. Before Susan became ill, Dr. Francisco Camero had prescribed coumadin for Susan as a preventive for blood clots. An old clot was discovered in her left leg when she had foot surgery (bunion removal) for the third time. The vitamin K came around 9:30am, at approximately 9:36am, after much begging from Susan, she received an unauthorized sip of water from Georgia, and by 10:52am the ERCP procedure was completed. We were told they planned to remove Susan's gallbladder on Monday, and discharge her on Tuesday or Wednesday.
At 1:15pm, Susan was still in the recovery room. At 1:25pm, she was being moved from the recovery room to the Intensive Care Unit (the "ICU") to "monitor her blood pressure." At 2:05pm, we (Susie, Georgia and I) met Dr. Larry Killebrew, a surgeon at Garden Park and he pretty well ran the place. Dr. Killebrew was a chunky guy, great smile, very smart, and showed up in green scrubs and flip flops with a do rag on his head. He said he wanted Susan to stay in the ICU over night so they could monitor her and because she had a tube down her nose to stop the throwing up. At 2:45pm, we were admitted to the ICU for the first of many visits, and found Susan with an oxygen mask on her face, hooked up to a bunch of machines and IV drips, and she had been given morphine. We delivered to Susan her favorite pillow, "Rocky." Susan had had Rocky since before we were married, and that was in 1963.
On Saturday, January 28, 2012, Bonnie Rawlins and Bootie Farnsworth (two of Susan's oldest friends) were our first visitors, and after seeing Susan, they both cried. Susan was still in pain with the doctor concerned about her liver enzyme levels. The doctors wanted to add a cardiologist to the team of doctors to monitor her heart. Dr. Killebrew explained that Susan had an arrhythmia (atrial fibrillation, or "A-Fib"), and he called Dr. Paul E. Mullen to check her out and give the OK for the gallbladder surgery on Monday. At 9:09am, Susan had a chest x-ray which disclosed a nasogastric tube had been inserted in the upper abdomen to decompress her stomach (to help relieve nausea), and her lungs were severely under inflated. At noon, Susan had an echocardiogram. At 1:00pm the tube was removed from her nose. There was a concern about the lack of urine being produced, and if it did not improve by 3:00pm they would call a nephrologist (kidney specialist). Meantime, Susan thought she was in Pensacola and that Susie was stealing her stuff at home. At 4:15pm, the patient had a breathing treatment.
Susan's decreased urine output and lack of response to earlier treatments prompted Dr. Michael A. Wilson, pulmonologist, to more aggressive intervention. Dr. Wilson and I had a conversation in the ICU about his plan to improve Susan's kidney function. He recommended placement of a central venous catheter, an IV placed in her jugular vein the tip of which would be positioned in the superior vena cava. In addition to providing IV access, it would allow for monitoring Susan's intravascular volume. Dr. Wilson also recommended placing an endotracheal tube, a tube inserted through the mouth into the trachea or windpipe. Placement of this breathing tube would allow for Susan to be placed on a mechanical ventilator to reduce the work of breathing and strain on her heart that he anticipated could occur due to the increased fluid administration. After that, I told Dr. Wilson that I do not practice medicine and he could do whatever he felt necessary in order to save Susan's life. After Dr. Wilson departed, Susie nicknamed him "Dr. Gloom and Doom," not because she did not like him but because she did not like to hear what the doctor had to say. Susie was stressed.
At 5:15pm, the central venous line was installed. After that, Susan was placed on life support, i.e., a ventilator that controlled breathing. Two pulmonologists were assigned to Susan's case. They were Dr. Michael A. Wilson and Dr. Jennifer I. Rippon. Dr. Wilson was a no nonsense graduate of the University of Florida, and a man who told it like it was. For example, I remember the meeting the Girls and I had in the hall of Garden Park when Dr. Wilson told us Susan's chances of living were 50-50. (He did not say the odds had risen from 1-9). Dr. Rippon was a military brat and she was one of the most determined females I had ever met. She tried and tried again to get Susan off the vent and would not quit until she did it.
The nephrologist was Dr. Edwin M. Quinones ("Dr. Q"), who was very experienced and wise. Dr. Q explained to us on Sunday morning, January 29th, Susan was still critical but was stable and resting comfortably. Susan tolerated the vent well; her kidney functions were improving, but her levels were still elevated but lower than they had been; and he was watching the kidneys carefully. Later Sunday morning, Dr. Hiatt reported that Susan's pancreas and liver were better. Dialysis could be needed later but not now. Dr. Hiatt emphasized that Susan's treatment would be a slow process. Little did we know how slow it was going to become. That afternoon, we saw Dr. Wilson, and Susie, being the school teacher that she was, asked him to grade how her mother was doing. Dr. Wilson gave Susan an overall grade of C-, kidneys were a D, and the heart was a C. He also said to be hopeful, and that she was not getting worse. Sunday, January 29th, was also the day of the Pro Bowl. We had been invited to Claudia and Malcolm Dinwiddie's for dinner, but we missed it. We had also been invited to Linda Lou and Andy Schroeder's home in Metairie for dinner on Friday, but we missed it.
After the gallstones were removed from the common bile duct, Susan experienced complications, e.g., acute renal failure, heart failure, acute respiratory failure, and a case of acute pancreatitis. More complications were to come. Susan left the Endoscopy Suite January 27, and went straight to the ICU, where she stayed until February 20th (the 26th day of her journey), and the day before Mardi Gras.CHAPTER 2
The ICU at Garden Park was located on the third floor. There was a waiting room outside the ICU for visitors and family of persons being treated in the ICU. The facility was modern and up to date, well lit, and designed for efficiency. The ICU had patient rooms on the outside wall of the building, and each room had sliding glass doors and curtains for privacy. There was a hall next to the rooms which was large enough for patient beds, gurneys, doctors, nurses, and visitors to walk. Running the length of the hall was a counter with nurses' stations behind it. Nurses sat and watched computers that told them everything they needed to know about the patient in the room across from her or him. The nurses had direct access to the patients, and they were really the people who knew what was going on. When Susan was in the ICU, she had two primary nurses, Cindy and Diane. Cindy was Susan's partner in crime. She did a whole lot to keep me from falling under the bus. For example, Cindy made me a valentine for Valentine's Day which Susan gave to me as a surprise, and I cried. Then there was Diane, who was a very good nurse, but her bed side manner left something to be desired. For example, they had been giving Susan fluids, so much so that she began to swell like a balloon. Diane was concerned about Susan's wedding ring cutting off her circulation, and Diane suggested to me that they could cut the ring off. I told her we had been married for so long that I did not think that was an option. She said, "Then, we can cut her finger off." I thought Susie and Georgia were going to have a hissy fit. Anyway, the ring stayed on Susan's finger. Cindy and Diane combined to save Susan's life, with considerable help from a bunch of doctors.
Susan had an x-ray at 12:35pm, the first of many x-rays taken in the ICU that determined there was no evidence of free air seen on the images. I learned that it was routine for a patient that had a procedure to have an x-ray, or something similar, performed thereafter in order to check to see if the procedure was successful.
On Saturday, January 28th, an x-ray of Susan's chest found her lungs to be severely under inflated. Also, the x-ray found an anasogastric (feeding) tube had been inserted in the upper abdomen, and it was in position. At 5:35pm that day, another x-ray was performed. A central line had been inserted in the right jugular vein (I had to sign a consent form for that), she was intubated due to respiratory failure (a tube had been inserted in her larynx), and she had abdominal pain, and pancreatitis. The x-ray report advised Dr. Wilson that the endotracheal tube (the breathing tube) and the central venous line were still in place; and the lungs remained under inflated with persistent bibasilar infiltrates and pleural effusions. Got that? My crack research revealed that a pleural effusion is an accumulation of fluid between the layers of tissue that line the lungs and chest cavity. I have no clue what a bibasilar infiltrate is. Anyway, Dr. Wilson put Susan on the ventilator, a life-support machine. If he had not done that, Susan would have died.
On Saturday, January 28th, the 5:05am x-ray disclosed to Dr. Wilson no change in Susan's lung condition. The evening x-ray for ventilator-management showed continued poor lung volumes, but otherwise was stable. The Sunday morning 5:05am x-ray said pretty much the same thing.
On Monday, January 30th, suffice it to say the gallbladder operation did not happen. It was a pretty good idea that if someone was on life support, one did not operate.
Tuesday, January 31st, was a better day. Susan's fever broke, and her kidneys began to function. I do not remember when her fever started because we had more important things to worry about. All I knew was that a fever may be related to an infection and infections were bad. The morning x-ray showed improvement from the day before. However, around lunch time they did a limited ultrasound of the abdomen and found mild ascites. When fluid builds up inside the abdomen they call that ascites. Ascites usually occurs when the liver stops working properly. But in Susan's case, it was the result of severe malnutrition/low protein, systemic inflammation. Fluid fills the space between the lining of the abdomen and the organs. Susan's fluids were located in the right lower and left lower quadrants of the abdomen (commonly called gutters). I later discovered that people with ascites only have a five year survival rate of 30 to 40 percent.
My notes told me I made three trips to the hospital that Tuesday. Over all, last year I drove approximately 8,882 miles going to and from hospitals, doctors, Gulfport, New Orleans, Bay St. Louis, Waveland, and elsewhere. Traveling took a lot of my time to the exclusion of other things I would rather have been doing. I had no clue the effort it took to keep someone alive.
On Wednesday, February 1, 2012, Susan opened her eyes briefly. An attempt to get her off the ventilator failed. Dr. Wilson said she was close to coming off the vent but she was just not ready. He also told us she was in critical condition but she was getting better. He was hoping she would not need dialysis. Nurse Cindy told us she was regulating Susan's meds in conjunction with her blood pressure, which was going up and down. After going over lab numbers (I never could keep track of all those numbers and what they meant, but Susie was wonderful at it), Cindy told Susie, Georgia and me to adopt the three ps, (patience, perseverance, and prayer). That great advice was something I never forgot. Susan remained sedated and hooked up to all sorts of monitoring machines.
Thursday, February 2nd, was a big day. Susan had her eyes open when Susie, Georgia, and I went to visit. We had a wonderful time, especially when an unnamed doctor came in the room and cheerfully said, "Mrs. White, how are you feeling?" Susan could barely move, but she raised her arm up and flipped the doctor the bird and was able to say "Shitty". Cindy laughed so hard I thought she was going to cry. The expression on the doctor's face, priceless!
The other huge thing that happened that day was that Bootie Farnsworth took it upon herself to open up a Caring Bridge web site for Susan. (www.caringbridge.org/visit/SusanWhite2.)
I had been in the mode of answering all sorts of telephone calls from people asking how Susan was. Caring Bridge became a tool for communication that developed a life of its own. Much of what follows herein was taken from blogs that were posted on Caring Bridge.
The last major event of the day was that CT scans of Susan's abdomen and pelvis were made, and the results were consistent with a case of severe pancreatitis. Simply put, the explosion of the pancreas had made a big mess of things. Yuck and fluids everywhere. The kidneys seemed to be OK. Tube placements for the removal of solid and liquid waste were noted on the scan. The morning x-ray found a mild increase in pleural and parenchymal density at the right lung base and stable pleural and parenchymal density at the left lung base. Freely translated, "pleural and parenchymal density" means the lining of the lungs.
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