More Tunnel

Started February 4, 2020

Dear Family, Friends, and Diary,

A favorite sour joke of mine is that sometimes, when one starts to see the light at the end of the tunnel, someone else orders more tunnel.

After Marianne's third of four chemotherapy infusions, we started counting the days, or at least weeks or months, until we would be free to work in a little travel, nothing exotic, nothing foreign, but something. I'd even started scouting hotels and lodges in Utah among the great National Parks that take up much of the southern tier of the state. April. April seemed doable, with the last chemo in late February, followed by four weeks of radiation in March. Recovery in a National Park lodge sounded just right.

patient118 bpsHowever (always a however), on Monday, Marianne's heart rate doubled, fast enough to set off her Apple Watch alarm. She took extra medicine, but it did little good and by 10 pm we were back in the Kaiser Emergency Facility. From heart problems in 2014 and 2015, we knew the place. Within a couple of hours, she was given a series of tests (ECG, X-ray, Cat scan, blood tests galore, urine sample, nose culture) and two liters of saline, mixed with antibiotics and even more heart medicines (beta blockers and calcium-something-or-others). By 3am, no cause nor cure for the high speed heart had been identified.

The hospitalist doctor said it appeared to be atrial flutter, a more-regular but harder to control misfiring of the upper chamber of the heart (aorta) than previous afib (atrial fibrillation) episodes. So, Marianne needed to be admitted to the hospital to wait for the cardiologist Tuesday morning.

Tuesday morning. Our not-really-favorite cardiologist came in and said Marianne needs a couple days here taking even-stronger heart regulation chemicals. Discouraging. Consultation with another hospitalist confirmed this as an appropriate course.

Despite the added chemicals, nothing had improved when I left at 7pm.

136bpsWednesday morning started with a 5am phone call from Marianne. Never a good sign. Her heart rate had increased overnight to 130bps (and later,140) and she was feeling crummy. I showered, grabbed a bite, and headed out to Kaiser.

Our patient was indeed feeling worse. We again asked the nurse to make sure the hopitalist coveys that we need Plan B, including a different cardiologist. He heard. Eventually, the original cardiologist came in, suggested a Plan B (cardioversion) and confirmed that another cardiologist would be coming in to consult and do the shocking

The second cardiologist, "Dr. K", did squeeze in a visit around noon and explained the cardioversion option. He said it should be a pretty straightforward process since Marianne has a pacemaker to protect against too low a heart rate and was already on clot-prevention blood-thinners and heart medicine.

Tomorrow (Thursday) morning is the soonest they can put together an anesthesiologist, an operating room, and a cardiologist. So, "we" wait.

ps: T and K, thanks for the flowers.

beforeFriday. This is the big day for cardioversion and I was in Room 417 at 5am, before our patient was even awake for the day. Her heart rate was still very high.

At about 8am, the nurses started getting Marianne ready, mostly just shifting heart monitor leads, and then it was off to the Intensive Care Unit on the second floor. By about 9:15, her ICU room was filled with equipment, the nurse, and a nervous patient. The two doctors, cardiologist and anesthesiologist, came in and I left.

afterThe team finished in less than a half-hour and Marianne had her normal heart rhythm back. Yeah!!! By 11:00, we were back in Room 417, asking when she could go home.

The discharge was initially planned for 3pm, but Marianne's blood pressure was slow coming up after anesthesia, so hospital escape was delayed to at least Friday morning.

Friday morning. Early. Back at Kaiser, the heart has recovered enough for blood pressure to be fine, but the complications of chemo have roared back. The main chemo drugs from a week ago killed lots of cells, including red, white, and platelet blood cells. The fix is Zarxio, a drug to boost bone marrow cell production, but it comes with side effects, including bone aches, not unlike a child's growing pains or, according to the patient this morning, "child birth back pains". A little more tunnel.

12:00 last shot. Took off leads and IV. Got dressed in street clothes. Then waited an hour or so to get final discharge drugs and instructions. The nursing aide wheeled her down to the car and Marianne climbed in and we left, 89 hours after arrival.

By late afternoon she was soaking in her own warm tub and from there to her mom's hand-me-down recliner. It was nice to be home and, for me, to have her home.

It was a long week.

John and Marianne