A Catastrophic Event – Part 4

When we left Derek, he was sitting in a new room, having been moved to a “transit” area awaiting release on the Monday after 1 final CT of his Adrenal Glands.

The ward was mainly for neurological patients (strokes etc), so there were no TV sets.  To save him from boredom, I took Derek’s Laptop in for him to use, along with some DVD’s to watch.

He spent Friday night in the room.

Saturday was quiet.  He still didn’t feel like doing much, so just sat around, watching DVD’s, playing card games etc.

Sunday morning, I drove in quite excited.  He was coming home for lunch, and then heading back in in time for dinner on the ward.  I took some clothes in for him to put on.

I got to his room, and he was having a shower.  He came out looking tired, but happy to be getting day release (he had obviously been behaving himself).

I drove him home, watching him very carefully.  I was nervous.  He still didn’t look great and had almost died on me.  I wasn’t taking any chances.  I made sure I had his emergency kit that we were told to put together.

We had a quiet time at home.  Derek sat on his chair in the corner with his legs up.  He tired easily, but that was to be expected.

After watching TV for a while, I decided it was time to get him back to hospital.  Once we got there  I tucked him in for the  night and left, knowing I would be taking him home the next day.

Monday 29 Oct

I arrived at the hospital that morning by 9.00 am.  Derek was taken down by wheelchair for his CT scan.  He was away for about half an hour.  While he was gone, I packed up all his stuff, got out his going home clothes, and prepared for a quick exit.

All we had to do (after 2 weeks of sitting by his bed) was wait for the Dr to come in and say “yes, you can go home”.

We waited…..

And we waited……

An hour went by, and we still waited.

Finally the Dr arrived.  He pulled the curtains around the bed for privacy (as they always do).

“Right” he looked at us both.  “As you know we were looking to see what state your Adrenal Glands were in”.

He went on to tell us about the fact they showed bilateral bulky adrenal glands.  Much as we expected.  So it meant he would probably have permanent Adrenal Insufficiency.

“So we can go home now?” I asked.

“We need to refer you to the Hutt Hospital to be monitored, and managed”

“So we can go home now?”  again I asked.

“We also had a quick look at some other things while doing the CT.”

“What about going home?” I am beginning to get a bit concerned at this point.

“I’m really sorry”

I looked at Derek, then at the Dr.

“There seems to be a problem with your heart”

“Oh, for f…. sake” was all I could say.  Derek just sat there, quiet.  We both knew what was coming.

“We need to do another echocardiogram.  It looks like fluid around your heart, which explains the high heart rate.”

We were told he didn’t know when Derek would have the echo, but he was to remain on the bed while he waited, it depended on how busy the bedside echo tech would be.

An hour later the Dr comes back in.  There is a significant amount of fluid around the heart (a dangerous amount).  He is also developing fluid around the lungs again because of the pressure on the heart.

Complete bed rest!  2 hourly ops, peeing in a bottle, not allowed out of bed.  He isn’t even allowed to use the laptop.

He was to be moved back to cardio as soon as they could find space for him.

The put him down to have the fluid removed from his heart on the Tuesday, but (and with Derek there is always a but) they have worked for 4 days to get his INR to a therapeutic level and they now have to take him off warfarin, give him a vitamin K mixture and use hepron to reverse their hard work they have done BEFORE they remove the fluid.

He also showed signs of tempanade on repeat transthoracic echocardiogram (TTE).

3 hours later a nurse and an orderly from Cardio arrived on the ward to escort him down to the Cardio monitoring ward.  They wouldn’t let him go on his own, with just an orderly as he was not in a good state.

They also had him back on a heart monitor.

Tuesday 30 Oct

They took Derek into a treatment room of the Cardiothoracic ward to put the drain in his Pericardial sack.  It is a procedure that is not often done in a calm, quiet way, so being a teaching hospital, there were a number of requests to observe them doing the procedure.

Once the drain was in place, they bought him back to the room.  He was conscious throughout the whole procedure.  The fluid began draining from his heart.

Now he had to wait.  They were draining it for 24-36 hours, to see how much fluid would drain.

Wednesday I arrived at the Hospital to see about a litre of bloody fluid in the drain bag.  There should be around 15-50 mls.  A litre was a lot more.

Thursday 1 Nov

The drain was taken out on the Thursday.  It was a very long tube, and they simply cut the stitch holding it in place, and then started pulling.

They moved him into a side room with less monitoring, and informed him he  would be in over the weekend because they wanted him on a Hepron infusion for 2 days while they put him back on warfarin.  All things being equal he would be home on the Monday.  Hmmmm. We had heard that before.

Saturday 3 Nov

I arrived at the hospital to have Derek tell me that his heamoglobin was low, so he needed a platelet transfusion.  Just after he told me about it, two nurses came in with a bag of platelets.   He still had the Hepron infusion in his left arm, so they put the blood in his right arm.  He lay there with an arm stretched out on both sides of the bed, stuck, while they pumped both products into him.

Tuesday 6 Nov

They decided to wait until Tuesday to do another TTE.

Thankfully there was no more buildup of the pericardia effusion.  All being well he was finally going to be released from hospital the next day.

And so the worst is over.   He was released on 7 Nov.

 

Now for a new path.  That of the Addisonian. 

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