The Aneurism

Oh….well….so much for “Adventures in Third World Medicine.” It got a LOT worse before it got better!

Max and I are safely home after a week’s “adventure” at Jewish Hospital in Louisville, KY. On Wednesday afternoon, March 5, Max drove himself to our local hospital with chest pains—-he seems to always drive himself to the ER. When nothing showed up on the EKG, our local internist insisted on “aggressive measures,” so Max was sent to Jewish, in Louisville, a nationally ranked heart and lung facility. Since he refused to go in an ambulance, I drove him down there, arriving after dark. We wandered around until we found the ER, and finally he got to his room, which was full of SIX people from another family. Good Lord! The next day he had a heart catherization, or at least they tried. When the probe would not go through, the cardiologist sent him for a CAT scan, which revealed a massive abdominal aorta aneurism. The cardiologist came out into the waiting room, grabbed my hands, and pulled me over to a seat, saying we had “big trouble.” I didn’t quite grasp what was wrong at first—I though he had a brain aneurism. The cardiologist kept saying, “None of us have ever seen anything this big!!” Oh…my! Since we were in a nationally known heart & lung center, I realized we had a big problem. 

Finally, the cardiologist took me back to see Max, who was already full of tubes and quite upset, as they really were not sure he could live through the night. Dr. Stokivoc, the cardiologist, was very blunt and had also told Max he was in “big trouble.” Surprisingly, I appreciated their bluntness — better to know exactly where you are in a crisis. The family arrived late in the afternoon and we were allowed to see him in the critical care unit several times, each time progressively sadder and more frightening as our awareness of the seriousness grew. In Critical Care, two nurses hovered over him and a huge array of machines blinked on and off. Numerous IV pouches hung on the rods and he had tubes everywhere. A sense of crisis hovered in the air as we all knew that he might not live through the night or through the surgery. He was already bleeding internally and the aneurism could “blow” at any minute. The time of surgery was changed several times—from “this evening” to Saturday and then to Friday morning. The family was teary—there was that awful sense of no time left to say all the things that needed to be said. A squeeze of the hand and “I love you!” had to express all we wanted to say. 

As I drove home on the dark and silent roads late that night, I was determined to send him to surgery with a spiritual focus. When we gathered in the Critical Care Waiting Room on Friday, our pastor, Sara, joined us. We were allowed to see him before surgery in small groups. When grandson Ethan and I were alone with him, we held his hands and the three of us repeated the 23rd Psalm and The Lord’s Prayer. After that, the family came in together, with Sara, who led us in a beautiful litany. When the others left, I stayed with Max as he waited to go to surgery. I held his hand, and he and I repeated The Jesus Prayer together, again and again. Finally about 11:15 am, the surgery team arrived and I went with him in the elevator to the door of surgery. I kissed him good-by and good-luck—and went off to join the others in the waiting room for a very long afternoon of waiting. The ladies who run the surgery and critical care waiting rooms are tough—and we were assigned seats in order for the doctor to find us quickly. The surgery to repair the aneurism took four-five hours. The surgeons had a mix-up and neither came out to talk to us, so we had to wait for Dr. Rumisek to finish another surgery. Then Max popped the stitches fighting the ventilator as he came out of anesthesia and was rushed back to the OR for three more hours of surgery to repair the graft and completely re-close the wound. The very weary surgeon told us at 10:30 pm that he had ordered Max to be “completely out” all night. Max was in surgery from 11:30 am until after 10:30 pm. In the midst of all this, Louisville had a blizzard Friday night, so I was trapped down there a couple of nights—got low on cash, clothing, etc., as everything in the city ground to a halt.

Saturday and Sunday in ICU were just awful; the more anti-agitation medicine they gave him, the more agitated he became. He kept pulling out his tubes, driving the nurses nuts. He removed the ventilator tube on Saturday morning and the stomach tube on Sunday morning, way ahead of schedule. The nurses have terms for removing-tubes- without-approval, and shook their heads angrily about Max. Sunday, he was even more restless, and kept moving from bed to chair–and then back again–which is quite a chore with tubes running everywhere. No sooner would we get him settled in bed then he would insist on moving to the chair. Sunday afternoon, I thought he was going to pull out the swan clamp in his jugular vein, and I was beside myself. This clamp is a 8-9 inch tube surgically inserted into the jugular vein and then used to inject meds directly into the blood stream. The nurses took me into the hall and explain that if he pulled it out–and blood spurted—they would be there in 30 seconds with pressure pads to “save” him. The image of that possibility was not comforting. Finally, late Sunday afternoon, Dr. Rumisek, the surgeon, was called. He came in and after examining Max, ordered the clamp removed. Then, Max became even more upset and told off the nurse, refused to lie down, and kept trying to escape. The nurse finally called security. Suddenly, four burly security guards arrived in the room. Max, shifting into principal mode and his
authoritarian principal voice, kept telling them he had to go down the hall and fix a problem. He really was not rational at all. The nurse said his condition is called ICU psychosis and the doctor later said it was drug induced– [Refuse to take Adavant!] –and exacerbated by the noise and lights of ICU. 

Finally, Dee and I were sent home and his lights were turned off, the thought being that no-stimulation would calm him down….Wrong! As soon as I got home, the phone rang, with the nurse supervisor on the line, saying Max was more agitated than ever. I called several family members for advice and then I called the nurse back and requested that he be allowed to walk around some to calm him down, telling her I was sending Master Sergeant Rick Smith, our son-in-law. I knew that if Max could walk, and regain a sense that he was in control of his body, that he would settle down. The doctor agreed and our son-in-law and our grandson walked him around the ICU, taking about fifteen laps. After that, Max agreed to lie down again. This ICU was for patients on respirators—-someone up and fighting like Max was not in their protocol. Fortunately, that night he had a male nurse who calmed him down—the female nurses tended to be bossy, which set him off. He went to sleep and slept for 22 straight hours. In the midst of that, the doctor sent him to a private room, with an executive decor, saying he wanted to remove Max from the distraction of noise and lights in ICU. That move helped, too. They asked me to stay with him Monday night and brought in a recliner for me, so everything calmed down. When he awakened on Tuesday at 4 a.m., he was himself again.

By Wednesday, he was up walking around and recovering rapidly. The doctor sent us home two days earlier than expected—and it is so nice to be home again. When I stood in the living room the night before the surgery, I wondered if he would ever come home again. 

When we asked the surgeon to describe the aneurism, he gestured with his hands—-
the whole length of the aorta was the size of an orange in width. They also had to remove the spleen as its aorta was also greatly enlarged. Dr. Rumisek, a man of few words, said, “He beat the odds!” Later he told us “The aneurysm was the size of a football.” No wonder the surgeon and cardiologist got so excited and told me Max was the luckiest man alive, in that they caught it in the nick of time. They were astonished that he had survived. I teased Max, saying the operating room video will probably make all the thoracic/vascular conferences. Max’s scar is a good 14 inches; this was quite
a surgery—none of that LAP stuff. They cut him wide open and removed his internal
organs to get to the aneurism.

We were on many prayer lists. Our family, our friends, and especially our church family
have been beyond wonderful. We felt we were carried along during the ordeal by their
prayers and love.