CHAPTER 1
In the Beginning
On Tuesday, January 24, 2012, I drove to Metairie, Louisiana from PassChristian, 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 playingfriends had lunch at a Mexican restaurant in Gulfport. Then they went toBiloxi, Mississippi to participate in a two day bridge tournament. Susancame home Wednesday evening, fixed dinner, watched TV, read some ofher bridge books, and went to bed.
The next morning, January 26, 2012 (day 1 of her journey), around7:00am, Susan got up, went to the bath room, threw up, told me she was insevere 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 wentto Gulfport to see Dr. Francisco Camero, her physician. That drive tookabout 25 minutes. During the drive, Susan was in so much pain she couldbarely talk. When we got to Dr. Camero's office, he took a quick look atSusan and then sent her immediately to the emergency room ("ER") atGarden Park Medical Center in Gulfport, Mississippi ("Garden Park"), atrip of approximately 7.4 miles or about 13 minutes. While I was drivingas fast as I could north on Highway 49 toward Garden Park, Dr. Camerocalled his son, Luis, who was the doctor in charge of the ER, and told himwe 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 tooold 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 wherea team of doctors and nurses began an examination of the patient. I calledour daughters Susie and Georgia (also known as the "Girls") and both ofthem left work and came right away. I forgot to call Karen Crawford totell her Susan was not going to play bridge on Thursday. Susan had blooddrawn, x-rays, other tests, throw ups, and meds administered to reduce thepain. 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 at2:10am. 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 theyhad gotten stuck in the common bile duct. That caused the pancreas togo nuts. The pancreas was enlarged and inflamed. The gallbladder hadnumerous stones in it. The ultrasound of January 26, 2012, indicated therewas no definite mass or pseudocyst but the findings suggested pancreatitis.I found out later that the pancreas was a gland located behind the stomachthat most people do not know they have. The pancreas releases hormonessuch as insulin, glucagon, and enzymes that help with digestion. Thepancreas will eat anything, including other organs and its own self, if giventhe opportunity. On Thursday, January 26, 2012, the radiologist foundrelatively advanced degenerative changes of the lumbar spine and mildscoliosis. 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. Wewere told by the doctor that the gallstones had to be removed. A procedurecalled an "ERCP" (Endoscopic Retrograde Cholangiopancreatography)would be used to do that. An ERCP was a complicated procedure, soplease bear with me while I attempt an explanation. While the patient isunder anesthesia, a flexible fiber optic scope is passed through the mouth,esophagus, and stomach into the duodenum (the place where the stomachmeets the intestines). The opening into the common bile duct is located inthe duodenum. A guide wire is advanced through a port in the endoscopeinto the common bile duct past the stones. A balloon is inflated. Thecatheter with the inflated balloon is then withdrawn into the duodenumpulling the stones out ahead of it. This procedure was repeated to clear theduct. Welcome to the world of endoscopy. Thursday evening, the Girls sentme 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 onFriday, January 27th. At approximately 8:55am, Dr. Warren A. Hiatt, Jr.,a very good gastroenterologist, told Susie that Susan's coumadin levelswere still elevated and they needed to give more vitamin K to reverse thecoumadin prior to proceeding with the ERCP. Before Susan became ill,Dr. Francisco Camero had prescribed coumadin for Susan as a preventivefor blood clots. An old clot was discovered in her left leg when she hadfoot surgery (bunion removal) for the third time. The vitamin K camearound 9:30am, at approximately 9:36am, after much begging fromSusan, she received an unauthorized sip of water from Georgia, and by10:52am the ERCP procedure was completed. We were told they plannedto remove Susan's gallbladder on Monday, and discharge her on Tuesdayor Wednesday.
At 1:15pm, Susan was still in the recovery room. At 1:25pm, she wasbeing moved from the recovery room to the Intensive Care Unit (the"ICU") to "monitor her blood pressure." At 2:05pm, we (Susie, Georgiaand I) met Dr. Larry Killebrew, a surgeon at Garden Park and he prettywell 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. Hesaid he wanted Susan to stay in the ICU over night so they could monitorher 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, andfound Susan with an oxygen mask on her face, hooked up to a bunch ofmachines and IV drips, and she had been given morphine. We deliveredto Susan her favorite pillow, "Rocky." Susan had had Rocky since beforewe 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 abouther liver enzyme levels. The doctors wanted to add a cardiologist to theteam of doctors to monitor her heart. Dr. Killebrew explained that Susanhad an arrhythmia (atrial fibrillation, or "A-Fib"), and he called Dr. PaulE. Mullen to check her out and give the OK for the gallbladder surgery onMonday. At 9:09am, Susan had a chest x-ray which disclosed a nasogastrictube had been inserted in the upper abdomen to decompress her stomach(to help relieve nausea), and her lungs were severely under inflated. Atnoon, Susan had an echocardiogram. At 1:00pm the tube was removedfrom 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 (kidneyspecialist). Meantime, Susan thought she was in Pensacola and that Susiewas stealing her stuff at home. At 4:15pm, the patient had a breathingtreatment.
Susan's decreased urine output and lack of response to earliertreatments prompted Dr. Michael A. Wilson, pulmonologist, to moreaggressive intervention. Dr. Wilson and I had a conversation in the ICUabout his plan to improve Susan's kidney function. He recommendedplacement of a central venous catheter, an IV placed in her jugular vein thetip of which would be positioned in the superior vena cava. In addition toproviding IV access, it would allow for monitoring Susan's intravascularvolume. Dr. Wilson also recommended placing an endotracheal tube, atube inserted through the mouth into the trachea or windpipe. Placementof this breathing tube would allow for Susan to be placed on a mechanicalventilator to reduce the work of breathing and strain on her heart that heanticipated could occur due to the increased fluid administration. Afterthat, I told Dr. Wilson that I do not practice medicine and he could dowhatever he felt necessary in order to save Susan's life. After Dr. Wilsondeparted, Susie nicknamed him "Dr. Gloom and Doom," not because shedid not like him but because she did not like to hear what the doctor hadto say. Susie was stressed.
At 5:15pm, the central venous line was installed. After that, Susanwas placed on life support, i.e., a ventilator that controlled breathing. Twopulmonologists were assigned to Susan's case. They were Dr. Michael A.Wilson and Dr. Jennifer I. Rippon. Dr. Wilson was a no nonsense graduateof 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 Parkwhen Dr. Wilson told us Susan's chances of living were 50-50. (He didnot say the odds had risen from 1-9). Dr. Rippon was a military brat andshe was one of the most determined females I had ever met. She tried andtried 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 wasvery 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, buther levels were still elevated but lower than they had been; and he waswatching the kidneys carefully. Later Sunday morning, Dr. Hiatt reportedthat Susan's pancreas and liver were better. Dialysis could be needed laterbut not now. Dr. Hiatt emphasized that Susan's treatment would be aslow process. Little did we know how slow it was going to become. Thatafternoon, we saw Dr. Wilson, and Susie, being the school teacher that shewas, asked him to grade how her mother was doing. Dr. Wilson gave Susanan overall grade of C-, kidneys were a D, and the heart was a C. He alsosaid to be hopeful, and that she was not getting worse. Sunday, January29th, was also the day of the Pro Bowl. We had been invited to Claudiaand Malcolm Dinwiddie's for dinner, but we missed it. We had also beeninvited to Linda Lou and Andy Schroeder's home in Metairie for dinneron Friday, but we missed it.
After the gallstones were removed from the common bile duct, Susanexperienced complications, e.g., acute renal failure, heart failure, acuterespiratory failure, and a case of acute pancreatitis. More complicationswere to come. Susan left the Endoscopy Suite January 27, and went straightto the ICU, where she stayed until February 20th (the 26th day of herjourney), and the day before Mardi Gras.
CHAPTER 2
The ICU
The ICU at Garden Park was located on the third floor. There was awaiting room outside the ICU for visitors and family of persons beingtreated in the ICU. The facility was modern and up to date, well lit, anddesigned for efficiency. The ICU had patient rooms on the outside wallof the building, and each room had sliding glass doors and curtains forprivacy. There was a hall next to the rooms which was large enough forpatient beds, gurneys, doctors, nurses, and visitors to walk. Running thelength of the hall was a counter with nurses' stations behind it. Nurses satand watched computers that told them everything they needed to knowabout the patient in the room across from her or him. The nurses had directaccess to the patients, and they were really the people who knew what wasgoing on. When Susan was in the ICU, she had two primary nurses, Cindyand Diane. Cindy was Susan's partner in crime. She did a whole lot to keepme from falling under the bus. For example, Cindy made me a valentinefor Valentine's Day which Susan gave to me as a surprise, and I cried. Thenthere was Diane, who was a very good nurse, but her bed side manner leftsomething to be desired. For example, they had been giving Susan fluids, somuch so that she began to swell like a balloon. Diane was concerned aboutSusan's wedding ring cutting off her circulation, and Diane suggested tome that they could cut the ring off. I told her we had been married for solong that I did not think that was an option. She said, "Then, we can cuther 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 tosave 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 theICU 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 anx-ray, or something similar, performed thereafter in order to check to seeif the procedure was successful.
On Saturday, January 28th, an x-ray of Susan's chest found her lungs tobe severely under inflated. Also, the x-ray found an anasogastric (feeding)tube had been inserted in the upper abdomen, and it was in position. At5:35pm that day, another x-ray was performed. A central line had beeninserted 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 inher larynx), and she had abdominal pain, and pancreatitis. The x-ray reportadvised Dr. Wilson that the endotracheal tube (the breathing tube) andthe central venous line were still in place; and the lungs remained underinflated with persistent bibasilar infiltrates and pleural effusions. Got that?My crack research revealed that a pleural effusion is an accumulation offluid between the layers of tissue that line the lungs and chest cavity. Ihave no clue what a bibasilar infiltrate is. Anyway, Dr. Wilson put Susanon the ventilator, a life-support machine. If he had not done that, Susanwould have died.
On Saturday, January 28th, the 5:05am x-ray disclosed to Dr. Wilsonno change in Susan's lung condition. The evening x-ray for ventilator-managementshowed continued poor lung volumes, but otherwise wasstable. The Sunday morning 5:05am x-ray said pretty much the same thing.
On Monday, January 30th, suffice it to say the gallbladder operationdid not happen. It was a pretty good idea that if someone was on lifesupport, one did not operate.
Tuesday, January 31st, was a better day. Susan's fever broke, and herkidneys began to function. I do not remember when her fever startedbecause we had more important things to worry about. All I knew was thata fever may be related to an infection and infections were bad. The morningx-ray showed improvement from the day before. However, around lunchtime they did a limited ultrasound of the abdomen and found mild ascites.When fluid builds up inside the abdomen they call that ascites. Ascitesusually 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 ofthe abdomen (commonly called gutters). I later discovered that people withascites 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 fromhospitals, doctors, Gulfport, New Orleans, Bay St. Louis, Waveland, andelsewhere. Traveling took a lot of my time to the exclusion of other thingsI would rather have been doing. I had no clue the effort it took to keepsomeone alive.
On Wednesday, February 1, 2012, Susan opened her eyes briefly. Anattempt to get her off the ventilator failed. Dr. Wilson said she was closeto coming off the vent but she was just not ready. He also told us she wasin critical condition but she was getting better. He was hoping she wouldnot need dialysis. Nurse Cindy told us she was regulating Susan's meds inconjunction with her blood pressure, which was going up and down. Aftergoing over lab numbers (I never could keep track of all those numbers andwhat they meant, but Susie was wonderful at it), Cindy told Susie, Georgiaand me to adopt the three ps, (patience, perseverance, and prayer). Thatgreat advice was something I never forgot. Susan remained sedated andhooked up to all sorts of monitoring machines.
Thursday, February 2nd, was a big day. Susan had her eyes open whenSusie, Georgia, and I went to visit. We had a wonderful time, especiallywhen an unnamed doctor came in the room and cheerfully said, "Mrs.White, how are you feeling?" Susan could barely move, but she raisedher 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 onthe doctor's face, priceless!
The other huge thing that happened that day was that BootieFarnsworth took it upon herself to open up a Caring Bridge web site forSusan. (www.caringbridge.org/visit/SusanWhite2.)
I had been in the mode of answering all sorts of telephone callsfrom people asking how Susan was. Caring Bridge became a tool forcommunication that developed a life of its own. Much of what followsherein was taken from blogs that were posted on Caring Bridge.
The last major event of the day was that CT scans of Susan's abdomenand pelvis were made, and the results were consistent with a case of severepancreatitis. Simply put, the explosion of the pancreas had made a big messof things. Yuck and fluids everywhere. The kidneys seemed to be OK. Tubeplacements for the removal of solid and liquid waste were noted on thescan. The morning x-ray found a mild increase in pleural and parenchymaldensity at the right lung base and stable pleural and parenchymal densityat the left lung base. Freely translated, "pleural and parenchymal density"means the lining of the lungs.
