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Monday, January 20, 2014

The Stubborn Young Sailor

Dad is a World War II vet. He was a SeaBee in the Navy. He is very proud of that time of his life. He joined the Navy before he was eighteen. He went to Rhode Island to train, and eventually ended up in the Philippines. There he was part of a crew that built air strips. 

At times, the building crews had to share the airstrip they were working on with the aircraft they were building it for. There were safety rules. When the crews were working on one side of the strip, the planes were to go down the other. Pretty simple, in theory. As in all parts of life there are variables that can make theories dissolve, and when they do the consequences can be disastrous. 

Dad was on a piece of machinery working on an airstrip. A plane started down the runway. The pilot didn't see Dad or the bulldozer he was on. Dad didn't see or here the plane coming. The plane came down the middle of the strip, Dad was hit and his leg torn off. 

He was rushed to the hospital. They gave him blood in both arms. One doctor said they'd never get him off the table. Dad, the stubborn young sailor, loved proving doctors wrong. That stubborn young sailor refused to die. 

That stubborn young sailor has done well by Dad all of these years. He has gotten Dad thru all sorts of scary and life threatening situations. He got him through a triple coronary bypass in 1988. He got him thru placement of stents five years ago. He has gotten him thru years of blood thinners, for atrial fib. 

At the beginning of this year, Dad got a bad cold. He was miserable, coughing and coughing and coughing. It kept him up at night, it was awful. His abdomen and ribs were very, very sore from all of the coughing. 

One day he started doubling over from the pain in his abdomen. I thought he must have pulled a muscle  in his groin with all of the coughing. As the cough finally went away, the pain did not. I figured it needed a day or two to get back to normal. 

Then dad didn't have a bowel movement for two days. The pain seemed to be worsening. I figured he must be constipated and gave him some miralax. That day he had two bowel movements. Not his normal toilet buster bowel movements though. The pain was still there. Now I was getting worried. I was afraid he had a partial bowel obstruction. I decided to take him into the hospital. 

Dad is very comfortable at the Des Moines VA hospital. He has been a patient there probably sixty years. Since I thought it was either a partial bowel obstruction, or still maybe a pulled muscle I decided to give in to his request to drive all the way to Des Moines, instead of just going to Iowa City.

When we got there, they sent him down to Xray, and then back to a room to wait. And wait, oh, yeah, and wait. An hour or so later, they came in to draw some labs. More waiting. Soon the doctor came in to talk to him, and left. More waiting. Dad was getting tired and frustrated. He just wanted to go home. Suddenly all of the waiting changed. They came in and told us his INR, which measures how well his blood thinner was working, was at 8.9. Our jaws dropped. I looked at my sister and she looked at me. we were in shock. This is very high. The goal for him was between 2 and 3. His last INR which had just been a week before was 1.3 which was low. The doctors had raised his dose 2 mg on one day, only one day. We still don't know what made it rise so high so fast. 

The doctors started thinking Dad's abdominal aortic aneurysm  might be leaking. The last time it had been measured it was at 6 cm. Usually, it is recommended that surgery be performed to fix a AAA at 5 cm. Dad had decided against surgery at that time. Since then, he has decided against any surgeries or any invasive procedures. My sister and I support him on this. He has never gained his strength back after his gall bladder surgery last February. He doesn't come out of anesthesia well. Any more surgeries would just be more dangerous than helpful. He's done with being cut open. He's done with being poked or prodded. The doctor thought his AAA might be leaking. If that was the case, without surgery he would die. 

We talked to dad again. The doctor was in the room. Did Dad understand that with out the surgery that he would die? Was Dad ready for that possibility? I made him tell us and the doctor what would happen without surgery. "I'll have a peaceful death," was his answer. Even if the AAA was leaking, no surgery would be performed. 

It was a weekend, and they had to call a CT tech in to do the scan. It would be a little while before they could get it done. Stacey and I started making calls. I called my kids, to let them know what was going on with Grandpa. I told them I'd let them know as soon as I knew anything. 

Finally the CT scan was done and read. He had a bleed between the outer layer of a muscle and the muscle itself. They asked if he had fallen recently, he hadn't. The AAA was fine though, no leaking, it was a little larger, but stable. That was a huge relief. However he wasn't out of the woods. The bleed could still be dangerous enough to kill him. There was a fairly simple procedure that could be done, but it involved anesthesia and Dad didn't want that either, again my sister and I agreed and supported him. The decision was made to start an IV and give Dad fresh frozen plasma to bring down the INR, slow down the bleeding, and hope the pressure from the the hemotoma that formed might stop the bleeding. 

It worked. The stubborn young sailor that loves to prove doctors wrong was back. They kept Dad in the hospital until his blood count and INR were safe to go home. Thursday, his INR was 1.3, his hemoglobin was 9. It was decided to take him off of all blood thinners for at least a month. This meant a substantially increased risk for stroke. It was either that or risk another major bleed. It was all explained to him, and he seemed to understand. Dad was just happy to be going home. 

Right as we were leaving to make the hour and a half trip home, a freak, unexpected blizzard hit. The National Weather Service didn't even issue a blizzard warning until after it had started, that's how unexpected it was. We had stopped to drop off Kahlen's booster seat to Alyssa before we headed out of town. When I went in the house, the weather was fine, windy but fine. When I walked out five minutes later, it was snowing so hard you could barely see across the street. 

Dad and I got out of Des Moines and ahead of the blizzard.  By the time we got to Newton we had gotten out of the snow. We had to stop at a Casey's for dad to go to the bathroom. He had a large, unpleasant accident in Casey's bathroom, and I spent the next half hour cleaning him and the bathroom up. By the time we got back out the blizzard had caught up with us again. It was a long drive. It took us four hours to get home. Luckily, by the time we got to Bel Plaine we were out of the snow, and the interstate was dry, otherwise it may have been another hour or two.


Fast forward to Saturday night. About 8 pm Dad called me into his room. He was having chest pain. It was bad enough he couldn't lie down, and he was having trouble breathing. He is always short of breath, it is hard to tell when he is in distress. I could tell he was in distress. I gave him a nitro pill to put under his tongue. I set my phone timer for five minutes and waited. No relief. I repeated the process two more times. Still no relief. I called an ambulance. Willie went out to clear the walk and the ramp.

The ambulance arrived quickly and off to Iowa City we went. (I have decided that from now on when Dad has to go to the emergency room for anything, it will be the VA in Iowa City, so much nicer than the one in Des Moines!) We got there, the doctor had already read over Dad's history and knew a lot about him. They drew labs and started a nitro drip, which made him feel much better. It was probably angina. They admitted him for the night so they could watch his cardiac enzymes.

Without doing any procedures there were limits to what they could do for Dad. He couldn't go home on a nitro drip. He was already on a med, ranexa, that is basically a last ditch effort to stop angina pain. He was being told that this chest pain could be his new normal. It might be something he just has to live with. I didn't like that. I asked about stronger pain meds. Those, I was told, weren't very good at controlling angina pain, and could make him at greater risk for dizziness and falls. The last thing he needs is to fall and break a hip. Between his angina, and the arthritis in his neck, and his "good" leg always hurting and back pain, the man is in enough pain, he doesn't need to have a broken hip the rest of his life.

They decided to add one more med. Another nitrate, Isosorbide. This is it, if it doesn't work, he has to be in more pain. They gave him the first dose in the hospital to make sure that it didn't plunge his blood pressure. It seemed to help, and his BP stayed stable. He got to go home.

Today, Dad seems in good spirits, but didn't have the energy to get out of bed. He hasn't eaten much today. Just a banana and a few bites of scrambled eggs. I talked to him this morning. I told him that when he is ready, it is ok if he wants to let go. I told him my sister and I would miss him terribly, but we would be ok.

 He has been in so much pain for so long, he deserves a break. He is so tired. The stubborn young sailor is still hoping to stick around, but I think the very tired, old man, is ready to slap that kid around and tell him it is time to rest. The very tired old man, doesn't want to hurt anymore.

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