Wednesday, September 1, 2010

PINs, Platelets and Prayers

Post surgery, lying flat as per doctor's orders.
At first it about PIN numbers. Then it was about platelets and finally it was all about prayer.

A week ago, I was at work and Husband called.  He received a mildly concerning call from my parent. My Dad had forgotten his PIN number at Safeway. And they were headed to the ER. But my Dad was okay to drive.

Pardon me? People go to the ER for forgetting PIN numbers?

I tried in vain to reach them on their cell, but I inherited from them the never-have-the-cellphone-on-or-recharged-when-it-might-actually-be-useful gene.

So I jumped on some public transit and went to the ER to find them. Imagine my surprise to find out that they had already not only been triaged, but my Dad was being examined by the ER doc by the time I got there.

The doc did a series of coordination and neurological tests.  My Dad was speaking, responding to questions in great detail.

This is going to be embarrassing.

The ER doc said "your symptoms are subtle, but we're running some tests to see what we can find. But at the end of the day, we may not find anything".

The obvious subtext being "you're 76, people forget their PIN's at Safeway once in a while."

As luck would have it, that Tuesday afternoon a blue moon was obviously out.  There was almost no one else in the ER that needed attention. My Dad had a nurse to himself. She had no other patients.  My Dad didn't actually need her either so she was free to update her status on Facebook.

Within two minutes of the doc leaving the exam area, a porter came to take Dad for a CT scan of his head.  While he was gone, the blood lab lady came looking for him.  Dad came back from CT and made a donation of a small bottle of pee to the cause again missing the blood lab lady. While she might fairly be said to have the next claim on him, before she could mark her territory, another porter came to take him for a chest xray.  Another tech came and did an ECG before long-suffering blood lab lady finally took her 7 vials of blood and we were done with testing.

In 45 minutes Dad had incurred for the citizens of British Columbia a sizable health care bill.  And the blood lab lady waited longer than he did.

About 15 minutes later, the ER doc came in and started asking about a minor fall my Dad had had the prior weekend while mowing the lawn. Then he told us that Dad had a subdural hematoma. Basically a blood clot on the brain.  He showed me the CT scan on a monitor and I saw my Dad's grey matter all squished to one side.

I said I was a bit shocked about the diagnosis and  ER doc agreed. He said based on the way Dad was walking and talking he thought it wasn't anything "I forget my PINs all the time and I don't have a subdural hematoma" he told me.

We had an afternoon to wait for a consult with a  neurosurgeon. During our wait, it was apparent that quite apart from forgetting his PIN number at Safeway, Dad was struggling a little for words. And numbers.  He couldn't work out what 10 times 15 was. My Dad, it must be known, is really good at math in his head.

He struggled with days and time.  My Dad, who is an extremely articulate, smart and analytical man struggled mightily to figure out if the fall he had three days ago, may have caused the back pain he had ten days ago.  He thought about it, processed it before giving us his final verdict: the minor back pain, which he had first, could not have been caused by the fall, which occurred later.

As it turns out that fall was not the cause of the subdural hematoma, but the result.  An older conk on the head was the likely culprit (note to readers: don't walk into open cupboard doors). The hematoma was well underway by his more recent lawn mowing fall and a slight right side weakness likely caused it.

Those in the medical know, will know when caught in time subdural hematomas, especially older ones, are very treatable with a power tool to make an escape route for the blood.  The problem was that my Dad was on blood thinners (Plavix and Aspirin) and surgery was not a viable option unless he got into a life threatening situation.

I think we all took it in stride. My parents had strongly suspected a brain tumor. I feared a premature older age issue (dementia? senility?). We were all happy to be wrong.  So began our crash course in understanding platelets (which are suppressed by Plavix) brain physiology and crystal ball gazing. 

I say crystal ball gazing because it is a fine line and medical judgment call to divine the best time to have the surgery.   The neurosurgeon told us initially "five to eight days".  We counted down the days. Sunday was to be five days. We didn't think the surgery would happen on the weekend absent an emergent situation. So we thought surgery would be Monday or Tuesday.

Each day, my Dad's status declined a little. He struggled more for words. He forgot my brother's name one night.  He had trouble with simple multiplication - my acid test for his condition.  He became more laid back.  This was initially not entirely a bad thing when you're used to being busy and active and are suddenly confined to a small room in the neuro ward.

On Friday and Saturday the neurosurgeon declared that he thought we should wait eight to ten days for surgery.

What?!?!?!?!?!

 Did he just move the goalpost on us??  We had 4 to 6 more days to wait? The waiting was one thing. Watching the deterioration was quite another excruciating matter.

This is when I began working on a dissertation on platelets, their function, their ability to recover after Plavix, platelet transfusions and the test to assess platelet function. I read the product monograph and medical journal articles.  I read case studies and Wikipedia articles. Everything I read said waiting 5 to 7 days was appropriate. 

However, we had complete faith in the neurosurgeon.  We wanted the surgery under the best of circumstances so wait we would.  I had just completely embraced and was comfortable with the "wait 8 to 10 day" plan, when we got the news: surgery Monday, or day 6.

There had been no precipitous drop, just a steady deterioration every day.   Words were getting stuck.  Each day he seemed a little quieter and a little bit less like Dad.  It was time. 

As it turns out, it happened not a moment too soon. On Monday as my Mom and I waited with Dad for the call that the OR was available.   He was quite groggy and disengaged from the stimulating conversation his wife and daughter were offering him.  The only thing that seem to capture his fancy was Paris Hilton's claim that she thought the cocaine vial found in her purse was gum.  Note to Paris Hilton: we've got a guy with declining mental status and even he is not buying your story.

The nurse came to do her neuro checks. She asked the date. He knew that it was 2010 but could not come up with the month or day.   When asked his birthday, he kept saying "2010".  When asked his name he kept saying "2010".   It's like his needle was stuck.

At around 4 in the afternoon I asked Dad's nurse if they had any word on when he might be going in. She made some calls and came back with the news "the doctor is going to try really hard to get your Dad in today".

Excuse me?? Waiting for tomorrow was not an option. My Mom suggested that we pray.  We held hands and my Mom prayed for Dad to have the surgery that day. "Amen" she said.

Then we had the fastest and most tangible answer to prayer I have ever encountered. Not ten seconds later, the nurse popped her head in and said "surgery at 17:45".  We hugged our new best friend and sighed a huge sigh of relief.

Then we tried to prepare ourselves.  We wanted the surgery to go without any complications. But we knew better than to expect a miracle cure.  We took turns reminding each other of this.  

"He'll be just coming out of the anaesthetic"
"He could be very groggy".
"We won't know anything for a couple days".
"Let's not expect too much"
"He may not know we're there."

We had asked numerous people over the past week whether Dad would ever remember his PIN numbers or really know that 8 times 7 is 56. Would he have the spark, the smile and the ability to tell really bad jokes again?

The answers were less than reassuring.  Wait and see. Maybe. Perhaps. In time. With therapy.

At 10:15 as we waited in a conference room, Dad was wheeled to his room not far from us.  The nurse said to him "we going to turn the corner, you might get a little dizzy"  My Dad said with a visible smile, which we had not seen for days "I've been dizzy most of the last week". He meant metaphorically.  That was pretty subtle stuff for a guy who didn't know his name a few hours earlier.

He was back.

We saw him a few minutes later.  He was smiling. I asked him his name, his birthday and what 8 times 10 was.   When he got all those right and even gratuitously threw in his PIN number, we knew it was all going to be okay.

Thank you to the many who joined us in prayer.

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