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Saturday, July 25, 2009

Recovery From Cardiac Bypass Surgery: Day 4

I was a little apprehensive about what to expect as my brother and I made our way to the hospital on Friday morning. I had been picked up at the airport just after midnight the same day, and had not slept well. My brain was not feeling sleepy just yet because of the time-zone differences. And my brother and I had a lot to catch up on, so we ended up chatting while lying in bed for the longest time.

My father had undergone surgery on Monday around 11 AM. The surgery had taken about 2 hours. He had been shifted to the ICU out of the operating theater and my mother was shown that he was resting in the ICU at around 2 PM. He stayed in the ICU until Wednesday night and my mother had been able to see him through glass windows from outside the ICU a couple of times everyday. On Thursday morning, he had been shifted to a private room in the general ward. He had been in that room in the general ward since then. So, my first day at the hospital was actually the 4th day of my father's recovery from the bypass surgery.

The hospital is quite old and had been built over the years in layer after layer as the need for more rooms and more departments arose. There was no grand plan to the layout of the whole place. The patient rooms are on a floor guarded by a doorman who is supposed to make sure that people do not go up to the patient rooms willy nilly outside of regular visiting hours. The hospital issues various kinds of passes so that relatives who are supposed to attend to the patient can still come and go as they please. I had one such attender's pass and my brother had some other kind of pass, and the doorman let me through only after I showed him the pass. I was glad that the hospital had processes in place that actually worked to reduce needless crowding in the patient areas of the hospital. The rest of the hospital was, of course, a zoo with people milling around as they waited for doctors' appointments, tests, pharmacy services, etc.

I was quite apprehensive about what I would find in my father's room. I have never been a big fan of the strong anti-septic odor that always seems to permeate hospitals. And I expected my father to be extensively intubated given that he had undergone major surgery 3 days earlier. I was very pleasantly surprised when I made my way into the room. The room did not smell any different from my bedroom at home. My father was sitting up in bed and looked completely normal. He was not intubated in any way at all (in fact, he did not have an open IV line attached, which seemed to be somewhat risky). The room was also devoid of any monitoring equipment of any sort. My father was not hooked up to a blood-pressure monitor, pulse oxymeter or any other equipment to monitor his vitals.

Of course, my only experience of what happens in US hospitals is from what I have seen in movies. Other than that, my only direct experience with a hospital room was when my wife gave birth to my kids. A whole wall of the room had been filled with monitoring equipment of all sorts that beeped and blinked and drew out lines of various shapes all day long. So, you can imagine my surprise when I saw what looked like a normal bedroom in a house in the middle of this hospital!

The only indication that it was a hospital room came from two lines that ran into the room: an oxygen line and a vacuum line. It looked like these were used only in emergencies since they were not being used right now. The bed was a manual cranking bed that could go from a completely flat position to position that elevated the head and provided back support in case the patient wanted to sit up. There was a chair, a small two-seat sofa and a wooden bed with a thin plastic-covered mattress for the patient's attender to sleep in, to complete the furnishings of the room. There was also a small TV mounted on the wall opposite the bed. The room had a closet and a small attached bathroom with a sink and a western-style toilet.

My father was fully alert and we talked for some time. My father was wearing a shirt, so I could not even see his surgical cut, so he seemed completely normal to me. Then the duty doctor came to the room to check up on him and I had my first chance to look at the cut down his chest. It was very thin and clean, not at all reflecting the depth to which the cut had been made. It looked like a surface wound and was so thin and straight it looked as if it had been made with a pencil and a ruler.

The doctor was the first of a steady stream of hospital staff to visit his room throughout the day. There were cleaners coming in to empty the garbage, sweep and mop the floor and clean the bathroom. There were nurses who fed him his medicines (he was still on several antibiotics, blood thinners, and other medication we couldn't guess the purpose of from the names on the packaging). There were food service people who came to deliver meals and snacks at various times during the day, and to take orders for what my dad wanted to eat for the next meal, etc.

My mother was quite impressed with the care they were providing for my dad at the hospital. The nurses and doctors were competent, and had good bedside manners. They answered questions that kept my mom informed and in the loop. The nursing staff was pleasant, the food service was decent. Everything worked to a decent schedule with some predictability. Overall, my mother was very happy with the choice of this hospital to have this surgery.

The doctor checked his vitals, then made notes of all this in a thick patient file overflowing with papers. There was no concession to technology in the record-keeping arena as well! This file was always kept in the nurses' station down the hall from our room, and every nurse or doctor who came to the room brought it with them, and made notes on it so that it reflected the full record of his health statistics since his admission for surgery. The file also contained records of every medicine he was given, all the food and drinks he consumed as well as his urine and stool output, etc. The medicines he had been prescribed were on one sheet of paper, all together, so that doctors could tell whether there would be drug interactions by looking at one list rather than trying to piece together his drug regimen from multiple places in the file.

At mid-morning, the main cardiologist and cardiac surgeon started their rounds, and my mother shooed my brother and I out of the room because the senior medical staff frowns upon more than one person being in a patient's room during their rounds. We went down to a different part of the hospital and found some seats to sit on in an air-conditioned room (it was already more than 90 degrees outside by then, so we had no interest in taking a walk outside). We were chatting about various things, and had been out of my father's room for about an hour when we received a call from our mother asking us to come back immediately. Her tone sounded urgent and distressed, so we made our way back as quickly as we could.

When we entered the room, there were 5 or 6 nursing personnel and a doctor in the room. My father was lying bed with an oxygen mask over his face. They had wheeled an oxygen tank into the room (though it was not being used. The mask was attached to the main oxygen line in the room). My father was alert and talking, but my mother told us that he had been sitting in a chair when he had suddenly lost consciousness and had almost slid to the floor off the chair. The nursing staff had rushed in as soon as my mother had rung the call button, and they had lifted him up to the bed. By then, he had regained consciousness (he was probably out for about 20 seconds), and had told them he did not remember what had happened. He was in no discomfort, all the vitals were perfectly fine, and the doctor was still trying to figure out what had happened based on a description of the symptoms, and the vital statistics. She could not find out what was wrong, so she put in a request for a neurologist to see my father, and then they all left one by one. From then on, the nurses enquired more pointedly than usual about his well-being when they recorded his vitals.

Obviously, this turn of events was quite upsetting because this was the first setback he had encountered after the surgery. Only that morning, the physiotherapist had come and taught my father some breathing exercises, hand and leg exercises, etc. She had also asked him to start walking once in the morning and once in the evening, and my mother considered that a big step in the recovery process. Now the doctor had asked us to postpone the exercises till the next day, including the short walks.

The mood for the rest of the day was a little subdued as my mother recounted to us a few times what had happened. The neurologist came in the mid-afternoon and he did not find anything obviously wrong either. He prescribed an EEG to rule out any possibility of a systemic problem and left. My hypothesis was that there was nothing systemically wrong with him. The basic problem was that my father had always had blood pressure that was slightly on the high side of normal (150 to 160 over 80 to 90), but because of the various drugs he had been given, it had dropped to between 100 and 110 over 60 to 70. On top of that, he did not have a good appetite because of all the medicines he was taking. His stomach was obviously upset since he kept burping up gas on a constant basis when we were there. The lack of caloric intake combined with the low blood pressure had probably precipitated the fleeting loss of consciousness. Whatever the cause had been, it was still a little disturbing, and there was always the question mark of what the EEG was going to reveal.

Later in the afternoon, we had a stream of relatives visit my father during open visiting hours. We spent some time chatting with them while my dad rested and did not speak much. Around 7:30 PM, my brother and I reassured my parents that everything was perfectly fine and would work out without any problems, and made our way back home. We had dinner, then my brother packed up in preparation for his departure back to his home the next morning. Then we chatted for some time, copied some files between our computers, and went to bed.

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