One Week In: Day 7 (Nov. 10, 2008)

In Uncategorized on November 11, 2008 at 5:12 am

greetings from Toronto General Boutique Hotel...err Hospital

Greetings from Toronto General Boutique Hotel…errr…Hospital!

Well we do like having fun, regardless of where circumstances deliver us. That is Miss Alex on Day # 7 sitting up in her hospital bed. Lookin’ good, huh! You can click on the picture to make it bigger. Today Alex continued on her wild and wooly adventure, little bit of low and a little bit of high. Started the day off a little wobbly, big wrinkle midday and morphed into a fairly pleasant late afternoon and evening. Hey! Plus a nice long visit from her Mom & Dad (who are now out of quarantine). She was in a playful mood before I left tonight, and wanted to make sure that…

a) you could see a picture of us together in her “suite”


b) you could see a picture of me with a bed pan on my head.

Ever since she’s arrived in this room she has remarked on how much the cardboard inserts for the commode resemble a fedora. Most of you will know that I am a man who likes to wear a hat. In fact, many of you might not even recognize me without one. Alex simply put 2 and 2 together and the sum is me putting a bed pan on my head. The pic was taken by her night nurse Alan on a camera phone. Good fellow.


I arrived around 9:30 am. Alex had had another rough night. Lots of commotion around the Step Down unit. She’d tried to take a single oral painkiller to get her through the night instead of her once every five minute booster, hoping this would give her the chance to get into a deeper sleep uninterrupted by flashes of pain. Problem was, the painkiller kept her up and sort of in a strange state of consciousness. She became quite itchy and had to have a shot of benedryl to stop it.

So she was pretty much bushed first thing in the morning. And that is not a state to be in when the expectation is to wake up and do physiotherapy, stretch, walk and just generally try to get moving as much as possible. Oh yes, she was also to be moved down to the 7th floor. “The Floor” is the ward where many post-transplant patients are housed. It means that the doctors feel the individual patient is ready to go to the last step down before going home. This, by the way, will a long stay though, not a short one. But Alex was experiencing a lot of fluid retention this morning (common in a lung transplant) so this extra weight combined with gravity to make her fell sluggish and generally awful about doing much of anything.

The arrival of Alex’s parents helped somewhat, but Alex was starting to get a dreadful feeling, and began to panic that perhaps the lungs were starting to fail her. This feeling persisted as her oxygen saturation began to drop form yesterday’s 97 to 87. Not good. A sustained oxygen saturation of under 90% puts a person at risk. She got the nurse to page the Respiratory resident. The doctor was in a meeting, and after hearing the report got the nurse to administer an intravenous diuretic to get Alex to pass some fluid. He said he would come as soon as his meeting was over.

This often happens. The doctors and nurses know a lot more about the transplant process than we do. What can alarm us might not necessarily alarm them. But not always. So often Alex gets herself into an anxious frenzy, worrying that she is failing. And then her breathing gets shallow and her pulse quickens and (you guessed it) her saturation rate goes down. She was already on a fairly high rate of oxygen so that was not an option. She could only wait and work on that fluid buildup.


She got sitting up for a while, but when Alex gets into a nervous state she can be hard to talk down. Her agitation only increased with the fact that there were three of us waiting for the Respirologist resident to arrive. No amount of back rubs or exhortations seemed to work. She kept looking up at the monitor waiting for something to happen. An hour passed, but it seemed like a week. She wanted to talk to someone from the lung team. ANYone with some authority who could answer her questions and get her to calm down. We waited and waited and waited. Then the numbers started to climb up. Anxiety and dread finally gave way to slow but sure success in the diuretic department. And then, surprise, the respirologist came to the room. He spoke with Alex for a while and tried to assuage her fears. Told her that if they were ever genuinely worried she would be the first one to know. He told Alex that this was common, that there would be plenty of “tweaking” in the days and weeks to come. He left her feeling a little more confident, and as the IV worked, a little more comfortable. He also told her that she could stay on the Step Down floor for one more day.

Then the physiotherapist arrived. I took my leave to get some food downstairs, and when I returned I was informed that Alex’s mom had accompanied her on a two lap walk around her floor! Connie was very proud and happy for her daughter, and of course so were John and myself. It really is something seeing her concentrate and put those new lungs (and her battered body) to work. Sooo proud. I know she is too, beneath all her concerns.


Another milestone. Alex eats her first solid food. Tonight it’s chicken and rice with green beans. Stewed pears for dessert. She gulped down her food, and I have never been happier to see my wife gulp down food. She could eat like a lumberjack fresh out of the woods for the rest of her life and I would love it too.

After her meal her oxygen saturation continued to get better (with the aid of her ever-present oxygen line), and she was feeling like she was putting the desperate feelings of this morning behind her. The numbers kept climbing. 95…96…97…98…99. Suddenly Dr. Kashavnee (the doctor who had performed her surgery) arrived and…well, he gave her a talking to.

He walked in the door accompanied by his students, all of whom obviously revere this man. Then he stepped up to the oxygen feed, turned it way down, and talked to Alex as he looked at the monitor. Essentially he said to Alex that she was fine, despite her scary incident this morning. He said such things are par for the course, that her body needs to adjust to having two foreign lungs in it. He also told her that crumbling is not an option, and that she’d better get busier (a lot busier) on her incentive spirometer.That’s the blue plastic device on Alex’s lap in the picture above. Alex is going to have to do this exercise about 5 times more than she was doing it in order to clear the old gunk out of her lungs and encourage nerve growth and development. He told her in no uncertain terms (albeit with a strangely humorous sort of compassion)  that tomorrow she would be “walking downstairs” to the 7th floor. No ifs ands or buts. She has to cease being agitated immediately and must stop worrying and start  working harder. He said she needs to get herself off the supplemental oxygen and onto using only her new lungs as soon as possible. As such, he only brought it up a notch from where he’d set it. That will be your new flow, he said. He answered a few of Alex’s questions and then off he went, his students eagerly at his heels.

I thought Alex might be miffed by this. But she wasn’t at all.  She has utmost respect for this healer, despite his strange wit and odd bedside approach. She only wanted to get the word from the head honcho, and that she surely did. Alan the nurse told Alex that Dr. Kasavnee rarely visits a patient in Step Down. “Wow” he said “you must be a very special patient, Alex”.   It’s true, she is.


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