1.302-313 hiatus

Monday 9/29 – Friday 10/9/2020

Monday the 29th I described my symptoms to Dr. Ariana DiBiase, my cardiologist for many years. She said they were not inconsistent with an aortic dissection and I needed to get that checked ASAP. The only practical place was Stanford Emergency, and the only practical transport was by 911 and an ambulance. I hated the idea of going through 911, having a bunch of EMTs put me on a gurney and roll me out (I can walk fine, dammit), but also from prior experience I know that if you go to Stanford Emergency in your own transport and walk in the door there is a ghastly waiting time in a ghastly waiting room before they let you in. So 911 it was. At least you get gurney’d right to a bed and all your details are there ahead of you, no forms to fill out or interview with a triage nurse. So we did that. Adam, lead EMT was a chill dude and made the experience better.

I arrived about 11am, and 1pm I had been tested for COVID and had a CT scan; I think by 2pm I had the diagnosis: yup, your aortic lining has split itself from up here to down there (from 3 to 4 on the Wikipedia drawing), a Type B which does not require immediate intervention, but is still serious because the arterial wall outside the de-laminated lining is weaker, and prone to producing aneurisms. An aneurism does require immediate fixing, but I had none yet.

Typical Stanford Hospital procedure, it took until evening before a room was available (I remember similar long waits with Marian). Room J420 in the new hospital building.

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From Tuesday through Thursday I was in hospital being examined and observed. As was true during the many days I spent there with Marian in 2018, the nurses were always competent to brilliant, attentive, helpful; and the doctors were competent to brilliant, distracted and often uncommunicative. Over the days it developed that the recommendation was to perform a TEVAR procedure, in which metal mesh stents are placed along the inside of the aorta to compress the split lining and strengthen it. It would be performed by Dr. Amelia Watkins. When I finally met her on Thursday I was impressed. Well over 6 foot tall, red hair, and like any good surgeon, oozing confidence and certainty. Plus, she knows Dr. Gaudiani, who did my aortic valve in 2002, as “a mentor and a friend”. Ok, then. However, I couldn’t be scheduled before Monday.

Meanwhile there was stuff to do. There was another CT scan. There were three separate ultrasounds. The team wanted certainty about my heart, so I got a cardiac catheterization. During that the operator identified one cardiac artery that was 80% blocked, and placed a stent to open it. I had a dental X-ray because they didn’t want any dental bacteria getting loose into the bloodstream during the TEVAR. (Not quite sure how they could happen? Maybe because it involved full anesthesia with a breathing tube?) One of my fairly useless lower molars had clear infection around one root, so that was removed. They treated removing a tooth, a walk-in procedure at a dentist, as a minor surgery, complete with attending surgeon, resident surgeon, anesthetist and scrub nurse. Probably cost Medicare at least… I don’t want to think about it.

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Friday I was sent home, to return on Monday the 5th for the procedure. It was a little odd being back; on the other hand, anyplace is in improvement on a hospital room festooned with IV tubes and ECG wires.

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Monday 10/5 I went back to the hospital as verbally directed on Friday, at 9am because Dr. Watkins had hoped to snag an early OR. But she didn’t, so I had to kill five hours in a nice quiet waiting area until they could admit me at 2pm. I could have gone home and come back, but why?

Anyway, I was prepped for the surgery, including getting a whole body shave. What? This is a minimally invasive procedure, little gash in the groin, slip the wires up the femoral artery, badda-bing. No? Well, yes, but they have to allow for the possibility that things could go pear-shaped suddenly, and when something goes wrong inside the aorta, the surgeon might need to open the thorax stat, and there really isn’t time for shaving and such. Oh. OK, then.

Off we go to the OR. “Alright, David, take some deep breaths, we are going to put some medication in the air now.” The onset of the anesthetic was odd; it affected my hearing. The low-pitched room noises went away and voices got very clear, as if the bass knob had been turned down and the mid-range up. And then I was in the ICU with a sore throat from the breathing tube, a small bandage in my groin, all done.

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Tuesday and Wednesday were hospital days. Tuesday I got up to stand and to sit in my chair for a couple of hours. Wednesday I got to go for a walk, three laps around the unit. (Memories of accompanying Marian on walks around the Whipple Recovery unit.) That night I was taken for another CT scan.

Thursday morning Dr. Watkins came in and shared some of the scan with me, showing how the stents lie along the upper third of the aorta. She could see where the top of the dissection had been closed off and was starting to clot solid. She also said that the lumen, the central opening of the aorta where the blood is supposed to flow, had been very restricted in size at the lower end (I think she used the word “pencil”), but is now much wider, allowing better blood flow to the renal and leg arteries. I wonder if I will be able to perceive this change?

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Thursday I was to be discharged; I had another visit from members of the cardio-thoracic team to get instructions on what I can’t do for a few days (lift anything over 10 pounds, drive) or ever again (lift anything over 20 pounds). They went away at 10am to post their discharge orders for me. As typical in hospitals, it took until 1:30pm before the orders were executed and all the paperwork finished, but eventually I was stripped of my last IV and wire, put on street clothes, and could go.

Meanwhile an adventure had been unfolding at Channing House. A city-owned transformer had blown during the early morning, and the main building was without power. When I got there at 2:30pm there still was no power. The Lee Center, nursing and AL, was fully backed up by a generator, but in the older high-rise building, the backup only operates emergency lights and the freight elevator. Hah, and the wi-fi was still on. But I got up to my room and crashed. The lights came on at 6pm.

Friday I learned that it had looked like a several-day outage to get a new transformer, but somewhat heroic efforts by our staff and the Palo Alto Utilities had found a used one that could be modified to work, and had located a large crane to bring it in, and the job got done in the one day.

So that’s the hospital hiatus. Several times during this, the thought occurred to me: you have a blog that is supposed to be about your life transitions, and this here is a transition if every was, so… but I just couldn’t cope with a daily blog. I did do pretty nearly daily emails to Patty, my designated medical spokesperson inside Channing House, and to several relatives. I’ve been referring to those to get the timeline right here. Saturday we resume our normal broadcast schedule!