Thursday 10/15/2020

Feeling dour and grumpy this morning. About the slow recovery from the dissection (if that’s what I’m recovering from, see yesterday). I started a walk, got sidetracked in a ten minute talk with Marcia about volunteer matters (we’re getting fewer, is it time to hand the jobs back to staff?), did a five minute walk ony.

And later having gloomy thoughts about the MG model. I tried putting clear coat on a three small parts yesterday. Inspecting them today it is plain to see that the clear coat is not going to level out all the microscopic bumps and model-scale orange peel in the color coat. Which means: sanding. To get a good finish I will need to sand the color coat before applying the clear. This is really, really hard to do. The parts are tiny. There is no such thing as a 1/16 scale orbital sander, so it has to be done by hand, or rather, by finger-tip. A little piece of 2400-grit or 3600-grit paper on the end of a forefinger. But there are lots of detail lines, it is hard to get close to them, and if the sandpaper overlaps them, you quickly wear through the color and expose the primer along the raised edge.

Possibly I could get a smoother color coat in the first place by applying the paint more heavily. I was really careful not to get runs, and I didn’t, applying multiple light coats to get the opaque color. But that ends up with the matte-texture. Maybe I will experiment applying one more color coat as wet as I can get it (and damn it, there will be runs).

Plus I am realizing there are small projections on these parts that represent hinges or door locks, which shouldn’t be given color and clear coats, they’ll get chromed later. So I should be masking them, and haven’t. Grump grump grump.

And my bag of clean linens didn’t arrive on schedule. Grump.

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Oddly, later in the day I felt better. I ate a good supper and took a second walk afterward.

Wednesday 10/14/2020

Taking Nurse Diane’s advice I set out first thing for a walk. I decided to use the timer in the phone, go 15 minutes out and when the timer expired, return. That worked ok, and later, before lunch, I did another like it. I was going to do a third after supper but felt too tired. Lord knows when I will feel well enough to try jogging again.

So I had a bit of a realization about this medical adventure. This is my own thinking, to be checked with the next professional I talk to (Diane on Friday, Dr. DiBiase next week). Why do I feel crappy, and have felt crappy all the three weeks since the event of Wednesday 9/24? The weekend after that I was already commenting on running a fever and reduced appetite and feeling unwell. Those have continued throughout. At first I commented maybe it was some random coincidental virus. Then I got stented 9 days ago; was that supposed to be a “fix”? I don’t feel “fixed”.

Here’s what I’m thinking now. The dissection was, in effect, an internal trauma. A derangement of certain tissues, just like a broken bone or a stabbing (or an invasive operation). Healing the damage of a trauma is a process, it takes time. The stenting procedure, by closing off the top of the dissection, makes it easier for the rest of it to heal (to whatever extent it will) but isn’t a fix as such. The on-going symptoms, I am speculating, are the results of the body trying to patch up and repair the internal trauma.

This could be complete fantasy. Certainly none of the medical people at the hospital advised me, “this will take time because your body has to blah blah and so you’ll probably have a fever and feel run-down for a while until that happens.”

Tuesday 10/13/2020

Began the day with the adventure of going into a grocery store. Rather than use instacart, I decided to enter Piazza’s, my favorite market, during their Tuesday 7-8am senior safety hour. I was surprised at the number of changes they have made in their layout to make it more open and safer-feeling. I quickly stocked up on my basics (bread, PB, coke, beer, grapes).

Then I had an hour to kill before meeting Harriet for coffee. Pleasant meeting; but there’s not a lot to talk about with all our shared sports and travel interests on hold.

Back to CH in time for the bi-weekly writers’ meeting. Of course I hadn’t done any writing for it, so I just listened.

Following that I finished spraying color on the red parts of the MG model.

I was feeling low when I got a call from Diane, the nurse coordinator for my surgeon, checking on my progress. I was glad to be checked up on, I’d been of several minds about whether to contact them and when. I described my minor but persistent chest pain. It could be a lot of things, she said; if it ever gets severe, or your blood pressure drops, that’s an emergency. Can you control it with tylenol? Yes, tylenol makes it mostly go away. OK, then, I’ll check back with you on Friday.

She also commented that taking three short walks a day would be better than taking one longer one. So starting tomorrow I’ll implement that.

Monday 10/12/2020

Not ready to attempt even a short jog yet, I went out at 7:30 for a 1.5mile walk. Back in plenty of time for the monthly Resident Association meeting via Zoom. Unusually low attendance, around 80, and I noticed the couple that just moved in on my floor did not attend. That’s too bad, because this is one event where you can really see CH as a functional community.

Later I put a couple of coats of red on the two big body sections of the MG. One more coat I think, and then it will be time to apply clear coat.

I’m not pleased with my condition. In the morning when I got up I had a bit of vertigo; it passed off before my walk but I hate the reminder it is always lurking. And I have intermittent small chest pains, like muscle aches. No, not angina. Easily suppressed with Tylenol, but it keeps me feeling unwell. Grump grump. I want to back in the state of “normal” which is simply the state of never thinking about my body at all, just occupying it.

Sunday 10/11/2020

I’m sleeping well, that’s nice. My appetite is all over the place, I woke up ravenous about 3am, made a little snack and read for a while. But at 7am, didn’t want any of my nice breakfast shake. Ate enough at lunch and dinner.

I went out for a walk mid-morning, the phone says only 1.3 miles. Felt like “enough”. Bed rest, it’s a killer.

After lunch I decided it was far enough from the op. that I could drive, so I took the Prius out for a run up 280 and and back. North to Millbrae, back south to Los Altos. Which eventually brought me to a cheap gas station on Middlefield, where I topped up the tank, 7.2 gallons. I had topped it up twice before, for a total of 17.5 gallons consumed since the last fill-up which was 1020 miles ago in… go on, guess. March. I’m on pace to break 40 gallons total consumption for the year 2020.

Saturday 10/10/2020

Got a lot of good sleep. Woke up sometime around 3am to pee, and had the conscious thought, “huh, I feel healthy”. Also felt that way off and on through the day.

Did a couple of deferred chores, including filling the hummingbird feeders. My neighbors may notice a reduced buzz crowd now. Then at 9am, took the first walk of the day, just around the neighborhood. I went to the Saturday Farmers’ Market, but then realized, I hadn’t gotten my money clip with bills off the desk. So no cash, no farmer foods.

Did a lot of sitting around in one or another of my comfy spots. After lunch I got serious about my ballot, which had come last week. Went through various recommendation sources, voted everything except the De Anza College district board. Then went out for walk number two: up to City Hall to stuff my sealed and signed ballot into the collection box.

On this walk I realized I was breathing harder than I normally would. Is that shortness of breath? Does it mean something? Dennis, when he called later in the day, said, it means you’ve been lying on your butt for two weeks. OK, I’ll go with that explanation. Two weeks until I see my cardiologist.

I am eating better than in the prior weeks, although still not up to normal; also my temperature is still typically +1 to +1.5 over my historic norm. Do I have a new norm? I shall try to find something on TV to keep me up to 10pm, which I did last night. But I may cork off early.

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!

Sunday 9/27/2020

Woke up from a very restless night and, after coffee and a shower, suddenly realized I felt normal. It’s hard to express the difference between feeling a little bit ill, and not feeling that, because after all, normal is normal, you don’t usually comment on it. Its your basic condition. But to realize you feel normal after a couple of days of feeling more or less crappy, is pleasant.

Did some color spray on the model; all the small parts are now a rather luscious red. Tomorrow I will start spraying the two big body parts; and then go through the whole thing again with two coats of clear.

Mid-day I made sure I had the Sutter Health tele-medicine browser extension installed (they only support Chrome and IE, no Firefox or Safari, come on, people what is this, 1998?) and working. Then I wrote up a day-by-day account of this — what is it, an illness? — that started Wednesday morning. So I won’t waste the doctor’s time tomorrow. The nurse who brought lunch said she would make sure the test nurses knew I had this 9:30 appointment, and would call me for my swab before or after it.

By afternoon a degree of fever was back, but the pain was not. I sat on the deck and read. I’ve been getting more reading done these few days. I read all of The Salt Path by Raynor Winn and liked it. If you’ve lost your home and everything you ever worked for, and your partner has a fatal diagnosis, what should you do? Well, maybe take a 600-mile hike?

I got quite a few chapters forward in The Dream Machine by Waldrop, about a guy central to computer history of whom I had never heard: J. R. Licklider. The book is immensely detailed about computer history in the Twentieth Century, stuffed full of anecdotes about people whose names I do recognize, like McCarthy, Englebart, Fano, Shannon, Von Neumann, and detailed stories about the creation of machines I talk about at CHM, ENIAC and SAGE and so on. But apparently it was Licklider who, as the head of ARPA, created the vision and pulled all of them together to create computing as we know it now. I’m just up to the point where it is all coming together in “Project MAC” at MIT, the first useful time-sharing system. That was 1963-64. It’s kind of pathetic that at that time, I was putzing around in San Francisco, doing nothing of any value, feeling aimless. And in another universe… I could have gone to MIT and been one of the student hackers helping cobble together the first-ever online community. Not a very likely other universe, mind you. But geez. If only.

In the afternoon my temperature blipped up a bit. Couple Tylenol fixed that. Watched some TV. Wrote a long post on reddit. Going to watch Travels by Narrowboat and go to bed.

Crappy night, many small discomforts kept me tossing. Still, I got many hours of sleep.

Saturday 9/26/2020

My temp this morning is 98.3. Or 98.0, on the second try, or 97.7 according to the nurse that used an infrared gun to my forehead when she brought the breakfast I didn’t order. Anyway, approaching normal, a little high still. I don’t feel feverish, which I did yesterday. That’s weirdly disappointing. I want my fever back!

By 8:30am I had dealt with several emails related to volunteers. People saying, I can’t deliver meals for various reasons. One person, Linda, had a really good excuse; her husband had taken a fall in their kitchen area last night, and had to be transported to Stanford Emergency. Well I guess you are busy, then. Anyway, after a flurry of business I think I’m ready for a nap.

Other than some time spent spraying little car parts, most of the day was like before: reading, watching youtube videos, napping.

The chest pain that has been with me since Wednesday was minimal in the morning and afternoon, and has stepped up a little tonight. It comes on if I take an extra deep breath, or lean forward to pick something up. This led me back to Doctor DuckDuckGo (I haven’t used Google for searches for years) and to pericarditis. Marian had this for a couple of weeks following her heart attack, about 1998 or so, and that article says, it commonly follows myocardial infarction but also has lots of other causes including “huh?”. It’s a hit in that (1) the pain onset can be sudden; (2) can involve shoulders and/or back; and (3) it can cause a fever! Hello-ooo!

I had a fever the day after the pain started. I’ve been assuming that was a coincidence, an unrelated viral infection. But, hmmm.

Unfortunately “The pain is usually relieved by sitting up or bending forward, and worsened by lying down” which is exactly the opposite of my pain. It is cool with lying down and gets worse leaning forward. Also unfortunate in that there’s no real good diagnostic test.

Still, I will propose this hypothesis to Dr. Dibiase on Monday.

Friday 9/25/2020

Went to bed last night about 8:30, right after a phone conversation with Scott. He very sensibly pointed out that if my “back pain” was spine-related, I would feel it if I bent or twisted my back, which I don’t.

I had lots of sleep with frequent wakings. At 5am I got up. Temp 99.4, and feeling crappy, feeble, low energy as one does with a temperature. So I reported that on the morning report form, and ticked the box for “fever” as well — only that, among about 20 other symptoms. My sense of taste is fine, I thought, sipping coffee.

Lounged about mostly on the bed waiting for the staff to react. Feeling a little better after a couple of hours and temp down to 98.9.

At 10am I called the nursing desk. Valentina asked the usual questions about symptoms and said she’d be right up. I reported honestly that I’d been in a hobby shop (only 2 other people, both masked) and had walked through the Cal. ave. market Sunday. Neither got any reaction. She came to the door soon, asked more questions about symptoms, took my temp with an ear-gun. 99.2. She cautioned me about not leaving my room, and put the dreaded red dot on my door, meaning nobody can come in. I’ll be getting my meals delivered by a nurse. I know how that goes, from doing volunteer meal delivery. A special cart comes out of the kitchen, with trays for isolation units, before any other carts come out. A nurse comes and wheels it away.

Now, why did I not mention the might-be-angina etc? Two reasons. One, that pain has subsided to almost nothing during the night. There’s just a bit of sensitivity if I inhale deeply to expand my chest. Two, I didn’t have any confidence in being able to communicate with Valentina, who has a heavy Russian (well, Eastern European) accent, and is just a nurse, not a doctor and certainly not a cardiologist. If I tried to explain all that, either she wouldn’t get it or else would overreact and call 911.

But I really do have some kind of bug causing a temperature, could be a cold, flu, or COVID. That, she can deal with and has appropriately. She said the COVID nurse would come around for a test later.

No test was done today. I shall call the nursing desk first thing tomorrow. For the rest of the day I just flumped around the apartment, reading and napping and soaking up the sensation of having a mild fever.

On Rhonda’s 4pm call, it was clarified that of the seven AL residents infected, three have gone to hospital. All are expected to return “in a few days”. Some restrictions have been lightened, for example two residents can ride in the same car, if one drives and the other sits in the back, both masked.