Wednesday, April 29, 2015

the week of living dangerously

The past week has been beyond weird for my family.  Specifically, for Stevie Wonder, Wretched Daughter and Grumpy Grammy.  It started out normal enough last Monday, April 20th.  But by Thursday it began to go downhill.  I'm going to share my week since then so that if you experience anything remotely like it, you will realize you aren't alone.

Thursday SW (Steve) told me he had another dizzy spell.  This had been occurring more frequently the past few weeks, but I remembered that he first complained of some dizziness months ago (I tend to file information like that for future reference).  I got really insistent (the kids say I am overbearing when I am like this and they are right) that he call his cardiologist on Friday and tell them what was going on.

Friday he did just that.  Fridays are my off days now, and so I listened as he dealt with it.  The doctor's nurse left a note with the doctor, and Steve paced waiting for the call back, which came late morning.  He was told to call the pacemaker clinic, who tried to access his pacemaker via the wireless machine that sits on his bedside table.  Only today, for some reason they didn't receive any next call was to St Jude's to talk to the tech, who told him the transmission had gone through.  More phone calls followed, and finally the nurse asked Steve if he needed to go to the ER, and of course he said no, he was fine right then.

Saturday, SW went with Wretch  to Wal Mart, and he had a spell so bad he grabbed Wretch's arm in the parking lot and bent over, which freaked her out.  He insisted on going in and shopping, leaning on a shopping cart (something he had never ever done before).  When they left, she called me even though he didn't want her to.  My response was simple:

Take him to the nearest after hours clinic or ER NOW.

Princeton Hospital lobby
Steve agreed and Wretch carried him to the nearest clinic to have his vital signs checked and be triaged.  The staff at the After Hours Clinic told him that since he was a heart patient with a pacemaker, he should to go straight to the ER.  Steve, being the cooperative person he was, said he would, but to Princeton Baptist ER in Birmingham, an hour away.  Deb was totally wretched now about what to do, and I told her that if his vitals were ok (blood pressure was somewhat elevated but he was not symptomatic) then to come home on their way and get me.  (This decision would be a pivotal one later that day).

I had been putting some color on my hair (of all days to do it!) and by the time they got to the house I was almost ready to go.  I was giving orders about medications, clothes, etc to pack, because I KNEW they would keep him.  Don't ask me how, I just knew what I felt the problem was after spending the time waiting on them reviewing all the odd signs and symptoms over the past several months.

Off we went to the ER, Steve quiet most of the way, until he said:

I feel worse today than I did the day they put the pacemaker in.

He could not put his finger on it, just a general feeling of unease.  I kept asking him different questions about how he felt, pain, etc.  Nothing but the feeling of just "feeling bad".  This hardened my resolve as we got to ER.  Within a short period of time Steve was on a bedside monitor that showed a normal rhythm being paced.  The physician's assistant came in shortly after that and had multiple tests run on Steve.  All were ok,  No odd findings and Steve was still feeling ok at this point.

Watching Steve, I still felt in my gut that something was not right.  Steve suddenly said:

I'm getting really dizzy now.  It's bad.

I jumped up and stood looking at the monitor while this happened.  AND I SAW IT.  What had been causing my gut feeling.  Steve's pacemaker was firing, but the ventricular lead was not causing a ventricular contraction as it should be doing.  So what I saw was several pacer spikes, with no heartbeat.  Then SW's heart kicked back in and he said:

Ok, I feel better now.

I stood there watching him and saw 4 more episodes happen.  A few seconds each, it caused Steve to become extremely dizzy lying perfectly still on the exam table.The PA came in, and when he indicated they would probably send Steve home because they couldn't find anything, I told him I didn't think so.  I described what I had seen.  The PA  told us he was going to talk to the ER doctor.  In a couple minutes the doc came in.  He was very kind (as all the staff had been) and listened to me.  I explained what I saw and he said he had looked through the last hour's strips and couldn't see anything like that.  I told him in a firm but polite voice that I didn't know what time it had happened, but that I was a nurse and  knew how a pacemaker was supposed to function, and THIS ONE WASN'T.  He smiled at me (a real smile, not a condescending one) and said he believed me, and that he would go look some more.  He said the tech from St. Jude's was coming to interrogate the pacemaker just to be safe, at which time I relaxed just a bit.  The doc left to chase the elusive pacemaker strip, and while I waited, Steve had the worst episode he'd had, his heart rate dropping to 28 and getting very anxious and dizzy.  I stepped to the door and hollered for the first staff member I saw (turned out to be another ER doc but I didn't know that) and I explained again, in a slightly less polite tone of voice, and thank god, this time I had a witness!  He listened to me explain briefly what had been happening, and I told him the episodes were getting more frequent and I was not taking him home until this was addressed.  He told me he would go talk to the doctor, and I waited again.

In just a minute or so the ER doc came in waving a paper and said "I found it!  You were right, and I also saw this last episode happen while I was finding this."  At this point I looked at him and said "I knew I was right, I've been reading monitors for 20 years, and the ER doc said they were moving Steve immediately to the ICU part of the ER and were going to externally pace him.

More tests, external pacing (don't let anyone ever tell you having your heart paced externally isn't painful), and an injection of Morphine and Versed into Steve's IV to calm him and help him rest. THAT lasted about 15 minutes, at which time he woke up, said he needed a shot of Scotch, and then made a ribald comment about me, at which the nurses at the desk laughed and asked if we needed the curtains drawn.  I told Steve sternly to BEHAVE or I would fix his pacemaker permanently myself.  He laughed and we waited....

He went to the CICU (Cardiac Intensive Care Unit) after the St. Jude's tech told me he thought the wire was fractured.  To test this theory, while SW was in the ER ICU, the tech turned Steve's pacemaker off briefly twice, and during those few seconds, Steve thought he was dreaming, but to us he looked like a dead person, skin waxy, eyes and mouth open and body jerking.  Wretch got through the first episode, but the second time I told her to get some fresh air and she left in tears.  I knew what was happening and the technology around me, and felt secure with the situation.  She just saw her daddy die in front of her.  Twice.

To cut things short, the pacemaker was defective for some reason, although Steve had been too vigorous with his activities and was told to take it easy on his left arm from now on by the surgeon who replaced the whole system on Monday.  Yep, Stevie Wonder had worn a 7 year pacemaker out in 2 years.  Not something the cardiology department saw every day.

By Monday I had also caught some bug and had a sore throat, ears that felt like they would explode every time I swallowed, and a cough that made me feel like I was coughing my lungs up.  But SW had a new lease on life, hopefully more than two years this time, and it was all ok.

I came away from this whole week feeling two things so deep in my gut that it was hard to deal with.

1. On Sunday, while we spent a long day together passing time, Steve took my hand during a moment alone, looked into my eyes and said "thank you for saving my life".
2. If I had not been a nurse, I would not have known what to say to the doctors.  They were good doctors, willing to listen, but my training helped me identify the solution and communicate it to them. If I were not a nurse, I would not have been able to put all the pieces together in my mind and realize what was happening.

You see, the heart can't be resuscitated with no electrical activity to sustain the beats.  That is what
fires the beats.  We live so far in the country that he would have died. even with CPR, long before any ambulance could have arrived.

Again I was left with deep feelings of gratitude, and of feeling that the reason I became a nurse goes much deeper than even I realized.
No, SW is alive and waiting for his first post op bite of real food is sweet; savor every moment. ~cath
find me @jonesbabie on Twitter

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