Hickman Removal

Mi Amigos de Chemo 13

What a day. I mean it was a good day, but still -- what a day.

After the excitement of the night before when one of lumens on my Hickman exploded and the debate about whether and how to save the catheter ended with a tsunami of saline, I had been waiting for someone to come by and yank the thing.

At about1500 the pre-yanking flurry of activity began. Papers were signed, platelets loaded in the IV (to ensure clotting if things got messy), and Teddy Bears removed from the bed – that’s right Teddy Bears removed from the bed in the room – I wasn’t going to the OR like when they installed the device, the Hickman-ectomy was being done in the room. Kinda freaky huh – to move a fella’s Teddy Bears when he’s just about to get cut in his own bed. At least the bears were put on the windowsill so they could watch and take notes.

At about 1530 a PA from the doc’s office comes in carrying an ominous looking grey steel box about the size of a good camera case. She introduces herself and starts explaining the procedure in great detail. With any luck, she says, the explanation will last longer than the procedure. The whole thing should last about 30 minutes.

She opens the steel box and I don’t know what I’m expecting – maybe eerie vapors creeping down the side of the thing once it’s open, or special instruments for an incredibly complex procedure – at least something with enough gravitas to merit a grey steel box fit for a spy movie. It was laundry – sterile laundry I grant you, but laundry nonetheless. The PA pulls a towel with a strategically placed hole, some other towels, a gown, some gloves, and a mask from the box.

Well she gets suited up in her ‘I’m gonna cut Bill open’ duds and puts her tools on the room table to the left of the bed where she will be working. A nurse from the floor goes to the right side of the bed and holds my hand; she reminds she has been there for every “in room” procedure I’ve had including the very first Ommaya time they tried to access the reservoir – we all know how that ended.

The PA injects numbing medicine around the Hickman’s entry site. I have my head turned toward the nurse holding my hand, and pretty soon the digging starts. Digging, excavating, exploration – call it what you will but it is bull work. You see there are two problems: first, the PA is working in a tiny hole in my chest trying to free the line without damaging it and really can’s use a cutting tool to slice away any excess scarring tissue; second, there is a ton of scar tissue grown around the delicate latex tubing inserted in the vena cava.

So now it’s tough going, the PA has to tug, tear and rip her way through the tissue grown around the Hickman tubing in my chest muscles. Although the area is numbed and I can’t feel any pain, I can feel the digging and tearing of the scar gristle through the numbness.

At a several points in the procedure we stop and re-numb the area and start again. Every time we stop the PA has to refit herself in sterile clothing, gloves, and masks. Because the sterile gloves are flesh toned and covered in blood, she looks like a mad scientist from an old creature feature or a fiend from Dexter.

At about 1700 a food service tech wanders in to drop off my dinner, realizes she’s in the wrong place at the wrong time, drops the tray on a chair walks away – it’s all very surreal. I couldn’t see her face, but I bet she wished she had wandered into different room. Then the phone rings, the nurse picks it up.

 “Mr. Potter’s room,” she says. “No he can’t come to the phone right now. He is in the middle of something and can’t be pulled away.

“That was your sister. She wanted an update.”

Eventually the PA calls for help because the amount of scar tissue is so enormous; she is at a loss to explain it all. Pretty close to 1730 a doctor comes in.

“You know what’s going to happen,” he says. “As soon as I get in there, this thing will pop loose because of all the work she did before I got here.”

That’s exactly what happened.

The Doctor went in and with two tugs of gristle the line was free. I was covered in a bit of blood, but the infected Hickman was out. And where I expected to see a lot of blood and a big hole, all there was a small puncture hole the width of coat hanger wire and some translucent red swaths across my chest.

So we’ll what happens next. With the infected Hickman out maybe everything else will fall in line, or at least be a bit easier. Even so, I have to cool my heels in the room for 24 hours to ensure my fever’s gone.

Well, that’s it for now.

More tomorrow,

Bill

Shots rang out

Hey Posse:

I’m not really sure how to tell this story, but here goes one attempt. This is true.

Night had just fallen over Christiana Care in Newark Delaware when the nurse entered the room with what looked like an arm full of vials, needles, and test tubes. She knew the patient.  In fact she was one of the original nurses who was there when he started his cancer journey. No, no, no that’s terrible – Let’s start again. BTW in case you never noticed I don’t use names of people in my posts.

The nurse walked into the room with the litheness of a ballerina even though her arms were full of medical supplies. Litheness of a ballerina? What the heck is that? Okay I’ve almost got it. Hang in there.

There’s only one thing more reliable than a good nurse and that is a tide chart. Really? That’s the best I’ve got? Tide chart? People will think about laundry detergent. Okay maybe straight is the way to play this.

Bang!!!! The sound of the shot filled the room. Okay this works.

One of the first nurses I met when I started this cancer journey was _______ and she has been wonderful from day one. Last night she came in with and armful of vials, tubes, syringes, and medications. I was sitting up in my hospital bed getting yet another transfusion of blood.

Even though I had been through it all a million times, she explained what was going to happen, what drugs were which, and what time schedule everything would be administered.

“First I want to flush the lines of your Hickman,” she said.

A Hickman Catheter is a white latex, flexible, thin tube inserted through my chest in my Superior Vena Cava. The tube goes from the Vena Cava out my chest to teeny little splicer, which further divides the tube into three lumens, or ports if you will. It’s very like a garden hose attachment to which you can connect three other hoses.

“Fine with me,” I said.

Earlier in the day they (whoever they is) decided the Hickman had to be removed; it is the cause of my repeated blood infections. Regardless, it was still being used for antibiotics and other stuff pending its removal.

The nurse skillfully sterilized the tip of the first lumen, connected a syringe of saline solution and began to push the plunger down to push solution through the tubing and ensure the Hickman could disperse drugs, blood, and etc. One down – two to go. The nurse sterilized the second lumen, connected the saline syringe, and pushed the plunger.

Bang!!!! The sound of the shot filled the room. The Nurse’s face was white, my bed was wet, and my roommate’s visitor’s were stunned by the report of what could have been a small caliber handgun.

The nurse immediately grasped the seriousness of the situation.

“We blew the Hickman line,” she said grasping and pinching the tattered lumen while rolling it in her fingers to keep blood from escaping. “We need a clamp.”

“Look in the bottom of red gym bag on the windowsill,” I said.

“Pinch this here,” she said placing my fingers on the ragged, ruptured tubing and she leapt to the bag and began rifling through it.

“You don’t have one,” she said.

“Check the side pocket.”

“Got it,” she said.

She took the blue hemostats – a kind of scissors with a needle nose pliers ending – and clamped off the lumen stopping anything from leaking and me from losing blood.

“Wow.” I said. “That was crazy.”

“Yeah, I didn’t push that hard either; it just went. I never had that happen before.

Okay that worked. Just a note – the nurse in question deserves an award for coolness and taking control of the situation with am aplomb far beyond her apparent years.

I guess that’s it for today,

Bill

Good Morning -- waiting for next steps

Good Morning My Posse, Gang, and etc:

I’m not sure what has been harder, spending a day with clothes drenched in sweat or not having my wonderful MacBook. I think it was going without the MacBook. Anyway I’m just chilling here in the beautiful confines of Christiana Care. I have window seat for this flight and get to watch birds land on the black tar roofs below – helluva view. It’s 0614 and the only things I can see at the moment are reflections off the window in my room of the nurse’s station outside the door.

As you all know, I love my nurses.

What’s up with me today? Well my room phone number is 302-733-6446. If you call I may or may not answer, as the chairs are on the other side of the room and I won’t make it to the phone, or a particularly insightful Jerry Springer may be on. Oh I almost forgot to mention, the best way to contact me is probably via email at Lettice123@yahoo.com. It’ll probably be a waste of time to use my state email after Friday when I enter the rolls of Long Term Disability and am no longer technically a state employee. One would assume they’d turn that email off; I would.

It turns out my Hickman port thing has a bacterial infection so they may have to pull it out and replace it with a new one. The doctors are thinking great thoughts about that and will tell me something today – maybe; if they haven’t run out of great thoughts. While they may be debating the prose and cons of replacement, I say “yank it!” The Hickman that is.

I meander again. 

My permanent doc is on vacation, so there really hasn’t been much discussion about next steps and the impact, if any, my new heart wrinkle has to play on the next round of chemo. All I know for sure is I won’t be getting any chemo ‘till next week (at the earliest). My platelets are too low at the moment. Thank God for small favors. Yikes!

I have a lot of reading to do today. I got a book-size mailing from the state yesterday about long-term disability. I guess I better read that sooner, rather than later before I go awry of some detail I should’ve known about and everything goes south on me. I also have a library book that I need to be done by Sunday as it s only a seven day loan.

I think I’m also going to spend the day writing some notes and other stuff. I’m working on a project for a close friend of mine and need to start getting down to business – today would be a good day to make some progress on that.

I guess that’s it for now.

Peace to all,

Bill

Back In stir

Believe it or not I usually write these meanderings on an MS Word document and then cut and paste to the blog. I don't have that luxury this morning because I am using this funky keyboard from the hospital's Get Well Network.

Regardless, I didn't post yesterday because I didn't have anything positive to say and I had to run to some appointments.

Remember I mentioned an echo cardiogram? Well it turns out that didn't go as well as I hoped. Apparently, my ticker isn't pumping blood as forcefully as it should. Here's the deal as far as I can tell. When blood enters your heart, your heart usually pumps about 60 to 70 percent of the blood and waits to to the next heartbeat to get the next 60 to 70 percent of of the blood pumped. Mine ticker has taken a side road and I am doing about 35 to 40 percent.

That plus the low hemoglobin is what has caused the shortness of breath and difficulty walking etc...

What caused it? The doc is mystifies. He said I am the least likely candidate for heart disease.

He doesn't think all the chemo has anything to do with it.
I of course do think it is the chemo.

Anyway, the doc said he thought I had a blockage across an artery that runs across the front of th heart. This blockage somehow kicked itself loose damaging the pumping stuff. Either that or I had an undiagnosed heart attack.

I don't know! I go for a stress test on this stupid heart thing on Tuesday.

But that's NOT why I am back in the hospital. My blood infection is back and I am running a wicked bad fever.

So that's it I guess.

NO Post today -- This is a post damn it

To chemo? I doubt it

Good morning my gang, posse, homeboys, er, ah, um homegirls:

Funny thing, the word homeboys doe not trigger a spell check, but homegirls does. It’s weird.

As you know it usually takes me a paragraph or two to get warmed up this early in the morning. Well today may be a hospital day but, as the British would say, “ I rather doubt it.” I suspect my platelets will be too low, but if I am wrong and I do hit Christiana Care I think I might deviate from my usual roast beef sandwich induction lunch to something different. I’m thinking pizza!

Anyway, I’ve got about a dozen things to do before I go to the hospital. I have to run up to the office and turn in my cell phone, state credit card, ID badge, and final paperwork for my long-term disability. I am supposed to pick up some goodies too. My quandary is, do I run up to the office first thing this morning, or accept risk that I won’t be sent to the hospital today and go after my doctor’s appointment, or do I wait an go tomorrow. Hmmmm – big decisions.

Well, I guess that’s it for now, I’ll see you guys later.

Peace,

Bill

Not much today

Guys:

Not much to report today. Still fighting a helluva cold. Actually, I think it is low platelets and hemoglobin, but what do I know (I'm not sure this kind of sarcasm requires a question mark or a period).  hmm. Well, I'll know more tomorrow after I get my blood work done. I can't imagine I have enough platelets to be admitted tomorrow for round seven.

I'll let you know.

Bill