Consequences and Repercussions II: Anemic Boogaloo

Failed my iron count for the platelet donation . . . again. They tested me as soon as I walked in instead of setting up the machine (which would mean throwing away all the tubing and bags and stuff if I failed) or letting me fill out all the paperwork.

Missed it be that much.

I'm not sure what the scale is, parts per million, per cent of hemoglobin, whatever, but I missed it. Came in at 11.8. 12.5 is the minimum required and I usually rate up in the 13s somewhere. I don't know why it's taking so long to recover from the whole blood donation. It's now been eight weeks.

We rescheduled for two weeks from now, and the phlebotomist gave me a list of iron-rich foods (which doesn't look any different from what I eat regularly anyway) and recommended taking an iron supplement.

I know she's a little embarrassed and feels responsible since she's the one who accidentally took the whole blood last time. That's part of the reason we set the new appointment for two weeks out: she wants to get a successful donation from me this month, before the regular nurse gets back from vacation.

No cookies this time.

Oopsie!

Went in for my platelet donation today. The "new" phlebotomist (the same one I had last time, new to this location, not to the hospital system or the profession) had me again and, again, she did an excellent job picking a vein and maintaining the draw without me making the machine beep all over the place. But . . ..

She pressed the wrong button.

She pressed the wrong button when she started my session and, instead of donating the usual unit of platelets, I ended up giving two units of platelets and one of whole blood.

It's not a problem per se (my platelet count was up and my iron is good) it's just that it wasn't the plan and nobody noticed until I was almost finished when I looked at the screen on the apheresis machine and noticed the column indicating platelets processed was maxed out (as it should be when done) yet she was telling me I had ten more minutes to go. Then I noticed another column, which had never been active during any other session of mine, rapidly counting up milliliters of . . . something.

The bags were obscured by the screen itself so I didn't notice them until staff realized what had happened but, yes, there were indeed three of them and they were full. Two white and one red, all from the same vineyard.

The good news is: I didn't beep even once, a record for me. The bad news is: I'm tired and my fingertips are wrinkly as if I just got out of a long bath.

I think I deserved the T-shirt this time.

I'm going to take a nap, now.

The Best Laid Schemes . . .

My niece was tentatively scheduled to go home last Monday. I am astonished by the speed at which people can recuperate from major surgery these days mostly as a result of improvements in surgical practice that minimize trauma to the body. When I was a kid, people stayed in hospital longer recovering from tonsillectomies (surgery like she had wasn't even possible).

As it was, those plans went agley when she suddenly developed a level three (whatever that means, but it was serious) heart block and they rushed her back into the OR and installed a pacemaker. I'd like to think her heart, after struggling for years and years just to keep her alive, suddenly reacted to the lack of stress due to all the new replacement parts and upgrading and sort of "overclocked." Or kind of like pushing and pushing on a stuck door when someone finally removes the doorstop on the other side (not that that's ever happened to anyone I know).

So now not only does she have bionic bits, she's battery powered as well.

At least she got a nice visit from a cute service dog. And will stay in the hospital for another week or so. Just to be sure.

Thank You, One and All

After a long day and night I think this Facebook post from my niece's Mom says it all:

"Caitlin's father spent the night with Caitlin in the ICU. She
looks good and had a good night. Dr. Baird did some pretty
extensive work on her yesterday. He reworked her tricuspid valve
and tightened it with a ring, put in a titanium mitral valve,
replaced a patch covering the hole in the septum, trimmed off some...
scar tissue, adjusted a small group of heart muscles, and performed
an ablation to the right side of her heart. In ICU now and they are
keeping her asleep for a little while longer."

That's a hell of a lot for a fourteen-year-old to go through (and not for the first time) but her Dad reports that the oxygen tubes are out and she's breathing on her own although still drowsy from the sedatives. The use of an artificial valve this time means she should not have to ever do this again.

In a previous century she never would have made it this far, and I am extremely grateful to not just the superb surgeons who have the skill and talent to perform such work, but also to all the people over the years who developed the techniques and trained the doctors, who invented and manufactured the tools and replacement parts and those who built and maintain the organizations that could bring them all together to accomplish something so extraordinary. And to my fellow citizens, who help to pay for it all through your taxes and insurance premiums. This is the definition of civilization and, today, my niece and her/my family are the beneficiaries.

Thank you. May it all be there for you when you need it.

Nothing To Do But Wait

So today is the culmination of weeks and months of growing anxiety as my sweet, beautiful niece goes into surgery, yet again. She's fourteen and this is her fourth open heart operation. It was originally scheduled for last month but she came down with the flu a week before that date and had to reschedule.


I think at least part of the anxiety (our own, that is) comes from knowing that she is now old enough to be aware of the risks herself. The first two operations occurred when she was an infant and the last one a couple of years ago, but fourteen is a good age to have a real grip on your own mortality.


She's pretty good, although not perfect, at hiding her nervousness and spent yesterday evening swimming in the hotel pool in Boston before going in for pre-op.


The first three operations involved stitching together her heart valves and repairing leaks but they just wouldn't hold up permanently, so this one will install an artificial valve that should last.


One of her big brothers, the middle one who was just sent by the Navy on an extended tour of the Eastern Mediterranean and Black Seas (Romania, Israel and Greece, so far), made a video for her wishing her well because he couldn't be there this time. His political consciousness was formed almost entirely by 9/11 and tends to be somewhere to the right of John McCain but he is a sweet, caring, loving human being and the best big brother anyone could ask for and I'm quite proud of him.


I just received a report from her Dad that the operation is proceeding satisfactorily. They have finished replacing one valve and are working on the second one now. She went under around 8:30 this morning and the expect to be done in another couple of hours.


So we continue to wait.

When Things Go Well

"Enjoyed" an exceptionally good platelet donation today.

I was in and out in an hour with hardly a protest from the machine except for a couple of minutes when the tubes connecting my vein to it suddenly started vibrating randomly, a sensation I could feel all the way into my arm. The phlebotomist (not my regular who runs the office but someone who has been there and worked on me before) assured me it was not me but the machine at fault and jiggled the plumbing around until it stopped which made me a little nervous seeing as one end of said plumbing was stuck in my vein but she was careful and everything worked out in the end.

At the start of each donation they run a test tube of whole blood down to the lab and in about ten minutes they're back with a detailed breakdown the one part with which they are concerned being, obviously, the quantity of platelets per given volume of blood. They let me see the test results, too. I was surprised to see two categories marked "high" and we spent a few minutes trying to figure out what they were and whether they were important.

It turns out the lab can measure not just the number of platelets and red and white blood cells but also the size (width) of the red cells and a slightly elevated number of mine were outside the standard deviation which is an indicator for anemia a problem which I do not, and have never, had. The other out-of-range reading was for monocytes as a percentage of total white cells, but nobody had any idea what that indicated.

I took a T-shirt, in addition to the usual cookies, as my reward mostly because it was humorously illustrated with a cowardly Thanksgiving turkey running away from donating. I stay away from the serious, especially the patriotic, shirts because they're not only preachy and propagandistic but tend to be maudlin and sappy. My favorite is still the giant mosquitoes chasing after the mobile donation bus. I have two of those.

For some reason, they wrapped the donation site with a leopard print bandage which is neither inconspicuous nor retro enough to be cool and can not be passed off as camo, either. That's definitely coming off ASAP.

Hair and Back Again

Well, that debate may have been resolved.

I went for my monthly platelet donation today and both the nurse phlebotomist and her assistant not only noticed my haircut but complimented it. That's a first.

It had been my habit, on donation days, to fill the car with gasoline, get a haircut (if due), and go to the hospital since they are all in the same general direction from home and vicinity to each other. Yet, in spite of repeatedly coming in to the donation center with new hair, no one had ever said anything before.

I haven't fully made up my mind, yet (and it's going to be a while before I have to decide), but it's not looking good for semi-competent quirky weirdness right now.

Also, I found a cheaper gas station, run by a nice Pakistani family, in the complete opposite direction over toward the grocery store. So that's another factor.

Civic Calories

I voted yesterday in our city's non-partisan open primary for mayor and one council seat. It was a pathetic turnout, only 8%--seriously 8%--bothered to turn out. I think more than that write in to the newspaper every week to complain about the mayor and city council; they just won't get off their lazy butts to actually do anything about it.

One of the advantages, as I see it, to participating in a low-turnout election is that, proportionately, my vote carries more weight than it does in the general election (when people do show up to vote on the candidates already selected for them in the primary). Even so, my candidate for mayor came in second behind the incumbent although my choice for council member did win (the right to run in November).

The other advantage to a low-turnout election is that, since the polling place is usually stocked with edible goodies as a little reward to voters, the poll watchers still had mounded plates full of cookies, doughnuts and brownies when I came in a half hour before closing time. They insisted I take large quantities with me when I left. I obliged.

Free snacks are always a good thing as they go but the cookies at the hospital blood center are objectively better. And since I am scheduled for a platelet donation tomorrow . . ..

My Back. Let Me Pat It.

I received my 6 gallon certificate from the hospital blood services department today. That's 48 pints or approximately 24 liters. I donated another 43 units or so back in Salt Lake City before moving but the Red Cross doesn't give out prizes like the local hospital here does. (I have enough blood related T-shirts to last the rest of my life already.)

And that's almost all platelets, too. I switched from whole blood to platelets back in SLC when they asked me to do a directed donation for the children's hospital. Even though my blood type is common, for some reason, I am part of the 1% that does not carry the common cytomegalovirus making my otherwise plain vanilla blood suitable for people with compromised immune systems.

Before that I gave in both Connecticut and New Jersey when I lived/went to school there but I wasn't nearly so conscientious then. I think that may have something to do with a bad experience at school in New Jersey when the Red Cross did a drive and everyone I went in with was all through and done and the next batch was finishing up while I was still on the table because my vein had collapsed and nothing was drawing so the doctor in charge pulled the needle from my right arm, walked around the table, and jabbed it into my left arm. Now a days, the slightest thing goes wrong they pull the works, stop the process and trash the lot but back then there was no HIV/AIDS or BSE and very little concern for hepatitis or any of the other horrors now on the questionnaire and that doctor was not going to just walk away with a half-full bag.

Anyway, if I totaled them all together I'm probably somewhere around 20 gallons, lifetime. So now I've got my certificate and I'm scheduled again for the 15th.

I feel so noble.

Apologies All 'Round

I went in for this month's bloodletting today. So much for the left arm being a better donor site than the right.

Everything was going great, vitals, etc., until the nurse stuck the needle in. It just didn't feel right. It hurt. We talked for a couple of minutes while the machine took its sample and began the draw. We even got the results of the sample test back. And then the stupid machine started beeping and wouldn't stop and my vein started leaking making a small but intense little purple hemorrhage and the nurse just pulled the whole thing.

I apologized to her for wasting her time and a draw kit (all that tubing--and there's lots of it--is one use only). She apologized to me for wasting my time and the pain.

She offered me a T-shirt, a meal ticket to the hospital cafeteria and a commemorative pen. I refused. I took a cookie for the pain and suffering.

We'll try again Tuesday.

"I will gladly donate Tuesday for a cookie today."

Failure, Then and Now

So, I went to the hospital yesterday for my monthly bloodletting. I filled out the questionnaire as usual and Bill the Phlebotomist took my vitals, as usual. It's been cold the last few days (relatively speaking, for around here) so I opted for both the heating pad and a blanket and hopped up onto the couch.

Normally, there's just a slight "pinch" associated with the needle insertion and maybe a couple seconds' "burn" from the alcohol used to sterilize the site. This time, although not terribly intense, the pinch and burn went deep and stayed. Nurse Karen, the regular, in-charge person, noticed me wincing and tried adjusting the needle which didn't help. She said, "Breathe in," which I did. I started chanting, "Breathe in, scream out," which got a laugh from both of them. It's much more amusing when you're the one standing up.

After a couple of minutes Nurse Karen said, "That's it. We're done here," and pulled the needle out.

• CSB: Many years ago, when I was in college, the Red Cross came by for a blood drive. They set up a dozen or so gurneys in the dining hall and had a pretty good turn out. When my turn came I lay on my table, and they poked my right arm, hanging the bag below gurney height, I suspect both for the gravity assist and to keep donors from seeing their blood draining out. This was back when I was still giving whole blood and the entire donation process should have only taken 15-20 minutes. (This was also long before HIV/AIDS and a whole bunch of other disqualifiers and the questionnaire was mostly height, weight, blood type and did-you-eat-recently.) After a half hour, though, I was starting to get bored and I noticed that several people who had come in after me were already up and enjoying their juice and cookies. After several more minutes, a Red Cross doctor wandered by and examined the receiving pouch which was only a quarter full. A couple of minutes later he returned, looked at it again and said, "Huh. Your vein has collapsed. It's not drawing." He then proceeded to pull the needle out of my right arm, walk the entire apparatus around to the other side of the gurney and stick it into my left arm. It was a different world back then. There was no question of him not making his quota for the day and I ended up the only student on campus with bandages on both arms.

Anyway, Nurse Karen apologized, said she'd inserted "too high," whatever that means, and that, in addition to any pain, this attempt just wasn't drawing properly anyway. Now, given my history, above, and since I know where that needle has been (I mean, it was sterile before the first attempt, right?) I'm perfectly O.K. with trying to find another spot but, nowadays, that's against the rules and Nurse Karen trashed the lot which included a massive amount of tubing since with platelets the blood has to be drawn, channeled, centrifuged, separated, redirected and returned.

They offered me cookies and a T-shirt but, really, I was only there for a half hour and only five minutes of that was on the couch.

We're going to try again on Tuesday.

A Temporary Setback, Rapidly Repaired

My poor, brave niece went into the hospital today, again, this time because the two halves of her recently repaired heart were beating at different speeds. According to her mom, her atrium was beating 35 times faster than her ventricle. I don't understand how that's even possible.

Her mom rushed her to Yale-New Haven Hospital in New Haven where, after a short delay waiting for an operating room to become available, the doctors checked for clots and then shocked her heart back into regularity.

As of 2:00 p.m., her mom reports she is in the pediatric intensive care unit, awake and sipping juice. There were no clots. Her heart rate is a little high but not excessive or irregular.

For some reason, she claims to be sick and tired of hospitals and just wants to go back to school. She's a tough kid.

One of Those Days

Sometimes a bunch of little things that, individually, don't mean anything accumulate in such a way that you just have to say "Well, this has been a strange day."

Today was platelet donation day but my appointment wasn't until noon so I decided to get a couple of things done on the way.

First off was gasoline since the car was running on fumes. As I pulled into the station I noticed a lizard had hitched a ride and was now clinging to the driver's side window opening just off the mirror. It was maybe three inches nose to tail tip, brown with a gorgeous delicate greenish stripe down its back. I tried catching it with the intention of releasing it in some nearby shrubbery and ended by chasing it up and down and around the side of my car while the attendant looked on from a distance. Eventually it got away. I tried looking for it when I was done fueling up but couldn't find it so maybe it got to somewhere green on its own.

(Not my barber. Although the resemblance
is scarily close. Stan's hair is fuller on
the back and sides.)

Next stop was the barber shop for my semi-annual shearing where I found my barber undergoing some sort of identity shift. He's always been on the doughy side and kind of soft with a Richard Simmons Sweatin'-to-the-Oldies thing going on, especially with his own hair, which I found amusing because of his very vocal full-on-Ebeneezer are-there-no-workhouses? libertarianism. Today I didn't recognize him. He's gone the full "It's Pat!" His voice is still upper baritone but he was wearing big dangly emerald glass earrings and his hair was classic middle-age matron.

Then it was on to the hospital where the TV over the donation couch was playing an episode of "House" and a patient was crashing out. "Oh uh," said my phlebotomist, glancing at the set while she stuck me. "Somebody's dying!" There's a reason the airlines all have a policy against showing in-flight movies involving plane crashes. I changed the channel.

And then on to the Smithsonian website where today's puzzle turned out to be an exercise in three-d. Even now that I'm done constructing it, the lettering makes no sense. I've already rebuilt it once. Well, back to feeling stupid again.

And Home Again Already

My niece is out of the hospital and home again.

She's on Tylenol and Motrin for pain relief and is walking around, playing her harp, playing card games with Mom and complaining of being bored already. She wants to be back in school again. I'm sure her friends can't wait, either.

Her Mom reports she was running a small fever, but her doctors expected as much, and as long as it stays below 101 everything is supposedly fine.

So, now we can get back to the annual Hallowe'en battle of the inflatable lawn decorations, wherein Neighbor Dan has already taken the offensive and may have a commanding lead.

Strolling Through the ICU

A little more than twenty-four hours after open heart surgery, my niece is up and walking around . . . with a little help.

She signed a little to her big brother but had to tell her Dad to go get Mom because Dad just couldn't understand her and Mom could. Then she wrote, "I can't breathe," meaning the tube down her throat was interfering so the doctors removed it and now she's talking again.

It's still going to be a while before she can be discharged, but I am so proud of the little fighter.

The Girl Is Doing Fine

I've received some word regarding my niece's surgery in Boston. It went well.

The operation was delayed half a day and she didn't go under until just after noon on Thursday. The whole thing took about seven hours. The doctors knocked her out, cooled down her body to slow respiration and circulation, attached her to a bypass machine so they could stop her heart and then repaired the leaky valve. Her parents and oldest brother were there the whole time and were given progress reports as the operation went along. There turned out to be three defects: two they knew about, although one was worse than expected, and one they only found when they were already in her heart. Once they were done and had tested their work, it took an hour to warm her back up and another one to close her.

The doctor planned to keep her unconscious and on a respirator over night but her parents saw her as they moved her to ICU and report that she already shows better color than before the operation.

Her Mom reported this morning that the docs plan to start removing her from her various tubes this afternoon and begin to wake her.

The family is planning on staying in Boston for most of next week while she recovers.

It's hard to express the depth of our gratitude to the doctors at Boston Children's Hospital and to all the staff there (let alone the researchers and equipment manufacturers and builders of sophisticated systems procedures and the almost-limitless list of others who have contributed in some way) who made this possible. This is what the interconnected web of civilization produces.

Latest update: 3 p.m. Caitlin is awake and when asked how she felt gave her Mom thumbs up. Tube down her throat will come out soon.

A Trip to Boston

My 12-year-old niece goes in for surgery tomorrow morning, 6 a.m., at Boston Children's Hospital. This will be her third open heart operation, although the first two were done when she was a baby so this is the one she'll remember. I just got off the phone with her and her Dad (my Other Brother). They and the rest of the family, except my younger nephew who is stuck on base in Virginia, are all going off for a Duck (DUKW: ex-military amphibious vehicle) Tour of Boston Harbor.

Caitlin with her Dad and two older brothers.

Fortunately, insurance will cover the operation itself, but there are other expenses including travel costs, living arrangements in Boston, lost income and additional doctors' bills that are not covered so the family has been conducting a number of fundraisers to help defray them.

Caitlin, in the middle, because of the stress on her heart,
has always been  . . .extra petite. For comparison, her friend,
Elizabeth, in pink, is a classmate and the same age. Credit Kevin Kane

I have been very impressed by the support her friends and the community have shown her. Her classmate, Elizabeth McCann organized a bake sale and lemonade stand. The local grocery has been selling fundraising cookies and the church hosted a fundraising dinner. In addition, a number of individuals and charities have donated to her cause.

On the one hand, I wish none of this, the operation or the begging, was necessary. On the other hand, I am proud of how, when the need arises, we do all pull together, just because it's the right thing to do.

Back In Business, or, The Things I Do For Cookies

Well, today's platelet donation went swimmingly.

The nurse found my vein on the first try. Blood flowed (in both directions) with minimal beeping. The actual donation time (time attached to the machine as opposed to filling out paperwork and pre-donation testing) took barely an hour. I had my skull-themed pointy stick at the ready and had everything so under control the assistant phlebotomist took a nap in the couch next to mine (to the nurse's annoyance).

My reward: my four gallon pin and a really bright yellow all-purpose multi-pocketed tote bag/carryall.

And two cookies.

Just because.

Tapping a Vein, or, The Well Runs Dry

I was scheduled to donate platelets today. I didn't.

There were omens, signs it was not to be.

The blood pressure machine farted and shut itself down while I was cuffed. While it cycled through its reboot, the nurse and I debated whether my walking around without a measurable pulse meant I was a ghost or vampire. I told her I preferred undead (which I have been accused of being before by a number of people who have never seen me out in sunlight).

After she looked me over disbelievingly when I told her I had lost ten pounds over the last two months (when I gain weight it is distributed pretty evenly across my frame and when I lose it it disappears the same way) she informed me that I would probably not be able to donate a double unit ever again since that ability is conditioned upon a volume/mass ratio (platelets to weight) that I no longer achieved. Who knew?

While settling into the couch, I mentioned that her substitute last month (she'd taken Memorial Day weekend off) had commented on how my vein bifurcated just above the usual draw site and how she had spent several minutes palpating the spot and debating which path she should take which ultimately made no difference as the apheresis machine kept beeping throughout the procedure anyway.

The nurse then proceeded to stick me and missed the vein entirely. She could tell because there was no draw and I could tell because of the pain. She wiggled the needle around and I began to turn red and sweat. Finally, she broke the wall of the vein (I could feel it) and filled her little sample vials. Then the machine started with a continuous series of beeps unlike the usual ones I am used to. There was maybe five inches of blood in the draw tube and the rest was clear plastic. Nothing was moving.

At that point we gave up. She told me that if it wasn't drawing right (which it obviously wasn't) it would never return right which meant at some point it would "infiltrate" which is med-speak for squirting the blood back, not into a vein, but directly into the muscle which, I can testify from previous experience, is extremely painful. (Not laser beam-to-the-ear painful, which is another story, but still.)

She removed the needle and we rescheduled for next week.

I took a cookie anyway. For "pain and suffering."

Mom, A Life: Part Eight

Mom, A Life: Part Seven

Sunshine, Real Estate and Art

Using the money from the sale of the Connecticut house and the property in Arizona, Mom and Dad built a new, small ranch house on the property they had bought on the north end of town. Unfortunately, the developers had opened up huge tracts all at once and so people moving into town bought and built all over resulting in isolated houses on barren streets across the peninsula.

The city was billed as a planned community but it was really just an artificial one. No plans were made for any commercial development commensurate with the expected residential population. Hundreds of miles of canals were dug across the city but, in an attempt to save money and with total disregard for future traffic growth, bridges across the canals were intentionally built narrower than the roads. To this day the city hall, police department and post office all sit in the middle of nowhere, miles from the naturally developing center of town as does the library (but in a different direction).

So, of course, Mom and Dad got their real estate licenses. At first they sold houses and condos as agents for a larger firm. Mom's heart wasn't really in the profession and she ended up mostly sitting open houses and model condos. After a couple of years they realized it would be decades before their "neighborhood" filled in and they bought a condo in an 8-unit building "downtown." At least it was within walking distance to stores.

Mom requalified as a nurse in Florida and did some work at the local hospital but didn't enjoy it saying the profession had changed too much over the years for her to really keep up. The technical aspects were difficult as were all the new drugs to memorize.

It was about this time that Mom and Dad came back up north and kidnapped my brother and his dog. My brother had moved in with me after mustering out of the Air Force and brought the dog with him from California but he was showing symptoms of depression, partly from his military experiences, including scraping two of his pilot friends off the runway when they'd crashed, and the death of his best friend, an innocent bystander in a high-speed police chase in Connecticut. They thought a change of scene would do him good, showed up one weekend, packed him up and took off. It worked.

Dad opened his own agency but it didn't really go anywhere until he met some commercial developers and started specializing in buying up and consolidating lots into workable commercial size properties. Mom left the business and concentrated on her artwork. She had enjoyed painting over the years, mostly still lifes in oil on canvasboard although she did a huge owl with glowing yellow eyes in acrylics on cloth and hung it at the top of the back stairs in Connecticut where it scared her grandson so much he would only ever use the front stairs. They moved again, this time to a larger higher-end condo where Mom figured out how to make beads from rose petals and began creating necklaces and earrings, some of which she sold, some of which she gave away and some of which are now in the local historical society collection. It was also around this time that she became interested in ceramics.

At first Mom was content to decorate premade greenware, experimenting with paint effects and glazes. Soon, however, she started creating completely original works, mostly flowers: roses, chrysanthemums and lily pads although she also did some dessert dishes and rice bowls. She took lessons at the senior center and eventually the staff asked if she would teach the class, which she did until her fine motor skills started to go and her work became clunky. Eventually she went back to using greenware and finally stopped when her painting started getting muddy, too.

Succumbing to the Gypsy urge one last time, Mom and Dad sold the condo and built a last house, the one my brother and I now share, in a neighborhood that was finally filling in.