When Dad Had Surgery

Those who have read my blogs know that my family is no stranger to various cancers and health issues.  My mom had bilateral mastectomies (separate surgeries), a lung resection, and brain tumor removed- all cancer. She also had chemotherapy and radiation. I’m a medical train wreck, including leukemia (APL/ AML- sub-type M3), diabetes, dysautonomia, multiple pulmonary emboli (all three lobes- acute, subacute, and chronic -all found at the same time), lung scarring, seizures, multiple concussions, yadda, yadda, yadda…  My dad has been the rock for both of us (mom died in 2003, after being 17 years free of cancer, but with 10 years of dementia caused by the radiation to her brain; she died from sepsis- not cancer).  Dad is the one who takes care of my beloved schnauzer when I’ve been in the hospital.  He didn’t own a bottle of Tylenol until a month ago.

Dad had to go to the doctor for an annual look-see before getting his year of thyroid pills refilled. The doc poked and prodded on his neck, as per usual, and felt ‘something’. He decided he wanted to get an ultrasound to figure out what the hard pea-sized ‘thing’ actually was.  Dad got scanned (I had to reassure him that it was painless and very quick), and instead they found a large (2 x 1.5 x 1.5 inch) mass coming up from the right side of his thyroid.  That’s BIG for the neck area- there are a lot of veins, nerves, arteries, muscle, windpipe, and esophagus related structures in there.  Now they wanted a biopsy.  Numb it up, take some needles and withdraw some of the tissue. They did that, and dad did well… the results, however, were inconclusive.  He was sent to a neck surgeon to figure out the next step.

The neck doc had seen the biopsy and ultrasound results, and felt that it was a cancer, but that it had actually replaced the actual thyroid tissue on the right side; the left side looked OK, at least from the tests.  The ENT surgeon (neck doc) decided to get a CT of the area to check for any lymph node involvement. He did feel that it was some sort of cancer, but reassured dad, and myself, that the vast majority of thyroid cancers are fixed with surgery. Dad should be fine.  But, in the meantime, they wanted to get some more biopsy material, to see if they could narrow down what was going on in there- but bottom line, the thing had to be removed.  It was too squirrelly to leave in there.

Dad is a guy who is 80 years old, and takes a lousy Synthroid pill every day. That’s it. He lives alone, runs around ALL over the place, has a social life that pretty well has him ‘booked’ every day with something, and has really never known anything about chronic or life-altering illness. He has been incredibly blessed.  He had a busted appendix in the early 80s- that was bad. But he got well. He had his gallbladder removed, and aside from post-op vomiting, he was good to go in a week.  He’s been remarkably healthy.  SO, all of this medical stuff that involved HIM was completely foreign.  Mom had numerous surgeries and became totally dependent on him during her last 10 years (he was amazing as he cared for her at home). I’m mostly independent, but when I’m in the hospital, he’s been the go-to guy to make sure my dog is OK, and my laundry gets done when I’m holed up. He has been really healthy.  This whole ‘being sick’ thing isn’t something he really knew what to do with.

While I know that I’m likely to outlive him, I hate even thinking about him not being here.  I have very few people around here that are very present in my life. I’ve got friends- mostly in Texas. The people I know here are mostly interacted with on FaceBook- most I haven’t seen in 30 years.  Dad is the person I talk to daily.  He’s the one who I know always has my back. I don’t have anyone else who could take care of a schnauzer in heart failure with medications (or who even knows her very well), or who I can call for just about anything.   I have some amazing and incredibly dear family scattered about… but dad is just a few minutes away. They are wonderful, yet my physical situation doesn’t make it possible for me to be all that mobile to see them all that much; I certainly feel that I’ve been too much on the ‘fringes’ to just call anyone.  Thinking that something could be wrong- and BAD wrong- with him was a lot to take in.  I have been going to MD appointments with him during this- partly because I want to be supportive, and partly because I’m an RN (disabled, but still have my license since I earned it, and it is MINE) and understand more of the medical terminology, so when we leave, I know how to answer his questions better.

The day for surgery finally came, and while a friend of his got him to the hospital, I definitely wanted to be there before he went into surgery. I wanted to talk to the anesthesiologist about his severe vomiting after getting Versed for other procedures (the anesthesiologist practically challenged me on that- said it wasn’t possible- must be the gasses used, even though it was the only common denominator the times dad had gotten sick- and a few times he hadn’t had ANY gas….time to back off when the doctor thinks he’s always right- wouldn’t help dad, and the doc wasn’t going to listen).   He ended up giving dad Versed, and sure enough, he was sick- though not nearly as badly as other times since they gave him more anti-nausea meds post-op.  Evidently, this type of surgery is more likely to cause a problem with nausea and vomiting because of one of the nerves in that area- which dad didn’t need to hear minutes before going into surgery.  He was already terrified.

They wheeled him off, and his friend and I began the wait.  It took about 3-3.5 hours for the actual surgery, then about 2 hours in recovery. After the surgery, the surgeon (who is wonderful) came out and talked to us.  The initial pathology report sounded potentially ominous. He thought it was a low grade lymphoma, and it might require chemotherapy. It wasn’t thyroid cancer. But until the final pathology reports were back in about 5 days, there wouldn’t be any more information than that.  No point in telling dad part of the story, so he could worry- we all planned to stick with ‘the final pathology reports aren’t back’ which was true, and kept him from spending days in terror thinking he was up against something terminal.  Nobody hears ‘cancer’ and their first thought is that it’s positive.  Since I’d been through extensive chemotherapy, my initial reaction was that he’d have that to deal with, even though most chemo isn’t a daily occurrence.  Most chemo is anywhere from every few months to a few times a week (until the time when pills are used daily for maintenance for a period of time).  I cried. I didn’t want that miserable existence for him…he was always on the go.  Having an indeterminate amount of time to deal with feeling lousy was no way to spend the precious years he has to live.  He’s no where close to slowing down.

Dad stayed in the hospital for 2 full days after surgery. More on that in another post.  He did  pretty well from a nursing standpoint, but from the perspective of a daughter, he had one rough day after surgery and was gradually improving, but it was still tough to see my active, never-holding-still dad lying in a bed, or sitting in very institutional furniture.  My dad who can graze his way through the day eating anything in sight was doing well to get a diet Sierra Mist down.  This is a guy who likes to eat!  He was nauseated most of the time (but can’t be the Versed!).

We got to the appointment to hear the final pathology report…more anticipatory tension.  We ended up getting some relatively wonderful news- yes, it’s a low grade cancer, and he’ll need scans to check the rest of his body for other masses- which may or may not have to be removed, depending on if they were causing trouble.  The mass was well-encapsulated, so not just spreading willy-nilly in his neck.  Also great news. The surgeon thought it had been there for 5-10 years, it’s that slow growing. He’ll be seeing an oncologist after the scans to find out what was next (come to find out, he’ll be seeing my oncologist, so I could reassure dad that he’s a good guy).  I got some label for what the description of the mass was, but when I looked up the words online, it was more confusing than helpful; will wait to ask the oncologist 🙂

Dad is going to be OK.  The doc said that this kind of cancer won’t kill dad. It’s quite probable that he’s going to have another 10 years of quality living.  That is a huge answer to prayer.  Yes, one day dad will die. But thankfully, it won’t be anytime soon. ❤

Why Work At A Nursing Home…

If you work at a nice one, there’s no reason not to work at a nursing home. I’ve heard the slams by non-nursing home nurses over the years that somehow nursing home nurses are the bottom of the barrel, but I’ve found this to be quite untrue.  Different types of nursing require different skill sets, and nursing  homes often deal with many specialties under one roof.  There is always the physical maintenance of chronically ill and dependent (in some form) patients. The knowledge of medications is extensive.  Nursing home nurses must be able to deal with psychiatric issues, and know the most effective ways of handling them.  There are always the emergency issues that require adequate assessment to get the resident the proper level of care. Wound care is critical- from surgical wounds to superficial skin tears that are so common in fragile elderly skin.  The nursing home nurse has to be very familiar with various hoses and tubes, and how to keep them functioning.  And then, there are the family dynamic issues that can change on a dime with any one of the nursing home nurses’ typical 15-30 patients and their families.  Time management is crucial.

Then there is the fun part of nursing homes.  I’ve been fortunate to work at some great facilities over the years. My first job out of nursing school was at a facility where I’d done staff relief work as a CNA.  When I started my nursing career there, I was the only RN educated person in the building most shifts I worked.  The ADON (Assistant Director of Nurses) was there until 4-5 p.m. when I worked 3-11 p.m., but otherwise I was in charge- without a license.  I was a GN (Graduate Nurse), and since I had access to an RN 24/7 it was kosher back in 1985 in Illinois. Now, I think that’s nuts.  Fortunately, I’m not so stupid that I didn’t realize what I didn’t know, so was very good at asking questions.  I was typically responsible for 30 heavy care and/or Medicare patients on 3-11 p.m. AND another 30 dementia patients when I worked 11 p.m.-7 a.m. – my actual shift.  I did a lot of double shifts.  That’s how things were done back then. I was 21 years old.

I mentioned ‘fun’.  I had some very entertaining residents.  Most were out to lunch in a very sweet way.  Those were the days of ‘reality orientation’ which is actually quite cruel. It attempted to ‘make’ the demented person come back to the right year and place, and it might have lasted about 3 seconds, and then they were still confused and unhappy again.  Things moved to ‘validation’ some years later (I started using it as the result of frustration… when in Rome…) which didn’t lie to the resident, but acknowledged where they were in their heads.   They weren’t going to be ‘fixed’. Dementia is progressive.  Let them be in 1954.

One of my little ladies wanted to call her mother every night before bed.  This lady was about 89 years old, which in a generous ‘young’ estimation made her mother at least 107. Uh huh. I was still in reality orientation mode, and asked this lady how old her mother was.  She gave me some age that was younger than she was.  This wasn’t going well.  I asked her how old she was. She gave me some number younger than what she said her mother was (well, at least she was keeping up with the story she was sticking to).  This went on for about 2-3 minutes. Finally, I unplugged the phone, put it on the counter, and she called her mother, said “Thank you”, and went to bed.   After that night, we bypassed the inquisition.  She was happy.

Then there was this skinny little man who tooled around in his wheelchair wearing a hat with his name on it.  Going by the nurses station counter, all I’d see is the hat scooting along on the other side .  “Max” was toothless, clueless, and so sweet. He also had an irresistable dopey, toothless grin.   He  was about 5 foot 5 inches, and probably weighed 85 pounds dripping wet.  And he was quite a character.  One day, he came up to the station in his chair, and stopped.  I saw the “Max” hat, parked in front of me. I heard his gravely, soft voice saying “Hey! I want a cigarette.”  Max didn’t smoke. Hadn’t for decades.  I told him “Hey, Max, you stopped smoking 30 years ago.”  He replied “Oh yeah”, and left.  We went through that routine often.  Another night, all hell was breaking loose with numerous patients having to go to the hospital for various reasons. I had ambulance crews coming from all directions at various intervals. While I was waiting for another crew, I was on my way down the hall to see the sick resident when I saw Max walking towards me, naked as a newborn, with his catheter disconnected from the bag, swinging like a pendulum as he took each step.  Max was about as stable on his feet as  a greased pig on glass. The naked part was just not pretty, and with an ambulance crew now in the building and heading towards me, I had to get Max covered up (and keep him from falling on his tail). Too late. One of the ambulance guys looked at me in horror and said “Tell me we’re not here for him” (or something close).  I told them which resident to get, and went to wrap Max in a sheet as I guided his skinny butt back to bed.

Another night, Max’s catheter was clogged, and no amount of irrigating it worked. I had standing orders to change out catheters as needed (we used a lot of catheters back then), but I couldn’t get the balloon deflated. This was a problem.  The catheter was stuck.  I could feel poor Max’s distended bladder against his skinny skin, and knew he had to be miserable.  SO, I called the doctor and explained the situation. He told me I could send him to the ER to get it removed, or do the same thing at the nursing home that the ER would do. I was young and game for a new task, so asked what that involved. He told me that I needed to keep injecting air into the balloon port until the thing blew up.  Uh huh.  Alrighty then.  Well, if that’s what the ER would do, it sure would save  Max a trip to the ER, and me a lot of paperwork to just get it over with.  I got a 60cc syringe with the proper tip, and went to work.  The first  60 ccs went in with no change. Max wasn’t reacting, so I figured it wasn’t bothering him. The second 60ccs also went in with no change. I was getting nervous. The balloon was 30cc and already full of sterile water before I started in with the air.  About halfway through the third syringeful of air, I heard a pop, Max went “Ooh”, and the catheter shot out of him like the bullet from a military assault rifle, shooting pee on the wall about 6 feet from where it was coming from… OK, well, that worked!  I replaced the catheter, and Max went to sleep, much more comfortable.  Now we have bladder scanners that would have told me how much ‘room’ I had before blowing up the bladder was a major concern.

Another resident in that facility was a former missionary. She was now way out to lunch, and had some big issues with her feet that made them look ‘clubbed’. Normally, she rode around in a wheelchair, but with her bedtime routine, she could walk to the bathroom with guidance, and get some exercise while she got set for bed.  She’d go to the bathroom, wash her hands and face, and uncerimoniously hand her dentures to whoever was helping her. Then she’d toddle back to bed, climb in, sit bolt upright, and recite the 23rd Psalm. When she was done, she’d look towards the door (her vision wasn’t so great), salute, and say “Goodnight Everybody”, and lie down.  Every night!

These are just a few examples from one place I worked.  Yes, it was hard work. I had a lot of medications to pass, treatments to do, and paperwork (with a real pen and paper!) to get done on each shift. But the residents were great.  Well, most of them. But if being there and taking care of them meant that even one or two felt better, that was worth something.  I got a lot of great skills for a new grad.  By the time I went to work in a hospital some 8 months later, I could deal with stuck tubes, time management, and  brand-generic medication names with the best of them.  I loved the nursing homes I worked in, because I worked in great facilities. Had I worked in a pit (and I’d seen some as an agency CNA), I’d feel differently- but I never made the choice to settle for those. 🙂