It's been a rough 7 (almost 8) weeks. On August 13th Bruce went to Fawcett Memorial Hospital for a bronchoscopy which is a procedure where a Pulmonologist uses a bronchoscope and goes down the bronchi of the lung to look for abnormalities as he had had problems with a recurring pleural effusion between his rt. lung & lower pleural space. This was to be done as an outpatient procedure. When he got into the procedure room the anesthesiologist noticed that Bruce had an irregular heartbeat. His bronchoscopy was cancelled and Bruce was schedule to have a heart catherization by a cardiologist to see what caused the irregular heart beat. Bruce had a history of an irregular heart due to Atrial Fibrillation & had had a cryoablation procedure that was to block the abnormal pathway that was causing the irregular heart several years ago. He was followed by his interventional cardiologist for 2 years & then released from his care but obviously the atrial fibrillation had recurred. The cardiac procedure was done on August 14th. He was found to have a 70-80% stenosis of the proximal left anterior descending coronary artery according to one cardiologist & another was apparently asked for an opinion & that cardiologist said 90%. Unfortunately the cardiologists choose to ignore the possible complications & didn't consider the fact that Bruce had already been told that he only had about a year to live due to his cancer diagnosis. The cardiologists decided that Bruce needed a stent placed even though he had the history of Atrial Fibrillation(irregular heart) & was on medication to control his heart rate. After placing the stent the cardiologist then put Bruce on 3 blood thinners and sent him home the next day. Putting him on one blood thinner let alone 3 put Bruce at an increased risk of bleeding. Common practice was to be on 1 blood thinner for a month after stenting due to the risk of a clot developing in the stent causing a complete blockage of the stent & then the patient having a heart attack which isn't necessarily fatal. Apparently it had also become a practice to put the patient on 3 blood thinners while doing the heart catherization. Bruce was sent home the next day on 3 blood thinners. It should also be noted that one of the blood thinners was heparin.
In my opinion that stent should never have been placed but then we were never asked what we would have wanted. He would have been better off without the stent...as he is now dead. His chance of the artery blocking & causing a heart attack (which he might have survived) before the cancer killed him in my opinion would have been slim but of course as I said above we were not asked what we would have wanted done if they found a blockage. The following day Bruce started vomiting blood & I took him back to the hospital. We sat in the Emergency Department for several hours & he was finally admitted to the hospital. It turns out that Bruce's platelets had a reaction to the Heparin that he received during the heart catherization & stent placement. Bruce platelets developed antibodies to the heparin & his platelets which caused a drop in the number of platelets he had. He initially had 150,000 and they dropped to 37,000. When platelet counts get to 20,000 people are usually given a transfusion of platelets but this couldn't be done for Bruce due to the antibodies. This put him at an increase risk of bleeding...which is what happened.
He ended up having a esophagogastroduodenoscopy (EGD) where he was found to have two bleeding arteries that had to be clipped to stop the bleeding & the blood thinners were stopped, although one would remain active for 4-5 days. Now he was at risk for a clot to develop in the stent that had been placed. He was initially admitted to the ICU. It was the weekend so he saw different doctors for each specialty (a hospitalist, gastroenterologist, cardiologist, pulmonologist, & oncologist) each day. They were all doing their "thing" but no one seemed to be in charge. This continued the following week & soon it had been 5 days...Bruce wasn't getting anything to eat...wasn't even offered any food. I asked the nurse what he weighed & she said he hadn't been weighed so I asked if he could be weighed. Before Bruce came in to the hospital he weighed 139 lbs although his records said he supposedly weighed 154 lbs (apparently taken from previous records). The day he was weighed he was 121 lbs. Since he couldn't eat as it hurt, someone finally listened to me & started Bruce on TPN which is Total Parental Nutrition which is given intravenously. They also put in a central line in his rt upper arm(PIC line) & a port (an access that is under the skin in the rt chest area). These were put in to give better access for intravenous(IV) feedings as well as antibiotics. The reason for both was the PIC line could be used immediately & the Port would be for use later (although actually it could have been used immediately as well). Bruce was started on antibiotics because he had also developed pneumonia probably from aspirating blood or other stomach fluids into his lungs.
The pulmonologist then decided that Bruce needed to have his pleural effusions drained. He initially had one drained twice as an outpatient but it recurred again under his rt lung & he also developed a small one above his right lung. The doctor placed two pigtail catheters in the two effusions. Bloody fluid drained from both although the upper one only drained about 10cc & the lower drained another 800cc. The lower one continue to drain bloody fluid slowly over the remaining time Bruce was alive until it had completely filled the chest tube container...3000cc.
Bruce died a slow & painful death. He couldn't eat, he couldn't breath & his pain could not be controlled. He was moved multiple times to different rooms. He was in the Cardiac Care Unit, the Intensive Care Unit, on the cardiac floor, on the oncology floor & was moved twice in one night from the oncology floor to the cardiac floor and back down to the oncology because he was on a monitor & was noted to have an irregular heart rhythm. He was to be put on Amiodarone a antiarrhythmic medication that requires cardiac monitoring(which he was already receiving). By the time he was moved his heart was back in a regular rhythm & he didn't need the medication so they moved him back down to the oncology floor. Over the next several days he started having breathing problems & pain. He was given breathing treatments that didn't help & was on Morphine & Dilaudid for pain. He could have the Morphine every 3 hours but initially he had to ask for it & when he did it meant that he actually went a lot longer then 3 hours between doses as the nurse was also caring for possibly 5 other patients & couldn't always bring the Morphine when he needed it. He was then able to get the Morphine scheduled meaning he didn't have to ask for it, it was to be brought every 3 hours automatically but still there were times when he had to wait. The Dilaudid was for break through pain & he was eventually given a PCA machine that would allow him to give himself a dose of Dilaudid. He could give himself 6 doses an hour but every time the machine needed to be refilled it took the nurses about 1 hour & 3 nurses to get that accomplished...either the nurses didn't know what they were doing or there was something wrong with the machine. Of course he was in pain while waiting for them to get the machine working again. This along with waiting on breathing treatments when he was short of breath caused Bruce considerable anxiety for which he was never given anything for...except the pain medication.
It was now September 7. Bruce had finally received the chemotherapy starting on 6th, which we had been asking for since December 2014...although now it was a waste because he was already so sick & not expected to improve. I had basically been living at the hospital for all of this time. I think I when home three or four times...to shower & try to sleep. I was told by the gastroenterologist that Bruce's condition was declining quickly & that I should call Tye & tell him to come as quickly as he could from California. Brannon had been with us the whole time that all of this was going on & Tye, too, had been home for at least a week but initially when Bruce seemed to be doing better & we decided that he should go back home so he could take care of some work. He was to arrive Tuesday night shortly before midnight.
Bruce's breathing continued to worsen and Bruce decided that he did not want to be intubated again. He was put on BiPap which is a machine that helps the patient breath by forcing air through a mask. This machine is similar to what people wear at night for sleep apnea. Unfortunately it didn't help & Bruce wanted it removed. He knew that it would result in him dying but he said that was what he wanted. Brannon & I hoped that Bruce could hold on until Tye arrived but that was not going to happen. He died gasping for breath & in pain at 20:43 while the nurses sat in the nurses station. We couldn't reach Tye to let him know as he was in flight to Fort Myers. I asked if a doctor needed to come & pronounce him dead & the nurses said no that they could do that for the doctor. So officially, even though they never came into the room, Bruce was pronounced dead at 20:45.
I removed Bruce's IV lines, his chest tubes & his foley catheter. I bathed him & Brannon helped me dress him in his T shirt, underwear & shorts that he wore into the hospital. I pulled the sheet up to his chest & at that time his nurse asked if there was anything we needed. We had already gathered all of his things & we had already asked about who to call as far as a funeral home & she said she would notify them. We then left to head for the airport to meet Tye. His flight was on time & it was a bittersweet greeting.
The following day we gathered at the funeral home & said one final goodbye to Bruce. My sister, Vicki & her son, Ken, were there with us. Bruce & I had decided a long time ago that we wanted to be cremated & our ashes scattered. So on November 7th we plan to go out to sea & scatter some of Bruce's ashes. Anyone who wants to come along is invited as I want this to be a celebration of his life. In the spring we will celebrate his life again with family & anyone else that wants to join us as we scatter more of his ashes in Maxwell near his parents.
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