Hiatus: Bad Week

This past weekend was supposed to be all about networking: I planned to go back to Portland for OHSU's Anesthesia Conference, where I would have a chance to meet Oregon CRNAs and scope out the job market.

Before that was able to happen, I had a day and a half of clinicals. On Thursday I was scheduled to provide anesthesia for a patient undergoing an aortic stent-graft, which was supposed to treat his aortic aneurysm. It is inserted through a large artery in the leg. The patient looked fairly ill, with fairly severe vascular, lung, and kidney disease. He had had some teeth removed a few months before to prepare for this surgery, and during that case he had dropped his blood pressure to an extremely low level, requiring more than one medication to keep it up. So we knew that it would be a risky procedure for this patient, and we prepared all the medications we thought we might need, and planned to do it with him deeply sedated rather than as a general anesthetic. (It's not unusual to do this procedure under deep sedation, but more common to do a GA.)

As we were preparing the patient in the OR, we gave him a tiny bit of sedation and a tiny bit of pain medicine. As I went around to place an arterial line in his wrist, my preceptor gave him a tiny bit more medicine because what I had given hadn't affected him yet. Then the patient complained of feeling "funny", turned purple and stopped breathing. We checked for a pulse and found none--started CPR. The code continued for about an hour and a half until we were finally able to transfer him to the ICU.

That was Thursday.

Friday I had a half day of clinicals so I could start driving to Portland early and get there in time for the networking reception downtown. While I was at the reception, my father called and left the same message he always leaves me when he calls: "It's Dad. Call me." I got the message around 8, and planned on calling him the next morning.

Saturday I went to the conference, which was very good. I turned off my ringer out of courtesy to the speakers, but towards the end of the day heard a few calls vibrating on my phone. On my way out of the auditorium, I listened to the voicemails, one from Dad and one from my brother. Just seeing that they had both called, I knew something was wrong. It turns out that my grandparents were in a bad car accident on Friday evening. My grandfather, who is 92, was driving my 88 year old grandmother somewhere. There's a 2 lane highway near their small farming town in Oregon, and my grandfather was trying to cross the highway and was hit by another car. Both of them were taken to different hospitals about 40 miles apart. The occupants of the other car had minor injuries.

(I'll interject here that our family has been trying to get Grandpa to stop driving for years. It is nearly impossible to get an independent, elderly adult to stop driving in this country, despite all the evidence in the world that the driver is no longer safe. Ironically he had actually tried to get his own mother to stop driving when she was in her 90s, and was unsuccessful, but that didn't help him see that he shouldn't be driving, either. Grandma used to drive instead until her heart attack last year, and now she can't. Not that she should be, either. But she would have been safer.)

My grandmother has bruising on her lungs and heart, and a broken rib. In a healthy person this would be a relatively minor injury and would heal without any problems. But my grandmother has bad cardiovascular disease, and has been intolerant of exercise since she had a heart attack about a year ago. Now, she was having constant chest pain and signs on her EKG that her heart was not getting enough oxygen--which is what causes heart attacks, ultimately. The accident was on Friday, she was in the ICU until Sunday and they moved her to the step down unit. She was still having severe chest pain the whole time, and they decided to do an angiogram to see if there was something they could treat to relieve the pain--even though they knew her heart disease was severe, and she was not a candidate for bypass surgery. What they found was that her heart disease is even worse than they thought, that she had had another heart attack, that all of her major vessels are blocked, and that she is expected to live no more than a few weeks. The plan is to discharge her from the hospital to hospice once her chest pain is under better control.

My grandfather was brought to another hospital about 40 miles south. He was not breathing initially, and his heart stopped a few times between the accident and the hospital. The reason he wasn't breathing is because he sustained a very high spinal cord injury in the accident--essentially the same injury Christopher Reeve had. He is unable to move his arms or legs, or breathe without a ventilator. For the first 24 hours, he was unresponsive. The family gathered and brought in their advance directive, which said basically that he didn't want artificial life support. Then, he woke up. A few more days were spent examining his situation and determining that he can actually respond by blinking and sticking out his tongue to yes/no questions, and that he seems to understand what is explained to him. Because of this, his advance directive is not effective until he is no longer responsive, and he has indicated that he wants to continue treatment. But remember, he is 92 years old. A healthy young person with this injury has a life expectancy of 2-5 years. Christopher Reeve survived 9 years with the best care money could buy--and he still died from complications related to his immobility. Even if my grandfather wishes to be sent to a nursing home on a ventilator, and despite his excellent health for a 92 year old man, he will not live long this way.

So this is why I haven't been blogging. I am taking a temporary leave from school while we deal with all of this. I don't know how long any of this is going to last. Both of my grandparents remain alert and able to interact; my grandmother is just as funny and smart as ever, but she knows that both of their conditions are grave. It is unlikely that they will see each other before they die. They are the hub of our family; they have been farming the family farm their whole lives, living in the house in which my grandfather was born. They now have a 5 generation family--they became great-great grandparents 2 years ago. I remained in Oregon until yesterday, when I finally had to get back to Spokane since I was only packed for 2 days, and I hadn't planned on anyone looking in on my cat. I'll head back either today or tomorrow morning and see what the weekend brings.