Dad

A few weeks ago, during my seemingly annual crisis of confidence, I deactivated Facebook & Instagram. I also changed my Twitter avatar to the wound vacuum that sat at the end of my Dad’s hospital bed back in May.

I’m including it here for folks to ogle:

The eagle-eyed among you should be able to clearly read the word “stump” written in Sharpie on the device. It’s written there because a) my dad had two wound vacs, and b) this was the one for the stump of his right leg, the result of a below-knee amputation.

A few points of order before I get into the nitty gritty (and hopefully non-grisly) details:

  1. My dad was never a smoker
  2. My dad doesn’t have diabetes
  3. Somehow my dad has vascular disease

1 & 2 make 3 a head-scratcher but we’ve been building towards this nightmare scenario for a few years.

If you haven’t read the harrowing story about the aneurysm & heart attack my dad had back in 2013, you should do that now.

If you have read my account of that experience you should know that my dad has had several fem-pop procedures in the intervening years to guard against another aneurysm and keep blood flowing to his legs. Spoiler alert: one of them didn’t work.

Without going into too much detail my folks moved to Florida a few years back, rehabbed a house on the “Forgotten Coast” which then got totally demolished in last year’s hurricane and, in between, my dad had a graft put in behind his right knee so a “pseudo-aneurysm” didn’t graduate to full aneurysm status.

Make sense?

So after the hurricane left my folks functionally homeless they bounced around to the homes of friends, relatives, and children until they took a trip to Indian Wells for this year’s tennis tournament. My dad has terrible pain & discomfort in his leg so they had to cut their trip short to stay with us and be examined.

Here’s where shit gets weird and worse.

Dad has surgery to replace the bypass behind his right knee. All seems well. Mom comes home to sleep in our guest bedroom instead of the hospital.

A little after 10pm she’s in the living room, visibly shaking, asking for someone on the other end of her phone to repeat the news they’ve shared and which she’s having a hard time processing. I take the phone and listen in.

Dad is back in surgery. He crashed while seemingly OK in the ICU recovery bed. Bleeding from his hip (surgery site), seemingly losing blood and bottoming out of his BP. No one knows why but they’re trying to find the cause.

Mom & I head to Atlanta Medical Center in their truck – I drive – and spend hours in the ICU waiting room. Sometime past midnight a surgeon gives us a 20-minute talk that’s the equivalent of the shrug emoji.

We go home exhausted but happy that he’s still alive and wait to see him the next day.

Dad, chipper as ever, recounts his side of the ordeal the next day. Remembers feeling woozy and losing consciousness but no worse for the wear. They release him a few days later and he spends a couple of weeks at the house convalescing.

Dad seems mostly fine but is very run down. He sleeps a lot be we mostly chalk that up to recovering from surgery. It’s a big damn deal to have a cadaver vein put inside of you. The scar alone, two ruler-length ribbons – one above the knee, one below – are enough to make me need a nap.

No one is too concerned, except my Mom who wants him to move around a bit more to aid in healing.

Turns out she was right to be concerned.

One afternoon after Mom had picked up our girls from elementary school Dad was in such discomfort & pain, she had an ambulance come & get him. I met her at Atlanta Medical again and Dad ended up spending the night in the hospital. The ER visit was like a throwback to his initial aneurysm from 2013, but he seemed generally OK.

Maybe it was just the flu? or so the thinking went.

It was not.

10 days later he’s in awful pain and back in the hospital. They’re having to take out the vein because it’s gotten occluded somehow. Maybe it’s an infection or maybe it’s just a failure. Doctors aren’t 100% sure, they just know his blood flow is terrible.

The fix is that they’re going to put a plastic vein in his body since the wait for another cadaver vein of the proper length is too long.

I don’t remember my brother coming to stay with us, but I know he was there in the ICU when they brought Dad back from surgery. Dad’s intubated and still asleep and now has a single scar running from his inseam all the way down to his ankle.

His foot is purple. The sharpie-written note on the whiteboard reads “No pulse LRE”.

No pulse lower right extremity.

I share a glance with my brother and we walk Mom into the hall. None of this is good.

At this point I think we meet with 3 of the 4 surgeons from the vascular practice who’ve been helping Dad. Their respective attitudes range from determined to dour, but they all say we have about a day or so of waiting to see what happens.

None of them bring up amputation, but we do. It’s always an option but they want to wait and see.

When Dad wakes up they can’t remove the tube right away. Having to deal with a parent as they grapple with their own muteness and the gravity of the failed and (now) failing bypasses was heartbreaking. He was already ashen but the prospect of more surgery, the simple fact that he’d lost 24 hours he couldn’t remember, and our inability to discern his thoughts (especially my Mom) really frustrated Dad.

This all happened on a Monday or Tuesday and by Thursday morning it was clear that his leg was in dire shape. For reasons related to how many good veins were left and how multiple bypasses on the same system tend to get less effective as surgeries progress, he had a choice: take a less than 10% chance on another surgery or proactively have a below the knee amputation.

As fate would have it, he made his choice and was booked for surgery within the hour and was under the knife only 90 minutes after choosing.

If you’ve read this far, it might surprise you (or not) to learn that even after all of this drama, Dad actually had another post-operative setback. He had a skin graft to close his amputation wound a few weeks after surgery and, unfortunately, an infection was trapped in there so he had to have another surgery – two in fact – to remove the infected tissue and then heal slowly. Much more slowly.

It’s now been just over 6 months since the amputation and this coming Friday he’s hoping to get molded for a prosthesis. Maybe by Thanksgiving he’ll have the first iteration of his eventual new leg.

I know I’ve waited too long to get all of this written out because my brain is missing some key dates and other details could stretch for paragraphs or blog posts all on their own. I’m trying to be a little more kind to myself and realize that I needed time to process all of these events before I could commit them to the blog.

Hell, they didn’t even happen directly to me, but to say his struggle hasn’t affected me wouldn’t be true either.

Maybe now is the perfect time to be sharing this story. It’s a reminder that none of us is promised tomorrow (or even today, really) and that we should be thankful all of the time and hug our loved ones while we have the chance.

I know I’m going to be extra happy for the holidays this year.

Be safe out there.

Wednesday, May 8

This is writing as catalog. Writing as journal. Writing as catharthis.

Maybe this is a blog post. Maybe it’s a memory. Maybe I just need to write.

On Wednesday, May 8th at around 10:50 am I texted my Mom to remind her that Owen’s kindergarten performance was the following night at 6:30 pm. I’d initially told her 7:00 and I wanted to clear up the confusion.

The text that came back – 10 minutes later – chilled me to the bone.

“Dad is vey ill. Ambulance here”

My stunned “What?!?!?” was answered with “Helicopter will come to golf course, that’s all I know”

There aren’t many times in your life that you’re heart beats so loudly that you’d swear other people can hear, but this was one of those times. Mercifully the meeting I was attending was just wrapping up so I went outside to call my Mom. When I reached her she was in hysterics and could only get out “stroke or heart attack” before saying she had to go.

Not knowing who knew what, I texted and called both my younger brothers. One knew (as little as I did), one knew nothing.

I spread what little word I had around my office and went to the car. My Mom initially let me know he was going to Piedmont, but later got diverted to Emory Crawford Long. Only once I got there and in the ER she called me back and told me Atlanta Medical Center.

My uncle was beeping in. He was en route too. Almost to AMC. Meet him there.

I pulled in past the ambulance bay and got his text. Room 21. Noted.

I went in the wrong entrance of the hospital. I left through an emergency exit and texted a brother – I don’t remember which one – the details I knew.

I saw Randy (my uncle) through the door. He peeked out to tell me how to get credentialed. It took to long.

It always takes too long.

Dad was on a gurney and in pain. Pale. Sweaty. Moaning a little to himself but trying to rest or close his eyes to the pain.

“We’ve got to stop meeting in ERs like this.” I joke when I’m really nervous. I was really nervous. This was a terrible joke.

He groaned again and I backed out in to the hall to talk to Randy.

Two doctors had examined him. Initial diagnosis was aneurysm and now two nurses were taking him for a CT scan.

As he was wheeled off, Mom arrived.

She looked OK, considering our earlier conversations. Flush and still in her jogging clothes.

I apologized for not getting to the ER sooner and she apologized for telling me the wrong hospital. Neither was necessary. Both were appreciated.

I could still hear Dad asking Randy “did they say aneurysm” when I first got there. I didn’t write that earlier, but I remember it. Or did Randy tell me that fact later? Was I really paying attention? I tried.

Doctors seen, in order, upon Dad’s return from the CT.

Corey, a nurse anesthetist, who thought Dad had a “Triple A” (abdominal aortic aneurysm) and started making Mom sign surgical consent forms

Dr. Sunaan (or something similar) – a surgical resident on the vascular rotation. He spoke only a sentence to my Dad before being called by Dr. Poindexter (the vascular surgeon)

Now it gets crazy. Corey is asking us about medical history – smoking (none), drinking (social) and past surgeries (we forget his shoulder surgery from a few years back). Dad answers “penicillin” from the gurney when Mom & I forget his allergy. His head is now below the level of the rest of his body. He is on his 3rd unit of saline. He has a minor heart attack while we are there.

It starts as pain in his left hip. He describes it “arcing” across his chest and now he has pain in his left shoulder. He arches his back and is a shade whiter than the sheet and two blankets warming him.

Saline is cold (or at least room temperature) and his body was already shivering before it convulsed. We won’t know it’s a heart attack until the following afternoon. We just know we want something to happen, something medical or surgical, soon.

We wait outside as they stabilize him with more saline and blankets. They don’t give him pain medication. His blood pressure is already too low but it’s being kept up by the saline.

We go back in and my Mom kisses his forehead and tells him it will be OK. He’s in the hospital and the vascular surgeon is on the way. Dad apologizes for being sick and tells the story I’ve already heard about how we got here.

Back pain. Shooting pain in leg/hip. Faintness.

“Neal, do you want me to call 911?”

“Yes.”

My Mom had been on the phone with my youngest brother, Graham, but she hung up to call 911. Now I remember that he knew something and Thad, our middle brother, hadn’t.

I work in Midtown Atlanta. Graham is in Knoxville, Tennessee. Thad is in West Virginia. We are all scared and communicating by text for the next 2 hours.

Poindexter arrives. He tells my Dad, “You’re in a real pickle, Mr. Miller.” Neither my mother or I hear this. It is relayed to us the next afternoon by my Dad. He can remember Poindexter from that one conscious meeting while in the ER. I can’t remember Tuesday anymore.

Poindexter talks to my Mom & I in the hall while a curtain is drawn and they try to give Dad a Foley catheter. He screams and it sounds like a cat has been thrown in to a blender. I try to focus on Poindexter’s mouth to make sure there are two sets of ears listening to the prognosis.

Randy is in the waiting room. Only two family members at a time in the ER.

The stats, a la Poindexter:

Iliac artery is the size of a pinky. Dad’s is 7.5cm. That’s the size of a baseball.

Coronary artery has an aneurysm too. That’s only 3.5cm. They normally don’t operate until it gets to 5. They won’t be fixing that today.

98% mortality rate if either aneurysm ruptures. 90% success rate upon repair.

Going to surgery. Meet us upstairs.

We go in a separate elevator with the resident. Mom kisses Dad again as he’s wheeled in to the operating room.

We go back to the waiting room and wait.

I make two phone calls. One to Thad, one to Graham.

An hour passes and we get our own phone call. It’s the OR, surgery has just started.

It’s 4pm. We got to the ER around 12:30. Dad first went down at 10:30. Surgery lasts 2 hours if it’s elective. This is not elective. Time has no meaning apart from all our talking and trips to get bad break room coffee and to the rest room.

Another call comes just past 7pm. They’re done. Poindexter will be out soon to talk to us.

At 7:45 we talk to Poindexter and his nurse, Pam. They’ve repaired both aneurysms. Took them 90 minutes just to get to the first, but he responded so well they kept on going.

Does he have a brother? He needs to be checked.
When did his father have his aortic aneurysm?
What questions did we have?

Not enough, but we knew he’d be in for another 7-10 days. May have had a heart attack pre-surgically. Had to look out for heart, kidneys and infections.

We could go back around 9, if the nurses said it was OK.

Shakes and hugs.

An hour passes and Corey stops by. He is almost frenetic but he has nothing but nice things to say about Dad. He tells a story that cracks him up and says lightened the mood before surgery.

“How are you doing, Mr. Miller?”

“Oh, pretty good, considering the circumstances.”

This is how he approaches the anesthesia and the surgery. It works for him, the humor and the surgery.

We see him at 9:15. Corey has prepared us that he will look bloated because of the fluids. This is no preparation at all.

He looks like a drowned man, all sausage fingers and taut skin. He can barely open his eyes. He is still anesthetized somewhat, he is intubated and he is more handsome than I have ever seen him.

He is alive.

We both talk to him a bit, Mom and me. Neither of our voices crack. We both squeeze his hand and kiss his forehead and go home for the night.

He is alive.

That’s all I can write right now.

He is alive.