Happy Island Home

Waking up in the morning looking out at the lake, listening to the birds’ morning, smelling the coffee wafting down the hall these are the little moments of contentment we treasure. The dark cradle of co-kee, co-kee and other night sounds rocks away the stress of the day. We love our home in Puerto Rico.

Happy people tucked up in an island hideaway. That’s us. Most days we don’t let Kirt’s amputation diminish that image. He works out with his weights, so he’s ready for the new leg. I think he sees the possibilities for his life. We want to drive around the island visiting the beaches and mountains, the charming plazas call our names. Some days I see optimism in his eyes, but not today.

Today he seems weak. There’s a lost look in his eyes I don’t like. His blood sugar is fine, so that’s not the concern. He’s fallen twice, slipped out of bed, which he hasn’t done before, so I worry. He fell last week, but had the strength to pull himself up, didn’t even call me. Today he could hardly get up even with my help.  Who will get him up, if I can’t? I feel isolated for the first time.

My Aunt Margaret says we made a mistake in coming here. We’re happy here is what I told her. She says we should be near family. We’ve never lived near family, so I don’t relate to that comment. We take care of ourselves, always have. The beauty of nature is an important part of our days. Aunt Marge says we should have a house in the shadow of a good hospital. She’s eighty-seven, of course, she’d think that way.

Last year we lived on the other side of the wall from a person who was very unhappy. Before long she began to share her misery. We couldn’t take it. We’re happy here.

After I got Kirt back in bed, I took the garbage out. The German Sheppard somebody dumped yesterday was standing in the road wagging his tail. He came up for a bowl of kibble. A big bull frog sat on the porch with uncomprehending eyes. It didn’t budge when Chi-Ping sniffed it. She went in the house, so the dog could eat without her growling.

Kirt’s snoring, needs his c-pap on, so I hook him up. Whatever we should do is in God’s hands, I’m not going to worry.  

Another VA ER Saturday

Hey, anybody remember what we did last Saturday? That was so much fun let’s play Saturday, San Juan, VA Emergency Room again. This time Kirt rode in an ambulance.

The morning began with Castor Oil just like last weekend. This week there wasn’t the pain of butt ripping turds, yippie ki. What we had here was failure to defecate followed by reverse flow. You wouldn’t believe what came out of his mouth and nose. “Pat,” he bellowed like a dying bull elephant. I recognized my name or I wouldn’t have known it was Kirt calling me.

Getting an ambulance to not stop in the nearest town, but to go directly to VA San Juan took a little doing. In a sincere desire to ensure the best care for my guy I spoke probably every word I know in Spanish today. I knew I was in trouble when the EMT guy who was speaking some English to me relayed to his partner his opinion of the course of events. The EMT partner assertively told my neighbor Gerardo, to tell me something. Gerardo, who speaks no English, looks me compassionately in the eyes and ever so slowly, enunciating carefully tells me what all the guys think in (what else?) Spanish!  

With Kirt headed toward help I sat on the bed stunned. When I first saw my love, my best buddy in the whole world slumped in the wheelchair spewing like something out of a horror movie, I wanted to throw up, and cry and scream. My head had thoughts of blowing up. I locked the dogs and cat in the house and headed to San Juan.

The ER Doc had been told that Kirt fell on the bathroom floor, couldn’t get up and his belly hurt. No mention of vomiting, constipatation, Castor Oil, being incoherent, or that I had given him aspirin because I thought he may have had a stroke. Armed with this new information the doctor continued with what he was doing.

Short story treated and released; we were home before Sunday. On the ride he complained of pain in the long leg. The stump hurt less than the good leg. His belly hurt less than the whole leg. God, please let it be his back. 

New Amputee's First Hurtle

Quarter past five this morning, the sun lights up haystack looking hills along the northern coast; we’re on the road to San Juan. As drives go this isn’t a bad one until traffic screeches to a halt.  First post discharge doctor visit questions race in my head. Kirt tolerates the drive with a little help.

Unloading is easier when the entry attendants give a hand, but I can get the wheelchair out of the trunk fairly well myself. Kirt transfers easily. Giving him our gear and double checking that I haven’t forgotten anything we may possibly need takes the longest. Morning parking is a competitive event. With any luck a kind vet may lead me to the space he’s about to vacate. God bless our Veterans. They are the heart of the nation.

My husband can’t touch more than his coffee for breakfast in the canteen. Stress mingles with the discomfort from the drive. He takes another pain pill. By the time he sees the doctors, everything is wonderful. I’m happy to report that the doctors agree with him. The wound, which they debride is looking fine. Oh, happy day, Kirt hurtles the first post discharge appointment with rave reviews, yeah!

We request that he be taught how to use crutches, so he can do more than transfer and head home to Lago Guajataca. 

The Rocky Road to Recovery

Almost 24 hours in an ER overwhelms on a good day. Somehow we’re never having a good day when we go to the Emergency Room, yes, 24 hrs. in emergency. Finally he had a good poop and went home. Happy Mothers’ Day everybody! And thank you, apparently he couldn’t have done it without you.

Today, stormy Monday sees grey enveloping all. Rains’ steady roar ringing in my head drowns the jazz radio station playing in the living room. Nothing but grey invades the day, but it’s not dark. My introvert loves days we can be alone together. Chi-Ping and Smoki are puddles on the floor around my bed. Blondie is at my feet. My Honey is in his room. Today, it’s good to be me.

Tomorrow will start on the road to San Juan. Did I tell you about the fool’s errand I was sent on last week? Run down to the VA San Juan with a prescription for medication to knock the socks off his pain. When he hurts it’s a son-of-a-gun. Rush hour traffic demands endurance I no longer possess, but there I was in early morning parking lot, I mean expressway traffic. Bitch, piss and moan, but I made it. It was early in the morning, so the wait to hand in the prescription wasn’t “killer.” Next wait, to pick up prescription could happen any time before close of business. Basically this is a whole day venture for me.

The line to pick prescription meds was short, when the guy at the window where the meds are given told me to go back to Window 2. That’s where the Rx is handed in; this isn’t good. I just know it. They’re not going to hand me his meds in the privacy of a small room and wish me a safe trip. I could feel my eyes bulge out of my head. The pharmacist is going on in Spanish about his meds. My answer is simple; don’t know what the doctor wanted to prescribe, call him; let’s get whatever it is so I can get back home. Through a haze of Spanish it becomes clear. I am brining NOTHING home.

Double the dose of what you have and bring a new prescription with you when you come to the next appointment. Son-of-a-gun, if that didn’t make sense. Why did I have to drive about two hundred miles round trip to find out? I was supposed to tell the doctor what? No, we don’t get trip pay.

So tomorrow, San Juan; we see the Docs. We are not ready to hear more above knee talk. Last year Kirt’s toectomy took ten months to heal. Kind of tells about the quality of circulation in his right. Tomorrow we’re talking left leg all the way. The suture/staple line is mixed with a couple of areas closed between big gaping separations with big scabs. In the middle a clear exudate continues to drain. Diana, the home care nurse does a bang up job of cleaning the wound. I’m glad to have her on the case.

Just when I think pick up the medication and go home something always happens and on Mothers’ Day when not too many were around I got stuck in an elevator. After a while that’s unnerving. The policeman who got me out steadied me. It can always get worse somehow always taunts at moments like this.

See you on the road to San Juan. Bendiciones.

Home From the Hospital, Now What?

Home from the hospital post op below knee amputation with wound separated from the staples, in pain; now what do we do? I wish we had an answer.

Each day we start with medication. Thank you, God, for the chemists, who make lives tolerable, when they are not.  Meds, some days are the only answer, but it gets better.

Kirt gets bored, every five minutes he’ll call, “Can you give me some…. Can you get me some…. Would you get it for me, is my personal favorite. Before of course, Dear, becomes sarcastic we must have the talk about planning wants and needs. Don’t wait until I get back in bed to tell me you just filled the urinal. That’s not funny.

The muscle spasms Kirt had in the hospital continue with his knee popping back and forth. The stump leg looked like a giant crochette hook with him holding it writhing in pain. We found that holding the lower leg in a gentle traction help with the cramps plus his knee extension improved. On the dark side sometimes he had rebound cramps if I pulled too hard. Kirt asks to have his leg pulled, so I’m a leg puller with a reference. Today for the first time in a week he had cramps; not the hook screaming variety. Gracias a Dio.

Since our talk Kirt is getting exercise by doing more around the house. If I don’t make the coffee fast enough, he is set up with filter, grind, beans, etc. to make it for himself. He looked proud this morning, as he brought my first cup of coffee. Sweet.

VA Stay in Time Perspective

The beauty of life for me is that given time and distance the better memories rise to the surface. Yesterday at the VA, where I was sent on a fool’s errand, smiling nurses and doctors appeared in my vision greeting, “How’s Carr?”

When I walked through the corridor, the nurse I thought of as the “dark hulk”, who would wake Kirt up with a raspy voice, “Carr, show me your arm band.”  The grand baldheaded silhouette towered over us, shading the suddenly bright light with his form. It became a regular morning treat, well, some days not so much, but a quietly competent, sweet, gentle man; we’ve come to know.

Tell you the truth, during the stay I felt like my brain sparked and caught on fire. Sometimes the top of my head felt hot, shit, it hurt. Seeing my darling man so sad, so hurt caused my heart chakra to pulse; that scared me but what the hell I was in a hospital. The big ebony guy wanting, now, to know how Carr’s doing is my angel. Each morning he looked into my eyes and smiled from his heart. I wasn’t just, “La esposa de Carr.” He saw me. That was priceless. Thanks, God, and VA San Juan for hiring my “Dark Hulk Angel.”

On the third floor sweet Ada with the knowledgeable hands and eyes, who does wound care extraordinaire smiled, “How’s Carr.” When “Les Miserables” were in the hospital all I could focus on was anything perceived as not good for my husband. I felt so comfortable with charming Ada’s skill. I allowed myself to go out of hearing range. My conversations with friendly confidants during these times kept me somewhat sane. Thank you, God, Ada, and my friends, Cheryl and Adri, for answering the phone.

Dr. Rodriguez, the shrink, whom I admire a whole bunch, Mary, the Social Worker, who does a bang-up job, and the Case Worker, Debra, maybe my favorite, all came for updates and well wishes. Dr. Aviles, the Rehab Doctor, who is one smooth dude on any continent listened to my description of Kirt’s leg, asked questions and gave me answers. Slam, bang, thank you and we’re on to the next item.

Next item is a whole “nother” story, which we’ll get to later. I just want to say that during the hospital stay it seemed natural to focus on the imperfections of a day. I’ll bet the shrinks have a spiffy name for it, like Patient Family Syndrome. When you love someone so much that you could go crazy with worry, no doubt, some of us can be a pain in the butt, but it’s all for the good of the patient; right! Thank you, VA, for seeing it that way. 

To make the rough times in a person’s life even tolerable is a tough job. Thank you San Juan VA; that’s all I have to say today.

Stay at Va Over

A two month odyssey in the VA medical system gave me sensory overload, starting with the ubiquitous room freshener. Symptoms began with headache, nasal swelling, sore throat. Oh, crap, was I getting a cold, which meant Kirt would get it, and then, I’d smell it, air freshener. I can’t be the only person in the world allergic to air freshener. This is the same thing that happened to me at the Hilton in Trinidad, where a fresh spray gassed the room overnight. An asthma attack froze my lungs after insisting my nose be closed. Thanks for your attention to detail. Ingesting the outdoor scent of chemicals is so much better than opening a window.

Kirt was treated to a plethora of experiences beginning with two weeks bed rest. At seventy what could be better for you? Then he was treated to a femoral bypass with staples from the crotch down his left inseam. The soft, chubby inside of my legs cringed every time I looked at his tender thighs. A fifth toe removal followed the bypass about a week later. Suture line quality made moot by below knee amputation around a week after toe extraction. The bypass surgery failed, but the suture line is healing beautifully until it intersects with below knee amputation. Trimming a nice flap for a stump must be perfected by OJT, on job training. I don’t imagine all flaps coming out of residency to be created equally. Kirt’s surgeon did a really lovely flap.

I thought the stump staple line had issues from the first time I saw it. One of the residents disagreed with me saying that it was beautiful; Kirt had held  his leg wrong, messing everything up. Leave it to a patient to screw up perfectly good work every time. Within days of the amputation the suture line was bright red radiating to dark further away, a couple of black spots looked to me like clotted blood, since then, the staple line has opened up in those areas. I would no longer even call it pretty. 

After the amputation, muscle spasms hammered his thigh and what remains below knee. Dr. Aviles, the excellent rehab doc, ordered calcium, which has helped decrease the cramps, and probiotics for Kirt’s intestines, but had no influence with the quality of breakfast whatsoever.

On Thursday, the surgery residents pitched another amputation on the basis of the poorly healing suture line and the stump healing at an angle impossible for prosthesis. Additional leg removal declined at this time, so Kirt was sent home on Friday. Hallelujah, saints be praised.   

   

Another Day at the VA San Juan

Last evening about 9 pm concerned nurses called the rehab doctors, who informed them that Kirt had been seen about 3 pm and antibiotics were ordered; get them started. I won’t bother to rag about lack of communication or that I was in the day room making a phone call for five minutes when they buzzed in and out. By this time Kirt had a low grade temperature and much more pain. This shift of nurses did a fine job of getting him settled down for what promised to be a better night.

About 2 am Mother Nature called. Kirt transferred from the bed to the wheel chair with a fair amount of skill. The physical therapy paid off already, well, not too much. He got stuck in the bathroom, so I had to call in the night nurses. When he yelled, “I’m getting out of here tomorrow,” I wanted to cry. Once back in bed he writhed in pain holding his leg above the amputation. One of the nurses told him to stop squeezing his leg, that he was making it all red.

Where the hell do you go with a stupid comment like that? She kept insisting that he was responsible for the inflammation in the stump below the knee. I should tell him to stop doing that. Sometimes there’s no point in arguing, so I told her I’d get on that right away.

Just a little sleep and we’d feel better, but that wasn’t to be Kirt ripped his IV out when he dozed off. There was blood all over the sheets, in his hair. He needed a bath and linen change.

With all of the pain and negative experiences it’s easy to over look the really great nurses and care that he is getting. I don’t want to do that because some of Kirt’s nurses have been tremendous; Ada, the kind and gentle, Felix the great, Eileen, the love have tended to him, when he was at the end of his rope. My darling’s recovery will be in no small part due to these wonderful and gracious nurses.

When he recovers all the difficulties forgotten, we’ll remember this time more kindly. 

Today at the VA San Juan

After five weeks of sitting by my husband’s bed in the VA Hospital in San Juan I went home for a couple of days to pay bills, wash clothes and sit on the porch looking at the lake. The rehabilitation team introduced themselves in such a positive way; surely he was in good hands.

His first physical therapy came on Saturday. He did exercises for upper body strength. Reports from our friend Adri about his good spirits helped me relax. Tuesday morning when I arrived I expected Kirt to be headed for therapy, but no. His pain had increased; the amputation was cherry red and oozing. Around 9 am the nurse informed me that the rehabilitation doctors put in a consult to the surgical team for evaluation.

Kirt waited in pain, holding his stump, so I stalked the medication nurse from room to room until she came with the pills that promised relief. Slouched posture and I sure as hell don’t want to be here demeanor spoke volumes as she scanned my husband’s wristband. The first pill she popped out of the bubble wrap plastic. He was unable to take it, so with her long painted fingernails she scooped it out and plucked it into his mouth. Now, it’s been a very long time since I went to nursing school, but as I recall contaminating a patient’s medication is a no-no. She opened the second pill, I pulled out my cell phone and caught the photo of the long nailed vixen handing him the other pill. In between she pushed the hair back from her face, so in complete disgust, I took her picture. It’s too bad her hair fell forward again before I could snap it.

By late afternoon even the rehab doctors were annoyed that the surgeons had not shown up. They ordered that an IV be inserted so Kirt would be ready, if the surgeons ordered IV antibiotics. We waited some more. While a nurse checked his blood sugar I noticed the fingers on his right hand were bloody. I asked the nurse if she knew where the blood was coming from, the short answer was no, and then she left. I washed his hand and pulled back the blanket. His arm was bleeding from where he pulled out the IV. I walked into the hall with the needle and wad of tape, presented it to the nurse just in case anyone wanted to know where the blood was coming from other than me.

A little later another nurse came in the room while I was taking pictures of his stump. She curtly informed me that no picture taking was allowed at the VA. “Did I understand that?” I informed her I did not wanting to be escorted out by security. Police power is an intimidator.

As of this writing it’s now 8 pm and a still no surgeons. The redness is covering a larger area of the stump. Again I asked the nurses to call the doctors and was told they could not call the surgeons that it was between doctors. Either the surgeons will come tonight or in the morning. I’m afraid to cause too much of a ruckus because I want to be able to spend the night with him. I realize that it’s by the good graces of the staff that I’m able to stay to watch my husband’s condition deteriorate this night.