Goal #2: The Work and The Glory

Another goal is to read all the Work and The Glory books. There are 9 of them. So far she is on #5 already. She studied church history and the Doctrine and Covenants this past year in seminary so the books are reinforcing a lot of what she learned. We are having many conversations about the gospel because of her reading. She asks good questions and our discussions are personal and deep.

Tuesday night, the 2nd, she wanted to have a Work and The Glory movie marathon.

I crocheted the edging on baby blankets while we watched.  The movies are really good, but I've never met a movie that is better than the book or books it was inspired by.

I've really enjoyed this private time with her.

Progression Pictures Days 5 thru 10

 Pay attention to the eyes.  They tell you how she feels.

 Now that the swelling has peaked and is starting to go down, we are to put moist heat on her face.  A wet washcloth heated in the microwave.  It helps the swelling reduce better and is soothing.

One of her goals is to master all the Beatles Rock Band songs during recovery!  She's getting pretty good.

Another goal is to read all the Work and The Glory books.  There are 9 of them.  So far she is on #5 already.  She studied church history and the Doctrine and Covenants this past year in seminary so the books are reinforcing a lot of what she learned.  We are having many conversations about the gospel because of her reading.  She asks good questions and our discussions are personal and deep.

Day 4--PolarCare

 This is Day 4, post surgery.  Friday, July 22.

The swelling is beginning in earnest.  It starts about 3-4 days after surgery (interesting, huh?) and continues for about 3 days until it peaks and then starts to go down slowly.  It takes a lot longer for it to go down than for it to swell up.  We cut off all her 'guaze helmut' today.  The doctor told her she needed to hold the PolarCare bladder with her hands now.  Now she didn't have the use of her hands to gesture or write what she needed to communicate.

What to do.....

I got one of her elastic headbands and it was perfect to hold the ice water bladder on her face!  We just put it under the chin, up the sides and on top of her head.  It worked perfectly.

You can notice some of the bruising starting to color.
We were prepared for MUCH worse and it never happened.  A great blessing.  It is pretty much all gone as of today, August 4th.  However the swelling did get about 2-3 times this big and nice and red and shiny.

The Hospital

Timpanogos Regional Hospital

This was such a good hospital.  New. Clean. Good staff.  They treated us like gold.

They always made sure Duff and I had meals.  Lunch, dinner, and breakfast the next morning.  Whatever we wanted to drink.  We hadn't planned on staying the night because we were told she would be pretty much out of it, but with all the vomiting and nausea she was very aware and was scared.  So we spent the night.  Duff and I were talking about which chair we were going to sleep in when they brought us two roll away beds, scrubs to sleep in, soap, towels, washcloths, deoderant, toothbrushes and toothpaste, lotion, and even facial wipes for me to take my make-up off with before bed.  The nurses rearranged the room to accomodate the beds and we settled in for the night.

Until she is 18, she has to be in the pediatric wing.  There was only one other patient in the entire wing.  One came in during the night.  But that was it. 

The surgical wing was to the north of us.  On Tuesday morning I needed to take a walk.  I went outside for a while to get some fresh air and then back up to the pediatric and surgical lobby where I sat for a little while.  A medical team came in and sat down.  They were discussing a patient who had just had surgery for a very serious illness and how and what they were going to tell the family. It wasn't good news.  I was very touched at the thought and care and feeling that went into that conversation so they would all be on the same page in helping that family. 

Medication

 Here is our little pharmacy set up.

Everything is liquid except for the Ativan. It is so tiny that she pushes it through between her front teeth and the cast and then irrigates it down with the catheter and syringe.

Lortab for pain every 3-4 hours.  Keflex (which was already in the trash by the time I took this picture) every 6 hours.  Prescription Afrin twice a day 8am and 8pm.  Ativan for anxiety.  By the end of the day people with this kind of surgery usually get claustrophobic with their mouth unable to move, wired shut, and the nose closes up inside. I questioned the Ativan initially and once we got home was really glad we had it.  It helped a lot before bed especially.  Advil and/or Aleve as needed.

The bulb syringe is for home suctioning.  I am surprised how much we really did need it and used it.

My scratch paper list of the meds.

Now she doesn't take any of them except for the nose spray about once every one to two days for another week.  Then off completely.  Did you know Afrin is addictive?  I didn't know that.  If you use too much of it too often it actually constricts the nasal passages so they close up.

Sleeping

The first three days and nights Christine was parked in one of the recliners.  She stayed there all day and slept there at night.  It was where we could keep her head at a 30* angle.  The recliner is big and puffy and soft and adjusts to a lot of different positions.

Friday night she had had enough of the recliner and tried to sleep in our bed.  She couldn't get comfortable and her head was at the wrong angle.  She has been very light-headed and a little dizzy when she gets up or changes position.  This is due from a) the surgery in general, b) not hardly eating and being sick a lot, c) her swollen head, and d) not being up and moving very much.  We ended up situating her back in the recliner and I slept on the couch again next to her.  One night she tapped me and wrote out, "Mommy.  Please just hold my hand."  I held it most of the night with my own head crooked on a pillow on the arm of the sofa.

Saturday night, she was determined to sleep in a bed.  We put her in our bed again and set up the pillows differently.  She slept on my side and I slept on Duff's and he went upstairs to the office loft on the futon.  (It is the most comfortable bed.  Everyone in the family loves that futon.)

Since all of her medications are on a 'time' schedule,  we have to get her up at night around the clock.  This didn't last after the first 8-10 days, though.  During the day, when she napped we tried to get some sleep too.  It was kind of like having a new baby.  Tired from being up during the night so we got rest when we could catch it.

Duff has been working upstairs everyday.  I'm really grateful he can do that so he can be here this first week.  He's been a good help.  The picture above if of Sunday morning.  When I got up he went and climbed in bed with her and they both didn't wake up until almost noon.

Eating

This is how Christine eats for the next couple of weeks.

The catheter tube is cut in half at an angle and placed on the end of a large syringe.

The nurses and I all tried placing the catheter down the side of her cheek, but she decided she was better at it since she could tell exactly where it needed to be.

Fill the syringe with thin liquids:  above is warm chicken broth.  We have also used beef broth, un-set jello, Ensure, Carnation Instant Breakfast, water, 7-Up, and V8 Fusion.

That is pretty much her diet right now.

Surgery--Day 2

We made it through the night!

I was so tired and so asleep that she threw a towel at me to try and get me to wake up because she needed to use the restroom.  Finally she started clapping and Duff woke up and we got the nurse in.  When you can't talk it's a whole other ballgame.

 Good Goal!

 The three things she insisted on having with her in the hospital:  her quilt from Grandma Sigie, her elephant from Sammy, and her Beatles pillow from Adrianne.

They were able to stop the cool mist oxygen mask.  Good step. Very tired and still sleeping most of the time.

Dr. Nicholls came by during rounds this morning and said she could be released.  We left a little after the noon hour.  She wrote down on her white board that she was scared to leave.  Me too.  I like the security of a hospital.  I'm never one anxious to go home.  Even when I had a baby.  I like being able to rest and have someone take care of me in case of an emergency.

The last requirement in order to be discharged was to be able to eat with her catheter.  She finally could do that and keep it down, so home we came.

It Happened--The Vomiting

I have no pictures of this.  I am glad and anyone reading this will be glad too!

One of my biggest worries about this surgery was vomiting.  I was hoping it wouldn't happen, but the simple truth is my family vomits from anesthesia.  I knew that, but was hoping nonetheless.  It didn't take long.  She started complaining about the nausea about 2 hours after coming to her room.  She had been dealing with it, but now it was worse and going to happen.

All of a sudden there it was.  We no longer have to wonder what happens when this occurs while one's mouth is banded/wired shut.  It comes out in ANY available space no matter how small and spews with volatile force everywhere and then runs out the lips.  I have spared you the more graphic details, believe me.

I worked with Shurron and held the bucket while she started to clean.  I'm usually pretty good with blood.  But I really had to hold it together with this.  Lots and lots of blood.  We got her cleaned up, then changed her gown and the bedding.  They explained it to us like this:  during surgery, especially oral surgery, there is a lot of blood loss.  Even with suctioning, a large amount gets into the stomach.  It mixes with the stomach acids and curdles.  Then it most often causes nausea and comes up.  Christine was dealing not only with that issue, but the anesthesia effects too.  Double whammy. 

They kept her on Zofran right in her IV and then started phenergan suppositories too.  It worked for a while, but after the shift change it started again.  The night nurse, Molli, was awesome.  (All the nurses were great, but Molli was our favorite.  She embodies the title 'nurse'.)  This time, I had to leave.  Maybe I was too overtired but I felt sick myself and no one needed to have 2 of us in that condition.  I felt bad as a mother, but reconciled that I am human too and Christine was well taken care of.

Molli and another nurse worked for over an hour with Chris after.  Sooooo patiently irrigating her mouth so she could dislodge the curdled chunks and they suctioned them out from her lips.  These people are made of something special to be able to do that.

She was sick the next morning again.  They doped her up that afternoon before we checked out and she did pretty good on the drive home.  She had at least one sick episode everyday through the following Sunday.  It just unnerved me.  She couldn't eat as it was and everything we kept getting down her so carefully kept coming back up.  Dave had called us on Sunday morning to check on her and when I told him, he wondered if it was from the Lortab (pain med).  I let him know that she seemed to be tolerating that ok, but it was after the antibiotic that she didn't do well.  He told us to stop it immediately.  She had had a pretty significant dose in her IV's while at the hospital and that the Keflex he prescribed for home was just precautionary.  Try and have her rinse a few times a day with some Listerine instead.  She could do that by tilting her head back and forth and front and back, (can't move the jaw or mouth) so I threw that antibiotic in the trash!  Only trouble now, was she was so scared to drink/swallow anything except water or 7-Up.  It took 2 more days until she had enough confidence that she wasn't going to be sick before she started 'eating' again.

That was my other big anxiety:  eating.  I would be in charge of that and would I be able to get enough calories and the right combination of proteins and carbs, etc. in her.  The eating process for the first week or two is through a catheter tube in the cheek and a large syringe of thin liquids.  Broths, ensure, etc.

We were now free of the nausea and vomiting and that was a relief for all of us. 

***We learned something about this.  Adverse effects to anesthesia can be consistent with motion sickness.  Dave asked us if she ever gets motion sickness.  Yes!  My kids get it from me.  I have suffered with it my whole life.  Just part of who I am.  I have to sit in the front seat of a car with air on me, etc. Long ride, short ride, it doesn't matter.  Can't do big rollercoasters.  Duff doesn't get it.  Mike doesn't either.  But the rest of us do. Isn't that interesting?  So if you ever need to have surgery and can be motion sick you should tell your doctor and anesthesiologist.  They can help. 

Surgery Over--Her Room

The surgery started a little before 8am.

It was a weird feeling for Duff and I to go back out to the waiting lobby.  Even though it was only 8 in the morning it felt like we'd been up all day.  There was nothing to do but wait, so we decided to go and get some breakfast.  We went to IHOP.  I got swedish crepes with lingonberries and some bacon and Duff got ham and eggs with hashbrowns.

We went back to the hospital and got settled in with some good books.  He was reading King Follet and I had picked up Stolen Life by Jaycee Duggard when we were at Costco the day before.  I watched that ABC special about her kidnapping and recovery after 18 years and have been intrigued about it.

At 10:15, Mandy called me on my cellphone to let us know that the surgery was done, it had all gone well and as expected.  Dr. Nicholls was closing things up and would be out in about 1/2 an hour to see us.

We met a nice parent couple across the waiting room from us.  Their daughter was having a hysterectomy.  A big tumor the size of a melon was removed.  When their doctor came out and let them know it was benign they were very relieved.

A little while later, Dave came down the hall.  He pulled up a chair and took off his hair cover and sat down.  Told us all about it and that she had done great.  Christine has always been a discreet mouth breather.  I hadn't really thought much about it--Duff is a mouth breather.  Dave said that while he had her opened up he repositioned the nose from the inside so her passages would open up and she could breathe better.  He let us know that they were very narrow and small the way the jaw and nose was positoned.  He told us that as soon as he did that her body kind of took a big breath like 'ahhhh'.  Who would have thought?

She was having a bit of trouble with pain management in the recovery room so they didn't let us see her until they got it under control and brought her to her room.  Kathy took us up to pediatrics.  I didn't realize that it is like the baby nursery:  locked and secure and you have to get buzzed in.

We waited about 40 minutes and then they wheeled her in.

 She was out of it.  We talked to her and held her hand and she gave us a thumbs up, but that was about all.  Her nurse was Shurron and she kept a close watch on all her monitors and different medications and vitals.  There is a computer in each room in a locked cabinet that the nurses keep track of everything on.  It was really interesting to observe how they do that now.  Much more efficient than hand writing on a chart.

 They had ordered lunch for Duff and I.

We were surprised at that but grateful for their thoughtfullness so we didn't have to leave Christine.

Delicious tuna salad on a croissant with lettuce fruit and dessert.  We hadn't realized how hungry we were. 

On the inside of her bandaging, is a bladder that circulates cold water to aid in the swelling and pain management process.  It is connected to tubes that go into an electric cooler that is filled with crushed ice and then water.  It cycles through the bladder keeping the jaw and cheek area cold.  That was a lifesaver.  They sent it home with us and we kept it going 5-6 days.

Notice her elephant and also her Beatles pillow.  She insisted on them before and right after the surgery in the recovery room.  The nurses obliged.  Adrianne made the Beatles pillow case for her before we left.  She used a t-shirt that she found at Target.  Clever!  Everyone wanted one.

Surgery Morning--July 19, 2011

Tuesday, July 19, 2011.

We got up at 4:30am.

I don't know about Christine, but Duff and I didn't sleep much.  We kept tossing and turning.  Finally I said to him, "You can't sleep either?"  We held hands and layed there and talked about all of our fears for her which translates over to our fears for us.  We knew she was in the best capable hands possible.  That's why we came to Utah.  To have Dave do the surgery. And for the cost.  $4500 less than in California.  That's a LOT of money.  But even if the cost would have been equal, we still would have had Dave do the operation. There is something about trust.

We had to be at Timpanogos Regional Hospital at 5:30am.

Gosh, that's early.  There is a lot to do before surgery.

 In her pre-op room.  She has just completed all her labs.

She showered late the night before and had me comb and braid her hair so it wouldn't be in the way.  This morning produced bed-head.  But who cares at this point.

We had a very nice nurse named Kathy.  She was a grandma lady (who am I kidding.  I am a grandma.  What I mean is that she was probably my mom's age.  It was comforting.)  She was so kind.

 Check out the gowns for surgery.  They are a heavy paper-like material lined with a thin flannel like fabric.  Inside is a pump and tubes.  They connect to those leg thingys that help with circulation.  Kind of cool.

Jose was her 'driver'.  He wheeled her all around the hospital.  To the surgery waiting area for the anesthesiologist, operation room, and the recovery room.

 The lovely hospital socks.  No matter what, you have to wear them.  I wonder if they could come up with some better colors....

 All ready to go!

Sammy Lima gave her the gray elephant.  They have been friends for so many years I've lost track.  Samantha and Chris did that big APEuro project together earlier in the year.... I'm in love with this elephant.  When I was a baby and toddler, I had a gray and pink stuffed elephant.  I loved it, and I still remember it.  My mom kept it for years in a linen cupboard and finally threw it away.

Here is the surgery group in the pre-surgery waiting room.

Christine is starting to get a little groggy.  The anesthesiologist had just given her the nose drops to open up all her passages and started some meds in her IV.  Because it was oral surgery, the breathing tube for the anesthesia went through her nose and not her mouth.  I hadn't thought about that beforehand, but as soon as he explained it to us it made perfect sense.  The mouth area had to be free of any obstructions.

Christine, Dr. Dave (surgeon), Paul (anesthesiologist), and Mandy (surgery nurse).  This was quite a jovial group.  They had a good comraderie.  You could tell they have worked together before and had a respect for each other.

Paul announced, "Mom!  Come give her a hug now, because it's time to go and she's getting sleepy!"

Maddy wheeled her through the door to the back right, and Dave gave me a hug and told me everything would be fine.

Christine's Surgery Update

Today is August 4th.

My intention was to blog everyday about Christine's surgery and each day record her recovery. My intentions were very good, but haven't happened. It has been a full time job to take care of her. I thought I might even post and back date them to the corresponding day, but finally it dawned on me that it didn't matter. There hasn't been time to blog. And it's taken all of these last two weeks to get to today. I have been physically and emotionally exhausted. Today I finally feel like I'm the one turning a corner and a little more myself. I have 5 children. Four of them have had some kind of surgery in their life. Appendix, reduction, hernia. I've learned something from the process for each one. Not only about our bodies, but medical things, emotional things, psychological things. This major oral surgery of Christine's has been the hardest one. There is something so vulnerable about not being able to talk/communicate--except with hand gestures and a white board to write on--and not eating conventionally. Those two variables are things we really take for granted each and every day.

I'm going to catch up now on the last 17 days.

I do want to THANK YOU for all your thoughts, prayers, emails, texts, and phone calls. They have meant a lot to us, and we LOVE you all right back!