The Surgery and Beyond

So the surgery to replace Mom’s heart valve was supposed to be a minimally invasive procedure where they would make an incision between the ribs and replace the valve without having to crack the breastbone etc. Needless to say, this is NOT what happened. It turned out that the blood vessels surrounding the valve had grown too calcified to allow for this type of procedure. Additionally, because the original valve was too small, the space into which the valve needed to be inserted was not sufficient. This was not determined until after they had opened up the chest. At this point another series of bypasses were required in order to create room for the new mechanical valve that they wanted to put in. So all of a sudden we went from a minimally invasive 1 procedure surgery to an open chest with multiple procedures required. The surgery also took considerably longer than originally anticipated. All of this made the outlook for recovery less than optimal.

While in surgery, of course she was intubated, a machine was substituting for her heart and her body temperature was lowered to minimize the risk of damage to the brain. In the recovery room, she remained intubated as they slowly warmed the body and began to try to bring her back to consciousness. The goal is to remove the breathing tube and other machines as soon as possible and get the patient up and running fairly quickly. This actually increases the chances of a full recovery. It also is the only way to assess whether there has been any loss of brain function. Only when the patient is conscious and can respond to stimuli and questions can their mental status be evaluated. By the second day, they had removed the ventilator. Unfortunately she wasn’t responding as they had hoped. She seemed disoriented, in a lot of pain, and really not recognizing her surroundings. Now here’s the thing. Mom has a DNR. The hospital was fully aware of the DNR, it was in her file etc. However, one thing to remember, is that when a procedure is performed in support of another surgical procedure, it may not be subject to(nor should it be subject to) the restrictions that come with the DNR. If she had had a heart attack and entered the hospital with a DNR, they would not have intubated her nor performed any extraordinary life saving procedures, including ventilators etc. But this is a different set of circumstances. She agreed to the surgery, so she agreed to the supportive care following the surgery. Therefore, if reintubation is needed that can and possibly should be done. This is exactly what happened. The plan was to reintubate and then support her through the next couple of days until she was stronger and began breathing on her own. Unfortunately things went from bad to worse at this point.

Next: All the machines!