Quiet on the Western Front

Tonight, for the first time since October, Ashley will be sleeping 7 hours away from me. School starts tomorrow for her, and she had to go for a few important days before coming back up here (Biola is allowing her to miss some time). That time in October was the only other time in our marriage of almost 1.5 years where we didn't sleep together. It's going to suck, but things already suck. At least she can come back by Tuesday night. My mom will be around on Monday and Tuesday to help me while Ashley's away, but she won't be spending the night here. That's a right I reserve for my wife. :)

So it's kind of quiet today. One of my drains is acting up- it gave up a good amount of bile-y fluid this morning, but is quieting down. However, I think when the nurse emptied them, they equaled the combined total of yesterday. So if nothing else comes out of the drains today, it'll be the same as yesterday. We'll just have to watch it to see if it's a new trend or an anomaly.

When the doctor finally came in around 12, I told him how much I wanted to go home; if I'm waiting for my drains to dry, may as well wait at home where I can actually get some sleep, you know? He said he wants to see at least two more wound vac changes, so on Wednesday, he can think about it, but of course other factors are involved, and it's all so very tricky, an art really, so we'll just have to wait and see. Unpopular answer, but probably the best. So. Not much new to report.

Pray for the usuals:

drain stoppage

accelerated wound healing

rest

absolutely no new complications rearing their ugly heads

We've already discussed this.

Well, it took me 3 weeks but I got a mild scolding from McGreeky. With everyone wanting to know a solid plan, it falls to me to do the questioning. Apparently, he is getting tired of it. He has been very patient, though, so his firm "we have already discussed this several times" didn't sting as much. To my credit, we have heard 2 different plans for the past couple weeks and we just want to know which one he's working with today!

Anyway, Dan's doing well today. The residents are all taking a huge test today, so doctors didn't bother us until 0930. Whoa. McGreeky and the nurse changed the wound vac again, and he was very pleased with the progress. He's making some modifications to the suction and sponges to help Dan's wound begin to contract. This is certainly a large step in the right direction.
The drains have decreased dramatically. The past few days totals: 250, 140, 120, 110, 85-ish. They MUST continue to decrease in this fashion for Dan to be able to eat. Labs have been ordered for every other day now and antibiotics might be discontinued tomorrow or Monday.

As for the "plan" I got in trouble for asking about, McGreeky really wants to do a feeding trial before Dan goes home. Accordingly, he wants to see the drains continue to decrease in output, let Dan eat a couple of days (Monday, maybe), then see what happens. Just like before, if the output stays the same, Dan is free to go home and eat. If the output increases, he has to spend a couple days "in-house" waiting for the TPN to start again. Either way, the surgeon says he should be home by end of next week.

For McGreeky's safety, I hope he lets Dan out before the Superbowl. Dan might get violent :)

Today will be spent with our sisters, Lise and Laura. They drove all the way up from SoCal yesterday to see Dan and I. So fun to spend time with people who don't live or work in the hospital. I'll be driving back with them tomorrow afternoon (I'm happy and sad about this, of course).

Prayer Requests:
* Release from the hospital earlier than the docs think (before Feb 7th)
* Decrease in drain output to nothing!
* Continued healing of the wound
* Feeding trial to begin on Monday and be very successful (no increase in output)
* Safe travels for me tomorrow and Tuesday night
* Comfort when we're apart
* Patience for McGreeky (too bad, buddy, we're asking questions)
* Confidence for Dan to go home to La Mirada soon :)

Praises:
* Wound healing
* Progress and improvement
* Good friends visiting (Lise and Laura!)
* A mighty God

Another week?

The doctors must be getting tired. They arrive later and later every day. Today, McGreeky didn't arrive until nearly 11am, when Dan very kindly told him that he had hat head. The doc was in-between cases, so it was nice of him to come by and check things out.

Amazingly, he says that Dan is looking at one more week. Honestly, that is the 3rd or 4th time we've heard that, so who knows. Yesterday, it was 5 days. Today, it's a week. Tomorrow? Maybe he'll go backwards and decide on 3 days. Ha.

Anyway, he wants to change the wound vac tomorrow and Monday, while watching the drain output. He wants to "reassess" on Monday and probably try feeding Dan for a couple days. If the drain output stays the same, Dan gets to go home and eat! If the output goes up again, Dan will be have to re-cycle the TPN before going home. So, Dan could be home by Wednesday or Friday...but we have certainly heard that before.

To make matters worse, McGreeky is consulting a surgeon (McChief) who changes his mind a lot and could develop a new plan. (I'm not being impertinent or disrespectful; McGreeky actually told us that the other surgeon "changes his mind every day, so we don't really know, but I'll go with his advice.") We plan on asking McGreeky if "the plan" is changing or not, because it gets pretty old hearing his plans and then hearing them change due to another opinion. Of course, he keeps reminding us that dealing with this problem is stylistic...so, I'm hoping McGreeky sticks to his guns this time.

I think something has clicked in our minds that we can do absolutely nothing about getting Dan out of here. The nurses really don't think he needs to be here (nor some of the doctors), but I'm not sure we'll ever hear, "You can go home today" from McGreeky. Even when goals are met, new goals are made to delay discharge. Dan feels good, but it must be discouraging to not be able to get out of here even after great improvement.

So, I'm driving to LA on Sunday, then flying up north again Tuesday night. It's my last semester of nursing school, so I have to actually go (Dan's doctor seemed glad that I was coming back, so maybe I haven't bugged him too badly yet). I'm hoping, I'll be able to drive Dan out of Stanford before I go back to school again.

Let's just pray that Dan is home for the Superbowl...9 days.

Prayer Requests:
* The surgeon feels confident to trust his decision-making and actually commit to a "plan"
* Dan's release from the hospital...4 weeks is a LOT different than 10 days
* Complete drying up of drains (I mean NOTHING)
* Improvement of wound
* Successful feeding trial--no increase in drain output at all while eating
* Cooperative/flexible professors to allow me to keep spending time up north
* Dan going home to La Mirada SOON (before I begin clinicals on Feb 17)

Praises:
* Dan feels fine
* Families being helpful and coming to visit
* Financial security
* Ability to fly back and forth

A little sunshine

If you've been keeping up with the blogs (or have been in Northern California for a few weeks), you may remember that it had been raining and storming pretty nastily. Well, I think we're on day 3 of sunny days. Today, I ventured the furthest I have gone since surgery (the reader is now aware of the author). I went out to the hospital front door and out by some nice fountains with a few ducks lounging in the corner. Despite my new low weight (165 down to 145 and now up to 148), I wasn't too cold in the January air. It was nice to see the outside and feel real air.

Earlier this morning, the doctors changed my wound vac. My skin did NOT appreciate the removal of the adhesive covering, and the whole of the procedure hurt pretty badly, even after taking some pain meds beforehand. But the doctors said it looked better than it did before. It is 'granulating', which is a step towards healing, I have been told. I am getting tired of having an open wound, so this wound vac that is speeding things up is my friend right now. I mean, had it not been for an infection, the wound would have never been reopened and my only concern would be the drains. Too bad. Speaking of the drains, I think they're still at their low pace (about 140/day combined), so that's good.

My surgeon thinks I'll be out of the hospital in 5 days. That is not the greatest news, because that also means Ashley will have to go to school while I'm in the hospital. But at least it's better than 'we'll wait and see.' Here's some sunshine breaking through the clouds: after 3 or 4 days, they're going to put me on a food trial and see what happens with my drains (as was the plan before- if the output goes up, I go back on TPN, but if the output stays the same, I can go home and eat!) Either way, I get to eat soon. You may or may not know how elated I am by that thought.

We've been loved on by some special women today. First, my mom came (and is still here) to spend the day with us. Then, we got a care package and some letters in the mail (I get more mail here than at home!) The package was from one of Ashley's nursing instructors, and had stuff for Ashley and me, including a 5-year-old's rendition of a football game between the Jets and the Angels (he has some learning to do). The cards were from a friend of my mom's; she and the people in her office pitched in and gave us some money to pay for Ashley's flights to and from LA. Then my Aunts Patty and Debbie wandered in and talked for a while, then took my mom and wife out to lunch.

Today was a good day (all things considering). We needed a good day. There have been a lot of mediocre to bad days. There might be some more coming, too. But today--- today was a good day. It was a nice gift from God. I'm open for more of it.

pray for
drain stoppage
wound vac efficacy
wise decisions from the doctors
sleep-filled nights in the hospital
more good days
:)

Word Choice

We have heard nothing new today. McGreeky hasn't actually stopped by yet. The team of residents simply looked at the wound vac and the drains and left. Not a good enough reason to flip on the exam light at 0630, in my opinion.

While we wait for any news, I'm going to take the opportunity to improve semantically. In the spirit of fairness, Dan wants to clarify that he does not HAVE to go to Lodi. He has chosen to go. The surgeon wants him to stay in northern California for a little while after discharge, and since I will not be able to be here, it makes more logistical sense to stay at his parents' house. The plan was originally to stay in Santa Rosa, but without me there, it won't really work.

Just so we're clear, Lodi is not the unfortunate middle ground on the way home. And when I said "Lodi isn't home for him," all I meant was that it wasn't our apartment in La Mirada with me. Dan will be taken care of very well by his parents, and I am grateful for that. Our first choice would be being together, but he will have anything he needs in Lodi. Honestly, what surgeon would choose a nursing student caretaker versus a surgeon and a licensed nurse as caretakers?
If Dan is sad about anything, it is not that he will be in Lodi indefinitely, but that we will be separated.

Anyway, Dan is feeling more comfortable with the wound vac, though he isn't thrilled with it. He received blood products last night, so he has more energy. The docs also increased the calories in the TPN, so he isn't even hungry. Unfortunately, the decrease we saw in the drain output has increased again, so maybe the leak isn't getting better after all. The "2nd opinion" surgeon was quite clear that Dan will not taste food until the drains are dry, while McGreeky just wants to see a solid and steady decrease. Who knows which opinion will be followed?

It sure is getting frustrating to get excited about an improvement and watch it get worse again. Something positive that lasts would really help us out.

Prayer Requests:
* Drying up of the drains (no more increase in output)
* Efficacy of the wound vac
* Surgeon's confidence in letting Dan out of the hospital
* Good news today
* Good communication between Dan and I and others

Praises:
* Less pain with wound vac
* More energy from the blood and TPN
* Free coffee all the time

Sucker

Not a whole lot has changed today, but things are finally starting to make some progress.

The day began with an ambush by the residents at 0620 wanting to change the wound dressing, followed by the charge nurse telling us that we had to pack up our stuff and be moved to another room by 0730. Fun. We had been warned that we were moving to a new room eventually because all of the rooms are getting new TVs and Dan's room was one of the last to be modified. So, I packed up our stuff and my sleepy husband and moved to a new address down the hall. Everyone was busy at shift change, so I had move it all by myself--even the bed! But, I got to keep my sleeper couch, which makes up for the work.

The doctors finally decided to put the wound vac (the sucker for the wound) on Dan's wound today. Everything went fine, though Dan said it hurt quite a bit from the intense suction. He is slowly getting used to it. McGreeky was very confident that the wound vac would greatly speed healing. We certainly hope so.

Also, Dan's hematocrit dropped a teensy bit more today. The doctors believe that his marrow is having a hard time recuperating from the stress of surgery and blood loss. Accordingly, McGreeky has agreed to give Dan a blood transfusion (RBCs and fresh frozen plasma) to give his system a boost. Dan's been pretty tired today, but after some blood and a higher calorie TPN mix, he should feel almost great tonight.

We are getting used to our new room, which has a good view of the helicopter landing pad. A few friends even came to visit to help break it in. Thanks, Grant and Lise!

Now, we just have to keep ourselves occupied until things really turn around and Dan can get out of here. Dan's drains have decreased today, but we need to keep them decreasing permanently! At discharge (which seems like another week away), Dan has to go to his parents' house in Lodi for at least a week. We're both bummed about this because it means I will be living alone in our apartment for a while until Dan can come home. My professors are only making me do a couple days a week for the next two weeks so I can be up north with Dan. Lodi isn't home for him, but it will be better than the hospital!

Prayer Requests:
* Continued decrease of drain output...permanently!
* Efficacy of the wound vac
* Safe tranfusions today
* Confidence for the surgeon so Dan can leave the hospital earlier than expected
* Drastic improvement (we're talking huge enough that the surgeons are surprised)
* Release before I have to go to Biola, so I can help him get settled :)

Praise:
* New TV?
* Wound vac!
* Drain decrease (at least a little)
* Understanding professors
* God's power and love
* Transfusion

Just a little PO'd

If you read the last blog, you read that

1) another surgeon was going to consult on my case so that I could be assured a well-rounded decision

and

2) the plan was two days NPO, two days eating, decide from there TPN or not and go home.

Well, this morning the surgeon came in (who reminded me of my US History prof at Biola) and consulted. I kinda wish he hadn't.

He said that I needed to be NPO longer, though he was going to up my TPN so I wouldn't be as hungry. He wants to put a wound vac in tomorrow (which I think is a fine idea- I'm ready for the wound to close). He wasn't too concerned about the underlying hole- there's something they can cover it with and it won't be a problem. However, instead of a set timeline like McG gave me, now, I'll have to be evaluated at the end of the week. I suppose that could still mean a release date of Friday, but it could also mean I'll be stuck here longer. And even when I do get home, I'll be on TPN for sure, to be renegotiated by weekly meetings with the doctor.

So I mean, there's good news mixed with bad; I think the good news is marred by the fact that I'm still here. I even think the drain output went down. Maybe if it keeps going down, today's decision can get overridden and I can go home sooner. Maybe that's just wishful thinking.

Also, Ash just spoke with her nursing professor and needs to be down there a couple days a week to be able to graduate. So, pray for cheap flights and safe drives. This will be a long month.

What we do now is wait and see (surprise, surprise). Keep walking. Keep breathing. Keep doing something to pass the time. Pray for drains to stop. Pray to go home. Pray just because that's what you do in all situations.

Right now my goal is to be out by the Pro Bowl, of which I could write another entire blog, because of the timing and location change this year which the NFL will likely regret and hopefully reverse. But that's not what this blog is about.

Keep praying for us.

Dan & Ash

A tardy update

As the night got later, I suddenly realized that neither of us had updated the blog. I apologize for the lateness. Our day was full of visitors.

This morning was basically the same as the past few have been. Early rising for a dressing change, rounds by the residents and waiting for McGreeky to come by. The wound is looking better, though there is a small hole in the fascia that will result in a hernia. Fortunately, the surgeons will be able to fix it during the next surgery very easily. The surgeon is going to consult another attending on the unit to ensure that it is safe for Dan to have the little hole for a few months. We're just hoping whatever they decide will not interfere with Dan's discharge. McGreeky mentioned another week, and I became uneasy with the repetitiousness of his time intervals. After he left, Dan and I talked about what was going on and decided that the issue of length of stay needed to be discussed.

I went out and caught the surgeon before he left, and he graciously came back into the room. Dan explained that it feels as though all he has been doing is waiting, and waiting is something he could be doing at home. He told the doc that being NPO for a week and being in the hospital was harming his strength and spirits. Dan told him that he wanted to do what was safe, but was tired of waiting for something that wasn't working. Accordingly, McGreeky decided that Dan will be NPO today and tomorrow. Tuesday and Wednesday, they will let him eat. If the drainage increases substantially, Dan will need to go home on TPN (which will need to be re-cycled through his body a couple days before d/c). If the drainage stays the same, Dan will go home on a diet and just wait out the drainage. The surgeon even conceded that there really isn't much being done for Dan in the hospital right now.

Having the doctor give specific days and plans and admit that Dan really doesn't need the hospital, gives Dan and I some leverage for negotiation. At the end of the day, Dan is the one in control of what's going on--it's his body. The doctor is here for Dan, not the other way around. I was so proud of Dan as he expressed how he was honestly feeling and only hope that he can continue to press the doctor to stick to his word. Being in the hospital is not helping Dan get better. He needs to go home.

After the doctor left, we got cleaned up and prepared for an onslaught of visitors. Lise finally made it to Stanford for the first time after arriving home from Rwanda on Thursday. She is our sister in all the ways that matter. Oh, it was so good to have her around.

Then, Katal arrived. She found someone (well, her husband found time) to watch her little rug rat, so she came to see us. It was so lovely to be able to hear about someone else's adventures and ongoings.

Finally, my parents, brother and grandpa showed up to keep us company, too. Mom brought clean laundry and a refill of food. Dad brought some homework, Nick brought some hunger and Papa C just brought himself as a buddy to watch football with. Amazingly, Dan didn't get too tired out with all the company. I loved having my family and my closest friends around me. Sometimes, a hospital gets a little lonely.

Now, the day is coming to a close, and I am perched on the edge of the hospital bed as Dan sleeps. His arm around my waist keeps me warm and reminds me of something very important: 'home' can mean very many things. As much as we want to be back in our little apartment in La Mirada, we are home as long as we have each other. It seems so strange that we have only been married a year and a half. Feels like a decade at least. We have surely seen some good times and bad times in our relationship. Yet, standing upon the Solid Rock, we are safe.

Prayer Requests:
* Healing of the wound without any new infection or complication (no additional surgery necessary)
* Healing of the pancreas leak
* Approval for Dan to be able to go home on a real food diet THIS WEEK
* Wisdom for the doctors and an understanding of the benefits of home
* Discharge home BEFORE SUNDAY (so I can go to my first day of classes)
* No need for Dan and I to be separated during recovery (he wants to go to LA after d/c)
* Supernatural intervention and healing

Praises:
* Wonderful friends and family
* Patient doctors
* Resolution of infection
* Energy from the TPN

Extended Edition

Today is day 15 that I have been in the hospital (16 if you count surgery day, but I was unconscious for most of that day). According to the doctor today, they want to add another six to make it a full 21. Four days they want to watch me and my drain output while I'm NPO (not eating), then the next two days see what happens when I eat. So the good news of me being able to eat is masked by the fact that it is preceded by four more days of NPO. I've lost about a pound a day since they've been weighing me (came into surgery at about 170, fell to 150, and have since fallen to 145), and I'm eager to start eating again and regain some weight.

Ideally, the output from the two drains should go below 200 combined mL/day; right now, hovering at about 250. The two-day eating test is to see what happens to the output when I eat; if it rises substantially, they'll send me home with TPN (not ideal); if it doesn't rise too much, then I can go home and eat.

This six-day idea kinda tweaks plans. Before, there would be plenty of time to stay in NorCal for a little while so I could be close enough to Stanford in case I needed a little extra doctoring, but the plan ultimately being to go back home to La Mirada while I recoup. Now, we're cutting it close to the beginning of Ashley's school. A lot depends on my exit status (can I eat, what will my wound care look like, what do I do with my drains), so it's hard to make plans.

It's just really frustrating because of how many times it's looked like I could go home but just never happened. We have plenty of things to occupy our time in here, but hospital rooms are no place to live. We need to get back to something real. It's also frustrating because other factors are improving, like my fevers going down. In other words, while there is progress, it is not the progress we need.

Pray that:

my drains stop up. period.

my wound heals more quickly than is medically expected.

we would not be discouraged at the extension of time.

that the timeframe would not be extended any longer.

Pleasant People

You know, I bet it takes a lot to still be willing to answer a bunch of questions right after you've performed a 5-6 hour surgery and spent the day in clinic. McGreeky is just a pleasant guy. Dan had a CT today and rather than making us wait until tomorrow to hear the results, the surgeon came on over and listened to us. Patiently. Listening might do more for calming a person that having all the right answers at that moment.

The CT provided comforting results that the excess fluid floating around has lessened by half and there appear to be no signs of additional infection. Good news.

Dan and I asked about his hematocrit that has dropped rather than increased and about the leaky pancreas. The hematocrit levels are blamed upon Dan's chemo a couple years back and on the toll of hospitalization. The pancreas drainage is still chugging along, though it might be losing some steam. McGreeky was humble enough to admit that things are not going as quickly as he would have expected, but also told us he was being as aggressive as possible (without opening him back up). Yet, he thinks the rate will decrease and the worst of the dangers are behind us. He said to cross our fingers, but we'll stick to praying.

McGreeky also mentioned that he wants Dan to fully heal before going ahead with the next step of the surgery. Instead of 2-3 months, he's thinking more 4 months.
My nervous mind makes me worried...I graduate in 4 months. So, hopefully, we can talk the doc into doing the surgery at least a month before May 29 or waiting until after. I don't think I could walk without Dan there...he's how I got through nursing school! Before anyone starts telling me "Slow down, stop worrying, my goodness, blah blah blah." I know! At least if I vocalize this concern, I can be joined in prayer for it right?

Another group of pleasant people also visited: the Sizeloves! They brought all the kids and sat at the front lobby of the hospital so they could see Dan (kids aren't allowed in the hospital due to H1N1). Mark and Rachel were thrilled to finally see Dan, since they've only seen me these past few weeks. The kids even packed us a present bag: play-do, hot wheels, bubbles, a puzzle and a book. They drew us pictures, which now decorate our wall. I'm not sure we can ever express how thankful we are for Laura and Jon. They have never failed to open their home to us while at Stanford. Such a blessing. I hope someday, Dan and I can be just as hospitable as they.

Anyway, this is the 3rd blog in one day. Phew. Unless something major happens, I'll update more tomorrow.

Prayer Requests:
* Healing of pancreas and wound
* Recuperation of Dan's bone marrow (for hematocrit)
* Wisdom for planning the next surgery
* Rest for the surgeons (they look tired!)
* God to be glorified through us and this situation
* School scheduling, etc.

Praises:
* Good news from CT
* Patient doctors
* Encouraging friends

Path Report

We forgot to share the the pathology report came back from Dan's tumors!

The lab is still having a difficult time determining the exact kind of cancer Dan has and has sent some samples to Johns Hopkins for a consult. The pancreatic tumor was fairly active, though encapsulated to make it behave a little better.

2 liver tumor samples showed just scar tissue and DEAD tumor tissue. The other 2 liver tumor samples showed mostly scar tissue with a small amount of necrotic cancer. That means his liver had a nearly complete response to the chemo and radiation.

The surgeons saw some swollen lymph nodes beneath the pancreas and believed that the cancer may have spread to the lymph system (very bad). They removed 22 nodes...and NONE had any trace of cancer. Yay!

The doctor is very pleased with the report and pointed out that the most active cancer is gone along with its margins.

That being said, one more small procedure and one more large surgery could make Dan a cancer-free man. Whoa!

Today is yesterday's tomorrow.

I tried to get Dan to write this since he wrote such a great blog yesterday, but...no luck. You're stuck with me.

Today is much like yesterday and the day before yesterday and the day before that.

Dressing changes show a wound that is healing, just very slowly. The skin and adipose tissue looks very healthy but the fascia (tough under-layer) is healing with some holes. Thus, Dan will have a hernia when the wound closes up. Luckily, he's having another surgery in the near future (the other half of the liver resection) in which they will fix the hernia and shrink some of the scar. The docs still want to put a wound vac on him, but are waiting for the slow-like-molasses-in-snow wound to clean up and look nice. No point trapping infection inside under a sponge and suction!

The drains may have slowed a touch last night. One of them went for 8 hours with nothing! And then drained faster to catch up with its twin. Dan is on a medication called octreotide to lessen the secretions, which has been increased in dosage 3 times already. Between that and the NPO status, his pancreas should stop throwing a hissy fit soon.

McGreeky announced that discharge will not be until midweek next week. Dan will most likely go home on TPN at nights and clear liquids in the day time. He's thrilled (note sarcasm), but wants to go home regardless. So, we will have two addtions to our little family: Mr. Wound Vac and Mr. TPN.

Right now, I am discussing with case management where home health needs to be. We thought we would be going to Santa Rosa for a week to recuperate before going to La Mirada, but as this hospitalization has grown longer--the beginning of school for me has grown closer. I may need to miss a couple of the first days (if you know me, you know I'm bummed), but we hope to get to our apartment as soon as is safe. Luckily, Biola's nursing program has surrounded Dan and me with prayer and support and is doing everything possible to help me graduate on time.

For those of you concerned that we are going to be in SoCal alone, we will not be alone. We live in a complex filled with wonderful families who have offered to help us in anyway possible. Additionally, I work at a hospital on a surgical floor where I believe I can find answers to questions that arise. Also, I'm in nursing school surrounded with wonderful and skilled nurses. Finally, Stanford is always a phone call away (and a quick airplane ride if necessary). Psychologically, Dan feels he wound heal better in our apartment. He needs some normalcy. If for some reason, something comes up that would necessitate staying in Northern California, however, we have enough wisdom to do what is best for Dan's health.

Today will hopefully provide some good news as to the collection of fluid in Dan's abdomen. He is currently drinking more contrast fluid for another CT. This one will be before 1 am! McGreeky is specifically checking to see of the small abcess has resolved or if there is anything else to "go after" in his abdomen. We are praying for only good results. No more setbacks!

Thank you for all the prayers and support you have given us. From cards to games to food (for me) to flowers (thanks, Mama!), your love is very apparent.

You will note that I am now including praises to the Lord. Many prayers have been answered. To God be the glory.

Prayer Requests:
* Clear, good results on the CT today
* Drying up of the pancreatic drains!!!
* Continued wound healing and start of wound vac
* Flexibility and understanding of the case managers and doctors in d/c planning
* Encouraging news
* Release from the hospital in time for me to begin school on February 1st
(We can be surrendered to God's timing and still hope and ask for expeditiousness)

Praises:
* Safe surgery despite its length
* Very excellent pathology report
* No VRE/MRSA in wound
* No increase in drainage last night
* Encouragement from family/friends
* A private room for me to stay with Dan (and a shower!)
* Compassionate nurses and excellent doctors
* The Great Physician is in control

An apt word

I think one thing I've learned through this whole ordeal is how to deal with bad situations. Not something like patience or perseverance, which I think I have developed quite substantially over my lifetime, but how to both be in a bad situation and trust God in it. What I mean is, before, because of my unusually optimistic outlook, when a bad situation arose, my mind would tell me, 'Don't worry. Everything will be ok. Time to be happy.' Now, I think, 'Don't worry. Everything will be ok. But it still really really bites.'

There are a lot of sunny-faced Christians out there that love to be happy and don't know how to be sad. I'm pretty sure I used to be one of them. I'll tell you what, the term 'the joy of the Lord' means a whole lot different to someone who's stuck in the hospital and can't eat.

One of my verses that I have recently adopted as one of my go-tos is from 2 Corinthians, verse 9, where Paul asked God to take away the thorn in his flesh: "But He said to me, 'My grace is sufficient for you, for my power is made perfect in weakness.'" Note that God doesn't take away the thorn. He denies Paul's request. Does the thorn, then, all of a sudden, become so easy to deal with? Paul says that from then on, he delights in weaknesses. But the thorn never changes. The thorn still sucks. It's still a bad situation. God's grace is sufficient for me. He is here with me and has been working wonders throughout this ordeal, thanks to a multitude of prayers that have been pouring in. So many good things have happened-- I have a lot to be thankful for. And that helps. But you know what? It still sucks right now.

Dan

Discouraged

Neither of us feel like blogging, so this will be short or not very exciting.

Dan is basically the same as yesterday. His wound looks about the same--not getting worse, but not clean enough for the wound-vac idea the docs had. It would speed healing, but his wound isn't ready yet.

His drains have shown no decrease whatsoever. Even without food for 3-4 days, his pancreatic leak persists. Dan would prefer to have a leak because of food. The TPN keeps him from being too hungry, but knowing his GI system can handle food makes it difficult to still be allowed to eat. As the leak persists, there is no reason for the docs to let him eat again.

His infection seems to be mostly gone. WBC count better (10.7) and no fevers.

McGreeky says he'll be here at least through the weekend. Personally, I've lost my confidence in his estimation skills (a couple hours=7 hours?), so I'm not getting too excited when Monday rolls around.

Basically, room 339 is getting restless, discouraged and sad. We aren't getting any reasons to believe we'll be living any where but here in the near future. I'm beginning to feel the pressure of school being a week away. I need to write essays, order books, pay rent, organize my schedule, etc. Biola is being very flexible with me, but I was hoping to be able to make it to the first day of school (February 1st). That is very unlikely.

Dan's day revolves around 4 dressing changes, antibiotics, getting cleaned up, walking around the unit and sleeping. For someone who doesn't feel that bad, days in the hospital go by slowly.

I apologize if this is not the tone everyone is used to from us. We're tired. We're hoping God will intervene, but having a hard time expecting Him to.

Prayer Requests:
* Continued healing of pancreas and wound
* Increased speed with which Dan's body heals
* Dry pancreatic drains
* Multiply the hours of sleep we are getting
* Some form of encouragment from the doctors
* Something good to happen--more than just a day of waiting
* Release from the hospital by next Monday (can't hurt to ask)
* Dan and I can make it home (La Mirada) in time for the first week of school
* Good spirits

drip drip drip

It's really coming down out there. There are likely going to be floods in some places. And I am stuck inside hooked to a pole where my food and antibiotics drip, drip, drip. Such is my recovery: drip, drip, drip. The wound looks a little better. The drains are leaving about the same amount of liquid, but it looks like it's slowing. But still: drip, drip, drip. I'm really tired of being here, and I'd really like to be eating food, but I must keep dripping until I get to go home. At least things are improving. The TPN (food) in my new PICC line keeps my energy up to a fairly normal level, but I still miss eating for real.

I'm really glad that Ashley is here with me. She has been an amazing help and encouragement to me. I promised her I'd do this blog so she could watch a baby show on TLC, so... I don't really have much else to say. Keep praying, keep loving each other, and I'll see you when I get out.

Dan

Hurry up and wait

I looked at the clock and just realized that I haven't updated everyone today! Oops. My folks came to visit, I went to the Sizeloves to take a shower, went for lunch, and just hung out with Mom and Dad. Felt so nice to have them around. (Thanks for doing my laundry, Mom!)

Today is another day of waiting, which is something we are going to be doing a lot of in the near future.

We were told to wait patiently for the PICC nurse...and she showed up early! The line insertion went by the textbook, and Dan said it barely hurt this time. Luckily, his PICC nurse has been doing it for 19 years and teaches all the other PICC nurses. She had lots of stories, explained the newer technology they're using now, and gave me tips on getting into oncology nursing as that was her old field. She loves to teach, so she had an eager student for a while.

We were also told to wait for Dan to feel better after starting PPN (partial parenteral nutrition) last night...instead, he woke up feeling somewhat better. He even woke me up this morning with all of his energy. Though he still wants real food, he feels as though he is getting much better nutrition to keep him running on more than fumes. He'll be starting TPN (total parenteral nutrition) tonight through his PICC.

The biggest things we are waiting for are his drains to dry up and his wound to heal. These will keep us waiting for quite a while. The docs are hoping his pancreas (and now biliary anastomosis) will heal quickly while Dan is resting his bowels. One of the drains began putting out a new color of drainage: bile green. So, that means another anastomosis is leaking a bit. It is low output (by the doc's estimate), so they are simply watching it for now. The pancreas is slowing a little, but only a little.

Dan's wound got some special cleaning attention this morning from McGreeky. He spent a little time cleaning out the "nooks and crannies" before packing it. He feels that it is improving, albeit slowly. He is contemplating using a wound-vac to speed the healing, but the wound has to be very clean before that can happen. Perhaps a couple more days. Another doc just stopped by to see Dan's most recent dressing change and was surprised how good it looked this evening..."improving by leaps and bounds," she said.

So, now, we wait. It really does feel like we're rushing to get things done to get out of here, but it really won't be soon. Dan's really hoping for discharge this weekend, but we both know that he is safe here. Better to have most of the surprises occur at the hospital rather than at home!
Dan is getting restless and a little bored, so I'm trying to be creative. Any ideas for "fun" things to do in the hospital?

Prayer Requests:
* Continued healing of the wound by "leaps and bounds"
* Drying up of the pancreatic/biliary leaks (quickly!)
* Lack of hunger for Dan while NPO on TPN
* Safety for PICC line--no placement probs, infections or mix-ups
* Endurance and encouragement
* NO MORE COMPLICATIONS
* God's glory to be shown throughout this situation

A blog I do not want to post

As much as I had wanted to blog today about going home, this update will be much different.

Dan finally got his CT around 1245 am! Luckily, the results showed that there are no large abscesses to "go after" surgically. There is some fluid rolling around in his belly, but they think it will begin to go away.

The bad news, though, came after the good. Dan's pancreas is leaking too much for the comfort of the docs. If Dan were not having more surgery in the near future, McGreeky said he would send him home with the drains and let the pancreas heal on it's own. However, with more surgery on the horizon, the surgeons want to be aggressive with forcing his pancreas to heal. Thus, Dan is again NPO. He'll be getting another PICC (peripherally inserted central catheter) line tomorrow to start TPN (total parenteral nutrition). He's lost about 20 pounds the past 10 days, so he's very behind on nutrition.

The plan now is to let Dan's bowels and pancreas rest long enough for it to heal. He will not be allowed to eat more than sips of clears until his drains dry up. The earliest this could happen in Thursday--the very earliest. Dan could go home on TPN if his body tolerates it well. It is becoming more and more convenient that I am in nursing school (and almost done), as I can do the dressing changes for his wound, his PICC and take care of the TPN.

McGreeky wants to be aggressive and cautious, making sure Dan recovers completely. He sees this as a definite setback, but one that can be repaired.

Dan and I are obviously disappointed that we are looking at least 5 more days of hospital life when we were first told we could go home today. Yet, he is in really good hands here and it is comforting to know that the docs are keeping such a close eye on him.

As for me, I am basically living here. I have a comfortable couch to sleep on and a kitchen to make soup and such. I'm going to try to canoodle my way into the shower room on the floor...washing my hair in the sink might get old after a while!

Dan needs some cheering up--that's for sure. He is feeling fine and will feel even better once his nutrition picks back up. That being said, please call or email or visit. As long as you aren't sick and call first, Dan likes a little company to distract him.

What will help most, though, are your prayers. Dan needs a lot of healing.

Prayer Requests:
* Healing of the pancreas--quickly and finally (drying up of the drains)
* Resolution of infection(s)
* Endurance and encouragement for Dan (and maybe me)
* Understanding of the nurses (they've been very accomodating thus far)
* God's kind of healing--the massive kind that shows that only He could have healed Dan
* Good news!
* God's glory through our actions

Where's the Barium?!

So, CT was supposed to be around noon. Ha.
It's now nearly 2pm and radiology hasn't even sent up the contrast.
So, Dan has to eat nothing for a CT that we don't have any timeline for. Lame.
Dan just had the charge call down to see what the hold up is.
We'll see...in a long time!

Please keep praying that the CT does NOT show an abscess or anything scary.
Also, pray his wound cultures do NOT show VRE!

Stay tuned. (Or, just check in before bed and we should know something)

Another Day

The night was pretty uneventful. The intern came in looking exhausted, drinking coffee and sat down for a while. After talking about the latest movies he has seen, he finally welcomed our questions. Basically, he said the fevers could be from the wound infection or from another type of infection internally. The labs could be from the same causes. The increased JP drain output could be from jostling around or from increased pancreatic leaking or from the removal of the other drain. He said not to worry about it quite yet, but that they will be monitoring Dan to see what happens.

This morning, McGreeky stopped by and changed the dressing. He said the wound is looking better a bit, but still has some purulent drainage. Also, he was concerned about Dan's WBC count yesterday (20). Though it came down to 16 today, he wants to do a CT to check for a liver abcess or other type of fluid collection internally. If they find something, another drain will need to be placed and we'll likely be here at Stanford for a while longer. The doc says he thinks the CT will be a "low-yield test" in that he doubts that's what is happening. Accordingly, Dan will be staying today until more results are known. If all goes well, he can probably go home tomorrow.

Dan is still running low-grade fevers. It's becoming very frustrating. One vital sign (VS) check will show 37 and the next 38.3 and back and forth all day. His JP only drained 30ml last night, as opposed to 110 the (8 hr) shift yesterday afternoon. Unfortunately, the drainage is picking up again. McGreeky was fairly sure it is pancreatic juice being released, which means the leak is increasing a bit.

The CT is scheduled for early afternoon, but Dan has to drink contrast first, which hasn't shown up yet. Hopefully, it gets done on time and we can learn the results early evening. McGreeky said he will either call or drop by tonight, so we don't have to wait until tomorrow morning.

So, we're here another day. Dan still feels good, just a bit tired and frustrated. We need to go home soon.

Prayer Requests:
* A clean CT--no abcess or infection anywhere
* Resolution and healing of the wound infection
* Slowing of the JP drainage, eventual drying up
* No more fevers
* Sealing of the pancreatic leak on it's own (without surgical intervention)
* Guidance and wisdom for the docs
* Release from the hospital soon (and safely)
* Healing in all of Dan's body
* Encouragement and endurance

Bah!

Dan has been feeling great all day. He's taken two pain pills today at most, is eating more with no nausea and walking like crazy. He's even been less tired after his walks. When McGreeky saw him this morning, he felt confident that Dan would be going home tomorrow with only one drain. Unfortunately, the labs hadn't come in yet...

So, around 1300 I asked the nurse for a print out of the labs as I normally do. I was shocked to see that Dan's WBCs jumped from 11 to 20 today (normal below 11). Along with the words "toxic granulation" and "bands>20%" that means that his infection is not under control. Trying not to get too disappointed or worried, we decided to just ask the intern when he came around (picture a skinny, tall, apathetic Ben Affleck beach guy...his intonation never changes). Unfortunately, the intern is in charge of several units today and hasn't rounded yet.

While we've been waiting to ask some questions, another unfriendly change has occurred. Dan's drains were previously putting out hardly anything. One drain got removed (yay!) and we forgot about the drains for a while. Then, the CNA came to empty the remaining 2 drains and we discovered that one of them was basically full! This was a dramatic increase in output, which is worrisome because his pancreas is already leaky. So, this could mean that increased food has led to increased leaking of pancreatic enzymes, or some fluid just shifted when the other drain got removed or a little pseudocyst is resolving. Oddly, the drainage color has changed also. Unfortunately, we pretty much have no way of telling which one is going on.

We are still waiting for the intern to stop by, as Dan tries to cool down his fever. He's getting very tired of these temps :(

It is so frustrating to be so close to being released from the hospital to start recovery at home and then have things like this happen. Dan has felt so good today, that it's difficult to remember he's sick. Yet, it would be far worse for Dan to be sent home and have something unexpected happen away from the doctor's watchful eyes.

God is in control what ever happens.

Prayer Requests:
* Resolution of fevers and infection(s)
* That Dan's wound infection is NOT VRE (a nasty antibiotic resistant bacteria)
* Guidance for docs as to what the heck is going on with Dan's drain and labs
* Drying up of any pancreatic leak going on--big or small
* Peace and endurance for the both of us
* Getting out of here in God's timing when Dan is ready to go
* Cooperative digestive system
* NO MORE COMPLICATIONS

Hottie

It's official. Dan is a hottie.

He has had a fever every day of his stay at the hospital. Most of them are low-grade, but they are pesky. The docs believe they stem his incision infection and possibly his liver's activity. As long as it doesn't rise above 38.5 C, they're just watching him. No signs of a liver abcess or UTI, so that's good.

McGreeky said he can take out one of Dan's 3 drains today and possibly (not likely) take out another tomorrow. Just waiting on how the output looks. The surgeon seemed pleased with Dan's recovery thus far and is considering sending him home...tomorrow! I don't want to get too excited yet, but it would be nice to get outta here. Dan will be going home with at least 1 drain and a rather large wound to pack and dress. Maybe I should get clinical credit for this!

Dan's muscles are getting kinda sore from keeping his abdomen safe. Maybe he could get a massage today. Other than that, he feels pretty well. Not needing pain meds very often at all!

Thanks for praying. We have a good God.

Prayer Requests:
* Resolution of infection and fevers
* Removal of 2 drains (Dan hates them!)
* Continued endurance and strength for Dan
* Safe discharge home tomorrow (Guidance for the docs)

Leaky

The docs have determined that Dan is a little leaky.

His incision has continued to ooze some not-so-friendly stuff. Accordingly, the entire incision has been determined to be infected, and thus, has been completely opened up. Dan will go home with some wound care, but the surgeons are confident it will heal nicely.

After running some tests on the fluid coming out of Dan's drains, the surgeons have also discovered that his pancreas incision is leaking a bit of amylase. Luckily, the leak hasn't been producing much fluid, so they are confident it will heal on it's own.

In other news, Dan and I slept through the night...6 hours! Woohoo! Thank God for a private room and considerate nurses. We convinced the docs to let Dan have protonix twice a day, so his night was NOT interrupted by vomiting this time. Hopefully, it will continue to work.
He's eating a little more today and drinking quite a lot. Unfortunately, he's having a little trouble with gas pains (or at least that's what we think they are). Lots of walking.

4 of Dan's friends from Biola drove all the way up from La Mirada last night to visit. They've been holding down the fort for a while now. Dan looks tired but very happy to have friends around. Such an amazing bit of kindness! They also brought along our mail and a "goody bag" from one of my friends. Sweet!

Hopefully, the rest of the day will go smoothly and Dan's new pain will go away without being anything serious. The boys are about to leave and then, I bet, it's time for a nap!

Prayer Requests:
* Dan's pain continues to improve and even disappear
* Infection resolves (no more fevers or discharge), no further infections
* Going home becomes a soon reality
* Another night of solid sleep
* Cooperative digestive system
* Healing of the pancreas leak

Infeccion

Well, Dan has his first (hopefully last) infection. Last night, Dan had an episode of vomiting due to the nasty taste is his mouth. Concurrently, his incision began to ooze. When the surgeon came in this morning--dressed exceptionally nicely in a suit and tie--he decided to open up some of the incision to see what he could get out of it. McGreeky needed some help but it was shift change, so Jamie and I had to assist him. He tried to just open a tiny bit, but ended up opening up the lateral half of the incision. A lot of purulent fluid came out, so it's a very good thing he opened it up. Now, Dan has one more dressing to deal with, but hopefully less pain.

Dan said that he feels better today than he has since the surgery. Yay! He's walking and talking and even eating some regular food. He said it has taken away some of the bad taste in his mouth, which is great. Just taking things very very slow to prevent nausea and vomiting.

For now, the surgeons are thinking of discharge no sooner than 4 days. That's alright; it's nice to have so many eyes watching out for him. AND we have a private room now. Ahhhh.

Prayer Requests:
* Resolution of incision infection
* Cooperative digestive system...no more vomiting!
* Continued energy and endurance for Dan
* Helpful and understanding nurses
* God's timing for discharge and second surgeries

Tired

We're really tired and hopefully going to sleep soon. So, this will be a quick update.

After throwing up twice last night, Dan has felt better all day. The Toradol really seems to be working for him, to help him move and breathe as he should. He's had to take it easy on the liquids today, so he's hoping things begin to digest as they should tomorrow.

Apparently speaking your mind does help sometimes. Guest services returned and gave us a blanket, tote bag and parking pass as a sign of their appreciation. The best part of the day, though, was moving to his private room. It's bigger so I can sleep on a chair actually made for sleeping. Additionally, it should mean fewer interruptions in the night so Dan (and I) can get some rest.

Dan has had a low-grade fever all day. We thought it went away earlier, but now it's back a little higher. Ugh. Hopefully, it is not indicative of any infectious processes. Labs will help explain it in the morning.

Today was a blessing, though. Dan was lucid and happy and smiling. Amazing what pain control can do. I missed my husband these past few days. So glad he's coming back.

Prayer Requests:
* Fever breaks, remains gone and is NOT due to an infection
* Incision begins to heal more quickly and does NOT become infected
* Strength and endurance for Dan
* Continued improvement with no further complications
* A great night's sleep for Dan
* A cooperative and functioning digestive system
* Good news!

What a day

Today was pretty eventful...not in all good ways.

Dan's surgeons still feel that he is recovering beautifully. Poultsides even commented that Dan is in the 99th percentile of patients. His labs are improving steadily, except for that pesky hematocrit. As far as the things that the doctors are hoping to see, Dan has most of them. Yet, Dan still felt pretty crappy all day. The worst part was this strange fog that seemed to be clouding his brain. He would wake up, be alert for 15 minutes and then be exhausted and back to sleep again. This was not very helpful for doing the things he needed to do like walking and using his incentive spirometer. After discussing his grogginess with the surgeons, it seems like his liver just isn't clearing the narcotics as quickly as it should. As the day wore on, he became more and more lethargic, so he's now off the PCA and narcotics and valium...onto Toradol. The only concern with the new med is bleeding risk, so hopefully his H and H pick up tomorrow.

The next eventful thing was a visit from guest services to let me know that anything I post while on Stanford's wireless will be screened if it says something negative about the institution. A few days ago I wrote about one problem Dan and I have encountered: me staying with him overnight. The man from guest services wanted to know the full complaint and remind me that negative comments will be responded to. At the moment, Dan's surgeon has put in a request that I stay due to his mental status, the housekeeper is looking for a sleeper chair for me, a couple nurses just agree to let me hide out in the corner and now (this is exciting), Dan's next on the list for a private room! Having a private room would take away any problems with me staying over AND get me a cot. That would truly be nice. I'm not sure if/when any rooms will become available, but we're both hoping soon.

If anyone from Stanford is reading this, I want to express my gratitude for trying to make my husband's hospitalization as comfortable as possible. All of his nurses have been very skilled and intelligent and helpful. This is truly a wonderful hospital and in over 9 years of familiarity with Stanford, this is the first "bone to pick" I have encountered.

As for the last eventful moment, Dan's stomach finally decided that it was not happy with the amount of liquids and foods he had consumed. Accordingly, out of his groggy uncomfortable sleep, Dan awoke sweating profusely and emptying his stomach of it's contents. For a bit I panicked because I saw red coming out...then remembered the red Gatorade. The nurse came to the rescue with Zofran and was happy to see no green come up (bile). Incredibly, Dan came back to reality and said he felt a bit better. He could move better and breathe more deeply. We can't tell if the Toradol worked, if the Toradol made him sick or if his stomach was bloated and making his abdomen hurt. I suppose we'll find out in a few hours after his next dose of Toradol.

For now, it's nice to be able to talk to my husband clearly and have him smile a bit.

Prayer Requests:
* Pain management with the Toradol without side effects (bleeding, vomiting)
* Continued recovery without complications
* A working digestive system that allows Dan to eat (and keep it down)
* No soreness or injury from the vomiting episode
* Endurance and joy for Dan in the midst of suffering
* A private room soon
* Good news!

Mind over matter

I was right. It was a rough night.

Dan continued to feel rather crappy and began having worse dreams. He would wake up disoriented and it would take me quite a while to pull him back to reality. He began to feel as though he was being spiritually attacked. I set out the word for prayer, and we're determining to rely on God's protection and guidance.

This morning, we talked to the surgeons about Dan's alertness (or lack thereof) and they changed his PCA from dilaudid to fentanyl. He's not sure it's working any better, but he a little more alert. When McGreeky came to visit he was happy to see Dan more awake. I suppose we'll have to wait out the day to make sure things are picking up. The surgeon wants to switch Dan to non-narcotic oral pain meds tomorrow...which would mean no IV pole sometimes!

Speaking of McGreeky, he was actually happy about most of what's going on with Dan. He began diuresing the built-up fluids in his body last night without the help of Lasix. Additionally, his drains are putting out far less, which leads the surgeon to believe that the anastomoses are healing and not leaking. This is a huge praise as this was one of his initial concerns right after the surgery. Dan's hematocrit is still low at 24(it's been bouncing between 24 and 27 for the last couple days), but the surgeon is still waiting for the diuresis to balance out his levels. Dan's diet was advanced to soft foods, but Dan has asked to be backed down a level to full liquids to protect his stomach. He's getting a little more bloated and much more uncomfortable. Still no bowel sounds or passing of gas. On a good note, Dan is rid of the oxygen!

A few words from Dan: "I'm hanging in there and will be back to new in no time. I need my digestive system to cooperate."

Dan has been told several times now that this recovery will be mainly mind over matter. Yes, he feels rotten and in pain, but he's got to push through. He's stubborn anyway, so we just need to focus that stubbornness in the direction of getting better.

Prayer Requests:
* Bowel sounds and passing of gas (The longer it doesn't happen, the more miserable he'll feel. It could also prevent him from getting discharged on time)
* Pain control on less medication
* Awake and alert most of the day, no confusion or nightmares at night
* Letting me stay the night to help Dan with frequent ups and downs
* Husband/wife communication

Rough nights

Somehow, the days in the hospital seem to fly by. It's the nighttime that tends to bring along problems. Most of the day, Dan felt good. Able to drink fluids easily, walking often, using the PCA less. In the past couple hours or so, he has become lethargic, nauseous and dealing with more pain. We're waiting to see if he has a fever again, but he feels warm.

To be honest, I was getting a bit worried because he just dozes off mid-conversation. Sometimes, he'll say things that don't make sense, yet I'll ask him and he'll say he was dreaming. The nurse is calling the doctor eventually to see if there is a fluid or electrolyte issue. Earlier, his surgeon thought he was out of it and blamed the pain meds. I hope he's just overly tired, but it doesn't seem normal to me.

I get the feeling that this may be a long night.

Prayer Requests:
* Dan's nausea and fever do away for good
* Pain can be kept under control with less medicine
* The surgeon's prediction of "home in 4-5 days" proves true
* Nurses allow me to stay with Dan, especially when he feels so crappy
* No complications (bleeding, infection, etc)

Stanford and Family Care

Good things are happening today.

Dan's foley came out, his IV fluids were decreased, he's drinking more fluids (without stomach cramping), and he's walked 3 times already today. His labs are improving also, especially his liver function tests. His hematocrit is still low (24), but the surgeon is pretty sure it's due to the amount of fluids he's received the past few days. McGreeky was actually happy with Dan's progress, which was great to hear. He lowered his PCA dose to try to wean him down slowly. Now, we're just waiting for bowel sounds to return.

I just got back from the Sizelove's house where I took a shower and a nap. Thought I should reassure our friends and family that yes, I am taking care of myself, too. Dan is sleeping right now. He seems to have tired himself out from all the walking. When I left, he was going to sleep. When I got back, he was going to sleep again. All part of the healing process.

Stanford is a great hospital, but Dan and I have discovered a bone to pick with them...they do not like family staying overnight. This is odd to me because the hospital where I work has couches built into the wall that fold into cots. Throughout nursing school, we have been told that caring for the patient means caring for the family also. Well, Stanford is struggling with this a bit.
Last night, I made up my "bed" and went to sleep. At 11:15p, the new nurse told me I had to leave. Dan got upset and told her why I needed to stay. She checked with the charge nurse who agreed to let me stay. I'm not sure if she agreed because it was late or if Dan had made a good point. So, it looks like it's going to be a fight every night. I think (think) I could handle leaving late and coming back early before the docs arrive, but Dan really doesn't want me to leave. Keep that in your prayers please, for Dan's sake.

Prayer Requests:
* Continuing improvement of labs, pain and movement
* Appearance of bowel sounds
* Understanding charge nurse who will let me stay with Dan throughout his hospitalization
* Quick recovery...much more quick than the doctors expect

Slow and steady wins the race

So, the surgeon allowed Dan to have clear liquids today. What? That wasn't supposed to happen until day 4 or 5. Dan was thrilled to be able to drink some water, but quickly discovered that ice water has the tendency to make your stomach cramp up. Bummer. He's taking things very slowly where food is concerned.
I spoke to the nurse a short time ago and Dan's labs seem to be holding steady. No great improvement, but no discouraging trends either. We'll need to see how tonight and tomorrow morning's labs look to make sure everything is alright.
It seems as though Dan's fever is back, but no one seems very worried about it. Apparently, younger patients with this surgery get fevers frequently. Just makes Dan miserable.
Oh, and the nurse and housekeeper are trying to find me a sleeper chair. It would be lovely!

Prayer Requests:
* Fever and cramping go away
* Labs continue to improve or stabilize
* No more complications (bleeding, infections, etc)
* Endurance for Dan to keep moving

Bleeding?

A day with Dan in the hospital wouldn't be the same without some kind of worrisome problem.

Though Dan says he feels much better than yesterday, the surgeon does not seem to believe him. Additionally, some of Dan's labs are troubling. His liver function is not as good as the surgeon would have expected with this type of surgery. McGreeky was especially concerned about his hematocrit (a blood measurement), as it dropped from 35.3 to 27.5 since yesterday. This drop can be a sign of bleeding and has the docs and nurses on alert. There are no signs of external bleeding, so the concern would be internal bleeding in the surgical site. Accordingly, poor Dan is being bothered by all kinds of check-up questions to monitor for symptoms.

I'm anxiously awaiting the "noon" labs ordered by the surgeon, though he forgot to put the orders in so they might be "afternoon" meds. Please pray that Dan's levels stabilize and that there is NO internal bleeding. This would be a bad complication that set him back significantly.
Other than those concerns, Dan is doing well. Went for a walk, got cleaned up and is using his PCA far less than he was. Those things are very encouraging.

Prayer Requests:
* Blood levels stabilize AND no internal bleeding
* Pain remains under control with less medication
* Surgeon gains confidence in Dan's recovery
* Liver function begins to improve
* Dan remains confident and his endurance remains good

New Address

For some reason I didn't want to say for sure that Dan was being transferred until he really moved (I'm just a little stitious). Today, I can officially say, Dan is out of ICU! He is now in the transplant/surgery unit in a semi-private room with a very talkative neighbor. He and Dan talk over the curtain pretty often. They both had fevers last night, so they decided to turn down the thermostat...I froze but they were happy!

I was able to stay the night last night and will continue to do so as long as I get the "right" nurses. Apparently there is a charge nurse who might kick me out, but we'll see what happens. Perhaps, I can be persuasive. I had to be creative to make my "bed" out of two chairs, a pillow and some sheets. Yet, it felt nice to be able to help Dan at night time.

More excitingly, Dan went on his first walk last night. He did phenomenally! He said it hurt, but felt great to get up and moving. He went twice as far as most patients do on their first trek and impressed the nurses. His abdominal muscles have been spasming on and off due to trauma and lack of use, so he wants to walk as much as possible today.

Dan had a fever all day yesterday and it spiked last night up to 104. Around 2am, his fever broke! He's still a little warm, but walking around definitely helped. His pain is more under control, but the PCA had to be increased again. We'll ask the rounding team about getting an extra pain med ordered just in case.

Plan for the day: walk around a lot, clean up, and maybe find a sleeper chair for me.

Prayer Requests:
* Pain management
* No complications or infection
* Rest for Dan and myself
* Good reports from the doctor
* Continued improvement

Better

Dan is doing a bit better. His pain is under control now, though he still needs to use the PCA religiously. He has lost a lot of the tubes and lines he had after surgery. No more NG, no more art-line, no more central line (happening now). Strangely, his hand is numb from the art-line possibly hitting a nerve, but the doctors aren't too concerned. Also, he has a fever that has persisted since early this morning. Again, the doctors are just watching it.

As of now, we are waiting to hear from his nurse about when he is getting transferred to the med/surg unit. Yay! Dan is very excited to be out of the ICU. He'll get some sleep and we'll be able to see him for more than half an hour at a time.

Prayer Requests:
* Dan is moved safely and is received by a good/understanding nurse
* Pain management!
* His fever goes away and is NOT indicative of infection
* Dan can start moving around and walking tomorrow (big request, but possible)
* I can start staying the night in Dan's room (he really wants this to happen)
* No complications arise
* Recovery is speedy

Maybe Moving?

We got to back to see Dan, and he looks great. He's bargaining for tubes to get taken out of random places, talking to nurses, and pretty alert. He absolutely hates the ICU because of the noise and the busyness. He was told this morning that he will be transferred out to a med/surg unit today.

His surgeon just met with him, took out his NG tube and says he looks good. McGreeky is still unsure about moving him from the ICU because a few labs are "marginally high". We're frustrated because Dan was told one thing, looks great and now, might have to spend another day in the ICU. He needs to sleep, and let's face it, that doesn't happen on the Unit. Apparently, we have to wait for labs this afternoon to re-evaluate his transfer.

It would be such a bummer, especially for Dan.

Praise the Lord he looks so much better (to us)!

Prayer Requests:
* Dan's transfer to a med/surg unit TODAY
* Labs begin to come down and normalize
* No complications or infections (the doc is most worried about infection)
* Quick recovery
* Compassionate AND flexible doctors and nurses

A very long day

After nearly 15 hours, Dan came out of surgery last night around 2230.

Dr. Poultsides looked exhausted when he came to talk to us. Apparently, the Whipple part of the surgery was done quickly, but the liver resection became very tricky. The tumors were surrounding major blood vessels in the liver, so the surgeons had to very gently and slowly remove the tumor tissue. Also, the surgeon used radioablation on the margins where he resected to try to kill off remaining unseen tumor cells. He said Dan's liver was very sticky from previous radiation treatment. Thus, the liver resection took 9 hours! Due to the length of time Dan was under general, the surgeon has left the last part of this surgery (ligating the portal vein) to be done a little bit later. Dan doesn't know it yet, but he has another procedure to undergo before he can go home.

The surgeon wants the second surgery to be in 2-3 months, which gives Dan a lot more time to recover. That was a sweet bit of news to hear. Though, he said the next surgery will also take an enormous amount of time. Yet, McGreeky (as I have named him), said Dan got the Cadillac surgery. Lots of time, care and attention. He deserves it!

The entire surgical team was very impressed with how well Dan handled the surgery. His "robustness" required a lot of extra narcotics to keep him sleeping. The anesthesiologist told us that he has never been able to extubate a patient after 15 hours of surgery...but with Dan, he could.

By 2300, Dan was breathing completely on his own. The pharmacy failed to fill the order for the PCA, so Dan was quite upset by the fact that he couldn't push a pain button. However, his first complaint was the oxygen mask...then the NG tube...then his dry mouth...then his 8/10 pain. Only Dan could prioritize his needs like that. Gotta love him.

The nurses allowed us to come back and see him in the ICU. After a day of helplessness, it felt good to be able to DO something. Dan was glad to see me, but far more happy that I could swab his poor mouth with some water. That made him smile a bit. It was terrible to leave him alone in the ICU, but rules are rules. Hopefully, he got some sleep with all of the ICU noise. He has 3 neighbors! Yikes.

McGreeky wants Dan to be walking and using incentive spirometry before he transfer to a med/surg floor. Everyone else thinks that's kinda crazy to expect. Dan's nurse last night said usually whipple patients leave the ICU the day after surgery. I hope so.

Jamie, Mom and I all stayed with the Steins in San Jose. As much as I hate to admit it, I really needed the sleep and the shower. Everyone has been telling me to take care of myself so as to better care for Dan...so, I'm working on it.

Now, the 3 of us are sitting outside of the ICU keeping guard ready to jump the surgeon for information. We can't be in rounds, so McGreeky said he would call my phone (ha maybe). Rather than wait all day for a phone call that might be forgotten, we're gonna try to catch him as he's leaving.

I'll keep updating through out the day.

Prayer Requests:
* Pain management, comfort, alertness for Dan
* Transfer to a normal med/surg unit TODAY so he can begin recovery (ICUs are not good for recovering, walking, etc) (no one except McGreeky thinks he should be in the ICU. Grr)
* Peace and endurance for Jamie and I (and Mom while she's here)
* A quick recovery...far more fast than everyone expects
* No complications: no leaky surgical sites, no infections, no fevers, no pneumonia, nothing that will keep Dan from getting out of the hospital "on time"
* Wisdom and guidance and compassion for the doctors

2 hours

We have been told that Dan's surgery will be done in 2 hours 4 times. Accordingly, I'm not sure I have any idea how much longer my husband will be in surgery.

An hour ago, the resident anesthesiologist walked past the waiting area on her way home and gave us the best update we've heard all day. She said Dan is doing wonderfully and is so strong that they're giving him tons of narcotics to keep him under. She said the Whipple was done at 1230, and they've been working on the liver since then. She said there was no reason to send him to ICU when she left. The only thing that could change it would be if he's intubated too long. Then, he would have to be on a vent overnight before extubating. Other than that, she said everyone was thrilled with how well the surgery is going.

She also said there was probably another couple of hours.

Just a minute ago, we had the receptionist call back to the OR to get an update. AGAIN, we were told two more hours.

So, I think the surgery will be done in 2 hours. I think. Ha.

Prayer Requests:
* Dan can be extubated and sent to a regular med/surg floor. He would be seriously bummed to wake up intubated.
* These next "two hours" go by quickly.
* Dan remains stable and continues to suprise the docs with his "robustness"
* The wife can hold it together for another couple hours until she can see him.
* Pray for endurance for the surgeons.

Update?

So, we have hit the 8 hour mark of the surgery. The latest update?

"Everything is just fine. We're in the middle of the surgery. Many hours left to go."

What?!

After being told that the surgery would take about 8 hours and being told they're "in the middle" at 8 hours, I am pretty uneasy. I have so many questions to ask of the surgeon, but he's busy in the surgery...of course. The person updating us is the receptionist who is not allowed to give real details.

Is the surgery going longer because of complications? Bleeding? Vital signs?
Has the surgeon changed his mind about something?
Did they find more tumors to remove?
Will this mean Dan has to be in the ICU for a longer period of time?
How many hours is many?

I hate having no way to get my questions answered!

You'll know when I know.

Prayer Requests:
* Guidance for the doctors.
* Safe surgery: no complications or problems
* That Dan's body will endure the surgery and recover more quickly than the doctors expect
* That I would be able to stay the night with Dan wherever he is.
* That those of us in the waiting room will have strength and endurance
* That God will comfort my fears and concerns

Wait wait wait

That is all we are doing right now. Waiting.

Dan and I arrived at Stanford before the sun came up to start the pre-op process. After starting an IV, meeting the anesthesia team and the surgery team, and a healthy dose of Versed...they took him to the OR. Gah, I hate that part.

Now, we (my parents, his parents, my grandma and my brother) are sitting in the surgery waiting area. Stanford has an interesting little airport-like screen showing where each patient is in the surgical process. Dan's number has been sitting at "Go" for an hour now, which means everyone is ready to start but they haven't started yet. Ugh. We are anticipating an 8-hour surgery, so I suppose I might as well just relax. Ha.

Dan was warned that he will wake up with 2 IVs, an art line and a central line. Good grief. Thankfully, he will also wake up with a PCA (aka: the Pain button). Additionally, the anesthesiologist mentioned that he may not need to go to the ICU. As the wife who would like to stay with Dan, I am hoping he just goes straight to a normal room. Stanford's ICU has nit-picky visiting hours.

I suppose that's all for now. I wish I had more information. Hopefully, soon.

Prayer Requests:
* Surgery goes as planned--no bad surprises. We don't want to see the surgeon early.
* God's guidance for the surgeons
* Peace and strength for those in the waiting room
* Good news! A successful surgery with great results.

Sleeping

I do not have problems sleeping. I can curl up practically anywhere (as long as I'm warm) and fall asleep. This trait of mine will be especially handy in the next weeks, as I will be sleeping in a variety of places. Perhaps a cot will turn up somewhere on the unit, but I have a sneaky suspicion that a chair will be my bed very often.

The only problem I do have sometimes is when I have to sleep alone. The last time Dan was in the hospital, we weren't married so sleeping alone was all I knew. Fortunately and unfortunately, I now know the loveliness of having someone beside me as I sleep.
As I think about this surgery and its nearness, I really am getting sad about the sleeping part of my day. I know it's a silly thing to think about in this time, but the heart chooses interesting things to focus on.

Anyway, the surgery is less than 2 days away.

Dan says, "It's about time." (Dan: 'To clarify: it's like... going away to college. It's a big deal, and there's always that feeling that you'd like summer to be just a week longer, but really, when it comes down to it, you just need to go.')

As for me, I wouldn't mind falling asleep and waking up when Dan's ready to go back to our little apartment. God willing, that day isn't too far away.

Fisticuffs at Dawn

Dan had his pre-op appointment yesterday with the anesthesiologist and everything is "go" for his surgery on Friday. Vital signs, lung sounds, labs...all great. The surgeon doesn't even seem too concerned about the cough, which is what we were worried about. So, now we wait.

As the blog title mentions, the fisticuffs (surgery) will begin at dawn-ish to remove the hoodlums (tumors). Hopefully, for good!

Everyone has been asking us: "Are you nervous?"
Dan's response: "Not so much nervous as I just want to get it done. Hopeful. Liking the prospects of being rid of the cancer."
Ashley's response: "Of course. This is huge surgery with lots of risks. I can't be excited about the possibility of a cancer-free Dan until Dan wakes up from surgery and recovers."

Both of us are glad the surgery is happening at Stanford with world-class doctors. Though we acknowledge that surgeons are just people, it is nice to know that Dan's doc has spent years as a fellow at Sloan Kettering and Johns Hopkins.

We are also very thankful for the support of our family and friends and know that it will become even more important during the recovery phase of the surgery. I will certainly be glad to be surrounded by people in the waiting room Friday morning.

For those who are wondering, I will be residing at Stanford with Dan while he's in the hospital. We both feel better being together, even if my bed is a chair for a while. The Sizeloves have graciously opened their home to us so that I can shower and nap here and there. Dan's mom will probably be staying there for a while so that she can be in the area.

Visits will be welcome after the first couple of days as long as you're not sick. Recovery will be pretty rough for a bit, so Dan will need all the rest he can get. Until visits become possible, prayers would be greatly appreciated.

Prayer Requests:
* The complete surgery goes off without a hitch--no complications, no surprise lesions/masses
* Dan only has to stay in the ICU for a day or two
* His digestive system kicks into gear quickly--Dan really likes to eat:)
* Pain is held at bay successfully.
* Recovery occurs much more quickly than the doctors predict
* Cancer is removed completely!
* The wife stays calm and gets some rest and doesn't snap :)