With only a few shorts hours of sleep, we got back to the hospital to be at Karl's side. He was pretty much in the same condition as the night before, still on the BiPAP breathing machine.
The team of doctors had met, reviewed Karl's scans and decided they needed to take action. Fluid had built up in the lining of his heart and lungs, causing cardiac tamponade (or pericardial tamponade.) This is an acute type of pericardial effusion in which fluid accumulates in the pericardium (the sac in which the heart is enclosed.) This pressure was effecting his breathing and heart-rate and needed to be addressed immediately.
Karl was hurried off to the OR. We couldn't believe what was happening- felt like we were back at square one all over again. Three weeks ago today, we all sat in that same dreadful waiting room hoping and praying for the surgeons to be precise and knowledgable.
We left his side at the OR doors at 9:15am. Two hours of waiting. This is the worst part. Doctor Cortelli came out at 11:30am and I think our hearts stopped. Then we saw him smile. He told us everything had gone ok and we, again, cried tears of joy and relief. Even as his own daughter was calling to wish him a Happy Father's Day, Dr. Cortelli took a good deal of time to explain how the procedure unfolded, and answer our questions. Below is my best attempt to explain what happened and how it was resolved...
During the first surgery, Karl's breast bone was wired shut so it could eventually heal and fuse back together. Somehow, this wiring was fractured and had loosened up, causing the wires to cut into his tissue, and the bone plates to move around. This could have occurred due to vigorous coughing early on or even overly agressive PT in rehab. We are still getting to the bottom of the cause. Since Karl was on the blood thinner Coumadin, any cuts could cause extensive bleeding- hence the blood build-up by his heart. This blood was building up in a small space between his heart and lungs and his breast plate, and was so intense that we did see reddening of the outer skin. When the doctors went in to drain the fluid, we were told it poured out and his heart rate changed immediately. Over 2 liters of fluid. No wonder he was in so much pain and no wonder his lungs were struggling to get air. It all made sense. The team drained the chest fluid, along with a small amount of fluid in his right lung, then as a last minute decision, rewired the breast bone more extensively. They saw his bone was heathy and strong and wanted to get it corrected.
Having made it through another serious procedure, Karl was taken back up to his same room in the cardiac ICU. He was once again on the respirator with a tender chest wound, only this time the surgery did not cause any strokes so the waking up process should be less complicated. Once the anesthesia and sedation started to wear off, Karl could immediately respond to basic commands such as wiggle toes and squeeze hands. He was very loopy but did manage to give acknowledgments with his head and eyes. The vent caused Karl to get agitated so they decided to sedate him most of the evening to let him rest. The goal is to extubate in the morning.
Despite the events of today, we are grateful that we can say Dad is still with us- and we are now moving towards celebrating Father's Day with him in 2014.
We love you Dad!
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