SINGAPORE - SEP 7: The Bank of China Building on Sep 7, 2012 in Singapore. The new block of the Bank of China Building was completed in 2000. It is 36 floors and a height of 168 metres.
The past two weeks I have seen the sickest, most difficult cases I have seen in my entire career.
One, a GI bleeder, had a band come off during an esophageal banding procedure to follow up on the one done five days earlier where five bands had been placed on bleeding esophageal varies.
I have never seen so much blood so fast come up in my career. I gave thanks for the breathing tube I had inserted before the endoscopy, so at least the airway was not filled with blood too.
The gastroenterologist aborted the procedure--there was half of a rubber band that she had been able to put on underwater, the other part fell off, and the bleeding stopped. We did CT scan and then angio suite for TIPS.
What got to me was that his birthday was this past weekend.
He made it.
There was a revision to do three days ago, but my colleague took care of it. The patient did fine.
There have been more and more like this.
Atrial fibrillation with rapid rate needing to be controlled.
Horrible fractures around a hip replacement that have been revised or infected like seven procedures at least before this one.
I've had to be at the top of my game.
What is getting to me now is that my antennae didn't work.
For a lot of things on this one patient.
I looked at this one, with full knowledge of the injury, and the family, the nicest, kindest family you could ever see supporting him, and I knew his disease was not survivable.
We went to the O.R., and even the surgeon left well enough alone, did the minimum to bring comfort, deciding if the patient survived we could come back at a later date with the specialist who had the skills to work on the liver where the mass was involved. It was a cancer of one organ that was next to another organ and grew into it by direct extension.
The patient did fine! He didn't like his bag, and we assured him it was temporary.
I had all my equipment ready, did my best, and the operation, the second one, went off without a hitch.
There was a code STEMI, followed quickly by a Code Blue mid afternoon. I was in the O.R. but caught news of it.
The cardiologist said it was due to the ischemia present from the old cardiac disease and stents, placed years ago, in the face of the ongoing sepsis, so it's not a STEMI, it's the clinical presentation (an S T elevation myocardial infarction).
The general surgeon and the specialist said their things too. And full supportive care was given.
At the end of my lineup I went up to see the family. He was 'Allow Natural Death' code now. It didn't look good.
The family said he'd had a vague pain in his side for months. Doctors couldn't figure it out. His white cell count had been high, so a hematologist was treating it. All of a sudden now with the uncontrollable rapid atrial fibrillation and the pneumonia, there was a scan and the mass was found.
I told them I felt devastated, so deeply sad, and after seeing him this morning I never in a million years would have thought this was coming. The surgeons are excellent (when others have difficulty in the O.R. these two are the ones who are asked to come and help the other surgeons get out of trouble) with the most experience and expertise and skill.
But the week earlier, I had correctly sensed the possibility of not surviving, and communicated it to the family, the patient, and the ICU teams. The daughter who spoke for the family said they had taken the information to heart, had their discussions on what to do if that were to happen, and they said their goodbyes.
I said it was good they had the conversation.
I shared how my father had pulmonary fibrosis, and his plans he kept secret with mom 'to spare us kids'. He was in a large foundation health plan, they called it 'Palliative Care' which wasn't officially hospice but close. And when I got the call that dad wasn't doing so well, I saw he was in respiratory distress and wanted to make sure something was done to give him oxygen. To put in a breathing tube. The nurse was doing NOTHING. I screamed at her. In agony. How could she let him suffer he was surely going to die?! My mother and my brother in law had to tell me to stop. They said 'this was what he wanted'. And to 'be the daughter'.
The only thing that got me through watching him die a respiratory death is to know that it was what he wanted.
So when the daughter shared that if his heart stops he wanted nothing done, she could say to herself, 'that's what he wanted'.
Her concern was that the three options given to the family for her dad were 'horrible'--let him die, do everything in the hopes he can be cured, or to relieve the pressure while leaving the cancer in and letting him be comfortable.
I agreed they were horrible. I told her and her brother that cancer patients with his type of cancer usually obstruct, like he had, and the pressure is very painful and makes you sick. It's a horrible way to die.
It also seemed clear to me that he wanted the 'thing out'--to go for cure.
I asked her if there is anything I could do for them or get for them, even a cup of coffee? (for my family when one is in the hospital, I take everyone to the doctor's lounge for the good Keurig coffee, I forgot to explain that part).
I told them if they thought of anything, to ask for me and I would come, because I'm not far. We said our goodbyes and they thanked me for coming. They had said how everyone loves him, it was so hard to see him go. I shared how I have spent a lot of time too, and I had grown to love him that's why I am concerned and came to show I care.
When I got back to the hotel, across the street, I was in distress in my heart. The image of my patient who had been alert and awake, now on a ventilator with full pressure support by at least six i.v. pumps of drips and eyes that were open but unseeing really bothered me.
A friend had to tell me to rest, to at least try to sleep.
She told me this at 12:22 a.m.
I had been talking to her because I had heard his soul say 'I am free!' just before midnight, and I was worried because I didn't understand the events of the day, and why my intuition wasn't working.
This case had a bad feel since I saw it on the schedule.
It actually had cancelled for a moment when I checked, but it was a clerical error. The scheduler called the surgeon to confirm, he said yes it was a go.
This surgeon is one who hates to work with me so much, he has cancelled cases in the past just to avoid working with me. He likes me as a person, he is friendly and polite. He offers Anthony breakfast or lunch if he sees him in the doctor's lounge waiting for me. But he likes to work in silence and is very particular who is on his team.
And Ross prepared me for working with him.
I had to shower and use a special soap and lotion. The Jo Malone mandarin/basil. I had to smell good Ross said. I also had to put on a little makeup.
Ross said it was VERY important for me to be loving to this surgeon. All the case. Which I was.
We had troubles intro putting in an arterial line because there had already been one placed on each arm in the prior week. The surgeon helped on one side. But after giving up and starting the case, I worked on it on the same arm he had, only higher up the forearm, and didn't say anything until the end of the case--that I had gotten it. It was a pleasant surprise to him, and he said the ICU would appreciate it.
That night, when I was trying to sleep, and I was in agony, I realized I had to let go and trust Ross. He had his own reasons. There were things I cannot see that were important taking place.
And I had a flicker of awareness that the deceased is going to come back and talk to his family with Ross in some formal way, I don't understand how, but I sensed it's official and I see the soul all in a blue uniform like a police or air force.
The soul also came to me and asked me to use the words I used to describe his family. It was important to him I use these words. I used them the way he asked.
And right now he wants them to know 'I didn't have pain, I never woke up, I just went to sleep for the operation and that was all I knew until I found myself standing in Heaven. There was no suffering. Only Light.'
I was tired yesterday. Worn out. I had trouble feeling 'right'. I felt numb.
For the first time in a long time, I felt so much stress that I couldn't eat.
I took Anthony to Jersey Mike's subs and didn't order anything for me.
When I came home, hours later, I made a salad and watched his football game with him. I enjoyed the company.
I made bracelets, again, listening to spirit. One is lava and pietersite. The other is amazonite, sodalite and spinel. The first one is on my right. It sends, the right side sends and the left side receives. Bracelets always feel better on one arm of the other to me, for this reason, and I go by the feel, not by the intention. The only intention I had was to feel better. And lava is grounding, and pietersite is unearthly strong vibration--heavenly vibration. If I look it up, my book doesn't include lava, I tried Vesuvianite, it sent me to Idocrase, which 'can be used to dispel anger, to banish depression, and to allay fear. It provides for a security with oneself and helps one to fearlessly face danger; it also provides for actualization of the wisdom to discourage dangerous situations.' My little cheap flyer I picked up when I bought myself an amazonite bracelet for Christmas (I still haven't worn it)--says Lava Stone--Emotion--can aid in calming the emotions. A stone of rebirth and shedding unneeded layers of emotional attachment. A grounding stone. Pietersite isn't on the cheap thing because it's rare and too expensive. It aligns the energy centers of body while grounding, not to the Earth but to the etheric body, this rarity in grounding ability has facilitated travel throughout the spheres of existence, culminating in access to the Akashic records. It further allows one to see beyond the horizon or mirage, helping to support human courage, tenacity, and dauntless effort to both create and maintain beauty.
Spirit is good, huh?
For the other, using the flyers from the store: amazonite--Self Discovery...a stone of truth, honor and trust. Increases intuitive wisdom and improves communication. Protects against electromagnetic pollution. Sodalite is Logit--Unites the logical with the spiritual. Encourages rational thought, objectivity, and truth. Brings truth to communications. Encourages honest emotions. Spinel is one of my favorites, it too is a gemstone--not on the flyer--but the book has taught me it helps the wearer to feel beautiful. This mineral can be used to renew energy and to provide encouragement for further attempts at difficult tasks. It can also be used to enhance one's appearance, to increase the positive aspects of one's personality, and to assist in obtaining, maintaining, and accepting victory with humility.
Today is another day.
We go to find the results of Anthony's MRI scan. The doctors have been in a hurry for us to come in. And they haven't said over the phone 'everything is normal don't worry'. We will get some news today. I'm not sure what. I'm grateful for the bracelets.
They really help my energy to soothe and calm.
Ross is waiting to talk tomorrow.
Aloha and Mahalos,
Ross and Carla