It's been a somewhat long day...
I got up at 6:30am for a 7am ankle physical therapy session.
I went to the hospital after that. When I got there, a sonographer was doing the echocardiogram on her heart to check the valves. I missed the doctors. Sarah didn't feel any more knowledgeable about her condition even though they'd been through.
The patient Sarah was sharing with had a bad night, caused her to have a bad night's sleep also, and she always deals with all of this crap much worse when she's got a sleep debt.
Dinner stayed down, but breakfast did not.
The sonographer seemed fairly confident about her heart condition. Usually they don't make any comments on what they're seeing and leave that to the doctors, so we took some comfort from that.
I managed to corner the physician's assistant who had been following Sarah in her office, and quizzed her on what was going on.
It turns out a PICC line had been ordered, and they get installed by specalised PICC nurses and that's all they do all day. The PA implied that it might not happen until tomorrow. The gall stones were definitely unrelated, and something to follow up with her primary care physician. Incidentally, Wikipedia has some wicked pictures of gall stones. Talk about freaky.
I think I hung around until 10am, and then headed into the office to try and get some work done, with the intent to come back after work.
Not long after, Sarah called me up all beside herself about the PICC line (she doesn't deal well with the idea of getting jabbed at the best of times, and being tired put her over the edge), so I scrapped work, and went back to the hospital for the remainder of the day.
I decided to hunt down her cardiologist to see if the PICC line was absolutely necessary, and I managed to get the exact low down on her condition.
- the infection is staphylococcus aureus, not one of the other staph strains that I can't remember, which are considered less serious. The one Sarah has/had is the "bad enough" one, a.k.a. "golden staph". Fortunately it's sensitive to antibiotics, unlike MRSA, which is the really bad news one to have. So my heart skipped a beat when he said it was aureus, but I recovered when he said it was sensitive. I could have sworn the staph infection she had last year wasn't aureus, but he seemed to think that it was.
- when she presented at the ER on I guess Sunday morning, this staph was found in the blood sample they took. What is unclear is whether this is because of contamination from the skin when they took the sample (staph is present on the skin, it's only a problem when it gets internal), or it was indeed in her blood, whereas with the infection she had last year, it was never present in her blood.
- because of her aortic root replacement/graft and the risk of endocarditis destroying her heart valves, they didn't want to take any chances. Hence the PICC line and the two weeks of intravenous antibiotics. Two weeks is really a compromise. He said if they'd wanted to get all paranoid on her, it'd be a six week course, and they'd have done a transesophageal echocardiogram to boot.
So armed with the facts, I headed back to tell Sarah the news that she really should have the PICC line installed, and that she was getting off fairly lightly, relatively speaking.
The PICC nurse had a cancellation, so she was able to do the installation today. It was totally less traumatic than I think either of us were expecting.
It took about 45 minutes to install, and it was done at her bedside. Sarah was very brave and I don't think it really hurt her all that much. I watched the whole thing, and it was very interesting. It was particularly interesting because there was another nurse observing, so the PICC nurse was explaining everything as she went. She was also really nice and good at what she did (she'd been doing it for 14 years) so I think all of that helped.
So Sarah's now got two IV ports strapped to the inside of her upper left arm (attached to the PICC line), and no other IV lines in. She should get discharged tomorrow after they sort out whether she's going to receive IV antibiotics on a 4 or 8 hourly schedule at home, and exactly how all of that's going to work. I think they send someone out to our place to give us some training, and someone comes out once a week to do a bit of maintenance on the PICC line itself. I presume I'll be her personal nurse again. All it involves is a bit of plumbing.
Her cardiologist seems to think she should be able to still do her CNA clinical training with the PICC line in. She may just have some problems with lifting duties. I guess we'll just see how all of that pans out.
So that was the excitement for today. Sarah had her appetite back at dinner time, and was generally in much better spirits when I left her this evening than she was this morning. I could go into much more detail about the ins and outs of the PICC line installation, but I don't really have the energy.