A Cardiac ICU Moment

Layne is fond of telling people that I can't even watch him take a insulin shot without a squeamish face.  I admit that I have to take a deep breath and look the other way when I am taking a shot or a blood test.  Okay ... that's why I am a lawyer and not a doctor!

Well, going inside the Cardiac ICU tonight is a test of being present and in the moment.

First, the surgeon dropped by and said that the surgery went very well and that he did what he wanted to and Layne was looking good.  That's very encouraging and great news.

Second, I have never seen so many tubes going in and out of a person.  He is starting to wake up and now the frustration, he still has the breathing tubes in him and that cannot be a pleasant feeling.  Also he can't talk.  Given Layne's normal challenges with breathing --- asthma & sleep apnea --- they are fully aware of the challenge, he also has to learn how to take slow deep breaths.  Patience. Breath. Patience. Breath.

So, and here's the good part, the nurse said "I am going to release his right hand from the bond but will you stand on that side and make sure he doesn't autonomically try to pull out one of the multitude of tubes."  Well, I did it for almost an hour n half  ... thanks for meditation practice, because it took all of that not to cry or pass out and stay present in the moment.   Breath .... Breath and oh by the way,  Layne, take some slow deep breaths to stop whatever monitors goes off when the number exceeds 52 or 53.  He listened with an expression that clearly shouted, "when I get out of this .. if I remember .. you'll hear from me."

Well, there is a shift change going on right now and I was asked to leave .. so without pictures .. I thought I would share this up close & personal Kodak moment.

Thanks for listening .. will have more later.

--- steve

From the Basement Cafeteria at Kaiser Santa Clara

.... at approximately 11:35 am, the surgeon came into the family waiting room and told me that the surgery had went well and he was pleased with what had occurred and that Layne was on his way to the Cardiac ICU.

Well, take a deep breath.

about a half an hour later, I went in for about five minutes.  He is still sedated and tubes are everywhere, but it was not grotesque and I didn't faint.  They told me that he would probably wouldn't be awake for at least 4 hours after the surgery. They got my phone number to call.

I then went out to the car and made calls to the magic list that Layne created for those who were to be advised.  I felt almost like a Barack or Hillary given the same message to all the media outlets. In addition to the cold factual data. I also wanted everyone to know how grateful we were for the prayers, support and good wishes being sent his way.  The same to all of you who may read these words.

I got gas at $3.89 a gallon and then lunch at slightly more.  

A few moments, I cam back to Kaiser to see if he was awake and they had just given him another shot of "the good stuff" and he will be out until at least 2-3 more hours.  So here I am in the cafeteria drinking my Starbucks to provide the "juice" to last until the next encounter with Cardiac ICU.

In a very positive sign down here, I was talking directly with Layne's brother Forrest to bring him up to date when a little kid was running around the cafeteria making noise with a decibel level equal to a pre-school after the candy has been passed out and eaten.  For those of you who know Layne, it was a good karmic sign, because he would have that kid quieted in less than a second with a look from him that would let the  kid know that Santa Claus had put him on the coal list for next three to five years.

My spirits are good and I am looking forward to helping Layne make the changes that will strengthen his heart and health. Don't worry, its not absolutely altruistic .. this fat boy needs plenty of better habits too.   Thanks for listening.  I'll try to write as much as I can .... Steve

Twas the Night Before Surgery...

Twas the Night Before Surgery... and all in my head,

I thought to myself, I'll make a post before bed.

I wanted to tell you how much you all mean...

to me and to Stephen... (who's oft' behind the scene).

My confidence is high and I have no real fears

As long as there's Vicodin ready and near...

My doctors are great - the team is fantastic

Soon I will have a new valve and gaskets.

In a couple of days - no more than a week

I'll be back on this blog and writing a streak

Anyway, dear friends, It's late and I must

Close out this thread (please don't put up a fuss).

I know that dear Stephen will keep you amused

Of the daily shenanigans and my benevolent moods.

I'll be stronger and better and healthy and whole

and ready to tackle the events that unfold...

So, stay tuned for more as it surely will come

With load of laughter and days filled with fun!

Love to you all...

Layne

Plop, plop.. fizz, fuzz.. oh what a day it was!

My day doing the pre-op procedural processes was a real picnic.  

Five hours of fun in the sun with a poke and a prod and a push and a ping.  I had my EKG, chest x-ray, urinalysis, and a blood letting like none other that I've had before.  The phlebotomist filled more vials of blood than I thought would be possible.  I think she might have gotten her training from 15th century Wallachian Prince, Vlad III the Impaler - aka Count Dracula of Transylvanian fame!

Anyway - I survived the ordeal and came home exhausted and ready for a quiet evening.  I am now closer to my day with destiny, the surgeon and the new valve.  I am confident about the outcome and looking forward... not so much to the surgery as to getting over this hurdle.  I'm sure you can appreciate that.  But, my mood is a bit somber and subdued.  I think today was a major step for me.  My humor saw me through it to the end.  But, I wanted to escape into a huge piece of carrot cake later that afternoon.  Enough of the medical jargon and metaphorical meanderings.  I just wanted to step out of it all and be still.

To enlighten you all about the day's activities... I was told in great detail all that would be happening to me on Wednesday, from the expected time of arrival (5:30 AM) to the time of the surgery (7:00 AM) to the expected length of the procedure (4-6 hours) to the time in Cardiovascular ICU (1 day) to... just about everything and then some.

I will have tubes in my throat, IV's in my arms and neck (ouch - that hurts just thinking about that) drainage tubes in my chest and a catheter in my you-know-what.  I won't be able to move a drop of fluid anywhere without the cardio-team at Kaiser knowing what is dripping and where.  I asked about the other side of my elimination system and it was explained that with all the narcotics and such that I will be ingesting... (wow, drugs!!) I will probably not be moving anything out that exit for a few days.  They have something else in store for me to fix that situation.  Wonderful.  Now when someone says that I'm full of it, they may be right!

I will have a complete body shave from my just under my adorable double chin to the calluses on my feet - inclusive of all points in between with nothing left out for modesty or prosperity.  Yes, I'll look like a ten year old again (no pithy comments, please) just as long as I'm naked.  (Some people say that to me now... but then they usually are out of striking range).  

I'll be working out the next few days - not on the stair climber at the gym.  But, on the Coach 2 Incentive Spirometer.  For those of you who have no idea what that is (relax - I didn't know either until they explained it all to me) it is a breathing instrument that measures your air volume (inhalations) with the goal of improving ones lung function (increasing lung volume).  They must avoid fluid build up in the lung because it leads to pneumonia.

I was given some antibiotic "goop" to put in my nose and body shampoo for my head to my toes.  The goal is to destroy all the nasty bacteria and reduce the chance of staphylococcus fever (infection). 

Gads - now I'm writing like I'm Dr. Seuss!  That's a sure sign I need to cut this off and save myself the indignity and ridicule from those who possess much greater linguistic skills.  

So - that was my day.  How was yours?

LK

We interrupt this blog for a test ... it is only a test ...

... many of you are unfamiliar with me ... my name is Steve and Layne is my domestic partner and has been since that fateful day in 2003 when we signed papers in front of a Notary at the Mail Boxes, Etc. in downtown Mountain View CA.

It was a simple ceremony ... I wore a simple T-shirt (oh, I'll give more details later if you want)

Seriously, on Wednesday and beyond, I am going to do the writing on this blog to keep you up to speed and informed as to how things are going. I know that we are all concerned and full of hope & prayer for Layne's speedy recovery. I will try to give as much information as I can with what I know when I know it. You are welcome to post questions and comments and I will convey them to Layne and will try to answer them as quickly as I can. Your patence is appreciated.

As soon as he is able after the surgery, I know that he will be back on line with his comments.

Thank you for your support. We really appreciate it.

We now return you back to Layne's regularly scheduled blog.

MR KULWIN... SHOW ME YOUR GROIN!

That's what he said.  My doctor. 

I saw him on Tuesday (forgot to enter my Blog comment) for a follow up to the angiogram.  I had my short list of questions and ribald attempts at humor...

Q - LK:  Dr... will I be able to play the piano after my surgery?

A - DR:  Yes, of course.  You should be able to play just fine.

R - LK:  Oh, good.  I don't know how to play the piano yet, but I've always wanted to!

(Tell me you didn't see that coming....)

He shared with me a two page list of items (do-s and don'ts) for after the surgery.  I was taken back by the restriction of no sexual activity for the first month after surgery.  I asked him:

Q - LK:  Dr... no sex for at least a month after surgery?

A - DR:  Well, yes.  But, you probably won't feel much like it anyway.

R - LK:  My God - what will I do with my hands?

R - DR:  Why not play the piano!

(I tell you.... I didn't see that coming!).

But, the crème de la crème creme, the pièce de résistance was when he said to me, "Mr. Kulwin, show me your groin."  I nearly fell off my chair.  For some bizarre reason, at that moment I had a reflection of (then) President Ronald Reagan telling Mikhail Gorbachev... "Mr Gorbachev - tear down this wall!"

WOW - so, anyway.  I did as requested so he could check the incision point in the femoral artery to ensure that it had healed correctly... which it did.  

But, gosh - I had some many one-liners floating in my head that I just knew would not be as funny once uttered as they were in my warped brain.  Besides, this guy is the kingpin to the Vicodin that I'll be screaming for after the surgery!  And, as they say... never bite the hand that feeds you... or for that matter the one that gives you good drugs!

Tomorrow is pre-op day.  I'll be spending five to six hours at the Kaiser Medical Center having my blood drawn for the myriad tests that they'll perform on it, my chest x-ray done, EKG and a host of other procedures in preparation for the grand event on Wednesday (April 30). 

I'll also be meeting the anesthesiologist.  Let's be honest... he may be as important as the surgeon.  I mean, he keeps you in dreamland while they're fixing the plumbing.  You surely wouldn't want to wake up early - would you?  And, on the other hand... you want to ensure that you do wake up at some point... yes?

Anyway - more to share after tomorrow...  Thanks for reading!

Layne

A Simple Prayer that Speaks Volumes!

I have received numerous phone calls and emails since I announced my pending surgery.   I suspect that the authoress of this piece is much too shy to post it... but, I thought I'd share it with you 'cause it's so beautifully crafted. 

On Apr 24, 2008, at 6:52 PM, KT Eckardt wrote:

Gee-sus, Layne!  You're going to be better than ever.  In fact, we'll have to go get a gun and shoot you to get rid of you. I'll be praying for you especially after recovery.

In fact, I am praying for you right here.  

"Lord, this man is good.  He doesn't shine his halo and has made his mistakes, I'm sure less than I have, but I like the guy and I know you do too, so take 'er easy.  Don't let him fuss, don't make him cuss and don't let him or us down who love him just the way he is.  I am sure when he gets his mojo back, he'll be taking extra care of the parts you gave him plus those that were replaced.  We thank you for his brain, his heart, his soul, his smile and grace.  Take care of Layne Kulwin, Lord, God.  

Amen. 

 KT... I thank you from the bottom of my heart! KT... 

HAPPY BIRTHDAY TO ME...

Yes - today is my birthday and I am 39 years old... AGAIN!  Listen, it worked for Jack Benny so it should work for me, too!  Actually, I turned 57 years young today and am looking forward to quite a few more years to come.

It was pretty much a quiet day in the Kulwin/Kline household, as we spent most of the day looking at storage boxes for the pantry area. Earlier this month we were hit with a "moth" attack that rivaled something out of an Alfred Hitchcock movie (THE BIRDS).  Several boxes of flour, grains, cereal and other edibles went into the trash... the exterminator came, sprayed and prayed... and now the moths have gone.  We are putting everything into air tight containers to ensure that all the little creatures of the world say the hell out of the kitchen and pantry!  Once they get a job and contribute to the house payment, we might consider other alternatives.  But, until that happens - I say... "get thee to a nunery" and "out damn'd..." moth!  

(My apologies to Wm. Shakespeare and all of England).

Birthday dinner at the Lobster Shack in Redwood City - a culinary delight beyond one's imagination.  (It was as if I had gone to Boston for dinner without having to stand in line for the airport TSA inspection or reschedule my American Airlines flight!)  Trying to be nutritionally conscious and heart happy - oh what the heck - it's my birthday - get a life!  So, I did and it came in the form of a wonderful potion of New England Clam "Chowdah" and a delectable plate of Full Belly Ipswich Clams that just melt in your mouth.  (One if by land, two if by sea... bring me more clams... pretty, pretty please!).

Gosh, do you think the hospital food will be this good? 

Anyway - I see my cardiologist on Tuesday and do the pre-op routine on Friday.  I am feeling emotionally solid at the moment (much to my surprise) and am very much at peace with the upcoming processes and surgery.  Only 11 days to go till the operation... let's see how stoic I remain as I get closer to THE day.

Physically, I can feel a noticeable difference in me.  I tire very easily, have recurring bouts of shortness of breath and some mild discomfort in the chest from time to time.  These are symptoms that I've been expecting - just didn't think they'd be here so soon.  I am convinced that now is the time to get the valve replaced.  As already noted - pay me now or pay me later. The bottom line is that you do have to pay... sometime...  and now is that time.

I have received numerous emails, phone calls and cards from family, friends and well wishers - and I thank you all from the bottom of my heart (that part's healthy) for your thoughts and well wishes for my speedy recovery.  I am sure that your energy will bolster the healing power within me to come through this with nary a hitch and a minimal stitch!  

You know what they say - when the going gets tough, the tough go shopping (which I did all day today).  My credo at the moment is to remember the charge up Surgery Hill.... VICODIN!

Till the next post...

LK

BACKGROUND TO THE OHS & AVR

It was a dark and stormy night… when all of a sudden the phone rang!  OK – so much for the attempt at drama!

It was actually in the middle of the afternoon when I got the telephone call from Dr. Dan, my primary care physician at Kaiser.  He was calling to tell me the results of my latest test, a cardiac sonogram.  Essentially, he said that there was a defect in the aortic value (stenosis – a buildup of calcium) and that it was easily corrected by open heart surgery (OHS) for aortic valve replacement (AVR).  This was fairly common procedure and that there was nothing to worry about…

So, being the person that I am and the offspring of a hypochondriac father – I start to worry!  I think it would be fairly safe to say that I was catatonic for a brief moment or two as the words sunk into my mind and I digested the plausibility of what was to come.  I thought of those immortal words of Alfred E. Newman, “what me worry?” so indelibly etched into the minds of my generation who grew up on MAD magazine.  And, I knew the answer was – hell yes!! Worry – by all means worry and get your act together, now!

During my studies I remember vividly reading and discussing On Death and Dying by Elizabeth Kubler-Ross. According the Kübler-Ross model, there are five stages that a dying person goes through when they are told that they have a terminal or serious illness. The five stages go in progression through denial, anger, bargaining, depression, and acceptance.  In John Bowlby's pioneering trilogy on attachment and loss, he discusses the major emotional consequences of loss, including feelings of sadness, depression, grief, and bereavement.

Well, move over Liz… and John, save a seat for me on the bench.  I managed to go through all nine levels at least six times in the first 30 seconds of Dr. Dan’s call!  But, I digress…

Subsequently, I asked to see a leading cardiologist in the Kaiser system – someone that I had met previously through my partner Steve… Dr. Philip Lee.  He had graduated with honors and distinction from University of California at Berkeley with a BA in Biochemistry and received his medical degree from Washington University School of Medicine in St. Louis, Missouri, one of the top five medical schools in the country.  Dr. Lee then completed his internship and residency in Internal Medicine at Stanford University School of Medicine, and was appointed Chief Resident in Internal Medicine at Stanford University School of Medicine and the Palo Alto Veterans' Affairs Medical Center in 1990. During this time, Dr Lee supervised and helped train over 75 medicine interns and residents. His Fellowship in Cardiovascular Medicine (Cardiology) was completed at Stanford University School of Medicine in 1994.

Very impressive credentials… but, do I dare call him Dr Phil?

We had a consultation and discussed the facts of (cardiac life) and arranged for one additional test – the dreaded angiogram.  Now, I must confess that this procedure, for some reason, just scared the p’jeesus out of me, altogether.  Many years ago when I was living in Anaheim, my next door neighbor, Buddy, told me about his OHS for quadruple bypasses.  He said that the dye they injected into you was like fire.  So, what the heck – I don’t like anything incendiary going up in my face let alone in my personal plumbing system… so I was quite worried.

The day of the angiogram procedure was not all that complicated.  Basically, you show up at the appropriate location and at the agreed upon time and lay down.  They do most of the rest.  They gave me a huge hospital gown designed by Omar the Tent Maker… but it was most fashionable and did manage to hide my derriere as I sojourned down the hall one last time under my own steam before being wheeling into the testing facility.

They gave me a cocktail containing 5mg of Valium (obviously a generic as I was saddened that it was not the usual yellow tablet …but it managed to relax me none-the-less… and 25mg of Benedryl.  After they situated me on the exam table they put some sort of blue blanket on me that was absolutely the toastiest most wonderful feeling in the world.  I was in heaven.  All I needed now was a foot massage and a scotch!

I was so relaxed during this exam (they must have spiked the I.V. with something cause I just can’t believe that one tiny little valium tablet and an antihistamine would make me feel so wonderful).  Finally, Dr. Lee informed me that he was going to inject the dye and I might feel a “flushing” feeling.  Flushing – well, according to Buddy, it was more like the “fires of hell” than a “flushing” I was going to experience. 

OK – hit it Doc – and he did.  Well, knock me over with a feather… I was absolutely amazed.  No “fires of hell,”  no pain, nothing at all negative.  In fact – it was one of the most wonderful feelings I have ever experienced!  Honestly!!  Taking the bandage off my arm from the I.V. was the only pain I experience through this entire exam!  WOW. 

The results from the exam were good.  No arterial blockages to deal with and just the valve to contend with at this time.  The only downside was that based on the pictures and what I was experiencing physically from the dysfunctional valve, it would be best to get this done sooner rather than later.

I set up an appointment with my cardiac surgeon, Dr. Hon Lee (no relation to Dr. Phil) to discuss the upcoming event.  A wonderful and talented man!  He studied at Brown University and did his residency at Catholic Medical Center of Brooklyn and Queens Inc, Jamaica, NY.  He is also the Chief of Staff at Kaiser Medical Center.  Also, he wears a bow tie and that made all the difference in the world to me! 

I am most impressed with my medical team and their individual sense of commitment to patient care, and their willingness to spend as much time as needed with me to answer my question and reassure me.  Plus – they have a great sense of humor and are very willing to share it!

Dr. Hon and I talked about the procedure and what type of implant might be used to replace my defective value.  The options are somewhat limited – membrane tissue (cow or pig) or mechanical.  I opted for a mechanical valve due to its history of success, and longevity.  Tissue valve will normally have to be replace – who knows when – usually within a 9-10-15 year period.  The mechanical valve can go for 20 years or more without a hitch.  One person I’ve noted has had his mechanical valve for 40+ years!  (I should lived so long…).

Downside is that I will be taking Wafarin or Coumadin for the rest of my life.  That doesn’t seem too bad of a downside.  The nature of this mechanical valve is it is very effective in preventing a buildup of cells, forming clots.  In fact… this value is so good that it is possible that I might not have to take a “blood thinner” down the road – or at least a minimal amount of the medication.

Well… I think that I’ve about exhausted myself on this first blog entry.  I am sure that there will be more of my ramblings as time goes on.  Steve will keep the blog updated as things progress and provide everyone with the latest information and developments.  You can also post your own comments or questions on the blog – it is unrestricted in that regard and I welcome the opportunity to read them once I get on the mend.

Thanks for listening…

Layne