A Long Slow Slog

The weekend was mostly devoted to the incremental, slow process of healing. On Friday Faina had a drain put in to clear the fluid that had pooled up in her pelvic region. By late afternoon Sunday, that appeared to have been effective. The staples that were removed from just below her navel continue to allow the draining of the slowly leaking bile from some small hole, probably at the connection between the esophagus and the intestine. The doctors advise that this can be expected to heal on its own. Dr. Sichar, one of Dr. Schulick's residents, gave a clear explanation of this less than rare occurance.

Faina's hemoglobin count dropped and so on Saturday and Sunday she received transfusions of blood. Given the choice between a new IV line and using the port she had put into her chest for the chemotherapy she opted for the port, even though that meant more than an hour without the pain killing morphine.

All of the doctors and nurses encourage walking and Faina is getting the reputation of a marathon walker. We were given the opportunity to leave the 4th floor and the suggestion was made to go to the "Jesus statue." The statue is a bit of a curiosity since Johns Hopkins was a Quaker and founded the university, hospital and medical school to be a non-sectarian institution. This was a heretical concept in 19th century Baltimore and was righted, somewhat, some would say, by installing this 10.5 foot work. The highly polished foot was clear evidence that people touch the foot of the statue, presumably accompanied by a prayer or a meditative hope for healing. At any rate, the statue has taken on secular meaning and it served as a milestone, a destination, a measure of progress from the limits of the 4th floor of the Weinberg building.

3:00 PM

Faina is beginning to despair over whether or not she will ever get out of Hopkins. Sharing her feelings in darker terms with Dr. Schulick he replied, "I promised I will get you through this and you will get through this" and you will get your life back. It has now been 16 days in the Weinberg building.

This morning's CT scan showed that her intestines are not blocked, the contrast made it through practically to the terminus of the GI system. Encouraging news. It also revealed that she has a small leak in her intestines, around the sutchers now connecting her esophagus to her small intestine. There is also fluid pooling just under the skin at her belly. For now the prescription is closely monitoring her progress, giving her time to heal, and draining the leaks. A third surgery remains a possibility, but is on the back burner for now. Pain is consistently a nine. Envisioning a discharge date is not a subject of active speculation.

3:00 AM Call

Soupy is starting to look like a leak of indeterminate origin. Faina is just back from an early AM CT scan and there is fluid pooling outside the abdominal cavity. Dr. Schulick has been called and he will be meeting with his team in a few hours. It could be another surgery.

Elevated White Blood Cell Count

An elevated white blood cell count is an indication that the body is fighting off an infection. Faina's numbers continue to call for attention and she is getting regular doses of antibiotics. This morning Dr. Cunningham removed a few of the staples from the incision, described the site as "soupy," absorbed some of the moisture with gauze and cotton swabs, packed in one piece of gauze (pointing out to the two students he had in tow that this will lower the chance of leaving something behind), and covered the now open wound.

Earlier in the day, Dr. Schulick visited telling Faina that it will take time for her intestines to get active again. He pointed out that at this point she has had nine weeks of aggressive chemotherapy and two surgeries. This is going to take some time.

She is still seriously uncomfortable and not sleeping well at night. Despite that, she looks well, takes everything in stride, and enjoyed reading the stack of cards I brought in of wishes for a speedy recovery, admiration, and encouragement.

Slowly, Slowly

At this point, almost every nurse on the 4th floor recognizes Faina. A lot of them cheer her on when they see her up and walking around. The encouragement serves to motivate her to do more. There are some exceptional nurses here. May, Maria, Jennifer, Heather, and Kerry in particular are skillful, attentive, and knowledgeable. They are all patient, positive, and encouraging.

Faina is making a project of weaning herself from the morphine. She only gets a dose at the push of the button, but tries not to take that step. She is in constant pain.

Progress is slow. There is some gurgling from the intestines, but not much other activity. Walking and chewing gum are supposed to help, but it is mostly going to take some time. She had her first post-surgery drink of water, about two ounces. Dr. Schulick is in no hurry to discharge her from the hospital and thinks that will happen Friday, at the earliest.

Up Your Nose With A ...

One of the first things Dr. Schulick did along with the second surgery was re-insert a drain hose up Faina's nose, down the esophagus, and into the intestines. Besides being an uncomfortable procedure, just imagine the discomfort level of a rubber hose running down the back of your throat, not to mention up your nostril. One a scale of 0-10 ... I was happy for Faina yesterday evening to see her sans hose. Besides being a lot more comfortable, she is also free of the connection of the hose to one of the multitude of ports behind her bed, in this case to a slow drawing vacuum.

There is still very little sound coming from the intestines. This condition is challenging Faina's sense of peace. What can it mean that her intestines are not perking back into action? In medical parlance, her body suffered an insult, "a bodily injury, irritation, or trauma." For now chalk the quiet up to an insulted intestine. Nurse Jen advised patience, "These things take time. Meanwhile do what you are doing, get up, walk around. It is the best thing you can do. Give it some time."

Pain Management

The two biggest questions asked the past few days have been: 1) "On a scale of 0-10 with zero being no pain and 10 being excruciating pain how would you rate your level of pain?" 2) "Have you passed gas?" The main exam is listening to her abdomen for signs of activity.

Until about six hours after the surgery Faina's answer to the first question was consistently nine or ten. It was constantly insisted that she could not be given a steady IV dose, that she would have to push the button on the pump. That meant a cycle of pain, push the button, 2 minutes later feel relief, fall asleep from the dose, wake up in pain, push the button ... The pain management team visited Faina Friday morning and put her on a steady base dose of morphine that she supplements by pushing the button. Yesterday she infrequently pushed the button although she reported the pain level to be about 5-6.

Another hospital team inserted a PICC line so Faina is now taking her nourishment through a line that goes into a vein that goes directly into her heart. She has swollen up a bit from all of the fluids.

Faina placed an excited call in the afternoon, "Guess what I just did?" It was a yes to question number two. On a scale of 0-10 it was not quite Blazing Saddles campfire scene, but a start.

Her intestines gave off minimal signs of activity. The latest buzz is possibly real food tomorrow and expect three-four more days at Hopkins.

All of this gives special resonance to the Asher Yatzar.

Blessed are You, Adonai our God, Ruler of the universe, who formed
humans in wisdom, and created in us all manner of openings
and cavities. It is manifest and known before the throne of your glory
that if any one of them ruptured or were blocked,
it would be impossible to survive and stand before You.
Blessed are You, Adonai, who heals all flesh and is wonderful in Your acts.

Two Steps Forward, One Step Back

We're in a pretty good spot now, but the last 36 hours have been horrendous. After Faina's first bites of real food she was mildly uncomfortable. Through most of the day Wednesday she was slightly more uncomfortable with sharp pain in the abdominal region. This morning (Thursday) the pain was excruciating. She had a CT scan early in the morning and a Upper GI series an hour later. By early afternoon Dr. Schulick was scrubbing in, Faina was under, the week old stomach scar was re-opened, and surgery was underway. At about 5:30 Dr. Schulick reported that Faina had a kink in her intestines caused by adhesions, he removed them, and we will proceed slowly with re-introducing food. It is just one of those things that happens, not often, but not rarely.

Following surgery Faina was suffering from a great deal of pain until it was brought under control by 6 mg of morphine roughly every six minutes. That is triple the dose she was getting before the surgery. By about midnight her pain level was in the tolerable zone, a 5-6/10 by her scoring and at about midnight she was ready for some sleep.

This will probably mean another 3-4 days in the hospital.
Sister-in-law Maya arrives from Haifa on Saturday to lend a post-operative hand.

I think we're going to beat this thing

Faina called this morning after Dr. Schulick stopped by to check on her. During the surgery he removed 38 lymph nodes and said he would have the results by today. He reported that they all tested negative for cancer and added, "I think we're going to beat this thing."

HaTov v'hameitiv

Would You Like Fries With That Order?

Plenty of good news today. Faina was relieved of one more tube (that connected to a bag), generally speaking another step toward heading out the front door. From her left hip she only has the "just in case" feeding tube that, thus far, has not been needed.

She has not lost any weight. OK, she is probably full of IV fluid, but still, she looks healthy, radiant, in fact, kenahora. The biggest news of the day, a first meal. It happened to be the regular hospital fare, loaded with things straight from the list of foods "To Avoid" that the nutritionist gave her a few hours earlier. Maybe someone did not get the memo about a restricted diet or perhaps it was a test of her resolve. At any rate, her first solid food in nine days was chicken breast and mashed potatoes.

After another trip around the 4th floor we can safely say room C-19 is the cheeriest of them all. Adding to the visual appeal, an amazing balloon bouquet from friends at Beth El.

Field Trip - Upper GI Series

Today’s visit to Faina played like a bit out of the Keystone Cops. I came to her room and she wasn’t there, but the bathroom door was closed and the lights were on. “Hello,” and a tap at the door went unanswered and for good reason, she was not there. Maybe she is on a stroll? Stepping out into the hall, the nurse said she was in Nelson, having an Upper GI (Gastrointestinal) series, that she would be there for a few hours, and that I could go over and sit with her. So down I went, two floors, crossed the “Bridge” to the main building, up a hall, down a hall, then downstairs another floor, to Nelson. First I was escorted to a seat while they located Faina. Then I was taken down the corridor to a chair outside of room six and said I couldn’t go in, but that I should wait there for her to be brought out. A few minutes later, the same receptionist came back to me and said, “What is your wife’s name?” As she was bringing me back to the desk from which I had started this dance in Nelson, my phone started to buzz. It was Faina, back in her room. The nurse was embarrassed and apologetic. I told her it was no problem, I needed the exercise. The Upper GI results were good, no leaks.

Faina is still getting up, sitting in a chair more than in the bed, walking around a few times a day, pretty much has explored every inch of the 4^th floor corridors, hits the pain medication button with reasonable frequency, smiles a lot more, has good color, talks about the future, and generally has a great attitude about life, the world, and health care in America.

Six Minute Cycles

Faina never ceases to amaze. She took her first walks yesterday reaching, pretty much, every inch of floor space to be traversed on the 4th floor at Weinberg. As each day passes she is hooked up to fewer tubes that put fluids in and take fluids out. She is extraordinarily patient as doctors and nurses constantly come to administer various injections, test her insulin level, check her vital signs, inspect the various incisions, including the seven inch line from just below her navel to the sternum, and to ask the questions the protocols require. The miracle of modern medicine is a delicate balancing act of causes and effects. Months ago it was a matter of the body tolerating chemotherapy. Now, in post surgery recovery, the pain killers cause skin irritations, the Benadryl countering that brings on drowsiness. Heparin thins the blood to help prevent clotting, but also makes for easy bruising and it is a painful shot to receive. After daily changes to the pain killer, yesterday's fix was morphine. Faina has a button that activates the pump that doses out the pain relief. It is available on a six minute cycle. Along with the pain relief is a quick nap, just a minute at most. All day it was rare for Faina to push the button and not have the pump go to work. Her pain level, which on Friday she put in the eight to ten range, was more in the five to six zone yesterday.

Room 19C is coming to represent a botanical garden. It makes for smiles, visual appeal and compliments from the various physicians and each new shift of nurses.

On Monday they will try introducing a liquid diet and on Tuesday, the baby steps of solid food, possibly apple sauce or mashed potatoes. We are seeing good steady progress.

Out of the ICU

Yesterday was a day of great progress. By noon Faina was sitting up, took a few steps, and moved to a regular room. She is still hitting the button to get a dose of the pain medication faster than the pump can give it, so her dose was upped from 22 to 30. She is dutiful about breathing exercises with the spirometer, lowering the risk of pneumonia. Her spirits are good, she made and took a few phone calls, and mostly bounced through short wake-sleep cycles. Hospital is far from restful as the day was punctuated by a steady stream of doctors and nurses checking on her progress.

Margo and Jamie are doing well. Margo is serving as an intern at a downtown Baltimore law firm, and made a bee line down Orleans Street after work to visit. Neighbor Amy stepped up to get Jamie to camp/class and back and Russell got her up to Baltimore later in the day.

I still hear Faina ask, "Am I in the ICU?" with hope that the answer is "Yes," meaning yes, they did the operation. It is an odd joy to have this milestone behind us. I look forward to a day of nurses coming in and out of the room, doctors with residents in-tow, family and friends, and Faina making further progress.

Gastrectomy

What a day? At this moment, Faina is in the ICU following a successful surgery. Now begins the next chapter, the road to recovery.

Today started with the alarm going off at 4:00 am. The four of us were out the door by 5:00 and we were at Hopkins, on time, by 5:30. Faina was taken into the operating room at 7:35, pretty much right on schedule. All the earlier waiting, anxiety laden as it was, was really a build up to this next two hours of waiting, anxious by multiple degrees greater. In the balance was a repeat of April 27th, when Faina went in for a gastrectomy, was told the cancer had spread to her liver, classified as stage 4, and that she would have to undergo chemotherapy. Now, after three three-week cycles of chemotherapy, a month to heal, numerous doctors appointments, consultations and tests, it came down to this morning and an announcement that would take place sometime around 8:30: had the cancer spread or not, would the gastrectomy take place or not, and would the options suddenly all be either unspeakably horrible or a relatively well trod path toward recovery. The word came from the operating room: moving forward with the gastrectomy and, in an alternative universe sort of way, that was cause to celebrate.

This week's Torah portion begins, "See, this day I set before you blessing and curse: blessing if you obey ... and curse if you do not obey" (Devarim 11:26-28). Staring this particular biological beast in the face I can see blessing and curse. Is it health and good and bad choices? Is it to follow the advice of one person or another? Is it to do what one doctor or another proposes? Or is it ultimately to listen to that inner voice, the one that mediates between the yetzer tov and the yetzer ra, the one that we all really know is pointing us in the right direction. Parshat R'eih goes on to say, "You shall pronounce the blessings at Mount Gerizim and the curse at Mount Ebal" (11:29). I take this as a command to bear witness, to learn from experience, and to teach.

We are beginning a new chapter in this narrative. I pledge to probe it for its deeper meaning, find the path of the blessed, and steer clear of the cursed.

24 Hours To Go

What do you do when you have less than 24 hours to go before an operation that could very well define the rest of your life? Matters are out of your control. It reminds me of the verse from Jonah, "All the sailors were afraid and each cried out to his own god" (1:5). That is pretty much where we are. To pass the time today, we have talked to friends and family, taken a walk in the park, read poetry, and hugged, a lot.

The question of existance never gets straightened out except through existing itself. (Heidegger, BT)

48 hour Countdown

The weekend was spent mostly trying to keeping otherwise occupied. Shabbat dinner was gastronomically memorable. Lively conversation inevitably turned to politics, Obama, health care reform, and the "liberal media." We managed to fit in "(500) days of Summer," a trip to the Hirshorn and a few rooms at the National Gallery. (Where would you go if you had an hour to spend in that building?) Faina also picked up a few new blouses. She is wearing one now and looks terrific.
Last night's dinner was the last solid food for Faina for, hopefully, many weeks. Larry took on the challenge of preparing a meal that would go down as one of the great exhibitions of cooking skill, to be remembered through the ages. Julia Child, Emeril, Wolfgang Puck, check your rear view mirrors. Someone's gaining on you.
Faina goes in to work today to clear up a few cases. She is surrounded by people who care deeply for her, having invoked the powers of Buddah, Allah, Jesus, God, and the power of modern medicine for her healing. The anxiety level is on the rise. In just under 48 hours, its a date with Dr. Schulick at Johns Hopkins. Our hopes and prayers are that he can go ahead with a gastrectomy.

U'fros aleinu sukkat shlomeicha.
Spread over us Your shelter of peace.

Keeping Busy

The plan for Friday is to work a typical schedule. Out for dinner tonight ran into a patient. As is typical, no note or recognition of wearing a head scarf. Thanks to Janice, the kitchen smells of fresh challah, waiting for tomorrow night's dinner. Everyday is a countdown to surgery, scheduled for August 12th.

Here We Are

For now we are in that odd in between bracketed by chemotherapy, which ended on July 9th, and surgery, which is scheduled for August 12. At a recent oncologist appointment, the physicians were amazed by the appearance of general health and vigor. Keeping mind occupied by continuing to work part-time and staying busy with activities and social engagement leads to a better sense of well being. Just as "All roads lead to Rome," the future's fulcrum is an August 12, 7:30 am surgery at Johns Hopkins Hospital.