Pneumonia Part V - November 17th to 22nd

I have to apologize for taking so long to post this. I've discovered that although I know that everything turns out all right in the end...I really don't enjoy remembering the day of John's surgery. To start my day off I woke up at 6:30 a.m. when Charlene knocked on my door. I had planned on being up and ready to go by then. Since I was late and had to be at the hospital by 7 a.m., I got dressed, brushed my teeth, washed my face, thanked Charlene and RAN out the door. Really you can't be late for your husband's surgery. John was ready to go, I wasn't. I didn't act all panicky for him but you know those butterflies well I had more than my fair share. We made it to pre-op and had a great nurse...I do enjoy when they put the x marks the spot just in case the surgeon can't tell his left from his right. I met John's surgeon, he was informative, seemed excited by John's case and he made me laugh. John received his first drug cocktail and was feeling pretty good. He doesn't remember any of the rest of pre-op, which is good. He would have been amused when I went up to his surgeon, asked for a minute and said, "I know you do this all the time but that man is the entire world to three little girls. Please take care of him." The surgeon looked pretty surprised but reassured me he would. I met John's surgical nurses and they were quite alert...good for my husband and a little sassy...good for me to relate to. They told me that they enjoyed working with Dr. Rochwal, he is a great surgeon but they'd keep an eye on him just in case. They wheeled John out and that's when I started to cry. Just thinking about how worried I was makes me tear up all over again.
The staff at Toledo Hospital made sure to not only direct me but escorted me the teary eyed wife to the waiting room. When I arrived really it was such a relief to find Linda, my kids adopted grandma, there waiting for me. I hadn't called her the night before but news travels fast. Linda who lost her husband to cancer recently was such a surprise and a comfort for me. I was then sent upstairs to the waiting room for Heart Surgeries...it was closest to the operating rooms and we waited. As time passed my waiting committee grew...Uncle Jim, my sister Laura and niece Addie-the best distraction in the world, my mom-whose classes were luckily cancelled for the day, John's mom Ann, and his sister Leanne. We were quite the group! My sister brought Twilight for me to read again, you know another distraction. I couldn't sit still and could have definitely used something to take my worries out on. While not sitting still I discovered that there were besides my group three other groups waiting...really a wife, a husband, and a family...the ENTIRE family group was reading Twilight for the first time, we had a good laugh when we realized that we were all reading the same book.
It seemed like no time had passed when the surgeon had us called to family meeting room. The attendant looked like something had gone drastically wrong. I thought I might be sick...you know my heart started racing and I didn't really want to wait in a small room to hear bad news. I took my mom and my sister with me...we were all a little nervous. Dr. Rochwal came in looking very intense...my mom grabbed my hand and I was ready to hear the worst. Then he said, "The surgery went really well. Actually it went much better than expected." I vaguely remember the rest of the surgical details, but I was still a little stunned.
We were escorted to another elevator to go to the waiting room for the Surgical ICU. We waited and then they let us in two at a time, but I think rules are made to be broken and asked to take both mom's and one sister. Surgical ICU is in the new building and the whole floor is beautiful. I was prepared for John to be on a ventilator but he looked pitiful(sorry honey) when I first saw him. But I went up to the bed took his hand and he gave me a good squeeze. He didn't look like he was even conscious. That was when I knew it was going to be okay. He was already awake! I was warned that it would take a while so not to expect any response yet. His nurse Peter was hilarious. He did a great job helping John get off the Respirator. Although that is something I'd prefer to not have to watch John go through again. He also had two chest drainage tubes to keep the fluid from collecting in his lungs again. Friends and family stopped by and I have to say a thank you for the Dr. Pepper to Russ and Leanne and a special thank you to Aaron and Jean Buck for the hilarious birthday/get well card. No it definitely wasn't John's birthday.
The rest of the week progressed well. He had his drainage tubes removed and then was up and about. The hardest part of John's recovery has been getting his lung capacity back. When he left the hospital he only had 33% lung capacity=the same as a 70 year old smoker with COPD. There was some concern that his diaphragm was paralyzed, thankfully it wasn't. John was determined to get out of there. You could tell that he was finally getting better. Daily walks, on oxygen at first, helped him build up his stamina.
I brought him home on November 23rd! A special thanks to the Amsberry's for keeping my girls so late on a Saturday night. He was exhausted and it had taken a while, but at the two week checkup we were told that John was Pneumonia free. Really John will do anything for time off!
I can't thank my friends and family who have taken care of me and my girls over John's entire hospital stay.....I am truly blessed to be surrounded by people who love us.

For those of you with medical training you might enjoy looking at these images.

Chest full of pneumonia at the beginning of stay.

CT scan of his pneumonia.

X-ray of greatly reduced pneumonia when John went home.

Pneumonia Part IV - November 15th -16th

So John was in a regular room on Saturday. John's pulmonologist was concerned that John wasn't getting better a fast as he should be. He was going to look into a couple of things and get back with us. The weather put on an amazing show....giant snow flakes....flying by a ninth floor window over Ottowa Park, absolutely AMAZING.
You might not know that Saturday night is family night at the Rapp's. The girls were excited that this tradition could continue in the hospital. They got to see their dad! Happy, happy girls....six days without dad, teary eyed dad and weary, weary mom. Paige definitely couldn't figure out all of the stuff that John had attached to him. No hugs, just a kiss. Syd moved right in and snuggled up with her daddy. Kate who had a chance to visit John in the ICU was very impressed with his newer accomodations settled into the chair next to him and kept herself busy. I also took the girls down to the cafeteria. You would have thought that they were in heaven.....fries, ice cream, hamburgers, and a salad bar for Syd! Wooooooohooooo!
Sunday was our annual ward(congregation for those of you who don't speak Mormon) primary program and I didn't want to miss it. Kate and Sydney were ready with their parts. Leslie Pershing came along for crowd control and moral support. The program was great! My favorite part was that I wasn't responsible for any of it. I served in primary for over 11 years and boy was it a lot more fun to watch. Here are two of the great qoutes from the kids....keep in mind that the kids are asked to answer a question that they studied in class during the year and write their own parts.....names have been removed to protect the identity of my funny little friends.
A very fun yet serious 11 years old.....reading question....."Why is prayer important to me?".....long dramatic pause....."hmmmmmm".........really there was an answer but by the time it came I was giggling so hard! I've always loved a dramatic pause, that pause was a masterpiece.
One of our funnier littler ones...6 years old...reading with teacher assistance, "I know Heavenly Father loves me because?"......whispered into the microphone to his teacher."SO WHAT"S THE ANSWER?"
Then my phone rang. Does everyone hate when phones ring in church, a play or the movie? Well I do! I always turn off my ringer, leaving it on vibrate and cringe for my friends who foget to turn off theirs. I quietly answered Hello.....Hold on honey....and left the chapel. John had called to let me know they had found fluid around his lungs(empyema) and they would need to drain it. One bonus for John was that the shaking treatment to dislodge his pneumonia would also shake up the fluid so that treatment would be discontinued until they figured out what to do about the fluid. I had about an hour before the doctor would come in to talk with us. I arranged to send my girls off with friends....a special thanks to the Ethingtons, Millers, and Pershings.
Meanwhile I made it back to the hospital. We waited but not too long. Our pulmonologist came in and explained that we had three options that would only be excuted if necessary...
1. Use a ultrasound to locate the fluid and remove it through a needle, done in your hospital room. This was the plan. Easy, mostly painless this was the hoped for outcome.
2. Use a CT Scan to guide the procedure and have the fluid drained through a needle in radiology John's pulmonologist would be there to oversee everything. Less easy but still mostly painless.
3. Surgery to remove fluid, scrape the lining of the lungs, and insert chest tubes to help it drain.
Option one in room happened in the afternoon around 1:30p.m.. The radiologist couldn't find the fluid. The doctor didn't see what he saw on the xray. That didn't mean it wasn't there but that there wasn't a large enough pocket to see by ultrasound. So next on to the CT Scan. John was escorted to Radiology...when they didn't page the doctor I was hopeful that the xray had been wrong. John said that he felt fine and didn't have a hard time breathing. John's LPN Mike went with us he kept checking to make sure that John wasn't hurting. I discovered that Mike's daughter, who is cute as a button, is in the same kindergarten class as Sydney. Small world isn't it! An hour later Dr Jacobs, pulmonologist, came in to say that the fluid and infection was in many very small pockets around his lungs and John would need surgery. Not to worry this surgery would most likely take place on Tuesday. Surgeons schedule was full for Monday and the surgeons would glance at his chart today but work him in on Tuesday. WHO, besides John Rapp, get's surgery for Pneumonia? The doctor left and this is when I fell to pieces. I was tired with a capital T. Add to this that John had a hard time waking up from his last surgery five years ago. I sat on his bed and cried. I did not want him not to wake up from this surgery. This fear was so overpowering. I got myself together and went to collect my girls and go home for the night. On the way home John called and told me that they had scheduled the surgery for the next morning at 7a.m. I took a left instead of a right on Central and went back to the hospital. Hospitals don't usually do anything at a fast pace.....we've waited hours and hours for doctors, nurses, tests and results....but in the space of 35 minutes a surgeon had looked at his chart and scheduled his surgery first on Monday! This increased my level of panic but I wanted the girls to get to see their dad for a while before he was off limits in ICU again. This time the girls were a little more crazy and I was a lot more tired. I took them home around 8pm and called in reinforcements. I asked Leslie and Charlene to cover for me again. I knew that I had to be at the hospital at 6:30a.m. So after a few phone calls to give the 411 to everyone, off I went to bed. With a little more peace in my heart thanks to all of my friends.

Pneumonia Part III - November 14th

Okay so I was at the exciting part of the story where John got to leave ICU. We were transferred by a character named Ron. He and John got along swimmingly. Our new room was on the ninth floor of the new building, with a rockin' view. After John transferred into his new bed, his newest nurse, who I will call nurse X, came in to take vitals, reset the IV, all of the things that a nurse does best. My only problem was that Nurse X forgot to turn on John's oxygen. I pointed out that he wasn't getting any, that his pulseox was dropping you know 84 isn't the number that we were looking for. She assured my that the hose was connected, everything was fine. Now we all know that I'm not stupid and I don't like to be pandered to. I pointed out that although the hose was connected the oxygen wasn't going into his canula. I couldn't hear the oxygen! You definitely miss that sound when you've been hearing if for five days. After Nurse X spent the four or five minutes checking the IV hoses, his pulse, his temperature, remarking that his oxygen line would need extended for more mobility, which helped me mention John's low pulseox levels for the third time. Our nurse's LPN assistant came in listening to the concern and frustration in my voice took a look at the situation. Realizing that there was a cap in between the oxygen valve on the wall and the hose going into John's nose and fixed it. Viola once the cap was removed and the hose reconnected John's pulseox levels went back up to 97%. Thank the lord that the LPN came in at that moment. I decided that my level of nasty wasn't nasty enough and I'd have to watch Nurse X closely, very closely. Luckily John was clueless, pain meds before "the big move" made him a little punch drunk and unobservant.
Nurse X and I were not on friendly terms. I don't know if she was smart enought to realize it yet...she was a little young. Ha! I get to say she was a little young, when did that happen. Our next big adventure on the ninth floor was a bathroom break. Nurse X had forgotten to extend John's air line. She came in and took him off oxygen and went to check on her other patient. John took his "break" and got back into bed. She came back in later to check his vitals. I reminded her that John's oxygen wasn't plugged in. She looked at me, "Yes. You can tell it's plugged in by the bubbles in the water bottle. The oxygen is definitely on." I was SO DONE! I felt like I was arguing with Kate. I got up walked around the bed, Nurse X was busy checking his pulseox to make sure it was on his finger right, picked up the end of the oxygen hose, that was hanging over his IV stand you know the one that should have been connected to the wall unit. I said in my absolutely most done with your crap kid voice, "You mean THIS HOSE? This IS THE HOSE that should be attached to the wall ISN'T IT? Could you PLEASE show me how to attach everything so that I won't have to worry about you forgettting to attach things again." She didn't say a word, no oops, not a sorry, not even a let me check that for you. I attached it to the wall she left and I saw a lot of the the LPN for the rest of the night. What I want to know is what happens to the patients whose families can't stay with them on the nights that they are still out of it? I'm just glad I was there.
Friday uneventful, xrays, bloodwork, I went home for a while. The girls finally got to see John because he was in a regular room. Nurse X was back. John was quite capable of caring for himself so I went home to sleep. I did stop by to have a little talk with his nurse before I left. The conversation was...."Oh,"in a not her again tone, "Hi Mrs. Rapp." Everyone who got to know us in the hospital called me Susan. The Mrs. Rapp said with dread in her tone almost made me laugh. I decided to go with her talk down to them approach and said, "I know WE," you've got to love the royal we, "will make sure we, don't repeat any of last nights problems? You know like the few misunderstandings with his oxygen." I got a "Yes mam." out of that deal, I'm a mam now! Then went back to let John know I was a little bitchy with his nurse so she should be extra nice tonight. John found it hilarious that I had to resort to nastiness to get my point across, usually that's his job. That was all for Friday but don't worry I have another whole weeks worth of fun to write about.

Pneumonia Part II - November 10th - 13th

When I finally made it back to the hospital by 10:30 a.m. I was frantic. I was so frustrated that it took me so long to get everything done. I had called for updates on John's condition but I wasn't physically there. When I returned I got to meet John's new Pulmonologist Dr. Jacob. He explained everything about what was happening and then he said to me in the hallway, "He's not out of the woods yet but he did make it through the night. The next 24-48 hours are crucial." Talk about taking a punch in the stomach. I think I stuttered, "Okay." Then he went on to explain what they would be watching for if things got worse and what they would be doing to help John heal. So with that on my mind I sat by John's bed the next two days...praying, thinking, being entertainment for John, thinking, answering phone calls, making sure the nurses and respiratory therapists stayed on top of his care, thinking, and just to keep busy sorted all of my beading supplies. I've been waiting for the time to organize them for years and figured I might as well get something good out of ICU.

They took Xrays of John every morning. Usually from day to day there isn't a lot of change. Finally they sent him for a CT Scan. He had a really hard time during the test since they laid him down flat in order to send him through the imaging machine. When your lungs are full of goo and you lay down flat it's hard to get air into your lungs. The medical resident for the Pulmonologists group let John and I see a couple of slices of John's CT Scan. His entire right side of his lung was colored solid(infection) except for a few thin streams of black(air flow). Your lungs definitely aren't supposed to look like that! Between steroids, Morphine, Toradol, Mega Antibiotics, and Respiratory therapists pounding on his back every four hours, John was holding his own. They started John on a new machine that is used by patients with Cystic Fibrosis. It looks like a life vest and fills up with air when you turn it on. Then the real fun begins...it starts shaking you, kind sounds like when your washing machine isn't balanced. He tolerated it, but I could tell it wore him out, being knocked around for ten minute stretches will do that to you. It made me a motion sick just watching him. They should be so relieved that I wasn't the patient in that vest. Late Wednesday afternoon they put John on a nasal canula which was a great improvement over the Bi Pap machine. By Thursday evening they transferred him to a step down unit in the new area of the hospital (which is Room #3). Step down units are great since you still have extra care with one nurse assigned to less patients. Things were looking up!

The only reason I made it through those first five days were my friends. I was surrounded by people who love me, my husband, and my children. Leslie left her family and mothered my girls for five days...Charlene came every morning from Millbury to Sylvania to give Leslie time to go home and take her kids to school. My sister Laura and Lisa brought me lunch, snacks and some contraband Dr. Pepper(I try to be good and not get too sugared up.) Most of all everyone visited!!! Friends from Skrappaper, from church, from work, my family, John's family. The love of our friends those first few days was an encouraging gift that we received an abundance of.

Pneumonia Part I - November 9th

Okay everyone is asking WHY John was in the hospital so hear is Part One of our Pneumonia saga.
Four weeks ago our kids were sick, Paige, then Syd, then Kate and last but not least me. You know a virus, achy, tired, sore throat, etc. I took us all in to check for strep throat and our cultures came back negative. I was was busy treating the symptoms and we were getting better. Then John came down with it on Wednesday November 5th. He actually left work EARLY and he took a night off on Thursday to recuperate. We put him on a steroid burst since this bug was making him feel like he was having trouble breathing.Sunday morning he was feeling better but stayed home from church to rest. Later that night he spiked a fever, 102.5 and was struggling to breath. He wanted to go into the doctors on Monday but I chose a different course of action.

Which is why two weeks ago at this moment I was sitting with John in the Emergency room at The Toledo Hospital. We were there for 30 minutes before being seen. Which is not a bad wait time but is super scary when you are watching your best friend struggle to breath. I had only seen him like this when we moved into our apartment 14 1/2 years ago, our house 13 1/2 years ago and the first and last time he helped move a family at church into a new home 10 years ago.... all three time required ER visits for asthma attacks due to dust stirred up by moving.
They put John on rebreather mask to help him get more oxygen and gave him SIX steroid treatments. I heard the respiratory therapist express concern after being told to administer two more steroid treatments, "Doesn't the doctor know that I already gave him three." From the another room the doctor replied, "Yes, now give him two more." She went on to administer a third. They admitted him after being in the ER for only 40 minutes. John was there for four hours. We had to wait for a room the hospital was packed. They found us a room on the fourth floor (room number 1, keep track there are more) and John was the in transit. Mason our transport specialist, (Okay I made that title up) was instrumental in making sure that the nurses assistant actually plugged John into the wall oxygen. He did have to tell her twice, she seemed new and was more worried about taking his vitals. Then Mason took care of it himself. He also went out to make sure our RN was on the way in, which she was. When the RN came into the room and saw John on the rebreather mask she looked a little surprised. Her name was Vicki and she was amazing. She had respiratory down in John's room within five minutes. Then respiratory therapist called the head respiratory therapist who called our family doctors again and within a half an hour John was in ICU. I was so worried when we went to the fourth floor. I discovered later that I should be. Patients in rebreather masks shouldn't be out on the regular floor. At two a.m. ICU got busy working on John. There really wasn't much more to be done except for give him forced oxygen through a BiPAP machine. He was struggling all night. If he had gotten any worse they would have put him on a ventilator. Ventilator is not a word I wanted to hear and I felt a little panicky. I cried a few tears then...I don't like to watch anyone suffer and John wasn't getting any real rest either. Katie was his first ICU nurse and she told me it was okay to leave for a couple of hours to get everything set up for my girls. I told her my biggest fear was that John's heart would give out since he was working so hard to breath. She said he's so young that won't happen and promised to be right outside his door while I was gone. I finally had to go home to get the girls ready for school. My nighttime rescuers were first Katie Miller 8pm to 10:30, then Lisa Miller 10:30 to 12:30(she had to work at five a.m. or else she would have stayed the night,) and then my Mom who was chauffeur to my brother Jonathon who spent the rest of the night. I found out that night or really early Monday morning that they they had six other severe cases of pneumonia in the ER that night, all young otherwise healthy adults and three of them including John were admitted to ICU(which is room #2 if you're keeping count.) To be continued....