The tiniest of baby steps . . .

Saturday, August 28. . . Bob will be in surgical ICU for at least a few more days. All has been stable, heart is strong, other vitals looking good. Still on the respirator, sedated, though not totally knocked out, as his blood pressure has been slightly low (not alarming so, we're told), and putting him totally, unresponsively under would drop it even more, not be a good thing. He'll open his eyes if gently roused, and can responded with a nod or a shake of his head.

When I arrived this morning, Bob turned his head toward me and nodded when I asked him if he could hear me, if he was doing okay. He then tried to tell me something, he slowly raised his left hand, made a weak fist and slowly shook it. Or maybe he was trying to squeeze it, I couldn't quite tell. His lips moved around the the ventilator tube that's helping him breathe right now, trying to form words around the obstruction. I hate when he does this, because I am a worthless interpreter . . . he looks at me so intently, trying so hard to communicate, and I have no idea, simply no idea what he wants, but still awkwardly, anxiously try . . . Are you in pain? Head nods yes. Does the wound site hurt? No. Are you having chest pains? No. Keeps making the squeezing motion with his hand, almost like a modified version of "bathroom" in sign language. You have to go to the bathroom? I thought he nodded his head yes. You have a catheter right now, you don't have to worry about that. Slowly shakes head in frustration, continues to squeeze his fist. Does the tube hurt? Finally, a slow but definitive nodding of the head. I'm so sorry . . . I know you hate that thing, but there's nothing I can do about it. Hopefully tomorrow, they can remove it. . .

He wasn't yet started back on the Integrilin, which sent me into mini-panic mode. Ummmmm. . . what do you mean "not yet?" I keep myself under control, as the last thing Bob needs is me going all wacko on his ICU nurse, but I gave her the litany, that the surgeon told me last night that it would be started up again right away this morning, and that I hope everyone in ICU is well aware of his heart-attack history, and that Bob's cardiologist gave explicit instructions that he was to be on it right away after surgery, come hell or high water . . .

I think she sensed my panic mode rising and went to find the doctor to come and talk to us, because I'm told there's good reason to keep him off it, and he could better explain that to us. The doctor found us in the waiting room and sat down to explain, very carefully, so we could understand this complicated balancing act, why Bob isn't back on the Integrilin. He said that because Bob lost so much blood (1.5 times his blood volume) during the surgery, and that there's still a risk that he could be bleeding internally, restarting the blood thinner could be extremely dangerous. Integrelin is a very powerful anticoagulant, and right now, Bob's hemoglobin and other blood levels have been safe and stable, and putting him back on Integrelin isn't recommended. He is back on Plavix, and has been on the full-strength aspirin throughout the surgery, so it's not like he's not on anything. . . he said he completely understood my concern, but they are keeping a very close eye on Bob and will react and adjust things as they progress. All this is being done under close consult with the cardiology team . . . I felt a little better after talking to him. A little.

Shortly after he, I checked my e-mail and there was a response to my late-night desperate plea to Bob's cardiologist, who told me that the good thing is, his planned worked—blood didn't clot up, heart attack didn't happen, but it also worked too well, with the excessive bleeding. He's well aware of the situation and concurs what is being done. Everything with Bob's situation is a risk and balance. Hopefully, the worst is behind us, he wrote. Feel better. A little.

Sunday, August 29. Nancy left around 6 a.m. this morning; she has a long drive back to Billings, back to her family, to work in the morning. She stopped in to see Bob before she left town and sent a text that his nurse said it was another quiet, uneventful night.

As of 10 a.m. today, Bob has been off the respirator, very groggy and labored when he talks but appears to be very cognitive, too. When he talks, his words are almost a whisper, thick and clumsy falling from his mouth, but I can tell he has so much to say. Of course he would. I talk a little with him, but after a while, I can see it takes so much out of him to utter the short sentences that require such force to get to me. I tell him to rest, I'll be in and out to see him. There's plenty of time to talk when he's feeling better.

He's not in pain when he's just lying still, he told me, but when the nurses have to turn him, the pain is so excruciating, he can't even describe it. From his neck down to his feet, intense pain floods his body like nothing he's ever felt before. After a 13 hour surgery, and all that had to be involved with that . . . all the hands and tools inside of him, manipulating, mutilating, twisting and turning, pulling apart, removing things, trying to put things back, make parts fit that weren't meant to fit, stitching, stapling . . . for 13 hours straight . . . a victim of torture is probably the only person on earth who would be able to understand the physical agony that ravages Bob's body right now . . .

But even in this weakened state, he stays strong. So strong.