"Wow, great view you guys got here. . . "

Why is it that whenever someone comes into Bob's room bearing bad, or at least not-so-great news the first thing they mention is the great view we have of the river, as though to soften the blow of what's to come next. . . we've seen three season changes from this room, entering the fourth. The green of the trees below have already begun to fade, I swear, since this morning . . . if I never see the view from these windows again, once Bob is out of here, it'll be too soon. . .

Bob ended up back in the OR today, as the incision on his back opened up a day or so ago, has been draining considerable amounts of blood, despite attempts to stop the bleeding with pressure dressings, etc. I called Bob on my way to the hospital early this a.m., to see how he was, he responded with this latest development, that his sutures needed to be redone. Initially, I thought it was just quick bedside procedure, but after hearing how despondent Bob was about the whole thing, I called Doc BoHunk and asked for more details. He told me it was a more involved procedure, an actual surgery in the OR, to open the wound, clean it out, check for any infections and close it up again. Because of the location of the site, and the fact that Bob's been up and moving around quite a bit lately, coupled with the copious blood thinners he's on, all contributed to a nice little scenario for complications.

Add this to the past few days of other minor setbacks over the past few days—drops in blood pressure (80/40 range), which sent everyone into hysterics, changing meds, throwing him back on antibiotics, upping his steroids again, to "stress doses . . . " There had been talk of transferring Bob to acute rehab either today or tomorrow, but that's postponed until everything else falls back into place.

Over and over, I'm begging staff to look at his history, look at his charts, quit making changes and messing around with him unless they know his history—have they seen that he has had drops in blood pressure in the past, a situational thing (when getting up from lying or sitting or being more active), when on higher doses of cardiac meds? Does anyone know that Bob's hypersensitive to cardiac meds, and has a history of low blood pressures as a result? Why not decrease his cardiac meds first, before messing with the steroid stuff, or better yet, how about consulting with his cardiology team first? And, how safe is it to keep putting him on and taking him off antibiotics for "suspected" infections that aren't verified? Or, does anyone know his adrenal issues/steroid history? Isn't going up on the steroids going backward—that's what caused his adrenal shut-down to begin with???!!!

I get the patronizing answers, the "yes, we know, but . . . " excuses, reasons, theories . . . so, he was wheeled down to OR around 4 or so this afternoon. Doc Rockstar came in, and in his usual confident, non-alarmist manner, said that he doesn't expect the surgery to last long, and hopefully won't have to open the entire site, just the part that's open and draining. He said that due to the location of the incision (particularly the lower part), it's not uncommon to have some complications with healing. That, along with the blood thinners (he's recommending that the heavy-duty injection of Lovenox that Bob's been getting daily, along with his full-dose aspirin and Plavix, needs to be stopped, to help in the healing process), and the fact that Bob's nutritional status over the past few weeks post-surgery have all impacted his progress. The nutritional piece is that he's hadn't been getting a lot of nutrients, protein, etc, that are critical to help the body heal . . .

The procedure didn't take long, I think maybe an hour and a half or so, when all was said and done. Doc Rockstar came out, said everything went well, nothing critical, that this is something that he's not surprised it happened, that it's actually fairly common to have issues with the location of his incision site . . . that this shouldn't set him back more than a few days, getting into acute therapy, when the time's right. He'll make note in Bob's record for nursing staff to be extremely careful in keeping the area clean and hermetically sealed, for the next few days, and that he'll be monitored very carefully, as it heals.

I'm waiting in his room for his return. In my head, I get it, that he's an extremely complicated patient, with countless layers of issues to address, and that it's so hard to predict from one day to the next how his day will go. But tell that to Bob, who's checked out, mentally, at this point. Sick of this ride. Sick of being told, "just one more hump to get over." Sick of being sick. Really, who gives a shit about the view from here?