Hope and optimism

Dad's been stable through the day. He was sedated for most of it, because he's been ornery and cranky and fighting the breathing tube. Yes, he hates it enough that even though he's strapped down to keep him in place, he somehow managed to pull it out on his own! Go dad!! Unfortunately, his breathing was too shallow, so the victory was short-lived. They gave him another tube and more sedatives. The goal is to get him off of the tube tomorrow, as soon as his breathing stabilizes.

A few minutes ago, Kevin and April went in to check up on him. He's been sedated and non-responsive pretty much all day. They were talking to him a bit, and Kevin mentioned that Matt and Karrie are coming up in a few minutes. All of a sudden he pulled his head up a bit and tried opening his eyes! He's alive. His heart is beating on its own. His brain is recognizing names and voices, and arms and legs seem to be functional.

We're hopeful. We're optimistic.

Timeline of RK's aortic dissection

Thursday, 29 Nov. 2007
Around 4:00 PM Randy was on the job in Clinton (close to Layton) and felt a stabbing pain in his chest. Steve, one of his workers, noticed that he was pale and pointing to his chest, and asked if he was choking. Randy explained he just had a bit of pain and was going to drive home. Steve said no, and called an ambulance instead. Within 15 minutes he was on his way to Davis Hospital--by that time he was becoming incoherent. Barbara got word from Steve and headed to the hospital. En route she thought "it's probably indigestion from the cookies he was eating!" But when she got there she was told that he was in "very critical condition" and that he was being life-flighted to U of U hospital. Barbara saw Randy and described him as "agitated and gray." She was told by Davis hospital that Randy may not survive the flight. Barbara was then unable to drive, but a 76-year old grandma transported her safely to the U of U (and some friends later retrieved her car--thanks John, Barbara, Kelly, Paul, Liz, and Boyd!).

Surgery began around 6:30 PM and lasted until about 12:30 AM Friday. During the surgery we received updates about every hour or two, and it was always "things are going well." So we all became quite optimistic and mixed our tears with smiles. Lots of people came, lots of people called. It was a relatively happy, hopeful atmosphere with band members, ward members, friends, and family, but then the doctor came out at the end of the surgery and shot down our optimism. The doctor said things were very bad. He explained that during the helicopter flight Randy had gone into cardiac arrest twice, and was in full cardiac arrest at the time of his arrival. The doctor emphasized that there could have been extensive damage to the heart muscle and extensive damage to the brain during these episodes. We were told that there was a good chance he would never come out of anesthesia, or that if he did there could be paralysis or loss of mental function. Now that the party had been rained on, we all hugged, cried, prayed, and talked. Through the tears Barbara wanted everyone to know how grateful she was for the love and support she had received, and she told everyone how lucky she was for the time she has had with her best friend.

From the doctor we learned that the coronary arteries were pulled away from the heart by the dissection, which caused the heart attacks. They had to replace the aortic semilunar valve, about 3/4 of the aortic arch, and the coronary arteries.
















If you want some technical details, this image shows the aorta, which starts at the aortic semilunar valve (the exit of the left ventricle). All of the blood going to the body must pass through the aorta, so it is the largest artery and under the greatest pressure. As shown, a small hole developed in the inner layer, and blood pushed the middle and outer layers away from the inner layer (creating an aneurysm). Randy's dissection went a bit further than the one shown here, so the three major arteries at the top had to be attached to the graft. The three arteries at the top are the brachiocephalic trunk (it splits into an artery going to the right brain and one to the right arm), the left common carotid artery (going to the left brain), and the left subclavian artery (going to the left arm).





Friday, 30 Nov. 2007
Barbara, Kevin, and Tyler saw Randy in the Intensive Care Unit for the first time around 1:30 AM Friday. He was very pale and swollen, with a breathing tube, a stent in the neck, and tubes in the chest. He had acidosis (pH of 7.27), which was stabilized within a couple of hours. His blood pressure was low but all in all his vital signs were stable. Tyler and Kevin gave him a Priesthood blessing, and some tender family moments were shared as we contemplated this great man and wondered whether we could keep him with us any longer.

Around 6 AM the anesthetic was wearing off enough that Randy started to pull against his restraints. We were thrilled to see that he was moving all of his limbs. Even better, he was able to respond to our voices. He could squeeze his hands or wiggle his toes when asked. Barbara asked if he was in pain, and he nodded. When she asked if he could open his eyes he shook his head. We once again became quite hopeful, but with the realization that in the best case scenario it will be a long and painful recovery.

After Randy's initial responsiveness, they administered sedatives for the pain and for most of the day he has been asleep. When Barbara talks with him he starts to move and the nurses get after Barbara for stimulating him too much.

The work crew stopped by and told the story from their end. Steve, Gordon, and Gary shared some laughs with Barbara, and they all agreed that if Randy pulls through he's in big trouble for putting us through all this :) Being the good guys they are, they went back to work. Many friends and family have been visiting Barbara through the day. Dave, an anesthesiologist resident and brother-in-law of a friend, stopped by and answered questions, listened to our account, and gave an optimistic assessment. Matt, and Karrie will be arriving from Boston tonight and Janell is coming tomorrow.

We took it as a good sign tonight that in spite of the restraints Randy found a way to rip out his breathing tube (they said he wasn't yet ready so they drugged him more and put it back in). We thank you all for your prayers, kind thoughts, and loving support. So far we've witnessed miracles we did not expect and shared many tender family moments.

Welcome

Dear friends and family,

Thank you for all of the support we've received from you so far! The show of love and support from so many people has been overwhelming and deeply humbling.

We're so grateful for all the love and concern that's been shown. In the early hours we started using a telephone tree to keep the immediate family updated on Randy's condition as soon as more information became available. While we're still making calls to family, many extended family and friends are having to hear the news second- or third-hand. The information that gets passed down ends up being vague and incomplete at best.

At the moment, this blog is being written from the waiting room at the University of Utah Hospital, about 100 feet from the entrance to the Surgical Intensive Care Unit (SICU). We don't get updates very often, but we're committing to post whatever updates we receive as soon as they come in.

We'll try to respond to any questions that are posted in the comments of this blog. No promises, but we'll do what we can.


Thank you again for all of your love and prayers at this poignant moment in all of our lives.