Chapter Three: Another Manic Monday

Monday, January 13

Monday morning I picked up Dad before 5 a.m., and we headed down I-75 to his appointments in Atlanta. After a false start in the wrong building, we found the Emory Clinics and took the walkway to the hospital's pre-op. Here Dad would do all the check-in labs and paperwork. He hadn't eaten breakfast (fasting for all the planned tests), and I'd only had cinnamon toast and coffee. Even though we began the process at 7:30, we had to call the surgeon's office and tell them we'd be late for his 10 a.m. appointment.

When Dad entered the exam room, with me in charge of his jacket and extra papers (he'd meticulously hand-copied his records and history for all the medical people we'd see that day), he was visited by a barrage of nurses taking blood and histories. He wasn't enthusiastic about the blood-drawing, especially when he learned they would take it again two hours after his glucose drink. All these women were friendly, compassionate, and extremely thorough. The anesthesiologist listed to his aorta, heart, and lungs and checked his thyroid and neck. He told her about his heart murmur, which she heard, and explained about his various medications and supplements. With the parade constantly entering and exiting the room, two hours passed quickly.

Around 11-11:30 we hiked back to the A-Clinic to the surgical waiting area, a hexagonal room filled with various seating areas and flanked by three types of surgical counters with three desks each. Dad checked in--after we finally figured out it was general surgery we wanted and actually signed him in the right place. We waited. And waited. I asked one of the desk ladies what we should do, since my dad had an appointment with the cardiologist, originally at 2:00, then moved up to 1:30. She told us Dr. Sarmiento moved his patients steadily and to see her again if we weren't called back by 12:45. In the meantime, I'd discovered an apple from our hotel in Charleston still hidden in my voluminous purse. Apologizing to my dad, who still couldn't eat in case he had any more fasting-necessary tests, I gobbled the apple.

Just in time, we were called back to Dr. Sarmiento's examining area. If my dad was already sick of people taking his blood pressure, he didn't let on. Again, two lovely ladies--the one who escorted us to the room, and the one who talked to Dad and took vital signs.

Then Dr. Sarmiento entered the room (which I am sure was AIR-CONDITIONED on a chilly winter's day). He spoke softly, telling us one fact after another about his Whipple surgery:

1) typical operating time 6 hours or less--we'd heard some were 6-10

2) preserves the pylorus--so the stomach stays intact. As Dr. Sarmiento puts it, "the way God made you." He says it makes no oncological difference [no different outcome with cancer]

3) vertical incision, smaller than typical--less to recover from

4) NO DRAINS, NO FEEDING TUBES--this thrilled my dad! He's heard scary stories about abcesses, much less grimaced when he imagined these tubes protruding from his abdomen. And Dad is all about real eating (which you can't tell so much by looking at him).

5) patient is up the next day, eating ice chips the first day, and usually rid of the NG cath by the day following surgery

6) typically removes more than 15 lymph nodes to test for cancer, usually 16-25

7) works closely with the pancreatic pathologist, whom he considers tops

8) seldom transfuses patients or puts them in Intensive Care

9) 6 days is the median length of his Whipple patients' hospital stays

10) out of last 100 patients, mortality rate around 2%

11) pain management is better with an epidural cath

12) confirmation of Dr. Esnaola's info about Jemsar, the chemotherapy cited in a significant
trial--if given to all comers, it doubles the survival rate. And its side effects are minimal.

Lucky 13) performs about 75 Whipple surgeries a year [Whipple surgery removes a part of the pancreas, usually to take out a cancer, and then resects the remainder of the organ with the surrounding tissue, including the jejunum, a part of the duodenum, also known as small intestine.]

He invited Dad across the hall to view the scope images together and discuss it.
We left feeling sure the Lord had worked out for Dad to have this surgeon.

Up on the third floor, we arrived to sign in at the cardio waiting room, set up similarly to the surgeon's area. Dad and I were led back to a room, where we knew the drill--questions about medication and history, Dad pulling papers out of his soft briefcase, blood pressure taken. Everybody, once again, was kind and friendly. A kid who claimed to be the cardiologist entered the exam room. His tag read, "Robinson Williams," and sure enough, he went by Robin! He felt everything would be fine with Dad's heart during the upcoming surgery, as no trouble had surfaced in many years. He agreed it would be good to have a recent ECHO cardiogram and arranged it for that afternoon.

More waiting in the chilly cardiac imaging suite (leather coat over my lap), as Dad went back for his stress ECHO. I was so hungry, I dug in my purse hoping to find something and turned up a tiny pack of airplane peanuts from our Charleston jaunt. An hour or so later, Dad was back. As far as he could tell, it went well. We received a call he would need to report to Clinic C at 8 in the morning for a carotid artery ultrasound. This changed our plans, as we had been Chattanooga-bound until now. Fortunately we learned this before leaving Emory.

We had talked to my brother Gary on and off throughout the day, and now he invited us to dinner. We checked into a nearby hotel on the Emory campus and followed directions to Gary's house. There we enjoyed pork tenderloin and good company--Gary, Sherry, Ben, Rico the Pit Bull, Laney, and her friend Rebecca. Mom called and gave us a message about a heart cath on Wednesday morning. This was both a surprise and a mystery to us--no one had informed us. We resolved to learn more from the cardiologist, Dr. Williams, on Tuesday.

I was thrilled to return to our rooms and turn in with a book--which I didn't read long. Lights out before 10:30! Dad later confessed he was up till midnight. Bad patient!

I let Dad out at Clinic C and parked. His ultrasound only revealed a bit of new plaque in his carotids, and he enjoyed meeting the tech who'd trained with my brother Gary and viewing the images with the radiologist. While waiting, I had called to update the church about the situation with the heart cath and ask for prayer about the surgery moving forward if it were safe to do so.

We were on our way to learn about the heart cath from the cardiologist when he called us. He was surprised to hear about it. He was only calling to report that the ECHO cardiogram had shown my dad's heart to be in great shape. He called me back in a few minutes, saying it must be some kind of mixup. Neither cath lab had my dad on the schedule. Relieved we picked up the kit my dad had left at the surgeon's suite and made a hasty retreat to IHOP!

We were able to rendezvous with Emily at a Taco Bell before she headed back to college.

I delivered Dad home, and he, Mom, and I began our individual preparations for the trip back to Atlanta on Wednesday.

I look back, and I marvel at the way God worked out every detail with perfect timing and gave us wonderful moments along the way--my visiting with Dad and having a chance to help him a bit after all the things he and Mom have done for me, plus the fun family time with Gary, Sherry, Ben, and Laney last night. Funny how the Lord can use that scary C-word to draw people closer and create warm memories.