Tropical Storm Jeff, Our Own Personal Storm…

The decision to remain in the hurricane zone during the season turned out to be just fine with regard to weather.  Hurricane season will officially be over November 30th. It had been predicted to be an active season and was in some parts of the world, lucky for us it was calm in the Atlantic.

On a personal front, we recently felt like we were in the midst of our own tropical storm shortly after arriving in Detroit October 23rd.   We are extremely fortunate to have weathered the storm and expect to be heading back to Puerto Rico within the next few weeks.

We had known for the past several weeks that Jeff had a cardiac issue and had been working with a cardiologist in Puerto Rico since mid August.  It first became apparent when Jeff noticed a shortness of breath and tightening in his chest when he headed out for a jog in early August.  We were in the tropics in the summer and it was oppressively hot so we initially hoped it wasn’t a cardiac issue but something respiratory due to the environment.  After the second occurrence while just walking Jeff asked me to schedule an appointment with a cardiologist.

Scheduling the appointment proved to be a challenge due to our language skills, or lack there of.  While it is not a problem finding English speaking doctors in Puerto Rico, it is a problem to call their office and schedule the appointment in English.  After several calls I connected with HIMA Health system which, through it’s “Medical Tourism” office, provides the service of an English speaking health concierge.  The initial appointment was scheduled fairly quickly and after an EKG and exam by the doctor everything looked ok.  The doctor called for a stress test which unfortunately was not scheduled until several weeks out.  We were pretty bummed about the delay but again the language barrier was in play.  Also, it seemed the doctor felt the symptoms were indicating respiratory rather that cardiac problems.

During the intervening weeks Jeff’s symptoms gradually came on quicker with less exertion.  He never felt pain but describes it as the feeling of exercising too hard and needing to slow down and catch his breath.

During the stress test he quickly experienced the symptoms and for the first time felt some pain.  The doctor also saw evidence of problems in the EKG report and stopped the test.  He said the next step would be a cardiac catheter and felt he could schedule it the following week.  Our initial thoughts were to proceed with the next step but we became more concerned as there were delays in scheduling once again.  Our trip to Detroit was nearing and Jeff contacted a cardiac group at Beaumont hospital in Royal Oak where he was able to schedule an appointment for 8:30 the morning after our arrival.  We collected all the reports and records from the doctor in PR in preparation for the meeting.

We arrived in Detroit the evening on Wednesday, October 24th.  Thursday morning (10/25) we went in to Beaumont expecting a consultation where the doctor would call for more testing.  It didn’t take long to see that these doctors were approaching the situation with a much greater urgency than we had seen in PR.  Dr Goldstein quickly determined that he would admit Jeff and arrange for a cardiac catheter that afternoon and, at a minimum, Jeff would stay overnight following the cath.  Dr Goldstein was leaving town that afternoon and organized for Dr Dixon who runs the cath lab to do the test.

Once settled in the room we contacted Brian and Sarah to fill them in on what was happening.  Prior to this we had hadn’t felt it was necessary to let them know since we didn’t know much ourselves. Brian had arrived in Detroit that morning from Seattle and Sarah was due the next evening.  We were all looking forward to seeing each other and to attend Lindsey and Tim’s wedding.  We had been pleasantly surprised to meet Jeff’s first nursing team when we arrived on the floor shortly before, Tim and Lindsey.  It was a nice coincidence and they were a great team.

It was early afternoon when transport came to take Jeff to the cath lab where we met Dr Dixon who explained the procedure and reiterated what Dr Goldstein had said that morning.  It was likely they would find a blockage and fix it with a stent.  Dr Dixon told Brian and I that it would be about an hour and a half before we would hear anything so when we were called back in 45 minutes later I knew it didn’t go as expected.

What Dr Dixon had found was that Jeff in fact had several blockages and would require surgery. He showed Brian and I video from the procedure, one artery was fully blocked and others were as much as 70, 80 and 90% blocked.  He also pointed out the passageways Jeff’s body had created itself to provide some blood flow.  He had already contacted the surgical staff and explained that he had asked them to consider surgery Saturday but we should expect at least Monday.

Just after getting settled back on the room Dr Tepe breezed in and introduced himself as a cardiac surgeon and explained that Jeff was lucky to have been added to his schedule the next afternoon.  He explained that he does only this surgery and has done over 5000 of them.  Jeff would need a quadruple bypass involving harvesting one vein from his calf and a mammary artery for use to construct 4 new pathways to restore sufficient blood flow.  The procedure is called CABG – Coronary Arterial Bypass Graft.  Dr Tepe explained that each of his micro snitches would be identical and perfect.  He displayed just the amount of arogance and confidence you would want in your cardiac surgeon!

Once on the surgical schedule there was a stream of people through the room that needed blood, respiratory function tests, signatures, etc.  I can picture Jeff trying to eat his dinner as people stood in line waiting to get access for what they needed. We called Sarah and found that her flight would have her in the air during Jeff’s surgery which would not work – she is not a good flier under the best of circumstances.  Also, they had made this same trip just over two years ago for Nate with a very difficult outcome.  She and Katie arrived Friday morning (10/27) and were able to visit with Jeff for a bit before he was taken to pre-op.

Jeff was in surgery for about 5 hours during that time we received periodic updates.  The vein removal was complete, he is now on bypass, still on bypass with all going well, off bypass, etc.  Once he was in ICU we were able to see him for a few minutes. He still had all the tubes, monitors and the ventilator and was still out of it but was doing great. He got through the initial recovery very well and was released from the hospital the following Wednesday.

Jeff is doing very well and continues to get stronger daily.  We also continue to be amazed with how incredibly lucky we are to have the outcome that we do given the significance of Jeff’s condition, the remote places we have been and the strenuous activities he has been involved in.

Jeff and I did miss the wedding but Brian, Sarah and Katie went and were able to enjoy the festivities without too much worry for Jeff.  We missed the opportunity to see so much of our family but are trying to see some people while we remain in the area for Jeff’s recovery.

We see both his cardiologist and cardiac surgeon on Wednesday and Thursday and hope to have a better idea of when we can head back to Echo in Puerto Rico.  It was nice to see a bit of fall in Michigan but with snow flurries and daytime highs in the mid 30’s we are ready to move on.

Drugs are good.

Yesterday was Nate’s birthday. Being here in Michigan makes Nate more present to us in every way. We are surrounded by our memories of him and of the memories of all the friends and family that continue to remember and love him. Yes, the pain of his loss is even more acute, but so is the joy of all the memories. Happy Birthday Buddy.