Never a good sign when the nurses from the ICU remember your name when they see you. As some of you know, Elana had to have another procedure this week that also required a 48 hour stay in the ICU. Because, it is almost impossible to find a vein to start IV's, Elana had to have a MediPort installed on Monday. A MediPort is a permanent IV that is inserted just below the skin. Elana's MediPort is just below her right shoulder. The other reason she needed the MediPort is that the RSD has spread to her right hand as a result of all the IV needles that were required there during her last stay in the ICU following her gall bladder surgery in early March.
Although the procedure is relatively straightforward and is usually done outpatient, for Elana there is no such thing as a simple procedure. Because there is an incision and a trauma to the skin, in order to prevent the RSD from spreading to the MediPort area, Elana requires a 48 hour ketamine infusion. While it is not necessary to have an infusion in an ICU setting, Mt. Sinai Hospital requires that Elana have the infusion in the ICU because it does not have any experience with ketamine infusions (except for Elana). As a result they want to have maximum control and support during the infusion. Therefore the safest place for her to be is the ICU. I don't have a problem with it and I am just happy that they are providing the infusion in the first place. Although, it adds a sense of unneeded alarm when I tell someone that Elana is in the ICU.
Like, everyone of Elana's medical treatment and procedure's this one required enormous amounts of coordination between several doctors. At the head of the coordination effort was one of my closest friends, Dr. Michael Rogoff. As the doctor who performed the procedure he had to coordinate the anesthesia and ICU in addition to managing the various hospital administrative obstacles. From the very beginning, Michael took control and never showed anything but optimism and resolve as the different hurdles were placed in his path. Thanks are not enough for his work to make sure this procedure happened in the short window of time that we had to perform the procedure. As I have played golf with Michael nearly every week for the past 10 years, I am sure that he knows I am still going to try to kick his ass the next time we play. I am also certain that he would not want it any other way.
As always, Dr. Brett Kandell provided the anesthesiology support and has become an integral part of Elana's permanent medical team. For sure, this procedure and every other procedure that Elana has had at Sinai since the onset of the RSD could not have happened without Brett's consistent support and continuous effort.
Lastly, Dr. Farcy of the ICU once again offered his support to this procedure by permitting the ICU to open its doors to Elana after the surgery. That would seem like a given, but I can assure you that there are no givens when it comes to treating RSD and only with Dr. Farcy's active support could we have provided Elana the essential post surgical care.
Today (Wednesday 4/28/10), Elana's infusion will finish at 10:00 am and she will transferred to a regular hospital room the rest of the day. Elana will sleep at the hospital tonight as a precaution, and if all goes well, will come home tomorrow morning. Next Thursday, Elana will return to Monterrey, Mexico for a another series of ketamine infusions with Dr. Cantu. After a very stressful last three months following the Coma, the hope is that this infusion will help Elana get back on track with her recovery and will lead to significant improvements going forward.
One final comment. As anyone who has dealt with an ongoing medical issue, there is no auto-pilot or cruise control when it comes to managing care. I am personal friends with nearly everyone of Elana's doctors. We are fortunate to have access to major supporters of both Mt. Sinai and University of Miami who can provide access otherwise not usually available. I have the personal cell phone of everyone of Elana's doctors and can call them 7 days a week without issue. However, even with all that, every single procedure and treatment requires enormous amounts of coordination and follow up. Without fail there are miscommunications and inadvertent mistakes made by administrators and sometimes even doctors too. You can never take anything for granted and every commitment needs to confirmed and reconfirmed several times. I mention all this because I know there are times when I am not myself when I am talking with friends or family. Sometimes, I may appear to be aloof or not concentrating on the conversation I am having at the moment. I ask for your patience and understanding because I assure you the only thing I am thinking about at those particular times is what do I have to do next for Elana's care and treatment. It is very hard for someone like me, who always wants to be in control of a situation, to have to cede control to others when it comes to such a critical issue like my wife's treatment.
Thank you all for your continued love and support. It is always welcome and appreciated at all times.