Normal Life

Well the primary care physician seemed a little defensive about Zora’s initial care when she described her own work as being able to “stand up in court.” Is that supposed to be reassuring?

But now that things are more back to normal. Here of some shots of Zora in her daily workout:

No news is good news (redux)

Zora saw her I.D. doctor today (the “Good Doctor”). There’s happily no news to report. Well, there’s some good news: the I.D. doctor said that Zora can drink while on antibiotics, so here’s to that!

Zora will still have checkups, but barring something bad and unforeseen, the timeline is as follows:

The I.V. antibiotics end on January 5th. The PICC line in her left arm is promptly removed after that. The endocarditis should be history. Then, a week or two after that, she’ll have another echocardiogram to re-evaluate the heart damage. Ideally, but unlikely, mitral valve regurgitation will be a little better and surgery would become unnecessary. Most likely, open-heart surgery will remain on the “to do” list. But as long as Zora remains asymptomatic for heart failure, surgery won’t be urgent.

Beverly left today and it’s nice to have Zora back in what passes for “normal” condition. Between her endocarditis-induced “malaise” of October and November, and the hospitalizations of December, it’s been awhile since Zora’s been her normal beautiful self.

Tomorrow Zora her original primary care physician for paper work and referrals. Next week is an appointment with our costs-a-pretty-penny cardiologist. But we’re not certain if it’s useful to keep seeing him as we’re now happy with her (insurance-covered) doctors from Mount Sinai.

So (and though the last time I wrote this preceded her returning to the hospital) no news is good news!

Nun in the house

It’s not everyday we have a nun in the house. In full habit, in fact.


These are friends of Beverly’s. And they performed Reiki to help Zora.


I, of course, kept having thinking of Sister Mary Stigmata (aka: the Penguin) from the Blues Brothers, and was sure to watch my mouth, especially when near the stairs.

Merry Christmas

We sit hear, listening to a John Waters’s Christmas songs, eating Stollen, reading the paper, and watching Zora’s medicine drip. It’s the best Christmas ever.

Is that pretty woman…


…injecting herself.



Here’s Zora’s arm. It’s not really the best Christmas picture, I suppose. But I just realized I hadn’t shown it before. This is the PICC line, that goes way into her arm. It allows for easy home I.V. use and effective use of antibiotics, as the drip starts right by her heart. Now there’s only one antibiotic, so the drip takes about 30 minutes, once a day. Then everything up to the white part near her hand stays attached to her arm. She keeps it all in place during the day with a cut-out sock.


Maybe we'll continue our Christmas cheer by seeing the movie, Munich, and getting Thai food. True New York Christmas style.

Domestic Bliss and an I.V.

After Zora’s triumphant return home yesterday (who would have thought she would get so good at one-armed pull-ups in the hospital!?), I cooked a nice dinner for me and Zora and Beverly and three good friends who stopped by (one after trying unsuccessfully to find Zora in the hospital).

While shopping (for beer), I was treated to a shot of tequila at the corner bodega. Best of all, it was served in a little plastic take-out salsa container. Ah, Christmas spirit at its best.

Here’s Zora looking smug.



Notice the handy use of the I.V. stand as a coat rack. You might this is the first time I’ve used an I.V. stand as a coat rack. But no, for some reason, Johnny G and I had as I.V. stand in Boston. So we hung coats on it.

Here’s Beverly. She is small, but poor Beverly looks like she’s getting swallowed by our living room.


We’re planning on having a very Jewy Christmas: movies and eating out. Meanwhile, I have to finally grade my papers.

It’s also beautiful outside. If anybody has a baseball mitt and is up for Christmas catch, stop on by.

I guess Zora being home means I’ll miss the lecture at the hospital by Dr. Gabriel E. Gondolesi on Wednesday, December 28th. For anybody interested, it’s titled: “Evolution of Small Bowel Transplant—The Mount Sinai Experience.” 7–9am in the Hatch Auditorium, Guggenheim Pavilion. I wonder if light refreshments are provided?

Doctors Examine Zora’s Head. Find Nothing!

Yes, the headline I was waiting to write. And Zora is now home!

Same old same old

It was a pretty good day. Zora got some sleep and was in better spirits. Karine and Karl stopped by and we all had a good time.

They gave Zora an MRI. Most likely unnecessarily. But what the hell, it’s nice to contribute to overpriced health care. Somewhere very recently I just read that 10–15 percent of U.S. health care costs are due to unnecessary procedures. Doctors order them because they’re afraid if they don’t, and something goes wrong, they’ll be libel for not performing every test they could.

The rheumatologist, unlike the cardiologist, seems to suspect that the mysterious hand condition (which is fading) is the result of emboli. If were immune related, he believes, it would be in all the fingers are at least by symmetrical. Perhaps he’s right. Repeated emboli would be an indication for surgery. But that’s still not likely. When informed that Zora was going to get an MRI, he looked puzzled and said, “well, better to be safe, I guess.”

So the MRI can see emboli in her brain, if they’re there. Evidently they can’t see them in the hand, because they’re so damn small. If they exists, I believe they’re not actually flappy breaking off, but rather small blood clots breaking off from flappy.

I’m just waiting for the results to come back so I can say they looked at her brain and the results came back negative. Well, even without the results I made that joke a few times, if you can imagine.

Zora described the MRI as a bizarre John Cage-like performance. It’s a very loud machine that’s often very rhythmic.

Meanwhile the rest of us were waiting with dinner and watching TV in the “day room” (which, given the cliental, sometimes looks suspiciously like the lobby of a flop house). I went down to reclaim Zora and found her, as I suspected, waiting an hour in her bed for “transport.”

She can walk just fine. They just like wheeling people around in a hospital for safety’s sake. I didn’t mind being a bit of jerk in here, because I figured we’d never be back in the MRI room (despite my general cardinal rule: always be nice to nurses). I asked the woman manning the MRI waiting room what would happen if we just up and left. She said she would have to call security.

Fueled by two beers, I thought “Fine. This could be fun!” What are they going to do? Take her to her room? That’s where we’re going! Hungry and eager for excitement, I rallied Zora: “You’re not prisoner. You can do what you want!” Just as I had infused Zora with the rebel spirit and we were up and heading toward the door, in comes “transport.” Zora got back in bed and they wheeled her away. Sigh. I told the woman on the way out that I would have just asked for a 2-minute head start. She didn’t seem amused.

I brought my camera today. Here’s Zora in her bed. Notice the new (and somewhat fashionable) nightgown.




Her bathroom setup.



Then Karine and I took Zora for a walk around the hospital. I don’t have any pictures of the I.M. Pei designed lobby atriums. But here is the fry machine. I thought they only existed in Japan.


Mmmm, french fries. They weren’t great. But they did actually seem deep fried. The display on the machine says 15 seconds for “prep time” and then about 2 minutes “cook time.”


Tomorrow’s menu.



Then I tried to take a picture of us with a 2-second delay



Take two!



I admitted defeat and switched it to a 10-second delay.



Karl managed to open the mystery “mirror drawer.” Oh the things we found.



Rubber glove treatment.



Sweet breath.



The girls comment that they “haven’t seen that kind of makeup since the 80’s.”



All clean.



As usual, I was too eager to remember to take pictures of dinner. Karine went out and got Vietnamese food when Zora went down for the MRI. It wasn’t that good. But what can you do. But here’s desert. And notice Zora’s new hot water kettle (courtesy of Karine). Tea anytime, baby!



Assuming the scan of Zora’s brain comes back negative (there I go again), I don’t see any reason she can’t come home again. We’ll see.

Yes, the hospital routine

Zora (and I) are a bit better today. Again, the main problem in the hospital is that she doesn’t sleep well. That’s why it’s better for her to be home.

On the plus side, a posse of good and kind doctors came by to see her. The mysterious tenderness on her hand is strange and not good. But there’s little chance it’s a result of embolism. Still, the doctors prefer to have her there, which makes sense. But it also makes sense that home is a healthier place. She will probably be in there for the weekend.

A surgeon came in—not Dr. Evans, but one of his co-operators—a very pleasant British man of Nigerian decent (I called him out on being Ibo—I said they were the smart ones). It’s interesting, because he mentioned all the things that could go wrong during surgery, but managed to do so in a non-alarmist way. It’s really hard to overstate how important bedside manner is. Now I understand.

Nothing has really changed regarding surgery. It is probably inevitable, but not urgent. This surgeon said that it probably is better to operate before Zora becomes symptomatic, as symptomatic means that the heart will damage itself. He also said that there is probably a 95% chance that unless something else bad happens, the valve can be repaired and not replaced. That is very good news. Given that Zora does not have other problems, the doctor said that such surgery for them is routine. And I believe him. Dr. Evans is gone till Friday. And this surgeon will be gone between Christmas and New Years (they work together). So unless something changes, and we want to go ahead with surgery, nothing should happen in the next month.

The hope now is that this hand pain (Zora did manage some tylenol with codeine for pain) is just some weird fluke that will go away and never be heard from again. It does baffle all the best doctors. Bad case would be some infection that isn’t responding to these massive doses of antibiotics. The important thing remains to be to get rid of the endocarditis.

Zora also went off of the “bad” antibiotic, gentamicin (2 days before originally planned). This drug really seems to give most doctors the heebie-jeebies. Taking it, there is the risk of kidney damage. I’m hoping that now that she’s off it without problems, there is no further risk of kidney damage. And if it helped get rid of the bug, then all the better. Zora remains on other, more benign antibiotics.

Meanwhile Zora’s mom comes in late tomorrow. I hope she brought her walking shoes. The hospital is 5 miles away. There’s really no good way to get to Manhattan other than biking. And I got extra bikes. But I don’t know if she’s up for that. Perhaps she can find a place to stay in Manhattan. Cabs don’t seem hard to get.

There’s a kind of street-festival atmosphere crossing the bridges. I got to ride on the other (South) side of the Queensboro Bridge. A nice new view and there’s no ugly fence there (and they’ve just put up a nasty chain-link fence on the bike-path side for no good reason other than to ruin the view). It’s just annoying that pedestrians have no respect at all for the bike lane. But the only real problems are around the bridges. Once you get the Manhattan streets, there’s less traffic than normal.

It’s also interesting that if you enter the hospital from Madison Ave., it seems like the ghetto hospital, with public housing across the street. But if you enter from 5th Avenue, it looks like the Upper East Side, with Central Park across the street. I like to enter from 5th Avenue.

Zora’s roommate sounds like very elderly woman. On the plus side, she’s not loud. On the minus side, she wet her bed tonight. Too bad Zora doesn’t have the window-side bed. But Zora’s room is away from the nurses’ station. And there’s a little more space between her bed and the hall. So it’s a bit quieter than that other damn hospital. And even other room on the same floor.

Dinner tonight was provided by Karine. Nice miso soup from a great little Japanese place we ate at not too long ago. I didn’t bring my camera, as there isn’t really anything new. But tomorrow I’ll try to bring it. If nothing else than to get a picture of all the people walking across the bridge.

Also, if you call Zora, please call her on her cell phone rather than reaching her through the hospital switchboard and her room phone. If you call the room phone, it rings (loudly), perhaps waking her up, and she has to answer it. If you call her cell phone, it rings (softly), and she can sleep through it or choose to not answer it. The poor girl needs her rest.

Fact for the day: did you know that endocarditis was first described (in English) in Baltimore? “The Canadian physician responsible for the laying the foundation of modern medical education, emphasising the importance of clinical experience, and the first professor of medicine at Johns Hopkins University Medical School in Baltimore, Sir William Osler, presented the first English description of endocarditis in 1885” (source: http://www.patient.co.uk/showdoc/40000580).

Back in the slammer

Zora is back in the hospital.

She is in better hands now. When we left the last hospital, a doctor told us, off the record, “if I were you, I would leave this hospital and not come back to the doctors who are treating you.” Enough said.

Either the weird symptoms are caused by emboli or an immune system reaction. Emboli (things breaking off and potentially causing stroke) are unlikely, I think. As did the cardiologist yesterday. But the body’s anti-immune functions aren’t really a good option, either. The body should be clean after 2 weeks on hardcore antibiotics.

No matter, the doctors wanted her back in the hospital. There’s also the insurance issue. The doctors who are seeing her now are good. And they’re not normally covered by our insurance. But by her being admitted through the E.R.—and these doctors “claiming” her—the insurance can’t say no. But if she were to go in with a proper appointment, well, our insurance doesn’t cover these doctors. And I believe she’s now in good hands. These doctors have been recommended by a few independent sources.

The doctors say that if they can rule out emboli, then she could come back home again. Multiple emboli are an indication for (i.e.: reason to have) surgery.

Deb drove us to the hospital. The transit strike sucks. We were going to ride out bikes, but after suiting up, Zora vetoed the idea because the pain in her hand would be right where the handlebar is. I asked (seriously), “can’t you ride with one hand?”

Deb got us. Because I know some “back roads” to the Queensboro Bridge, the traffic wasn’t so bad. We got to E.R. around 5PM. The I.D. doctor actually met us in the E.R., which is highly unusual and to his credit. This hospital admission took about 8 hours. Better than the 12 from last time. But still… “my God!”

Deb said I looked very worried. Of course I am, but I said, “yeah, but really at this point I’m just frustrated.” It is frustrating. It must have taken poor Deb a long time to get back to Queens. The damn transit strike. Those workers on average get paid more than me. Fuck them.

Tamara drove Ali’s car out to pick me up. She was able to get to Manhattan (her boyfriend lives in the City). I was able to get back to Queens (it would have been about a 90 minute walk). And Ali was able to smoke some sheesha. And then Ali and I had a few drinks, which also helped matters. Thanks to everybody who helped.

Zora is now at Mt. Sinai. I can bike there in less than half an hour. It’s much better than Manhasset.

The sad part is that Zora does so well at home. When one doctor said she should go back to the hospital, she broke out in tears. The hospital is not a good place to recover. She does better at home.

So here is the new and current band: Dr. Matthew Ornstein on Rheumatology (that’s a new field); Dr. David Adams on Surgery; Dr. Jeff Gumprecht, the good doctor, on infectious disease, and on the heart, Dr. Eric Stern.

Zora is in Mt. Sinai Hospital (101st St. and Madison Ave.), room N8 217A.

Damnit

Zora and I are off to the E.R. at Mt. Sinai Hospital, Madison and 101st St. And just how will we get there?

New swelling?

Zora’s got some new swelling/tenderness on her hand. That’s a bit of worry. One doctor wants her to go back to the E.R. in Manhasset. But we’re resisting. It's probably nothing. And if we do have to go back, we'll go to hospital in Manhattan.

In her own words

Zora is a big girl; she doesn’t need me to speak for her. In fact, she writes pretty well. And now that she’s home, she can. Check out her own words. Straight from the horse’s mouth. And her spelling is better than mine.

No news is good news

We met with another cardiologist today. A very nice man recommended independently by two doctors. He checked Zora out and said things are OK for now. Odds are that Zora will need heart surgery at some point in her life. But it most likely won’t be in the next few weeks.

The peak danger period for the vegetal growth breaking off has passed. There’s still a chance, of course. But it’s not a chance for which you perform open-heart surgery.

The heart regurgitation is a problem, but shouldn’t be acted on until it becomes an outwardly noticeable problem. Indications include being very short of breath after walking up a flight of stairs, for instance. In the meantime, the antibiotics need to run their course and Zora can and should resume her normal activities, including walking and biking.

The only downside is this doctor doesn’t take insurance. So he costs a pretty penny (60,000 of them, in fact). But we like him. Zora’s next check up with him is going to be in two weeks.

So from now on, no news is good news!

Morning routine

This post will be blessedly short.

Here's the box of our medical supplies.



And Zora hooked up for her daily medicine. I tend to take mine at night, staight from the bottle.

Flowers for Zora

Thanks Andrew and Saskia. These are what they look like. Ignore the fact they’re sitting on a box. Space is tight. Appreciate the fact they’re in the kitchen, a place of honor.

Home at last

It was nice to wake up with Zora. Because of anxiety, she had some trouble getting to sleep. But hopefully that will get better. I least once she did get to sleep, the bedroom was dark and quiet.

We actually were awakened at 9AM by the nurse. Last night a guy brought a big box of medical supplies, drugs, and an IV stand. The nurse was very nice and showed us what to do. It’s once a day and takes about 2 hours total.

Someone will come tomorrow as well. But once we can do it on our own (it’s not too hard), a nurse will come just once a week.

Also, because I now have the images of Zora’s beating heart, you can actually see the growth. It’s a very cool program that shows many images of Zora’s heart pumping away. Not that I’m qualified to analyze it, but here it is. The little arrow is pointing at the vegetal growth. It’s just under 10mm long.


What you’re looking at is the left atrium (top) and the left ventricle (middle of bottom). The mitral valve is the horizontal band in the center. There is a left and right “leaf” to it. They meet in the center, close up, and prevent backflow (when they’re working right).

In the second picture is a moment later, the valve is starting to open, the growth starts to flop around a bit.




In the third picture, the valve is open, and the growth isn’t visible.


Watching the frames in live action, the growth most resembles a guy trying to hold on to a bunking bronco, hand waving, with hat in hand. Hold on tight, cowboy!

These images are from a few days ago. Hopefully things get a little better everyday. As my friend Jenny, the doctor, puts it, as Zora has been on antibiotics for almost two weeks, the growth coming off becomes “increasingly unlikely…—think of it like a cut—when it first heals, the scab is really friable and breaks easily but as it becomes more like scar tissue, it becomes less friable.”

Hospital: Day IX (2)

Zora is home! News today was as good as we’ve had in a while. We found a guardian angel. A friend of a friend of a friend who just happens to be a doctor at North Shore University Hospital. I won’t say too much, but we were very reassured that the risk of stroke isn’t as high as Zora had feared. The risk decreases an the antibiotics kick in.

There is a chance (not a great chance, mind you) that Zora won’t need surgery. This wonderful doctor also recommended the same doctor we just happen to have an appointment with on Monday. We also have all of Zora’s important records, which we would not have been able to get on our own. And we got to see the actual moving images of Zora’s beating heart. Indeed, there is a little thing flapping around on the mitral valve. Actually, two things.

What I don’t understand is why we have to have a friend who knows somebody so we can find a nice doctor who is willing to take the time and give us the information that should be standard M.O. (copy editors: is that redundant?)

A nurse will come tomorrow to set Zora up with the IV antibiotics, which Zora will have to take once a day for a while.

And thanks to Deb for her car! Here she is in her trailer at Socrates Sculture Park.




This is her truck I drove. I think this shot is really an excuse to showcase my trustworthy bike.




Zora is looking great, if tired. And ever so hot back in civilian clothes!

So unless bad symptoms develop (fever, shortness of breath, or stroke), the next step is the appointment on Monday. We won’t be going back to North Shore (and to think, I just bought a 10-pac ticket for train).

Driving to Manhasset, by the way, takes a bit less than an hour. But it’s far less pleasant than the 90-minute public transportation commute.

Also, Zora asked me to keep her from people asking how the hospital was. She’s happy to be out and doesn’t want to talk about it over and over again. And she also says that talk about heart surgery makes her feel faint.

Hospital: Day IX (1)

Zora will be coming home today, ensha allah. Zora texted me: “A new ID doc said risk was low and I can go. He even said, ‘you’re going to be fine,’ in a convincing way.”
More details when we get back.

Hospital Day VIII (2)

No real news today. Zora is still in the hospital but should be released tomorrow, hopefully in the morning. Strangely, the delay was with the insurance. You’d think they would be fast to approve a switch from hospital care to cheaper home care. But that is not the case.

I assume I’ll have to borrow a car from one of my two driving friends.

None of this is made easier by the transit strike. Which is 15 minutes away from starting. They don’t seem to be making any progress. But at least our favorite NPR reporter and occasional Sunday-night dinner diner, Beth Fertig, on the transit beat, is reporting up a storm.

We made an appointment with another doctor, for Monday at 11AM.

If there is a strike, I think we’ll stay with our family friends on the Upper East Side Sunday night. We could then walk to the doctor’s office from there. What a pain. I may have to push Zora over the Queensboro bridge on her bike. I wish I were joking. The problem isn’t just the lack of transit (I mean, we’d probably take a car even if the trains were running). It will be the impossibility of getting a car and having that car get through traffic.

If only it weren’t for this potential fatal heart problem, I’d be kind of giddy at the thought of the transit strike, as I zoom around the city on my bike. But not this year.

There’s also this web-savvy Dr. Gammie in Baltimore. I sent him a question over the web last night. He responded quite quickly:

Dear User,

Your question was as follows :

Dear Dr. Gammie,

My 33-year-old wife is in the hospital with sub-acute endocarditis (viridans streptococcus). She was symptomatic for endocarditis for 2 months before antibiotics began. She has been on antibiotics for 7 days. The cause of the endocarditis is unknown (no previous IV drug use or surgery).

Because of the results of a trans-esophageal echocardiogram, doctors believe surgery is needed. The problem is on the mitral valve. There is “moderate to large” vegetal growth on the mitral valve. Leakage is considered “severe.” Yet she is not short of breath and outwardly symptomatic.

Given her age and overall good health, we would very much like to avoid valve replacement. Is surgery even necessary? If it is, could we wait till symptoms develop regarding the leakage and take our chances with the growth.

Assuming surgery is needed, can you offer advice on the possibility for repair, given both the leakage and the vegetal growth?

Yours,
Peter

Here is Dr. Gammie's answer:

Hi Peter:
happy to help; i have a very strong interest in this process; we do a LOT of mv surgery for endocarditis at the univ of md (i have done 55 cases in last 3 years); basically, the fact that mr is severe means an operation is necessary; if the vegetation is large and the infection is controlled (ie, no fevers etc) would move to operation rapidly, as there is a risk of embolization (ie, vegetation breaks off and causes a stroke or something else); the overall repair rate for mv endocarditis in the usa is about 25-30 percent, based on a paper i wrote in annals of thoracic surgery this year; in our experience at the university of md, repair rate is 70 percent; would be happy to take care of your wife, please call us at ...; if you can't reach me via that route, page me at ... hope this helps jim gammie


Please do not reply to this Email. Visit www.umm.edu to post any further questions.

Thank you,

Ask The Expert Administrator

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Seems a little strange to contact a doctor in a way you might ask for the best way to find a old bike frame or a cheap date. And he comes off a bit like a used-car salesman. But if he can fix Zora’s valve rather than replace it, I’ll buy the extended warentee. He also has a lot of posts on on-line medical posting boards (to other doctors). So I’m kind of hoping he’s just a tech-savvy geek. And I really like how his speciality is “Mitral Valve Repair” and not “Mitral Valve Repair and Replacement” like all the others cardio surgeons list.

I’ll call him in the morning.

I was able to bring Zora her e-mail and a copy of my blog. I just text-messaged Zora to ask if she had any more words to her fans. She replies: “Uh, rock on? I’m going to pee, and then maybe the strike will magically be resolved.” She adds in a 2nd message, “Do say thanks for all the nice emails and calls, especially from the super secret copy editors’ network.” Just for the record, her text messages are always perfectly spelled and correctly punctuated.

Oh, Grant and Victoria, Zora did get your flowers. Just as she was being wheeled out of Forest Hills a few days ago. The other flowers were left behind, but yours made the move as I was able to hold the box in my hands. So now those are the only blooms gracing her bedside. Funny, I’ve never bought my wife flowers (I’m not proud of this fact… I’m just saying). And they way people are sending them, I may never have to.

I also learned, thanks to that trusty dictionary, that vegetal isn’t quite the same word as vegetable. They just both come from the same Latin root, vegetare, to grow.

Now Zora text messages me: “Goddamn it. Stupid cardio guy just showed up to tell me I really shouldn’t leave, and then said he was trying to be mellow and balanced. I told him he was in fact the most alarmist of all the docs, especially thanks to his bad timing. But being mad at him just makes my heart rate go up.” Oh, and then she corrects a typo in her previous message to the copy editors.

I wish there were easy answers. She would love to be home. And would be healthier at home, especially if she’s got to go into surgery. And the risk of embolization is lower, as the antibiotic treatment goes on. But of course there still is a risk.

Her main complaint through all this is lack of good sleep. We also can’t get an answer as to just how big this growth is (more than 10mm would be very bad). What to do?

Hospital: Day VIII (1)

I’m off to the hospital. Zora said the ball is rolling on getting her released. But it probably won’t happen today. So feel free and visit. First the home-care people have to come. And well, everything works very slowly at the hospital. And she’ll get any e-mail that was sent to her as of an hour ago. I’m bringing her e-mail to her on a disk. Hopefully the tech won’t fail us and she can import the file and read everything.

M-I-T-R-A-L. And I can use it in a sentence.

I’ve learned a lot about the mitral valve the past 12 hours. Starting with the spelling. Luckily, I’m a quick learner. Based on a flurry of, well, web research, valve replacement doesn’t really seem like an acceptable option. At least as long as Zora is outwardly asymptomatic for valve leakage. Valve repair has got to be Plan A for any surgery. Maybe the wisdom teeth analogy isn’t so bad. Except, of course, that unpulled wisdom teach won’t kill you. There is that vegetal growth issue.

Still, tomorrow, I think the important thing to do is get Zora home, if possible. And then try and get her to a different hospital, like Columbia Presbyterian. And interestingly, University of Maryland Medical Center in Baltimore is very proud of their repair/replacement ratio. Interesting, because I didn’t think I’d ever want to go to Baltimore for anything other than crab cakes or heroin. Actually, I know that hospital pretty well, as Shock Trauma. It’s where all the seriously hurt cops go. I’ve seem a few bloodied friends of mine there. Most of them pulled through. It’s a good hospital.

Hospital: Day VII (2)

The news was not good today. The results from the trans-esophageal echocardiogram came back and the doctors believe that heart surgery is required. Assuming that happens, it won’t happen for at least for another 7 to 10 days. First her blood has to get clean. So she needs to continue her antibiotics.

There are three main doctors involved with Zora: the cardiologist, the infectious disease doctor, and, now, the cardiothoracic surgeon.

I knew there was trouble with the cardiothoracic surgeon, Dr. Sheel Vatsia, came into the room. He was a man I didn’t want to see. He described the surgery as “inevitable.” Zora was still a bit groggy from the echocardiogram and the surgeon was off to operate, so he didn’t have a lot of time. But wanted to tell us the news. “He’s very good,” someone told Zora, “he operates on infants.” Yes, but are they sick?

Dr. Vatsia said that he would go into the heart and try and clean it up. Depending on what he saw while operating would determine whether or not the valve would be replaced. Repair is definitely a better option than replacement.

There are two problems, both involving her mitral valve. The mitral valve is on the left side of the heart. Quick biology lesson: blood comes in to the right side of your heart, which pumps blood to the lungs. Then the blood goes back to the left side of your heart, which does the hard work, pumping blood to the rest of your body.

Problem one is the “severe” leakage of the mitral valve. Two flaps are supposed to swing shut when the heart pumps. If this doesn’t happen, then blood is being pumped back into the the left atrium and the lungs. Blood backing up. Very inefficient.

Problem two is the “moderate to large” vegetal growth of bacteria, again on the mitral valve. The fear is that this breaks free, goes to the brain, and causes a stroke. The cardiologist with a horrible bedside manner, Dr. Sumit Mittle, also said that surgery was needed, but seemed a little less insistent that the surgeon. The third doctor involved, the I.D. man (and Northwestern graduate), Dr. Bruce Farber was not present today (at least when I was there).

Zora wonders if there’s a parallel to dentists wanting to pull your wisdom teeth. Sure it may be better, but is it needed? I guess that is what second opinions are for.

Meanwhile, a family friend proposes that Zora gets transferred to New York Presbyterian Hospital. North Shore University is good, but perhaps Presbyterian is better. It is certainly closer. We’ll see.

Zora’s main complaint right now is having to stay in the hospital. Outwardly, she seems perfectly fine. So we’re trying to spring her tomorrow. Because she can continue the IV at home. This will be up to the I.D. doctor. Zora feels like if she has to have surgery, she’s not really in a position to get her strength up while staying in the hospital. We can bring her food. But she can’t get a good night’s sleep there.

The PICC line is the key to her trip home. Zora’s worried about a slight redness around the PICC line. Hopefully this isn’t an infection (how could it be with all the antibiotics?). So hopefully it’s fine. But again, we’ll see. It certainly would be nice to have her here.

For those wanted to visit. Here are a few more details on the journey to North Shore University. Again, we’re going to try and get her home tomorrow. But who knows? Take the LIRR to Great Neck (next stop after Little Neck and before Manhasset). $6. From there take the N25 bus (metrocard taken) to the Hospital. The bus leaves from the outbound side of the train station. Go to the street and walk forward a bit, to the second bus stop (just past the first bus stop). The train ride is about 20 minutes. The bus about 10 minutes. The connections actually work pretty well. Door to door (from Astoria) it’s an 80 to 90 minutes journey.

Google "mitral valve repair replacement endocarditis" for many interesting links.

Hospital: Day VII (1)

I just got this text message from Zora (11:41AM): “Motion towards test, finally. Next phase--waiting around in a wheelchair.” I’ll be off for the hospital soon.

Hospital: Day VI (2)

There is no real big news today. Zora moved hospitals. But the big test is tomorrow. If all goes well, in the best case scenario, she could sleep in her own bed tomorrow night! But still hooked up to IV antibiotics every 8 hours for the next three weeks.

If the test doesn’t go well, well, we’ll see. But I like to be optimistic. The bad option would be “vegetation” (aka: bacteria) growing on the heart that could break off at any moment and lodge in a strange place and cause a stroke. Or something else needing open-heart surgery. Interestingly, the leaky heart-valve issue wasn’t mentioned today. We won’t know till tomorrow. But I’m feeling more hopeful than I was two nights ago. But who knows?

So I got my Vietnamese sandwiches (“Awesome!”). Details on that adventure I’ll post elsewhere.

I arrived at Forest Hills hospital at 2:45 PM. The paramedics where already there for her 3PM appointment and ready to take her out. That’s the first time in all these days that anything has been early. The kind paramedics took me along (even though they’re not supposed to—for legal reasons) because they felt sorry for poor public-transportation dependent me. And truth be told, getting from Forest Hills to North Shore University would not be an easy trek.

After a long and slow drive through New York City traffic, through a part of Queens even I consider “outer borough,” we arrived at the new hospital. It’s a big complex. Still not Johns Hopkins in size. But clearly “the real deal.” The paramedics assured me, “you’re going to like this place.” Like it’s some resort. That being said, it is a noticeable step up. All the hooks on the bed partitions are in place. The doctor-and-nurse-of-the-day notice board are up to date. There are two, not three, patients per room. The room bathroom is “for patients only.” They put a pink band around Zora’s left arm (the one with the PICC line) indicated that you shouldn’t do any tests on that arm. Even the Christmas decorations are much more fancy.

That might look like just a snow globe to you. But first of all it’s the size of the hallway. Second of all there’s some constant motion that looks like a waterfall that doesn’t come up in the picture. The hospital seems very ship-shape. At least by comparison. In fact, it feels just like it is: a move from Queens to the richer suburbs. I’m sure a move to Manhattan would be similar, but with a more liberal urbane feel. And nothing that says, “Christmas.”

Before the move, the old, nice, I.D. doctor said, among other things, “the I.D. doctors there are better than me.” Not only was he good. But he’s modest too! I’m glad Zora is already taken.

[By the way, word on the street is (i.e.: one paramedic told me) that Astoria Hospital isn’t really a place you would want to be.]

Anyway, they took Zora, but only after strapping her down like a mental patient. I kind of got a kick out of that. She couldn’t even move her arms. Tee hee.







This is her arrival at North Shore.


Here’s her new bed.



Once we got settled in, Tamara came with dinner.


Tamara and I caught the 8:30 bus to LIRR. The train to Woodside, and then the 7 to the N home. It all worked very well. It’s certainly not as convenient to get to Forest Hills. In fact it’s a pain in the ass. But, given that there may be a transit strike Friday, transport could be for the better to North Shore. I can always bike to Woodside. Of course, I could always bike to Forest Hills. I guess the real issue is that fewer employees at North Shore are likely to be affected by the strike. Or so I hope.

There was just enough time waiting for the train to get a few beers (“Tamara,” I said, “If I don’t make it… just go on without me!” She said, “I’m not leaving you behind.” Until I told her that the next train was in an hour.) Here Tamara is on the 7 Train (for those who care: notice the bucket seats facing in. Neither of us have ever seen that before).



Tamara said she had never drunk a beer from a paper bag. Say what?! From someone a double-wide and a chain-smoking Virginia-Slims habit away from being white trash, she has a strange sense of propriety and decency. On a hot summer day (OK, sometimes other times, too) it’s one of the great privileges of living in New York. I don’t want to say it’s encouraged, but bodegas (corner stores) are open 24 hours, sell and price beers singly, place your beer in a paper bag, and, if you buy a bottle that needs an opener, pop it open for you. I asked Tamara, “you’ve never walked down the street with a beer in a paper bag?” She answered, and I quote, “I only walk down the street with a drink in a glass.” Uh, you go, girl.

You can drink beer legally on the LIRR and most communter trains, by the way. It’s like the Eddie Murphy skit where he disguises himself as white and the then gets to ride the bus for free. Why do white folk get to drink a beer on the way home while we city folk don’t? Ain’t right, if you ask me.

So Zora will (again) eat her last food at midnight. And hopefully the echocardiogram will come out well in the morning.

Last, I just have to post this very sweet e-mail I got from one of my Turkish students. Just be happy you don’t have to grade their papers: “Today we have been sadly learned that madam has been taken to hospital upon her sudden feel of unwell. I hope she will get better very soon.” That sure beats a Hallmark Card.

Hospital: Day VI (1)

Zora still hasn’t been moved. Apparently there are insurance issues(?). But I did call a call with caller ID from “North Shore Hea…” asking for admittance. Strange. That makes me think something is happened. If not, that’s a very strange coincidence.

I’m off to get Vietnamese sandwiches for when Zora can eat again. Does insurance know that she can’t eat?! And then I can take the J or Z line out to Jamaica (Kind of fun for me because I’ve never taken the J or Z line in Brooklyn--And it’s above ground!). Once I get to Jamaica, either Zora will have already been moved, and I can hop on an LIRR train from there. Or, if she’s still at Forest Hills, it’s a short ride back in on the E. I’m so clever. And just the mere mention of those sandwiches made Zora say, “Awesome!”

Hospital: Day V

No real news today. Zora didn’t switch hospitals, but she will tomorrow, they say. She’ll be going to (I think) North Shore University Hospital. You can get there by taking LIRR to Great Neck on the Port Washington Branch Line (basically every half hour, about 30 minutes from Penn Station, 20 min. from Woodside). From either train station, take the N25 bus (suburban in frequency). Or it’s about a half hour walk (1.75 miles). Take the bus. There are also, of course, cabs at the train station.

On the plus side, there was a very reassuring phone conversation with my friend, Jenny, the doctor (Sorry I keep saying that. But the Jewish mother in me just loves adding “the doctor”—there’s an old joke about a mother crossing the street with her son and her son gets hit by a car. The mother says, “Somebody help! My son, the doctor, just got hit by a car.”).

Mind you, Jenny is in Boston so it’s not like this is a hands-on diagnosis, but she says she can’t really see a reason why they would be talking about heart valve replacement at this point in time. Mind you she said it with a lot more big words and concepts than I’m telling you here. So we’re still hoping the heart-surgury part is just a false alarm.

Zora herself appears to be functioning just fine. She’s not short of breath or anything like that. And, so I hear, a leaky valve in-and-of-itself is not sufficient cause for replacement. There could be some other reasons it may have to be replaced, but these reasons still seem to be more hypothetical.

It’s nice to talk to a doctor you know and like. Jenny, my friend the doctor, and I have been good friends since high school. In fact, the first time I was ever in New York I was visiting her as a big college freshman at Columbia. Then, the three years after that, I was just jealous as Jenny was still in New York and I was in New Jersey. Why didn’t I go to Columbia? Oh yes, of course, then I wouldn’t have met Zora!

And oh yeah, it turns out that the cardiologist doesn’t have a good bedside manner. The one with the good bedside manner is the infectious disease doctor (we call that the “I.D. doctor,” for short). The cardiologist is the S.O.B. that runs in at midnight, wakes up Zora and says with glee, “You’re going to have heart surgery. Good night.” Anyway, hopefully he’s more enthusiastic than knowledgeable.

Zora also got moved out of the cardiac section. To the same floor. Now she’s in room 500. But that should just be for the night. Still, I guess that’s a step up.

I forgot to bring my camera today. Alas. So I don’t have any pictures of the room change. Or the other visitors. But you get the idea.

More upsetting is that Zora has joined the patient cognoscente and now sports two hospital gowns, one facing forward and one facing back. It’s much more covering, to my dismay.

Still at Forest Hills

Now Zora thinks they're not going to move her today. In part because they're letting her eat. Anyway, I'll be off to the hospital soon.

Leaky valve?

Zora's cardiologist (with a very nice bedside manner) seems to think that Zora will need a heart-valve replacement. But the trans-esophageal echocardiogram hasn't been done yet. So hopefully all this is a false alarm.

Zora thinks they're going to move her to the other hospital in the late afternoon.

Hospital: Day IV. Sunday Night Dinner

No real news today. Zora had friendly visitors. Karine covered the morning shift when they decided rather abruptly to move her to the cardiac unit because her blood pressure was low. But that was just because she had just awakened. It’s strange, Zora points out, that you’re supposed to recover, yet it’s very hard to get a good night’s sleep.

There was a comedy of errors in the move from 6th floor to 5th floor. Like bumping the bed into other things (like other patients) on the way out. And then there was some air in the catheter fear. Luckily, there was no harm and I missed it all. It was good Karine was there. And Karine did write me some very nice notes with all the highlights. I’d reprint them here. But I left them there.

Tomorrow Zora gets moved to another hospital for the echocardiogram. We don’t know if she’s going to stay there or if she get’s shuttled back and forth. It’s very hard to find out information in a hospital, I’m learning. I took some of Zora’s things to make the move easier, including her computer. So she can’t check e-mail.

Deb and Joel were there when I got there.




We almost always have a nice Sunday night dinner. Almost always at Tamara’s place. Tamara cooked dinner and brought it to the hospital. It was a nice chicken. A fennel salad. A bottle of wine. A loaf of bread. It was delicious. Meanwhile the neighboring patients (the rooms are triples) had the TV on with musical numbers on public television. It was actually nice background music.





I love that it’s published by “cook.”


Me and Zora.




I brought the miniatures.
Hey, just because she’s in the hospital doesn’t mean we can’t drink.

Hospital: Day III

Zora is not getting out of the hospital on Monday. They’re going to give her a trans-esophageal echocardiogram, which involves sticking something down your throat to get a closer look at the heart. I don’t know if this is purely “just to be on the safe side” or if they have reason to think there is more serious damage. Either way, they’re going to do it in North Shore University Hospital in Manhasset, another hospital that’s part of the North Shore-Long Island Jewish Health System chain (known for it’s excellent cardiac treatment, by the way).

Zora also called this morning to say they’re going to move her to the cardiac unit. So she won’t be in Room 601. I assume she’s going to be hooked up to a beep-beep machine (she has extra earplugs). And they may be more picky about cell phone usage. I don’t know. But you can still visit.

For those who can’t visit, here’s my virtual visit:

The entrance.



The sign-in desk.



The elevators.



Ding!



The Shabbat elevator is slow. And no matter, I like to live on the edge and push buttons on the Sabbath!



Welcome to 6 North.



Room 601.



Zora's bed.



In the room.



le menu



le dinner



le chicken cacciatore?


Zora was defending the food for a while. It’s not that bad. But I think she’s finally getting sick of it.

le patient



les visitors. This is the CASA crew that was together in Cairo many moons ago.



my new hip looks like a kickstand!



state sponsored health ads



Orange whip? Orange whip? Three orange whips!