Sandra Peralta, Badass

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Christmas 2018

Early last Wednesday morning, Sandra sat alone in the lobby of the cardiac procedures unit at Kaiser Santa Clara Medical Center. The bright lights and intensity of the cardiac ICU faded into the background of the joyous Christmas and New Year season. Inside the unit, a surgeon was replacing the implantable cardioverter defibrillator (ICD) that was placed into my chest in 2011.

An ICD is a small device designed to deliver a shock to a heart that goes out of rhythm. A surgeon cuts a 3-inch incision into the upper chest and places the ICD into the tissue. It’s like dropping the device into the breast pocket of a dress shirt. Waiting while a surgeon performs a procedure on her husband is old hat for Sandra. She felt lonely and helpless as usual, but put the outcome in God’s hands as always.

A little more than an hour after she left me in the surgical prep area, the surgeon came out to the lobby to tell Sandra that the procedure went perfectly. Shortly after that, she was in the recovery room laughing at my corny jokes caused by the light anesthesia. On doctor’s orders, I spent the night in the hospital for observation.

Over the past 9 years, Sandra has endured over 120 nights in the hospital to be by my side. This time, I finally persuaded her to go home and sleep in her own bed. The past two and a half months have been especially hard on her. Reluctantly, she agreed to go home. Alone in a dark hospital room, I thought about her and our life together.

To borrow a phrase from today’s young and ambitious women, Sandra is a badass. When we met, I was like a ship floating aimlessly in the vast ocean. I had big dreams and ambition without focus or purpose. As Sandra still says, I’m a dreamer. As our relationship grew, so did the dreams and ambition. When I fell in love with her, my life’s purpose came into focus.

For those who don’t know, let me tell you who Sandra Peralta is. She’s an amazing mother who continues to guide our two adult daughters. She was a star student in grade school, ASB president at her high school, and an award-winning elementary school principal (2013 Silicon Valley Principal of the Year). She’s done it all with the utmost grace, integrity, and compassion.

She would vehemently disagree that being my life partner has been the most challenging part of her life. But, it’s true. While I traveled around the country as a corporate executive, Sandra took on the lion’s share of raising our two wonderful girls. When I knocked on doors campaigning for public office, she walked door-to-door with me. She has been my guardian angel since a heart attack changed all of our lives in 2010.

I’m a driven and independent man. No matter the circumstance – chasing professional success or living with compromised health – my love for Sandra has always led me to support her dreams and daily obligations. But let’s face it, living a full life with a compromising illness can’t be done alone. Even stubbornly independent people like me require substantial support.

Since open heart surgery in November, I’ve been pretty high maintenance. I haven’t been cleared to drive, so Sandra takes me to the many doctor appointments. The dressing for the wound on my chest needs to be changed daily. I have a small opening in my abdomen for the electrical wire that powers the pump connected to my heart. That needs to be dressed every other day.

Sandra changes the dressings every evening despite managing a full work schedule and helping her sisters care for elderly parents. She learned how to dress the wounds from the LVAD team at Kaiser. I want to take over these responsibilities, but she’s not ready to delegate them to me. I could insist to do it myself. However, if I’ve learned anything in our 30-plus years together, insisting isn’t such a smart idea.

We both have heard many stories about how chronic illness breaks up marriages and causes irreparable harm to families. In fact, according to the AARP, “the divorce rate for couples in which one spouse has a serious chronic illness is as high as 75 percent.” This is especially the case in younger couples. I was 46 and Sandra was 43 when disaster struck in 2010.

Financial stress and lifestyle changes that limit activity are major reasons that lead to tense marriages. Our annual income dropped significantly when I could no longer command an executive salary. With a hefty mortgage and two teenage daughters looking ahead to college, our finances were stretched to the limit overnight. Family gatherings, community events, and our social calendar took a backseat to the illness.

Added to those trials, depression and anxiety in a chronically ill partner bring feelings of inadequacy, self-loathing, and shame to an already strained relationship. For caregivers, fatigue, impatience, and resentment seep into their daily lives. Together with financial and lifestyle changes, the mental health of the couple is a train wreck waiting to happen.

Sandra and I have experienced and continue to face all of the tests that confront a couple with a chronically sick partner. In his oft-quoted first letter to the Corinthians, St. Paul the Apostle wrote that love, “always protects, always trusts, always hopes, always perseveres.” Somehow, Sandra, the girls, and I have persevered.

I truly believe that Sandra’s strength is the reason that we’ve weathered so many storms. She has an unshakeable faith in God, an uncompromising will, and a limitless reserve of hope. More important, she truly loves me, Marisa, and Erica. St. Paul also wrote, “And now these three remain: faith, hope, and love. But the greatest of these is love.” That’s Sandra.

I can’t help but wonder at the amazing gifts that God bestowed on her. I’m eternally grateful that He made our life together the primary beneficiary of her talents. She has many titles: Mother, Daughter, Sister, Wife, Comadre, Caregiver, Teacher, Principal, School District Administrator. Yup, she’s a badass!

 

Oh Boy!

 

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On November 29th, I visited with the cardiovascular ICU team a day before going home.

Oh boy…

***

I was sitting alone on a folding chair in the lobby of an upscale social club. Double doors opened up to a long marble-floored hallway that led to a podium where the club’s director stood managing traffic. On one side of the hallway was a casual bar where cocktail tables dotted the linoleum floor and flat screen TVs lined the walls. Wearing medical scrubs, club members relaxed at the tables sipping drinks after a long shift.

 On the other side of the elegant hallway was a stately dining room. Guests sat at round linen-covered dinner tables. The well-dressed club members enjoyed gourmet meals, chatted over drinks, or played cards. The clientele was an eclectic mix of doctors, hospital administrators, business executives, and public officials.

 The club director was a tall, dark-haired, and handsome young man in his early 30s. Wearing a navy blue blazer, charcoal trousers, a crisp white shirt, and a royal blue tie, he looked regal standing at the podium. He welcomed club members with a warm grin and a gracious southern drawl. Even though he wore a yellow surgical mask, you could see his eyes smiling above the sterile covering.

***

The passage above never really happened. Or…maybe it did.

For a few days after the surgeon successfully closed my chest cavity, I remained on Propofol as doctors and nurses watched over me. This drug is a powerful sedative that’s used for major surgery. It gained notoriety almost a decade ago when singer Michael Jackson famously died of an overdose.

When administered correctly by an anesthesiologist, Propofol is invaluable as its properties keep patients asleep during surgery and causes memory loss while sedated. The medication worked like a charm for me. I don’t remember anything about surgery or the days afterward when my chest was wide open.

According to the Journal of Neurosurgical Anesthesiology, hallucinations are common for patients that receive even a modest dose of Propofol. As the sedative wears off, the dreams are referred to as post-operative delirium. Some hallucinations are based on reality. In other words, activity happening around the patient could be translated in the brain in a different way.

I’m pretty sure that post-operative delirium danced around in my mind as the Propofol slowly left my system. The passage above is in italics because it was part of the hallucinations. I experienced this phenomenon in 2010 when I spent the summer in the ICU. I wrote about this in an earlier post (Check out my blog post from June 22, 2016: https://esereport.com/2016/06/22/summer-in-the-waiting-room-how-faith-family-and-friends-saved-my-life-excerpt-52-new-excerpt/).

The “social club” hallucination is based on real events. I remember so many of these types of dreams from the summer of 2010. Interestingly, this time I subconsciously understood that my experiences weren’t completely true while I was still emerging from the delirium. When Propofol finally washed out of my system, I intuitively knew that something went wrong again.

When I described to Sandra what I knew was a “dream,” she recounted real events in the ICU. The well-dressed club director was actually a nurse who cared for me during the days when I was emerging from the fog. That explains the yellow surgical mask. Sandra said that the nurse stood at the door to my room typing into a laptop that sat on a podium.

In the “dream,” I remember having conversations with doctors, nurses, physician assistants, and the hospital’s managing executive. All these people were members of the social club in the hallucination. One incident I will never forget from the delirious dream was the club’s director cheering me on as he helped me to walk. According to Sandra, all of these events happened while I was in the ICU.

Many characters came in and out of my dreams. I reconnected with old friends and welcomed the faces of family. While all of this was happening in my confused brain, I was semi-conscious and talking to people in the real world. During the first few days of consciousness, I borrowed a phrase (“oh boy!) from my Compa Pancho. He uses “oh boy” when he’s surprised or bothered by something.

I must have sensed that I was in medical trouble. Everyone who visited my room one day remembers that I repeated, Oh, boy!” at least a million times in a hoarse and whispered voice. This brought comedic relief for my family and the ICU team. My daughter Erica described me as my usual goofy self, but “just extra.”

I held court by telling stories that didn’t make sense, many replete with every variation of the F-word like a character from The Sopranos. I invited nurses to join me and Sandra for dinner and a movie. I tried to convince one of the Kaiser speech therapists that we worked at Comcast together. Although she had the same name as a former colleague, she never worked there.

The patience and professionalism of the cardiovascular ICU team was astonishing. The team cared for me with warm smiles and supportive words throughout my state of silliness. Going through this experience for the second time was frustrating and a little scary. It also gave me hope. It meant that I was alive and in the beginning stages of recovery.

***

President Trump stood next to a conference table at one of his resorts. As the president walked toward his office, he looked tired and aggravated. He wore an ill-fitting business suit and his infamous hair was messy. Sandra greeted Trump in the hallway with a hug telling him that she was honored to meet him. Watching from a hospital bed in another room, I was disappointed with Sandra.

***

How Sandra and I ended up at a Trump resort during my delirium is a story in itself. Friends and family who visited the ICU told me how I recounted the story of Sandra hugging and complimenting the president. In a raspy voice, caused by the breathing tube that was in my throat for almost a week, I summoned visitors closer to me so I could describe the scene.

Oh boy!

**********

Next Time: Beginning the long road to recovery

 

 

 

 

 

 

 

 

 

 

 

 

God’s Birthday Gift – Another Miracle

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Pastor Brandon Bryand, my lifelong friend Rudy’s son, leads a prayer circle in the cardiac waiting room at Kaiser Santa Clara Medical Center.

November 6, 2018, my 55th birthday, was a day filled with hope and excitement. The night before, Monsignor Francisco Rios joined me, my family, and a few friends in a hospital room at Kaiser Santa Clara Medical Center. He led prayers for a successful open heart surgery the next morning. The 30 or so people that crowded the room sang Las Mañanitas, the traditional Mexican birthday song.

In the morning, the surgical team and cardiovascular ICU team sang happy birthday before wheeling the gurney into the operating room to implant a mechanical pump called a Left Ventricular Assist Device (LVAD). The procedure is straightforward. A surgeon cuts an incision on the chest, saws through the chest bone, opens the ribcage, inserts the titanium device into the lower heart, wires the chest bone together, and closes the incision. The operation typically takes 4-6 hours barring any complications.

Kaiser Santa Clara Medical Center established the LVAD program in 2017. The hospital hired the surgeon who participated in creating the program at Stanford Hospital. While there, he successfully implanted 250 LVADs.  After more than a year of planning and assembling a team, the surgeon performed the first procedure at Kaiser about month before my surgery. I would be the second patient at Santa Clara to undergo the procedure.

Doctors were concerned about the condition of my heart. For 8 years, the right side was compensating for the damaged left side. The transplant evaluation confirmed that the right ventricle that pumps blood into the lungs was getting weaker. This causes elevated pressure in the arteries that carries blood to the lungs. The condition called pulmonary hypertension could be fatal during and after surgery.

In the months prior to the operation, doctors prescribed medication to relieve the pressure caused by pulmonary hypertension. This strategy worked until the weeks before surgery. During this time, I increased my activity level in a sort of “nesting” way. I wanted to make sure that my personal and professional affairs were in order before undergoing a major procedure.

When I checked into the hospital on November 2nd to prepare for surgery, the lead LVAD doctor approved the use of intravenous Milirinone, a short-term drug that helps the heart beat stronger and decreases pressure in the arteries that pump blood into the lungs. With that stress relieved, Sandra and I spent the next 3 days learning about the LVAD and post-operation care. The plan included up to 2 weeks in the ICU and another couple of weeks in the cardiac unit of the hospital.

After the festive singing of Happy Birthday on the morning of the procedure, the surgeon led an entourage of doctors, physician assistants, nurses, and support staff into the operating room at 8:00 AM sharp. Sandra, the girls, and a waiting room filled with family and friends anxiously settled into what was sure to be a long morning and early afternoon.

Just before noon, a physician assistant came out to inform Sandra that everything was going well. The surgeon successfully implanted the LVAD and was preparing to begin the chest cavity closure process.  The waiting room erupted in cheers and a round of hugs. With the nightmare of 2010 still lurking beneath the surface of everyone’s memory, relief and gratitude filled the space.

For the next couple of hours, there was a relaxed mood in the waiting room. After getting a quick bite to eat, family and friends settled down in anticipation of the surgeon confirming that the procedure was complete. The room grew tense and concerned as the hours began to tick by. Finally, the physician assistant emerged from the waiting room with additional news. This time the news wasn’t so good.

The physician assistant reported that complications delayed completing the procedure. The surgeon and his team were diligently working on resolving the issues that prevented them from finishing. Once an update was available, a report from the operating room would be forthcoming. Everyone sat in stunned silence with the ghosts of 2010 swirling around the room. Prayers and whispered voices replaced the animated chatter and joking from 3 hours earlier.

Later in the evening, the surgeon provided a briefing to Sandra and the girls. Although he looked concerned, he still showed the same confidence we became accustomed to. As feared, the right side of my heart reacted negatively to the procedure. This may have caused inflammation of the lungs. My lungs were too swollen to close the ribcage and complete the procedure. Also, the heart had grown so weak that any contact with the heart tissue caused it to bleed into the chest cavity.

The good news was that the LVAD was working. With that in mind, the surgeon’s strategy was to leave my chest cavity open until the right side of the heart pumped efficiently enough to decrease the swelling in the lungs. He also inserted 3 tubes into the chest cavity to drain the blood that was pooling around the heart and lungs from the internal bleeding. After answering a blizzard of questions from Sandra, the surgeon returned to the operating room.

When Sandra and the girls were allowed to see me in the ICU, they found me in a deep sleep from the sedative medication. I had a breathing tube inserted in my throat and 3 tubes draining blood into 3 canisters sitting on the floor next to the bed. The gap in my chest was held open by a clamp-like device. A skin-colored mesh dressing covered the 8 inch by 5 inch opening. Sandra and the girls could see blood flowing and my heart pumping through the sterile mesh.

For the next 4 days, I remained in this condition as the surgical team ushered me from the ICU into and out of the operating room. On the second day, my heartbeat raced to unsafe levels as it struggled to find a rhythm. Doctors administered many electrical shocks to pace my heart. During one of those incidents, I was in the hallway being transported to the operating room when family and friends heard a doctor shout, “clear!” My body convulsed from yet another shock.

Finally, on November 11th, the surgeon emerged from the operating room with a wide grin to announce to Sandra that the internal bleeding had stopped and my lungs were no longer swollen. The procedure to close the opening in my chest was successful. As Sandra listened to the surgeon, she could see and hear his team in the background near the operating room doors joyously clapping, hugging, and high-fiving each other.

The dedicated surgical team remained in the hospital throughout the 5-day ordeal. The surgeon who came to Kaiser Santa Clara Medical Center from Stanford to start a state-of-the-art LVAD program kept vigil outside of my ICU room the entire time. There was little doubt of his commitment and dedication. His determination literally saved my life.

Some people mentioned to Sandra that I must have some sort of strong and amazing will to live. That will had to come from deep in my soul, they reasoned. Nothing else could explain the vigorous fight I put up while heavily sedated and unconscious. At first glance, that reasoning makes sense. It’s one thing to be conscious with the ability to make the decisions to do what it takes to survive. It’s another when no conscious control exists.

That’s where faith comes in. Sandra and I relied on our unconditional faith in God to provide answers to my unconscious will to live. We went into the week with hope and the comfort of knowing that the outcome would be in God’s hands. As it turned out, another hopeless medical crisis ended in a miracle. I’m comforted that God will determine when it’s my time to leave this world. That week, my faith journey reached new heights.

With God’s grace, a talented surgical team, and a supportive community of family and friends, my life was extended yet again. At that moment, I was still in critical condition. The following days would surely be difficult, but hopeful.  November 11th ended the same way the previous 5 days had. The waiting room gathered in a prayer circle to thank God .

******

Next Time: As I recovered from surgery and powerful sedative and pain drugs, I lived in a fantastical dreamlike world caused by ICU delirium.