Home in the good ol USA. Nan is doing well.

Dear Family and Friends,

Since Art was kind enough to blog for us last evening much has happened. As you know we were escorted off the ship and into a waiting ambulance Mexico style, all our luggage, wheel chair, Nan on a gurney and an attendant and the driver. We raced to the hospital which did not look so good from the back side where we entered. The floors were tile, the room was clean and there were three nurses ready to help us but no english could be found anywhere. Eventually the doctor who met us on the ship arrived and then an internist and then an oncologist. Nan was undressed rapidly and a nice johnnie was put on, blood was drawn with a huge needle but in the first stick and after a couple hours we were wheeled to the elevator and up to our room on the 4th floor, wow what a room, it was huge, had a private bath and a nice place for me to sleep. The doctors tried to catch up with the complicated patient Nan is and then started IVs of antibiotic. They also decided that she needed a transfusion which is of course the reason we were removed from the ship. The hemoglobin was 7. The doctors were in agreement that Nan needed to be mediflighted to her home hospital and told Amy from Travel Guard that from the beginning. She was very proactive making calls to the ship, the hospital, the doctor and my cell to keep us all heading the same direction. Mid afternoon we were told in broken english that the blood had been found. We were amazed since it often takes two days to locate blood for Nan's rare antibodies here in the states. WE were both very concerned about the blood supply in Acapulco but the doctor told us that the supply was carefully screened, we will see. Then the fun began. Early evening the first unit of blood was delivered and the nurse walks in and hangs it up and connects to the PICC line expecting it to just flow in. WRong. You have to use a pump since the PICC line puts up considerable resistance. We tried to tell her but our english words fell on deaf ears. For two hours she tried everything to no avail. We finally asked to have them call the doctor and he told them to use a pump, then he came in to make sure they did. Then for the next hour they could not get the pump to work. All the while the blood is warming and not getting into Nan's body. Finally the stubborn nurse went to get another pump but the doctor came back to tell her, just do a new IV, Nan was horrified but they came in with a big needle, found a vein and then the blood flowed well. Then Nan's heart rate started to increase signalling the beginning of a new fever. We asked for Motrin or Advil, not Tylenol but of course the language barrier prevented us. Finally the doctor called in and we got the right stuff to head off the fever. Nan's body wrestled with a bit of fever for hours but by morning it had dropped back to normal. They waited for about a hour between blood units for the temp to keep dropping. Mid evening a cute young doctor came in with excellent english and she solved many problems for us. For example we ask for something we could use to empty the colostomy and the nice nurse came in with a bottle of water! During the night one of the nurse refused to allow Nan to help her close up the colostomy and of course this morning it was all over the bed just missing the nephrostomy insertion point. Then an eager young nurse or lvn came in with a basin of cold water and soap to do a bath, she scrubbed and nearly froze Nan with the cold water, finally Nan told her enough but she meant well. I stayed in the room and helped Nan with meds about 11 pm, TPN replacement about 2 am and empying things when I could get to them before the eager nurses.

One thing we discovered, no food was served the entire we were there and none was offered. Most patients have families who live nearby who bring in food so we had nothing to eat. I walked a few blocks to a large Safeway type store and bought some drinks, protein bars and peanuts but Nan had nothing to eat all day and nothing this morning either, in fact she has had nothing to eat all day today either.

Amy called to let us know that the medivac Jet would be arriving at 2 pm local time. How to get there? Well our doctor said the hospital ambulance could do the job. Oh and by the way you can only take 2 small carry ons since the jet is very small and full of hospital equipment. The doctor knew someone who could help so Roberto came to pick up our extra luggage pieces and let me know it would be about $700 for the three suitaces! That should have been a warning about what was to come. As we were preparing to leave the hospital a man said I must come now to a little window where I would pay up. So I paid for the three doctors, the ambulance, the meds and the hospital room. Only $6,600 charge to faithful AMEX.

Nan had asked to get up and dress about an hour before the plane arrived and after some effort we got her all dressed and she sat up in the recliner until time to leave. All three doctors came to wish us well and we thanked them for their caring services.

We loaded Nan in the ambulance along with the wheelchair, our two carryons and headed out through busy traffic. Our driver was pretty amazing and finally got tired of being nice and turned on the siren which continues for the next 20 minutes as we raced through traffic, dodging buses, driving on curbs and weaving in and out of traffic. The scenery was beautiful along the way I guess. Jason was on the phone at one point and said it sounded like I had robbed a bank and was being chased by the cops. When we arrived at the airport the driver pulled up to a gate that is usually opened quickly for medivac situations, not this time, the guy would not budge and after 25 minutes of sitting in a very hot and sticky ambulance we finally had to get out and go through customs, a guy wheeled my luggage out to the plane which was 20 feet away and then stood there, I thought he was an official but finally he asked someone to tell me I needed to pay him a tip. I had some change from the shopping trip so tried a 10 peso note and he was happy. We boarded our precious little jet, a citation 1 and found it to be very cramped. It had a crew of 4, two pilots with thousands of hours experience and two very professional and approachable EMTs who have special flight training. Nan was gently moved into the plane to a narrow bed and strapped in, hooked up to an ekg, blood pressure cup around her leg, no arms available without IVs in them, covered with a sheet and we took off. AFter a lot of juggling they disassembled the wheel chair and got it on board as well. The interior was hot since the temp was about 95 and humid but soon the AC system took over and we were too cold. The guys worked well together as a team and were over qualified for the trip. They showed us where the cold drinks were kept, the chips and we settled in for a 2 hour trip to LaPaz where we got out and stretched our legs, they let Nan sit up and emptied her bags and worked to make her comfortable. I had to pay 50 bucks to enter the US and show passports. Then back to the plane and to San Diego. The scenery below was mixed and beautiful, clouds, ocean, beaches, dunes, little towns. The seating was very tight and I was never fully comfortable yet the time passed. The EMT guys and pilots were great. The little jet flew at about 350 miles an hour and was fast on takeoff and the landings were perfectly smooth. In San Diego our pilots hours were up sinc they had been flying since about 7 in the morning. we took on two new pilots who told us the trip from San Diego to Concord would be 1 hour and 30 minutes. It was to the minute. We landed and the ambulance was waiting to take our jet emt guys, Nan and myself to the hospital. AFter the emt guys were satisfied Nan was delivered propertly they were taken back to the plane to fly back to San Diego and some much deserved rest.

Nan is resting quietly now and I'm staying here in the room with her in a little window bed, that is unless they admit a roomate and then I have to leave for the waiting room. I'm stuck here since our van in parked safely over in SF by the ferry terminal. Since the fire on the freeway will cause massive traffic backups for anyone trying to help me get my car tomorrow I am considering BART to the city and then walking to get the car. I've got to confirm first that I can even get the car because it is a special cruise lot and the cruise is not back until next friday.

We are so very thankful for the way God has led over the past few days. We have had many anxious moments and frankly I am having some this evening. They just weighed Nan in her bed and she is 160, that is up 14 lbs since we left monday. That means the medical center on the ship and the mexican hospital have added even more fluids than she can handle, where does it stop? I have ask the nurse tonight to put no more fluids in than absolutely vital. I called our doctor this morning to ask him to have a TPN ready for her tonight but that did not happen perhaps because it is sunday. So when this TPN bag is out she will go without for the rest of the night. Perhaps that is good though since the TPN is hydration also.

This is certainly something we want to ask you to pray about, getting rid of 30 lbs of extra fluid on her body.

We are thankful that the trip on the jet went smoothly today. She was strapped to her little bed for 9 hours of flight and yet her blood pressure and heart rate were some of the best we have seen on the trip. I am extremely grateful to be back near her oncology team and to be able to communicate in english. I want to be very careful to insure you we appreciate the efforts of all the staff at the hospital in Acapulco. There were very caring and attentive. The language barrier is huge in medical situations.

We are very sad that our cruise came to an end almost before it began but the infection that gripped Nan was very serious causing several times of 104 and above temperatures. She had some very miserable hours in the sickbay of the ship. Had her hemoglobin not been low we would not have been removed from the ship as she was much better by Sat. morning but they felt that to continue with such a lot blood count was dangerous since we were in the town with the best available hospital. We are not bitter just disappointed and I hurt for Nan who wanted this trip so much and had planned for it for months and months. The last three days have cost about $45,000 and Travel Guard is covering all of it even to the phone calls to doctors here on shore. How soon they cover I don't know but they seem to be very aware of doing a good job for their clients.

We have been touched by your kind responses to the blog and to our situation. How can we ever thank you enough for your prayers and concern. It was situation of our own making and entered into it knowing things could go wrong but we had no way of anticipating an infection so strong that the fevers were higher than ever before in her life. So in light of everything tonight I am just grateful, it was very scary last night to know our ship sailed away at 11 pm and were left there in Acapulco not knowing anyone and not sure of what was to happen next.

We took several phone calls last evening which we very helpful. Roberto Salas called from Monterey offering encouragement. He is very active with GIST organizations and it was so good to hear from someone more nearby.

Since we arrived here we have found some disturbing news. Since we left on monday on the cruise her weight has gone from 146 to 160. That means in attempts to cope with Nan's fevers and infections enough fluids have been added to her body to add 14 more lbs. It is my prayer and hope that while she is in the hospital some efforts will be directed at getting some fluids off and the weight down. When I heard she was 160 I just felt like someone hit me in the gut. She does not need more weight or fluid retention.

Well as you might guess I am very sleepy tonight. I'm settling in on a little window cot here in the room to be close to her. She is sleeping so soundly and is so tired tonight. Dr. Melynk has ordered three kinds of antibiotics and they have just been hung and are going in now. Her heart rate is 133 which usually means we are heading for a nasty fever. The nurse is very attentive and has agreed to check her temp every hour this evening just in case we need some ibuprofen which seems to always work at breaking her fevers eventually.

We thank God to be back tonight.

love

tim and nan

The three men with Nan were her doctors in Acapulco. The others are of the air transport.