Monday, April 12, 2021

Exceeding Expectations!

Isn't that a great title for a post? The fact that it's completely accurate makes my heart sing. Now for the transplant back story:

The donor daughter and I traveled to Toronto without incident. I elected to not inform her prior to our flight that it was the newly reintroduced 737 Max8. Apparently Air Canada has opted for less flights and more capacity in their scheduling, although the midday direct flight was approximately half full with the majority of passengers appearing to be 'transitional workers' headed out west. We accessed an Uber and Habeeb regaled us with stories of his impressions of Canada vs Pakistan then deposited us at Skyview Rentals. We organized the details and headed next door to our penthouse apartment. With only a small amount of clothes (ensuite laundry) we were soon set up and an Instacart order underway. This is a service (one of many springing up) where a personal shopper selects for you from various stores (Loblaws, Costco, Shoppers Drugs, Walmart, Staples, Bulk Barn, Indigo, Mastermind Toys and various other markets) then delivers to your door. Of course the service is only as good as the shopper, but it was smoother than my experience in Ottawa last spring. Usually it's new Canadians shopping who are great at selecting fruit and veggies - especially plantains, avocados, and bananas (although one professional couple in business attire and upscale car dropped off our order after work - assume one of them did household shopping and the other ours) and all their 5star ratings were well earned. In less than an hour from hitting send on the app the groceries were in the cupboard - I can't drive to and fro the grocery store in that time, let alone negotiate the aisles. We also indulged in some baby toys to amuse Juan as he recovered and a 1500 piece puzzle for adults from Mastermind Toys. A definite perk of urban living. We availed ourselves of a DoorDash supper delivered by bike and considered ourselves settled in. 

The first ten days passed quickly as we caught up on Netflix series - Superstore and Schitts Creek in their entirety. Slept in. Baked (me) and attended appointments (she) with various podcasts and news conferences to keep current. Read good books - the library doesn't care where you're physically located to download - this past month I've read Winter Garden, This Tender Land, One Ocean Boulevard, Hotel on the Corner of Bitter and Sweet, Becoming Mrs Lewis, Where the Crawdads Sing, and am now making my way through Eleanor Oliphant is completely fine. I crocheted a poncho for the donor daughter (easier than a jacket post op) and a shawl for the expectant daughter at home. I also managed to complete a summer top for myself (was supposed to be long sleeved and just managed to squeak out a tank top....who calculates those yardages in patterns and on ball bands anyway? And speaking of crochet:

Here's a great story about Kamala Harris, Vice President of the USA (I've downloaded her autobiography but not read it yet) I am already a fan - articulate, educated woman  with Canadian relatives, and of course "I'm speaking" but to find out that she is a crocheter? That just knocks it out of the park!


After the first week, we also relocated from our 16th floor apartment to one on the 12th due to a roof top leak requiring remediation. Thankfully this happened pre-op and we were able to smoothly transition. The condo was lovely with lots of space, two bedrooms, two bathrooms and a pullout sofa, two balconies with pigeons included but a sunny spot to read in, fully equipped with appliances and everything for daily living (and of course I travel with my pastry blender, whisk and spatula as I am a transient apartment pro). I was a particular fan of the garbage chute just steps from the door. We also had an 'incident' in the second apartment where we were awakened by security at midnight asking to inspect because the apartment below had water dripping through the ceiling. I was not impressed and stated my displeasure as the grandson was in Sick Kids and with this imposition I was afraid they were trying to reach us. After a tour of both bathrooms - nothing to see here - security apologized and left talking on the phone. Didn't hear anything else about it. A few days later a letter from the rental agency stated that property management advised there'd been a leak and we were to ensure shower curtains were inside the tub. I quickly phoned SkyView Suites (fearing the damage deposit might be jeopardized) to state that 1) there was no water running in our apartment as we'd been awakened from a deep sleep 2) there are no shower curtains, there are shower doors in this apartment 3) we had already cooperatively relocated to another unit after water leakage on the roof so there are building issues. An apology and promise of note to the file with call to property management was made. As my daughter stated "Mom they don't know how polite you were because they're not Eastlink". Zackly. 

The grandson and his parents joined us on day 10 as he had pre-op appointments as well and we got to spend some time together before the March 18th date. At one point he woke at 10 pm to watch the rental movie with the adults as he felt he was missing out. So good to be a baby and not realize what was ongoing - only the grownups worrying. 

His mother took him over to Sick Kids and he was admitted on Wednesday, then 5:30 am Thursday the remaining three of us walked over to Toronto General and Sick Kids Hospitals respectively. I accompanied my daughter to the pre-op admission and relocated to the waiting room. I have put in some long shifts over my 45 year nursing career but the 12 hours I spent waiting for my daughter and grandson to return from the OR post transplant sure beat even waiting for a medevac in a blizzard with a critically ill patient. The transplant process is....adult surgical team at Toronto General begin procedure with donor and only after confirming the liver is acceptable does the baby go to the OR in Sick Kids. Apparently 2-3% of surgeries aren't completed even at this stage. The pediatric surgical team at SickKids begins the procedure with the baby and remove the diseased liver. A second pediatric surgical team assists then heads over through the tunnel to Toronto General and receives the left lobe from the donor (about 25% of an adult liver) and returns to transplant it in the baby. The adult surgeon leaves the team to close and goes to Sick Kids to assist with the completion of the pediatric OR. A very tightly choreographed performance. By late afternoon the surgeon stopped to tell me how pleased he was with my daughter's OR and that things were going well with the baby as well. A few hours later I was able to visit my daughter in MICU (step down unit) and we were elated to hear from her sister that the baby would be out of OR shortly. I stayed until a photo of him sleeping (without being intubated even) arrived from his mother who had been told by the surgeon they were very pleased with the transplant. You know what that feeling was like? We won the lottery!!!! 

The next day both donor and recipient had ultrasounds and all was well and liver enzymes quickly returning to normal for the baby. I was able to visit the daughter three times as she was in MICU for three days due to no available bed on the floor - there were six liver transplants done that week - but no access after transferring to the floor. Nausea was her biggest hurdle (thankfully she'd never had hyperemesis gravidarum so no practice) but she was discharged on day six and we strolled the 10 minute walk back to the apartment. The parents had devised a system of shifts where Mom did 12 hour day shifts and Dad did nights as only one parent at a time was allowed in hospital. The baby made a miraculous recovery, was well ahead of anticipated goals and quickly required lots of entertainment. At one point he refused to get in the crib for exams - who could blame him? I was the logistics coordinator keeping the home fires burning with meals, laundry and cleaning. When the post op daughter returned I added private duty nursing to my job description. It was a team effort. 

The post op daughter had a surgical appointment for clearance the next Tuesday and I booked flights for Wednesday after she was given the green light - using a companion fare and travel bank which would be expiring anyway. On the final days in hospital the baby was allowed to be out an about in the stroller so we got to visit with him as his mother brought him out. It was wonderful to hold him and see him so well, not jaundiced, happy and active. The day after we departed the family got to return to the apartment with only daily homecare nurse visits for IV medication through his PICC line. Unfortunately being out of province the tubing, nursing visits and meds are charged with insurance only picking up some of the costs. It will all be settled with a return home as covered here. They are hoping (blood work results dependent) to be home between Thursday and Saturday. 

Maternity leave is ending May 1st for the oldest daughter and she received her laptop / cell phone from work as head office is in Toronto. A new tertiary hospital (very overdue) to replace the ancient/decrepit/fragmented one at present is in the planning stages and her company is establishing a Nova Scotia office. There is long term job security with a number of projects in the wings. Things are starting to come together for them now with the move to NS, well baby and job here. 

I did have an email from NS Health about casual work for vaccination clinics but it was while I was in Toronto doing family nursing so I advised I be in touch when available. Have emailed but not further response...oh well. The weather is starting to improve here with warmer temperatures and sunny days...they'd be wise to make haste when dealing with an old nurse, especially one who is seriously looking at retirement vs just planning it. And especially one looking forward to her super hero grandson's first birthday party. 

This morning I had another swab for Covid as it was day 12 after returning home. The most recent change in PH protocol is the provincial recommendation to test on day 1 or 2 and day 12, 13 or 14 after entering NS in addition to the 14 day self isolation requirement for all out of province travel. We were granted an exemption as traveling for medical but decided to test as downtown Toronto is the epicentre of all things pandemic, especially as it relates to the new, more virulent variants of the virus. Gives me a chance to catch up with former coworkers. As a rotational worker I'm mandated to do tests on day 1 or 2, 6,7, or 8 and 12, 13 or 14 and maintain a 'modified self isolation' for 14 days....meaning only walks and drives, no visiting or having visitors, drive through or pickup only and family are allowed to conduct their usual routines. Although there are a variety of rules, they are intended to fit the risk and are surely working at keeping us safe. With single digit daily positive cases and a case count of 46 our province is seen globally as a bright spot. This has led to a real estate boom where many local properties (many previously on the market for extended periods) are being purchased after only being viewed online by out of province buyers (often from central and western Canada) and frequently for above listed price. The ability to work from home (now that high speed internet has arrived) allows for geographic mobility and increased quality of life. 

So to conclude....life is good. It's a breezy but sunny April day and the cats are snoozing and shedding on various pieces of furniture. The shore captain is puttering about readying his gardens and greenhouse and it's a lovely day to walk to the mailbox. Lots of waterfowl this spring with shell ducks (mergansers) and sea ducks (eiders) loons, shags (cormorants) and geese coming by for visits. The local lobster season (which finishes the end of May) is continuing with record high prices. One of the local boats hauls traps across the harbour in front of us a as the gulls wheel overhead squawking. Ahhhhh

Mergansers in the  morning



Spring lobstering