The Recovery U-Turn

When recovery isn't a straight line and caregiver instincts become vital

Photo by Deva Darshan on Unsplash

My father-in-law is a miracle of modern vascular surgery. He survived a ruptured abdominal aortic aneurysm - a medical event with an 80% mortality rate that usually claims its victims before most patients even make it to the operating room. By some combination of pure luck and the elite skills of the team at MGH, he wasn’t just alive - he was recovering. Apparently, surviving a ruptured aorta is just another Tuesday for him, a minor scheduling conflict in an otherwise busy retirement.

For the first two weeks back at his senior living facility, we were operating on a cautious, giddy kind of hope. His home recovery had started slow - for the first week he was apartment bound, not very mobile and was having his meals delivered. By week two, he had reclaimed his seat at the bridge and cribbage tables. He was back in his social ecosystem - the high-stakes, cutthroat world of senior living card games where the gossip is fast and the shuffling is slow. I thought we had stuck the landing. I thought I could finally pivot my focus back to my own life which had been thrown into chaos during my father-in-law’s high flying miracle adventure.

But by the third week of his home recovery, reality started to crowd out the miracle.

It began on Monday with a mention of “very mild” back pain. In the world of an aneurysm survivor, back pain is never just back pain. It’s a low-frequency hum of dread. By Tuesday morning, the hum became a siren. His blood work from the day before was screaming.

During week two of his at home recovery, they had stopped his IV antibiotics because his kidney tests showed signs of strain. Some antibiotics, and particularly the ones he had been taking, are harder for the kidneys to filter and flush out of a person’s body. I’m now conversational on creatinine levels and mGFR - terms I never wanted to know, but here we are. Perhaps I should add “unpaid nephrology consultant” to my resume. The infectious disease doctor ordered a hold on the medications and we expected his kidney values to rebound as a result . Instead, they plummeted. My Tuesday morning update to the family group chat was a grim translation of clinical data - “The concern is the possibility that he could be experiencing mid-to-late stage chronic kidney disease. His kidneys are failing to filter.”

Meanwhile, I was wading through an insurance paperwork issue - because clearly, the universe felt the life-or-death vascular surgery wasn't quite stressful enough without a side of soul-crushing bureaucracy.

By Tuesday afternoon, the “wait and see” pattern was already disintegrating. A quick urine test revealed a “complex UTI” with fungus and yeast present. Ugh. The doctors at Infectious Disease started him on a course of Doxycycline. He was “pre-renal” - stable enough for outpatient testing, but the physician notes contained a phrase that made my stomach drop - “Possible graft infection”. For a man who has a pretty large graft holding his aorta together, a graft infection isn’t just a complication - it’s a catastrophe. It's the medical equivalent of discovering a structural crack in the foundation of your house while you're trying to host a fancy dinner party.

By Wednesday morning, the “mild” back pain had localized to his lower right side - right where the “bad” kidney sits. The plan was a renal ultrasound and more blood work on Thursday. I was trying to manage the logistics from an hour and a half away, which is essentially like trying to remote-pilot a drone through a hurricane. I was coordinating transportation while he insisted he was “fine” - a word that, in caregiver-speak, usually means “the house is on fire but I like the warmth.”

Then, the cognitive fog rolled in and my caregiver “spidey senses” kicked in to high gear. I was used to my father-in-law’s typical apathy towards taking care of himself - even the lackadaisical manner in which he was treating his recovery from surgery. This was different - something was off.

We were staring down a 2:30 PM lab deadline - the kind of hard stop that, if missed, creates a medical black hole over the weekend. I had repeated this deadline to him like a mantra for three days. Yet, when I called at 2:00 PM, he was drifting. He was talking about “waiting for a van” that wasn’t coming, reacting to a hard deadline as if he were hearing a foreign language. He was flustered, confused, and his CGM showed his glucose had been pinned over 400 since mid-morning. He hadn’t touched his insulin.

While giving him step-by-step instructions to find his shoes and grab his coat, my thumbs were flying across the family text chain - “I’m now concerned your dad is having cognitive issues - a UTI can do that. I had to rush an Uber over there just to make the lab cutoff. He’s very out of it.” I quickly ordered an Uber for him. I’m beginning to think I should suggest they add elderly ambulance service as one of the benefits under their new “Seniors” offering - considering how often I have used it as such.

At 3:00 PM, the distance between us felt like a thousand miles. I was no longer a good judge of “stable” versus “crisis.” I called him one last time. He was flailing, unable to communicate well - I tried asking him basic questions, all of which he gave confusing answers to.

“Walk directly into the emergency room. If you need help - ask someone to direct you,” I told him. He didn’t even argue. He just asked, “What should I tell them?”

The next health crisis had begun - a 37-day odyssey that would eclipse any that had come before it.