The AV Fistula

I think this was the most scared I had been up to this point in my life, as a wife and caretaker.

The cardiologist recommended they address the arteriovenous fistula Jeff had placed in 2005, almost 5 years before his first transplant. He would no longer need it, and it could easily cause extra strain on his heart during kidney transplantation.

He also had a St Jude mechanical heart valve that was placed in the year 2000, and this surgery would allow the valve to function more properly. (He had to do a stress test before this transplant to make sure his heart and the valve could handle it.)

So at 6am on July 12th, 2023, we headed to Jackson North Medical Center.

This was a huge transition Jeff was about to go through; as this extension of his arm had been with him for nearly 18 years!

We arrived shortly before 9am and began the check-in process. My heart felt heavy as I was imagining how big a deal this was, but they’d told us it would be an out-patient procedure.

A woman ushered a large group of us through door after door, up an elevator, around the corner, and through more doors. Suddenly the patients were being pulled one way, and the family members were being escorted to a nearby waiting room. I quickly said “I love you”, grabbed Jeff’s personal belongings from him, and took my leave to the waiting area. A cold, dry room with a tiny coffee station and two dozen chairs, randomly arranged around the room. A tv above the coffee station was playing National Geographic; something about sharks.

The surgeon came to introduce himself, and let me know a time they were hoping to be done. Jeff was administered his first “calming cocktail” at 11am. I got a text from him at 11:43 saying “they’re taking my phone now”, but then an hour later he was sending me selfies of the marker points they’d put on his arm! The surgeon said they’d begin at 1pm.

I was running on half a cup of coffee, a few sips of water, and getting colder by the minute. Afraid to do more than pace by the door; I didn’t want to miss whoever might come to get me. I’d been told Jeff should be ready for me to see him by 3pm, but what time was it? 4:15. Everyone from both sides of the family was texting for updates, but I had nothing to share.

20 minutes later, the surgeon comes in and says I can see Jeff soon, and that he’s starting to wake up from the anesthesia. I couldn’t imagine what state Jeff was in and how he might be feeling.

I reached his bedside by about 5:30; he was very groggy and bandaged up far beyond my expectation! At this point neither of us had eaten in about 22 hours; not only from necessity but who has an appetite during all this?

As much as he was able to talk, he let me know there was no stitches, only the dissolving bandages that would come off on their own later, after we unwrapped the full arm-length worth of gauze in three days. He squeezed my hand a lot (with his other hand).

“Don’t go anywhere”, he whispered.

Three hours later and we’re letting family know that Jeff has been admitted for the night because the anesthesia was wearing off so slowly. This was expected with his low kidney function, so he kind of had to suffer through and sleep it off. The doctors didn’t seem too concerned, but checked on him often.

We spent the night shifting around sleeping uncomfortably and eventually shared a few nibbles of hospital food. I am grateful to the nurse who came in around 3am and showed me that my chair would recline!

By 7am the following morning, they did some extra testing and Jeff was able to sleep off much of the sedation. However, the exhaustion remained. It was around noon when we finally got back home, grabbing a coffee before we went to the house. I got Jeff set up on the couch with pillows, cranked down the AC, and both went into relaxation mode, as best we could.

We each took a couch for the night, since the bed was no good for Jeff, the way he’d need to be propped up. Absolutely couldn’t risk him rolling onto his heavily bandaged arm in the middle of the night.

Like I said, this was one of the more heavy, stressful moments of 2023, but after that first couple days, Jeff quickly snapped back and started noticing an improvement in his overall circulation without the weight of the fistula. I did not at ALL enjoy helping him remove the bandages a few days later, as I am very squeamish with human discomfort, but we managed, and I knew it would all come out okay.

He experienced some extreme pain during those first couple weeks of recovery, and I felt awful I couldn’t fix it. “That was more painful than either of my kidney transplants”, he told me later. The bandage went from his armpit all the way down his arm, wrapped around between his thumb and forefinger. The swelling made this increasingly uncomfortable! (We ended up getting permission to unwrap to above his wrist, as the pressure was becoming unbearable.)

We took the next two weeks as much needed downtime to rest and recover, in preparation for whatever might be next. Who could say?