Tuesday, February 3

<-- The Sunrise

At 15 minutes before 8am, the surgeons came for Sou's dressing change. Sou already had his fentanyl lollipop in his mouth. They wanted to try this in combination with the oxycodone for his pain. He made the regular moans but in the end he said it was alright. After the procedure, the nurse disposed of the lollipop and gave Sou his morning medications along with his chemo pills. Before Sou took his nap, he asked if I could go to my mom's place to make some spaghetti. He was craving non-hospital food and missed my cooking. I called up my mom and told her to pick me up. I figured I could also make Kaliya some cupcakes too. She's been begging me to make her cupcakes. 

When 10am came around, the new md fellow came by. He replaced the previous fellow, Dr. Khera. He wanted to talk to Sou about taking some bone marrow. This would be the actual test to determine if we could go home soon or not. They were going to check if Sou had any remaining leukemia cells in the bone marrow. If so, he would need to go through an additional week of chemotherapy. The doctor agreed with Sou to do the bone marrow at 8am tomorrow morning just after the dressing change. All Sou was concerned about was the pain. He clearly remembers the events of the last bone marrow he did. The doc said that he wasn't taking a bone biopsy, just aspirating the marrow. He also said he would give Sou more pain meds than the doctor in Anchorage. About five minutes after he left the room, he returned with the group of docs. The leader thought Sou was ready to be released from the hospital and said it was alright for him to be released tomorrow. FINALLY. YAAAAY!!! They would make sure I had all the necessary supplies to perform the dressing changes. We asked about when we could go back to Alaska and he said it would depend on the results of the marrow and what the surgeons thought regarding his wound. He mentioned that they could probably remove the rubber drains from the wound in about a week. 

After the docs left, my mom picked me up to make spaghetti for Sou. We stopped at Safeway for the ingredients and went to her place. While she made the spaghetti I made cupcakes for Kaliya. I baked french vanilla cupcakes with whipped cream frosting. I packed up some of the spaghetti for Sou and waited for Kaliya to come home from school. When I heard her coming in the door, I hid in the shower. 

"AAAAHH CUPCAKES!!!" I heard her yell. "Aww, I wish Jheri could be here," she added.

"She was here, but she left already," my mom told her. 

"She was??? Haaww," she whined. My mom told her to wash her hands before she could have a cupcake. She came into the bathroom. I waited til I heard her shut off the water.

"BOOOOO!!!!!!" I shouted as I threw the shower curtain open. 

"AAAH" she screamed. "JHERI!!" I gave her a big hug and told her that I needed to go back to the hospital. She asked if she could come with my mom to drop me. Before we left the apartment, Kaliya scarfed down a cupcake leaving frosting all over her face. 

When we arrived at the hospital, I layed out the tupper ware with Sou's spaghetti. I also brought a loaf of french bread for him. He prefers soft french bread over garlic bread. He ate everything like he was Cookie Monster. When he was just about done, he said, "Oooh my stomach hurt." He ran into the bathroom. When he came out, he washed his hands and finished his meal with a cupcake. His appetite was definitely coming back. 

His nurse came in and gave him his pain medication so he could get a dressing change. Before leaving the room, the nurse said, "Okay, you're comfortable with the dressing changes?." I told her I was. 

"Okay, so call me if you want me to be here when you do it. Or call me if you have any questions," she said. 

"Sure, thanks, " I said. While waiting for the medication to take effect, Sou took a shower. As he did this, I got all the supplies ready. Sou hopped onto the bed and got comfortable. I turned on the super bright lights so I could see. I threw on some gloves and pulled out the dressing. I noticed less gauze came out. I peeked inside the cavity and saw that the wound was getting shallower and more narrow. I didn't see any gauze left over so I pulled out the gauze from the other side. I threw the bloody gauze into the biohazard bin and pulled on a new pair of gloves. I wet the gauze roll with normal saline and grabbed a sterile cotton tipped applicator (large q-tip). I held the gauze in one hand and the applicator in the other. As I pushed the gauze into the back of Sou's wound, I unraveled the gauze roll little by little until the wound was completely packed with gauze. I tossed the applicator into the nearby trash and reached for the scissors. I cut the piece of gauze and repeated the process in the second wound. This one was really shallow and healed a lot. You could probably fit one of those bouncy balls in there. The kind you get from those vending machines for a quarter at the front of the stores. In no time, it was all over. I put an abdominal pad over the wound and called it good. Like usual, Sou was asleep again within 5 minutes. 

Later on, I ordered chicken wings and we watched two movies. It was 2am and I was sleepy. Sou stayed up all night in anticipation of tomorrow's bone marrow results. 

SPAGHETTI!!!
CupCakes for Kaliya


Kaliya eating a cupcake

Monday, February 2

The yummy-yummy lunch -->

This morning, when the surgeon did Sou's dressing change, I forgot to ask them about the firmness in one of Sou's butt cheeks. Sou said one of his butt cheeks was "harder" than the other. He also complained of some pain too. I was so tired, it slipped my mind. The surgeon said the wound looked really good, just as always. She asked me if I would be comfortable doing his dressing changes out of the hospital. I told her yes. She said she would contact the pain doctors to get a plan set up to get Sou off the fentanyl IV. 

Later on, Jaime and Dr. Shustov stopped by. We asked about how soon Sou could be released. He said either Thursday or Friday they'll do the bone marrow biopsy again. If it came back negative for leukemia cells, we would be able to fly home.   Thursday or Friday was when Sou would be done with his IV antibiotics and hopefully will have a pain plan for his wound. If everything could be done and over with by then, that would be fantabulous. If there was still leukemia cells in the marrow, Sou would need to continue treatment. I asked them if he would be able to return to work normally because when we were in Anchorage, Dr. Liu mentioned that it would be hard to work afterwards. But this was before we knew the exact sub-type of AML that Sou had. Jaime said that Sou has the most favorable sub-type and he should be able to pick up life where he left off. That was good news. I remembered to ask about the butt cheek. They threw on some gloves and pressed on the cheek here and there. Dr. Shustov said they would have the surgeons stop by today and look at it because they didn't want any "set backs". They left the room and off to sleep Sou went. 

For lunch, Sou had fruit while I had some of the sushi from downstairs. I decided to try it because they always run out by the end of the day. It was alright. I may eat it again. I had the smoke salmon with cream cheese. Then one of the surgeons stopped by after lunch. He looked at Sou's "firm" butt cheek and said it was inflammation around the cavity of the wound. At around 4pm, Sou got some oxycodone instead of fentany and took a shower. The pain doctors decided to take Sou off the fentanyl to see how the dressing changes went. When he was done, he needed his dressing re-packed. They wanted me to give it a try. I've seen them do it a million times. I put on regular gloves and the nurse helped me get all the supplies together. She saw the regular gloves on my hands and said with her filipino accent, "Oh no honey, sterile, must be sterile glubs." I never saw any of the surgeons use sterile gloves before. But whatever. She also got a sterile cloth to put under Sou's butt. I slowly tugged on the piece of gauze in his wound. He began to whine and moan like usual. There was some resistance but I just pulled a little bit harder. There wasn't as much gauze in there like before. His wound was significantly smaller than before. After he got a "breather" I told Sou I was going to start packing in the gauze. Occasionally I would say, "Okay, deep breath in," as I pushed the gauze in. He made louder moans and the nurse put in an order for the fentanyl lollipops for tomorrow. In the end, Sou said it wasn't too bad. 

For dinner, Sou was craving a chicken burger. I went downstairs to the Cafe Plaza and grabbed two chicken burgers, one with fries and one with onion rings. I also got Sou a coke. He wanted some ice cream so I grabbed two drumstick ice cream cones. It was interesting to see the people look at my tray as I walked back up to his room. Yea, like I was gonna eat two of everything! Sou inhaled the burger before I could get two bites in. It was relieving to see him eat more. In the past few days he felt like eating only fruit. After dinner, Sou took another nap while I went upstairs to the family room to take a shower and do a load of laundry. While upstairs I managed to get more reading done. My mom called and said she would pick me up to do a store run. We were low on shampoo and body wash. On the way back, we made a stop at McDonald's to get Sou a snack. I got him one of those cheeseburger mini-meals that was only $3. I had a bacon ranch salad. We ate the fast food while watching Defiance and Bolt (one of the movies Mark burnt us). After those two movies, Sou still felt like watching another. It was already midnight and I was tired. I put on Lost instead because it was in episodes. About 15 minutes into the first episode we shut it off and went to bed.

Sunday, February 1

The gauze they pack in Sou's wound     ---->

This morning I was half asleep during Sou's 7am dressing change. I went right back to sleep afterwards. I was so knocked out I sleep through the doctors' daily visit. Sou told me they said he would be able to leave the hospital next week. These things keep changing so I don't count on it. I woke up at around 10:30am and ordered some food. Sou didn't have too much of an appetite but I ordered him some fruit. I had their beef tenderloin with jasmine rice. It usually tastes good, but they forgot to give the salt and pepper packets. Sometime after lunch, Dad called. I gave him a quick update on how Sou was doing. Right after, a physical therapist came by to work with Sou. She made Sou do some leg exercises while standing up. Then, the three of us went for a walk in the hallways. Sou did a total of 4 laps around the floor. It was the most he walked since being in the hospital. When we came back to his room, we waited for the Super Bowl to start. I got some snacks and soda for Sou from the vending machine downstairs. After he ate his potato chips with coke, he fell asleep. I finished up a chapter in one of the textbooks and tried to read more in my anatomy & physiology book. I wasn't in the mood. 

After 5pm, the nurse started Sou's series of fentanyl doses. Sou went to take a shower while I straightened up the room.  When he was finished, the nurse did his dressing change. She explained to me the importance of keeping things sterile and not doing this and that. They mentioned that if they could get Sou's pain under control with a less strong medication, he could be released from the hospital. That means I would be doing his dressing changes. I'll do it. Pshh. It's not as deep as before so I have no problem.

After the Super Bowl was done, we watched The Office. It was this episode of dwight starting a fire and no one in the office knew what to do. Everyone freaked out and Stanley had a heart attack. Because of that, Michael Scott decided to have a CPR training course. Michael was not doing chest compressions at the required rate of 100 beats per minute so, the instructor told him to do it to the beat of "Staying Alive" by the Bee Gees. Everyone began to sing and dance (even Michael). The instructor broke up the dance and said that because Michael neglected the dummy and decided to dance,  the victim died. She asked him, "What do you do next?" Dwight said to check his wallet to see if he was an organ donor. Dwight assumed the dummy was and took out a knife to harvest the organs from the CPR dummy. Then it went to a commercial. After The Office, we watched The Curious Case of Benjamin Button on the laptop. It seemed like a long movie. I was surprised because Sou didn't fall asleep like he normally does. We called it a night after the movie. 

Saturday, January 31

<-- Sou's Chicken Wings

As scheduled, Sou had his dressing change with the surgeons at 7am. This time, seemed like it went better than the last. Sou was moaning less. The pain seemed more tolerable compared to the first couple of dressing changes. He usually wants me by his side during the dressing changes so after it was done, I was able to go back to sleep.

At 9am, I was woken up by the group of docs that stopped by. Like usual, the leader, the 3rd-year resident, and Jenny were there. This time, they had a "new" newbie. It was this young, asian dude with glasses. And like the previous newbie, he stood there, didn't say a word, and just observed. The leader did most of the talking. He said Sou was on day 17 of 21 for his chemotherapy. 

"At around day 23 or 24, we will check your marrow again to see if there's any leukemia cells," said Dr. Shustov. He also mentioned removing Sou's foley catheter and central line today. Today was going to be a busy day. Not only doing what Dr. Shustov said to do, but Sou was supposed to walk around the floor with physical therapy and take a shower. That didn't give us a lot of time because of how drugged the dressing changes left him. But to my surprise, Sou wasn't as sleepy. He didn't go back to bed after the docs had left. He just watched Ninja Turtles on the Cartoon Network. After a while, the nurse came in to remove Sou's catheter. It was more painful coming out than when they put it in. He was okay except for the lingering memories. He still complained about it a couple hours after.

Sou took his nap around lunchtime. The nurse woke him up around 1pm and said he should start walking around. There was significant swelling in Sou's legs. She brought Sou some "anti-embolism" stockings to help reduce the swelling.  Shortly after, Jaime stopped by to remove Sou's central line. It's kinda like his PICC line, but in his neck. They were saying that because they weren't using the central line, they should removed it due to the risk of infection. She cut the stitches that held the line in place. After she had the dressing taken off and the stitches cut, she quickly pulled out the catheter that led to Sou's heart. It was the size of a 6-8 inch long spaghetti noodle. After applying pressure with some gauze, she taped the gauze to his neck. The next couple of hours consisted of more textbook reading and watching the movies that Mark burnt me. 

Around 6pm, Sou took a shower and brushed his teeth. At the same time, I ordered chicken wings from Wing Zone. I picked up their brochure in the lobby area last week. Sou said he wanted plain wings so I ordered that for him. My mom was supposed to swing by and bring cheeseburgers from McDonald's after work. She said she was going to this casino afterwards but was making the time to bring food. It was out of her way and there would be traffic so, I called her to tell her that we already ordered food. She insisted on bringing the cheeseburgers anyways. After his shower, the nurse also changed his dressing around the PICC line. The smell from the alcohol pads really bothered him. He had the blanket over his nose the entire time. One of the nurses told me that chemo can heighten your senses. A couple weeks ago Sou was having issues with the smell of his urine and had to use a face mask every time he used the bathroom. They decided that because the dressing from the abscess would get wet in the shower, they would also do that dressing change right after. Sou got his doses of fentanyl and his wound packed. The nurse made comments on how well his wound was healing. Sou said each dressing change was becoming more and more painless. After that, Sou didn't feel like eating yet and took another nap. I watched another movie from Mark.

Around 10pm, they gave Sou his chemo through IV. While his PICC line was getting flushed, Sou covered his nose with a blanket again. It was getting late and I figured that this would be a good time to take a shower. I prefer to take my showers when no one is in the family room. When there's a crowd in there, usually someone needs to use the bathroom while i'm taking the shower. I can hear them try to open the locked door and walk away. So, they end up waiting until i'm done. For some reason, they all think that bathroom is the only one in the hospital. There's a toilet down the hall and another one on the floor below us right by the stairs. But they always prefer to wait til i'm finished. So in the end, I feel rushed. Sou finally was hungry. He asked the nurse if she could microwave a cheeseburger for him. 

"I would rather have you not eat those because of how long it's been sitting," she told him. She also meant the same for the chicken wings. I know this disappointed Sou. But she was right. If a cheeseburger had been sitting at home for a couple hours, we would usually eat it. She, in turn, offered some frozen lasagna that she could microwave. It was a veggie lasagna. I know Sou would never eat that in the real world, but that was his only choice for dinner. 

Friday, January 30

This morning, they gave Sou's medication before doing the dressing change. It went really well. His pain was less than the previous packing. This time, two surgeons were here to do the packing. They both agreed that his wound looked a lot smaller and was healing really well. Just like last time, Sou fell asleep afterwards. Around 11am, the group of docs stopped by. Jaime wasn't there because it was probably her day off. The leader said that he thought Sou was making great progress and that his main reason for being in the hospital is his wound. Sou didn't need to be in there for his chemo. Dr. Shustov, the leader, said he could do chemo as an outpatient. But because of the high doses of fentanyl for Sou's pain, there was no way they were releasing him. 

"I would say, at least four or five more days you would be here," he told Sou. 

I got a chance to sneak out of the hospital for a few hours. My mom took me to Bellevue to pick up her paycheck. We went to Alaska USA at a Fred Meyer's and they said the check needed to be put on hold. The teller said that nowadays, with the economy, any check can have a hold put on it. My mom was pissed off and we ended up going to a Wells Fargo. I told her she should move back to Alaska. Thousands of people were loosing their jobs in the Seattle area and that didn't seem to be the case in Anchorage. The gas prices in Alaska seemed ridiculous but I haven't heard anything about job shortages. We continued on to a California Pizza Kitchen. The food was pretty good. It had that "fresh ingredients" taste to it. It was too bad they didn't have one in Alaska because it seems like every time something new opens, the whole Anchorage flocks to its doors (e.g. Target and DQ).

I was dropped off at the hospital after. I managed to save some pizza and pasta for Sou. I walked into his room and he was awake. He ate a slice of the garlic chicken pizza but turned down the tequila chicken pasta. It wasn't long until he fell asleep again. I figured that would be a great time to read more of my textbooks. I ended up falling asleep too while reading. I woke up around 6pm when the nurse came in with Sou's medications. Like always, I poured him a cup of water so he could swallow the ginormous pills. It was the acyclovir that seemed to be huge. A nurse told me last week that they make bigger pills than that. It makes me wonder why they don't just make a smaller-sized pill and have the dose be two or three pills. Sou took another nap after that. At 10pm, the nurse gave him his 4 doses of fentanyl before changing his dressing. Like the other nurses, she took a little bit longer packing the wound than the surgeons did. She did make sure to clean around the wound and made sure the things that needed to be sterile, remained sterile. Sou did the usual moaning, but not as loud. He said it was a little less painless than the previous dressing changes. Sometime during the procedure, the nurse needed me to hold his buttcheeks. While doing so, I noticed that the wound did look a lot smaller. Yaaay! It's healing! Not a whole lot went on that night. He received his regular antibiotics and chemo via IV. He also swallowed more pills. They took away his morphine button while I was gone and said they wanted him to try and make do with oxycodone. Later on I went online to check the claims for Sou's health insurance. Thank God he had insurance. He had a million labs that were already submitted to Aetna. Every single doctor that came and talked to Sou at Providence ER billed at least $400. The anesthesia from his first surgery was $1,700. He only gets to pay 20% of everything. But his maximum out-of-pocket is $2,000. He'll definitely meet that once this is all over. I still didn't see a charge for the flight down from Anchorage. One of the ambulance bills was around $550. A couple months ago, the thought of bills reaching that amount would have made my jaw drop. But as your perspective on life changes, those bills are nothing. A price tag cannot be put on someone's life. 

**The Leader**

"The Leader"

Dr. Andrei Shustov is an assistant professor at the University of Washington School of Medicine and an Assistant Member of Fred Hutchinson Cancer Research Center. He cares for his patients at Seattle Cancer Care Alliance and specializes in hematologic malignancies, such as non-Hodgkin and Hodgkin lymphomas, multiple myeloma, acute and chronic leukemias. He is especially interested in systemic T-cell lymphomas, Cutaneous T-cell lymphomas and Castleman’s Disease.

As a physician, his goal is to provide state-of-the-art patient care based on current advancements in clinical research and participation in well-designed clinical trials. “I believe every patient is different, and I try to find a unique individual approach to the patient and his disease within the boundaries of current standards of care and recent discoveries of clinical science,” he says.

He received his medical degree from the Crimea Medical Institute in Ukraine in 1993. He then moved to Maryland at the urging of a friend and fellow physician to perform research on graft-versus-host disease. After six years, he realized he missed patient care and took the medical boards and went to York Hospital in York, Penn. in 2003 for an Internal Medicine residency where he became interested in oncology. “And I liked working with the uniqueness of oncology patients and their families,” he says.

He graduated from a Hematology/Medical Oncology Fellowship Program at the University of Washington and Fred Hutchinson Cancer Research Center in 2006. He now works alongside his mentors, Dr. David Maloney and Dr. Oliver Press treating and looking for new therapies for high-grade lymphomas.

When he isn’t working, he is a “fanatic traveler” who prefers civilization-free vacations in the depths of the South American jungles where he can practice his other passion, wildlife photography.
He specializes in hematologic malignancies, such as non-Hodgkin's and Hodgkin's lymphomas, multiple myeloma, and acute and chronic leukemias. He is especially interested in systemic T-cell lymphomas, Cutaneous T-cell lymphomas and Castleman’s Disease. Read more about him and his work at SCCA.

 

Title

UW Medicine; Hematologic Malignancies, Attending; Hematology Division, Assistant Professor

 

 

Patient Care Philosophy:

To provide state of the art patient care based on current advancements in clinical research and participation in well-designed clinical trials. “I believe every patient is different, and I try to find a unique individual approach to the patient and his disease within the boundaries of current standards of care and recent discoveries of clinical science”.

 

 

Cancer Types / Diagnosis:

• Acute Lymphocytic Leukemia (ALL)
• Aplastic Anemia
• Blood Disorders
• Hairy Cell Leukemia
• Hodgkin's Lymphoma
• Leukemia
• Lymphoma
• Multiple Myeloma
• Myelodysplastic Syndrome (MDS)
• Non-Hodgkin’s Lymphoma

 

 

Clinical Expertise:

Non-Hodgkin and Hodgkin Lymphomas, Multiple Myeloma, Acute and Chronic Leukemias. Special clinical and research interests: T-cell lymphomas and Chronic Lymphocytic Leukemia.

 

 

Education And Training:

• MD: Crimea Medical Institute in Ukraine, 1993
• Residency Internal Medicine: York Hospital, York, PA, 2003
• Fellowship, Hematology/Medical Oncology Program: University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, 2006

http://www.seattlecca.org/physician-detail.cfm?PhysicianID=79

http://www.seattlecca.org/physician-detail.cfm?PhysicianID=79&Story=1&DiseaseID=0&NetworkMemberID=0&UsePageID=0

Thursday, January 29

Sou Getting an Echo

"Jheri, wake up," said Sou as the nurse shot his fentanyl down his PICC line. It was 15 minutes before 7am. The surgeon was on her way to change the packing in Sou's wound. I thought this time might be better being that the nurse was giving him his pain meds a little beforehand. When the group of people came into the room with the surgeon, I sat out of bed and stood next to Sou. The surgeon asked if Sou already received his medications. The nurse said yes. There were two guys who held up Sou's legs. 

"Okay, big deep breath," said the surgeon. She began pulling out the gauze packed into Sou's wound. He yelled in pain. This went on a couple times more. One thing I liked about the surgeon was she was quick. When the nurses changed the dressings two days ago, they took their time. They weren't sure about this, uncertain about that. After all the gauze was out, they let Sou have a breather.  The nurse also gave Sou more fentanyl. It turns out, she only gave Sou 75 beforehand. Two days ago, Sou had 300. Because it usually takes 10-15 minutes to take effect on Sou, it was pointless now. Then the surgeon began to pack in the fluff roll, damp with normal saline. His yelling continued for another 20 seconds. When she was done, they put some padding  down to absorb the drainage. Before she left, she told us that the first week is the hardest and that it would take at least 4 weeks to heal. When the surgeon and her crowd left the room, the nurse checked Sou's vitals. His O2sat was 86%. 

"Big deep breaths Sou," I told him. I saw it go to 94%. The nurse put on Sou's oxygen and Sou fell asleep. Now all the medications were kicking in. His nurse held off on checking his vital signs to let him sleep.

At 10a.m. they came to his room to do an echocardiogram. It's like an ultrasound of your heart. The procedure lasted almost an hour. She kept zooming in and looking at different spots. She turned up the volume on his heart beats. Sou began nodding his head like it was music. Occasionally you would hear a wierd noise that was inconsistent with the beats. She kept looking at one are for a while. After she was gone, Sou slept even more. A little after that Jaime, his regular doc, came in to listen to his lungs. She also let him sleep. She told me that they decided to skip a couple days of the chemo because they thought he might be having some side effects in his heart. Skipping a few days shouldn't bother his chemo treatment entirely.  At 11:30a.m. a couple of pain doctors came in to talk to Sou about the dressing change that happened earlier. He said that there was no way to be entirely pain free. Their objective was to make the pain tolerable. They decided that because he's been getting 300 of fentanyl and still experiencing a great deal of pain, he adjusted the time schedule and amount he would be getting. He explained to his nurse that he wanted Sou to have 75 every five minutes, starting 20 minutes before the procedure (a total of 300). 

"So, four 75's," he told her. I saw the nurse write down "475". 

"No he means 75 times four," I told her. He looked at me and said, "Thank you." If the pain was still unbearable, he said that he could have two more doses of 75. The doc expressed that timing was key and the surgeons should not touch Sou until he's had his 4 doses of 75.

Sou went back to sleep until after 2pm. We watched some tv and I read my textbooks. A little bit before 6pm, they decided to start giving Sou his fentanyl. This time the nurse would do the dressing change. She said the surgeons will only show up in the morning. She gave Sou a dose of 75 every 5 minutes until she had given a total of 4 doses. Sou was more relaxed. I guess the surgeons didn't communicate to her about how deep Sou's wound was. She thought it was a couple of gauzes. She had Sou lie on his stomach and began to pull out the gauze. As more and more of the gauze came out, she began to see how deep his wound was.

"Ahh my gawsh! The surgeon did not tell me it was like that! I asked if I needed to use a q-tip. They said to use my fingers! I'm not gonna stick my finger all the way in there," she said. But she did stick her fingers into the wound. She was a lot gentler than the surgeon. I saw her lightly pack the wound. Sou was much more calmer this time around. I wasn't sure if it was because she didn't pack enough gauze in or because of the medication timing. Who knows. We'll find out when the surgeon returns tomorrow morning.