Seward County Independent

    It's a Saturday afternoon and he is relaxing between college football games on television, surrounded by family.
     For Bob Schnell, it's good to be home - even if he doesn't have a pulse.
     "It's a steady-flow pump," he said of the ventricular assist device (VAD) implanted in his chest to take over duty for his failing heart. "So you have no pulse."
     Just one week before, on Sept. 30, Bob was allowed to return home after two months of emergency care and surgeries that kept him hospitalized since July 26.
     The pump takes blood from Bob's left ventricle and sends it through his aorta, powered by an external controller connected via a cable running through his upper abdomen.
     "This actually was discovered through NASA," Bob, 55, Seward, said. "They were experimenting with this pump for fuel. It did the job, so someone just thought up the idea, well why can't we use that in humans to pump blood?"
     As he spoke, the VAD controller slung over Bob's shoulder cut him short with a high-pitched beep.
     "Battery," he said, after checking the controller display.
     His son, Tim, retrieved an object similar to a videocassette in appearance and inserted it into the control pack.
     Despite the limitations that come with being bound to a five-pound VAD controller with a two-and-a-half hour battery life span, Bob was fortunate to receive the pump at all. Only 29 states currently offer the surgery, and Bryan LGH East - the hospital Bob was taken to - is the only Nebraska location to offer it.
     "We were very lucky that we actually even went to that hospital," Bob's daughter, Katie Vongphasouk, said. "Otherwise they probably would have been like, 'yeah, well, you're a goner pretty soon.'"
     Bob's heart trouble began suddenly and with little warning prior to late July.
     "I was not feeling well," he said. "I was weak."
     A trip to the emergency room at Seward Memorial Hospital ended without a diagnosis of his heart condition.
     As the week progressed, however, he began experiencing chest pains and his daughter, Amy Vrbka, made Bob an appointment for a stress test.
     "He failed it big time," Katie said.
     "I failed it and I was out of here to Lincoln like that," Bob said. "They diagnosed me in Lincoln...the whole left side of my heart, there's nothing there, so they couldn't do no bypasses. I must have through the years had several heart attacks and just not known it."
     Bob's arteries were 95- to 100-percent blocked, however, and Bryan staff were unsure if they could install a VAD in his heart.
     "They were telling us that there wasn't anything to do and that it's pretty bleak," Bob's wife, Kathy Schnell, said. "I called my best friend who was at a family reunion and told her...'Hey Karen, I need a prayer...a group prayer.' And the next morning they did another test and they said there's one artery left that is 75-percent blocked."
     "We got our miracle, thank God," Bob's daughter, Ginny Schnell, said.
     "We had a miracle," Bob agreed.
     Still, delays kept getting in the way of Bob's surgery and he waited in the hospital for the operation until Aug. 17, more than three weeks after checking in July 26.
     "It was just sit and wait, and that was the worst part," Katie said, "for Dad I'm sure more than all of us."
     "Yep, that was no fun," Bob said.
     First the family struggled to acquire insurance approval for the procedure. Initially the insurance company approved a pump but not the one Bob's doctor wanted. Even after getting the OK from insurance, dozens of tests and images of Bob's heart were taken to ensure the size and model of the VAD would work.
     Surgery was scheduled and rescheduled, leaving the family in limbo.
     "They would tell us surgery's going to be tomorrow," Katie said. "Ginny lives in Colorado and (my husband and I) live in Iowa and then we'd all come home and they'd be like, 'Well, we're not going to be able to do it until Thursday now,' and we'd go back home - three times. It was very frustrating for all of us. So then when it really did happen, we didn't believe it until they actually were going down the hallway."
     During the wait, Bob's family members quickly set to educating themselves about the pump and procedure.
     "Those girls were on the internet 24-seven," Kathy said. "They called constantly and would tell us, 'OK, well I learned about this.' They'd get together with the doctors and (the doctors) would say, 'You guys are way too informed.'"
     "We all had a really long time to find out all the information about it instead of just saying, 'This heart pump - oh, we're going to put it in. Oh, OK,'" Katie said. "I think Dad would have been better, though, if he would have just gone off and did the surgery."
     "(He had) too much time to think about it," Ginny added, and Bob nodded.
     Bob spent 14 days in the intensive care unit (ICU) following his surgery. A nosebleed - brought on by the breathing tube used during surgery and exacerbated by blood-thinning medication - hampered his recovery and sent him back to ICU for another week.
     "I had a seven-and-a-half hour surgery," he said. "They went in and blocked the main blood vessel to my nose. That was probably the worst part of the whole ordeal."
     Following his nasal surgery, Bob began to recover more quickly from his heart operation and was able to return home nearly 10 weeks after he was first admitted to the hospital.
     Back at home and gaining strength, Bob still has a number of restrictions due to his operation. He cannot be fully immersed in water, and must use a special waterproof case for his controller when showering. The controller must also be kept between 15 and 104 degrees Fahrenheit.
     He has a defibrillator implanted in his chest and must use extreme caution around sources of electricity.
     "I can't vacuum the floor, because of the vacuum cleaner's static electricity," Bob said. "I can't touch the TV screen or computer screen because of static electricity. ...I can't use a cell phone on my left ear because it's right here by my defibrillator. So yeah, I've got some restrictions."
     Additionally, because the area where the tube enters is essentially an open wound to Bob's heart, Bob's wife cleans the entry point and changes the wound's dressing twice daily.
     "It will heal in time, but it takes a long time," Bob said. "Forever we'll have to change the dressing."
     In order to maintain a steady rate of blood flow, Bob must drink plenty of fluids to keep his blood thin.
     "He's already on the maximum dose of blood thinners," Katie added.
     In fact, Bob must take 18 different medications in different doses throughout the day. Kathy organizes his medicines and said that keeping the amounts and times straight can be a difficult task.
     "I have 10 pages of notes from the hospital on doses of medicine and what the milligrams are supposed to be and how many times a day," she said. "And then after his blood tests they'll tweak it."
     On Oct. 4, VAD specialists from Lincoln and the Schnells met with area emergency personnel at the Seward Fire Station to provide information on VADs and the proper emergency response to people with VADs.
     While CPR may be administered to a person with a VAD, an external defibrillator may not. In the event of an emergency, little may be done by local emergency personnel other than to arrange for Bob's immediate transport to Bryan.
     "And it's OK if he doesn't have a pulse. Don't send him to the morgue or anything," Katie joked.
     "That's how we made it through it was humor," Kathy said. "They took him to take pictures of his heart and Katie just matter-of-factly goes, 'Did you smile?'
     "You had to laugh because otherwise it made you want to cry. You couldn't do that for two months straight."
     "(I have a) very supportive family," Bob said. "They commented on that a lot - all the doctors and nurses."
     "The surgeon said before he even did the surgery, 'I know you're going to break the record for recovery for this because you have this great system of support,'" Kathy said.
     "He would have if he hadn't had that nosebleed," Amy said. "He couldn't even recover from surgery because the nosebleed started when he was in ICU."
     "Yeah, you did really good, Dad, for all that you had to go through," Ginny said to him
     Though the family described themselves as always having been close, Bob's operation brought them even closer together, as the family practically lived out of the hospital waiting room.
     "The two girls that live out of town, they were there almost constantly from start to finish," he said.
     The pump is not meant to serve as a permanent fix for Bob's condition, but to do the job of his heart until he can receive a heart transplant.
     Ventricular assist devices are becoming better and better at replacing donor hearts, however, and Bob spoke of a Columbus-area man who actually removed himself from the heart transplant list because he got along so well with his VAD - the same model implanted in Bob.
     "He does everything normal," Bob said. "He farms every day and rides horses. He does whatever he wants - pretty much a normal life.
     In order to get on the list for a heart transplant patients must not have had cancer in the last five years. Bob has been in remission for larynx cancer for just two years.
     Once he is on the list, however, there are no guarantees as to when a heart will be made available, as only 1,200 donor hearts become available each year on average, and approximately 40,000 people in the U.S. are awaiting transplants.
     "I've been through a lot and still got a long way to go," Bob said, "but we're just going day-by-day."
     "We just live one day at a time," Kathy said. "If you think about next week what's going to happen it just gets too overwhelming."
     From stacks of cards to meals to gas cards to prayers and kind words, friends and community have reached out to help the Schnells throughout Bob's hospitalization and recovery.
     "It just helped me to know that I wasn't in this alone," Kathy said. "That there were other people caring about us and praying for us and helping us get through it."
     Kathy's coworkers at Farmers and Merchants Bank, Milford, are organizing a benefit dinner and silent auction to defray the family's medical expenses.
     The event will take place from 5 p.m. to 7 p.m. Thursday, Oct. 26, at the Milford Fire Hall. Farmers and Merchants Bank is also accepting donations to assist the family.
     "The medication's very expensive. The medical supplies are very expensive, and we're going to pay that for the rest of our lives," Kathy said.
     Bob is unsure whether the many restrictions on his VAD will allow him to return to his former job at Tenneco Automotive. He is currently on short-term disability, but that expires in January.
     "We're taking that one step at a time, too," Kathy said.
     "We don't know what's going to happen," Bob added.
     "But that's OK that we don't know," said Kathy, "God provided for us in this whole thing, so..."
     "He's going to keep providing," Bob finished her sentenc