7.16.2006

Sunday, July 16, 2006 - 11:20 pm

Mike is the same today. Non-responsive, still in acute renal failure and acute tubular necrosis. Not making any urine to speak of. However, liver appears to be getting better as enzymes are decreasing. Also, Ammonia levels are down in the 90s compared to the 140s where they were a couple of days ago (normal is about 10-40 I think). Heart rate is 120-150 (a bit high), Cardiac output is good at 5-6. Blood pressure is good with mean arterial pressure at about 100.

CT scan of brain looks the same (midline is good and no sign of stroke). CT of lungs shows fluid outside the lung and increasing compression of that lung (more on that later). CT of abdomen shows that the digestive system is not working. He’s got EEG leads on him now – wires connecting to nodes all over this head – with a computer constantly reading his brain waves. This is to check for seizures. He’s had two thus far, but is not showing signs of constant seismic activity.

The decision right now is to wait for dialysis. His important numbers are not terrible. They’re not good, but there’s not terrible. His creatinine levels (which indicate the level of waste product in blood) which normal should be .7-1.2 have slowly crept up over the past 3 days. This morning they were 2.9, then 3.1, then tonight 3.3. But even these numbers aren’t awful. If his kidneys had totally shit the bed his levels would have skyrocketed over the past few days. It’s true to say that his kidneys are barely working and he’s barely putting out any urine at all (like 5 cc/hour when normal is 30), but he’s not far enough along this path do hemodialysis now. It’s just too risky. The process involved in hemodialysis is hard on the body, especially the blood. As Dr. Diana (Mike's seeeeester) put it, it chews up the blood as it goes through dialysis. Mike’s blood is so f*cked up anyway that this doesn’t make sense unless he’s at imminent risk of death. The DIC is a huge problem. His body gets platelets and plasma and then eats them up. His platelets have dropped again. The whole thing is intensely fragile.

You are welcome to visit Michael at 9321 Gibbon, but know that it’s a disconcerting scene. He’s critically ill. Because he’s carrying a bacteria called C. Diff, they are asking people to wear gowns and gloves (provided on the little cart outside his door) before you enter the room. It’s just to make sure that people don’t catch this digestive tract bug from Mike. It usually doesn’t affect healthy people, but people sick or with immune deficiency problems can have a really hard time with it.

Tonight at 9:45 pm, I got a call from the surgical team calling to get consent on a procedure to drain fluid from Mike’s lung. Now, I immediately felt like this was f*cked up because Mike is so fragile they don’t even want to do dialysis which could save his life in the end. Why drain fluid from the lung, risk causing major issues due to DIC and just generally stir the pot when his oxygenation is F.I.N.E. I called Diana and she called the surgical doctor to ask the logic behind this. He agreed that given Mike’s DIC issues, this procedure didn’t seem like a good idea. They had been called in by the neurosurgery team who recommended the procedure based on the 1 pm CT scan. Diana and I were like, WTF? Why why why would anyone consider doing a procedure on someone as delicate as Mike on a freaking Sunday night at 10 pm when NO ONE is there! No way. We told the guy no and Diana paged Dr. Evans. He, too, what like, “Whah?” ( though he would never actually say, “Whah.” )

We’re considering placing documentation, signs, or other requests that NO orders for procedures or meds or changes of any kind can be made to Michael without first consulting an attending who is on Mike’s case. After all this battle, I would not forgive myself if Mike lost because some 24 year old whippersnapper saw some fluid in Mike’s CT scan and wanted to suck that out of there and started a crazy forest fire of some kind. Can you imagine? What a f*cking nightmare.

7 comments:

Anonymous said...

Danna:
I have been down this road and I know there is nothing I can say to make it less hard. Please let me offer my solidarity in your struggle; and let me offer to be with you if think it can help. I see so much of myself, my feelings, my thoughts in your comments.

But things will turn out different for you.

I had a thought. When Adam was sick, he needed blood products the way Mike does. John and I have become devoted blood donors. The Red Cross is always facing critical shortages, and is always in need of help. Perhaps as Mike moves through this phase, we (not you, or anyone who has a tatoo this year) can all take an hour or so to offer a pint of ourselves. If we are compatible with Mike, they can actually direct the blood to him. If not, there is someone else who can desperately use it.

A donor center is quite nearby Jefferson:
700 Spring Garden Street
Philadelphia, PA 19123-3594
(215) 451-4000

It is clean, efficient and there is ample free parking, free juice, and free cookies.

You can call them for an appointment -- they take donations at all hours -- or you can visit the website at pleasegiveblood.org. If you haven't given blood before, you will see that it is a very positive experience. I hate needles too. But these needles save lives.

with love to you all, Amy J. (ASC)

Anonymous said...

Danna, thank you for being so on top of things in the midst of all this horror to stop and think before agreeing to procedures. Mike is so lucky to have you watching over him.

Elvie

Alice and Martie said...

Danna,

Whatever is the equivalent of prayer, we doing it for you, Mike and Bax. We had a long talk with Chris today. What fighters you all are. Hang in there.

Love, Alice and Martie

Lance said...

Danna,

Your continued advocacy for Mike is a marvel. It seems to me the documentation about no procedures being performed without consent is right on the money. We are thinking of you, as always.

Lance

Anonymous said...

Danna, I'm thinking of you and Mike and Baxter and sending good feelings and sympathy and wishes for wellness and strength (my version of prayers) - Jen H.

francine said...

Danna, I'm so sorry that you have to be so vigilient about his medical care. You're doing a fantastic job. Mike has great doctors and is in a great hospital, but this is such an eye opener about the need to watch for miscommunication or lack of communication among hospital staff. I just wonder about other spouses in this situation who are not able to take time off from work, do not have doctors in the family, and just aren't as smart or informed as you are. I bet a lot of people would say "yes, doctor, please do whatever you think is best. You're the expert."

Di of Di and Kel said...

Hey Danna,

Even though the news in the blog is very somber I still had to chuckle at a woman (you) who would use the word "whippersnapper" and "Wha the f*ck" in the same message.

Got my fingers and toes crossed,