Here’s a long post covering two days, so get comfy, but not so comfy that you don’t want to jump up & cheer!
Top of the news is that Denise is doing better. Still critical (and in isolation... gown, gloves, mask needed when I'm with her), still not out of the woods, still weak, still dealing with some infection somewhere and resulting high fevers. But better. In fact one of the doctors described it as having "a different patient this afternoon than we had this morning." It's been encouraging to hear several people say that Denise can recover from this. So there's some pretty rapid things happening, and they seem to be in our favor.
The most dramatic improvements are a higher cardiac index (saw it go as high as 4.2, SVO2 in the 60s & 70s mostly) and increasing urine output. The ejection fraction according to the EKG was 10 (low... yikes!). But the doctor said that between judging the heart's condition based on the EKG (which I learned has some subjectivity in the reading) and the cardiac index & urine output (kidneys wouldn't work unless the heart can get enough oxygen pumped to them), he said he'd "listen to the urine." I just thought that sounded funny enough to quote. Anyway, her oxygen saturation has continued to be in the high 90s, heart rate still fast (127-152), blood pressure acceptable (I saw 118-127 systolic, PAP 52/31, CVP 15 for the nurses among our family & friends) with about 3 micrograms/minute of Dobutimine. I saw a drip for nitroglycerine as well. I could describe that bit of news as "Dynomite" but that would be horrible punnery.
As far as breathing, she's on 35% oxygen concentration & a PEEP of 5 from the vent (another one of those Servo-i vents that offered the bi-vent mode that was so beneficial earlier in her struggle). At times her breathing rate went to a nice 22.
She got 2 units of blood yesterday because the hemo count dropped to 8.? (sorry, don't remember the tenth). I don't know what any of the other hemo results were. Arterial line inserted yesterday.
J/G tube inserted, too. She already had the gastrostomy tube, but it was replaced with another one, then a tube inserted inside of that goes to the jeujenum. If I understand correctly, the hope is that putting food directly into the intestine(J-tube) rather than the stomach (G-tube) will reduce the vomiting. The feedings started today at 10cc to see how she tolerates the "food" (Novasource 2.0) that looks like liquid Silly Putty.
On Tuesday, Denise was injected with the isotope for a gallium scan, which they anticipted would be performed at USC. Turns out that this would be a last resort. Instead, (and I hope I remember this right) a scan with venous contrast might be on deck. She's already had an indium scan. But that was a nuclear medicine thing, and the venous contrast is apparently tracked with EKG equipment.
Yesterday they were not using Tylenol because of questionable liver function. Today it was used and it seems that the liver is doing somewhat better. The whites of her eyes look a little yellow to me, but hopefully things will progress toward healing.
The infection that’s causing the fever is quite the enigma. The fevers went up to 103.5, then an ice bath brought it down to 99.8. I’ve noticed that some of Denise’s skin is peeling off in places. I can’t help but wonder if the alternating heat of the fevers & then sudden harsh chill of the ice is blanching her skin, same as a peach or tomato. Anyway, throw everything you’ve got into lifting up the infectious disease doctor. These infections were/are the ultimate causes of the other problems. Once the infections are licked, the road to healing will have a smoother surface. He gave me a great deal of encouragement today. In spite of the cheerleading I’m doing when visiting Denise (which isn’t much, with all the times I’m turned away due to all the procedures), I started to crack a bit. The I.D. doctor said that pregnant women who have had disseminated Valley Fever (cocci going beyond a lung infection) have nearly a 100% mortality rate, and the cocci has gotten into the brain. Denise’s brain is uninfected, according to the spinal tap weeks ago and evidenced by her cognitive abilities & physical coordination when not loopy from sedatives & painkillers. That was a major boost to morale amid all the pressure of this ordeal. On a side note, the I.D. doctor has perhaps the best enunciation of anyone I’ve met in several years. If his gig as a doctor ever falls through (fat chance), he could make a living by narrating audiobooks.
I'm glad there's been a turn for the better. I (and I'm sure lots of you that are medically-inclined) would like to know what was done medically to help her out. Different meds, equipment, techniques, timings... what? I've heard of lots of switching around of meds (I've heard just about all the names before in our ordeal). I heard a suggestion that she may have been just pulling out of the trough of sepsis as she was handed off to USC. I heard that the p/a catheter might have been giving inaccurate readings. Indeed, while at Arcadia Methodist, that was suspected and they were planning to replace the p/a catheter but knew USC would just pull it out and put in a new one anyway, so it wasn't done. Actually, I heard many things that might have been the case in explaining why there's been such a rapid improvement in some of her numbers. I hope that as a few more days pass, there might be a definite answer. If not, I'll still be happy, of course.
It's been an adjustment at this hospital. Extremely busy, and as such, sometimes hard to catch someone to find out exactly what's going on (actually, it's so busy, I feel like I'd be bothering someone if I asked my usual number of dumb questions). There are uber-doctors teaching residents, fellows, interns... peppering them with questions at an astonishing pace. It's intense. I listen in whenever I can. I tried taking notes and then finally gave up because my writing was so sloppy, I wouldn't be able to read it. Now I know why doctors write that way. There are questions, suggestions, scenarios, facts and theories all jumbled together. So it was difficult for me to determine what exactly was going on with Denise. During one of these exchanges yesterday I heard someone ask when the gastrostomy tube was put in. I butted in and said that I have been recording such things on this blog, and they pointed out a computer & told me to find the g-tube insertion date. So I did, and it seemed to be something that mattered to them. I was elated that this web site might in some way help the doctors heal my wife faster. Later, a funny thing happened (read: I made a fool of myself). Amid fast & furious questioning & answering, I heard something about attempting bi-level ventilation. Emboldened by my previous perceived usefulness, I blurted out (as fast as I could, to keep pace with them) everything I could remember about Denise going from the "old" vent to the new Servo-i vent in bi-level vent mode, how beneficial that was, then attempting CPAP mode, how long she tolerated that mode, at what oxygen concentrations, PEEPS, and everything else I could remember. There was a short pause. Silence. Somewhere in the distance, a coyote howled. Then the "teacher" doctor said that he was asking that question primarily so that the residents could answer it, for educational purposes.
Doh!
What else today...
Oh! At one point Denise indicated that she wanted to touch my face & hold my hand without the gloves. That was a drag. But at another point, she had her forearms up. Usually she's raising & lowering her forearems repeatedly, but this time they were just up, perpendicular to the floor. I asked if she was exercising (shook head "no"), stretching (no), in pain or discomfort (no), trying to draw my attention to something (no), if it just felt good to do that (no), praising God (yes). That's my girl. Along these spiritual lines, I forgot to mention something that the chaplain from Arcadia Methodist brought up quite some time ago. I told him how, even though Denise was sedated, couldn't move, talk, eat, or do anything, even though she was near death, God was still using her to draw people nearer to Him. I told him that some friends have told me that their entire church congregations would pray for her during services sometimes. The chaplain said, "Across denominations... Wow, God's even using Denise to unite the Baptists! He can't do that alone." Just thought my Baptist buddies would get a kick out of that.
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