Four weeks ago, this current journey began. It was Memorial Day morning and a sunny day suddenly fell apart when Shirley went into acute respiratory failure. Since that time, she's been under constant monitoring. Even when she takes an elevator ride to Radiology, it is with a vitals monitor strapped to the foot of her bed and with a nurse and respiratory technician in tow.
Today, another attending physician rotated on to lead the Surgical ICU (SICU) team. Dr. Satish "Sats" Bagwhanjee introduced himself during morning rounds. Like each of his three predecessors, Sats brings his own style to the game. But while I've been impressed with all of them--both in terms of their dealings with Shirley and in watching them oversee the Residents--I must say this guy really clicked with me. He's got perhaps the best bedside manner of any of the physicians I've seen here. And his approach with the residents is from a conservative style of "first do no harm."
His logic being that Shirley is stable. She's sick, but not so sick that we just want to go and throw everything at her. He wants time to rule things out and make sure treatment prescribed is targeted. For that reason, today Shirley was cultured--almost literally--head to toe. The goal to see if they could isolate the whatever it is that is causing her white cell count to stay high. Today cultures were taken from her mouth, nose, skin, urine and blood. All came back negative. They held of on the trip to Interventional Radiology until these other possible sources were checked. But with the findings today, they will tap into the fluid pocket in her belly tomorrow and check it.
I've mentioned before that pain management has been a challenge of late. Today, Sats prescribed a "PCA" which is a patient initiated IV system for pain control. Shirley has a button and each time she pushes it, she gets a small dose of Dilaudid. She can administer as often as once every six minutes, but each dose is very small and they normally find that a patient needs less medication over the course of a day than if they try to provide larger doses and intervals of four, six or eight hours.
Shirley has been so uncomfortable of late, the she has been reluctant to do her PT and OT sessions. I'm hoping that with better pain control she will be more up for doing these critical exercises to help her regain her strength.
I called Shirley's transplant buddy Gretchen and her husband Walt today. I don't think they are big internet users, and I hadn't checked in with them for some time. Long time readers may recall we got paired with them a couple months ago when Shirley was in doldrums after her first go with an infection. Gretchen is also from Portland, also has Alpha 1 and also endured multiple complications after her double lung transplant back in September, 2012. When we were first introduced to them, we didn't pry too much into Gretchen's complications, but after I shared with them some of Shirley's obstacles, they shared a very similar story. Right down to emergency abdominal surgery. It was very reassuring to hear how well she was doing and that she is now walking a mile every day.
No comments:
Post a Comment