Friday Morning

4th radiation this morning.

Jim was eating by himself when I went in this morning, and he seemed more oriented. And they were not transfusing him. A nurse I've never worked with before told me she could not give me any info about his condition; I would have to talk w/ Dr. Kahn. Fine. Page him.

(She also would not let me wait outside Jim's room when he was being tended to because I was violating other patients' HIPPA rights. I told her that because of my chemo-induced neuropathy, I could not go stand in the hall. She backed off.)

AND, Jim now has severe edema (swelling) in his arms and hands. This was just starting yesterday. Still some bleeding from his nose, but not fresh.

Dr. Kahn said he's leaning towards the hospice side of the equation. I asked why, given he had asked for until Monday. He said Jim is not improving with the change to supportive medication only. (I'm thinking, you said Friday or Saturday would be the time to tell, and it's only Friday and look he's eating!) He said Jim is even more confused; I disagreed and Dr. Kahn said any apparent improvement is transitory. Nothing in his belly on the MRI except fluid (that is, no masses). Don't yet have the results back from the blood test for the autoimmune disorder. Apparently, it can be common with large transfusions of platelets to have the body reject them.

I asked for a meeting on Monday with Dr. Kahn, the GI DR, Jim's cousin Lloyd, and me to talk about an action plan. Dr. Kahn won't be in the Wilmington Hospital so Dr. Cosamanis will be the internist, and he's not sure how that DR will feel about having the GI guy in on it. I said I wanted the GI guy because the root cause is GI. Dr. Kahn said having Lloyd there was good.

Jim asked how the phone call went. I told him everything except Dr. Kahn's comment about hospice. I have not yet told Jim about hospice. I told Jim that if he was feeling well enough on Monday, he should be part of the conversation, and he agreed.

I'll have to think about how to tell Jim about hospice. If anyone has ideas, please let me know. And soon, because I would want to do it maybe Saturday afternoon (unless I see and hear about a remarkable change).