ICU Revisited

Jim's internist left a message this morning that Jim had been transferred to ICU and his condition was "fairly serious." When I called the number the DR left, I got a nurse coordinator who told me to come to the hospital ASAP, even though it was 1.5 hours until ICU visiting hours.

I got there and of course, the ICU people wouldn't let me in. I kept ringing the buzzer and asking to see Jim. A tech came out to find me in tears, and said she would talk to the nurse. The nurse said that Jim had just gotten there and they were trying to get him settled. The internist was in ICU, and he came out to talk to me in a private place. He held my hand as we walked down the hall to the ICU waiting room. During our walk I asked him, Dr. Kahn, whether Jim was going to survive this. He said that his gut tells him no.

Dr. Kahn explained the situation. The platelet count has fallen so low as to be almost nonexistent--5 (normal is 140-415). Jim is bleeding constantly from his nose and mouth. He has several places on his arms and chest that are spontaneously bleeding. Dr. says he's likely having microscopic bleeding internally. He's had another platelet transfusion, but he's just bleeding it out.

As I explained before, there are at least 3 reasons for the low platelets, but the DRs are guessing it's a medication reaction, and have removed all medications that could cause this.

Jim is angry. He knows going back to ICU is a step backwards. The DRs and staff are all trying to convince him it's just to be able to keep a closer watch on him, but he's not buying it.

I asked Dr. Kahn about the possible scenario going forward. He said Jim's belly will continue to expand as he retains fluids in his peritoneum (ascites). (He also is getting leg edema.) They can't drain the belly because they can't put a needle into him because of the clotting problem. His ascites will put pressure on other belly organs, like the pancreas and gall bladder, possibly pushing them into failure. The ascites will push up against his lungs, making it difficult for him to breath. (Which is happening; his respirations are up from the high teen to the low 30s.)

He will likely develop a serious infection, maybe pneumonia or an infection in his central line. They won't be able to treat with antibiotics, because antibiotics may be causing the platelet drop, so he's not getting those now.

Jim wasn't able to have the MRI last night because they were unable to start a peripheral (in his arm) IV line (and I don't know why they couldn't use the central line). The GI DR said that getting the MRI would have been nice, but not really critical right now because if it showed a problem that required a procedure, that procedure likely could not be done with the platelets so low.

The GI DR looked disgusted with the whole process. I also asked the infectious disease DR the chances for Jim's survival. He didn't want to answer the question--one day at a time, he said. I have yet to meet the hemotologist/oncologist, but he seems to be the guy everyone is waiting for--because this is a blood problem right now.

Dr. Kahn and I had to fill out the "do not resuscitate" (DNR) order based on the living will Jim has in his chart. Certain things, like feeding tubes, are allowed. Other things, like CPR and intubation, are not.

I told Dr. Kahn I had started radiation this morning. He didn't know about my breast cancer (maybe he just thought I had a funky haircut). Finding out about my disease seemed to make him feel doubly bad that I may be losing my husband.