Wednesday, January 11, 2012
Part 36 - ICU 2.0
Continued from Part 35
After a day of ups and downs, the oncologist made his final rounds before the three-day holiday weekend late in the afternoon. He delivered a pep talk to Dad, who as usual “faked” how he was feeling in front of the doctor (“Doing great, Doc!”), and then the doctor asked us to step out into the hall with him. I tagged along, and my sister stayed in the room with Dad.
“I’ve heard from the nurses that he’s mentioned dying a few times,” the oncologist said, “and I just want to be sure before I leave for the weekend that you want the chart to reflect that you want ‘heroic measures’ to be taken should anything drastic happen.”
Wow, I thought, as I looked at my mom in shock. OF COURSE we want HEROIC MEASURES, I thought; we want a MIRACLE - we want him to be healthy again! We want someone to be a hero the way Dad is to us, and if that takes ‘heroic measures,’ then so be it!
“What do YOU think?” Mom asked the doctor.
“At this point, I think he is still recovering from the infection, and I expect him to respond to the treatment for that, after which we can press on with the treatment for the cancer,” he said. “So I would say we do not want a DNR [Do Not Resuscitate order] in place at this point, but I want to be sure you agree.”
“Yes, we agree,” Mom told him. “We need more time.”
Exactly, I thought, and we said goodbye to the oncologist and went back into Dad’s room.
That evening, the night nurse (unfortunately not Meredith, who had the night off) administered two units of whole blood to Dad; as per the protocol, she gave him IV Benedryl beforehand, and as a result Dad slept soundly for the first part of the transfusion. After that, though, he was very restless and talkative, although most of what he said was “mumbly,“ as we noted in the Notebook. He had just gotten back to sleep at 3:45 a.m. when a phlebotomist (whom I referred to in the Notebook at “The Blood Bitch”) burst into the room, abruptly flipped on the ceiling light, and announced loudly that she needed to take blood. As Dad stirred in the bed, I jumped up, turned the lights back off, and told B.B. that, unless the order had been specifically written for blood to be drawn at that exact time, she needed to come back later. She retreated and returned again at 7 a.m.
The rest of that day, which was Christmas Eve Day, was a whirlwind of activity, disappointment, and stress for us. We had quite a string of visitors that morning, and Dad seemed to get more disoriented and more distressed with each person who entered the room. Shortly after the nurses’ change of shift, the stand-in-oncologist Dr. M came in to introduce himself. He said that Dad would be getting a transfusion of platelets that day and that he was increasing the insulin dosage due to the increasing blood sugar numbers that had been noted over the past 24 hours.
Next was a visit from the Physical Therapist, who tried to help Dad turn onto his side in the bed. It seemed like every movement was not only exhausting but also excruciatingly painful for him, and, after a couple of minutes of listening to and watching Dad groan and grimace in pain, she said, “I want to get him sitting up at the edge of the bed again, but I’m concerned that doing so will agitate him for several hours.” Looking at the anguish on Dad’s face, Mom asked the P.T. to come back later, and the P.T. agreed to check back that afternoon.
Next through our revolving door was a volunteer with a therapy dog. Like the rest of my family, Dad loved animals, but he seemed totally disinterested in interacting with this dog, even turning his head away when the volunteer asked if he wanted to pet the dog. “Thank you anyway, but I really just want to see my own dogs and my cat,” he told her.
Things continued to spiral downward, with Dad becoming more miserable and with his condition becoming more perilous as the day progressed. When the nurse started to give Dad a sponge bath, he yelled, “I know you don’t mean to, but you’re really hurting me! Can’t I please just skip this?” A little while later, in preparation for the platelet transfusion, she brought in the Benedryl, and two minutes later Dad was snoozing, even sleeping through a shot of 15 units of insulin, which, due to the alarmingly high blood sugar reading, was much larger than the 6 units he had been getting.
Not long after the platelets had been administered, Dad’s blood pressure and blood sugar levels started climbing so rapidly that the decision was made by the stand-in oncologist to transfer him to the ICU. “There’s just way too much going on with him,” the nurse commented, and, terrified, we agreed. As the arrangements were being made for the transfer, Dad started hallucinating; he seemed less in pain and more confused and in his own world, which frightened us even more.
Because of the skeletal holiday staffing, the Neuro-ICU was closed, and Dad was assigned to the Cardiac-ICU, or the “CCU.” When we got the word that we were moving, we hurriedly gathered up our belongings, and Mom pushed a cart with our stuff on it as I speed-walked alongside Dad in the bed, which was rolled down several long hallways by the nurse and a transport aide. I was worried that the movement of the bed would hurt Dad, but instead he called out “Whee!” each time the bed was rolled across a bump on the floor along the way.
As soon as we got to the little glassed-in room on the unit, Dad was taken back out for another CT scan ordered by the oncologist due of his worsening condition. As per the results of the scan a few days before, again no signs of bleeding or inflammation in the brain were seen, which seemed like good news but - with the improvement of his blood count - instead left everyone wondering as to what was going on and what should be done next.
Up next … Part 37 – The Fight