Joanie spent most of the first week after round #2 of the chemotherapy at home. There was little evidence of nausea, and though she was having some trouble sleeping well, her appetite was improving. That started to change the week of the 17th.
She went into the office on Monday, Tuesday and Wednesday of that week, mostly in the afternoons. It was on Thursday that I saw a change coming, and it was coming quickly.
That morning, she announced she was tired, and wasn’t going to go into the office that afternoon. I took her temperature, and it was right at 100 degrees. Low grade fever, I suspected, but then I started taking it about every half hour for the rest of the day. It got as high as 101.6, and at nine that night, I called the emergency room and talked to Dr. Amin, one of the hematologists, and he told me to bring her in.
Joanie told me she didn’t want to go in, so I said, “Okay, but here’s the deal. I will check it again in a half hour to forty-five minutes, and if it is still over 101, I was going to take her in.” She agreed to those terms, and when I checked it in a half an hour, it was down to 100.6, and forty-five minutes later it was down to 99.5. I looked at her, and thought to myself, she just willed her temperature to drop so I wouldn’t take her into the emergency room.
I checked her temperature hourly beginning at 5:30 in the morning, and throughout the day on Friday, and it had stabilized at 99 degrees. Right then I was hoping things were improving.
As much as I hoped, I knew things were not right, but it didn’t seem like it had reached a critical stage. She did have on incident about 5:30 Friday morning, when she got up to get some milk, and when she left the bedroom door, I heard this crash. When I got up, she was on the floor, and after I found out she was okay, I asked her what had happened. She just sat there for a few minutes, then told me she was a little light headed. I helped her into the kitchen where she sat down while I got her some milk, and then she seemed to settle down. She went back to bed, and there were no recurrences of light headedness.
I did note it, and called Dr. Thomas’ attention to it when I spoke with him on Saturday morning. He didn’t seem that concerned about her temperature, since there were no chills associated with it, and he told me he was prescribing Cipro again for her urinary tract infection, and because her white blood count was low.
During this time, she seemed to have a problem emptying her Miami Pouch. The normal output wasn’t showing up. Her colostomy output was light, and with a lot of liquid, but that was a factor of what little she’d been eating. The pouch output was of some concern.
By Monday, thirteen days after round #2, it was clear to me what was going to happen. I was going to take her into the clinic, even though she wasn’t scheduled for a blood draw until tomorrow.
I had to wake her up so she could cath the pouch, and then I fixed her some cranberry juice and ice water and put her Cipro and Premarin out, and just after 9:00, I went to get some coffee. When I got back, she was sitting in exactly the same place, sound asleep. She stayed asleep until about 2:30 when I woke her up so she could cath her pouch.
It was then I saw that her motor skills were somewhat impaired, as she was having difficulty putting the Surgilube onto the catheter, and it was scaring me. I told her to forget it, we were going into the clinic. I talked to Thomas, and he said to bring her to the emergency room.
Joanie was as weak as I had ever seen her. She was having difficulty getting up off the couch without my help, and was walking ever so slowly. I told her she didn’t have to worry about changing clothes. When she got her coat on, she sat down at the kitchen table, and said, “I don’t know if I can make it.” I said, in as calm a manner as I could, “Look, darlin’ we are going to take you to the clinic one way or the other. If you don’t think you have the strength to walk to the car, I’ll call an ambulance.” She knew by then I was serious, and somehow she mustered up enough strength to walk the few steps to the car. When we got to the ER, I drove right in, and they brought a wheel chair to pick her up and begin to get her settled.
They got her hooked up to an IV, and took her down for an ultrasound to determine what the problem was with the output of the Miami Pouch. I asked Thomas if they could put a foley catheter in the pouch and hook up a leg bag to see if that would help keep the pouch empty.
They also took blood for lab work. When Joanie was back in the ER and the lab work came back, Thomas said her hemoglobin was low, her platelets were low, her creatinine and BUN numbers were high (those two are indicators of kidney function) and she was anemic. He said her potassium was low as well. The diagnosis on the notes read, “Acute renal failure, hypolakemia, (low potassium) and anemia (low hemoglobin as well as platelets).
Thomas said he was ordering two pints of blood, and other fluid to address the problems she was dealing with. Then he said to me, “I’m glad you brought her in when you did.”
He wasn’t near as happy as I was. At least now, she was in a place where they could do things for her I couldn’t, and I felt relieved.