Hope, disappointment and “What the hell is septic shock?”
Joanie continued to grow stronger each day as we approached the day for the third round of chemotherapy, giving us some confidence she would get through this round without a repeat of problems seen after the first two. We figured she needed a break.
When we went to the clinic Tuesday the 9th of May, the day of the infusion, the blood work came back with good numbers, meaning white and red blood cell counts were excellent, platelets were good, creatinine and BUN numbers were good, and there was no clear sign of any infection.
Dr. Thomas told us they would give Joanie a shot of Neulasta following the end of the chemotherapy. Neulasta is a drug meant to stimulate the white blood cells, and to help ward off infection following chemotherapy. So, we went over to St. Alexius Medical Center and got her checked into her room to begin the 7 hour infusion of Ifex, Taxol and Carboplatin, and we went feeling better about it than we had before. She still wasn’t happy about having to stay overnight, but had accepted it, and besides, she was feeling pretty good this time.
The infusion went well. Joanie did throw up after the Ifex, but I had anticipated that. She had done that every time, going back to the treatments in 2003. After that episode everything went well, and by 8:30 that night she was done, and they had given her the shot of Neulasta. She was feeling a little tired, but was in good spirits and I was thinking, “Could it be we’ll get by this one without any problems for her?” Tomorrow would be her 56th birthday, and while there would be no wild celebrations, at least it looked like she would be feeling good enough to enjoy the day.
When I got to the hospital the next morning, she was smiling, alert, and they had given her the Kytril around 6:00 for the nausea, and she was feeling good. I got her home finally around 11:00, and she had a pretty good rest of the day. A few friends stopped by to wish her happy birthday, and she spent a good deal of time on the phone.
That was Wednesday. On Thursday, she continued to do well. There was no sign of nausea two days out from the chemo, and I began to think we were going to make it. A few of her friends stopped by to see her, and she was having a good day. Friday was much the same, however that was to be the end, and beginning on Saturday, things began to go south, and go south in a hurry.
On Saturday, she throws up. Doesn’t eat all day. Does drink some fluids.
On Sunday, she throws up in the morning. Doesn’t eat all day. Does drink some fluids.
On Monday, just short of a week after the chemo, she throws up in the morning, and again in the afternoon, and doesn’t eat all day. By now, I am getting excited. This is not what I had expected to see after things looked so good going in to this latest round.
I began to check her temperature, and around 6:00 that evening, it was 101.5. This got my attention, and I called Dr. Thomas, who happened to be on call. He told me I might have to bring her in to the emergency room. I mentioned what Thomas had said to Joanie, and she just shook her head. She wanted nothing to do with that. I waited until about 6:30 and took her temperature again, telling her if it had gone down, she could stay home. It spiked at 103.3. I told her we are going to the emergency room.
It took her about half an hour to get ready, and just before we were about to leave, I checked her temperature again, and it was 101.8. I told her we were going in anyway.
I got her into the emergency room about 7:20, and her temperature was 103.4 again. I knew I had done the right thing. Something was wrong, and there was no way I could have figured it out, or dealt with it at home.
Joanie was in some pain, but it wasn’t serious pain, and it was obvious she was anxious and agitated. They got her into a room, and began hooking up an IV and that’s when I first began to pay attention to her blood pressure (BP). I had my notebook with me, and kept track during the next couple of hours. When they checked her in, her it was 88/26. I didn’t think much of it at the time, since her BP has always been somewhat low.
After they hooked up the IV, they gave her some Zofran for nausea, and took blood for lab work. They wanted to do a blood culture, as well as check the white and blood red cell counts. Then we started to wait for the lab work to come back so we would have an idea of what was going on.
About 9:30, the nurse came in and gave her a some Ativan through the IV, and that seemed to settle her down.
At 9:40, we were still waiting for lab results.
At 9:50, her temperature is down to 100.4.
At 10:00, the emergency room doctor comes in and tells us her white count is down to .4, which means she virtually has no defense against any infection she might be dealing with. He said he’d talked to Dr. Thomas, and they were going to put her in for some IV antibiotics. That meant a trip back up to the oncology floor. He told us he was just waiting for the orders before they would take her up.
Joanie, at this time, is quiet, looking pale and listless, and I’m getting more concerned as the minutes tick by. It turns out there was a good reason for what I was seeing.
At 10:23, her BP is 73/47, pulse was 116 and her temperature was 99.7.
Four minutes later, at 10:27, as the nurse is getting her ready for the trip to the oncology floor, she sees her BP is now 64/41. The nurse left the room in a hurry after seeing that, and returned shortly with a new IV bag, and cranked the Baxter up to full speed. It was now 10:31 P.M.
At this point, I just sit and stay out of the way. I knew something was going wrong, and seeing the blood pressure drop as quickly as it had, I wondered if her body wasn’t trying to shut down. It scared the hell out of me. All I could think of was how glad I was I had brought her in when I did.
By 10:40, her BP was 75/49, and her pulse was 72, so they had stopped the drop. Then the doctor tells me they need to stabilize her BP before they will take her up to the oncology floor.
At 10:50, her BP is 78/43, pulse is 110.
At 10:57, he BP is 79/50, pules is 117.
It is now 11:00 P.M., and they have started her on a Dopamine drip, and I was informed they will admit her to the Intensive Care Unit for monitoring overnight. I heard the term “vasoconstrictor” used, and later learned that helps in raising blood pressure.
During all of this commotion, Joanie didn’t say anything, and it was all I could do to do the same. I figured these people know what they’re doing, so I’d best stay out of their way.
At 11:20, her BP is 109/55, and her pulse is 127. Then they wheeled her bed up to the ICU. I had to wait to see her until they got her hooked up to all of the monitors they use in ICU, and so I moved the car around to the front of the hospital. When I got up to the ICU, and her room, I was amazed at what I saw. There were monitors and beeping, and she was lying there hooked up to all of them. She still looked dazed to me. I wasn’t sure if she knew what was going on, or why she was there.
I talked to the ICU doctor, and he told me Joanie had a serious infection, and no cells to fight it since her white count was down to .4. He told me after her blood pressure stabilized, they would take her off the Dopamine and keep giving her fluid along with antibiotics to work on the infection.
Dr. Thomas, who was on call that night, came up, and I had a chance to visit with him. He told me Joanie had a blood infection, and called it sepsis. He told me she had gone into what he called “septic shock,” and that it was a very serious situation.
I went back into Joanie’s room, and it was now almost 1:00 in the morning. She was groggy, and after seeing that she was going to be okay, at least hoping she was going to be okay, I kissed her goodbye and left for the night.
The first thing I did when I got home was head for the computer, to see if I could find out what the hell this thing was they called septic shock. I was stunned at what I learned, and how many people die from it. I found it can cause multiple organ failure and death, since the immune system can’t fight the out of control infection, sepsis, and the mortality rate is anywhere from 25 to 50 percent.
As I sat there at home that night, staring at the computer screen, I also realized she wasn’t out of the woods yet, but at least she was in the right place. I also thought how lucky we were that I had taken her in when I did. I didn’t understand until that moment how close we had come.