The President’s speech.
Tuesday morning, I got up about 5:30, unable to sleep any longer. I made some coffee, and sat down for my morning cigarette, and wondered how Joanie had done in the few short hours since I left the ICU. I assumed things were okay, since there had been no phone calls, but I was still concerned about what I would learn when I got to her room, and what lay in store for her considering what had gone wrong this time following the chemotherapy we had so counted on being the right stuff.
I went to the hospital about quarter of eight, only to find the door to the ICU locked. There was a sign on the door that explained it would reopen at 8:30. Seems they close it from 7:30 to 8:30 to accommodate a shift change, so the nurses coming on duty can be briefed on the present situation on the floor.
Since I had forty-five minutes, and that gave me time to run to Starbucks, get some coffee and pick up a paper.
When I finally got into her room, I found they were now giving her another drug to raise her blood pressure. They were now using Norepinephrine in that effort.
Dr. Thomas came in shortly after I arrived, and told me he didn’t know when she would be getting out of ICU. He said they were going to have to wean her off the Norepinephrine and see how her blood pressure stabilizes.
Though her blood pressure (BP) was being monitored continually, I continued to take note of it along with the times. At 10:40 that morning, her BP was 91/54. I didn’t think that was out of line for her.
The ICU doctor, or as the sign on his office door proclaimed, “Intensivist,” was a Dr. Blake. I found myself slightly amused at the nomenclature the medical profession uses, since I had never seen that term used before. Anyway, Dr. Blake tells us the preliminary lab work indicates a bacteria had set up shop. As I understood what he said next, was that the bacteria in and of itself doesn’t present a problem, unless, as what happened in Joanie’s case, your white blood cell count goes south, or the bacteria is able to make its way into the blood stream. Then the bacteria becomes a real problem.
Blake told me it’s like your skin. There are all kinds of bacteria on your skin which do not pose a problem until you cut yourself, or break your skin in some manner, and some of the colonized bacteria is allowed to get into your bloodstream.
All the time Blake is telling us this, Joanie is watching TV. When Blake left, she didn’t want to talk about what he said. The first thing she said to me was that she was wondering about the President’s speech last night, and how people feel about using National Guard troops on our borders. All I could do was look at her and wonder.
At 12:00 P.M. her BP was 102/56.
I went out for a smoke and to get a soda.
When I got back at 12:27 P.M., her BP was 80/47. I know it is not unusual for blood pressure to bounce around a bit, but in her case, this bouncing got me concerned, especially the lower number.
Three minutes later her BP was 67/43. Those numbers were only two or three points better than they had been last night in the ER.
They ICU staff was paying attention to their monitors, for it wasn’t but a couple of minutes when a nurse came in with more Norepinephrine for her IV.
By 12:46, here BP was back up and it registered 120/58.
I continued to write down the BP readings every fifteen minutes at first, and then every half hour later, until the early evening hours. The lowest the high number, the Systolic number, got was 96, and the lowest the low number, the Diastolic number, got was 47.
That afternoon, I had another conversation with Dr. Blake, and he told me that Joanie did indeed have a blood infection, or “sepsis,” and she would be in the ICU until they can wean her off the Norepinephrine, and her blood pressure remains stable. He also told me they were keeping a watch out for any potential organ involvement with the infection, e.g., kidneys, heart, etc.
I had never even considered that last bit of news, since I really didn’t know how serious this whole thing was. It was becoming more clear the longer I stayed there. Joanie’s heart had always been strong from the beginning. I would be relieved to find out it still was, and whatever the infection was, it was not affecting her heart.
When I began to think about what Joanie was dealing with right then, and added it all up it was a worrisome picture. Not only was she dealing with metastatic cancer, and new lesions in her chest and ribs, but consider the list of problems presented that had brought her to the emergency room and the ICU this time.
These are from the medical notes:
1.“The patient has a neutropenic septicemia with septic shock.” Neutropenia refers to her white count, the cells relied on to fight infection, which was in the tank. I knew what septic shock meant.
2. “There was renal insufficiency, possibly perirenal.” Renal insufficiency refers to kidney failure, and perirenal refers to the tissue surrounding the kidney. I wasn’t sure what that meant, but I did understand kidney failure.
3. “Mild thrombocytopenia.” That term referred to the platelets in her blood. They were low.
She was also noted to have Pancytopenia, which is a long word that simply means there was a shortage of all types of blood cells as well as platelets. Her urine also tested positive for a bacterial infection, and she was suffering from Hypokalemia, or low potassium.
As I considered all of that, it seemed to me that besides the cancer, there wasn’t much else that could have gone wrong at this particular time that didn’t, and despite all of that. Joanie was laying in a bed in the ICU wondering about how the President’s speech from the night before was playing across the land.
I always knew she was tough.