Posted by: Ken Wheatley | August 5, 2009

Day 2: 8.4.09 Differences of Opinions – corrections

Sheila had another bad night and when I got here at 9am she was still struggling with intense pain. We talked with the nursing manager about the erratic pain management regiment and she pulled the nursing team together in Sheila’s room to “discuss’ the unacceptability of what had been going on.

It actually wasn’t the fault of the nurses, the doctors were so busy going from one patient to another that their orders weren’t being placed for sometimes up to an hour after the consult.

Nonetheless, the problem got resolved and Sheila, while still at a pain level of  “4” or “5” wasn’t hitting the upper and lower limits of those thresholds.

For the past year and a half, 99% of Sheila’s consultations with doctors have all been in lockstep. So as a result we hadn’t experienced a polar opposite difference of opinion from two or more doctors.

The radiologists and the doctors we saw yesterday all said that Sheila has a number of new clots and that the existing clots from a few weeks ago had grown. So that’s what the course of treatment was based on. Another doctor this morning added that the x-rays they took yesterday seemed to indicate that she may also have an infection in her chest. So he immediately started on her on Cipro, an antibiotic.

Then this afternoon, the Attending Pulmonary doctor came in for his consult and said that he didn’t agree (he didn’t use those exact words – professional decorum and all) with the assessment that there were more or bigger clots. However, he didn’t have a solid counter answer as to what the problem could be, so given her history, it must be clots. Hmmmmm….

He also didn’t agree that she has an infection. But he did agree that in the absence of a definitive determination that there was an infection, treating her with antibiotics was a prudent move. He felt that the problem was due more to the fact that she has fluid built-up around her lung. Now that was the first we were hearing about that.

Because of Sheila’s propensity to have clots – whatever the cause at this point – they briefly talked to us yesterday about putting an IVC filter in today. An IVC filter is a device that’s inserted into the Inferior Vena Cava vein on the right side of the groin to trap clots before they have a chance to reach the lung(s).

After the consultation with two pulmonary doctors and someone from interventional radiology, they went ahead and put the filter in this afternoon. She was gone for about two hours and returned to the room at 6:30pm. She then had to lay perfectly flat for 4 hours while the entry point to the femoral vein had time to close-up.

She hadn’t eaten all day – it was too painful to even chew this morning – so by 10:30pm she was really hungry. Fortunately, TGI Fridays was open, so I ran and got burgers and fish and chips for us to eat in her room.

When I left at midnight she was smiling and for the first time in quite awhile, she had a calm face. She still has some hurdles to overcome – like not needing oxygen support (her oxygen level falls pretty quickly without it), getting some pain management strategy that’s sustainable outside of the hospital, and finding some combination of blood thinners that will hopefully zap the clots before they form or cause problems.

While it didn’t start out as the good day we had hoped for, it certainly ended better than yesterday.

I have to mention that part of the better part of these days is the constant vigil that friends and family provide at the hospital, the phone calls from those who can’t be there, and the beautiful flowers that many have sent Sheila. It’s a wonderful testament to how much she is loved and how much she means to all of us.

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