mike's pneumonia chronicles #13

I haven’t had energy to write again for several days. I have spent so many hours here at the ICU. I brought my laptop today to write here at the hospital because otherwise I don’t think I could get around to it.

You have been off of the paralytic medicine since Tuesday the 14th of October. In the past week you have been opening your eyes – sometimes even opening them on command – and each time I see your eyes open I have a new feeling of hope for your recovery. This Tuesday you started moving your mouth and tongue some. Then this Thursday evening you wiggled your toes! These things are all little signs that everything is OK neurologically, and I am excited for any reaction to my voice. Unfortunately, you do not always feel like performing these little tricks. I say, “Mike, stick out your tongue, blink your eyes, wiggle your toes!” and you are probably lying there thinking to yourself, “When are you going to stop asking me to do all this dumb stuff, I’m tired!” Along with these good pieces of news, I am also worried because your white count is up (30K or so)… it used to be about 20K 3 days ago. This indicates infection. Also your liver is really working hard because of the intravenous feedings. (TPN) The whites of your eyes look yellow now. It isn’t so bad that the doctors are too worried “yet” about your liver, but I am. I found out today from Roberto that a bag of TPN is the most expensive meal you will ever have… about $1,600.00 per bag! Thank God we have health insurance! For eating so well every day, I would hope you would look better by now, but I am just thankful that the medical advancements that make TPN possible have allowed you not to starve even though your guts are still not moving anything.

Your cousins Lisa & Josh came with aunt Linda & uncle Shelby to see you last weekend. They were out from AZ and NY to see you and Pop Pop for his 91st birthday. Then Lisa came up again from Encinitas on Tuesday and spent the day here with me. We got to know each other better. She arranged for a special consultation from a UCLA doctor who she was somehow referred to by the doctors she knows at NYU Medical Center. She took care of the arrangements and on the following day (when she was on her way back to Manhattan) Dr. Sagar who is a specialist in pulmonology from UCLA came for a consult. He was actually a med-school classmate of your Kaiser doctor, Dr. Shah. It was very interesting to have another doctor look over all of your labs, x-rays, and review your entire case. Dr. Shah sat with him at the computer helping him go over labs, look at your CT scan, look at all of the blood tests, urinalysis, sputum tests, pressures, medications, health history, etc. Then later Dr. Sagar and Dr. Shah took me into a conference room and spent over an hour talking about you and all of your challenges and the questions and possibilities at this time.

Dr. Sagar made a few medicine change suggestions, some observations about your x-rays, some requests for possible other tests. One such test was an echo-cardiogram to make sure that your heart is ok, another was to scan your legs to make sure there are no clots. They were due anyway to do a lot of new labs and cultures on your various fluids, so those were all done again. One thing that ended up weird, though, was that the doctor from UCLA wanted to push for a CT scan ASAP – thinking that they need to see for sure how much of your lung is collapsed and cannot be appreciated on a 2-dimentional chest x-ray. He seemed to believe that your ARDS was resolved and that something else is now causing your oxygen requirement to remain high, hence all the new tests. He also would like to see you with a trach instead of the tube in your mouth ASAP.

After Dr. Sagar left, Dr. Bach pulled me aside to talk. Dr. Bach is another brilliant pulmonologist, and also used to be an electrical engineer. His mind works in a creative problem-solving way, but always considering every aspect of treatment very carefully. I highly respect his point of view. He is happy to consider and do some of the suggestions such as running tests that can be done right by your bedside with no risk to you. However, he said that there was no way in hell he was going to move you all the way downstairs while your O2 requirement was still 100% and your ventilator was set on 40 breaths per minute. You would have to be “bagged” for the transport and he said it was too likely that you would not make it through being moved like that. As long as your ventilator settings are so high, you are much safer staying here in your room on the ventilator. Also, he did not want to risk losing your kidney functions forever by giving you the “contrast” which would be necessary in order to see things well on the CT scan. He is wise, Mike, and he is not willing to risk your life just to answer some questions. He would like to know the answers too, but if there is not clearly something likely to be there that would make a difference in your treatment, he would rather keep on wondering than risk losing you just to fulfill his own curiosity. He said that one thing Dr. Sagar would like to know is if there is a clot in your lung (pulmonary embolism). Dr. Bach said, “There is no clot! If there was a clot there, you would be dead! So why look for it?” He is a good doctor, Mike, and I am feeling very fortunate and blessed to have the insurance that we have, and the high quality of care that we have here.

Angela Moser came on Thursday and stayed overnight. She was so happy to see Joey and Julia again, and to see you. She said that she felt so much vitality and strength coming from you and she was extremely hopeful for your recovery, and confident that you will be fine in time. She sang to you, Mike, and she also played her flute for you. It was beautiful and it put a palpable vibration in the room. You have heard her sing before, and I remember you saying that it moved you emotionally to hear such a strong and beautiful voice. Well she didn’t sing opera in your tiny private room, but she sang you the song “The Circle Game” and also one I don’t know the name of, but it is “Today, while the blossom still clings to the vine, I’ll eat your strawberries and drink your sweet wine… etc.”

I really enjoyed Angela’s company for Thursday and Friday. She left late on Friday to go help her mom get her art ready to sell today at the Village Venture in downtown Claremont. I am missing the Village Venture for the first time in several years. I don’t think I could handle being there without you. I think of it as something that we do as a family.

LaTesha spent the night with me again last night. I was happy to have company. When at first it seemed that I would be alone because Jackie was going home last night, I started to feel a bit panicked. LaTesha was going to come for the evening, and I called to ask her to stay over, and she did. That makes me much calmer.

This morning Terry and Marilyn visited you. They are really wonderful people, Mike, and you have so much in common with Terry. You have similar family backgrounds and you both love music. Terry and Marilyn both graduated from RCC and they’re getting their bachelor’s degrees online now- Terry in psychology and Marilyn in social science. I spent over an hour with them in the room visiting you. Terry massaged oil onto your left foot while I did the right. They both talked to you, and they brought you a card, a CD of healing music, and a pretty green stone that is supposed to heal the lungs. Then we went out to Taco Bell while you were getting ready for dialysis and we all talked for a long time.

Now I am happy to have you pretty well updated, and today one of my favorite nurses (Roberto) is your nurse, and his wife Raquel is doing your dialysis right now while I am typing this. It is peaceful here in the room with you. There is almost a pleasant sound to the humming, bubbling and pumping. The ventilator makes a swishing inhale and a release sound to exhale. There is a low buzz from the dialysis machine. Every once in awhile the IV’s beep at needing to be refilled. Baby steps… baby steps forward.

Just a minute ago you opened your eyes… I walked right up to your face and talked to you. You blinked at me when I asked you to. You stuck out your tongue when I asked you to… then Raquel told me I had to stop and tell you “relax, just try to sleep” and just go sit down again even though you were awake, because your heart rate and blood pressure started to rise. They went down again when you went back to sleep.

I love you Mike. My heart rate sped up for you too.