Ups and Downs......

It's Sunday afternoon as I write this, and we've had a rough few days since my last entry. It began on Friday, as Sonja's team of doctors decided that the time had come to take her off the IV nutrients (TPN and Lipids) she was still receiving intravenously. The reasoning is that much of these fluids are composed of sugar and water, very good for feeding a patient, and unfortunately also very good for feeding bacteria should Sonja develop another infection. We had come far enough in her progress that now this one more possible area of setback could comfortably be eliminated. Well, that's really the wrong word, because if you stop feeding a patient that way, obviously they either have to now be ready to eat whole food again, or have a thin feeding tube inserted down through their nasal cavity past the stomach to the duodenum, a small, hollow tube that is the first part of the small intestine, where most chemical digestion takes place (sorry, probably should have had a Don't Read Right After Lunch Disclaimer on this section). Well, you can guess where this is going. The docs gave Sonja the choice of the two options listed above, and she strongly turned down eating whole foods. If any of you have gone through a prolonged illness or a surgery, you'll recognize that reaction to food in general; your intestines, like your legs, haven't been working at their usual rate, and food seems not only irrelevant but a bit repulsive. So we went with the tube (which has the added advantage of providing the nurses with what amounts to another iv line for the administering of necessary medicines). This took some time. First a mild sedative had to be administered (Versed in this case), and then the tube has to be introduced down through the nose, and the patient has to be alert enough to assist the procedure by literally "swallowing" the length of the tube as it's placed past the stomach. Well, there isn't a "mild sedative" in the world that's going to actually take the pain and general discomfort out of this procedure, but done well it doesn't last very long and is, if you'll pardon the expression, pretty straightforward (as long as it's not being done to you!). So mid-afternoon we get the tube down Sonja's throat, and then they have to x-ray it to ensure that that it's correctly placed. Then the docs have to look at the x-ray and ok it. And THEN the nurse can finally start the process of slowly weening her off the IV fluids and onto feeding her through the tube. All that takes a couple of hours, but it works out, and after about an hour or so, I look up to where Sony is lying in the bed, and realize that she has pulled half of the tube back out of her nostril. OK, it's not entirely out, so one of the ICU nurses (what the other nurses refer to euphemistically as a SWAT nurse) comes in and re-places the tube down her throat......and then we need another s-ray, etc. All that happens, it's all copacetic, and I leave for an hour and a half to grab some dinner. When I come back, her nurse informs me that Sonja has just pulled the tube out again, this time all the way. Little stinker is lying there with a half-grin on her face, successful against all the odds!! Sooooo, the doctor has to return, and re-do all of this process again, really only a serious problem in that Sonja has to suffer once more through the re-insertion. So we don't get her actually started on the change in food regimen 'till 10 or 11pm. Part of the problem in the process of course is that Sonja's delirium continues to come and go at this point in time, so you can't just reason with a rational adult about why pulling out the tube is a bad thing; when she's phasing through a foggy patch, it doesn't mean anything to her. Now, why she's still evidencing the delirium is tougher to answer. It looks at this stage of things as if it has to do with her own body's chemistry, rate of fluid removal and retention of excess sodium in her system. I had the whole thing explained to me in pretty explicit detail, but that's about all I could glean from it. And it's further complicated by the fact that other elements (intermittent sedation, response to the previous infections, etc.) could still be in play as well. it should at some point lift more consistently, but in truth no one can say whether in a day or a week. All small potatoes really when it was discovered this morning that her lungs weren't working as well as they should. The fear this time was that she may have aspirated some of the food from her tube when, late Sat. while re-positioning her in the bed, she regurgitated some of that same food. The danger here is that if that food (or even a small part of it) worked it's way into her lungs, it could lead again to infection and in this case, pneumonia. That would be, in her current condition, very, very,very bad. So we went from the little two pronged nose tube that fits comfortably into your nose to give you oxygen, to a less comfortable little face mask. That has helped. And x-rays of her chest (anyone keeping count of the # of x-rays here? Sonys going to start to glow in the dark) did show that she has fluid in and around her lungs (what it can't prove or disprove yet is whether she's fighting off pneumonia as well). So as long as her blood pressure stays strong, they can use lasik and other diuretics to continue to draw off the water in her system, and hopefully help the lungs clear. That's been the past two and a half days........kidneys are still working very well, etc., etc., but these are the kinds of complications that can crop up as you respond to one issue, only to have other problems arise from that correct initial response. Hopefully over the next few days all this will just be last week's problem; I know better than anyone how strong she is, and I think she's going to overcome this bump in the road just fine. -- Paul