NOTE: This post is REALLY stinking long. But- if you want to know all about what has been going on with Paul the last 48 hours or so and why he is back in the hospital, you'll get all the juicy details. So get comfy : )
DIANNE: So it's Thursday night, a little past 10pm. Last time we checked in it was Monday and Paul was talking about what it was like coming off of chemo this go-round. At that time he knew he wasn't feeling as good as quickly as he had when coming off of chemo during this past summer. Well... since then things have certainly taken us for a wild ride.
The last couple of days, Paul just didn't quite seem himself. He was up and doing as much activity as we expected for his circumstances, but being at home with him he just didn't seem "right." Of course our parents were both talking with him over the phone and they all seemed to think the same thing to a certain degree. We questioned all the medicines he was on, and some of the dosages, wondering if perhaps some of what we were seeing were the more ill side effects of some of the medicines.
PAUL: During all of this I know that I wasn't always catching onto everything going on around me. Sometimes Dianne would talk to me and I didn't really know what she was saying. Imagine if you will the parents from Peanuts: "WhawhaWHAwhaWhaWHA?"
DIANNE: I couldn't tell to what degree he was "off" because even though it sometimes took him a minute, he was still coherent from what I could see. It was like I could tell he was a little zombie-like, but figured it was to be expected because of all of his medicines. After all, I'm the one who has been giving him all of that stuff. However, parents being parents, by Wednesday afternoon the four of them were starting to call each other, unbeknownst to me. But they love us, so I guess it's okay : )
PAUL: If Dianne didn't know that was happening, I definitely didn't know that it was happening. Obviously though, I didn't want to go to the hospital.
DIANNE: Neither did I! And I say this knowing that it was oh, about 90% selfishness, but I didn't. I didn't want to go to the hospital knowing that even if it turned out to be nothing too serious that we would be stuck there. Even when it's a small thing, once you're at the hospital, that small thing grows exponentially. I didn't want to repack the bags I hadn't even gotten unpacked from returning from Vanderbilt last week, and then the stint at my parents' house. I wanted to be at home, sleep in my own bed, and for everything to be fine. I wanted to be able to take care of Paul. And let me say, that when you are put into a position to take care of someone else, it is really difficult to swallow your pride when you simply can't give them what they need.
PAUL: Sometime during the evening I realized enough of how I was feeling that I changed my mind about wanting to go to the hospital. I knew I really didn't feel good. My chest was really sore still. I had talked to a doctor at Vanderbilt earlier in the week about the chest pain but they mentioned the fact that I'd had hiccups so bad while I was doing chemo that it could be some bruising. Oh, and I forgot to mention that I fell down at 6 in the morning and twisted my ankle. I was up trying to get to the kitchen for some water and tripped in the dining room. So along with everything else, I couldn't really walk on my right leg.
DIANNE: Which was pretty crappy. I'm not exactly cut out to help lug Paul around if he's having a hard time walking. But, when we did decide to gear up and head to the Emergency Room, I asked our always amazing neighbors Jackie and Michael for a little help, and once I got a little overnight bag together, Michael came over to help walk Paul out to the car. This was especially good because it was getting icy outside by that point. We told our dog "bye" (again, our neighbors are awesome because they took her 'outside' and then got her situated back in the house so that we could be on our way), and then we were off to the Murray-Calloway County Hospital Emergency Room.
This is also where I will pretty much take over... because, well, Paul wasn't coherent enough to know what the heck was going on at that point. (And, they just came in to give him his bedtime meds... nighty-night!) SO:
We got to the hospital, pulled up to the ER patient entrance and popped inside to ask for help getting Paul out of the car and inside the building. They said they'd have someone right out. In my mind I simply expected the Brawny paper towel man (in scrubs) to be coming out ready to help. Alas, it was a very petite nurse... my brain apparently read all over my face as she said "yeah, people don't usually expect to see me when they call for help. It's okay, I'm used to it". Whoops. I chuckled and told her while yes, that was true, I was sorry for the 'look' hahaha : )
Anyway, got him in, took my handy dandy medicine chart (check out that post here) which has (much to my ego's approval) been very helpful to the doctors and nurses who have seen him, and provided a much simpler way of reviewing that critical information with people over and over again. They were concerned about the pain and nausea. He was given hefty injections of standard ER practice pain meds, and our old friend Zofran. Right about the time they were doing this though, Paul became nauseated, and got violently sick, and following each bout, he did what my mind can only compare to seizures. I don't know if in fact they were seizures, I'm just saying that the type of shaking he was having looked like that.
This was a pretty big concern to all the medical team there. He was running a fever, throwing up, shaking, sweating, and had a sore chest and a swollen ankle. His biggest complaints were chest and ankle pain. They drew lots of blood for tests, and took him for a chest x-ray. They looked for things like pneumonia, which they said didn't seem to be an answer. However, with his level of dehydration, and that one of pneumonia's tell-tale signs being fluid in the lungs, they probably wouldn't ever see that sign because his body had no fluids to spare.
They also checked his blood counts. As I also mentioned in my previous post (here) the chemo hurts a lot of good healthy cells along with the bad ones it's attacking. So naturally, after chemo, those numbers are nowhere near what they should be compared to a normal healthy individual. Paul had some blood levels checked on Monday or Tuesday (can't remember which) and his white blood counts were, I want to say, around 500 or so. If you'll check out this handy page from Medline/NIH you'll see that the numbers they indicate as being normal for this are "4,500-10,000 white blood cells per microliter (mcL)." Okay... well, they told us at the ER that his numbers were more like 0.000nada.... He basically had no immune system. Because of all of the other symptoms (fever, for one) they could pretty safely assume there was a pretty serious infection somewhere in his system. His lack of immunity makes him susceptible to becoming very sick, very quickly from things that might not even affect you or I. Although I'm not sure they should have necessarily told me this, albeit I DO ask a LOT of questions, they said that a big fear was that he could be Septic. Not good.
They got to work pumping fluids and mega antibiotics into him through IVs. Then they started getting in touch with Vanderbilt. Because the more definite answers about his condition would come once they got results from his bloodwork back, (and that would be something around a minimum of 24 hours.) They wanted to prepare for all the worst possibilities, including things like kidney failure. Now I realize I'm throwing a lot of stuff out there without a lot of the conversation that went with it, but I'm still running on a quarter of a tank, and the highlights are about all I can give. I don't remember the "why" of all of these things, I just know they were brought up.
So, overall, they knew they wanted to try to get him to the much bigger Vanderbilt with the thought that they were better equipped to handle all of the "what ifs". They kept him on fluids, pain meds and nausea meds and prepared for ambulance transportation down to Nashville. I had only planned on a visit to our local hospital, so while they were waiting for transportation, I ran to our house and threw whatever into a bag, kissed the dog again and got back to the hospital.
Now, for those of you who have experience the joys of driving over the lakes on your was from Murray to Nashville or Cadiz, etc.- riding in an ambulance on that crap-tastic-ness is a whole other level of yuck. I was, however, happy that they said his condition was stable enough that I would be allowed to ride in the ambulance (up front.) I didn't want to be driving there in the middle of the night (I think we finally left around 1 am?) with deer and possible ice. So, even though that meant no vehicle once we got to Nashville, it seemed like the better choice. I got to doze off a little, Paul not so much.
Got to Vanderbilt and was brought into the Emergency Department here (approx 3 am). We had already been told that is probably what would happen because they wouldn't have an available bed (room) for him. We saw several different people (techs, nurses, doctors... you name it) right away, and they evaluated much to the same effect as they had in Murray. Again: fluids, antibiotics, pain meds, nausea meds, and so on and so forth. Stayed in this BIG room for quite a while (lunchtime or so?) just doing that. They were focused on keeping him comfortable and continuing to hunt for clues on the mysterious infection. Oh, and they did an x-ray on the ankle- not broken! So yes, hung out there for a while. Then we moved to what I shall lovingly call the closet. Where it should be illegal to have one person, let alone the point when it was Paul in bed, me standing up out of the way of the nurse so she could reach him, plus three doctors. Those doctors talked about things that could potentially be causing the chest pain, and also about how they wanted to do some more tests, but they would hold out until his kidneys were behaving a little more normally so as not to overload them with the chemicals involved in those tests.
We've been in the closet the rest of the day. We've seen a few different crews taking care of Paul, and his parents came in for a while this afternoon. They had to wait to make sure they could travel safely because there was a lot of ice where they live. We're just continuing to wait for better, more specific answers. Paul looks better than he has in days. Which is interesting, because that still isn't great. He still hasn't been able to eat, but no one here seems to have said much about it, so I guess the hydration issue really trumps the eating business. He tried to sleep all day, but in the ED, the intercoms are inside each room, so you hear every announcement for everyone for everything. However, they've kept up the pain meds and then tonight gave him something to help him rest, so right now he mostly sleeping soundly.
We were told by the trio of doctors that we should expect for him to be here for 3-5 days assuming he recovers in a good and timely fashion, longer if not. Hopefully tomorrow will lend itself to better answers, bigger (non emergency) rooms, and shorter blog posts : )