As it turns out, my Mom, Dad, and I all had active mornings.
My Mom’s started with a fever detected overnight, which led to more frequent vitals checks, more antibiotics, a mid-stream urine test, and a chest x-ray.
My Dad’s and mine started with a quiet knock on our door at 7:50 am saying that our cars had been broken into! As it turned out, it was only my car and another person’s in the house. Both of us had a window smashed. All of my belongings – two suitcases full of clothes, in preparation for my upcoming work trips, were dumped on the ground. And then it rained. Nothing stolen. Not the GPS, not the iPhone cable, and the trunk was never opened. (The trunk is full of stuff) The other person had an American Cancer Society bag with some cookies stolen.
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Rude awakenings all around.
Because I had to deal with the police, the insurance company, and a glass repair company, my Dad made the lunches and came ahead to the hospital. I didn’t want my mom to know something was up. I arrived an hour later.
At the 4 am vitals check, my mom was found to have a temperature of 38.2 C (100.8 F). 38 is the temperature everyone watches for. This triggers a blood culture of all 5 lumens on the CVL, the mid-stream urine test, and the sputum test. (My mom hasn’t been able to produce any sputum yet – but there is a little cup waiting next to her bed.) They also immediately hang Zosyn (piperacillin and tazobactam), which is given every 6 hours for 7 days.
The chest x-ray, (at 7:30 am, involving a trip OUT of the unit) showed a spot in the right lower lobe. The doctor called it a little “dirty”. They are keeping her on IV antibiotics “for a while”. He said she could have a little pneumonia. She needs to use her incentive spirometer more and to walk more.
Her BP was low this morning so they are watching that.
TPN (total parenteral nutrition) ended at 6 am
Had to have more magnesium hung.
By 8 am her temp was down to 37.4 and held for the 11 am check and the rest of the day.
Her counts:
WBC 4.89 (down from yesterday)
Hemoglobin 8.5 (down from yesterday)
Platelets: 59 (up)
ANC: 2.84 (down)
My mom commented that, once the fever was detected, there were even more interruptions the rest of the morning.
She is really tired. She slept on and off until 2:30 pm.
At noon, her Lomotil (diphenoxylate and atropine) came in the liquid form and she didn’t want it. She was beginning to experience more nausea – perhaps from the new antibiotic – and the liquid Lomotil does not taste good. However, overnight, she had no diarrhea, though it has continued today.
At 1:20 pm we asked for some Ativan, which she was due for at 3 pm, but can be given early. This also means that she sleeps since it makes her tired, but it works much better for her than Zofran. She alternates between the two since Ativan is every 6 hours.
At 2:30 pm she finally got up, and we got her into a fresh set of pajamas and into the chair. Her sister was here, so there was a little talking and my mom opened another of the open-one-gift-a day gifts and cards from her sister-in-law.
At 3 pm the doctor came in. Some changes: Lomotil and Imodium (loperamide) will now be in pill form and PRN (i.e., as needed). The pain pump is gone (was being removed as he talked to us) and oxycodone is PRN for pain. They discussed the nausea meds – Ativan and Zofran. The Ativan dose can be increased, but my mom wanted to keep it the same. She gets it every 6 hours, but it could be every 4. For now, keeping at 6 hours. She is hesitant to add more meds.
Next week, they might do a gastric emptying study. They put a tracer in some food to track how long it takes to empty. Interesting.
He noted that the high dose melphalan is very hard on the GI tract and another reminder that, due to her age, this is all going to be a bit harder to get past.
I asked about the lowering blood counts. He said this happens and will watch to make sure the ANC stays above 1.5.
The hope next week is that she starts to feel better, that there is no fever, that she switches to oral antibiotics, and that she can eat and drink.
This led to a discussion about the TPN. I feel like, since she went to 12 hour TPN, she is much more lethargic. He said that, sure, she isn’t getting that dose of sugars all the time. I wondered if going back to 24-hour TPN might give her more energy during the day to walk and do her exercises and have a better quality of day. He said that was possible and that it was really up to her. He said that, usually, the 12-hour TPN is given in hopes that the patient will eat more during the day, but this has not been the case with my Mom. She has eaten less and less over the last two days.
He is a little less sure about discharge now. However, it will be the decision of the next doctor who is on the service next week.
We all really like our doctor, who we had this week. I like how he explains things and the analogies he uses to help us understand what is happening. And he is very patient about answering questions.
After an hour in the chair, my mom needed to lie down. Her Lovenox shot and Lomotil (now a pill) came at 5 pm.
Her Levaquin was discontinued (IV) and she now gets Zithromax (azithromycin) in the morning and Declomycin (demeclocycline) at night. So many antibiotics!
At 5:45 pm, the nurse drew some blood to check on the magnesium levels (which were fine) and to hang the TPN and the Zosyn. She also did a C. diff test, which they do once a week.
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My mother perked up a little bit over dinner. She drank an entire bowl of chicken broth, most of her tea, and even asked for a few Lorna Doone cookies, which we have tucked away. I asked if all this was because she wanted it or because she knew that she should. She said it was a little bit of both.
I couldn’t talk her into any more activity for the day. Not walking today. We will have to face the PT tomorrow about it (!). She is wiped out. It will be interesting to see how the 24 hour TPN affects her energy level tomorrow.
We have just met the night nurse. The night meds will come at 8 pm and then, hopefully, my mom can get some more rest.
As for me, I’m headed back to Hope Lodge to deal with the remnants of this morning: piles of clothing to wash and reorganize. My father has gone home to take care of the carpet cleaners tomorrow and to bring back some things for my mom in preparation for her discharge. This is likely his last trip home until they both go home. May that be soon.
-Allison
