March 27, 2011

the cliff


"Don't look at the monitor."

"What's going on????"

I muster every bit of courage that exists within my being and grab his cold hand.  I look into his eyes and see my own fear reflected in his own countenance.  "Look at me.  Take a deep breath and breathe."

The nurse hurriedly left the room and I heard the page go overhead throughout the ER, "ANY doctor to room 8.  ANY doctor to room 8."  My brain begins to slowly add up the facts of what might be happening.

My dad's heart rate had escalated to 150 beats/min....160....170.....182.  Heart attack?  Septic Shock?  Cardiovascular collapse?  A doctor entered confidently in less than 60 seconds.  By the time he entered the room, the heart beat had slowed down into the 120s.  An EKG was quickly hooked up.  No heart attack.  No fever spike.  Normal sinus rhythm.  Just really, really, really fast.  It's not unusual for an accelerated heart rate to accompany an infection.  Just not to the degree that we just saw.  I'm still not sure what happened during that minute and neither was the doctor.  IV antitbiotics were started in short order and he was pumped full of fluids to treat the severe dehydration that was accompanying the infection and preclude any cardiovascular shutdown due to septic shock.  I'm used to those pumps going at chemo speeds which is a slow drip.  I never heard them pump so fast.  They put nearly 2 liters of saline into him in almost no time.  15 hours later, we're still not sure what's going on but he's stabilized.  The official admitting diagnosis was "neutropenic fever".  Depending on the type, patient, and underlying disease, the mortality in cancer patients undergoing neutropenic fever can range from 4% all the way up to 30%.  The ER doctor did a hell of a job and I wish I could've thanked him more.  I shudder to think what might have happened had we waited another half a day to get to the ER.  I don't think I'd have a dad anymore.

My dad has been admitted to the Leukemia Ward of the inpatient hospital of MD Anderson.  There he will be for at least 3-4 days receiving constant attention and IV antibiotics around the clock.  Confined to strict bedrest, he's not allowed to get up out of bed.  For an active guy, that's a hard pill to swallow.  But he's accepted that in order to live another day.  He's also receiving daily doses of Neupogen to boost his white blood cells.  Blood and urine cultures are pending (in a lot of these cases, the actual site of infection is never identified).  He's stabilized but not out of the woods by any stretch of the imagination.  His heart rate has slowly come down to the 80-90 beats/min range (anything above 100 is tachycardia).  His temperature is holding between 98.0 and 99.4 (fever is anything over 100.4).  His blood pressure is low (90s/50s) but holding steady.  So long as those things hold steady, he'll stay in the leukemia ward.  If the blood pressure goes any lower (he's right on the threshold), or the fever spikes, he'll probably be transferred to the ICU.  As I type this, I'm amazed at how close to the cliff we got and how damned quick it happened.  He had a bit of a cold for several days but no fever or severe symptoms.  His attending oncologist had already put him on an antibiotic, given him a dose of Neupogen, and seen a clear chest x-ray.  In less than 12 hours, that progressed to a potential life threatening infection.  The human body and its foes are an amazing and scary battlefield.

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