no rest

After the death of my brother, I wanted nothing more than to go home, sleep, see my own family, and then grieve.  I left Dallas Sunday morning.  Exhausted, I had to pull the car over once and sleep about half an hour in a parking lot before continuing on.  Once I got home, I spent some much needed time with my wife and son.  By 4:30 in the afternoon, I was ready for bed.  I downed two benadryl with a glass of wine, climbed into my bed and visited Mr. Sandman.  I wake up disoriented and on the couch.  The cause of my arousal from slumber was because a cat was on top of me.  I have no idea why I'm out on the couch and I'm not even sure what day it is.  I guess I was sleep walking again.  The next thing I know is that I'm on the phone with my wife.  Much like arriving on the couch, I don't even remember running to answer my cell phone.  My first sense of consciousness was hearing these words from my wife, "your dad has a fever."  She said it very slowly and loudly, speaking as if to someone who had cognitive difficulties.  I am jolted awake now.  "I'm on my way."

And on the way over to my parent's house, I automatically reach for the phone to call my brother to let him know that I'm taking dad to the emergency room.  A split second later the realization hits me that he's not there to answer the phone anymore.  Ah, shit.  I can't break down crying now.  I need my wits about me.  I'll be damned if this week will hold two funerals.  So I call my mom and request a source of caffeine waiting with my dad.  Into the car he goes along with my mom and we're flying down to MD Anderson's ER.

I'm in the left lane flashing my lights at every car in my way.  Most get out of the way.  Then I realize that the next vehicle in front is a cop truck.  He flashes his sirens as if to signal me to slow down.  I pull up next to him and start mouthing "H-O-S-P-I-T-A-L."  He doesn't understand me but he knows something is wrong.  He then changes lane to get over to the passenger side of my car.  My mom and dad roll down the windows and yell it again.  Even though this is happening at 90 mph, he's close enough to them and finally, he recognizes.  "Which one?" we read his lips.  My mom signs M-D-A-C-C with her fingers.  He nods in understanding.  His diesel truck roars to life, gets in front of me, turns on his lights and begins to clear traffic out of the way for us.  Only in Texas.  God, I love this state.

We get to the emergency room.  Like last time, by the time we get to there, he is not presenting with a fever.  It doesn't matter in his cases like his.  He had a fever at home and he's a leukemia patient recently out of chemo.  Unlike last time, though, he's stable with respect to blood pressure and heart rate.  No sign of impending septic shock this time around.  The critical test results are the white blood cell counts, especially his neutrophils.  By midnight, we have the results and his white counts are definitely low but his neutrophils are right on the edge of normal.  It wouldn't take much of a drop for him to become neutropenic.  IV antibiotics and fluids finish up around 1 am and the doc comes back around 2 am.  My dad is right on the cusp and the doc is not sure what he wants to do.  Technically, he could discharge my dad.  He no longer has a fever and by definition, is not neutropenic.  But good docs don't use just numbers. 

Given the current situation, he asks my dad, "what do you want to do?"  My dad turns and asks me.  I love the doc's response, "I'm not asking him.  I'm asking you."  We start talking through the process and it's clear that if he admits my dad now, the hospital stay has a higher probability of being shorter since he's very early on in the infection.  That would increase the likelihood of my dad being able to attend his son's funeral.  If he discharges him now with oral antibiotics, it's possible (in my mind I would say almost definite) that my dad's counts would start to plummet.  With a limited number of infection fighting neutrophils, a secondary infection could set in and then we'd be in real trouble.  Not only would he miss his son's funeral, he'd be at risk of his own funeral.  With septic shock, it's not usualy the first infection that kills the patient.  It's often the second much harder to treat one that does them in.  The doc makes the decision.  "I'm admitting him."  I tell him that I agree and he kinda smirks and says, "good."  He could care less if I agree.  He's making the right decision about what's best for the patient, period.  I like that even more.  So instead of my parents being able to grieve properly together just 24 hours the death of their son, my dad is in the hospital.

Cancer sucks.