random shots

How shall I hold on to my soul, so that

it does not touch yours? How shall I lift

it gently up over you on to other things?
I would so very much like to tuck it away

among long lost objects in the dark,

in some quiet, unknown place, somewhere

which remains motionless when your depths resound.

And yet everything which touches us, you and me,

takes us together like a single bow,

drawing out from two strings but one voice.

On which instrument are we strung?

And which violinist holds us in his hand?

O sweetest of songs.

Love Song by Ranier Rilke

update

My dad has been switched off the IV antibiotics to oral antibiotics, his blood pressure has returned to normal, and he has no more fever.  All those suggested that he was going to be discharged from the hospital today.  But last night, his heart decided to start acting up and he's been having on and off bouts of atrial fibrillation.  At least, that's what we're calling it right now.  That's based on how it feels to my dad since he's pretty familiar with this condition having been diagnosed with it back in 2006.  Given the current circumstances, they're going to play it safe and keep him there.  They've requested a cardiology consult and are in the process of getting all his cardiovascular medical records from the Texas Heart Institute down the street.  So it'll be at least one more night in the hospital.  That'll make 4 nights/5 days.

random shots

Show me beauty, but there is no peace

ghost rider by neil peart

the cliff

"What?"

"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.

casualties

What's that, you may ask?  It's the result of an incredibly difficult conversation.  I seem to have a lot of these of late.  My wife and I have been very open about cancer with my son but he's never talked about it much.  Like any teenager, the answers to our questions tended to be monosyllabic in nature.  But one day our son started to open up about everything that's been going on.  A faucet had been turned on and so we let it flow.  Questions arose such as, "they can cure this, right?"  The hope and naivete was ripe in his voice.  I will not lie to my son and paint a picture that does not exist.  The first obligation I have to a patient is to be honest.  Surely my son deserves no less.  The conversation surely get no worse until he sprung another on me.  He asked me, "My papa has cancer.  My uncle has cancer.  What about me?  Am I going to get it?"  To the kids involved, the first casualty of cancer is innocence.  My son has full knowledge of what's occuring, to the extent that any of us can wrap our brains around it.  How can he not.  I'm gone a lot lately and under great strain.  But he's a perceptive kid and he must surely see more than that.  He sees how the outline of a skull under his uncle's skin is plain and insistent.  He sees his papa reduced from a man of labor to one who labors to merely walk.  So the picture above was my attempt with the aid of my wife to answer truthfully and honestly but still honor the emotional struggle and turmoil that it engages.

mantra

Cancer sucks.  Say it with me.  Cancer sucks.  It's become a mantra for my family.  Everytime something goes wrong, it's inevitably a casualty of cancer.  For my dad, it's not the cancer itself that threatens his life.  It's little things that can rapidly become catastrophic.  A sliver.  A simple cold.  This morning, I woke up on a Saturday expecting to do a bit of light studying.  Instead, my wife says, "I think your phone has been ringing."  I go downstairs and pick it up.  It says "3 missed calls".  Uh-oh.  All three calls are from my dad and came rapid fire.  I quickly call him.  He has a fever of 101.  Uh-oh.  He has two brothers and a sister-in-law from Canada down to help him out.  His sister-in-law is already bringing him over to my house.  It's down to MD Anderson's ER we go.  Cancer sucks.  Cancer sucks.  Cancer sucks.

playing doctor

bam, bam, bam...

bam, bam, bam...

bam, bam, bam...

DING, DONG...

Huh?  Wazzat.  I groggily rub the sleep from my eyes and try to jump start the grey matter to process what that sound is.  It's the door.  Somebody's at the door.  It's morning and somebody's at the door.  My wife has already left for work.  You need to get up and get the door.  My son beats me to it.  It's my dad.  A splinter decided to stick his finger last night and this morning decided to makes its presence known by pulsating.  Not necessarily a good sign when you can feel your pulse in your finger, especially in someone whose immune system's might is on par with France.  He has with him some really nice tweezers.  Swiss made of high quality tempered steel.  Nice.  They fit comfortably into my hands, a familiarity bred by long hours spent together.  They should.  With these types of tweezers, I was once able to dissect the vasculature of mice.  I make quick work of the splinter.  Remembering my anatomy, I look for streaking up the sides of the fingers or any swelling in the hand.  None.  Good.  I clean it with soap and water, apply some iodine, and then slap a band-aid with a hefty side of neosporin on it.  It's reassuring to me that I can do basic things while half asleep.

Later that day, I play doctor again.  This time it's for a grade.  I need to extract a comprehensive medical history from a 'standardized patient' (SP) who's pretending to either have a headache, abdominal pain, or chest pain.  Mine has abdominal pain.  Like most of my exams of late, I pretty much wing it.  I figure with the amount of time I've spent around doctors of late that if I've not picked anything up along the way, I have no business becoming a doctor.  Other than forgetting two minor questions, it goes off without a hitch.  At the end, the SP is supposed to critique us and offer constructive criticism, especially on our bedside manner (my school is making an honest effort to train humane physicians).  He states, "I'm supposed to find something for you to improve upon, but honestly, I can't find anything.  You put me ease.  You listened.  You didn't have your face stuck in your notes."  Well, this ain't my first rodeo but it still feels good to hear it back.

When I get out of the exam session, there's a message on my cell phone from my sister-in-law.  She has a question about my brother.  He has developed these little bruises all over the back of his leg.  The word petechiae jumps right into my mind.  Not sure how or why.  I think the word stuck in my mind because it's fun to say.  Petechiae, most likely, I tell them with some level of confidence.  Essentially, they are little bitty bruises where the capillaries rupture and can be evidence of several different things.  Infection, vasculitis, or in his case, most likely indicative of a very low platelet count.  In the absence of any fever or bleeds, it's nothing to run to the ER about but it's also something that the doc needs to know in short order.

A hat trick of doctor-playing episodes later, it's striking to me that all of these came to me with little conscious effort.  I'm not sure I'm any better at dealing with the emotional struggle at hand (in some ways, I think I'm worse with practice), but when it comes to basic medical questions, it's becoming second nature to me.