Admitted to ICU, fighting an infection

On Saturday Oct 1st night Rachana was very uncomfortable and she hardly slept. She was complaining about pain in her neck, elbows and back. She also had a small cut in her left index finger that was getting worse. Around 6am she started complaining about chest pain and that was getting worse too. We called the doctor who advised us to go to the emergency. In the ER the chest and back pain escalated. They gave her two shots of morphine over an hour and that seemed to help for a little while. The ER doctors did all the usual tests; x-ray, urine, CT, blood, and started antibiotics after determining that it was an infection in the lung which showed on a x-ray. They were planning to move her to the 11th floor (BMT/Cancer floor) so her usual doctors can assess and plan the next steps, but then her BP dropped, heart rate jumped up and her temperature rose to 103. The ER doctors discussed the situation with the BMT doctors and decided to move her to ICU to stabilize her situation.

In the ICU they put a new IV line in her left arm, because the chest port was used for other medications, and an artery line in the right hand to get better readings of her BP which was still running low. The procedure to put the artery line was quite bloody. They pushed a small tube into a small artery near the wrist and connected a saline bag to it which was connected to some machines. The few secs between putting the catheter into the artery and hooking it to a saline bag was where blood just pumped out of the catheter. Basically, instead of using an armband to check BP, they went right into an artery to have an accurate reading. After they had an accurate reading of her BP, they gave her a medicine that got her BP under control quickly and the ICU doctors literally high-fived each other going out the room. Not sure if this was a delicate procedure or one of the first times the young ER doc did it. I learnt later that getting a precise BP reading is the only way to calibrate this BP reducing med and only when calibrated right will it work. Things got under control quickly once the BP was brought to manageable levels. It was around this time that she started feeling better. After an uncomfortable night and a very difficult morning, she was finally calm around 2pm. There was a constant stream of staff coming in for labs – they did x-rays and ultrasound of the heart, stomach, liver and lungs.  All this to figure out the exact infection so they can treat it better than generic antibiotics that she started on in ER. But this process of identifying the infection can take a day or two. Unlike the last few times that we came to the ER, this time it looks like she has a real infection that had caused all these problems. The ICU doc explained that from the x-ray and her condition it looks like the infection started in her lungs and quickly spread into her blood (because of low WBC), which inflamed the arteries, which dropped he BP as there is the same amount of blood in going through the inflamed/enlarged arteries. One way to bring back up the BP is the give fluids, but the flip side of that is excess fluids can go into the lungs and then you have to put a pipe in the throat to assist with breathing. Anyways, the doctors are not expecting such drastic measure and are hoping that she responds to the antibiotics and her BP goes back to a stable rate soon. She has two pipes in her chest port, one in her left arm, one in her right arm and is breathing through a oxygen mask. All of this medication should help.

Last week was hectic for everyone around us. Rachana as usual had multiple trips to the clinic, for chemo and bloods tests. I was out all week on a business trip and Alaap stayed home and worked remotely to make sure someone was available if she had to be taken to the clinic/hospital. Rachana’s sister arrived from Amsterdam and her parents left to India. Family and friends made a surprise visit to celebrate her birthday. Her blood counts dropped quite low and the doctors had to transfuse two units of blood on Friday to keep her stable. It was probably these low counts that helped her catch this infection, she was around a few people this week but no one was sick – so who knows where she caught this from. But it’s lucky that I came back on Friday night and this happened a day later.

For now it’s wait and watch. Hopefully she’ll get a little stable in a day or two and then they’ll move her to the BMT floor for further treatment and we’ll be back home in a few days.