Rachana is still sedated but off the paralytic meds. She looks calm and her vitals (heart rate, BP, oxygenation) are ok. She developed a fever last night and we hope it’s just the existing bacterial vegetation on her heart that is causing this, for which she is getting antibiotics.
The doctors are still focusing on her lungs as that remains the primary and immediate concern. The CT scan showed a worsening picture with many lesions on and within both lungs which can takes weeks to recover. These lesions can pop, but the chest tubes should pull that excess air out and prevent a lung collapse. Her CO2 level is a little higher than normal so the ventilator settings remain high to support her. The doctors are essentially having the ventilator provide her lungs the necessary support to continue to work.
The clots are the next problem to solve, which first needs her platelets to rise. The toes and half of her feet continue to get darker. Her feet will possibly not survive, but the gangrene spread seems limited till mid feet and not touching the ankles. The platelets have held up better and she hasn’t needed a transfusion in the last 3 days. The doctors say this partially because her fever has been under control too. Hopefully this morning’s fever is a one-off and will not sustain. It seems fever consumes platelets. If the fever stays away the doctors can change the antibiotics to a narrower drug to focus just on staph infections rather than a broader set of infections. This narrower antibiotic can also help boost platelets.
The bacterial vegetation on her heart valve is a little longer term issue as she has to be generally a little healthier to undergo that surgery. That vegetation is at risk of breaking off and causing a lot of problems but there is nothing the doctors can do; either the antibiotics are successful in making it go away, or a surgery will have to be done to replace the valve.
Everything they do here is a balance between risks and benefits. Example: They are ready to take the risk of losing fingers and toes to clots vs. the benefit of giving blood thinners to resolve the clots which comes with the possibility of creating spontaneous bleeding that cannot be stopped. That is perhaps a no-brainer decision. But another example of risk and benefit that ended up being a problem was the left chest tubes. On Nov 2nd, they put a chest tube on the left side to help reinflate the collapsed lung that stopped her heart. This was done in an emergency and therefore not in a sterile environment. The doctors planned to remove that tube and put a new one in to limit the chances of a new infection. So they took the risk of putting a new tube in to remove the old, possibly infected, chest tube. The new one ran into complications. Now we have a larger issue on hand as the new chest tube is bent and possibly puncturing the lung. They don’t want to remove or mess with the new tube fearing bleeding in the lung, and they cannot remove the old one as that is still supporting the lung instead of the new one. So for now she has two chest tubes on the left, one possibility infected and another possibly puncturing the lung.
In the next few days, signs of progress will include no fever, lower ventilator settings, higher platelets.