ICU Day 57 – Wait & See

Nothing much has changed in the last few days. Rachana is still stable but critical. Stable means her condition is not constantly deteriorating, but Critical means the doctors are not sure if it’ll continue to get better, i.e. they are unsure of how things will unfold. Medically there is nothing much happening other than support. They are giving her antibiotics to keep the infection under control, but other than that it’s all supportive care. The ventilator is supporting what her lungs are currently unable to do. To keep her comfortable she is getting a sedative, anxiety control and pain medication. It’s a wait and see situation to see how soon her lungs get better.

Lungs are still the focus of her care. Currently the ventilator settings are not very high, but her lungs are severely damaged and her general condition is very weak from almost 2 months in the ICU. The doctors think it’ll be weeks or months before she can be taken off the ventilator. They plan to do breathing trials to confirm how much the lungs are able to work on their own. The last trial, which was for about a day, set her back by a week with higher ventilator support to get the O2 and CO2 in check. That gave a good indication that her lungs are not ready to be on their own and will need ventilator support in the near term.

The situation with the clots is also stable. Gangrene because of clots seems to be limited and not spreading, which would have been really bad. All 10 toes, almost half of her feet, three left fingers and one right finger is basically dead tissue i.e. dry gangrene. Early on she used to have pain in these areas but now it’s not that bad. As I explained earlier, there is nothing the doctors can do here except wait for her Platelets to come up to around 50, and they are currently staying around 20. When it comes up they will reassess the damage and see what options they have, starting with blood thinners and then surgeries.

Endocarditis (heart valve infection) also seems to be stable. It not affecting any function of the heart and so currently it’s not an issue to worry about. Once in a while it does shoot off some bacteria causing a new clot. The clot in the right index finger about 10 days ago was one of these situations.

The WBC and ANC numbers had dropped in the last few days, but they are recovering now with the help of some neupogen shots. The doctors were contemplating doing a bone marrow biopsy to makes sure this is not because of recurrence of cancer, but the fact that the WBC came back up gave them reason enough to cancel that.

The kids has a great Thanksgiving break with their cousins and are very excited about the new school which starts this Monday.