Around noon on Christmas day, Rachana was discharged from the ICU to a regular floor.
The last three weeks have been nothing short of a miracle. The nurses and doctors in the ICU have said, time and again, that this was one of the toughest case they’ve seen and are amazed at her resilience. They said they are very happy that Rachana proved them wrong on multiple occasions and that she is one of the very few cases who has left the ICU after staying there almost three months.
Early this week Rachana had a ‘swallow test’ to see if she can swallow and guide the food into the stomach rather than her windpipe. Our anatomy basically relies on a muscle in the neck called the epiglottis to close the path to the lungs and let food go down the food pipe. After three months of not using this muscle, some people cannot control it and food goes into the lungs causing problems. So they took her down to the examination room and had her slowly try liquid, semi solid and then solid food which were dyed and they watched the food go down under a machine. She did well and they cleared her to eat and drink anything. She has been trying to increase her appetite for the last 2 days, but it’s difficult for her to eat a healthy amount. They plan to remove the feeding tube if she can increase her appetite.
The doctors had planned to move her out of the ICU to a regular floor a few days ago but she developed chest pain, which paused things. They ordered a CT scan to make sure things are stable, but had inconclusive evidence if one of the holes had popped or just expanded in size. Rachana’s lungs still have significant pockets/holes in number and size. Some of these pockets have infact grown in size and are taking up, in my view, about 10-20% of the right lung and about 30-40% of the left lung. You can imagine the reduced capacity of her lungs with that much damage. So, what is the fix? Unfortunately, there is no medical intervention that can help; it’s totally up to her body to decide if and when the lungs can improve and eliminate these pockets. For now she needs some O2 assistance for a few hours in the day and most of the night.
Next week the vascular surgeons will try to figure out how to clear her arteries and restore enough blood flow to her legs to facilitate amputations and it’s recovery. The podiatry team is still deciding on the level of amputations that can benefit her most. One option is to limit it to mid feet where the gangrene stops but the nerves in her ankles are damaged and that brings the second option of doing below the knee amputations, which can give her more prosthetics choices and full movement. Obviously our preference is to save as much of her legs as possible, but that will depend on restoration of blood supply and recovery of her nerves.
Another bit of good news of that the bacterial vegetation on her heart valve is gone. The antibiotics seems to have done their job and a TEE test confirmed it. This test is a pretty cool piece of medicine and engineering. It’s essentially an ultrasound done from inside the body. A small tube is inserted from the mouth into the stomach and when the tube is close to the heart, they do an ultrasound. I was pretty nervous when they did this test because if the vegetation was still there and causing issues, it would have been another major surgery to replace the heart valve. So she dodged another big issue.
Merry Christmas everyone!