Another bout of Pneumonia

After the stay in the hospital, which lasted 4 days, Rachana was back home and still on home IV antibiotics when she spiked a fever and complained about chest pains. This time we were a little confused as she was already on antibiotics and her bloods counts were pretty much in the normal range. When we called the 24 hr hotline, the doctor also advised to watch if her symptoms changed, else come to the clinic the next morning. Her fever basically stayed at 101-102 all night and we showed up in the clinic early in the morning. In the morning the fever was gone, but the chest pain was still around and her BP was quite low which triggered the clinic protocol to send us to the hospital. So there we were, in the emergency again after just a week at home from the previous hospital stay.

Unlike last time, the diagnosis this time was conclusive pretty quickly. Through a CT scan the doctors saw that she had fluid collection in/around her right lung; they suspected it was pus and the reason for her chest pains and fevers. The medical name for her condition was Empyema Pneumonia. The pulmonary doctors wanted the opinion of a thoracic surgeon, whose visit and explanations of options triggered bad memories. He essentially said that her condition is serious and we have two options. 1) Undergo surgery to open up the space that has fluid collection to physically remove the pus and fill up the cavity with mass from elsewhere. 2) Put a chest tube and hope that it can drain the liquid, which if is not successful, go back to option 1.

You can imagine Rachana’s reaction and the flood of emotions that took over. After the surgeon left, she cried uncontrollably like never before, asking me who will take care of the kids. It was probably the most defeated she/we felt in a long time. During the Oct-Dec ICU stay, she woke up to deal with the aftermath. This time she was walking into one, wide awake and acutely aware of the possible complications. We asked the doctors how this could have happened and if we can take any more precautions. They explained that after the Staph infection, Pneumonia, Endocarditis complications in Oct-Dec, her lungs were severely damaged and were left with large cavities which are easy targets for bacteria. With chemo she is immuno-compromised and even more susceptible to infections. Even if we lived in a single room with no visitors, we cannot reasonably protect her all the time. We’ll have to continue to take precautions and hope for the best.

We were happy that the doctors choose to go with option two and it worked very well. They placed a chest tube and pushed an enzyme to dissolve any stubborn material and over two days she produced about 200 ml of liquid that was stuck around her lungs. The doctors were happy with the results and said there is no need for any surgery. The liquid that came out was definitely not pus and test on a sample produced no bacteria growth, which was great news but left the doctors puzzled. Maybe the antibiotics she was already on from 2 weeks ago took care of the culprit. Clear evidence of what was growing in that liquid would have charted a definite path forward, but now the doctors had to shoot in the dark in deciding the next course of action. They decided to continue two separate IV antibiotics for 2 more weeks to make sure all bases were covered. On the 5th day after admission, they removed the chest tube and Rachana was feeling good enough to be sent home, just in time for the July 4th holiday weekend.

Rachana is recovering reasonably well at home. There are days when she has no complaints and suddenly the next day she is very tired and does not have the energy to get out of bed. Although the chemo is on hold while the antibiotics run their course, her blood counts are low because of the heavy antibiotics. We are hoping that she recovers fully in these 2 weeks, does not have any other complications and can get back to her chemo schedule quickly.