August 17, 2017
After a week of IV fluids, the creatinine level gradually dropped, the edema improved, and the nephrologist released him from the hospital. The cough, however, continued along with severe thoracic pain. The pain management doctor prescribed Gabapentin (Neurontin), a fentanyl pain patch, and Dilaudid for break-through pain, but nothing worked. We continued to search for the root cause.
Our oncologist scheduled an MRI and a PET scan for September 27, three weeks after his hospital release. When he arrived at the cancer center, he was so weak he could barely walk in, and when they took him back for the scans, he was unable to lie down. (Beginning in the early summer, a soft bump had popped up on Jim's back. The oncologists looked at it but didn't seem too concerned, since they were certain it wasn't a tumor. By now, it was inflamed, hard, and covering a seven inch area.) The radiologist sent us to the second floor to see our oncologist who took one look at his back and sent us directly to the hospital.
No one knew what the trouble was, but everyone knew there was trouble.
Jim's case is unusual and complicated. To live for ten years with eight recurrences of Stage IV lung cancer is unheard of. (Jim had been stage IV since his first metastasis in 2006.) With every recurrence, the doctors were working in uncharted territory. Thus, it took a whole team of physicians to treat him.
First order was to get the fever down and the pain under control. The night we were admitted, the infectious disease doctor aspirated the area on his back and sent the aspirate to the lab. You can watch the video I took but be warned, it is graphic. https://www.youtube.com/watch?v=9Z2egq4hKQ4 That procedure did alleviate some of the local pain, but the aspirated area was just the tip of the iceberg. For the next several days the pulmonologist, cardiologist, oncologist, nephrologist, ID doctor, and pulmonary surgeon worked to find out what was lurking beneath the surface, using every diagnostic procedure available.
They concluded that disease, surgeries, and radiation had left Jim with a seriously compromised left lung, providing a trap for bacteria and secretions. Pus collected in the pleural cavity forming an empyema (an enclosed abscess). In Jim's case, the fluid caused a fistula or crack, allowing the pus to escape into the back causing pain and swelling. None of the doctors had seen anything quite like it.
The thoracic surgeon finally decided to make an Eloesser Flap, an archaic procedure developed in 1935 and used primarily for TB patients prior to the advent of antibiotics. Occasionally, it is used today in patients like Jim who have a stubborn infection that cannot be eradicated with oral antibiotics. The surgeon had performed the procedure once in his career; physicians and interns throughout the hospital came in to observe. I took this video the morning after surgery so that I would have a visual for unpacking and packing the wound. again, this is graphic but I include it for educational purposes. https://www.youtube.com/watch?v=f4bngOG_dzA (On Day One, there was already talk of my performing this task when he was sent home. Little did I know, that wouldn't happen for eight weeks.)
The recovery was not easy. Already weakened from the previous months, he was completely bedridden. Each day he was visited by the six physicians, the wound care nurse, the respiratory therapist, the phlebotomist, and multiple others, leaving little time for rest. After a few weeks they added physical therapists.
In November, thirty pounds lighter and much worse for the wear, he came home to begin the slow road to recovery.
No comments:
Post a Comment