Joke's over folks

I definitely lost my sense of humor for a while last night. Caren deteriorated over the course of the day. She just felt sicker and sicker. Around 7pm, we were just watching some Jeopardy and she started shivering uncontrollably. Out of no where she developed nearly 102 F fever and almost completely stopped producing urine. Earlier I had poked fun at our lack of attention to her foley catheter; the truth is that she had a serious problem brewing there and for some reason, no one was paying close attention.

I need to explain a little bit about how hospital care works here. In the real world, when someone realizes they have a fever, they take some Tylenol to try to control it. If it appears as though urine production has slowed, you notice that your pee is getting darker and darker, you hydrate and try to get back to balance. In the hospital, no one does anything without permission. The nurse, who literally looked like she was in her 70's, and turned out to be very sharp, could not give Caren ANYTHING without asking the doctor. Well at a teaching hospital, there are all sorts of doctors. Some doctors that know things, some doctors that don't know anything and the worst kind of doctors that don't even know that they don't know anything. Well when the nurse asked the Resident on the floor, he didn't know what to do (although he was at least self-aware enough to know that he didn't know what to do). He contacted his Chief Resident who wasn't sure how the Attending (Caren's surgeon and head of Colo-Rectal surgery at the facility) would like to proceed, so she contacted the person covering for the Attending (it was after 8pm at this point). Around 9pm, a man in a white lab coat strolled in and started asking about Caren's vomiting episode. In retrospect, it wasn't his fault he was woefully uninformed about the case, but he certainly didn't get a warm reception. I gave him a cross look and said that the vomiting happened over 6 hours ago and could we please discuss something more recent. Caren just looked at him and said, "Who ARE you?"

With that he started shuffling through his paperwork, obviously frustrated, he said his name was "Victor" from the surgical team and then stormed out of the room. From the bedside, I could hear him screaming at the nurse, who wasn't even the one that called him, about missing information and he couldn't do anything unless he knew what the problem was and "This is a waste of my time." Caren actually needed some help right then or I would have taken a moment to explain to him that the needs of my wife, or any patient for that matter, should never be considered a waste of his time. We never found the opportunity to have that conversation.

He ordered a chest x-ray, so we took a trip downstairs. I ended up staggering out of the hospital around 12:15am to get back to my sister's to get some sleep. I had a feeling today would be another long day. On the overnight, the chest x-ray came back showing some decreased lung capacity (not uncommon for a person who has been bed ridden for a week), but no pneumonia, which was the purpose of the test. Meanwhile, her blood work came back showing signs of a massive infection somewhere in her system. Caren took this moment to remind Victor that she only has one kidney, a congenital anomaly, just lucky I guess. He ran out of the room yelling, "She only has one kidney?" Now they finally took a close look at her urine, which by now was the color of Lipton Iced Tea and had chunks of tissue floating in it. Sorry for everyone with weak stomachs out there. I just can't express my frustration with the fact that we have a patient with an obvious infection and urine that looks like that and we're still looking for a respiratory infection despite a complete lack of respiratory symptoms. I understand the desire to be thorough, but when you're looking for a needle in a haystack, why would you start the search in the barn?

In any case, this brings me to this morning. I walked in the door around 9am to find Caren unleashing the fury into the all-to-familiar basin with her surgeon at the bedside. I swear, that guy makes her puke! She vomited not 5 minutes after he left yesterday and purged as soon as he walked in the room today. She apparently had been increasingly nauseas all morning. The doctor waited until she had finished and promptly inserted an NG tube to relieve the pressure. The procedure is awful and the feeling of the tube sitting in the back of her throat is nearly unbearable. As soon as the tube hit bottom though, two quarts of nastiness filled the suction basin. There was just a ton of goop sitting there, unable to down and just waiting it's turn to reach for the sunlight through her mouth.

The surgeon is not convinced there is a blockage. He thinks the bowel isn't mobilizing well yet. However, in the constant grasps at being thorough, Caren is currently having Cat Scan contrast dye injected into her NG tube. We should be headed down for the CT scan shortly, the results of which should definitively show if the new GI tract is working or not. We'll know more this afternoon. I will post as soon as I have something to update ya'all with.