Saturday, January 01, 2005

Will had a strange day today, but strange in a good way. We left him in a good place last night, but came in this morning to find him again needing a lot of oxygen. The nurses chart his every move with precision, and his chart this morning showed his oxygen needs each hour: 40, 40, 40, 45, 50, 55, 80... It was a steady downturn that left him at about 75 this morning. He improved to 60 while Mary and I were with him, but he then started flailing about as if in pretty constant pain and discomfort. He was given a sedative, but that seemed to help for only a few minutes, if at all. The doctors had said they'd probably need to tap the area around his lung this afternoon, but by 12:30, we were asking them to do it because it was clear he was going downhill. He has a new attending physician (they rotate each month), and she seems more convinced that Will should have a chest tube inserted to keep the area drained if he's going to continue to accumulate fluid. While we went to get something to eat (we don't stick around to watch things like this usually), they tried to tap his lungs. Before doing so, they also increased the pressures on his ventilator because his lungs looked a bit less inflated than they'd like.

We returned expecting them to say they'd taken out a lot of fluid and that they were planning to insert a chest tube soon. Instead, they told us they got only 10cc out of the tap, in part, they think, because some blood from all of the holes they've poked in his side has gotten into the fluid and clotted in the end of the needle and blocked their attempt to get more fluid. A subsequent x-ray showed that while there still was some fluid left behind, his lungs looked much better. Throughout the afternoon he continued to improve, and ended up having a good day and (at least until we left) a good night, too. An x-ray tonight showed that he still has some fluid around his lung, but it doesn't seem to have increased, and it hasn't seemed to bother him much. We know better than to think this is anything but a fluke, but if it is an indication that the octreotide is working, that's a good sign. The new attending physician increased his dosage more rapidly than Dr. Dagle had, and maybe they've finally hit the right level for it to work. Then again, maybe not. The medicine has its downside, so we were certainly OK with Dr. Dagle taking it easy on the dose, but Dr. Colaizy (she's so new there's no web page to link to for her yet) is still mindful of not giving Will too large a dose. We'll see what happens.


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