Medical report
Teri is only one week out of the MICU (medical ICU). Initially unable to walk, she began to walk 50, feet, then 230 feet, then 230 feet twice a day, and today a giant step to 690 feet. She is undergoing PT (physical therapy – walking and strengthening) and OT (occupational therapy – self care). She is eating and drinking sparingly, mostly pureed watermelon and some fluids. She needs help with feeding, walking, bathrooming ...
Teri’s WBC count ranges from 1,700 and 3,500 (normal > 4,000). Her hemotocrit (red cells) varies from 23-31% (normal > 41%) and her platelets run from 17,000-34,000 (normal > 150,000). She receives platelet transfusions every other day and red blood cell transfusions every 5 days. Her albumin (protein that helps retain intravascular fluid and prevent edema formation) is now 3.4 (normal > 3.5) as a result of continuous nasojejunal Nutren (nutritional supplement) feedings. Her urine has become bloody again from the BK virus. Her CMV viral particles have plummeted from 90,000 to 4,000 in response to IV foscarnet. It remains unclear as to whether she has nephrotic (kidney leakage) syndrome or not. The good news is that the nephrologists have decided not to do a kidney biopsy through her back. We don’t need to flirt with any more complications.
Yesterday Wednesday was a quiet day, medically. Many rounded – BMT, infectious disease, nephrology, psychiatry, PT, OT. However there was one procedure – another (3rd) paracentesis performed under ultrasound guidance – to remove 4.5 lbs of fluid from her abdomen through her abdominal wall. They seal the puncture site with cyanoacrylate (super glue).
Recalling the MICU experience
Teri spent time during the last several days exorcising memories of her MICU experience with two of her favorite faculty – oncologist and psychologist – much of it awash in tears. I had no appreciation how aware she was while sedated and intubated there.
- She felt isolated and disoriented despite knowing that she was in the MICU because she didn’t know what floor, where in the hospital and what direction she faced (her bed faced away from the window).
- She was tethered to the bed by the ET tube in mouth, PICC line in elbow, arterial line in wrist, central venous line in neck, NG tube in mouth and most of all by restraints to her wrists and ‘boxing’ gloves on her hands to prevent ‘harm to herself’ by potentially pulling out lines or tubes.
- She was frustrated by the inability to communicate even by mouthing words around the tube, outlining letters on the blanket, writing letters on a pad, pointing out letters on an alphabet card.
- She felt a complete loss of autonomy and privacy requiring a bedpan, requiring assistance to scratch an itch, requiring a nurse to change positions in bed, and requiring us to put Vaseline on her dry lips …
- She felt one nurse mistreated her without recourse.
- All in all, It was a horrific experience that she remembers.
Teri is definitely improving. She is having wartime flashbacks. She is regaining her self. She is sad that Tony her brother is leaving tomorrow - he has spent the most time with her of anyone other than me and comforted her through her lowest phase.
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