Mom at Shands, 16 Oct

Hi, Everybody! Even though the use of chemical pressors to stimulate the heart or constrict the blood vessels is not as dramatic as chest compression or inserting a breathing tube it is another heroic procedure because a terminal patient can become dependent on it. After reminders from different teams of doctors about advance directives Ruth and I talked to Mom while we were in the Emergency Room. I described different resuscitation techniques and Mom was quite vocal about not having them. So I signed the DNR paper. Unfortunately, that also includes chemical means. Intensive Care Unit was called in to evaluate the situation. The echo cardiogram technician reported to Dr Tallidge directly after our talk. Dr Tallidge then contaced his supervisor and the three of us reviewed the situation. Mom's heart couldn't take the chemical stimulation. Constricting the blood vessels will likely cause blood to pool at the extremities causing black fingers and toes. Even if we can stabilized her enough to track down the root cause it will be unlikely for anyone to effect a cure at Mom's age. At this point they are suspecting cancer somewhere in her body. I made the decision to not sign another DNR document. They proceeded to make Mom comfortable and reduced the rate of the saline drip, at about 7pm. The mood at the nursing station seemed to change. Mom's heart rate was hovering around 148 bpm. Hong, Richard, Joan, and Lang called and talked to Mom around 10pm. Soon afterwards her heart rate dropped to the 80s and high 70s and stayed there all night. Blood pressure and sugar level were also in the normal range. Dr Vu said this morning that they are still waiting for the cytology report. He suspected that some infection might have caused the dropping blood pressure. Cultures from urine and blood samples taken in ER take three to five days to develop. They have been treating Mom will numerous antibiotics. Fluid will continue to build in her right lung. Re-inserting the chest tube may cause new infection. Prognosis: poor. He advised us to notify relatives in the area so that they may have a chance to see her. Keeng and Lang are trying to take a flight into Jacksonville around noon. Megan is on her way from Tallahassee. Cara and Sanford are arriving at JAX around midnight. Hong, Joan, Jonathan, Adelaide, Victoria and Hayley will be driving over from Houston. Take care. Love, jonah