Update #2 from Megan, 22 Oct

Grandma has had lots of doctors visit this morning! Uncle King and I have been so busy talking to them that I have not had time to post. First Dr. Seeram stopped by. She was going to call the thoracic surgeon to have him do the pleurodesis, but when she checked, she found that Grandma is still draining fluid from the chest tube. It is supposed to slow down to 100 ml or less in a 24 hour period before pleurodesis would be advisable. Dr. Salimi, the oncology fellow, came by while Dr. Seeram was here. He wanted to follow up after having spoken to us on Friday. Confirmed that we had decided on inpatient Hospice care. He agreed, though his funny way of concurring is to say "I do not disagree". While both Drs. Seeram and Salimi were here I asked what happened yesterday morning. They speculated that it was a cardiac event of some kind, either a clot or heart attack. A little while later the attending physician, Dr. Palacio, came on rounds with three of the residents. He asked Dr. Seeram questions about Grandma's care and asked King and I whether we had any questions. We asked if it was possible for Grandma to stay here through the end of the week, since Deng will be arriving. He said yes. This was the first time I had met Dr. Palacio. He has a very quiet, easy manner. Dr. D'Agostino, a thoracic surgeon, visited Grandma to check on her chest tube. She is still actively draining fluid. It looks like there is 500+ ml in there now, and Dad left a note saying the container had been emptied at 4:50 a.m. Dr. D'Agostino wants to see if there are any ways he could slow down the drainage. He left, saying he was going to think about it. As D'Agostino was leaving, a Dr. Reisfield came in to introduce himself as a staff doctor who specializes in symptom management. His training is in anesthesia and palliative care... he may have listed other specialties, but I didn't have my notepad handy. We did learn that some of his training was in Houston at the Texas Heart Institute. He asked Uncle King and I questions about what we understood about Grandma's situation. We must have passed muster, as he did not have to supply any additional information. We let Dr. Reisfield know that Grandma will be going to inpatient Hospice care at some point. We explained our concern that Grandma had not yet been able to see one of her children and that we didn't want her to go to Hospice too soon, as removing the IV fluids might hasten her death. Dr. Reisfield said that would be a false choice, as Hospice care is about achieving goals. If one of Grandma's goals is to see Uncle Deng, then they can arrange to have IV fluids at Hospice until then. Suzanne (Sue) Bell from Community Hospice came by to check on Grandma and confirmed that Grandma could go to Hospice with her IV. Dr. Reisfield asked if there was anything he could do to help Grandma with pain or breathing. He showed me how to listen to Grandma's breathing with a stethoscope to identify wheezing or rattling. There was none. He explained the Fentenyl patch that Grandma is wearing: it slowly releases pain medication over a 72 hour period and is often used in elderly patients. Dr. Reisfield explained that there is still a standing order for morphine; we should ask for it when Grandma seems to be in pain and/or is having difficulty breathing and a breathing treatment is not yet due. Dr. Reisfield asked if it was ok if he came by each morning while Grandma is here. We said an enthusiastic yes. Dr. Reisfield is a very gentle, kind, patient person and Uncle King and I agreed that his presence alone was very comforting. He will bring several business cards by later. Megan