Saturday, February 21, 2009

Back Off the Eiger

It's been a rather nasty February for respiratory problems. We've seen more than our normal share of respiratory syncticial virus infections in adults. That of itself is unusual, as is the number of staff members (usually a robust group) who have used sick days due to pneumonia.

Darla works at another hospital. She had been getting recurrently sick and was not improving. Her lungs rattled like an old washing machine, a moist cough persisted, and she had no energy to work.

Doctors suspected a possible lymphadenopathy and performed a mediastinal biopsy, during which Darla suffered a pneumothorax and her right lung collapsed.

So things weren't going so well.

After that, doctors also recommended endoscopy. During that procedure Darla's esophagus was perforated and subsequently she got really fucking sick. So they shipped her off to us. There's some surgeons at our hospital who have good reputations for fixing these kinds of problems.

Her lung required a thoracotomy. That's big enough a surgery alone. But the espophageal tear was messy. Afterwards Darla had three drains placed along her lower right flank, one which was internally very near the esophageal abscess and two others to suck away fluid that might accumulate in the pleural and peritoneal spaces.

The right scapular incision for the lung surgery ran 20 staples long. About 7 inches.

They placed a gastro-tube to drain and decompress her stomache and a jejeunostomy tube provided tube feedings. The mid-abdominal staple line ran 15 staples long; just big enough for the surgeon to get their hand in there. Maybe 5 inches.

Darla dealt with it. She was always up walking around. I was able to help her with pain control, balancing on that line between discomfort and somnulence. Her bowels woke up nicely, the tube feedings maintained her energy level, and she was compliant with the strict order not to take anything by mouth until the doctors were sure that the espophagus would not leak post-operatively. That would be really bad.

Her friends from work visited, as did her protective and gentle Richard-Gere-look-alike boyfriend Casey. Over the few days I worked with her she improved steadily and everybody was thinking that in a day or two she might get some of the tubes removed and go home.

A swallow test was scheduled to evaluate her esophagus and we began to set up home services for her continued tube feedings. She would need that for a few weeks yet. After normal oral fluid and food intake resumed the G and J tubes could be removed during a visit to the doctor's office. Her main problems were resolving.

But we still have no fucking idea why she was getting so sick in the first place.

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