July 6, 2010

Today was supposed to be a good day. Yesterday Linda was up to go to the bathroom and took a wheelchair ride down to the bamboo garden in the hospital courtyard for half an hour in the sunshine and a long drink of iced tea. She was in great spirits and looking forward to further progress in her quest to get well and come home. The liver doctors came around and told us they were going to take out her chest tube and transfer her off the TICU to a regulate room in the organ transplant ward. She had oxygen saturation of 100% on room air at that point. I got a big wheeled cart and moved all our belongings into her new room, and put everything neatly away, in preparation for her arrival from the ICU down the hall.

Removal of Linda's chest tube was delayed by a liver transplant surgery for another lucky organ recipient, but her earlier progress meant the only lines she had connected to her were the PICC line in her right arm and the chest tube, so at 10:00 p.m. the nurses wheeled her bed from TICU over to the OTU. They lifted her across to her new bed, and began the process of rolling her from one side to the other to get the soiled sheets out from under her, and they pulled her chest tube out of her rib cage with the bed linens, not under the circumstances under which the doctors intended for it to be removed. They called one of the residents from the transplant unit, and she put a Vaseline and gauze dressing over the chest wound. One of the liver fellows showed up about 3:20 a.m. in response to reports that her breathing was becoming more difficult, and he ordered a portable chest X-ray which disclosed a pneumothorax with about 20% collapse of her right lung.

This fellow, Dr. Shah, decided he needed to put in another chest tube, at the bedside. In light of our experience of 2 weeks ago, I asked him to wait until Dr. Tector got to the hospital before he started that procedure, so Dr. Tector would be on hand to deal with any complications. Although he denied that the situation was an emergency at that point, and although Linda was talking and breathing on her own, Dr. Shah told me that Dr. Tector was on the way, and would be at the hospital in 20 minutes. Dr. Shah said it would be irresponsible to wait the 20 minutes for Dr. Tector to arrive. He numbed Linda's right side with Lidocaine injections and made an incision down to the layer of muscles between Linda's ribs. He inserted a guide wire into her chest cavity to position the chest tube. Then he slipped a trochar over the guide wire in order to cut through her chest wall muscles and insert the chest tube.

As Dr. Shah pushed the trochar through Linda's chest wall, she cried out loudly twice, in obvious pain. Dr. Shah asked the nurse to get a vial of injectible narcotics to dull Linda's pain, although narcotics depress respiratory effort. The drugs arrived and a nurse injected them into Linda's PICC line. Linda stopped breathing and turned blue before my eyes. The doctor called a "code blue" and I left the room when six or seven other people came rushing in, so they would have room to work. The last thing I saw as I walked out was Dr. Shah tilting Linda's head back, her face blue, his hands on either side of her jawbone attempting to keep her airway open.

I sat outside Linda's room waiting for Dr. Tector to show up as promised. 20 minutes passed, and he did not come. In fact, as I sit here writing this 12 hours later, I still have not seen him. Apparently Dr. Shah's representation that Tector was on his way to the hospital was a fabrication intended to get my consent for him to proceed with the chest tube insertion.

For nearly an hour and a half, no one would tell me anything about what was going on in Linda's room, though I questioned every nurse and RT technician who came out to fetch a drug or piece of equipment. There was a fellow in a white lab coat, who introduced himself as a "nurse manager," standing right outside the door of Linda's room watching the proceedings, but he also refused to tell me anything about what was going on. I could hear them asking for atropine, and then for more atropine, a pretty clear indication that Linda's heart stopped beating, but still no one would say anything about what was happening. After about 90 minutes they told me Linda was stable and they were taking her back to the ICU. When they rolled her bed out of the room I could see she had been intubated and the RT was bagging her with oxygen. Her eyes were closed and her face was bright red. I followed her bed over to the ICU, but once they had her back in a room there I was introduced to a student nurse who was supposed to "help" me fetch all our belongings on a cart from the OTU and bring them back to the TICU room. I surmise they wanted to get me out of the room for a few minutes so I couldn't see what was going on in there. It took about 10 minutes for me to pack everything back up and return to Linda's room in the TICU.

By the time I got back to Linda's TICU room with everything, they had her on a ventilator. Seven IV channels were hooked up to one or another of the three ports on her PICC line. Dr. Shah put an arterial line back into her groin, and instructed one of the nurses to insert a Foley catheter into her bladder. So, we are back to the point where we were right after the surgery to remove the errant chest tube from Linda's liver two weeks ago. Shah insisted on changing out Linda's ET tube for a larger size so he could perform a bronchoscopy to look at the interior of her lungs. After two attempts, with two ET tubes pulled out of her throat with blood on the cuffs laying on the blanket on her bed, he inserted the bronchoscope. By this time it was 6:30 a.m., though the clock on the bronchoscopy screen said 4:30 a.m. This would make it seem that the scoping happened two hours sooner than in actually did. After the procedure was complete, I called this discrepancy to Dr. Shah's attention, and his response was that it didn't matter, since he wasn't recording the images. I guess he doesn't want anyone to be able to look them over in the future and contradict his interpretation of what they show. Typical.

Using the bronchoscope, Dr. Shah suctioned some secretions from inside Linda's bronchial tree, and rinsed the inside of her lungs several times. Undoubtedly this must have made her feel as if she were drowning every time he pushed water down her ET tube into her lungs.

As I write this, Linda is sleeping on the ventilator. She has awakened several times during the day, and tried to write notes questioning why she is back on the vent, though her handwriting is completely unintelligible. Her wide eyed fear and utter frustration with her situation are very apparent to anyone looking at her. One of Linda's nurses [she has 2 now] just brought me a card from Nick encouraging her to never give up and "Keep fighting, Don't fucking give in." How perfectly timely.

The respiratory therapists are giving Linda breathing treatments every four hours, and after every one they suction a couple tablespoonfuls of bloody secretions off her lungs. No wonder she is terribly frightened. I hope they get it right this time, because it doesn't seem like she could survive another round of this nightmare.