Comfort Care, Do Not Resuscitate

After my last post, thngs continued downward. Her breathing was labored, shallow, vitals all over the place in both directions high and low. Blood sugars irratic, pain level increasing, flow from the chest tube very minimal to where they decided to remove it. Feeling that it might help her be more comfortable. The decision made that she was very depressed and in lots of pain and the talk of taking back to ICU only highten that depression. So, family discussion and DNR order written. The doctor felt if the tube went in, it would never come out and thats not what anyone wants. Once the decision was made and she was able to discuss her wishes, see family members she became more calm and that seemed to help her breathing. Changes in her meds with the inclusion of a mood elevator also helped; not only her-- but family as she looked better. The tough part is is it an elusion? Her vitals are better, her breathing was better, they took out the G tube also. Her hemaglobin continued to drop farther and got down to 8 again; 2 more units of packed cells were given. This now makes 12 or 14 units of packed cells she's been given; so clearly the bleeding is still an issue. After the cells are given she has a little more color, a little more energy and her level actually got to 12 one day, the next day it dropped to 11.5, wonder what it will be today. If the count levels out or maintains, they may feel the bleeding is coming under control; but we've been many times before. Confusion and pain increase when hemaglobin drops.

Yesterday, they decided to see if she could tolerate any food. This is the 3rd attempt since surgery 7 wks ago. She had small amounts of hot tea at all 3 meals yesterday with some very thin diluted brooth, a little Italian Icy. She didn't throw up, or have more pain as she has in the past; but it's too soon to tell if her stomach is going to process it this time.

Her partially calapsed lung has worsened in the past 2 days, and yesterday 2 Interns/Residents were talking about chest tubes again. I told them she's already had 3, and I didn't think she'd let them put another one in. They wrote orders for an occlusion dressing at the site of the last chest tube to hopefully prevent air from the outside from entering, feeling that might help the situation. They'll do another chest x-ray today. The other possible reason for the calapsed lung would be a hold in the lung; but that isn't showing up on x-ray.

She's so very tired of this all, depressed. I don't think I can count the number tests, tubes, holes etc. her poor body's been through.

Thanks again to all for your continued support both here via comments, emails etc. I truly appreciate each and every hug, good vib, and prayer.

Bleeding among other things.

Good grief, things just keep happening; and not good things folks. She's had maybe one good day after chest tubes were removed and things started going downhill again. Instead of being able to feel better or do more, much the opposite has taken place. They tried again to introduce food and she's been unable to tolerate it; brings it back up. Each day she has more pain; not less and got weaker not stronger. She was very pale and blood work showed her hemaglobin quite low, only 7.9. 12 is normal. They gave her 2 units of whole blood last Friday to bring up her level and thought it would give her an energy boast. We all thought her discharge in several of her tubes had changed color and looked like blood, but when we questioned it we were told no ...docs don't think there's a problem. The following day her hemaglobin had dropped yet further to 7.3...a whole point lower after getting 2 full units of blood. They continued to monitor her blood counts over the wkend and it dropped a little bit more; but not drastically so. Sunday they decided yes, she was bleeding and they needed to schedule an endoscopy to determine the source of the bleeding. This is a risky procedure for someone who's had stomach surgery; though they said they would be very careful. The concern is pumping air in there to see, and rupturing the stomach due to the stitches etc.

Monday they did the endoscopy but told us they still didn't know the source of the blood. Yes she had blood in her stomach, but there was too much for them to see to know what was causing it, so they wanted to do it again the following day. Today that is, Tuesday. Today, we were told the same thing; it was too bloody to know the source of the blood. They think the source is ulcers, lots of ulcers that they saw on day one of the procedure and again today. Though in both cases they say they are not bleeding ulcers, but they think they might be seeping, oozing. They want to do yet another one tomorrow. Get this! The main reason they want to do another one tomorrow is someone was suppose to prep her for todays test and didn't and thats why they couldn't see!!!!!!!!! This woman hasn't been through enough; now because of yet another medical persons fault she has to endure more?

She was out of it most of the day today, she's still bleeding, she's getting the prep and they will consult ....the surgeons and the GI guys to determine whether or not to do this again tomorrow. They're typing and crossing her again for more blood and checking her hemaglobin again.
***forgot to mention she got 2 more units of blood yesterday.

Tired, frustrated, worred and now we're approaching the 5th day since we first wondered if she was bleeding.

Spent all day at the hospital, came home for a break and will return again a little later this evening.