A long Christmas Day

25 December 2024.

72 hours ago the attending oncologist told me I should review any advanced directive we may have so that we are all on the same sheet of music today. Your wife’s respiratory rate is over 3x normal limit, and her heart is beating 145 a minute. This is unsustainable.

 I said – Doctor - I feel like you are having the talk with me like in the movies …. Are you having the talk with me?  He looked down for a second and looked back up and said – yes, I am having the talk with you.  She could code right now in front of us, but in my experience, it always happens in the middle of the night when we are not watching so I want to make sure we have this all on the table today, in the light of day.  I want to make sure my staff acts in accordance with your wishes. The next 48 hours are critical – they will tell us a lot about the direction your wife is going. We are looking for a rise in BP, and increase in output of urine and hopefully her immune system will start to come back – these things well help restart her gut ad eventually we believe overcome delirium again.

After much toiling and later the Nurse and Doctor asked me – If the next 48 hours are critical on which way she goes then we change nothing - if she codes you will administer CPR and bring her back. If she deteriorates and we think it could go the other way, we will re-do this conversion. That makes sense Sir.

Those 48 hours turned into 72 – scrutinizing every CBC,  charting the data – looking for trends – reporting to family and friends where we are. Some where in there, CBC numbers that indicate kidney function began to dominate the daily conversation.

Something has happened to the kidneys, and they are not doing what they are supposed to do.  More chart making. I hate making these chart …. They often tell me things I do not want to hear.  

Today Christmas morning, I was visited by a young kidney doctor - who told me – Sir, I think we have to talk about the possibility of dialysis. I am not saying you must decide anything right now, I am just saying it is trending toward us having to have that conversation soon and I want to have it when we are not in crises.

This Christmas day has been about reviewing options, understanding risks and benefits and gauging how a patient with her complications might perform.  Doctor 1 – the young guy is not optimistic – “ Sir , I have seen a lot of cancer patients do this, often, they do not do well – you need to know that. In other, less complicated cases it can give them more time.  Dialysis does nothing for the underlying issues – it only helps the kidneys and often adds risk to existing problems.  

 Another crossroads.