Wait and See

Jeff had a rough time last night.  His night nurse disapproved of using pain medication, saying, “It will delay your recovery.”  He said she was on a soap box about it.  He was confused by her contentions and was afraid to ask for the meds that had been prescribed for him.  Dr. Kennedy spoke with the nurse manager to find out what the night nurse was thinking.  The nurse manager spoke with us and we told her that although the nurse was probably trying to be helpful, she really wasn’t.  Jeff doesn’t want to make any of his nurses angry since he has another week to go. Still, she has to know.

It had taken us a week to talk Jeff into using pain meds and in 10 days with Typhlitis, he had taken only about 3 low doses of Dilaudid.  He was in pretty bad shape – fever and pain - when I got there this morning around 8:15 a.m.  The nurses were having a mandatory meeting and his day nurse did not see him until 10:20 am, after we had asked several times for his meds and after I asked if it was alright if I give him Tylenol from my purse. 

The infectious disease doctor checked Jeff’s belly today and asked his routine questions including, “Any sweats, chills?”  Yes, he sweated through his miserable night and, yes, his teeth were chattering, too.  The doctor looked at him with a serious expression and said, “That’s a problem.  Where is your IV?”  Jeff lifted his arm to show him his PICC line (#2).  When the doctor saw the flaring red skin of the underside of Jeff’s upper arm, he said, “That has to come out.” 

The PICC line had been giving Jeff trouble for several days.  Dr. Kennedy had asked the IR technician who inserted it to look at it again and stitch it in instead of relying on the clamp.  The clamp wasn’t holding the hub of the port outside his skin properly.  In preparation for the removal of the PICC line, an IV was put into his right arm but it cannot handle the TPN (IV nutrition) so Jeff will have to make a better effort to eat.  The technician hadn’t been able to look at the IV on Monday or Tuesday.  When he came to remove the PICC line today, he said the clamp was missing.  Jeff remembered that on Sunday, the night nurse had cleaned it.  The clamp must have come off then.  The PICC line will be cultured.  Jeff sighed in his drug-induced rest/sleep and muttered, "one less thing that hurts."  He was relieved to get rid of the darn thing but where will they stick him next, I wonder?

Dr. Kennedy heard from Dr. Porter today.  Dr. Porter thinks that the bone marrow biopsy should be repeated on Day 27 (Wednesday or Thursday next week) and it may show better results by then.  So we are in wait-and-see mode.