Guessing Games

The amount of respiratory support Cathy is receiving from the Bi-Pap was increased yesterday. It is getting harder and harder for Cathy's respiratory system to remove CO2. As a result (in the words of the resident from the pulmonary team) "Cathy's mental status isn't quite where it should be". I thought that it may have just been my paranoia over the past few days, but I thought that Cathy had become a little 'mentally distant'. She had a blank stare most of the time. This was one of the issues I wanted to discuss with a doctor today. This resident brought up this issue before I had the chance to ask. The theory is that the increased respiratory support will help remove the CO2 which will in turn improve Cathy's 'mental status'.

I also spoke with the attending physician responsible for treating infectious diseases. He stated that nothing has shown up on any of the latest cultures, even the mold that has always shown up in the past. It is to early for any results from the bone marrow biopsy. This doctor had a different twist on the reason for Cathy's 'mental status'. He thinks it could be due to the dialudid she has been taking for pain. Four months of dialudid, every four to six hours, may be taking its toll. He followed up this comment with a statement about pain management being the priority.

The one issue that I cannot even get a theory on, is how they are going to address Cathy's pressure sore. This sore was close to being healed when two days ago it became an open, bleeding, wound. Apply dressing, rotate positions, give antibiotics, and treat the pain is the approach that they are using. However, this is the same approach that has been used since August. I don't think it is working. When I question this, all I get are quiet looks and "yeah.......yeah......I know....... yeah....." and shrugged shoulders. Over the next couple days I will be working my way up the food chain with this question.

On the topic of pain, with the pressure sore now an open wound, Cathy's ever-present chronic headaches, and now a biopsy wound (within inches of her pressure sore if you can believe that), Cathy is continually fighting pain.

Cathy is under the care of a very persistent physical therapist. Today this therapist insisted on getting Cathy up out of bed for some marching in place (she cannot go far connected to the Bi-Pap) and leg exercises while sitting in a chair. Cathy had tears in her eyes, and at one point she begged me to help her convince the therapist that she was in to much pain. It tore me up to take the side of the therapist. After it was over, I think Cathy was glad she endured and exercised. It is needed for so many reasons.