Saturday, September 10, 2011

There's a clot that's wrong

So in the process of putting in the dialysis tube, I entered the ICU to see what was going on. The nurse hustled me out because they were actually in the middle of the procedure. But the doctor called me back and showed me a syringe with blood at the top of it. He said it was a clot. And he had just pulled it from my father's neck. The clot was blocking him from putting in the dialysis tube. He said he was going to try the other side, but then if that was blocked he would have to use the groin. This he was reluctant to do because he said if dad started bleeding the they would not know because the blood would drain into his back. I went back to the waiting room to await the verdict. Some time later someone told me I could go back in. The doctor told me he was very concerned about the clotting and thought perhaps this would explain some of the things they were seeing. He didn't have an explanation for why this would have happened. Its possible that a person could develop a resistance to the heparin that dad was on before the surgery. In that case occasionally there is a rebound effect where the heparin facilitates clotting rather than preventing it. All of this would have to be studied in dad, the doctor said, to figure out if this was the case. Certainly there is some evidence of this, but more data was needed and he would order some blood studies. In the meantime they had gotten the line in and he was starting dialysis. I talked to the kidney specialist. He indicated that dialysis would go on for probably a couple of weeks before the kidneys would have had a chance to heal. But in the meantime, he thought if dad's sleepiness was the result of his kidney problems it would probably be 24-48 before his BUN level lowered to the point he would be returned to regular mental state. The doctor said in a normal person one's BUN level is around 20-30. If it gets up between 40-50 confusion sets in. Dads level is above 70, so he has a ways to go before it gets low enough to get back to normal. This leaves me with a quandary as to what I'm going to do. I will talk to the doctor again, but apart from the clotting issue that could cause stroke or respiratory failure (though I believe he has a filter in the vein to his brain), the other things are rather long term issues. If there is no immediate danger, I will probably go home tomorrow. But its unclear to me whether we are there or not. I am not sure how I feel at this moment. As he becomes more and more machine dependent eventually there will have to come a time where he breaks those dependencies. When that happens its showdown-at-the-o.k.-corral time., do or die. But it seems to me we are days and possibly weeks from there.

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