My brother joins the circus

As I mentioned before, I plan to head to L.A. next weekend at the doctor's behest. In the meantime, however, I wanted to get a better sense of what was going on and so I turned to my brother. My brother is closer than I, but certainly not close (about 1000 miles away from dad). But still when asked, he hopped on a plane and headed to L.A. Once he arrived he was a pit bull, grabbing every doctor he could find, getting them paged and generally putting together as complete of a picture as he could. I owe him a debt for all the work he did this weekend.

Here's what we learned:

Its all about the liver: Every doctor that my brother talked to said the same thing. The minimal functioning of the liver is a contributing cause to all the other problems he has. Be it the lungs, the kidneys, or his varying responsiveness, it all is impacted by the liver. When the liver sneezes the rest of the body gets a cold. Now generally the liver is a resilient organ, so part of what troubles the doctors is the lack of improvement in the liver. What we were perturbed by was that there were not liver specialists that were focusing on dad. I'm given to understand that that changed today.

The kidney's are not coming back: My brother did talk to a kidney doctor and he is very pessimistic about the likelihood of the kidney's function returning. Probably, if dad is able to recover he will be on dialysis several days a week.

A tracheostomy is a definite: The pulmonary doctor that my brother talked to stressed the need for the tracheostomy. She did think, however, that that might improve dad's chances of getting off the respirator. Right now when he does the practice breathing, he's able to do it for about 5 hours, then he gets tired. With the tracheostomy, it is hoped he will have less far to move air and might be able to actually get off the ventilator altogether. This is key to his recovery, he needs to be able to breathe on his own.

The heart however is doing great:The positive side in all this is that the heart continues to work like a champ. The VAD is doing its job, and his blood pressure is good. They don't know why he had an arrhythmic episode this week, but he has been doing fine since.

None of this is very encouraging, and my brother noted that the phrase of the day was "we are hopeful but..." The hope window seems narrowing, at least from my brother's perspective. This seems to be the week they expect things either to turn around or start to go downhill.

I was last night trying to think about this in terms of patterns. Has my dad shown points where he has plateaued and then moved back towards recovery. The answer, I think, is yes. Certainly we saw this with his responsiveness where he was completely non-responsive and now has much more responsiveness. We also saw something like that for the heart, though that was a little cloudier since the RVAD masked what was going on there. Still we saw recovery there. Thus I still think its possible that he's in this fight and may still surprise everyone with a comeback. We watch, we wait, we hope, we see.