Emerson now has 3 of 3 cultures (1 peripheral & 2 line draws) positive for gram negative rods. She’s on very, very strong antibiotics that should be treating it & should have prevented it from growing in the first place. It is where we’ve feared this path would lead us for a long time… to an organism medical science is unable to treat – one so strong it is resistant to every available antibiotic known to exist. Are we there? I don’t know. No one does. Until we have final identification & sensitivities from the lab we won’t know what we’re up against. That information should be back in the next several days. Until then we sit tight & continue to support Emerson as needed. There are really no other/better antibiotics to add so she remains on the same ones she’s been on for a week now. The same ones through which this bug grew & flourished.
It’s all a little unnerving to be honest. At the same time, though, Emerson has been able to remain remarkably stable despite the potential severity of what her little body is fighting. That is very encouraging. Her platelets continue to drop & her lactic acid is high – among other things, it’s a clear indicator she’s septic. She continues to complain of lots of belly pain and is pale and lethargic, there is little change there. Thanks to the adjustment of some meds, though, she is managing her own blood pressures off nor-epi this evening & that is a huge win!
Little was said in rounds this morning… there is little to say. We discussed this exact scenario at length before we left Omaha 2 months ago & I think some are surprised to see us back. We had, at that time, expressed our strong desire to pursue quality of life for Emerson and to stop chasing infections. I suppose a few good weeks at the beach made me second guess my intent to intervene. I travel at all times with a signed DNR, but have been unable still to change her official code status here or elsewhere. In the end I just don’t know how to stop fighting until she clearly tells me she is done. And she’s not done. Not tonight. Not yet.
Jim and I, as you might imagine, have had lots to discuss in the past week. Clearly Omaha knows Emerson best, but we’re willing to accept the expert level of care she receives in Denver. They, also, know her well. And while Denver would decline any surgical intervention we feel comfortable they could manage her through a crisis without the need for a life flight back to Omaha. If something should happen to Eme in Denver I think we could both find peace in it. We weren’t comfortable, though, trying to get her through a crisis in Detroit. They’re a great hospital but they really, really don’t know Emerson & they don’t manage many (if any) bowel transplants. We wanted to give Eme a chance & felt that was best accomplished here in Omaha. Once we’re able to return to Colorado, though, our intent will be to manage out the remainder of her cares there.
There’s not much else to update tonight... things here remain mostly status quo. Eme is going to IR tomorrow to have her perf drain replaced & the doctors here seem to think her abdominal wound looks okay. There was some discussion re: a surgical skin graft, but in the end it would only leave her with another wound & I just don’t see the sense in that. All are unclear as to if it will ever heal & my bet is no, but time will tell… The ID doctor is concerned the antibiotics left available to treat Eme’s infection may only be intermediately susceptible, which could explain why she’s not getting significantly worse but is also not getting much better. If he’s right there is some concern we won’t be able to kill this bug. I’m not sure where that would leave us, but for tonight I’m trying not to get too worked up about the “what ifs”. Things will be clearer soon. Until then… Good night & God bless!