On Tuesday evening Valjean, Mary (her medical power-of-attorney) and I had another frank talk with Dr. Sporn, the pulmonologist. This time the discussion was not in an emergency situation, and VJ was in prime interview mode, posing carefully considered questions and giving no quarter to weasly answers. She's given me permission to be frank on the blog as well.
Dr. Sporn described Valjean's condition as having plateaued, with no significant change since last Friday. While there remains some hope of turning around the acute problem -- apparently severe pneumonia -- he said that the longer she remains on this plateau, the smaller the odds of her recovery. If her condition worsens and she goes on a ventilator, he said, there is no chance it will turn around. In addition, the fluid around her lungs (malignant pleural effusion), which continues building up even as it's drained, indicates a more advanced state of cancer.
Valjean was loud and clear: "I'm not going on the ventilator." So while Dr. Sporn said there's no risk in trying one more course of antibiotics, and Valjean agreed, she also asked for and received a DNR (Do Not Resuscitate) order, which would prohibit an emergency intubation.
Sporn thinks that if she's really improving, it should become more clear-cut over the next several days. As I write this, she's supposed to be having another CT to see if they can detect any changes, for good or for ill. Meanwhile, we discussed options such as long-term acute care (if it looks like there's a chance for improvement over a longer period of time), hospice (at home, which Sporn agrees is not really viable, given her need for breathing assistance), and palliative care, a kind of in-hospital hospice, at Northwestern, where the treatment goal would be comfort rather than recovery. Valjean and Sporn agreed that this sounds like the best option, barring recovery. We hope to meet with the palliative care team tomorrow afternoon, to learn more about the program.
I know it's difficult not to know what's happening. I'll continue to update the blog as soon as I can, whenever there are new developments.
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5 comments:
Thank you.
It is important to know.
All of you that have been and are at her side faithfully since the beginning are blessed.
I know how VJ feels about you and all your care and love.
My words fail me.
It's difficult to not be shocked by the the plans for the worst case presented in the blog but I'm still cheering for you to recover from this pneumonia. There are a lot more dolphins out there to swim with.
Love,
Stephanie
Valjean,
I tried to leave you a post yesterday, but I do not see it. My thoughts and prayers are with you through this episode and beyond.
The pictures of you and the dolphins are a treasure.
Valjean,
I think I just figured out how this comment thingy works.
I screwed it up yesterday, and tried again today and left a message just a minute or two ago.
I love the pictures of you with the dolphins. Your expressions are priceless. This is somethng that I have always wanted to do. Maybe next year when finances are hopefully better.
I wish you all of the best! I wish that I could stop in to see you, but I am easily susceptable to diseases and am probably a carrier of diseases as well. I get sick a lot in the winter and when I am working with the children.
I have not called to talk to you as I would rather your energies went to getting better. We can talk then. I have had pneumonia five times so far. In high school and beyond.
A little update on my doings. Last weekend I was in a film. This wss part of the 48hour film project. 26 film companies met and drew a theme from out of a hat and then had to create, write, shoot, and edit a 7-minute film in 48hours. We will see the screenigs for the first 13 films tomorrow night, and the second 13 films Friday night, and the winners on Sat night. I had 2 lines in the film. Look out Hollywood here I come.
Love and prayers,
Pat Casey
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