Conversations, Part Two

Invisible readers and friends of Jane, it's been a hell of a day. After last night, Tom and I didn't know what we were going to encounter at the hospital today when the attending told us on the phone that she and Dr LR wanted to meet with us. We were expecting to have That Conversation. You all know exactly the one I mean.

Turns out, we're not quite there yet. Jane's not quite there yet.

Let me back up and fill in details. Forgive me for lapses or redundancies; I'm not sure what I've told who at this point, so I'll try to be thorough. And, I'm afraid, a little blunt. I'm finding there's far more value in candor than in euphemism right now.

Last night, before Tom and I arrived at the hospital, Jane coded. Through what sounds like truly heroic measures, they brought her back, and after a good initial response to their efforts, she's pretty much just been sitting at a barely-good-enough place. The consensus is that Jane's problem now is a mechanical one. That is, the underlying disease hasn't worsened and there's not likely any new infection she's fighting. It's about the gunk in her lungs. That mucous plug that gave her so much trouble yesterday afternoon was a part of it. There's just a lot of crap in there blocking her airways.

Jane is on massive ventilatory support right now. The dials are turned about as high as they can go. The oscillator works in such a way that she doesn't really take many normal breaths (she did breathe over it when she was healthier, but not now). It's a high-frequency ventilator, which means it sends hundreds of tiny puffs into her every minute. But she's paralyzed and sedated, so she's not breathing on her own, she's not coughing, she's not moving. She's not getting the gunk out on her own, and she's not putting up with the suctioning very well, either. They suction, her sats go down, and she's so delicate right now that it takes her a very long time to recover just to the barely-acceptable level she's been sitting at for the last 36 hours. And her bones have been weakened by the steroids, so they can't really manipulate her to get the gunk out without risking breaking bones.

Here, then, is the dilemma. They know what they need to do to help her (clear the gunk out), but there's not much they can do to get it out because she's so fragile.

Before we sat down, Tom had a conversation this morning looking for advice and guidance from the ever-hopeful Dr R from back north. She said the one promising thing from last night was that the lobe going down meant there was a chance (maybe just a slim one) that the rest of the lung could expand and start working better. And she said that she wants Jane back -- but she can't be transported on the oscillator. And she said that she's been praying for us.

So. So Jane needs to improve, somehow, pretty much on her own. Dr LR was pretty blunt. He is not very hopeful. He hasn't given up, and he's not forcing a timeline or issuing an ultimatum. But if Jane deteriorates, or if she has another acute episode like last night's, or if she's unable to come off the paralytic, then we will have That Conversation. Everyone's listening to Jane very closely right now, wondering if she's going to ask for more time, or ask us to recognize that the fight is over.