"Have a Giddy-Up Day"

That's what my mother said to the radiology tech who took her chest x-ray this morning.

I'm going to start a book of one-liners.

Last night she said, "this chicken broth is like a gift from heaven." This in reference to the hospital-issue, tasteless, saltless, probably from a 25 gallon drum, chicken broth.

Her first night was a little rocky. She was out cold at 8:30pm after such a busy day, and thanks to some intravenous narcotics, a little dash of ativan, and a pinch of Ambien. But she woke up in the middle of the night feeling very disoriented, weak, and confused. Because of all the chemotherapy she has what's fondly referred to as "chemo brain," which makes it hard for her to absorb information, remember conversations, and repeat herself. It was likely a combination of all these things that made her so disoriented when she woke up.

Her electrolytes are significantly off balance, which is a common side effect of chemotherapy, but also largely in part to her not eating. In particular, her potassium and magnesium are extremely low. These two are closely related to cardiac function, so they did an EKG which showed something called atrial fibrillation. If you imagine a healthy pumping heart, it pumps in a steady rhythm, with big strong pulses. Atrial fibrillation means the heart is not contracting strongly, and in response, it tries to over-compensate by doing wimpy pumps more frequently and irregularly. The effects this has on the body over a period of time can be significant, because a healthy heart should be pumping the majority of the blood through it with each beat, but a heart in atrial fibrillation isn't pumping all the blood through, and stagnant blood clots. Additionally, her body isn't being perfused with well oxygenated blood because the heart is not pumping effectively.

There are a lot of components to cardiac function which I'm hardly qualified to explain, and at this point, the most logical explanation for her heart acting up is the low potassium and magnesium. So we're starting there, by giving her both oral and IV supplements. Sounds simple enough, right? Except the oral potassium pills are the size of my head and can't be crushed. That was round one of her spitting things at me. The liquid tastes like Tang and burned her open mouth sores. That was round two of her spitting things at me. Round three, thankfully, was far more successful. We did magic mouthwash to try to numb the mouth as much as possible, watered it down, and used a straw to bypass the worst sores at the opening of the mouth. After the first swig, she looked at me and said, "I'm going to break all the rules by saying this, but you are F***ing brilliant." I'm not sure what rule she's talking about though. Cursing? Who do you think I learned my curse words from? Our morning commute to school often started with colorful language when she's realized her coffee mug was left on the top of the car as it trickled gently down the windshield.

On to the next body system: her lungs. They're hearing a little fluid in her lungs towards the bases. This could be due to fluid back up because her heart isn't pumping effectively, or it could be that she aspirated a little bit of something. It could also be atelectisis. Visualize your lungs being lined with millions of tiny little fingers, and on the surface of each of these fingers is where oxygen is soaked up for circulation. These fingers are sticky, and if the lungs aren't being fully inflated, ie someone is not taking deep full breaths, these fingers can stick together, causing atelectisis. This may also explain why when she was admitted her blood oxygen saturation was only 88% (yours and mine would be above 95%). To correct this, she is receiving some oxygen through a nasal cannula, and we're making her do lots of deep breathing and coughing to recruit all those little fingers (alveoli if you want to be technical) to do their job and oxygenate.

As you can see, everything is related: we need to the heart to be doing it's job so the lungs can do theirs. Add pain in the mix, and everything gets even a bit more complicated. For example, the pain she is feeling in her bones may be be keeping her from taking deep breaths, setting everything in motion.

Since I started this post, I've been interrupted, oh I dunno, 8 times? Here's what's up now:

The most recent EKG showed no atrial fibrillation, so hopefully the IV potassium and oral potassium (that took an HOUR to drink) has helped put her heart in a better rhythm. She had a severe bout of pain where she was shaking uncontrollably and nothing was comfortable, but we've since repositioned her, covered her in warm blankets, lined her back with warm packs, and given her more IV narcotics. She's now sleeping quietly and comfortably. The low grade fever she had this morning has resolved, and they've loaded her up on antibiotics and sent blood cultures just in case (remember, she has ZERO immune function).

The plan for today is to manage her symptoms, specifically the pain, mouth sores, thrush, and electrolyte imbalances. We're also on call for an MRI to look at her spine and see if there is anything interfering with her comfort.

And it's only noon.