I arrived at the hospital before 8:00 a.m. Of course, I hoped Karen would be sitting up in bed and eating breakfast. But I knew that would be unlikely. Instead, she was still in her deep sleep. She had a peaceful night, well as peaceful as possible in the ICU.
The first dialysis was quite successful. Her ammonia levels fell slightly and her potassium count is back down to near normal. These are both indications that she is still responding well to all treatments. Because she has not eaten since Thursday, they discussed with me the need for a feeding tube. Now, in most cases such a measure is not even worth the discussion. You just do it. But I am walking a very fine line consenting to both dialysis and the feeding tube.
On Saturday evening, when Karen as last awake and able to have a discussion, she made her wishes known to the doctors, nurses, and me. She was quite adamant that she wanted no heroic measures to prolong her life. But those measures were restricted to breathing and heart functions. So she refused any CPR or breathing tube should it come to that.
Yesterday, when they raised the issue of dialysis, and today, when they discussed a feeding tube, I had to debate with the staff if we were violating the spirit of her wishes. In both cases I was convinced I was not.
Karen has suffered multiple organ failure as a result of the sepsis. Her kidneys stopped functioning on Saturday. The liver tried to compensate, but became overwhelmed so it started to shut down. On Saturday night, after I left, her lungs showed serous signs of stress and started to fail, but they came back on their own. Had the lungs not recovered we would be preparing for a funeral now. They did recover and there is no reason to assume they will be at risk.
So, I have to be careful to make sure I approve only those procedures treating her illness while not artificially prolong her life. I felt dialysis met that criteria because I am convinced if normal kidney function resumes her body chemistry will stabilize and she will see a full recovery. There is no timeline for the kidneys to restart. It can happen today. I can happen next month. But continued dialysis will relieve the pressure on her kidney and liver and extract the ammonia that is causing her to sleep 24 hours a day.
Similarly, I see the feeding tube as part of the healing process. I see no point in her starving to death when that can so easily be avoided. Another key to these two decisions is reversibility. In the event she stops responding to treatment, I have been assured by the staff that Karen, if she is lucid, or I can request the tube to be removed and the dialysis stopped. So I am confident these two invasive measures do not violate her request.
Now, the big question we all have is what happens next. As I have been told, the body can get sick quickly and heal slowly. So there is no timeline. My feeling is that after one or two more dialysis treatments she should wake up and that will be the best thing for her. Once she is awake, she can eat, walk, and exercise. These will be key to her recovery.
For those how have expressed their offer of prayers on Karen’s behalf, I suggest those prayers be targeted on her kidneys, that they may become fully functional.
If this is your first post, please click here to get the full story of Karen’s Health Journey.