So, after the eventful evening in the ER, Marye finally made it to radiological to get a CT scan. It was pretty late, so we weren't expecting to hear anything until the morning. However, we soon got the word that the scan showed Marye's gall bladder was as big as a grapefruit. Also, there was a lot of fluid around the liver, which could be ascites- or, worse, a ruptured gall bladder. Now things started to make sense: with the extremely elevated white blood cell count, the bloating in her abdomen, and the extreme pain, it was clear that she had a pretty good infection going on. I debated with the resident surgeon on the best course of action. A ruptured gall bladder is a medical emergency, but they weren't positive that's what it was. By this time, it was 3:30 a.m., and they figured that they would get in touch with her GI doctor within a few minutes. So I agreed.
She got into the Hematology/Oncology (HemOnc) ICU ward at around 5:30 a.m., and the circus with the residents and interns started promptly at 6:00 a.m. I won't bore you with too much detail about the peanut gallery of interns that make the rounds with the attending physicians, except to say there were at least 22 doctors in her room before 8:00. In any event, after talking to the oncologist and the GI doctor, everyone decided to leave the gall bladder in place for now, but to insert a tube to drain the bile/blood/pus from the gall bladder and relieve the pressure. Also, with the heavy antibiotics she's been getting since Sunday night, her white blood cell count went from 34 to 23. So, it appears that the infection is getting under control, and with the drain now in place, the rotten, infected bile is leaving her body. That's the good news.
The bad news is, the CT scan indicates that there are some new lesions in her liver. If that is what they are, then the taxol she's taking isn't working, anymore, and she'll need to change medication. But that will be only after the gall bladder infection is clear. Anyway, Dr. Riley (the real oncologist) came in and told Marye that the tech who reads the CT scan doesn't know what he's talking about and that there are no new lesions. Only a tumor marker test will tell us for sure. I'll keep you informed on that as we find out more.
As of 9:30 p.m. on Monday: Marye is pretty well doped up on dilaudid, a very effective pain medication, and numerous antibiotics. I'm trying to find out the latest WBC count numbers, but she looks a lot better than she did last night. Future plans: depending on how the infection reacts to the antibiotics, she might stay here for another day or two. They may send her home with more antibiotics, and will eventually decide what to do with the gall bladder. If it shrinks down to normal size, they could leave it in place, or remove it laparoscopically. It doesn't appear that the gall bladder is ruptured. Once we figure all this stuff out, we'll get back with Dr. Riley to address the possible lesions. I'll keep updating until she gets stabilized at home.
-Chris
