There haven't been many dramatic changes this week that paint one day differently from the next. Or, at least there haven't been any we couldn't deal with. We've seen it all, it seems, so when new symptoms arise, we spare the 'chicken little the sky is falling' routine, "turn and face the strain" ala David Bowie and make changes. And, usually, the adjustments are just in time.
Wednesday broke in the wee hours of the morning. Craig awoke at 2am, distressed over the foul tasting and aggravating thrush that's consumed his tongue and throat. Thrush is oral candida (yeast infection) that is associated with taking antibiotics, a weakened immune system, and the like. Craig has it and he has it bad. We started a regimen of oral medication to break up the white covered fungus on his tongue and palette, and it seemed to be working quite effectively. But, Wednesday morning, Craig woke up bothered by the taste, the feeling, and the general annoyance of having his mouth coated completely and wanted further relief. I gave him a dose of his oral thrush swish that had been delivered Tuesday evening. It was the first try of the somewhat flavored liquid and we all knew the damage such a substance could do to Craig's sensitive tummy. By 6am, he vomited and the vomiting continued on and off throughout the day, totaling at least 4 vomit sessions that day. It's anyone's guess whether the nausea was caused by the thrush medicine, thrush itself, or a cancer process that had outsized the daily drug regimen. Regardless, we needed to make changes. Not only was he having issues with the recurring thrush and breakthrough vomiting, his fluid retention has continued to increase even while on intermittent TPN and the areas in which it is pooling couldn't be more uncomfortable, "straining" and plum inconvenient.
Craig's spunky and always informative hospice nurse, Sandy, paid her second visit for the week Wednesday afternoon. For the first time, she brought along the hospice doctor, Doogie Howser (Dr. Bridges, who's literally Craig's age). Not to discredit his phenomenal bedside manner and superior knowledge in the field, but he could easily be mistaken for a manager of a local free-trade coffee bar who performs wicked tricks at the skateboard park after stretching out during lunchtime yoga. Otherwise, he did not fit the scripted "doctorly" image we're accustomed to - quite a refreshing change.
Sandy, Dr. Bridges, Craig and the sisters contemplated various alternatives to Craig's drug regimen and nutrition schedule to ease some of the burgeoning symptoms. We upgraded from his routine delivery of IV medications and pills to using one antiemetic bag - a mixed cocktail of his favorite friends Benedryl, Haldol, a Nexium alternative (Zantac), and Reglen. Instead of receiving the familiar IV boluses, the bag of meds is delivered through a scheduled/timed pump, which provides a continuous dose throughout the day and night. Zofran and Ativan sit in waiting as alternates should the "starters" have an off night. This gives Craig steady coverage to curb nausea symptoms rather than have intermittently scheduled (large) doses of meds that tend to wipe him out.
We hooked Craig to his newest of slumber party buddies by nightfall, infusing the antiemetic bag through the number two spot in his double lumen hickman. With both lines used - one for morphine, the other for the antiemetic bag-we had to give a temporary boot to ol' pal, TPN, which had been scheduled that night after being benched for two days. (The swelling became quite concerning in certain regions, so Craig elected to withhold taking in more fluids for a longer interval than the previously discussed ‘every other day' TPN regimen. Hence, the longer TPN hiatus).
Morning broke at 6am Thursday morning. For the first time in 5 ½ months (apart from stints at the hospital), we had nothing to do. Rather than stumbling into the kitchen to draw the various IV meds and dispense the half dozen pills as was routine, the sisters, Emily, and Craig turned to face the sunrise, and watched as the peach colored sliver of a sun softly rose from the horizon.
The view from his 31st floor window was spectacular, but second rate to the happy picture of the five of us wide-eyed and smiling in his bedroom... ~E
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