Wednesday, March 4, 2015

Failure of the Heart......

We've had the endless round of illnesses here.  My first ugly cold in January, triggering an asthma attack that lasted nearly three weeks, was just cleaning up when I came down with a SECOND cold.  The asthma kicked again, and I am in the second week of THAT attack.  Hubby and Babygirl decided to join the fun and come down with the cold also, but Babygirl just couldn't kick it.

Sunday morning she woke up with a sore throat so bad it making her drool.  This is not a good thing.  Since she had no fever I opted for the walk-in, expecting the usual rapid-strep-is-negative with positive results two days later.  Nope.  Rapid strep was positive - she has a standard-issue garden-variety strep throat.   But from where?  She doesn't attend school.  I tested negative during my last illness.  One of the tutors?  She's three days into the antibiotics and no better. 

Mom dove into the cold symptoms about four days ago, sneezing and runny nose along with the rest of us leaving us sounding like an old TB sanitarium.  Within a day she had increasing shortness of breath, and nebulizer treatments and extra water pills got us through until today.  When she came over for dinner, she was blue at the lips and fingernails and complaining of weakness.  When she left half her food uneaten I knew we had a crisis brewing (but I never, NEVER leave for a hospital on an empty stomach.  Unless CPR is in progress there is time to eat before you go).  Since we were in the middle of a sleet storm, I called paramedics.  It is still the best way to get a bunch of good-looking men to your house in the middle of the evening.

The ER doc evaluated her, and on the strength of her x-ray decided she had heart failure and sent her to the ICU for admission.  The ICU doc wasn't available for a couple of more hours, but I knew that if I didn't wait, she was going to overlook the obvious:  My mom might have an element of heart failure, but that's pretty much normal for her.  It's the COUGHING that's making this problem worse, and what is causing the cough?  And I really want this doc to know that trying a fluid restriction just ain't gonna fly - been there, done that, got the readmission.  By the time the doc got there, more of the labs were available and it was clear that heart failure really wasn't the sole source of the problem.

Have you ever had a test for influenza?  They blow about two teaspoons of cold salt water up your nose and then suck out the resultant boogers and send the whole mess to the lab.  Trying to get an agitated, uncooperative demented old lady to agree to hold still for this was, far and away, the largest challenge of the evening, beating even the IV placement.  It took the mention of Babygirl's need-to-know and the promise of chicken soup and lime Jello with whipped cream to secure adequate cooperation to get this specimen. 

Meanwhile the ICU doc is discussing sending mom home in the morning.  I mention that I had to have four strong men to get her OUT of the house. I imagine I might need that same team to get her back IN.  They are calling in a case manager and PT, which might buy us enough time to get the back stairs cleared.   Fluid restrictions were discussed and dismissed.  IV versus oral antibiotics considered. 

We doctors forget some important things.  The family knows the patient.  I know she needs to be here, and I know she needs to stay, and I'm pretty sure it's more than just her heart.  Thank God that the ICU doc was willing to hear what I had to say.


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