A Second Week in Dock

Monday 15th to Sunday 21st September 2008

I sleep last night for an uninterrupted three hours from midnight to 3am, which is a real bonus. But I am still here after a week in which very little progress seems to have occurred. This view is shared by John Duncan, who is the duty ward consultant this week. He puts in place a plan to try to move things on. I am to have a CT scan of chest and sinuses, a referral to the chest consultant with a view to a bronchoscopy, a review of my current anti-biotics and I need to be given some platelets. I find that the cannula on the back of my right hand has leaked while I was having my morning infusion – all over my blanket and sheets! Not sure how much went in my vein!! I have a visit from Jim late morning and do a little work in the afternoon, filing the returned questionnaires relating to my project. Kate gets my fourth cannula into place on the back of my left forearm. It is a very good site and a good vein – and gives me more freedom of movement than any of the previous cannulas have done. My blood results are Wbc: 3.5; Neuts 0.0; Hbn: 10.4; PLT: 21; CRP: 174. So here I am with my immune system right on the floor! Tina visits in the evening after work. She can only get away at 6pm, so it makes for a long evening for her. My temperatures today have ranged from 36.9 to a peak of 38.4.

I am awake at 5.15am Tuesday morning coughing up lots nasty sputum, some of which is bloody. There is a lot of activity for me today with my going on to the anti-fungal, Ambisone, 215 mgs once daily - it looks like a large bag of liquid sherbet!! – I have a CT scan of my chest and sinuses and then have a PICC line fitted into my right upper arm. This is great as it is becoming extremely difficult to get into my veins. At last I am able to have Immodium and take one capsule after lunch. My blood results today are – Wbc: 2.4; Neuts: 0.0; Lymph: 2.0; Hbn: 93; PLT: 16; CRP: 153. My weight is 74kgs. I have two bags of platelets. A count of 16 is amazingly low. They definitely need beefing up ahead of the bronchoscopy I will have tomorrow and had to be transfused before the fitting of the PICC line. I get a chance to see the x-ray showing where my PICC line has gone inside my chest – up the main vein in my right arm and down into my chest just to the right of my sternum. Tina is joined by Mia Morris when she visits in the evening. Six hours after my PICC line is fitted I am getting soreness on my skin from the Dermafilm dressing that has been used. I knew this would happen as it was the same last April when I had my first one. So the dressing is changed to the type used with cannulas, although Dermafilm is still needed to cover the entry site as, being transparent, it means that the site is always visible. We will have to see how this works, but by 3am it is worse and the site is redressed again. I am nil-by-mouth from midnight ahead of the bronchoscopy first thing in the morning. I have two big sweats during the night and have two changes of T-shirt. My temperature today is checked six times and goes from 37 to a peak of 38.5 at 9.45pm.

No breakfast for me Wednesday morning and I am away to the Endoscopy Department just after 8.30am. I think the annoying secretions that have been tickling my throat for the past week seem to have gone - if so, that is very good news. Also it appears that the one Immodium capsule yesterday has worked! Hurray! I am in for the Bronchoscopy at 9.30am and out in 20 minutes. The actual procedure takes about 10 minutes. Kate Hurt is the practitioner with Mark Jackson looking on. Once again it is a most appalling experience and I am coughing and spluttering as the scope goes down the back of my throat. They get a suitable amount of samples of gunge for analysis and I am soon out into the recovery room. Unlike the last time, my recovery is comfortable and I am able to rest, read, do some Sudoku and I have no nasty after effects. Whilst lying there I have the urge for some proper fish and chips and resolve that Tina and I will have some together tomorrow evening. I am there for two hours getting over the sedation and having my blood pressure, oxygen levels and temperature regularly checked. In fact my oxygen level dips, so I have to have 4 litres of oxygen given to me before I can go. After lunch I have my PICC line dressing changed again and it is decided that it must be changed everyday to avoid my skin getting cut. My blood results today are – Wbc: 2.0; Neuts: 0.0; Lymph: 1.7; Hbn: 8.0; PLT: 27; CRP: 165. My weight is 74kgs. By late afternoon the news abroad is of world finance in total chaos. Lloyds TSB is “encouraged” by the government to take over HBOS at a good price per share by today’s values but less than a quarter of its valuation earlier this year. The US government comes out with a multi-million rescue package for the giant insurance company AIG. There seems to be no end in sight for what is the worst financial crisis since 1929. At 9pm I have a unit of red cells, with two more to follow first thing tomorrow. My temperature shows signs of improvement as I have no 38 degree peak today and it ranges from 36.7 to 37.8. However I am still having big sweats late evening and during the night, with a change of T-shirt being needed.

I am told by Kat on Thursday morning that the CT scan indicates that I have a bacterial infection, rather than fungal. However they want to see the results of the bronchoscopy samples before drawing any definitive conclusions. My blood results today are – Wbc: 2.2; Neuts: 0.0.; Lymph: 1.8; Hbn: 8.5: PLT: 18; CRP: 140. So my platelets are still only 18 after two units were pumped into me ahead of the bronchoscopy. What’s going on? I ask myself. My weight is again 74 kgs. Peter visits in the morning, just in time to share a cafetiere of coffee with me. Suzanne is still snuffling with the leftovers of her cold so she is having a stroll on the seafront. We have a good chat about all this dodgy dealing that has brought the ceiling crashing down on top of the world of finance. Peter always worked in rock solid government bonds and triple A company bonds. Not for him all this spivvy short selling and derivatives. Sr Pete also comes in to give me Holy Communion. After lunch I have visits from Vincent Meagher and Bill Swallow, so I have plenty of company today. Tina arrives about 6.30pm with our fish and chips and we indulge ourselves with the best meal of my stay so far! A bottle of Muscadet would have gone down well with it as well!!! But you can’t have everything. At 9pm my PICC line dressing is taken off to show that the area immediately around the entry site is pink and sore and that there are three separate small places below the securing plate where the skin has been cut into - all this since yesterday afternoon. Lucy redresses it with Mepore and with no Tegaderm at all. This means that the entry site is no longer visible, but at least the chances of further skin damage should be minimised. My temperatures today are 36.7 on three occasions and a maximum of 37.4. I have no sweats to speak of and do not have to change my T-shirt at all. This is all promising news. I sleep on the bed from midnight to 2am and then change into pyjamas and get into bed for the first time since I was admitted. I sleep soundly until past 5am. Things are definitely improving!!

It is Friday and I am still coughing up loads of bloody sputum when I stir in the morning, so that side of things does not seem to have changed. By 11am I have brought my blog right up the date at last!! I am seen by John Duncan who tells me I now have 0.1 of a neutrophyl – yippee!! – and that my CRP is down to 89. This is all good news but I still have inflammation in my lower lung. The team will review my treatment plan on Monday. He has stopped the Clarithromycin tablets. My blood results today are – Wbc: 3.1; Neuts: 0.1; Lymph: 2.9; Hbn: 11.1; PLT: 17; CRP: 89. My weight today is 73 kgs. I have a big sweat mid afternoon and my temperature peak before it must have been quite high but of course it isn’t possible to know what it was. My guess is that it was over 38. I get a phone call from Anna in Palm Springs – which is nice. They are off to Yosemite, Sequoia and Kings before taking the Amtrak to New York and home. I then have visits from Mia Morris and Fr David. It is most amusing as Niamh Dineen, the trainee nurse, is tending to me at the time. Fr David recognises her surname as coming from west Cork like him. It transpires that he knew her late uncle, who was a priest and then realises that he knew her father as well – what a small world! Tina is in to see me about 6.45pm and after that I have a quiet evening and night, dozing and listening to my i-pod. My temperatures today have ranged from 36 to 37.1, give or take that likely higher spike in the afternoon.

I trim my beard Saturday morning, which makes me feel a lot tidier. The big news today is the letter from the West Sussex PCT saying that they have put back their PIN panel’s considering my appeal “in order for specialist advice to be sought”. Strikes me they should have sought specialist advice in the first place, then they might have made the right decision. They have obviously been badly stung by the loss of their High Court case. I say “good”. I have a visit from Peter Felchlin at lunchtime. Marva and he had a good time in Bath and Cornwall and were able to find Wakem family gravestones in Cornish churchyards dating well back into the 18th century. We are shortly joined by Matthew, Lily and Mia. Lily enjoys her rides on my moving bed, which she remembers from 18 months ago. Mia is far less keen. My blood results today are – Wbc: 2.9; Neuts: 0.1; Lymph: 2.4; Hbn: 10.7: PLT: 19; CRP: 50. So that is more good news on the level of infection, which has now been going down day by day. My weight today is still 73kgs. Tina and Marva visit me around 4pm and the rest of the day I spend quietly, reading and listening to the Ryder Cup golf on the radio. My temperature today varies from 36.3 to 37.4 and no sweats.

I am seen again by John Duncan on Sunday morning. With things progressing, albeit very slowly, they will be looking to discharge me next week, possibly towards the end of the week. They could continue giving me anti-biotics in the Day Unit but the key issue is to get my chest right first and to be sure that the infection is not fungal as well as bacterial. My blood results today are – Wbc: 2.1; Neuts: 0.1; Lymph: 1.6; Hbn: 10.4; PLT: 17; CRP: 32. My weight is the same – 73 kgs. I do some work on my project for a few hours either side of lunch and at 3pm have a bag of platelets. Sarah cleans and redresses my PICC line. It is looking good and the soreness has lessened. Tina, Marva and Peter visit after having lunch with Matthew and the girls at Shermanbury. I say my farewells and bon voyage to the Felchlins as they fly back to LA tomorrow. I have another quiet evening listening to the USA beating Europe in the Ryder Cup. I doze through to 1.30am and then take to my bed. This is only the second time so far in these past two weeks. I sleep very well.