Grimm Fairy Tales

Does anyone remember the Grimm's fairy tale, "Three Billy Goats Gruff?" As Nick makes this journey, I think of him as crossing this long bridge. In order to be safe and well, he must get to the other side. Underneath the bridge, lives the ugly troll. The troll is the one who keeps popping up and trying to eat Nick. He likes to throw obstacles in his way and try and thwart Nick's efforts to make it to the other side of the bridge. I already hate that troll and I must continue to help Nick keep that troll under the bridge where he belongs. It is almost 9PM and Nick & I have been here at the hospital since 10AM this morning. It has been a long day and Nick still does not feel well. The troll has rolled out some more of the items in his bag o' tricks. The troll is not amusing me!

The phone rang this morning at 0830 waking me from a much needed deep sleep. "Hello, Mrs. Pippen?' This is Ms. Prescott from the IPOP clinic and we see that Nickolas has been running a fever. Would you be able to bring him in an hour earlier, we are very concerned about this fever." I wanted to scream very loudly and then cling to my ceiling like a bat. Please see previous post for rant on fever!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Nick & I spent the day in the IPOP clinic! Kate joined us half way through the afternoon, this brought a smile to Nick's flushed and tired face. Nick started the morning with a fever of 38.9C (102F). He didn't eat anything and threw up before we even left the house.

In the IPOP clinic, Nick had the following things done: weight (158), VS (still febrile and BP low), CT scan of sinuses and chest (negative to date), CBC (all counts good, platelets, packed cell volume, white count and ANC were all up (ANC = 1,000!), chem panel (all electrolytes, kidney and liver function tests look good), stool, urine and blood cultures (all negative so far). They gave him some fluids to hydrate as his BP was low (95/50's). Nick had his antibiotics restarted (Vancomycin & Zosyn) via the IV. He also spent much of the day vomiting (all bile...he hasn't really eaten at all). Why he is vomiting is any one's guess. The doctor's don't seem to know for sure. Nick took three different anti-nausea, anti-emetic meds while over in IPOP and none seemed to really work. Nick was not a happy camper throughout this process. He has been very tired and the fever and vomiting are taking the last little bit of energy he has left. He spent most of the time in IPOP looking glassy-eyed and wiped out.

I spoke with anyone who would listen about my concerns regarding Dr. Livin' Large. The nurse practitioner said she would never have given him off from the clinic on Sunday. It seems that I was not the crazy one and I was told numerous times I had done the right thing by calling. I am not sure what will happen, but, I expect if this was the Army, Dr. Livin' Large would be doin' some serious pushin' right now. If only I could be a part of that...anyway, I was assured that my instincts were correct and the "issue" would be addressed.

The next decision involved whether to send Nick home or admit him. Long story short, Nick was seen by a different attending, Dr. Antfinder, who determined that he should be admitted to 5B for observation, hydration and continued IV antibiotics. I am still very worried as Nick continues to run a fever and his BP is still low. He is getting more fluids as I write so hopefully, this will perk him up. Nick has sworn off food for the night, so IVF's and sips of Gatorade will be the extent of his intake for a while. The doctor seems to think this whole process is one of two things, 1) something infectious that is yet to be defined or 2) "engraftment syndrome" - which sometimes happens when the neutrophil count rises quickly. I don't know much about engraftment syndrome so I am not sure what to make of all of this right now. The doctors are also looking for any signs and symptoms of GVH (graft vs. host), which can start to show up as the counts start to rise.

My gut feeling is that Nick will be in hospital for a minimum of two to three days until they can get a handle on his fever and figure out how to get the troll back under the bridge. I was hoping he would not have to come back into the hospital, but, I feel better knowing he is here and getting the medical care that he needs. I have been told by many of the nurses that it is not unusual for a BMT patient to have to come back into the hospital for a time. That doesn't keep me from worrying about the evil troll and what he has up his sleeve for the next part of the bridge.

Please keep my Billy Goat Gruff in your thoughts and prayers. The bridge is long and the journey is longer, especially when there is an evil troll waiting to pop up every step of the way. I will update tomorrow on how Nick is doing. I do not have his room phone turned on yet. Nick can be reached on his cell phone, but, please remember he needs plenty of rest with his fluids. I plan to call his nurse tonight and check up on how Nick is doing so I can try to have some peace of mind before I go to bed.