Tuesday night, back in the hospital . . .

Gonna try to make this brief (I know, I know: promises, promises, Jen . . .). Bob was hospitalized tonight, this time due to complications from the chemo. He actually started out doing really well—felt great, sounded great and had a wonderful appetite (the likes of which I haven't seen in months), Thursday, Friday and even Saturday morning. But, as Saturday progressed, Bob's condition started to take a turn for the worse. By Sunday morning, he was overcome with nausea, despite all the anti-nausea meds prescribed after chemo. Despite my coaxing to try to eat and drink even little, bitty bits, he simply couldn't. The pain in his leg seemed to be getting worse, the amount of time he could be on his feet reduced even more. Yesterday, I tried calling the U's triage nurse, but got a recording telling me they're not in, due to the holiday. I asked Bob if he wanted me to call the oncology on-call doctor; wasn't necessary, he said, he could hold out till the next morning.

This morning, he seemed to be even worse, if that's possible. Getting him to choke down a tapioca pudding was just that—by choking it down. Barely ate half of it. He's starting this game with a negative score already, being so severely underweight. He has nothing, and I mean nothing, to spare in terms of fat. What he's giving up now is muscle, essential body nutrients, to the detriment of his body functions . . . I called the triage nurse and explained what was going on. That Bob just had his first round of chemo and doesn't seem to be doing well, hasn't eaten in 2 1/2 days, that he's already underweight, and doesn't have anything to spare. That his pain is getting worse, that he's not supposed to see the oncologist for another 3 weeks, before his next round of chemo but can't wait that long.

The triage nurse said, based on what I told her, it would be best if I could bring Bob in today. The oncologist's physician assistant had an open schedule, and she felt if Bob were admitted, things could be better assessed and under control. Bob called his parents to see if they could come up and take him to the afternoon appointment, as I had to work all day. They were more than happy to accommodate and told us they'd be here early afternoon, as Bob's appointment wasn't till 2:30.

I kept watching Bob all morning and just didn't feel right about what I was seeing. I called work, had our beautiful and o-so-capable receptionist, Kelcee, reschedule all my appointments for me. I told Bob I'm going to be accompanying him to his appointment, so I could tell the PA exactly what's been going on since his chemo on Thursday and Friday. By the time Penny and Jim arrived, I felt anxious and nervous. Bob was edgy, anything I did or said irritated the hell out of him . . . in hindsight, no wonder . . .

We finally got him down to the U, where they drew his blood, then shortly after, was brought in to see his oncologist's physician's assistant. Bob gave her the lowdown on how he was feeling, what's been going on since the chemo sessions, etc. I supplemented with my own observations and with any details I felt he missed. That his pain is not being managed by the drugs he's taking now. That he's severely underweight, and has nothing left to give, so the nausea and lack of appetite are really going to take a toll, and I worry about what's happening to him now, and what will happen over the course of the next few weeks . . . that he still can't sit, still can't be on his feel long, and because he's getting so weak, this morning was particularly alarming as he could barely stand long enough to take a quick shower before he stumbled back to the bed and collapsed.

The PA listened emphatically, then asked Bob, on a scale of 1-10, 10 being the worst pain imaginable, where his pain rated. He said about a 7. She asked more questions, and then said she felt it was best to admit Bob to the U's oncology wing. What he's experiencing are typical responses to chemo for patients, but Bob appears to be severely dehydrated and needs to have his nausea, lack of appetite and pain management addressed. The longer we sat in the exam room, the worse I could tell Bob's pain was getting. The PA called an order for a phentanyl pop (an opiate-based pain med in a lollypop-like form), which gets into the blood stream quicker than a pill. She asked if I could run up to the pharmacy on 3rd floor and pick it up while she tended to Bob, admitting paperwork, etc.

I went upstairs as directed, and as I was waiting, the PA showed up. She asked me if Bob had been showing any signs of distress, confusion and possible hallucinating. I looked at her with confusion; had no idea what she was talking about. She said he seemed to be grabbing out at things around him and was talking in a somewhat confused manner. She said she would go back down by him, and for me to come back down as soon as I could. By the time I picked up the prescription and got back down to Bob, I found him in near convulsions, with the PA and a nurse at his side, talking in soothing voices to him. I could only stand and watch in terror, wondering what the hell happened to him, in the short time I'd been gone. I learned later that what he was experiencing was called rigors, and is basically the chills on steroids. He was convulsing like he was having a seizure, his arms reaching outward, hands grabbing at unseen objects, yet was fully conscious and completely aware of his surroundings and us. The look of terror in his eyes startled me and I quickly went to his side and held his hand, trying to soothe and calm him, as the nurse and PA were doing.

I can't say how long the episode lasted; at least 45 minutes . . . the nurse kept reassuring me that, while horrifying to witness and even more terrifying to experience, rigors are not life threatening. Somehow, she managed to insert an IV line into his arm while he was shaking so violently, and through that, gave him several shots of Demerol and Ativan, both of which will work as muscle relaxants, pain relievers and to control the anxiety Bob was undoubtedly experiencing. She said the convulsions may be a response to an infection, it may be compounded by anxiety, it may be a response to the chemotherapy in some way. The PA said this was all the more reason to have Bob admitted. His white blood cell count may be totally off, or he may be fighting an infection, and being admitted will give us the answers. . . .

So to make a long story even longer, eventually, he got into the hospital, after the violent shaking finally, slowly subsided. More blood work, a chest x-ray, more tests were done. A few doctors finally came in to share their initial findings. We were told that Bob is severely dehydrated and that his sodium levels are dangerously low, that his electrolytes are severely out of balance. They're giving him IV fluids, along with sodium and magnesium, and some of Bob's favorite, IV pain meds. Yeah for Dilauded!

In the morning, he's going to meet with pain management specialists, to determine a better plan for keeping his pain under control. They seem to be able to do so in the hospital, with the wonderful IV drugs, but not at home with the oxycodone, etc. I might have to pull the Crazy (and I mean Crazy) Redhead act out again, because he will not be coming home until we have his fluids/minerals regulated, his appetite/nutrition addressed, and an effective pain plan in place.

I may have to do some heavy editing on this one in the a.m. Long, tiring day and I'm trying hard to remember everything as my eyelids are starting to droop, and my fingers make typo after typo. 'nite, all. Big love to everyone.