A seemingly farfetched analogy . . .

I had this little epiphany last night, and it's pretty convoluted and I'll try my best to explain it, so stay with me here, peeps, but I still might lose ya . . .

Bob is staying at least one more day at the U, just to be safe. He had an "incident" last night, where he stood up and his blood pressure bottomed out. He thought he was having another heart attack and freaked out . . . he didn't tell me about it till this morning because, as he said, "I didn't want to worry you," as though I'm usually just sitting around, filing my nails, watching Housewives of Orange county, not worrying about him . . .

Turns out, it was a relatively minor incident; they called it orthostatic hypotension, which means a drop in blood pressure when one stands up from a sitting or lying position. It's usually not serious (unless it's a chronic condition), and I'm placing my bets on the fact that Bob's blood pressure medication was started up again yesterday likely contributed to this. I'm no doctor and I don't play one on TV, but since being unemployed, I'm getting to be quite in tuned to his body rhythms and what is "normal" and what is absolutely not with him. Yes, I'm nuts, but pushing that nurse call button or calling his doctors or bringing him into the ER when something arises that I think ain't right has become as natural to me as breathing or picking zits.

His blood pressure has been running fairly high over the past week or so because he was temporarily taken off all blood pressure meds during his last hospitalization, as they were causing him to have dangerously low b.p. The decision was made just yesterday, to put him back on b.p. meds, but on a very low dose, to start. His blood pressure came down almost immediately since starting licinopril, but because the drug's job is to lower blood pressure so the recovering heart doesn't have to work so hard, it's not uncommon for someone on this drug to experience a drop in b.p. if they stand up too quickly.

Bob's nurses are awesome and have been wonderful advocates for him, being that so many of them have taken care of him up on 7D and know him and his story well. As one of his nurses said to me when he was telling me the story, "We never hear a peep out of Bob, so when we heard him call out from his room, we knew something wasn't right, and we all came running . . ." When the incident happened, his nurse told me, it was alarming, but almost immediately, his blood pressure returned to normal after sitting upright for a short while . . . he was thoroughly examined, and it was determined that it was probably just because he stood up too quickly. Now that he's back on blood pressure meds, he has to remember to take it very slowly, when rising from a lying or sitting position. An easy remedy to prevent this, his nurse (who also has chronically low blood pressure) told us, is to simply wiggle his toes to get the blood flowing through the rest of the body before standing up.

It's a relief to know it was a minor, preventable incident, but at the time, Bob truly thought he was having yet another heart attack, and said this was the first time in this endless war he's waging, that he really felt like, "Please . . . just end this now . . . " And I do have to wonder, more and more lately, how much, just how much, can a body take? Can a mind take? How much longer can this go on?

I was with Bob for a few hours this morning then went home to let the dogs out, run a few errands and was back mid afternoon. Funny, how I can sit for hours in Bob's room and no one but his nurse says "boo" to us, but the minute I leave, he's flooded with visitors of the white coat kind. Dammit all to hell.

While I was gone, a team of endocrinologists showed up and decided that the likely culprit of this hospitalization is the steroid medication tapering that started this past Saturday. This was mentioned almost as an after-thought when Bob was first admitted on Wednesday, but I picked up on it, and when I got home last night, spend a few hours researching it, and had mentioned it again to the staff oncologist. Bob's been on a steroid called dexamethazone, which was prescribed months ago as an anti-inflammatory, particularly, for bone pain. Other beneficial side effects, especially to a cancer patient, are appetite stimulation and an increase in energy. But the longer someone is on it, the more adverse the side effects, most notably, adrenal suppression, which means that his body is not making natural hormones and steroids on its own.

Bob has been on this steroid for several months now, and it may be contributing to the countless issues Bob's been dealing with—dehydration, lack of sleep, anxiety. . . This lead the oncology PA's decision last week, to taper him off it, which may have been a wise decision, but the staff docs on 7D think it was done too much, too soon. When the drug is tapered, the withdrawal can be very dramatic, and from what I've read, exactly like what Bob had been experiencing prior to his hospitalization. Later, we're told that there's no "right or wrong" way to taper a patient off steroids, that it depends on the individual patient and their situation. Well, what the fuck??!?? As if it's a secret that Bob's health, for the past eight months, has been a precarious balancing act that takes very little to tip it? That he's as fragile as a rare orchid, susceptible to reacting to the slightest changes in his environment? And let's not mention the fact (oh, wait, I am mentioning the fact) that we weren't even told of the very common adverse effects of tapering a steroid . . .

So, the decision was made by the endocrinology team to adjust the tapering to be longer and more gradual, given Bob's already hypersensitivity to the process (which, from what I've read, is not uncommon . . . seriously, I am slowly but surely earning my MD with my own self-administered home schooling here. . .), and that a different steroid is replacing dexamethasone, with the tapering schedule being very different from what was first prescribed. When I read the note the endocrinologists left about the new taper schedule, scribbled on a piece of scrap paper, I immediately buzzed Bob's nurse into his room and asked, basically, WTF is this all about? I have lots of questions and don't want any of this happening until we get them answered. Has any of this been cleared with oncology and cardiology? Does this interfere with any of his current medications? Are there side effects of this new medication we need to be aware of? Are these doctors aware that Bob's health is extremely precarious right now, and that the slightest bit of tweaking and tinkering can send him into a tailspin?!?

I've been having a helluva time explaining to anyone—doctors, family, friends—just how delicate and precarious Bob's health is, and that the slightest inking, however farfetched it seems, can cause a crisis . . . I haven't been able to do so . . .

Until tonight, when my epiphany occurred. I stayed with Bob until almost 7, and then left to run to the grocery store and back home, to let the dogs out, feed them, and do whatever else I do when I'm at home. . . one of those "whatevers" was emptying trash cans throughout the house, and Rocco was tagging along with me. When I went into the master bathroom, he immediately trotted into the walk-in shower and started lapping up water on the shower floor. Odd, I thought, because he's never done that before, but the thought left my brain as quickly as it entered. He's an odd dog and does odd things all day, every day, but it still caught my attention, if only briefly . . .

I spent the better part of the night puttering around the house: feeding the dogs, cleaning the house, watering plants, filling bird feeders and other domestic chores. Eventually, probably a few hours after I'd gotten home, I went downstairs to let Rocco out to run around the backyard. As I walked through the family room, to let Rocco outside, I heard a faint, but peculiar, erratic puttering from the utility room behind me, almost, but not quite, like water dripping. I almost dismissed it as a strange-normal noise the water heater or softener or central air must make, something I've never noticed before.

But, absentmindedly, I walked over to the utility room and opened the door, and to my utter astonishment, found a big puddle of water on the floor. I looked up and saw more water dripping from the ceiling. A nanosecond's worth of thinking, and I realized it must be coming from the bathroom above. I ran upstairs to our master bath and found another large puddle of water covering the entire surface of the bathroom floor that was not there when I was emptying trash cans earlier. A quick assessment of the tiny room told me the water was coming from the shower. I tiptoed through the water to the shower and noticed a tiny trickle of water trailing from the faucet handle down to the shower floor and was now spilling out onto the bathroom floor. I fiddled with the faucet handle (which seems to be stripped) until I could stop the stream of water, mopped up the standing water in the bathroom, then ran downstairs and mopped up more water.

The water situation seems to be contained, at least for now; I might have to replace the shower faucet or at the very least, wrap some tape around the threads . . . this could have lead to a major crisis had I not absentmindedly listened to my gut. But still, I might have averted the water-leaking even sooner, had I acted on the fleeting thought as to why Rocco was licking water from the shower floor . . . but really, why would I have thought to investigate Rocco's goofy shower-licking behavior? As I said, he's an odd dog . . . but, in hindsight, if I had taken a moment or two and really observed the situation . . . but even typing that sentence seems ridiculous . . .

But now, perhaps, you all have a little inkling as to how my day is, every day, with Bob. Why each little hang nail, blood pressure reading, throbbing in his throat, medication tweaking, symptom, side effect—no matter how small and seemingly insignificant, can very quickly, turn into a big fucking deal. And I know, know, know that I'm trying to do, asking others to do, the impossible . . . but that's what you do when you're dealing with cancer and heart attacks and all the awful shit that goes along with the ride . . .