Easter Sunday Morning Report

Mary continues her struggle with cholangiocarcinoma.  It is Easter morning, I am sitting at the foot of her bed, and the area is eerily quiet.  I spent the night here after Daniel had done so for the last two nights.  As I type, I hear the hum of the air conditioning system as a background to Mary's very shallow, labored breathing.  


Thursday's procedure did not work for Mary's pain.  We did, however, make an interesting observation during the preparation.  Instead of continuing her sleepy and dreamy state, Mary became awake and sharp about 10AM.  We had skipped her most recent MSContin dose in preparation for the Thursday procedure.  Morphine is cleared from the body by the liver so given Mary's failing liver, any morphine hangs around much longer than is typical.  Giving her MSContin on an 8 hour scheduled was overdosing her into a dreamlike state.  I should note that MSContin comes in various sizes and Mary has been taking the smallest one they make. And, the pill cannot be cut because of the way it holds the morphine. 


To prove the theory, we would skip her MSContin dose on Friday evening to see if she woke up soon after the missed dose.  And, in fact, she did.  We waited a bit to make sure she was really clear and then we notified the nurse.  She called the doctor to witness the alertness.  The on-call doctor entered the room while Mary had her eyes closed.  He asked us what was up and we said we wanted him to observe her degree of alertness.  
A rather unctuous fellow, he stood away from the bed and said "I don't see much activity and I understand she is somnolent and non-responsive" to which I said, "Mary, please say hello to the doctor."  Mary opened her eyes, turned her head and clearly said, "Hello Doc, nice to meet you."  The doctor rocked back on his heels and started a whole rationalization of why he was so busy and couldn't possibly have known this and that about Mary's case and I don't know why he blathered about that.  I asked him to document what he saw so the pain doctors could proceed with their epidural catheter. 


On Saturday morning, Mary was in the best mental shape we have seen for many days. The MSContin was not administered and she was using short acting fentanyl which was actually acting a bit longer that normal because her liver was not flushing it as fast from her system. 


The procedure was done early Saturday afternoon.  The pain doctors are still seeking the best dose of pain killer through the epi cath. In the meantime, she is on liquid morphine for pain and that knocks her our for several hours at a time.  So the promised clarity from the epi cath has not arrived. 


The moments of clarity are so precious.  We want to maximize them as much as possible as long as they do not cause Mary any further pain.  A failing liver typically results in hepatic encephalopathy (HE).  The symptoms of HE are similar to the effect of morphine overdose.  Withholding those MSContin doses proved that Mary was not yet fully suffering from HE but rather from morphine overdose.  


If they can trim in the epi cath dose and Mary can stop taking the narcotics, she should remain in a clear headed state until the HE takes over and puts her back into a dreamlike condition.  


The other event is that Mary was moved to a private room. On Thursday morning, I told the nursing staff that we had all the kids and grandkids coming in from all over the country and I was concerned about the impact on Mary's roommate plus space to let them visit.  On Thursday afternoon, they moved Mary's roommate to a different room and gave us the whole room with the caveat that Mary would move when a private room opened.  From about 4PM on Thursday to about the same time on Saturday, Mary was the only occupant of a double room and now she is in a private room.  The best part is that it is "away from the action" and substantially quieter than the former room. 


Since Thursday, Mary and I have been surrounded by our families.  Mary's son Tim and daughter Charlize from Tucson,  Lara and Scott with daughters Madelyn and Emma from Pasadena, my son Chris with Casey and offspring Danny and Sarah from Denver, Mary's son Daniel from Pennsylvania and my daughter Erika from New York have all surrounded us with love and caring in this very trying and taxing time.  They have spent hours and hours with us here in the hospital and it is most appreciated.  


I also want to thank our friends who have done taxi service to and from both San Francisco and San Jose airports as needed.  Ingrid, MaryR, Glenn, Michele, Terry and Barnes have all helped so wonderfully.  


Mary's breathing continues in its shallow, labored style.  While typing this I have met the new day nurse, Davinder and nurse's assistant, Nancy.  I must comment that the nursing team here in the cancer section have been exceptionally capable, caring and sensitive.