One Step Forward, Two Steps Back

The phone rings about 4pm today and Heidi asks if I am "available to come to the hospital".  That is never a good sign.  By now I know the drill.  I rush to the hospital and arrive to see the familiar site of Jordan's room filled with doctors and nurses and a concerned look on the face of the attending physician.  "Jordan's blood gas levels are climbing again" he says, "and he has a pocket of air near his heart.  His blood pressure is dropping."  

Across the room I see Heidi standing at the head of Jordan's crib.  She has a resolute look in her eye that is a mixture of determination, frustration, and fear, and a tear running down her face.  "He'll be okay" I reassure her--and I believe it, because Jordan has more to do here.

A few hours earlier, the new attending on for today had requested a CT scan the next time Jordan's CRT (for dialysis) shut down or needed to be changed.  He wanted to get a better look at Jordan's lungs to see why so much air was being trapped.  It could have been days before the CRT filter needed to be changed but for some reason the CT scan needed to happen today because the CRT shut down on its own 20 minutes later.  

According to the radiologist, the CT scan showed an air pocket called a pneumothorax, which is putting pressure on Jordan's lungs and maybe on his heart.  The first radiologist felt this air needed to be released; the second radiologist wasn't so sure.  

As the day and night team form a circle outside Jordan's door to form a plan for the evening, I hear the second radiologist say that, "I can get a needle in there to clear the air and it will be at a most a millimeter from his aeorta...the chance that we puncture the artery is a significant risk."  Everyone in the circle looks at one another as if waiting for a new idea...something to try next.  

In the room, Jordan lie sedated once again with his eyes closed.  Without the ability to clear medication through his kidney and with the CRT machine still disconnected, he sleeps soundly.  

Once again, nurses bring in scores of medications such as epinephrine to boost Jordan's heart function and inhalants to relax his lungs.  Small machines to time-release the medications are once again set up like an electronic tree.  

While we watch and listen for updates, a nurse breaks away from the medical discussion to inform us that Jordan's chimera test shows CD3 T-cells; and that 53% of these are Jordan's.  She tells us the immunologist "would have been happy to see 10% and is very surprised to see 53%".  This is one more confirmation the engraftment is working.  

Jordan is in the ICU for a reason, but we believe he wants to be here and that his heart and lungs can hang on while his immune system develops.  "One more day", I whisper to him as I take his hand; "You can make it through one more day."