Poor Sarah was left holding the bag today...the IV and IV pump bag, that is! She had been counting the hours until she would be rid of her PICC line and the black albatross that she literally wears around her neck (or sometimes her waist). However, her follow-up visit with the Infectious Disease team at DHMC put a stop to any plans for stopping IV antibiotics today. Sarah's liver function tests have increased somewhat - not much, mind you, but who is taking any chances at this point. Liver function tests are mostly the measurement of enzymes in the blood that should be inside of liver cells. When those cells are suffering in some way, the enzymes that they make and use leak into the bloodstream providing the finger prints for possible liver trouble. For Sarah, that could mean a secret little band of bacteria hiding in her liver and waiting to pounce on her when the antibiotics are stopped. In addition, some other blood tests that provide a kind of barometer of a person's inflammatory responses to things like infections are remaining a little too elevated (or going down a little too slowly) for the comfort of the infection disease specialist. So, the tests show that it remains possible though not very likely that there is still some pocket of infection that has not been reached by the antibiotics. Not very likely....but we have been living in the land of the not very likely for the past two months. We know how dangerous that can be.
So the new plan...Monday will be a busy, long day at the medical center. It already included a follow-up visit with Sarah's heart surgeon including a chest-X-ray. Then, a follow-up echocardiogram was added. Now, the infection disease folks would like to see a liver ultrasound, an ultrasound of Sarah's abdomen, groin areas, and femoral blood vessels and also a bone scan. Finally, a stop at the lab for a quick pint - of blood that is - for another panel of blood tests. Meanwhile the antibiotics continue, the every 48 hour IV bag changes and daily heparin flushes of her PICC line continue, and the black satchel remains Sarah's constant, hated companion.
If the truth be told, Sarah melted down with the news of her continued burden. But, then she quickly pulled herself together, stiffened her upper lip, and carried on. She is a truly amazing, resilient person - if there is such a thing as existential forgiveness, Sarah is the one who has it.
Me, I'm "enjoying" 80 degree temperatures in Harlingen, Texas, while surveying an amazing primary care medical home serving a most vulnerable population of children and families along the Mexican border. But, I wish I was home - even if there are temperatures in the teens and a winter storm watch for tomorrow and Friday (please don't hold up my return).
By the way, did you know that Sarah now has blog readers in ten countries, and Belize is second after the US? The list: US, Belize, UK, Canada, Germany, Czech Republic, Pakistan, Singapore, Brazil, and Denmark.
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