More good news! John has continued to do well today. His pressure maintaining med has been decreased and so far he is managing to maintain his blood pressure in a good range. The goal will be to very gradually wean him off of it; as long as he can keep a normal pressure himself, other fluids that are causing edema can also be withdrawn slowly through dialysis (that process has already begun very slowly). That will bring him a measure of comfort and help even more with his breathing. Right now the ventilator is doing all the work of breathing but over time, John will begin to take over more and more of the work himself. Those are all long range goals.
For the immediate future, the doctors are still discussing the costs and benefits of a bronchoscopy. John is currently on very powerful broad spectrum antibiotics and anti-fungals that seem to be effective against the infection. Finding the exact pathogen would permit the medical team to discontinue whatever is not of immediate benefit to him. That would decrease his long list of meds by at least one and it would lessen the chance of his organisms becoming resistant to last line meds available to treat infections. One of John's doctors mentioned today that there is a (small) possibility that the lung consolidation could be caused by something other than a pathogen - for instance, it could be gvhd of the lung. It would be unlikely and an unusual presentation (as a consolidation in the upper right lung) but not impossible. A bronchoscopy could yield the identification of the pathogen but there are decent odds that the sampling would miss the part containing the infectious organism and then we wouldn't be any closer to knowing what is going on. Bronchoscopy also carries risks of bleeding and of upsetting all of John's systems during the procedure. It's very difficult to assess the cost/benefit ratio. At this time it seems like the doctors are still considering it but they might put it off until tomorrow or even Monday. Another recent development is dialysis - it is continuous so it does not remove a lot of blood at one time and does give the nurses and doctors a lot of control maintaining his fluids and pressure while removing toxins and waste products from the blood.
John was moved from the surgical ICU to the medical ICU this afternoon. We are so grateful for the excellent care John received in SICU. Every single staff person, nurse and doctor were just wonderful and worked hard to answer all of our questions and to make John as comfortable as possible while performing some pretty invasive and painful treatments. Everyone in MICU is great as well. The main advantage of MICU is that John's doctors are stationed here so it is easier and faster for the nurses and doctors to communicate.
A big new development is that John began receiving food through a feeding tube tonight. Just a little to start but this is important. He hasn't eaten for a long time now.
John has started opening his eyes, is able to squeeze your hand, can nod his head yes and shake it no (it was great to see him shake his head no when the nurse asked if he had any pain), and shrug his shoulders. He manages to communicate even though he can't talk, write (he tried though), or use his hands very much. We shouldn't be surprised. He is happy to see his brother, Bob, who is visiting for several days and Zacc who drove up from Baltimore today.
Thank you all for your expressions of care and concern. John is still a very high risk patient and still has a long way to go but today has been a much better day.
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