On Friday, Tristen, Erika (Joe's sister), Riza (Joe's other sister) and myself (John Samuels) met with the Dr. Chung, the ICU doctor in charge of Joe's case as well as the attending nurse and a hospital social worker. This was the first opportunity for the whole group to get a full understanding of Joe's situation and prognosis.
Joe's status remains critical condition but stable. He is currently fully sedated with a paralyticic, both being administered via a constant drip so he is completely unconscious. He is currently on a ventilator operating in an oscillating mode (which is very rapid shallow breaths, at roughly 2 breaths per second). The doctors moved to this ventilation mode when one of Joe's lungs partially collapsed on Wednesday evening. The ventilation is at 70% O2 levels (where air is normally 20%) and his blood oxygen levels are dancing between 83% and 90%, where 90% and above are considered normal. Other blood chemistries are considered at acceptable levels.
Chest x-rays and blood chemistries have improved over the last 24 hours but the doctor was unwilling to quantify, stating he will have good days and bad days.
He is on intravenous nutrients, having been taken off of tube feeding to his stomach due to concerns about his ability to process the nutrients in his physical state. Given his condition, it appears that his kidney, bowel and brain are functioning as expected at this time.
One key item that has the doctor's confused and concerned is Joe's extremely low white blood cell count. When Joe was admitted, his white blood cell count was at 1.6-1.9K/ul blood. Normal counts are typically 8-10K and someone fighting off an infection such as Joe's should be closer to 100K. This is very concerning. Since admission, Joes count has risen to 8-10K level, normal for a healthy person but still far too low for someone fighting an infection. The doctors have tested for Lupus, HIV, Rheumatoid, and other auto-immunes, all negative.
Most other test results for the cause of Joe's condition so far also have come back negative. This includes typical bacteria that cause Pneumonia, as well as H1N1 (Swine flu) through results are still coming in. The only item confirmed to be present is a candida fungus, but the doctors believe this is an opportunistic infection given his compromised immune system. Most people harbor this fungus in their system but it is normally kept in check. He remains on broad-band antibiotics though the doctors have removed him from one medication given the test results. He is still running a moderate fever that periodically spikes and is treated to bring it back down. At this stage, the doctor suspects Joe has/had a viral source of the pneumonia, but has no conformation at this time.
So where do we go from here? First, the doctor offered a recovery regime based on an assumption that Joe was a health 44 year old. More on this later. As it stands, if one assume best case and he improves steadily from this point forward, they will move him from oscillating ventilation to normal ventilation in 24-48 hours. After that he will require assisted breathing for 1-2 weeks in the hospital. After that, he will have a recovery time from 2-6 months including physical therapy and some home services as needed. After this they expect little long term lung damage, again, assuming Joe is a healthy individual and he continues on a solid path to recovery from this point forward. The doctor did offer that if the recovery is more prolonged, they can only keep the breathing tubes in him for 2-3 weeks and then will have to resort to a tracheotomy. They also asked our stance on dialysis if the kidneys show signs of failure.
At this point we challenged the doctor's basic assumption, that Joe was a healthy individual. We informed her of his back damage (which she knew), his failed shoulder and thumb on top of his previous failed shoulder and elbow, all within the past 18 months (which she didn't know), and his chronic pelvic pain and the treatments (which she also didn't know). She was noticeably surprised and stated that while it would not change his treatment to date or in the immediate future, she wanted to review his full medical history to evaluate his long-term prognosis and to try to understand is low immune response. We have initiated in getting her all this information.
So that's where we’re at. We continue to discuss what we believe Joe would want, given where he was at when all this started and where it is going. We look to all of you for strength and hope that this will have the best possible outcome for our dearest friend.
John
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