The Fat Lady Is Gargling With Warm Salt Water

The Cancer Van was full today during the short jaunt to the MDA campus. I sat in the very, very, very, back row of the Cancer Van, which is difficult to navigate to, especially with coffee and a briefcase, but I'm happy to ride back there because I can get there. Some people can't. I sat next to a lady from New Orleans so we talked about storm damage, etc. after The Big One of '05.

I arrived at Jerry's room, and Nolie and I had our daily Stand-Up meeting. There wasn't much to pass on. Jerry was the same as I left him last night; restless, coughing, and periodically raising both arms up to the ceiling as though someone was going to pick him up. Gayle said she's seen this before in hospice care.

After Nolie left to go the the hotel to take a shower, Karen, the Advanced Practice Nurse, came in and we talked about Jerry's cough. We decided to order a breathing treatment to see if we could loosen up some of the mucus in Jerry's lungs so he could breath more easily. For the last couple of days Jerry has been coughing very well, but not getting the mucus up far enough to suction out. Joe, the breathing guy, came up and administered the treatment, then pulled out a skinnier suction device than the one we'd been trying to use, and stuck it up Jerry's nose.

The skinnier device looks kind of like a slender, flexible, red garden snake. It can snake farther down Jerry's trachea to remove the mucus than the more rigid tool we were using before. Wow! Remove mucus, it did! Between the Slender Red Snake, and some sterile water to irrigate, we got out a whole bunch of nasty, black, tarry looking snot! Joe went through about six of the Slender Red Snakes because they kept getting clogged, and when he pulled the last one out, it had a big, nasty chunk stuck to the end of it that reminded me of a piece of shrimp on the end of a fishing hook. I actually said, "Ooh. Let's go fishing."

After the traumatic snot sucking, (and it was traumatic) they gave Jerry a little extra Morphine, and some Ativan. His pulse ox dropped to 41% and so they put him on 100% oxygen. His pulse ox started to rise and got as high as 85%, before dropping back down to the 40s. Karen believes he has another mucus plug in his left lung, because he's not moving much air through it. You can tell by watching him breathe, that the left side of his chest is not rising nearly as much as the right. The last time we checked his pulse ox, it was 61%. Pulse ox should be close to 100%. It would be great if Jerry could cough up that snot in his left lung. He would be able to breathe a little easier, and rest some. Anyway, in the mean time, he's on 100% Oxygen and breathing heavily.

Nolie is at MDA tonight, and I am at RIBM.