Dear Mica:
Thank you for this long and thoughtful e-mail. I share with you the concern we have for Tracy's life - that it should have some dignity and meaning. I wouldn't want it prolonged for the sake of suffering and nothing more. We considered sending him to Strong Memorial Hospital, but when Dr. Evans spoke to Dr. Trawick they appeared to offer nothing in addition to what we are doing. So, despite our earlier enthusiasm about transferring him, we have elected to keep him here in Ithaca. We have added further antibacterial coverage at their advice. We will know soon enough if he is responding.
There is some reason for hope as at present his lungs are affected, but his other organs are holding out. I know he developed a heart rhythm disturbance, but I don't think that reflects more than a reaction to his pneumonia. This also is likely to have contributed to his altered mental state. When I saw him this morning he looked sick from the pneumonia and was unconscious because of the opiates. His recovery depends upon his ability to clear up this pneumonia. He has no reserve and that is my fear - that he may require assistance with breathing. Also, he may need assistance with nutrition as he can't get better if he is so malnourished/catabolic.
Unfortunately, as patients as sick as Tracy have "non-linear" events. As we wait for the pneumonia to recover something else happens unexpectedly (like the pulmonary embolism, pericarditis and the atrial fibrillation). There is no easy way to factor that into formulating his prognosis from this acute illness.
I am encouraged by the 2 weeks of reasonable quality of life he has recently. This appeared out of nowhere and I cannot account for it.
He looked awful when I saw him this morning and my first reaction was like yours. He looked like he was dying. However, I have seen patients get through dark periods like this when the infection is appropriately and aggressively treated. We must expect the unexpected. He may succumb. However, I don't think we are at the stage for hospicare. That may come, but not today.
I am sorry I offer only slivers of hope and nothing more. We can do so much and the rest is up to Tracy's physiology.
