Another week has come and gone at Providence Milwaukie Hospital. The ERCP procedure scheduled for last Friday had to be postponed until Saturday morning because transportation was unavailable. We volunteered to take him or get Uber, but of course, that was out of the question! He would have to be discharged, go through the Emergency Department, be readmitted, and the procedure would be delayed. So, Saturday around 6:45 a.m., he was transferred to Providence Main, where a stent was replaced in the biliary bile duct. Dr. Razzac talked to me via phone afterward, indicating that replacing the stent with a larger plastic one was successful,-- no complications. His main concern was the condition of Mark’s liver. All along, we have known that the upper portion of the liver that can’t be reached endoscopically may be the problem. Even though tumors in the liver may not be active, they are not resolved, so bile can pool in areas around those obstructions. This area is likely the source of at least some of his infections.
Mark was returned to Providence Milwaukie around 2 p.m. and slept the rest of the day. Jessie took a “Dave’s hot chicken slider,” which he was most grateful for. He cannot stomach the hospital food!
Sunday, Rachel had the opportunity to spend some time with her dad. Recuperating takes time, so he wasn’t as chipper as he had been with the boys, but they were happy for some time together. Finally, on Monday, it was my turn again. While I was more than a little anxious to see him, the time the children got to spend with him was sweet, and it all fell into place amazingly well. The timing worked out for them to be there in succession without disrupting their schedules.
The plan was for Mark to be discharged yesterday, but his morning labs showed that the bilirubin count increased significantly. Although Dr. Taylor has no say at this hospital, he was uncomfortable with a discharge. We expressed our concern, so the GI doctor ordered another CT scan. It didn’t show much change, but the consensus is that the bile backup is from the unreachable area in the liver. Another procedure can be done, but it is not pleasant. A radiologist inserts a needle using imaging guidance to find the infected fluid in percutaneous abscess drainage. A catheter is placed to allow drainage to a sac outside the body. Again, the risk of infection is concerning.
This evening the GI doctor came by. His reasoning was along these lines: you look good, you don’t have a fever, no chills, there is not just one spot with pus that could be easily drained, your WBC is normal, not through the roof. The procedure with the outside stent is a lifestyle changer. Why not wait until you really need it? It is a good backup when things get bad, but they are not that bad yet! Go with low-grade long-term antibiotics and manage the C-diff.
The infectious disease doc seems to be on the same page. The GI doc wants to see how things go tomorrow to make the final call. If needed, Mark would be transferred back to Providence Main and would need to stay there to be monitored. We’re hoping it won’t be necessary, and maybe he will be discharged tomorrow. He is anxious to get back to a comfy bed, his high-back recliner, a room with a view, and for us to be together again! I like that plan, too!!
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