Gloom and Doom in the ER

Well, after my last post, my mother’s problems with the indigestion worsened to the point she was eating almost nothing — 6 prunes for breakfast and a piece of toast for lunch. Maybe 3 oz of Ensure if I was lucky. She didn’t like the Maalox at all, and said she thought it was causing her problems. Then I started noticing the swelling of her lower left leg, but at first just put it down to the neuropathy.

On Saturday we weighed her and she’d gained 4.5 pounds in a week without eating anything. Hmmm. She must be retaining water, and it did seem to be in the leg. Not only that, her breathing was becoming increasingly labored. On Sunday I realized it wasn’t just the lower leg, but the entire leg that was considerably swollen. And by Monday she was breathing hard just eating half a sandwich. I called her PCP and at first he signed her up for an ultrasound to see if a clot was causing the swelling — until he heard about the labored breathing and told us to go to emergency.

Oh noooo…. Not again!  All those people, hours sitting there, no water, etc, etc… We went expecting the worst. It was Monday afternoon, after all. All the people with ailments over the weekend would surely be there.

But they weren’t. There was hardly anyone there. At one point I was sitting in a waiting room with only one other person. This time, because the doctor had sent her in — and because of the swollen leg and labored breathing– they took her right back and started doing various test. When I came back with my lunch they were giving her a breathing treatment. Then it was off to x-ray. We sat in the hall for a while, and then they got her a bed. They did blood tests. Urine tests. The ultrasound. 

It was while she was away having the ultrasound that her emergency room doctor came in with results of the tests. He reminded me of Eeyore. He spoke very soberly and quietly. X-ray had shown fluid collecting in lower lobe of her right lung, between the lung and the chest wall. This, he said, was consistent with cancer. Not only that she had terrible numbers on her liver test. He had a paper comparing that day’s numbers with those taken back in February. “Something really bad is going on with the liver,” he said. He thought that was cancer too.

He could order a test to have the lung fluid drained and tested to confirm but… that would entail, he told me, a doctor sticking a huge needle into her chest to drain the fluid and could result in a collapsed lung. She’s 83. Even if it is cancer, would she be able to tolerate more chemo?  Probably not. It might be better, said he, to just let her pass and consider hospice.

Well, that was … not exactly shocking, but still… shocking. When she came back I told her, and she received it with her usual impassive demeanor. Then he came back and started beating about the bush as to what was wrong and I just told him that I’d already told her, so then he started talking plainly, repeating the description of the thoracocentresis with the huge needle and the collapsed lung. There were other dire side effects as well. Did she want to do that?

Well, it was 9pm by then. She was hurting, she was tired, she was probably shocked as well. She said no.

“Okay,” says he, “I’ll write up some prescriptions and discharge orders. And tomorrow you should try to get appointments with the oncologist and the primary care.” And off he went. Half an hour later he returned with his prescriptions… an inhaler and three pills she was to take by mouth. I looked at them and told him there was no way she could be taking more medication because she was constantly on the verge of throwing up. He seemed startled, then said he couldn’t send her home then if she couldn’t eat or drink. “I’ll have to admit her to the hospital. We can put her on fluids and get some nutrients in her and some pain meds and they can look into things a bit more tomorrow.”

So that’s what we did. When I left at 10pm, they were finally accessing her port to hook her up to the fluids and the morphine and promising to get her up to a hospital room as soon as possible. I was exhausted and everything seemed very gloom and doom. But I did wonder about the ER doc, and it almost seemed like a set-up by the kingdom of darkness to get us all upset…

Which is indeed what it turned out to be…

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