Ugh. The attending and the whole transplant team were here just now and the news is all bad.
His bleeding stopped on its own but his liver disease is a lot worse - MELD score is up to 38 from 33 mostly due to his INR creeping up to 4. Since MELD only goes to 40 this is bad: MELD of 38 has an 80% three month mortality rate if not transplanted. (MELD of 33 was 50%.)
Plus the liver is causing pressure issues with the right heart so they are consulting heart/lung people today to find out what to do about that....they thought probable right heart catheterization soon and “this will be tricky because of the underlying liver disease” so he could die on the table from -that- even before we get to transplant. All of this is depressing and scary.
The attending talked like we will be staying here till after the actual transplant because “you are very sick and I do not want you to leave and have something happen that will jeopardize your ability to -get- a transplant.” Apparently his actual lab numbers are a lot worse than his clinical presentation. (On the other hand, that statement means they are thinking transplant rather than hospice.)
He and I both got the strong impression that he is leaving this hospital either with a new liver or feet-first.
Oh Sam, my heart hurts for you both. You are on my mind a lot of late. Thank you for sharing updates. Thinking positive thoughts and saying prayers.
ReplyDeleteThis has been a trial by fire, emotionally, certainly. But at what point should you simply concede defeat, and let go? Medical science can certainly cut, paste, staple, and Scotch-tape the dying, allowing them to eke out a few more units of time, but...often, the patient should just accept that the body is shot, and decline further stop-gap procedures. Your time might be better spent accepting the end, and saying all your goodbyes. My husband is a surgeon, and he performs many operations only because the patient and family are desperately hopeful, and in denial. He often says he wishes people would listen when he cites the stats for likelihood of poor outcomes.
ReplyDeleteWell obviously “home with hospice” is the choice if his heart isn’t strong enough for surgery and we are accepting of that fact but as of yesterday afternoon the transplant team was still keen on getting him listed.
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