The ICU

As I write this Phillip is in the ICU at Mercy Hospital. Perhaps it was my positivity from last post that doomed us, or its the reality that cancer is unpredictable and our rollercoaster of a journey needed a sharp drop.

After a month-long lapse in chemo, Phillip received his second infusion of "pannekoeken huis" on Monday. The infusion took place at the Plymouth office rather than Edina, and I was so excited to see the vibe of Plymouth vs Edina. The infusions went smoothly in a quiet room, and we returned home for Phillip to settle into his usual chemo slumber. Everything seemed normal until the evening.

As we were winding down, Phillip seemed uncomfortable and kept leaning forward to burp. I've always assumed this was because of his acid reflux so did not think anything different on Monday night.

In the middle of the night, Phillip started waking up to be sick. That's odd, I thought. And after the third, and fourth time of him waking, I started to become frustrated because we have a toolbox of medications to alleviate chemo side-effects. I told him to take a Zofran so he could get some sleep. "Kel, it's not like that." His response was confusing because of course he was getting sick, how couldn't it be like that? At midnight, he finally told me, "I think I need to go to hospital in the morning, I am throwing up blood." This woke me from my sleep haze and I immediately began telling him we needed to go to the hospital.

As some of you know, Phillip does not have patience for doctors or hospitals, so the idea of going to the ER in the middle of the night was less than ideal to him. My trazodone fogged brain wasn't thinking clearly so when he pushed back, I just let it slide.

When morning came, I quickly started a pep talk to gather any energy he had so we could leave for the ER. That's when Phillip started getting sick again into a mixing bowl, and I realized that "vomiting blood" meant he was actually vomiting an entire bowl of blood, not just vomit with small traces of blood.

At this point I told him, "This has been happening every time!? You've lost a lot of blood and we need to go to the hospital NOW." Perhaps he had thoughts assuming this was all a weird fluke, or it would end soon and it was nothing serious, but I will never understand what gave Phillip pause to go to the hospital.

That morning, the drive to the hospital felt longer than normal. Forty-five minutes later, we arrived at Mercy where I quickly rushed to grab a wheelchair so I could help Phillip out of the car and to inside.

As we approached the check-in desk, I started explaining that Phillip had lost a lot of blood, and then he suddenly slumped sideways in the wheelchair. Without warning, his body went rigid, his eyes rolled back.

What happened next is a blur.

I remember screaming. Help. Help. Help. Just that word, over and over, people jumped up from waiting room chairs, the nurses ran from around the desk, it was chaos.

The one glimmer in this horrific moment is that it bumped us to the front of the ER wait. We were immediately rushed back to an ER room like something right out of The Pitt.

Nothing prepares you to watch the love of your life become non-responsive. I had no idea what was happening or if he would be okay.

Within moments, Phillip was hooked up to monitors, and the ER team had a working diagnosis: a likely rupture of esophageal varices. The attending had already paged the GI doctor, and she was on her way. The care was nothing short of exceptional, his condition was treated as the emergency it was, and every single staff member was attentive and present.

I say every single staff member because that includes the nurse who had to talk me down from the ledge of those first few minutes. They weren't just taking care of Phillip. They were taking care of both of us. I was met with kindness and compassion and a calmness that enabled my hyper-aware state to level-set with the calmness of those around me.

An endoscopy confirmed the source of the bleeding: a ruptured vein that was, in the surgeon's words, "gushing blood." The GI surgeon was able to band it and stop the bleed.

Since then, the goal has been for Phillip to maintain a stable hemoglobin and vital signs, He has received seven blood transfusions since arriving at the ICU. As of this evening, his hemoglobin is at 8.4, with the goal to maintain 8 over the next few days. It is expected he will be in the hospital until Friday because he needs a round of IV antibiotics to ensure there are no infections in his abdominal cavity. Let me tell you, Phillip is less than thrilled about his extended stay, but if there is a glimmer, its that he gets to enjoy fruit ice again.

So what does all of this mean? Esophageal varices are a complication of liver damage. When tumors obstruct normal blood flow, blood backs up into the esophageal region, which can lead to varices and, ultimately, ruptures.

This is a scary development and an unwelcome reminder of how critical it is for Phillip's liver to respond to chemo regimens. Despite the tumors peppered throughout Phillip's liver, the healthy sections of his liver are also overcompensating, and this causes strain. The health of his liver is pivotal for treatment continuation and for the avoidance of any further ruptured varices. Ongoing monitoring of his varices and liver function will now be an important part of his care plan moving forward.

The glimmer right now is that Phillip feels good again. This morning, while I was with him in the ICU, he was literally taking work calls. He really is something. I truly believe his stubbornness will be a blessing and a curse throughout this journey. But if there is ever a next time that he's vomiting blood, we will not hesitate and will go to the hospital immediately. This was a teachable moment in the worst way.

Please send all the prayers and positive energy for the next few days to remain uneventful so he can be discharged on Friday.

Kelley