Go read the previous post. This will catch you up.

Now, remember where I said "James changed his shirt"? This was a plot point. "Foreshadowing. The mark of good literature. Look for it everywhere."

We were on mutually exclusive paths yesterday afternoon if in the same house. He was in the kitchen, I was washing towels and the bathmats, making the bed, etc. This means I really didn't see him face-to-face at any point, even when we were both getting dinner in the kitchen. He always had his back to me or was sideways.

It was on round two in Guy's Grocery Games. The four kids had all survived the first round and the second was "winner take all." They were supposed to make a "weekend treat." James came up and stood behind and to the left of me. I looked up.

The kids were forgotten. I screamed "What is that on your shirt? Is that blood?" There were seven or eight big splotches of blood on the upper right quadrant of his shirt. "Did you cut yourself?" Then it dawned on me. That was where his permacath was. James looked down bewilderedly. "No I didn't cut myself." came out just as I shrieked "Pull up your shirt!"

The big square gauze bandage over the incision for the permacath was still there, but the two dangly tubes that attach him to the dialysis machine were gone.

I will spare you the combination getting-ready-to-go-to-the-emergency-room routine and me hyperventilating for fifteen minutes trying to find the tubes. My initial theory (which is probably what happened, but in a different manner) was that he took his shirt off and it caught on the cheap paper tape they put on the gauze patch and around the gauze over the access tubes and pulled the tube out. But it wasn't in the hamper with the shirt. I sat on the floor and even did a frenzied search of the laundry basket. Then I checked all the places James had been since he changed and could not find the stupid tube. If it fell out of his not-tucked-in shirt it should be on the floor somewhere. By then I was dressed and ready to leave when a light bulb went off. I checked Tucker's box. Sure enough, the little kleptomaniac had found the tube and taken the "treasure" to his lair to chew on. I grabbed it in case we needed it and off to Wellstar Cobb we went.

The admissions nurse took one look at the battered tube and gauze, and my face, and told James to sit down. He was feeling fine. He hadn't noticed the tube pull out, the shirt had absorbed the blood and there was none on him, and he was feeling normal. The blood on his shirt had been dry, so it had probably happened much earlier. He'd cooked, cleaned, and eaten and hadn't noticed. All we can think is that it came loose when he changed shirts, then when he got into the kitchen and started moving around—maybe when he reached up to the cupboard to put the plastic containers away—the tube fell out of the fresh shirt. Tucker spied it, since he always hangs around James when he cooks, and spirited it away. I tell you, you can't make these things up.

I calmed down at the emergency room, they took blood from James (again, everyone was very nice), and we sat waiting. His tests came back still good for what has been going on, creatitine at 3.1, GFR at 21 (you get dialysis when you get to single digits in GFR). The doctor came back saying he had called Kaiser and told them there was no immediate need for dialysis right away because his numbers were good enough, and that they actually didn't do permacaths there anyway. The wound was dry, with no sign of infection, and they covered it up again.

However, while we were there, they took care of another potential problem. (Warning: this may be TMI.) James had produced 600ml urine over Saturday night. Urine had just gotten clear after being bloody because of a new catheter insertion. It had turned brownish first and was now a cloudy yellow. However, since morning he had only produced about 100ml more. If it was still blocked up like that in the morning we were going to go to Urgent Care. Since we were in the emergency room, they took care of that for us; the nurse flushed the foley catheter with some saline. At first it didn't seem to do any good, then James stood up. Whatever was blocking it—a small clot, sediment, etc.—released, and then it was Katy-bar-the-door, about a liter and a half in an hour. (In 12 hours his output was 2 1/2 liters.)

The doctor came back. Kaiser said as long as the wound was clean, dry, and not infected, James could go home. Kaiser would call us in the morning about what to do.

So we stagger home about 2 a.m. hungry and tired. James shared some chicken salad and crackers with me, then I completed the routine we would have done at 10:30 p.m.: I washed his hair at the sink, I showered, I helped him bathe, we got the night bag connected (having had to empty the smaller bag—32 ounces—twice since we got home), and got to bed about 3:30.

DaVita called at 8:30 with an earlier seat for James, but we didn't hear it. Then Kaiser called about ten of nine. That we heard. Then followed this series of phone calls between us and Kaiser and us and DaVita. The summary: basically James' doctors were arguing over him. The nephrologist at Kaiser (Dr. K) wants to stop the dialysis because his numbers are better (the last creatitine that DaVita got was 2.65) showing his kidneys are kind of "in remission" and Dr. K would like to see if they'll stay there for a while. The nephrologist at DaVita (Dr. B) says "well, those are nicer numbers, but he should still have dialysis." Kaiser didn't order dialysis until he was steadily in the high 4's. So first the nurse from Kaiser scheduled James to get the permacath reinserted at 3 p.m. Then she texted back that Dr. K cancelled that. DaVita got irritated because Dr. B wanted the permacath in. We're sitting here saying, well, whatever is best, but if he doesn't need the dialysis right now could we put off the permacath? In face, I'm wondering if we can't work out a compromise. Maybe Kaiser can order blood tests once or twice a week. If his creatitine and CFR stay low, no dialysis (or even less dialysis). Meanwhile, the fistula surgery proceeds as scheduled so he's all ready for permanent dialysis. This sounds sensible to me, but I've had five hours sleep.

James finally got them to call each other, and they came to an amicable agreement. No permacath at least for today. Discontinue dialysis for the moment. And, yeah, he has to go for a blood test at Kaiser today. I am annoyed I know that foley blockage is going to skew the creatitine test; it already has gone back up to 3.1. So after lunch we will pop into the car and go over to Kaiser for him to get a turn with the vampire squad.

I need a nap. And maybe a sanity clause.

Labels: health, sickness

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