BMT Day 6

Ethan has been in Seattle for the past five days and isn’t allowed to sleep over at the hospital. At 1:30 a.m. last night I left the hospital to drive Ethan 0.4 miles to the Ronald McDonald House. After tickling his back and tucking him in bed, I got back to the hospital around 2:15 a.m. and noticed Ashtyn was shivering in bed. I took her temperature that showed 101.3. It was not just her temperature that concerned me, it was also her blood pressure that was a little lower than previous, she was more out-of-it, not getting up to the bedside commode, unable to drink pills or breathe in the incentive spirometer. Her respiratory rate was higher, she was restless and miserable, and could no longer verbalize thoughts. The nurse took blood for blood cultures, gave Tylenol to decrease her temperature, and gave a high dose of hydrocortisone which helps the body react to stresses. Ashtyn is already on a really good antibiotic called Ceftazidime for bacteria infections plus Valacyclovir for viral infections and Posaconazole for fungal infections. Because fevers aren’t necessarily uncommon in this setting and she’s already on a antibiotic, additional antibiotics are not started unless a bacteria grows in the blood culture. The problem was, to me Ashtyn behaved as if she was septic. I knew her side effects could be from the bone marrow transplant process, but I wanted sepsis treated immediately in case she had an infection. I explained my rationale and the doctor agreed to start another antibiotic Vancomycin for a day or two, in case she had a blood infection that ceftazidime doesn’t cover. Throughout the night, vital signs were taken every 15 minutes because Vancomycin was given over 2 hours and was a new added antibiotic. The nurse then gave a platelet transfusions. In the morning Lasix was given because Ashtyn’s body had retained over one liter of fluid. A red blood cell transfusion was also given in addition to all the other medications scheduled. She is described as being “medication heavy” which means she’s a very very busy patient. There’s also a balance we are trying to maintain between using pain and sedative medications to keep her comfortable but not too much to where she isn’t responsive. Ashtyn literally slept constantly today. Sedating medications are going to be given less frequently to see if she wakes up more. Her temperature was just taken and is back up to 101.5. She’s officially at rock bottom of the transplant. It will be a constant effort to support her through the next several weeks. I’m grateful her vital signs are good, lab values are able to be balanced, blood cultures are negative so far, there’s no serious complication, and she gets to sleep through one of most miserable experiences I’ve seen. Please continue to pray for zero complications while we wait another week before signs of recovery begin.