Relief and perspective

It's hard to know where to start explaining what happened today. We went from anticipating Susan’s brain surgery with all of its concerns to learning it would be postponed and waiting all day for a regular bed to become available so she could be transferred out of ICU. It’s all really good news and brings great relief – and makes my head swim. We’re thankful to God for answered prayer. It appears Susan will ride out this episode with no need for an operation, and it appears her bleed (or hematoma) will become absorbed in her brain over the next month or so, kind of like a bruise. Who could ask for a better outcome? There’s nothing like a reprieve from brain surgery to get your day going.

So what happened? Susan has two things at work – an obviously large hematoma discovered late Wednesday, and a history of infections that includes meningitis. Blood in the brain and meningitis have similar symptoms – fever, confusion, and elevated white count in the cerebral-spinal fluid. The infectious disease (ID) team rightly pursued the likelihood of infection given Susan’s history and symptoms. They suspected her L-P shunt was the source and should be removed. The neurosurgeon Dr Liau knew that if she removed the shunt, Susan would need a temporary replacement and an intracranial catheter (drain tube) would need to be placed surgically inside her skull. Dr Liau reasoned that if she’s doing a surgery to place the drain, she might as well do a full craniotomy and clean out the bleed. But yesterday when the ID team learned about the bleed, they reconsidered the need to pull the shunt because Susan’s symptoms could be caused by the hematoma alone. Late yesterday, when Dr Liau learned the ID team was comfortable with the shunt after all, and also that Susan’s last dose of Avastin was so recent and may complicate the surgery with bleeding, she dialed back the need to operate. Susan’s stable and improving symptoms overnight helped confirm the judgment. Still, my head swims.

The whole deal is a study in the decision-making process of medical specialists who need to share ever-changing, vital information and arrive at the best option for treatment. Dr Liau carefully explained the circumstances to me today when Susan was being taken out for her MRI and wanted to allay any confusion. She called me this afternoon with more good news – she did not see any tumor growth in today’s MRI, although the bleed itself could mask it. She’ll order a follow-up MRI in 2-3 weeks to check it again after the blood begins to dissipate. The lab tests for bacterial & fungal cultures will be available over the next several days, so clear results will allow Susan to begin discontinuing antibiotics as soon as tomorrow. She may have another CT scan on Monday to check for bleeding again. If the bleed has stopped, if there’s no infection, and if she continues to improve, Susan may be able to come home by Tuesday or Wednesday. She still was waiting for a regular bed when I left this evening; but all in all, this was a great day. God is good all the time.