Despite It All

Chapter 10

"Okay, I know it's early and I know you're tired but I really need you to get on the scale right now. Come on, I'll help you. I promise."

My eyes flit to her monitor, noting her oxygen saturation—the percentage of oxygen her cells are receiving—steadily bouncing between 86-88%. I adjust her oxygen flow, increasing the amount she receives through her nasal cannula. Hopefully increasing her from two to three liters per minute will help bump her up above 90%.

I grab Deandrea's hand, noting how puffy it feels. Her swollen feet swing over the edge of the bed, ready to steady themselves upon the cold, hospital floor. Her breaths are exaggerated, chest huffing with exertion. The monitor blares, unimpressed with her continuously elevating heart rate and decreasing oxygen level. She winces as her feet finally touch the floor, the arches beneath them almost nonexistent. Her rounded face sports some peri-orbital edema—swelling around her eyes—making her appear even more tired.

A slow, purposeful step. A pause, followed by a beep.

49.1 kilograms.

I take out my report sheet, knowing the number doesn't sound right off the top of my head. Hmm. Last night's weight was 46.4 kilograms.

"Okay, now let's step off and we'll wait for the scale to go back to zero, then we'll step on it once more, okay?"

She huffs, but nods.

49.3 kilograms.

"Okay, great. Thank you so much. Let's get you back in bed, yeah?"

Using the computer in her room, I take a moment to examine her chart. It's now 11 days after her allogeneic stem cell transplant, and it's starting to show. The harsh chemotherapy she received before receiving her donor cells is now wreaking havoc on her body. As the new, donated cells start to make residency within her, side effects are becoming more and more prominent.

Up until now, her biggest problem has been her persistent fever. It hasn't been under 38.6℃ in a while. Now, however, I'm noticing she has not had much urine output in the last couple of days, either. Her increased swelling and her up-trending weight definitely explain why she's having a harder time breathing—all that extra fluid is placing pressure on her lungs.

To compound upon the extra water her body is holding on to, we are giving her an obscene amount of fluids. She's currently scheduled to receive four different antibiotics multiple times a day, an anti-fungal, an anti-viral, anti-rejection medications, and around-the-clock anti-emetics—all of which are administered in IV fluids. This is on top of her continuous IV nutrition and pain medication. She also requires at least one blood transfusion per shift, and often needs IV electrolytes to maintain homeostasis. She has 47 medications scheduled for my shift.

Forty-seven.

She's drowning from the inside out—and we're not helping.

Looking back in her chart, I see that they have attempted to address this problem with furosemide, a medication used to flush out the kidneys which usually causes heavy urination. Obviously, it hasn't worked. Checking the math, I determine her average urine output has been a measly 0.5 mg/kg/hr. Ideally, it would be 2 mg/kg/hr. Her weight has increased almost 7.5 kiloggrams in four days.

A heavy awareness creeps up from my chest and settles into dread in my stomach. "I'll be right back Deandrea, okay?"

I knock briefly before entering the conference room that houses our heme/onc physicians.

"Hey, Brett?" I ask one of the heme/onc residents who responds with a head nod.

"Just letting you know that Deandrea's weight is up almost three kilograms in less than 12 hours. She's up 7.5 kg in just the past four days. I also had to increase her oxygen flow. I'm a little worried about her respiratory status. Do you think we could try albumin to pull the fluid from her interstitial tissues and into her veins? She's very edematous."