Monday morning – Dr. Nawaz’s last day before vacation. He finds my father awake and responsive to him. He tells me that two liver numbers are very high. It may be indicative of liver failure but more likely is a reaction the the TPN or the Haldol. He is withholding Haldol now and will schedule an ultrasound of the gallbladder STAT. As he is leaving the room I start to tell Dr. Nawaz about my father not getting the antibiotic yesterday. He says “yeah, I think he’s only getting one now, which is more than enough.” I go out to the nurse’s station where he is busy writing and when he looks up at me I say “I’m worried about the white count. If it were my father I’d be breaking out the vancomycin right about now.” He laughs and says, “Well I disagree. He’s getting a broad spectrum antibiotic that covers everything that’s out there.”

Later Dr. Kariya visits. I tell him about the 02 going into the 80’s briefly on Sunday night before Ron suctioned my father. Dr. Kariya tells me not to worry, recalling a recent mountain-climbing trip where he took a pulse oximeter along and found that in the thin air his 02 level would occasionally go into the low 80’s with no ill-effect. I feel relieved. A few hours later I see Dr. Kariya in the hallway. I ask him if he can order more frequent respiratory therapy, perhaps every 4 hours. He says to me “you know, to the patient, each time you suction it feels like choking. It’s torture. At some point you have to ask yourself if
you are doing it for his benefit or for yours.”

My friend Natalia visits. As she sits with me a man with a waxing machine enters the room. The room fills with a cloud of dust and we all start coughing. Natalia asks him in Spanish if he could please stop.

As the day goes by each nurse has something different to say about the ultrasound test, one saying she sees nothing on record, another that’s its non-emergent so my father is in the queue, still another tells me it’s scheduled for tomorrow morning.

Monday late afternoon my father wakes up a bit. He is awake for a few hours. I notice the infuser dispensing the Rocephin was not moving. There were no alarms but it was frozen in place. The nurse came in and started to remove the IV when I pointed out that it was still ¾ full. I suggested to her that the batteries probably were dead. She tried to figure out how to open it and replace the batteries. She left it on my father’s lap while she went to look for another infuser. She came back saying that the office in charge of this was already closed. This medication can be given “bolus,” pushed very slowly every few
minutes. I left for about 10 minutes and when I returned the syringe was gone.

I recall feeling very uneasy. Should I believe that I was just fortunate to be around the two times there were antibiotic delivery problems, or should I extrapolate and wonder how many times these kinds of things happened when I wasn’t there.

[On either Monday or Tuesday morning I asked my father’s nurse if she gave him his heparin injection. She said it was not on the computerized list of medications that she was responsible for. She could not tell me anything else. I went and inquired of the charge nurse and a few minutes later my father received the injection.]

Later in the evening a respiratory tech named Henry came in to do suctioning. I sat outside the room in the hallway feeling very downcast. As Henry came out he asked me if I was alright. I nodded as he continued, “you know your father can pull through this. He has a strong cough. He’s doing 70 percent of the work bringing up his secretions; I’m just suctioning from the very top.” I told him I heard suctioning felt like chocking to the patient and Henry vigorously disagreed. “I’ve been doing this since the Vietnam War,” he told me, “and I can tell how a patient feels by his reaction. Your father actually appreciates
having his airways cleared and being able to immediately breathe easier. You can just feel how relieved he is.” Henry continued, “If I didn’t think your father could pull through I would have just told you that I’m finished and you can go back in. Believe me, he can pull through.”

Henry tells me he was on the team that took my father down to X-ray 8 days ago when they tried to insert the NG tube and failed. “You moved things up 48-hours by calling Dr. White in and insisting that the PICC line and NG attempts be made on Sunday,” he said. “You can’t be serious,” I replied, and he said he was. “If not for your actions your father wouldn’t have had his PICC line until Wednesday.”