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Entry made by Brunilda Ortiz-Lopez, sister to Marjorie: Received text message from Margie the evening of September 20th, where she told me she had been hospitalized with pneumonia and with a very bad rash all over her body that the doctors thought might be a reaction to an antibiotic, Levaquin 750mg, which she had been given. She also said that while at home due to tremendous weakness she had passed out and hit her head. Bobby took her to the ER and a CT scan was done and fortunately the fall was not serious she said.
I arrived Tuesday, September 27, 2016, to visit Margie, she was in the ICU with pneumonia and had to be placed on a respirator as she could not breath on her own since last Thursday, September 22nd. Bobby called me on Sunday, as the prognosis was not very good as her kidneys, liver and lungs were not functioning well as per doctors assessments, but by Tuesday she started to turn around in a more positive way, was eliminating urine more frequently, swelling started going down, blood pressure was able to be controlled and her air levels began to improve significantly. By the end of the day she was more or less stabilized considering her gravity. She was able to rest fairly well all night.
Wednesday, September 28, 2016. Doctors reviewed her charts, abdomen x-rays, sonography, blood work and were very optimistic with her improvements, it was considered to wean her out of sedation with the hope of waking her up and with the goal of obtaining a conscious state so that her respirator could be removed. During this time frame of waking her up, respirator was adjusted to a point where she was basically breathing on her own but with minimal assistance from the respirator. Respiratory therapy as also applied during this period also. It was the physician's intent of exercising her muscles and was off the respirator for almost 4 hours. As sedation was wearing off, she started opening her eyes but a conscious state was not obtained. At this moment she still has a blank stare when she opens her eyes, does not respond to voice nor does she follow or acknowledges any type of response. Physician activated respirator around 4:30 pm so that she could rest more comfortably. It was decided that if she continued unresponsive, a CT scan will be requested to evaluate brain function.
Thursday, September 29, 2016. First thing in the morning, Margie had a Chest x-ray. Much improvement was noticed, Dr. Mann said it was like night and day. He ordered a CT Scan of the brain to rule out any issues as though she was being taken out of sedation, she was still not awakening, blood pressure had escalated during the night and even though she opens her eyes, there is a blank stare, not focused on anything and her pupils do dilate reacting to light but eyes do not move. She seems to be able to hear and recognize Bobby's voice, gets agitated when medical staff move her but his voice seems to calm her down after a few minutes, so we think that there is "some" response there.
CT scan was done, Dr. Mann said that the scan showed multiple infarcts in her brain which could be causing her delayed response. These infarcts could have been caused by an infection in her system, also could be the cause of the rash she developed, all possible infections were evaluated, bacterial, viral, fungal and have not been determined. An MRI has been ordered to see what damage these mini strokes have done, if any. Dr's always trying to be positive and reassuring. Even though this is to be considered a major setback, it was also being considered in this process. Recuperation is slow but steady. Rehabilitation may be necessary at some point in time, but first these tests must be performed to better evaluate the situation. Also a echocardiogram with a catheter through the mouth using her breathing tube to be performed today to evaluate any other infarcts or seeding of bacteria in the chest area near her heart. A neurologist has been called in to evaluate Margie also. Respiratory therapies have continued routinely.
This afternoon the neurologist, Dr. Stephen Hurlbut sat with us to go over the results of the MRI. Needless to say, the news was very disappointing. It presented a stroke known as "Bilateral Watershed" stroke. As per Google definition: A watershed stroke is named that way because it affects the watershed areas of the brain. These areas are thin strips of brain which are sandwiched in between the farthest end branches of two adjacent vascular territories (https://www.verywell.com/what-is-the-internal-carotid-artery-3146141
). Because these are the farthest tissues supplied by an artery, adequate blood pressure must be maintained to ensure that enough blood is pumped into these areas. Stroke presentations which are particularly suggestive of a watershed stroke include bilateral visual loss, stupor, and weakness of the proximal limbs, sparing the face hands and feet. As per Dr. Hurlbut, blood flow through arteries going to the brain are not sufficiently strong and deprive, in this case, sufficient blood supply to the area causing a stroke. In Margie's case the event did not manifest itself until they tried to awaken her to begin the process of removing the respirator. She has been under sedation, bombarded with antibiotics to stop unknown infection and pneumonia. In the process of continuing to make her wake up to remove the respirator we/they shall continue to evaluate her to see what level of damage she has suffered in her brain. At this moment, she is responsive to Bobby's voice, when she gets agitated he is able to calm her down and her vital signs stabilize and she then continues to rest. At this moment, she is in God's hands, recovery will be a slow process, hoping that nothing else develops where other decision would have to be made. All your prayers are appreciated.
Friday, September 30, 2016. Margie spent a quite evening, continues same stable condition as yesterday. Doctor's decided to wait until Saturday to consider removing her from the respirator. Sedation was given to keep her calm. Again she was evaluated by neurologist, Dr. Hurlbut, she still unresponsive but does seem to react to Bobby's voice. Other than that, neurological examination still has no response from Margie, does not follow with her eyes, no requested body movements or squeeze of the hands. Eyes are still in blank state. General opinion of physicians attending is that now is the right time to remove her from the respirator but decision have to be defined as to where the line is to be drawn as to what to do once respirator is removed. It was decided in general consensus with physicians that there would be no resuscitation in case of a sudden heart attack and would not be re-intubated if she could not breath on her own. She would be made as confortable as possible and let her go. This would be the first steps in this initial phase. One hurdle at a time.
Today is Saturday, October 1st, 2016. Margie rested all night, today's chest x-ray looks good, much improvement in her lungs, practically breathing on her own, minimum support from respirator. Vitals stable, still has no noticeable physical reaction, continues to have blank stare. As planned sedation was discontinued very early, to make sure she was as conscious as possible, was evaluated by Dr. Thomas and Dr. Hurlbut, they both agreed that whenever we were ready they would remove respirator. We prayed over Margie, she continued to be calm.
Respirator was removed around 11:30 a.m., her condition is stable, is breathing basically on her own, has oxygen support through the nose, also has a tube through her nose where they can feed her or apply medicines (don't know the name), has coughed a couple of times and is awake and comfortable, does not seem to be in any pain. Her vitals are very stable, good pulse, pressure, saturation and breathing is sustained and without any stress. At this time that I am writing this, it is 3:00 p.m.