No Surprises Here

Jaisal had his biopsy today. It should be a surprise to no one that the biopsy resulted in good news and some middling news. First the good news. No rejection! Jaisal's biopsy looked even better than the first one he had done post-transplant. Sir Oliver is a happy, healthy fellow whose new home seems to have taken a general liking to him. Woo hoo!

The middling news. After a biopsy, you're observed for 6 hours to check for internal bleeding. The liver is a very vascular organ and inserting a large needle into it creates a bleeding risk. So, 2 hours post-biopsy and 6 hours post-biopsy, nurses check your hemoglobin level to determine if you're bleeding. Jaisal passed those screens with flying colors.

What did happen though was that around the 2.5 hour post-biopsy mark, I noted to the nurse and the IR doc (who was called up for me) that Jaisal's heart rate was even higher than normal. No one was concerned.

About two hours later, Jaisal's heart rate spiked to 200, he had a mild fever, threw up when I tried to give him tylenol, and started getting a blotchy rash on his neck and upper chest. The nurse seemed unconcerned and said she'd passed along the info to the IR doctor, who would not be coming up to see us until after the 6 hour hemoglobin test. I was not pleased. I mentioned that I really wanted to talk to liver folks since a fever this close to post-transplant perplexes me. The nurse said IR is communicating with liver. I continued to be not pleased.

Post second dose of tylenol, Jaisal started to get a bit more comfortable but he didn't really settle down. At this point the 6-hour hemoglobin had been drawn (it was normal) and no IR doctor had appeared. In my frustration, I left a message for one of the outpatient liver nurse practitioners, who called me back irritated because she said this was a job for the surgical observation nurse and that she couldn't talk to any liver doctors on my behalf because it wasn't kosher. Really? There are politics in terms of making sure a patient is cared for? Not cool.

My simple issue was this, I just wanted to make sure that the IR folks who were focused on risks related to the biopsy were not overlooking any potential risks to Sir Oliver, and no one seemed to care that that was the question I wanted to get answered.

At this point our nurse tells us that Jaisal's reaction is a common one to anesthetics that are used. Hmmm, interesting information that would have been comforting to know a few hours ago. She confirms that she is communicating what is going on to the IR doctor.

IR doctor appears, says he's not concerned about the heart rate or mild fever. I mention the rash and vomiting, which he says is news to him, and he becomes more concerned.

Now liver comes to see us and they are concerned about some odd infection possibility. It's unlikely, but seeing as though Jaisal hasn't been sick and hasn't been around anyone who's sick, we can't just chalk up the fever to something totally unrelated to the biopsy.

Then anesthesia comes by and says his reaction doesn't sound like a reaction to the meds. Uggh.

So now here we are on a 48-hour admission to rule out a blood infection of some sort and on 3 time daily regimen of antibiotics. What should have been a simple daylong procedure which resulted in us going home if there was no rejection has now turned into a 48-hour admission. No surprises here about the lack of following a simple plan.

The other quirky issue is that we now need to figure out why Jaisal's enzymes remain elevated. That will be a conversation for tomorrow.

For those of you keeping track - 2012 = 2 admissions. My goal was to have less than 9 admissions during the 12-month period. We're not doing so hot, considering we were discharged from the PICU in mid-January.