Random sayings of Dr. House, MD… “If it works, we’re right. If he dies, it was something else.” “It does tell us something. Though I have no idea what.” “The treatments don’t always work. Symptoms never lie.” “Tests take time. Treatment’s quicker.” “Idiopathic, from the Latin meaning we’re idiots cause we can’t figure out what’s causing it”
Now that we’re home after ten days at NSUH, our latest hospitalization seems so surreal. The previous reference to the TV show House was not too far-fetched. While there was a near certainty that we were dealing with pneumonia, the exact type was up for grabs. On House, if you’ve never watched, the diagnosis is not always clear. So Dr. House and his team meet at their white dry erase board and begin to eliminate what the symptoms are, what possible diagnosis meets those criteria and the race is on… Test upon test. Prescriptions and treatments are tried with a huge question mark as to whether this is the right direction. Modalities change as new symptoms crop up, reactions to the meds or treatments begin or new information from family/friends/patient is discovered. Rich and I laughed as we watched a marathon of the show during his chemo days and said to ourselves, gosh, it’s like being in Cabot Cove, Maine…. You don’t wanna be Angela Lansbury’s neighbor … you’ll get murdered. You certainly don’t want to be the guinea pig of differential diagnoses… so the question becomes, do you want House as your doctor or not?
Pneumonia is fairly common when you are a stem cell patient, albeit we’d rather have avoided it. The chest x-rays and CT scans all confirmed what the doctors heard in Rich’s lungs. Pneumonia. But, what kind? Bacterial? Viral? Fungal? Rich has been on meds since September to counter all those, including specifically the fungal pneumonia PCP. Blood cultures and nasal swabs are also done to help rule out various other infections. Then the meds started coming in…. what differential diagnosis are we looking at? What exactly is on that whiteboard?
First, we start with four different antibiotics simultaneously. Anyone who has been on even one course of one antibiotic knows that it can cause intestinal distress… like we need to revisit that? We have to beef up the immodium style meds to counter this.
Anti-viral meds to stave off any flu that might be developing are prescribed… Tamiflu until the swab cultures come back.
Then comes the debate of debates…. The reading of the CT scan. Bacterial is the first conclusion. Then, of course, comes the counter…. Viral. Fungal is totally ruled out.
One way to find out… House mode. Stop the anti-bacterials and start steroids… lots and lots of steroids. Inhalation therapy, pill form, IV, you name it, he’s gotten it.
The feeling is, as Dr. House knows, if this is a viral pneumonia, bombarding it with massive amounts of steroids will show a rather fast result. If it is not, then we’ll see a reverse. Russian roulette, medical style.
But, as we know, our patient is sensitive to steroids and we have to bump up the Ativan so that the weepy restlessness will subside. Steroids also bring on the hiccups once again. The staff is slightly amused at the predictability of our patient. We’re grateful that for the most part, these are not painful and are limited in duration.
Thankfully steroids win. In consult with the pulmonary doctor before discharge, we learn that Rich’s lung function was 30% at admittance, 50% on supplemental oxygen, dropping to 48% on antibiotics but rising up to 61% on steroids. House wins. Viral it is.
The recovery is slow… it is thought that Rich’s preexisting asthma and the BCNU chemo cocktail infused prior to the stem cell transplant are both slowing down his progress since they both can affect the lining of the lungs. So patience is key.
As all this goes on over the course of our time here, there are blood pressure changes… up, up, up, then down again. Discomfort one night sets off a flurry of cardiac testing including more blood cultures, all of which comes back negative. As we laughingly decide, our patient just needs a nice big burp.
In March of last year, before Rich began chemo but after his initial diagnosis, we took a much needed diversionary weekend trip to Philadelphia via our beloved Amtrak. There, in a shop by the Liberty Bell, we came across Ben Franklin’s book “Fart Proudly.” Perhaps the direction Rich needs to go?