AML: My First Trip to ICU

Yesterday was an interesting day.

I woke up early feeling fairly good even though I had not gotten much sleep due to constant interruptions (nurses, machine alarms, 3am blood draws and so on) through the night.  I needed platelets so those were started about mid morning. 

I generally don't have issues with receiving blood products.  I usually get some Benadryl and Tylenol prior to getting an infusion just to be sure.  For some reason I started developing a fever late morning yesterday. 

Fevers aren't unusual for me.  I've had a few low-grade (less than 100) here and there during this stay.  This one was up to 102 which indicated something more significant going on.  In all likelihood there was some kind of infection breaking through.  So generally when a fever hits 100.5 or higher a  number of things happen. First they run blood cultures and urine to see if  they can identify the infection.

Blood cultures are no big deal.  They generally draw blood samples from my PICC and also directly from a vein.  They bottle these up and send them to the lab to see what, if anything, grows.  Results can take several days.  In the past these most often turn up negative, but I have had eColi, MRSA and Aspergillus appear before.  All 3 of these are quite nasty and can cause significant problems when in the blood stream. 

The problem yesterday was that not only did I put up a mid-grade fever, but my heart rate was at 150 beats per minute and my blood pressure was extremely low.  Put these 3 things together and the doctors here (all of them) got a little worked up. So... about mid afternoon yesterday they sent me up to the Rapid Response (Intensive Care) unit.  This unit can more constantly monitor my vitals and quickly administer drugs should my blood pressure keep dropping or should I go into cardiac arrest.  Both were serious possibilities.

You can imagine things move pretty fast in the Rapid Response Unit.  They sent me for more CT scans of my chest and abdomen.  I received extra red blood and platelet transfusions.  And they immediately started pushing fluids really fast.  They have these power cuffs where they can push a liter of fluid into my system in about 15 min.  The normal pumps usually take an hour, which is still quite fast. 

During all this, I felt fine.  Though it was all pretty serious stuff, none of it was causing any external symptoms.  By about 6:00 my fever had dropped and they had pushed about 5 liters of fluid which stabilized my heart rate and blood pressure.  No other drugs or major  medical intervention needed. It turns out I was just really, really thirsty. 

My blood cultures are negative so far and my CT scans are clear except for what is probably a minor irritation in my gut.  The dehydration issues are most likely the result of the chemo. Since my last treatment is today, my kidneys should do a better job of retaining fluid.  In all likelihood, I'll be transferred back out of ICU sometime this afternoon.  Going forward we'll have to watch my kidneys to make sure that no permanent damage was done. 

It was an interesting day to say the least.  Things are still progressing for my Lymphocyte infusion on Monday which opens the door to head home.  For some of the criticisms I've mentioned about the way things work at Mayo, I'll say everyone was at the top of their game yesterday and I was very well tended to by all the right people.