This has been a rough day. Aaron has been very unstable. His vitals are all over the map.
He’s got a high fever, every indication of a systemic infection. Moving him just a slight amount to perform a procedure causes his blood oxygen to plummet. There’s no place to go up, as supply oxygen concentration is 100%. All symptoms point to a systemic infection, but culture after culture reveal nothing. Every point of entry (probes, catheters, IV’s) is cultured for local infection; all are all negative.
The cold blanket brought in to help control the fever can’t be put under him, as he is too unstable. The blanket is spread over him, but it doesn’t work well. The refrigerator machine that pumps coolant through the blanket sits in the room. The room air conditioning can’t keep pace with the additional kilowatt being dissipated by the refrigerator. The machine is stopped; Natalie and Anne take turns using low-tech, time-honored wet towels; this works. The fever comes down.
Camela (his CCU day nurse today) works non-stop, never quite getting ahead of the demands. It took two hours early this morning to regain stability. Stability is finally achieved, but comes at an unsustainable price: 100% oxygen, and 22 cm PEEP. (Positive End of Expiration Pressure). This means that all the tiny air sacs (alveoli) in Aaron’s lungs are being constantly inflated like millions of tiny leaking balloons filled with pure oxygen. The breathing machine must keep the balloons puffed up to prevent collapse. Several quarts of extra fluid have accumulated in Aaron’s body due to the intense hydration required for successful induction of the poisons, and the inability of Aaron’s kidneys to eliminate the excess. The lung damage inflicted by the mutants (and possibly the poisons that killed them…there is some evidence that the mutants initially responded to the poison by further mutating, becoming more mature and more destructive.) is allowing these accumulated fluids to leak into the airways, so the leaky balloons have to be constantly inflated. The constant pressure and the pure oxygen, will soon destroy the lungs they are heroically working to save.
In spite of being heavily sedated, Aaron continues to initiate breathing on his own. This is of course a marvelous thing that living bodies are programmed to do without conscious effort: breathe. But the beat of the drum to which Aaron’s lungs are heaving is too slow. He needs to be breathing like he’s running a ¼ mile, not lounging on an air mattress (He actually is on an air mattress, which slowly inflates and deflates to provide a small amount of very slow movement to Aaron. Other than the machine-induced heaving of his chest and the slow, barely discernable movements of the air mattress, Aaron is completely still. The evidence that Aaron is alive are the numbers—numbers flashing on monitors, numbers of measurements from instrument probes outside and deep inside his body, numbers from computers calculating values from the measured numbers, numbers printed on test reports, numbers scribbled on paper, numbers that can lie to the ignorant, but render their arcane secrets those who, like Dr. Bajaj and Dr. Lee, seek the truth that lies beneath the numbers. This is medicine by the numbers: the numbers of life.)
The ventilator synchronizes its efforts with Aaron’s lounging pace, but it’s clear that at this point, the machine can do better if it could take over; Aaron’s efforts have become interference. The decision is made, and in late afternoon yet another IV bag is hung along with the14-or-so others that have been accumulating over the last week. Vecuronium Bromide begins to drip, totally paralyzing Aaron so he is unable to even attempt breathing. The machine is now in complete control. No part of the precious oxygen budget needs to power the lungs, and the machine’s drummer sets the pace.
The improvement is immediate; a small window of margin opens. The moment-by-moment struggle for stability a little less intense.
Aaron’s kidney’s are doing a yeoman’s job, but their efforts are not enough. Between the induced chemotherapy poison, the poisons created by dead mutants, and the great deal of other chemicals and fluid going in through the various intravenous tubes, his kidneys can’t keep up.
So yet another machine is wheeled into the room, yet another couple needles are inserted, yet another couple tubes are connected.
Blood begins to flow though the Mechanical Urinator.
Aaron is on dialysis.
The Urinator works just a little faster than Aaron’s own Lasix stimulated kidneys…with Aaron and the Urinator working together, he gets some breathing room.
A little after midnight, the Cytarabine bag is empty. The poison is finished.