Too Scared To Do Reiki: Code Sepsis

Yesterday was a short day at work. I was torn between seeing mom and heading home to 'catch up' on everything that had been 'falling behind' since she got ill before New Year's Day. That included sleep.

I spoke on the phone with my sister who lives close for an hour. At her request I called the doc on staff at the nursing home where mom had been admitted by her health care plan for post-surgical rehabilitation. It is not the best place*, but the only place insurance was willing to pay for it. There are times when as a doctor you have to take your knowledge of medicine, use it like a baseball bat, and aim it at a provider who is not doing 'enough' for your loved one.  I have a list of concerns about mother. Shall we go over them one by one? There are four... and I carefully clicked off each organ system and disease process that was dramatically (read: medically indefensible) out of whack. This doc 'saw the light' and disclosed that 'she needs a higher level of care'. No Duh. Even the urology attending could hear a lung process on her follow-up visit last week!

A large part of medicine, in practice, is the avoidance of things that if left unchecked could grow into greater problems. You 'head it off at the pass'.

This is where medical ignorance and 'burnout' are deadly. I once had a fellow intern who would not check labs because then there would be more work to do and more problems to fix. He got let go from the training program a couple of years later. Checking labs is how you get your patient better.

Mom was floridly septic upon arrival to the E.R. last night. They called a 'code sepsis'. She was hanging between life and death. I dropped everything, picked up the kids from school, ate a quick bean and cheese burrito with them, and drove an hour into thick traffic to say our goodbyes.

This is where I was too scared to to Reiki. I didn't want to know with my own mother how close to death she was; there is a characteristic slowing of the chakras until they stop completely. 

Instead I said, 'I accept whatever happens. I accept. I accept.'

The full-court press in the E.R. worked. On Levophed (norepinephrine), mom had a blood pressure that was compatible with life. But her WBC count was over fifty. I have never seen anybody make it with a count as high as this. Her internist said she has seen someone make it, but it took a long time to recover.
She also asked if mom was DNR. She knew from my sister that mom was full-code, full-care.

We surgeons called the Medical ICU 'The Death Star'. Unlike our surgical one, few made it out of the MICU alive. One of the reasons is the intensivists were so quick to make everybody DNR (do not resuscitate).

So I told her, specifically--Yes for chest compressions; Yes for chemical code; Yes for electrical code; Yes for intubation.

I was surprised at how confident she was that 'her chest x-ray is clear therefore her lungs are not the source'. Everyone who has had medical training knows that the clinical picture in a CXR can 'lag behind' the clinical presentation of the patient by two days. I pointed out that her breathing was labored and respiratory rate was high, she was gurgling with ineffective cough, and although her oxygen saturations were 100% she was going to tire soon. She would require intubation. We discussed tube sizes--the intensivists like a big one (8.0 or 7.5) to do pulmonary toilet, but the last time she had a tube emergently she couldn't talk right for six months after. So 'be careful' please?

We three sisters took turns with mom and the others with the kids. She was talking but weak.

When it came time to say goodbye, as the kids have school and I have work (docs can't 'call in'), I touched her arm and gave Reiki. I did what my Reiki teacher taught me to do, but with my mind/energy, not all the positions. Great peace reached both of us. I saw mom relax. I felt myself relaxing too. Her energy system was weak but not 'checking out' like I had feared. In our Reiki tradition, we give the Transition Symbol, to help make the crossing over to the Other Side easier. I gave this symbol to her. (I had also asked for prayer,healing, and Reiki on every list I know.)

Reiki is a wonderful gift at the end of life, especially when it is a close bond. It heals both the recipient and the giver.  If you haven't taken a Reiki Class, I would suggest it, if only for this one time for its use. It is worth it to take the training to have it available when your loved ones are very sick. Mom is being kept alive by chemicals right now. When the nurse giving break futzed with the Levophed pump because of 'air bubbles', I saw mom's BP drop from 120 systolic to 80 systolic. It took the regular RN coming back to 'fix it' with the pump. I pointed out mom's vitals, and said to him, 'she missed you' and he laughed. It takes a very alert and vigilant nurse and doctor, both, to keep a person this very sick, alive.

I thank you for all the Love and Reiki that you have sent. I can feel it, and it helps tremendously.

Namaste,

Reiki Doc

* SIX patients from the same insurance policy were 'bounced back' to the system hospital from the SNIF rehab center that same day. My sister overheard the ER nurse comment to another RN that 'the doctor there is making rounds again', implying that the medical care was suboptimal at this place.

Miracle #2: The Four-Hour Whipple

I was worried. The patient I was scheduled to do had been so sick that the Chief sent message for me to talk to the anesthesiologist who had evaluated her the day before. I had to make a separate phone call to him after getting my assignment from the front desk. We spoke for twenty minutes about this patient! I rarely have a concern over anyone that is sick: I have seen everyone and taken care of everything. I am a Cardiac Anesthesiologist. Anesthesia for the dying and the half-dead is my expertise! But for this one, I called Mom on the way in to work and asked her to pray for a good outcome on the case.

What was making me worry? It was the ongoing battle of sepsis. If the bacteria win, the patient has no blood pressure and anesthesia is very difficult and challenging, especially in the senior population. 

The tumor had blocked the biliary duct in the pancreas. Bile had backed up. A stent had been placed. But the bile did not drain. The liver, pancreas were inflamed. The urine was the color of coca-cola. The stool was the color of chalk. There was complete biliary obstruction, and early sepsis, with only a single dose of Zosyn stacking the deck in my favor.

And the surgeon. The most gifted one in the hospital. And his assistant, who normally scrubbed in for hearts and was frankly overqualified for this case.

I called in early for my Anesthesia Technician to set up for full invasive monitoring and transfusion capability during the case. At my old hospital we could send blood gases for lab work during the cases. Here, we did not, and I would have to fly by the seat of my pants in the case. I wanted arterial line with cardiac output monitoring capability, central venous pressure, and a blood warmer in the room.

In pre-op, the patient, a tiny thing, was eerily calm. No questions. The son was very concerned. I speak Spanish and I spoke well between the two of them. I did not give sedation prior to starting the case.

In the O.R., everything went like clockwork. Induction. Intubation. Securing the tube. The arterial line had some trouble going in, and then it jumped, like some unseen hand had guided it into the proper place. I moved on the the volume line, the large bore peripheral i.v. for access. And then the central line, the Triple Lumen Central Venous Catheter in the right I.J. In less than thirty minutes we were ready to scrub. For a heart, we allow one hour for anesthesia monitoring and induction, and I had expected one hour for this case.

Once asleep the surgery went flawlessly. The specimen had negative margins. Lymph nodes were negative. But there were two positive blood culture results reported to me in the O.R. Bacteremia with gram negative rods, Klebsiella most likely. The liver was a nasty shade of black from the backed-up bile within it.

I gave Reiki.

Inside, I was surprised. This patient wanted to die. They wanted to send the message to the family that 'everything had been tried', and to pass in the near future. The operation was going to be a success, but the patient was 'done'. I picked up the effort of trying to make a living and being a poor Latino just wore them out. The cards were stacked against me and I am tired and I want to go Home. I gave Reiki and the Transition Symbol, hoping there would be some resolution between patient, disease, surgeon, and family in the upcoming times. Most important, that soul wanted to be heard, and I understood. I let it know I did. (Mind you, all of this is taking place while I pretend to be futzing with my anesthesia equipment and the patient. I also am consciously running a safe anesthetic at the same time, which takes priority over the rest. During my treatment of Reiki, I got interrupted several times, for example, once to answer the phone from Pathology and put them on speaker for the surgeon to hear the results.)

We were done in record time. A Whipple takes six hours with the best of the best of foregut surgeons. This one took four, including a feeding jejunostomy and a g-tube to vent the stomach.

I woke the patient up, pulled the tube, brought them to recovery,  and talked to the family.

On some level, the son knew. He looked me in the eye, and kept thanking me as he shook my hand. He knew something major had taken place, on many levels. I felt it in his aura, not his words.

And the urine was bright yellow as we left the O.R. Not Coke brown. The jaundice was going to clear. 

I explained to the family that the bacteremia and sepsis I had anticipated were happening, but that their loved one was responding beautifully to treatments, and that all would be well.

While I went to the bathroom briefly during the case, the RN who was watching my monitors also goes to my church. I have given her anesthesia in the past, too, at her request. We are close. When I came back, she shared with me that she had been praying for our patient. I have never before or since heard anything like this. 

I said, 'I had been praying, too.' The R.N. said, 'When you told me that the patient was doing well, I wanted to start crying, I was so happy!'

We have hearts, those of us that work in Conventional Medicine. And we use them in our work. I thought you should know about this.

Namaste,

Reiki Doc

The Moribund: times when it is too late

This is mom saying goodbye to dad. 

There is an expectation in the community that is not balanced. Actually, there are several of them. Today I am going to share stories with you I have seen in practice as a resident and as an attending that are important for you to know.

1) Your loved one will get better

 Infection is a time race between the infecting organism (a parasite) and the host (your loved one).

It is a race of time between when the host immune system will beat the organism, or the other way around.

Sometimes the organism wins.

I have to intubate patients anywhere in the hospital who are in trouble. I was called once, while about five months' pregnant, to intubate a three year old in the Pediatric Intensive Care Unit. This kid was toxic. When infection spreads fast and far enough, the coagulation (clotting) mechanism is overwhelmed.  This is a late finding in the battle, and is not good. Blood comes out every poke hole in the skin, in the mucus membranes, everywhere. I intubated him. And even though I was in and the sats were up, he coded. I watched the PICU team code this child a half hour and give it up. I saw them go to the hall and tell the parents that their boy had died. I heard the scream.

I will never forget that scream for as long as I live. It was agony voiced.

The mistake that these parents did, is that for whatever reason, medical care was not sought until the infection had the upper hand. There is a race of time. When the bacteria or whatever is about to win does not give enough time for the medicines and therapy to work.

Any temperature over 101.5F is a fever. I know there are lots of parents out there that hate to go to the doctor. You have to take time off work, and it can be the middle of the night. But I think most parents should know that A) this is YOUR kid and B) YOUR kid is sick and you need to do something about it.

I don't care if the authorities are going to deport you back to someplace you worked hard to escape and you are here illegally. I don't care if you believe in antibiotics or not. If you are not trained in the medical field, you are going to miss some important signs and symptoms of illness if you do not have a trained person on your side. Give them a call as soon as possible. Ask them what to do. 

This is NOT GIVING UP POWER! This is using an important resource that is available at this time on Earth. Be sure you know when and where to use it.

2) The doctor is always right

I can't begin to tell you how many stupid doctors are out there. I diagnosed my own mother's cause of kidney failure. Her protein in her urine and blood was high when she had had nausea and barely eaten for six months. I asked for serum electrophoresis to make sure it was not Multiple Myeloma, which presents like that. I was close. It was a different antibody and was Goodpasture's syndrome. 

My niece around kindergarten had bloody diarrhea. This was not good. The doctor said it was the flu. That's what they said about my mom. My sister kept taking her back. Sure enough, full blown e. coli. Very severe. Almost died. My sister trusted her intuition and kept going. She has saved the life of my mother three times and her daughter once because of that.

Your intuition is as right as the doctor

Listen to it, if you are a child, a parent, a friend. When there is a conflict with what the doctor says, and your heart, always listen to your heart. For after all, you will have to live with your heart and the result of this decision for the rest of your life.

3) Natural is better

Primitive Mommy posted about 'was your birth plan respected?'

She and the entire birthing rights community has it backward. All births are special. Yes. Are all births normal? They are not.

If Nature was to rule, we would have to accept Natural Selection at work. That would mean, acceptance of death and injury to the infant/mother in childbirth.

People die. They always have. In less advanced societies. And historically. People die while giving birth.

There is only so much a midwife can do. I work with them. Sometimes they have to call the doctor. And we have to operate. This is called a 'crash section'. You do not want to be that.

Let me explain. A crash section means we rush to save the life of the baby and/or the mother.

Under good circumstances it takes less than five minutes to take a child out of the womb with adequate dissection of the bladder off the uterus to protect it. In lay terms, we 'make room' to get the baby out.

In a crash that child is out in less than a minute.

If you are faced with the prospect of a c-section, wouldn't you rather  have it be under non-Crash circumstances so they can take care of 'everything else' down there? I would.

And for those of you wary of epidurals and anesthesia in childbirth, here are the facts:

Onset and placement of epidural: fifteen minutes if mom holds still and has normal palpable anatomy of spine

Onset and placement of spinal: ten minutes if mom is not fat or thrashing

Onset of general anesthesia: less than one minute.

That's right. If you go through labor with no epidural, and crash, guess what? You are going to sleep. The event you are hyper-focused on will take place while you are unconscious and your spouse nowhere in sight. And you put your child at risk due to the general anesthesia that is in your bloodstream. They are born 'asleep' and have to 'wake up' in addition to going through a traumatic birth that made you need a c-section.

Bring your birthing balls and candles all you want. We honor your birth plans as much as possible. BUT, when birth starts to be anything other than routine, your Labor team will start to give suggestions. Try pitocin. Take an epidural. Why? Because these have helped us to avoid doing c-sections in the past with mothers whose labor patterns were like yours.

Healthy mom plus healthy baby. Isn't that both of our goals?

4) Our loved one is a FIGHTER!

I am sorry. When more than one organ system starts to go, in the ICU we call that circling the drain. Add any more organ systems (on a ventilator, with pressors to help the blood pressure and the heart, and add hepatic failure) and the chances of recovery are next to nothing.

This is the time to accept.

We did a take back on a patient with Hepatitis C with a large brain tumor who was bleeding into the wound. There had been a heart attack in the past. And coma with the hepatitis c. Why put your loved one through all that? Why spend your copayments and your loved one's insurance to stave off the inevitable? Give them comfort. Give them care. But don't try for heroics.

Last week a pulmonologist had a patient who was hypoxemic and and endotracheal tube of 7.0 mm diameter in. He wanted a tube of 8.0 mm, or at least 7.5 mm, so his bronchoscope could fit.

I got a partner to help me do it. Sats were 80% and weight was BMI of 80. I had said no to the doc but my partner said yes. I got the soft exchange catheter. We stick it in one tube, slide the old one out, slide a new one in back over it. Mine did not have good ability to ventilate, but it could. The partner wanted better. They went back to the stockroom and got the fat yellow one. Guess what? In shoving it down, the mucosa bled. Although the exhange was 'successful' all the pulmonologist saw in the airway was blood.

I think of situations like this as 'giving them their chance'. I think that sometimes we should not be so generous in doing so. This patient died the next day. The low oxygen sats took their toll on the kidney, and it failed. Patient was too unstable for dialysis.

5) They are THEM and we are US

That is not true. My fearful Bradley method mother in labor with the piercings, tattoo, dark as Priscilla Presley hair and husband from Portland had couplet contractions. They were two contractions close together with not much rest in between. She knew enough that this was not normal, listened to her body and knew herself, saw the big picture, and listened to her labor nurse and got an epidural. She was concerned that once her water broke she was going to have pain she could not tolerate any more. That is what made her decide. And after she did, she was glad.

I told her 'healthy mom, healthy baby', 'enjoy your labor', and  'at each step of the way, we make an informed choice'. Baby does not read the book on natural labor.

When the nurse left the room, I shared, "I gave you Reiki. I am a Reiki Master" It was a total disconnect for them. Their jaws dropped as they were struggling to understand. I had to rephrase it, 'I may not look like it now, BUT I AM ONE OF YOU! I can't tell anyone here now, but I want you to know I am working so that one day I can.'

Do you KNOW how many doctors and nurses have published about Reiki and Intuitive Medicine and Energetic Medicine? There are a LOT. Meredith Kendall. Mona Lisa Shultz. Caroline Myss. Many many big names. Look at Dr. Oz! Deepak Chopra...There is a movement. And for every one of them there are hundreds of healers like me who are afraid to talk.

Dad touched my arm and thanked me for what I did. I felt the Reiki coming back. They were healers too. That newborn was going to be lucky to have them.

Friday, I was at Starbucks with a Mormon coworker to discuss politics at work. We are both single parents and can't afford to follow the lead of others who had left over the disagreements. While we were talking, my first patient I gave Reiki to openly in the hospital was there. Evan. She was a nutritionist who told me to get off soy. And I did Reiki on her postpartum. I blogged about it. Well she said, 'You were the one that did Ray-i-ki on me' right in front of the Mormon. I was glad she did well, and would have loved to talk more, but I couldn't. Not with him. But she looked great and the child was a little crystal child. I could feel it.

Things are moving up towards enlightenment and ascension in the practice of Medicine. Give it time. Until then, please leave your expectations at the door and go into the medical center with an open heart. And listen to it!

Namaste,

Reiki Doc