A DIFFICULT DAY

Today was just crazy!  Tom was somewhat lethargic this morning but was making sense most of the time.  I called around lunch and he was not himself at all.  I talked to his nurse and she said he had been fine until I called.  Anyway, when I got to the hospital about 1, he was even more lethargic.  I talked to Dr. Richards who is taking care of Tom while Dr. Rutland is out this week and requested an ammonia test.  It was 190!!!  That explains a lot.

Tom is not much better this evening.  I got him to eat some of his dinner.  It's going to be a long night for the team tonight.

I called UAB just to get a reading on all that has been going on . . . is it normal for things to progress and the ammonia level to be such a problem?  Apparently it is normal - not such good news.  It still doesn't help his list placement.  I did find out he is actually 17th on the list - which is pretty low (in my mind, I had him at 140th or something, so the 17th doesn't sound too bad but he could move up or down depending on the others on the list).  Dr. Richards is going to make a call to Dr. Eckhoff at UAB tomorrow to discuss Tom's situation.  Maybe Dr. Eckhoff can get some more exception points to help his chances. 

I received a call this afternoon from NHC Cool Springs.  They have a bed for Tom tomorrow!  With the ammonia level, and the fact that his white blood cell count is up again too, I kind of doubt he will be going anywhere tomorrow.  I'm going to go by NHC and complete the paperwork just so it will be ready when he can move - assuming a bed is still available.

Dr. Richards came in this evening too.  He is changing some meds to see if he can help a few things.  He had a specialist look at the wound on Tom's leg which is still huge and horrible.  I can't believe they didn't stitch it up - it's that bad.  Anyway, the pain is excrutiating for Tom, not to mention a path to infection.  It doesn't look infected but it still could be contributing to some of his problems.  They are really struggling to figure out what is causing the WBC and ammonia levels to escalate.