what Dr. Berlin had to say

Around 6PM, we met with Dr. Berlin in front of Mom's ICU berth. He spoke at length, but what he said can be easily summarized.

1. Mom's on the brink of multiple organ system failures as a result of massive infection. It may be possible to swing her away from the coming crash, but the doc isn't optimistic. At the same time, he made a point of not wanting to say anything definite.

2. No one has determined the specific nature of the infections; the cultures haven't come back yet, and might not for a while. Dr. Berlin doesn't think that knowing what microorganisms are at work inside Mom will make much difference, given Mom's overall state of health. He described her decline as "dramatic." Mom's infections are, however, likely lung-related. Pneumonia is commonly associated with long-term illnesses, including various cancers, as the doctor noted. His evaluation of a patient's prognosis largely depends on how the patient's health appears to be, overall (think: Karnofsky performance score).

In Mom's case, things look grim. She has become less and less able to protect her own airways through the usual means-- coughing, spitting, etc. It's likely that her lung and bloodborne infections are the result of her having aspirated bacteria from her mouth and from the air. She also appears to have aspirated some of the food she's eaten, being unable to cough out any particles that made it down her airway. However, Dr. Berlin doesn't think those food particles are the primary cause of the current slew of infections. He does, however, believe that this situation arose over a fairly short amount of time.

3. Dr. Berlin suggested that we think of Mom's progress in terms of 12-hour blocks. It's a good way to divide time up, especially for someone in as critical a condition as Mom is. We'll be checking in on her periodically, singly and as a group, throughout the evening, throughout tomorrow, and for as long as all this takes.

4. While we have no clear idea what the next few days will bring, we do know that Mom is trying to breathe over her ventilator, i.e., she's attempting to breathe on her own. This in itself doesn't mean much in the larger scheme of things (in fact, Mom's being sedated to calm her breathing efforts down), but it is, nevertheless, a welcome change from the previous night. If trends like this continue-- if Mom can begin breathing on her own, and if the antibiotic and other treatments succeed in stabilizing her, we're going to look into transporting her back to Virginia. This might not be easy, according to Dr. Berlin: there are logistical and insurance issues to consider. "In essence, she'd have to be medivac'ed," he said. Hospital staffers are available to help us flesh out the particulars of such travel arrangements, but we can't guarantee success. Mom may end up having to stay in New York.

5. So the upshot is that we're focused on the proximate goal of taking Mom back down to Virginia, where she'll be cared for at Fairfax Hospital. As I wrote above, this may or may not happen. We might have to say good-bye to Mom here in New York City. We simply don't know, but we're aiming to get her back as close as possible to her circles of care, to her home since the 1960s.



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