My Battle with Merkel Cell Cancer

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the nurse came in and said he had developed atrial fibrillation at around 140 beats per
minute. When he heard that, he said "oh shit". On that night, the atrial fibrillation scared
him, because he held out hope of beating the cancer, or at least delaying death, and he
was starting to feel physically better. He was right, by the way. He had some good times
after that night, cancer be damned.
This night was different than that night in a key way: The cardiologist took us in, and told
him that he was experiencing not just atrial fibrillation, but atrial flutter. The top of dad's
heart was beating around 300 times a minute, but only about 1/3 to 2/3 of those impulses
were being transmitted to the bottom of his heart. This time, dad didn't say "oh shit". In
fact, he had little reaction at all. His body had already told him more than the cardiologist
ever could. I again recited my understanding of dad's DNR instructions in front of dad and
the cardiologist, and made sure that everybody understood his wishes.
** Email: Date: Wed, 18 Apr 2012 17:34:48 -0700
Subject: Update 17:27
No ct results yet
The cardiologist was just in. He said the prognosis was bad. He apologized for not having
"anything good" to tell us.
The top of dads heart is beating around 300 times a minute. About 1/3 to 2/3 of the
electrical beat signals do not get transmitted to bottom of the heart, and they're trying to
reduce that number. He says this condition doesn't usually yield cardiac arrest. The
bigger problem he says is no oxygen from the lungs. Without oxygen "nothing works". So
cardiologist is quite pessimistic.
My subjective evaluation of his appearance and affect is also pessimistic.
Mom and I are both having trouble seeking a path that ends with him going home, but of
course we're hoping.
Sent from my iPhone **
The medications dad needed to stabilize his heart were too much for his chemoweakened
veins. They had nothing but trouble putting in IV lines during dad's prior
hospitalization, and this time they needed to put some medication in that was not well
suited to a regular IV anyhow. They wanted to put in a central line (an IV that goes
directly into a very large blood vessel, in this case a subclavian central line). He appeared
to consent, but the nurse was no longer sure that dad was sufficiently alert to consent.
Mom and I knew dad better than the nurse, of course, and we were able to see that he
was sufficiently cogent to consent. Mom said to do it. Interestingly, dad then engaged in a
conversation (such as he could, pulling the BiPAP mask to the side) asking the nurse
about the preferred placement of the central line. The nurse's concern regarding dad's
ability to consent was not without basis, however. He was periodically losing
concentration, with his eyes rolling up or closing.
** Email: Date: Wed, 18 Apr 2012 17:56:06 -0700
Subject: Re: Update 17:27
They are putting an emergency central line in. We are being sent out since it is a sterile
procedure. Nurse refuses to accept dads consent because he's too sick and out of it. She
is looking to mom for consent.
They won't say it out loud, but he's crashing.
Sent from my iPhone **
Blood oxygen saturation. It seems like a rather arcane thing, but it turns out to be critical
in situations like this. The math is pretty simple -- if there is enough oxygen in your blood,
My Battle with Merkel Cell Cancer