The Rest of the Story

 Last night when we were draining the abscess, there was an additional significant finding on the CT images, that was not present on the initial CT images.  It really detracts from the happy feeling from finding the abscess and draining it.  There was contrast material present within the abscess.  We give the patient contrast material through their blood, which in turn goes through their kidneys and ultimately into their bladder.  We also make patients drink contrast material, which stays in their bowels.  The question is where did the contrast come from.  The likely explanation is that there is a small hole somewhere in his bowels that is opening into the abscess.  

What does that mean for J?  First, they made him NPO.  Nothing to eat or drink.  We can keep his mouth wet, but nothing by mouth.  This has already been hard because for the first time, J was complaining about being hungry and wanted to eat.  He also said the mouth sores don't hurt as bad.  If we chose the least invasive treatment, it would require him to remain NPO for about a week, to give the bowel time to heal itself.  Second, this means we have to stay broad with our antibiotic coverage for a while.  Perhaps even add more.  There is probably more than just one type of bug in the abscess, even though only one was found in his blood.  Third, is there a need for more surgery?  There are risks associated with surgery, especially when dealing with possible perforated bowel in somebody with low white blood cells.  There are also risks associated with doing no surgery.  For today, we feel it's best to not make that decision now.  We'll see what he is doing today.  We'll see what he's doing tomorrow.  We have a low threshold to send him to the operating room right now, but perhaps he can pull through and avoid the knife.  

Allow me a slight tangent on "informed consent".  Here I am with a pretty good medical background looking at the options and not knowing what is the "right" decision.  There are a lot of charged social topics where people claim that they know what is "right" or what is "best" for them or for their children, as though coupling their choice with an ill-defined moral value justifies their decision (particularly when the rest of society may not agree with their choice).  With all that I know, I think we are simply making a choice.  We will not know if it is "right" or "wrong" or "best", we will simply make a choice and see what consequences follow.  I feel for the people who don't have a medical background and only have the explanation of their doctor to base decisions on.  Add to it a bit of emotional stress, and you can set yourself up for years of regret or guilt if you think you are making the "right" decision and you end up with a bad outcome, because however informed you think you may be, you still can not predict the future.