The ammonia is coming down so Roy is back, still pretty miserable, but fully aware of who he is, where he is, and when he is. He’s still in Baylor Scott & White hospital with a full team of nurses, patient technicians, and a hospitalist. And his team now includes a nephrologist – a doctor who specializes in kidneys.
I’m guessing his body decided it had simply not gotten enough attention because the focus as of Friday has become what’s affectionately(?) known as AKI. AKI stands for Acute Kidney Injury. His new nephrologist believes that the contrast used on the CT scans during his time in the Emergency Department triggered the AKI – sometimes the contrast just makes the kidneys unhappy. AKI results when the kidneys cannot clear junk out of the blood, but it can be reversed by giving supportive treatment in most cases. So Roy’s getting a new medication (octreotide), fluids and albumin every six hours to help his kidneys. The nephrologist said they were treating this preemptively to protect his kidney function because while he’s retaining fluids, on the inside he is somewhat dehydrated still – seems the fluids are just not going where they are supposed to go. The labs they’re watching should improve over the next two days – they’re looking especially at creatinine, magnesium and phosphorus. Creatinine is a familiar measure from liver function tests but the others are not.
Roy is more jaundiced (bilirubin) than he has been. When I arrived this morning in time for rounds, Roy let me know that he’d had shortness of breath overnight so now he’s got oxygen tubes and they added a cardiac telemetry box to his growing collection of medical accessories. This level of adornment is difficult for a man who doesn’t like jewelry.
So far today, he has taken a field trip down to have a chest X-ray and an ultrasound tech came to do studies of his heart. He’s sleeping as much as he can between carers. He prefers the room dim and quiet with the TV off, so I have the shade up a little for some natural light, and today I brought my homework for Bible Study – I joined in week 17 so I have extra to catch up with the group.
He had a quick visit from Don Wednesday evening, and on Thursday a pop-in from Dana (ferrying me from the car dealership where the Mazda is getting repairs) and an afternoon with his sister Clair and her husband Wendall. And I have to let you all know, the place to order a fruit basket here in town seems to be the Farm Patch by far – a gorgeous “looks artificial it is so perfect”* basket of bounty arrived Friday from friends Don, Dana, Yvonne, Jennifer and Leni with their wishes that Roy “Get Well Soon.” We learned what a lychee fruit is and how to eat them because of this pretty basket with a gorgeous orange bow. *The description is from one of the patient techs who was pretty sure it was a decorative piece.
Given the new tests, I don’t think Roy will be discharged tomorrow as estimated. I did request that he try not to add any more specialties to the care team and he agreed to do his best. Nephrologist just stopped by and said it isn’t getting worse so they’ll keep doing this for the next few days, so definitely not going home tomorrow.
Waiting 
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