Decisions: Update on Mom

We faced a big decision yesterday. We’re well into our third week with Mom on a ventilator. In the first week she responded to intubation. Within days they were considering removing her breathing tube since she was breathing on her own. Then she took a turn for the worse and has been dependent on a ventilator since.

Unfortunately, she’s made minimal progress in the last 10 days. Yesterday the ICU attending called me. “You’re mother hasn’t tolerated tube feeds. We’d like to start TPN.”

TPN stands for total parental nutrition. It’s typically considered when patients are unable to absorb nutrition through the gut. Imagine getting your carbohydrates, proteins, fat, minerals and vitamins through an IV.

TPN doesn’t come without risk. Mom’s impaired immune system means her defenses are down. Direct nutrition intravenously could mean more food for bacteria or fungus to thrive on in her blood. In fact, TPN is associated with increased risk of sepsis, ie blood infections. Her lactate has been hovering around 5-6 and she continues to have low-grade fevers of 99 or 100. These signs point to an ongoing systemic or blood infection. Could TPN for Mom be the equivalent of pouring gasoline on a fire?

On the other hand, Mom hasn’t had adequate nutrition for two weeks. In the first week, her body was responding to medical therapies. In the second week, it was a stalemate. Now in the third week, the doctors feel like she’s loosing ground. What is there left to try after antibiotics, antivirals, antifungals, IVIG, and intubation? We’re really just waiting for Mom to turn the corner. Could TPN provide her body the support it needs in order to overcome this infection?

Dad wasn’t enthusiastic about the idea of TPN. I told him Mom’s KUB showed a dilated colon. He suggested a fleets enema to stimulate peristalsis to get rid of the gas. Ultimately, we’re leaving these decisions to a thoughtful ICU team and placing Mom’s life in the hands of the Almighty.

As for me I’ve committed to using this moment as a witness. I tell the doctors we are a family of faith. I tell them we serve a God who can turn Mom around. Then I tell them that we are praying God gives them wisdom with the decisions they have to make. The response from the attending was comforting. “Thank you,” she says. “I’ll be praying for you and your family, too.”

Pray for Dad and I as we travel to Houston today. Pray for the opportunity for us to visit Mom. Finally pray for Mom and the doctors as they make big decisions today.