A Surprise Twist: Septicemia and a New Stent

Posted 5 January 2016

At the end of my first week of chemo, I was feeling very tired but not terrible. I even went to a doctor visit Thursday afternoon.

Had a bowl of soup for dinner, and Irene went in the other room for minute, and when she came back, I had my head on the table. When she asked me what was going on, I looked up with a vacant expression, and said “I don’t know”. I have no recollection of this — this is from what she has told me.

She called the oncology doc on call, and he said to bring me into the ER. She asked me to get my shoes and coat on, and I did so unaided, and went to the bathroom. I have no memory whatsoever of any of this, or of walking out to the car.

Getting me to walk out to the car wasn’t as easy, Irene tells me, even though Loralee had come over by this point. Irene drove me to the Sutter ER, and the first recollection of any of this that I have is like a snapshot image of being outside the ER, heading in.

I remember very little about being in the ER. Just a few vague images of lots of people around, and lots of noise. As I’ve learned since, I did have some conversations with people, but I have no memory of any of them, or of the doctors who treated me.

They did a CT of my head (of which I have no memory), being concerned that I might have a brain tumor. Fortunately, that was clear.

At this point, they put down my condition as “altered state of consciousness”. One possibility was that I was overdosing on my pain meds, but that wasn’t the case.

To test for sepsis (a bacterial infection in the blood), they started a blood culture. It takes a few days for complete results, but initial results come back in a day, and they showed that I was indeed septic. They started me on antibiotics Friday, and I rapidly improved on Saturday.

The first thing I remember clearly from Friday is that I was now in a regularly hospital room, and there seemed to be an awful lot of visitors. I asked Irene, “Where am I, and what am I doing here?”. That was when I began to be conscious of what was happening.

Friday afternoon, people were not sure I would make it through the night. Apparently I said that I didn’t see how I could make it through the night, though I don’t recall saying that, or even feeling like anything particularly serious was going on.

They sent me for another abdominal CT, this time using oral contrast, which is truly vile stuff. The only time I have thrown up so far through this entire illness is after that test.

By Saturday, some semblance of normality had returned. They took more blood for another culture, and on Sunday the results looked like the sepsis was gone — though it takes several days to get full results.

The GI docs were concerned, however, about the results of the CT. The tumors had grown considerably, and it looked like food was making it through my duodenum only slowly, due to its constriction.

They thought that the biliary stents that UCSF had put in just two weeks before were working ok, but that I needed a duodenal stent to continue to be able to eat. This is a pretty rare procedure, however, and the existing biliary stents added complication, so no one in Santa Rosa was going to do it.

On Monday, they arranged for me to go to CPMC in SF to have the duodenal stent installed. CPMC is apparently the top place for GI procedures like this. (So why were my biliary stents were done at UCSF? Not sure, but I think it was the hope of making contact with their oncologists by checking into their ER, but that didn’t really work.)

Tuesday morning, an ambulance drove me and Irene from Sutter Hospital in Santa Rosa to CPMC in San Francisco. I spent a couple hours in a prep area, where they apologized for the delay and explained that I was being added to an already full schedule.

When I got out of the procedure, which is endoscopic but was done full anesthesia, I was surprised to find that I didn’t have a duodenal stent! Dr. Bhat explained that my duodenum was not constricted enough to hold the stent in place, and that it wasn’t necessary at this point. But the plastic biliary stents were clogged and not functioning well. He removed them and installed a metal biliary stent.

The metal stents have a much greater diameter, but they aren’t removable — the tissue grows into them. They last about 6 months to a year, at which point it is possible to clean them out and insert another stent inside them. But this is not a long-term solution. If somehow I live more than a couple years, I’ll probably need surgery to deal with the bile duct.

They took me back to Sutter Santa Rosa that afternoon, so I didn’t spend even a single night at CPMC. And on Wednesday morning I got to go home!