Tuesday, March 17, 2015

Went to morning report at 8:00 AM. Bob Danner reviewed what happened after I left the Unit last night. Creatinine now up to 2.5. Patient clearly in renal shutdown. Larry Altman gave very nice James C. Hill Memorial Lecture at the Lipsett Auditorium on the Journalistic Hx of AIDS. Decided not to go to the Wilson Center for the Tom Daschle/Bill Frist dinner since renal function continues to deteriorate and I want to go to the “sign off” meeting in the SCSU at 6:30 PM. At SCSU, Creatinine up to 3.3. . I am looking for a silver lining, but the upward trajectory of the creatinine is slightly less than it was yesterday. We may need to dialyze him, but I am hoping that his creatinine stabilizes at 3.7 to 3.9 and then starts to slowly come down without dialysis. Having said that, we will not hesitate to dialyze him. Also, he has some strange neurologic manifestations with an atypical tonic/clonic movements, but no other manifestations of brain or cord disease. There is a whole new chapter of Ebola disease manifestations to be written now that we can keep people alive who otherwise would have died days ago if there were in a Unit in West Africa without the equipment and manpower that we have. Last night there were 6 of us in the room with him. The good news is that his AST is starting to come down and the best news is that his CT value is now 29.96, which means to me that his immune system is starting to control the virus replication. If the downward trend of his virus continues and we can just keep him stable for the next 4 or 5 days, I believe and hope that we can get him through this. Meeting more ICU docs including Parker Ruhl from NHLBI. She is on call tonight and checked with her at 10:00 PM by phone. Also, am doing nightly e-mail reports to Paul Farmer who is in Peru with his daughter Catherine.