What happened... 1st night in hospital.

(Caroline):

I rode in ambulance with Dad - seemed like longest 1.5 mile ride of my life to Virginia Hospital Center (where Caroline also has her endocrinology practice).

Was seen immediately in ER - and Dr. Smith determined Dad needed immediate intubation and ventilatory support. Was stabilized in the ER, then transferred to the Intensive Care Unit (ICU) for further care.

In ICU: Dad's blood pressure dropped and required aggressive support - he quickly started to required pressors (medicines to keep blood pressure up).

Because of Dad's severe breathing difficulties and maximal vent support which was still not giving adequate oxygen - Dr. Duhamel -the critical care/pulmonary specialist decided to do a bronchoscopy (look into his lungs with a small camera that goes in through the mouth) - he suctioned out a large volume of fluid from the lungs - fluid that looked like stomach bilious fluid - evidence that Dad had aspirated -likely after 2nd fall. this explained the rapid decline in his breathing problems.

Aspiration (the entry of secretions or foreign material into the trachea and lungs) is a known problem in people with Parkinson disease - due to the motor decline in swallowing function and ultimate inability to protect the trachea that lives next to the esophagus. Dad has had swallowing problems for a while - with food or his meds sometimes getting stuck, requiring more food to get it down.

Around 1am - Dad's condition seemed to have stabilized - but obviously in serious condition, still requiring the ventilator and pressor support. Advised by Dr. Duhamel to go home for a few hours to rest. Kelly took Mom back to Kelly's house to spend the night.

I went back home, but couldn't sleep, felt uneasy and returned to the hospital around 2am. Within 30 min of arriving - the activity with nurses and medical housestaff started to increase around my dad. I called my mom and sister in a panic to return immediately to the hospital.

Dad's oxygenation was declining despite maximum vent support and BP (blood pressure) dropping despite the presence of maximum pressor support. His heart rhythm was entering a junctional pattern - a precursor to asystole. I saw the nurses flurrying around - pulling the code cart into the room - getting a back board under Dad - things which I knew meant preparations for an impending CODE for cardiopulmonary arrest.

The resident approached me as asked about code status (which was already addressed when he was admitted - i.e. are we to do all lifesaving measures if he stops breathing or if heart stops) - and encouraged me to consider not proceeding with any CPR if his heart was to stop as the hypoxia was not thought to be reversible.

I said - "Dad would want to be a FULL CODE" ...how could my dad not be a full code? he is only 67 y/o and otherwise quite active even with the motor limitations that his parkinson's lays on him. Was I being unreasonable? In my sobs of tears - I asked that Dr. Duhamel be paged to ensure that I was making the right decision - but as he called back...my dad HR stopped and CPR had already started.

Miraculously - Dad's heart rhythm returned with chest compressions, atropine, bicarb.
His oxygenation improved after about 1 liter of lung secretions were suctioned out.

We haven't left Dad at the hospital by himself since....