Sandra Kim

quick update

Today Sandra was stable and making some slight improvements with the breathing machine settings.  It will likely be at least a few days until she recovers from yesterday's events but so far so good.  She was moving her right hand quite a bit, held my hand and gripped it at times and could nod yes and no, wiggled her fingers and toes and opened her eyes for a second when requested by the nurse.  One day at a time, but yeah - so far so good.  -Willem

rough day

She's back in her room and stable now, but the surgery didn't go so well.  They needed to collapse the left lung - which is the worse of the two - in order to make room to work.  They had just made the incision and started the VATS procedure when her right lung collapsed.  No breathing. So things quickly changed from procedure to a resuscitation.  When your lungs collapse the air moves from inside your lung to outside it, but still inside the chest cavity.  So it pushes inward on your lungs making them difficult to inflate, like fist clenching your deflated lung.  So they put in chest tubes - inserting tubes between her ribs and into the chest cavity to vent it.  This worked and they were able to get her lungs going again with the breathing machine, but sometime during all this her heart stopped for 2-3 minutes.  They got it restarted but subsequently struggled to get her oxygen saturation levels back up and to stablize her.  She was back in her room by 2:00, but swarmed by staff.

The theory is that her right lung "blew out", meaning it tore open due to it being very weakened from the necrotizing pneumonia - plus taking on all the breathing without the left - and the air escaped and lung collapsed.  The surgeon described her lung walls being like tissue paper or bath tissue, they were so weak.

So this was really bad.  We found out in a meeting with the docs at 3:00 this afternoon.  We struggled to comprehend the severity and asked more questions trying to understand how bad this really was and got answers like 9 on a scale of one to 10, very bad, call in family if they want to be here, she's very critical...she might not make it kind of thing.  They weren't sure if she would stabilize, or how quickly or easily.  Luckily, she responded pretty well and relatively quickly.  They had her on vasopressors to raise her blood pressure for the first few hours but were then able to take them off.  She still has the chest tubes and may have them for several more days until the tear in her lung closes up.  She is getting nitrogen oxide (or nitrous oxide?) which is supposed to help her lungs work better somehow.  The breathing machine was giving her 80% oxygen but they were talking about turning that down around 9:00 when I left, so hopefully that means her lungs are improving.  Her heartrate is high but blood pressure good without any vasopressors.  And she's stable.  By 5:00 or so they were saying "7, on a scale of one to 10".

We did hear that they ended up sucking out some of the fluid that they were trying to get by way of the chest tubes (almost accidentally?).  They don't know how much, really, but at least there is some hope that some good came out of all this today.  Otherwise I'm not sure what the outlook will be.  For now we'd obviouslly be happy if in a few days she can get back to where she was this morning.  Seems apparent she has a very long road ahead of her still.  First step is to recover from today.  

You think she's been through enough and then this.  She really can't catch a break.  -Willem

VATS

Sandra went into the OR around 11:00 this morning.  The primary procedure is called Video Assisted Thoracic Surgery (VATS).  A basic overview of it is here:  http://www.rush.edu/rumc/page-1160429783340.html   -Willem

Monday surgery

All week she's continued to have fever despite the antibiotics so they did some CT scans of her torso and found something.  There is a fluid collection outside her left lung between the diaphram and lung.  This is an area where you don't get much blood flow and blood flow is what brings the antibiotics to fight the infection.  So they are going to operate on Monday to drain it.  The plan is to make a minor incision in her chest and go in with a camera/fiber optic guided thing that will locate the area and suction it out.  If things end up being different than how they look on the CT scan it's possible they might have to open her up more than that, but hopefuly not.  This will be done in the OR under full anesthesia. 

In a "while we're at it" sort of way, they plan to do 2 other things while she's in the OR.  They will send a camera through her mouth and into the lungs to look around and more fully evaluate their condition.  They also plan to make and incision in he belly and into her stomach and insert a larger feeding tube that way to replace the smaller one she currently has going through her nose and down to her stomach.  The surgeon says she has been losing weight and hasn't been getting enough nutrition, which is limited in amount through the nose tube.  Also she'll need extra nutrition in order to heal from the surgery. 

Of course it make me nervous that she is having this surgery, but I feel relieved that they have found a treatable source for these fevers.  In talking to the attending physician a few days ago he described what they want to see her recovery looking like.  3 areas - one, her lungs need to continue to heal. They have actually been improving already.  The breathing machine settings are as good as they can get right now, pretty much (which was news to me).  But they need to remove the fluid in her body also.  That's the second thing.  They talk about her lungs being "stiff".  This is at least partly in reference to this fluid in her chest that is basically pushing in on her lungs between her ribs and lungs.  This limits how deep a breath you can take and makes it harder to breathe.  They can remove fluid through a diuretic, but they don't want to do that while she has the fever and high white blood cell count.  The third thing is physcial therapy to build her strength.  They'd like her to be less sedated and start PT.  The fever/infection is blocking the second two things.  It's nice for me to at least see a path to recovery.  Surgery, stability/lack of fever, reduced fluid, reduced sedation, physical therapy and increased strength.  She still has infection in her lungs, and the surgery to remove fluid/puss outside her lungs may not really help the infection inside her lungs, but the increased nutrition will help her body be able to fight infection and heal in general, and having one area of infection to fight instead of 2 should be better.  They don't have a time scheduled for the surgery, they will just do it whenever they can.  -Willem

Fundraising Dinner Saturday May 2nd

Posting for the fundraiser that Meg, Christine and Sandra's other friends at Wing Luke are organizing.  --Arie

 

Wings of Hope

 

for Ms. Kim

Cinco de Mayo Fundraising Dinner

Please join the Wing Luke community!

Saturday, May 2, 2009    

6:30 – 8:30 pm

$20

Dinner, Entertainment, Auction, & Raffle

Holy Rosary School Hall, 4142 42^nd Ave SW, Seattle 98116

 

For information and tickets, go to http://wingsofhopeformskim.blogspot.com/

or contact ccjun@seattleschools.org

 On January 30^th, Sandra Kim, a classroom teacher at Wing Luke Elementary School, developed a rare and severe allergic reaction known as Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN). By early February, she was transferred to Harborview for surgery and intensive-care treatment of the burn-like effects of the syndrome.  Following surgery, she developed pneumonia and septic shock. As time goes on, she’s still in the Intensive Care Unit, intubated, sedated, and taking baby steps on the road to recovery. It’s going to take months for Sandra and her family – her husband and two-year-old daughter – to be back on the right track.

 

 

 All proceeds from the Cinco de Mayo dinner will go toward helping Sandra’s family through this medical crisis.

Lab results

The lab results came in from her lung sample and it grew out the same bacteria that she had before, primarily acinetobacter and also another one that she had in the past.  3 weeks ago they couldn't find any trace of these on the lab samples but it seems to have persisted despite 6 weeks on imemenum which was the antibiotic for acinetobacter.  So after being off it for a day, she's back on it for another 3 week run as well as another antibiotic.  I guess it's good news that she doesn't have a new lung infection but it's frustrating that it's taking so long to eliminate this one.  She had a fever again today. 

Although she'll generally respond with slight head nods if you ask her a question she mostly seems to be trying to sleep from what I'm hearing and seeing the past 2 days I've visited.  The nurses did get her to smile just before they needed to turn her (they alternate between having her lay sort of on her right side or left side) which was very nice to see.  They took blood and urine samples to the lab to make sure she doesn't have something like a urinary tract infection as well.  They're needing to suction her lungs less often (maybe once an hour instead of once every 15 minutes) so I think/hope she's able to get more rest.  -Willem

Better today

Clinically Sandra is probably better today than she was even on Saturday.  Her fever is down, probably as a result of the Tylenol they gave her, and her breathing steadily improved yesterday afternoon until it was back where it was on Saturday.  But she is also a more awake and responsive.  They have been slowly lightening her sedation and it's starting to show.  She can answer questions by nodding/shaking her head, holds your hand and even smiles.  The nurse or I would ask if she needed suctioning (of her lungs) and sometimes she would nod yes.  So she seems quite good today. 

On the other hand, the initial lab results from the bronchoscopy came back positive for another pneumonia.  They didn't know the exact type yet.  The doctors were rounding when I was there so I was able to talk to several , including her new attending who seems very good.  He views this as a minor setback in an otherwise gradually upward recovery.  A pothole.  I expressed concern because the last pneumonia she had seemed more like a gravel pit than a pothole.  He said that necrotizing pneumonia was "off the charts" relative to the typical pneumonias that people get in the hospital.  He said he can't say for sure until they get more lab results but in a typical case this would respond well to antibiotics and therefore be only a minor setback.

Fever

This morning Sandra had a fever, I'm not quite sure how high at that point but 104 this afternoon when I was there.  So they sent blood tests to the lab and did a bronchoscopy in order to get a sample from her lungs to test.  They finally took her off the imepenum (antibiotic) that she's been on for 6 weeks today, so she was almost off of antibiotics completely for the first time, but they put her on another broad-spectrum antibiotic due to the fever.  I visited her this afternoon just after the bronchoscopy and her fever was 104 and she was having trouble getting enough oxygen.  She kept fighting the breathing machine trying to breathe before it did it for her and her saturation levels kept hovering in the low 90's even though they raised the oxygen level the machine gives her from 40 or 50 to 75.  The nurse said this happened just since the bronchoscopy and she suspected some junk had been loosened that was plugging her lungs since then.  Another nurse said she could hardly hear any air movement in her right lung, and I think that was her better one.  They did an X-ray of her chest when I was there.  The doctor was worried this is a new pnumonia.  Hopefully it's not that serious. 

After the tracheoscopy last week I asked him for his guess on the stages of recovery.  He said to expect another month on the breathing machine in-hospital, and then they might move her to a "weaning facility" where they would try to take her off of it slowly.  He guessed another year before she was recovered well enough to go back to work.  I'm sure it's hard to say, especially regarding the latter.  But I really hope this new infection can be fought off quickly and doesn't mean more time on the breathing machine/slower lung recovery.  Maybe it will just go away without any real explanation like the last time she had fevers.

procedure went well

Quick update - the doctor called and said that the procedure went well.

Tracheotomy scheduled for today

Sandra is scheduled to have her tracheotomy right now (around 3:00 Wed).  To me this indicates 3 good things.  One, she has improved in the past few days to the degree that they now feel she can handle the surgery.  The doctor said they have made progress with the breathing machine settings (beyond what I was aware of).  Two, she should be more comfortable as a result.  She won't have the breathing tube in her mouth anymore for one thing, and it is very uncomfortable.  As a result, they can lessen the amount of sedation she is under and they say that she should be able to communicate via nod/shake of the head and that some patients are also able to mouth words (but not actually speak).  And third, this should be better for us "visitors".  I know I have been dying to be able to interact with her.  Oh, there is a fourth.  The doctor said that as a result of the reduced sedation level she may be able to begin some of the physical therapy.  She still has a long hospital stay due to the poor condition of her lungs but at least she should be able to start down that path. 

He described the Tracheotomy as a 1/2 hour long procedure that they can do at bedside.  It is a surgical procedure and as such carries some small risks, but she will be under full anesthesia and it should not be uncomfortable for her or anything.  I found this definition on the web:  http://medical-dictionary.thefreedictionary.com/tracheotomy

In other news she has a new attending physician now, whom I've heard good things about but have not yet met.  -Willem