The Deal

Here's the deal... we have no choice but to admit Liz; On Monday , she'll be a direct admit to the hospital. At least being a direct admit allows us to avoid going through the ER. And, going in on Monday rather than Friday allows me to get things settled here and for Liz to attend a special event with Walt and Kate that she has been looking forward to.
When we got in the car after meeting with her doctor and hearing his plans, I had the feeling of overwhelming burden, and I had an impulse to run- not to any place or anyone, just to run away. Today, I feel like I have my game-face on, and I am in a place of making lists and organizing things for the week ahead. It's amazing how our minds work to allow us to get through difficult things.

Liz will get an NG tube placed when we get to the hospital and this tube will remain in her nose and down her throat into her stomach for days. The GI doc feels it is important to use the NG tube for a few reasons-
1. Liz needs to gain weight . An NG tube will allow Liz to be fed a formula that will mimic a full-feed that she should be taking in by mouth (how we eat), and by having the full amount of calories and volume in her, the docs will be able to see if her body can even handle the amount she should be in taking. They suspect that Liz may have a metabolic issue and using the NG tube will help them to know if her body is capable of breaking down nutrients and using them as they should be.
2. Liz is impacted- on xray, her colon is literally visible in her chest cavity because it is so full of stool. Liz has a problem with motility and using the NG tube will allow mag citrate to be given to help clean her out.

So, she'll have the NG tube in, and we know she will gain weight. But what about what happens when we come home? She is so behind and so malnourished, days of an NG tube will absolutely help her, but she needs more than just the tube. So, the plan is for her to get a line placed. This line is semi-permanent iv access, and through this line, she can get IV nutrition, called TPN. She will have the line in for at least a month and we'll be able to feed her through the IV as a supplement to her eating by mouth. She will be able to come home and we'll have home health visit the house when needed.
I have wanted to avoid TPN since it was first mentioned many, many months ago. Liz's GI is very conservative- meaning  he  doesn't like to medicate or admit- but in his words, this has gone too far and it is serious. Her Prealbumin is too low and he feels uncomfortable not intervening. There will be another meeting with all specialties- Hem/Onc, GI, Immunology, Pulmonology, Infectious Disease- to talk about Liz, so I know that everyone will be on the same page.
I am terrified, as this is yet another circumstance when I feel like I am authorizing a medical decision that has many risks, but I have been reminded that actually, not intervening with the treatment is risky. She is just that sick.

So, there's the plan. Monday it is. I hate the hospital....have I said that yet?
Tonight, you can please pray for Liz's headache and fever. Also, for her mind, as she is aware of what is coming and she is very frightened. Thank you.