Strange Night

When I left E. last night, he was peacefully sleeping.  I expected him to get a great night's sleep.  So, I was shocked this morning when I came in and he had tall tales of a wild night of chaos.  Initially I was appalled at the mistreatment he suffered, but as the stories continued, I realized that things weren't lining up.  Clearly, he had been dreaming.  Or possibly hallucinating?  I tracked the nurse down and voiced my concerns.  Was he just super sensitive to the pain medication?  Was cancer growing in his brain again?  We obviously needed to discuss this with the doctor.

By the time the doctor arrived in the afternoon, E. was in need of pain medication.  The nurse and I discussed E.'s crazy night with her.  She reviewed his meds and decided the meds couldn't be the culprit.  Even though his pain patch was increased, it was still only at 25 mcg (and some people are on 400 mcg!) and he only received .5 of the Dilaudid.  She tracked down the MRI of the brain and those results were stable.  So, by process of elimination, they decided E. was "sun-downing."  I've never heard of this, but as they explained it to me, it's a condition that often occurs in dementia patients, but also occurs in patients with chronic illness.  What happens is when the sun goes, a different person basically comes out (kinda like a werewolf, I asked?).  Patients can become confused, violent, and delusional.  They often hallucinate.  This rarely occurs when they are at home (where they are comfortable and secure),  but rather occurs in strange environments (like the hospital).  There is no predictability as to when someone will "sun-down," as it is totally random, but does occur more often when someone is on heavy narcotics (E. is not on heavy narcotics, so that is not the case with him).  So weird.

We did get the results back from E.'s PET/CT scan.  They are not good.

There is a 10 mm metastatic left hilar lymph node.

There are five or six 6-7 cm metastases in the liver.

There is a 3 cm mass in the pancreas that is either a metastasis or a primary tumor.

There are bilateral small pleural effusions.

There is a large amount of ascites.

So, in layman's terms, the cancer has spread to the lymph nodes, the liver and the pancreas.  There is a lot of fluid in the abdomen (which they drained).  There is also some fluid in the lungs.  Not good.  Not good at all.