Jan 9, 2009 6:03PM from Anh Quoc

On Jan 9, 2009 6:03 PM, "JQ Nguyễn" <anisrael@gmail.com> wrote:
Everyone,
To sum up some of the disturbing, yet frank discussions that we've had within the past couple of days with Cau Nam's attending physician and his oncologist, it's come down to a battle for Cau Nam's will to survive. Although Cau Nam's physical state while on IV, chest tube and Oxygen has been somewhat stabilized. However, because of his lack of appetite and failure to eat, his overall health has dramatically declined.
An oximeter reading taken a few hours ago revealed Cau Nam's oxygen level at 89%. Earlier, the attending physician had hoped to send Cau Nam home soon after removing the chest tube used for draining excess liquids surrounding his lungs due to an apparent slow down of drainage. However, further examination indicated that the existing chest tube may be blocked and would have to be replaced by a new one. Cau Nam had to undergo a procedure to replace the blocked chest tube this afternoon and then another CAT scan afterward. After coming back from the procedure, his Oxygen level read 94% while on Oxygen. Since more fluid has drained as a result of the chest tube replacement, he is told to keep his Oxygen tube on. Therefore, we do not yet know what his Oxygen level would be without an Oxygen tank.
After examining the latest findings and consulting, both doctors agree that Cau Nam will need to remain in the hospital through the weekend with a qualified hope of seeing dramatic improvements in the following areas:
1) Significant improvement in diet. A liquid appetite enhancer will be given to Cau Nam toward this end. However, the attending nurse had indicated a few days ago that such appetite enhancer may take up to a week to take affect.2) Existing infection is healed. Procedure to implant a port-a-cath in Cau Nam's chest has been post poned until such time that the infection is healed. No port-a-cath means no chemotherapy.3) Cau Nam must demonstrate marked improvements by being able to walk or be wheel chaired to the oncologist's office for chemo. Being too weak to walk or use a wheel chair would indicate that he is too weak for chemo.4) Cau Nam must be able to breathe without the assistance of Oxygen. Currently, he does require the use of Oxygen due to his current oxygen level of 89% taken just hours ago.
Concerns regarding the attending physician's judgment have been somewhat quelled by the oncologist whose second opinion we sought. Work is underway to complete all of the documents related to an advance medical directive and general power of attorney. Both doctors strongly encouraged us to look into hospice care, and we received a brochure regarding a Vietnamese hospice care. We are told that some hospice care programs do not require the patient to leave their own home.
My understanding of where we stand right now is that once the new chest tube is put in and does its job, and is no longer needed, Cau Nam will likely receive antibiotics and be sent home sometime early to mid-next week. I am not 100% sure on this point however, because what we are told keeps changing. Then once home, the above improvements (#1 - #4) must be demonstrated before chemotherapy should be considered. The bottom line is that if Cau Nam does not start eating more and improve his health, he will most likely not undergo or survive chemo. It is all up to him. This is where hospice care comes in if he chooses not to eat a whole lot more.
I am sorry to have to share such a sobering message with you all, but it is important for all have asked me to notify them when things really get bad to know that at this point, all bets are off. His condition is so tentative that neither Anh An or I can really tell you just how long this will all last. Please take into consideration that at this point we really don't know whether it will be a few days, a week, or more, and plan accordingly. All I can really tell you is that both doctors were really alarmed by his chart reading today.
Last minute update as I finish up this email: The attending physician told me that he does NOT believe Cau Nam has very many DAYS to live, and highly suggested in-patient hospice care as soon as possible.
Quoc