Justin's and Lizzie's Journals 1/1/26
Justin's Journal 1/1/26:
Happy Near Year. No real changes, just waiting for infections to decrease. Confirmed heavy sedation expected for at least 48 hours. I had Rachel fly up (landed at midnight) and I booked a flight home to get my truck and explain to the kids est. time in ICU was 2 weeks minimum.
Lizzie's Reflection 1/1/26:
It's weird to miss NYE and have no idea you're in a new year. I have no known memories at this time other than my arm hurting so insanely bad when they touched it. I remember hearing "she's incredibly sedated but still flinches when we touch her right arm. It has really deep bruising." I have no idea if this happened on this day or not, but at some point when I was out, I thought one of the "villains" from Love is Blind was trying to perform surgery on me, and I wouldn't let him because he wasn't a doctor on the show. It made my mom cry because she wanted me to have the surgery, but I was really throwing a fit about it...Coma's are weird. I wonder if this is when I got strapped down to the bed. 😄
When scrolling through my medical records of this date I got a shocker of seeing a pic of my bright white tushy! I read through the notes and I had a bad wound on my tushy, and so I started receiving wound care, as well as them having to turn me every couple of hours. Neither Justin nor I were aware of this tushy wound, but it helps make a later experience make more sense. Some days down the road my CTICU nurse was crazy busy (2 of my ICU neighbors died), and she didn't turn me enough. She said "I have to take a picture of your bum to prove it's okay, even though I didn't turn you enough." I was so confused by why she would need a picture of my butt, but I couldn't communicate yet to ask what that was about. I just know they were moving me around constantly. I'll save you the shock of sharing those particular pictures. =) Justin said this day was really hard because I was getting worse, and they had done everything they could. The "not much changed" was in reference to me not improving despite maximal life support, maximal antivirals, etc.
Notes from Medical team:
Current Diagnoses:
Acute pain
Risk for deconditioning
Acute hypoxic respiratory failure
Acute Respiratory Distress Syndrome
Cardiogenic shock-improving
Multifactorial Shock-improving
bilateral digits necrosis
Esophageal Stricture
Acute Kidney Injury
Toxic Shock Syndrome
Pneumonia with a possible cavitary lesion
Influenza B infection
Strep A Bacteremia
Thrombocytopenia
hypervolemia
Disseminated intravascular coagulation
Deep Vein Thrombosis
Stress hyperglycemia
atelectasis
acute blood loss anemia
bicarbonate infiltration
Justin dropped the medical notes in co-pilot and this is what it spit out.
Here’s a prognosis‑focused interpretation that stays grounded in what the clinical picture means, without pretending to predict an outcome. I’ll keep it clear, direct, and realistic.
Prognosis‑Focused Interpretation
When you strip away the technical language, the overall picture is this:
The patient is in life‑threatening multi‑organ failure, and survival depends on whether the lungs, heart, and kidneys show signs of recovery while on maximal life support.
Below is what each major system tells us about prognosis.
1. Lungs: The Primary Driver of Risk
The patient is on VV ECMO, which means the lungs are providing almost no usable gas exchange.
Key prognostic signals:
- Pre‑oxygenation 72% → the blood coming from the patient is extremely hypoxic
- Post‑oxygenation 92% → ECMO is helping, but not achieving normal levels
- Chest X‑ray “very poor” → severe lung injury
- Needing max ECMO flows and high ventilator support → the lungs are not improving yet
Prognostic meaning:
Recovery is possible, but the lungs are currently offering almost no contribution. Patients can survive this if the underlying cause is reversible — but the longer the lungs fail to improve, the more guarded the prognosis becomes.
2. Heart: Right‑sided dysfunction is a red flag
The right ventricle (RV) is struggling:
- RV became “sluggish” when dobutamine was removed
- Required restarting inotropic support
- Blood pressure drops when support is reduced
Prognostic meaning:
RV dysfunction on VV ECMO is concerning because:
- The RV must pump blood into the ECMO drainage circuit
- If the RV fails, ECMO flow becomes unstable
- This can limit the ability to oxygenate the patient
The fact that dobutamine is required again suggests the heart is not stable enough to tolerate reductions in support.
3. Kidneys: Acute kidney injury requiring CRRT
Creatinine rising from 1.5 → 3.0 and the need for continuous dialysis (CRRT) means:
- The kidneys are failing
- Fluid balance must be tightly controlled
- Kidney recovery is uncertain
Prognostic meaning:
Kidney failure on ECMO is common, but it increases mortality risk because it signals multi‑organ involvement.
4. Severe Toxic Shock Syndrome (TSS)
TSS is a rapidly progressive, high‑mortality condition. The patient is receiving IVIG, which is appropriate, but:
- The rash is spreading
- The systemic inflammatory response is severe
- TSS can worsen heart, lung, and kidney function
Prognostic meaning:
TSS adds another major layer of risk because it can cause sudden cardiovascular collapse and multi‑organ dysfunction.
5. ECMO‑Related Complications
The patient has already experienced:
- Air in the ECMO circuit
- Flow instability
- Desaturation despite high flows
These complications are manageable but indicate a fragile situation.
Putting It All Together: Prognostic Summary
This patient is in a critical, unstable, high‑risk state with:
- Severe lung failure
- Right‑heart dysfunction
- Kidney failure requiring dialysis
- Toxic Shock Syndrome
- Dependence on high ECMO flows and inotropes
- Difficulty maintaining oxygenation even with maximal support
The prognosis is guarded to poor unless one of the failing organ systems begins to show early signs of recovery.
The key determinants of survival from here are:
- Whether the lungs begin to show any improvement
- Whether the RV stabilizes on lower doses of dobutamine
- Whether TSS can be controlled before further organ damage occurs
- Whether ECMO flows remain stable without recurrent complications
Patients can recover from this level of illness — ECMO exists for exactly these scenarios — but the combination of lung failure + RV dysfunction + kidney failure + TSS places this patient in one of the highest‑risk categories seen in critical care.
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