Justin's and Lizzie's Journals 1/5/26
Justin's Journal: 1/5/26 None
Justin's Update For Prayer Warriors:
1/5/25
Good morning,
Just had the rounds with the doctors. Her kidneys are still catching up and looking better. If the trend continues, they will remove the lines meaning they don’t think she will need dialysis in the future. Decision will be tomorrow but huge progress! Plus That would be 2 fewer tubes for her to deal with.
Her heart is also getting better. They will keep weaning the heart meds today and hope to be off one big one completely by EOD. They may add a different meds depending on blood test etc but trending right way.
Mixed news on her lungs. The xray showed improvement for the first time meaning her lungs are opened slightly. However; they had to increase the amount of oxygen in her airflow because her lungs are not functioning as well (drawing more air in, but getting less oxygen into her blood). This is not unexpected per the doctors, I’m supposed to expect 1 step fwd, 1 step back.
ECMO is still handling a majority of her oxygen needs, no change at all to its settings.
They are changing which sedative she is on today but plan to keep her pretty heavily sedated. They are also actively managing pain still.
I think specific prayers today are:
Kidney function - let’s get rid of 2 needles.
Safe sedative changeover and good efficacy for the new medicine.
Healing inside her lungs as they keep opening up.
Help finding a good spot for her oxygen sensor. They keep having to move it around which seems to pester Lizzie every time.
Pray for her oxygen right now and help them find what happened. ECMO suddenly stopped working and not enough oxygen getting in.
They got her stabilized but still trying to figure out what happened / how to prevent
Extremely scary. Her oxygen was struggling for about 15 min then just fell off a cliff. She was not getting enough for about 2 min.
She is getting enough now.
They are running labs and other tests trying to learn best next step.
They think her blood clotted in the ECMO which means replacing the ECMO with a different unit (this happens but would be early). That’s semi-invasive.
Other big “maybe” thing is they are trying to decide if she just needs more fluids. She’s super swollen so they were trying to draw it down. If the change, that’s not invasive at all but sign that she’s just not healing as quickly as they thought.
All the ECMO stuff looks fine. They think it was her body fluids causing her BP to drop. They shoved more fluid into her and will try to draw it much more slowly tonight or tomorrow.
1/5/26 evening:
No major changes from this morning in terms of Lizzie’s progress.
She did give us an extremely bad scare where she suddenly was not getting enough flow through the machine giving her oxygen. Her body oxygen levels got extremely low. The entire ICU team was in the room within about 1 minute and they got her stabilized about 3 min later.
After testing, they thought it was related to fluid balance (her kidneys worked too well). She had a 2nd episode this afternoon but the nurse pushed fluids immediately and Lizzie stabilized before reaching a dangerous level. They are passing all this along right now for the night shift to keep Lizzie stable.
Big thing they are working now is how to best balance things. They need to draw fluid away from her lungs but not cause circulation issues doing it.
She has been asleep all afternoon. I hope she stays that way all night.
Lizzie's Reflections 1/5/26:
Just like the last few reflections, I'm really fuzzy on the timing and details. But I remember suddenly being surrounded by loads of people and feeling like I was drowning in bright lights above me. I have no real reason for this, but I believe this may have been the day I had a choice in living or dying. Maybe that was 12/30 on the day my heart stopped, who really knows. But I think it was today that I was in total darkness, then a bright light appeared and got bigger and bigger. I then heard "you can come with me now to heaven, or you can go back to earth for more time with your family." I wrestled with the decision because my body was flat out miserable, and being with Jesus sounded real nice, but ultimately I didn't want Justin to marry anyone else, so I chose to go back. 😄
This is not a prediction of the future—it's an assessment of trajectory and likelihood of recovery based on the information from January 5, 2026, ECMO day 5–6.
Prognosis by Organ System (Based on 1/5/26 Documentation)
🫁 Lungs (ARDS, Influenza B, Group A Strep pneumonia)
Prognosis: Guarded
- ECMO sweep and flow stabilized; oxygenator functioning well (“Oxygenator performance: adequate”)
Concerns
- Still fully ECMO‑dependent for gas exchange.
- Severe ARDS from dual infections (Influenza B + GAS).
- Several episodes of severe desaturation requiring increased flows (“Increase in flows and FiO2 in setting of desaturation”).
Interpretation Patients with ARDS on VV‑ECMO often require 2–3 weeks of support. Improvement in oxygenation and stable ECMO parameters are positive signs. No evidence of refractory lung failure or oxygenator dysfunction.
Overall: Meaningful chance of lung recovery, but still in the early, fragile phase.
❤️ Heart (Acute systolic heart failure, suspected myocarditis)
Prognosis: Favorable / recovering
Evidence
- “TTE after showed normal LVEF, low normal RV” (Intensivist).
- “cardiogenic shock (resolved)”.
Interpretation This is a major positive turn. Myocarditis‑related heart failure often improves rapidly once infection and inflammation are controlled. Being off dobutamine with normal EF is an excellent prognostic sign.
Overall: Heart function appears to have recovered and is unlikely to be a long‑term problem.
🧠 Neurologic (Sedation, seizure disorder)
Prognosis: Cautiously optimistic
Evidence
- “Sedation weaned…”
- “Pupils equal, round, reactive to light”
- No focal deficits documented.
- Seizure disorder managed with Vimpat.
Interpretation No signs of hypoxic brain injury or neurologic decline are documented. Sedation is required for ventilator/ECMO synchrony, so limited exam is expected.
Overall: No evidence of neurologic injury; prognosis good, assuming no complications arise.
🩸 Hematologic (Thrombocytopenia, anemia, anticoagulation)
Prognosis: Improving but still vulnerable
Evidence
- Platelets rising: “PLT increased to 98 from 39”.
- Hemoglobin low but stable with transfusion support (“Hgb >7 goal”).
- HIT negative.
Interpretation Thrombocytopenia is common on ECMO. The upward trend is reassuring. Hemolysis markers (LDH 971, pfHgb 122) are elevated but not catastrophic.
Overall: Improving, but still at risk for bleeding and hemolysis while on ECMO.
🩺 Kidneys (AKI, CRRT recently stopped)
Prognosis: Good recovery expected
Evidence
- “CRRT discontinued with good diuretic response and adequate urine output”.
- Creatinine normalized: “Creat 0.82–0.88”.
Interpretation This is a very strong recovery signal. Early AKI from shock often resolves once perfusion improves.
Overall: Kidneys appear to be recovering fully.
🧠 Liver / Biliary (Rising LFTs)
Prognosis: Uncertain but likely reversible
Evidence
- “LFTs have been increasing in a cholestatic pattern so would image liver/biliary system”.
Interpretation Cholestasis is common in critical illness, ECMO, and sepsis. No evidence of liver failure (normal INR, stable mental status).
Overall: Likely reversible, but needs monitoring.
🩹 Skin / Peripheral Perfusion
Prognosis: Moderate risk
Evidence
- “Dusky fingertips bilaterally”.
- Cap refill >3 seconds.
Interpretation This suggests low peripheral perfusion, likely from vasoconstriction during shock and ECMO flows. Usually improves as circulation stabilizes, but can rarely progress to ischemic injury.
Overall: Monitor closely currently limb‑threatening.
🧬 Infection / Sepsis
Prognosis: Improving
Evidence
- “Not on pressors”.
- WBC trending down (22.9 → 20).
- Blood cultures after 12/30 negative.
- On appropriate antibiotics (ceftriaxone) and antivirals (oseltamivir).
- Completed IVIG for toxic shock.
Interpretation Sepsis appears to be responding to therapy.
Overall: Improving, but still a major driver of organ stress.
Overall Prognosis Summary
| Organ System | Prognosis | Evidence |
|---|---|---|
| Lungs | Guarded but improving | Stable/improving oxygenation; still ECMO‑dependent |
| Heart | Good recovery | Normal EF, off inotropes |
| Kidneys | Good recovery | Off CRRT, normal creatinine |
| Liver | Uncertain but likely reversible | Cholestatic LFT rise |
| Neurologic | Good | No deficits; reactive pupils |
| Hematologic | Improving | Platelets rising; mild hemolysis |
| Peripheral circulation | Mild concern | Dusky fingertips |
| Infection | Improving | Cultures clearing, stable vitals |
Bottom Line
Based on the notes from 1/5/26:
You are showing early but meaningful signs of multi‑organ recovery.
The lungs remain the main limiting factor, which is typical for severe ARDS on ECMO. Heart and kidney recovery are particularly encouraging.
Comments
Post a Comment