Here is the latest update on the condition of Dr. Rob Susil. As you can see, his condition is approaching a point where major decisions will have to be made as to continuing his treatment or allowing the cancer to win. His wife Gwyneth has been posting on the blog he began when he first received a diagnosis of cancer; a task she has taken up on Rob's behalf during this latest phase of his battle. When in her latest post, she speaks of desiring at least to grant him enough time to allow their three year old son, William to be able to see Rob in a state that will not traumatize him, it is clear that the situation has indeed become desperate.
I ask you please to offer your prayers of support in the comment threads of this post so that I can offer them to Rob and his family as a sign of hope in these dark hours.
Hello to all -
The last two days have been difficult, as Robert has not been able to move any closer to coming off the ventilator.
I met with his primary oncologist and his pulmonologist today and we discussed the fact that if the high dose steroids were going to have any significant effect, we probably would have seen that by now. And while we think that the amount of bleeding in his lungs has slowed, it does not appear to have stopped completely.
It is not good for a person to remain intubated for a prolonged period of time, since the pressure of the vent can cause damage to airways, and a person's breathing muscles get weakened by not being used. So, we talked about attempting to transition Robert to a different kind of breathing support - something called CPAP or BiPAP. These are both tight fitting masks, that when worn, provide some additional pressure into the lungs the way a ventilator does, but do not require a breathing tube. These masks can also deliver high concentrations of oxygen, similar to being on a ventilator. In order for Robert to be able to transition to CPAP or BiPAP though, he needs to be able to initiate breaths on his own. So, if we are going to try and make this transition, we need to begin to wean him off his sedation medications. In addition, before having the breathing tube taken out, his ventilator would be changed to a different kind of setting that would allow us to monitor whether Robert is able to initiate his own breaths with enough force to be safely extubated. We will try to move slowly towards these goals over the weekend.
Unfortunately, even if Robert seems ready to be transitioned to CPAP or BiPAP, it is possible that once we take the breathing tube out, he will not do well without it. If that happens, I may have an extremely difficult choice to make (one that he may or may not be able to contribute to, depending on how awake and verbal he is at the time). The question of whether or not to re-intubate will be a hard one to answer, and is something that I will need to think and pray about seriously this weekend. If he were to be re-intubated, he would likely require a tracheostomy (a surgical opening into his airway that is then attached to a ventilator). It is possible that with a tracheostomy he could be awake enough to communicate, although not talk, and if he were able to remain comfortable and do that, what a great gift that would be for myself and William. However, it's a very invasive procedure, one that Robert and I never talked about, and in the face of still having widespread metastatic disease, I would have to feel confident that going forward with a tracheostomy would actually contribute to meaningful time with our family.
If he is able to transition to CPAP or BiPAP, it is our hope that over time the bleeding in his lungs would stop and his lungs would start to heal. That would still leave unanswered that question of how to further treat the remaining cancer, but would hopefully at least allow Robert comfortable and awake time with us.
As you can see, these next few days are critical. I know how hard everyone has been praying; I ask you again to continue to pray with all your heart for Robert's healing, comfort and peace.
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