Tim’s Origin Story… Or Maybe it’s mine

“What happened?”
It’s probably the question that I get the most. And I get it. How did I go from having my fun-loving, kiddo-loving, running, weight-lifting, lawn-tending Husband by my side, to holding his hand every day in a bed, fighting for his life in the cardiovascular Intensive Care Unit of Fairfax Inova Hospital?I thought I would try to write a post in an attempt to answer that.The executive summary I usually give is:
He got sick out of nowhere and now has been in the ICU in critical condition since 5/16…He got b cell lymphoma (in his spleen) and we had no idea, wiped out his immune system. Then got a bacterial infection and without a way to fight it, went into septic shock followed by multiple organ failure. And suffered a brain hemorrhage from everything else going on. He’s on life support. Taking it one day at a time…Here’s the longer version..
First, what led up to the hospitalization from my point of view:Starting on Friday night before Mother’s Day, Tim was complaining of bad hemorrhoid pain. This wasn’t something he wanted to tell everyone so when I cancelled my manicure plans Friday night and through Sunday when anyone asked I just said Tim wasn’t feeling well. To detract from having to tell them he was having hemorrhoid pain I usually made some jokes about a “man cold” or simply said he wasn’t feeling himself.
The only thing Tim complained about all weekend was hemorrhoid​s, but it was clear they were bad because he didn’t really want to hold the baby and he didn’t leave the house although he did get up and join us for meals. I asked him to see or call the doctor but he said that he’d had them before and just knew what they would tell him. I didn’t push it. By Sunday night though he had a pain on his right side in his chest and a fever, and felt swollen in his neck. That didn’t sound connected to hemerrhoids to me, so I said we had to go to the doctor and he agreed to go Monday morning. He asked me to take him and so I took him Monday morning to the walk-in clinic at his regular doctor’s office. I had been up with the baby with near-newborn regularity, so when he went back to see the Dr, I actually fell asleep in the waiting room. He came out and I popped up to see what was up. He said he got two prescriptions. One for a special foam for hemerrhoids, and the other for an antibiotic for a tooth absess and had to make an appointment with our dentist at the end of the week once the antibiotics had set in. I was surprised. He had had a tooth ache about a week before, pulled out a popcorn kernel and never mentioned tooth pain again! I didn’t ask if he had a rectal exam; I didn’t ask if they did blood work. I did ask about his swollen lymphnoids in his neck. He said he’d been told that was a feature of the tooth absess. Well, ok then. We went to our Target pharmacy. Tim was extraordinarily weak. I assumed that was from fever and a bad infection and we needed to get those abx in him! Got his prescriptions, picked up a lunch for me and got Tim home and settled up in bed, and I went to work. That evening he still had a fever, but with the kiddos we know fever is highest at night. When the next afternoon (5/16) he woke up, had some yogurt before abx dose #3, and called me to say he vomited, still had fever and sweating – I said we were going to the ER. I got home and he really wanted to shower before going, so I let him do that while I got Annabelle from the bus then grabbed him to go to the local Inova ER on Ox Road. Again he was weak…wanted me to do all the checking in and most of the talking to nurses and doctors. I had Annabelle there so I was also trying to keep her occupied with worksheets.
After a slow-pace intake, things moved fast after blood pressure and blood work. He was pronounced hypotensive (abnormally low blood pressure) with septic shock. I heard the ER doc tell him, that it might sound like he was over-reacting but he was going to send him via ambulance to Fairfax Inova Hospital ICU. The nurse told me one person could ride with him in the ambulance with a meaningful look at Annabelle. Then said she recommended getting my daughter with a babysitter and meeting Tim there. I said I needed to pick my other two kids up anyway. Tim asked if I was going to the hospital. I said “Of course!! Let me just get the littles and get them all home with someone.”
Fortunately, as you all know by now, we have an amazing village, so a friend and then a neighbor took over at home for the night and I got over to the hospital. On my way, the ER Dr called me with his room number at the ICU. After I parked and asked directions to the ICU, I got a text from Tim with his room number and then “I have no white blood cells.”
When I got to his room they were about to take him for a CT scan. He told me they were going to test him for HIV. He said he should have had me bring his phone charger. He asked me if I brought a book. I asked if he wanted the TV on, I looked for sports, but he was happy with HGTV. Following the CT scan, we were told he had pnemonia in both lungs, and they were likely going to need to intibate him. He had an oxygen mask and it was getting harder for him to breathe. He told me he was so tired and wanted to sleep. That’s the last thing I remember him saying to me. We spoke to a Hematologist who said he would want to get some bone marrow to test. The intibation came on quick, a lot of people in the room, and it was scary​. In the night they called me to consent for kidney dialysis (CRRT) and as soon as I arrived Wednesday morning (5/17) they told me his lungs and heart were failing and I had to consent for ECMO (and a million other things). And that people needed to come.What we know now:

After over a week in ICU, Tim was diagnosed with Splenic marginal zone B-cell lymphoma (SMZL) via a Flow cytometry. SMZL is a rare malignancy involving the spleen, bone marrow, and frequently the blood. This wiped out his immune system.
He had a rectal absess (apparently very common in 30-40 year old males) which he mistook for a hemmeroid, and when it ruptured, it caused a bacterial infection which we could normally fight, but sent Tim into cardiogenic and septic shock with severely low oxygen in his blood, and acute respiratory failure. This also caused acute kidney injury, and disseminated intravascular coagulation (blood not behaving properly) as well as acute liver injury caused by insufficient blood flow to the liver.
On his fourth day in the hospital, a brain CT revealed a left frontal intracranial hemorrhage (which correlated to why he wasn’t able to move his right arm) cerebral brain compression and intracranial hypertension.

Basically, this nasty cancer attacked his bone marrow and blood, his blood got an infection that went everywhere and the bad blood mucked with everything. His medical care has been the best anyone could hope for, and yet he doesn’t just have one or a couple things wrong. He has all the things!! I think every type of medical specialist has seen him now! Every day is a balance to try to find the right mix of life support machine settings, tests, drugs and actions to save him. There are so many things wrong at the same time, and so much is interconnected, it’s a constant balancing act.

Tim is as sick as it is possible to be, but every day he’s fighting. Thank you for reading all of this. Thank you for caring, and for loving us. Your support is felt! Keep all the love, thoughts, prayers, vibes coming. We appreciate it all!

All my love,
MaryBeth (and Tim!!!)