Things are changing quickly as results come in and doctors confer. Here's what we know: 

Recap: Andrew's blood cultures from Wednesday night were positive for bacteria, leading to the sepsis diagnosis and antibiotics. The specific type of bacteria is typically associated with upper respiratory infections vs. GI infections. GI would make more sense for Andrew given where the organs with cancer. Infectious Disease ordered a CT to pinpoint where the infection started.

The imaging showed an angry, infected gallbladder with a perforation (hole). Again, this was unexpected because of the type of bacteria found and because he wasn't in acute pain. Surgery therefore wonders if this finding is incidental to the bloodstream infection and he just had two different things going on. Oncology says it's not impossible for this bacteria to show up in the gallbladder, but could imagine a world where the blood cultures showed a false positive and Andrew's symptoms (fevers, fatigue, etc.) were the systemic reaction to the gallbladder infection.

Either way, the gallbladder needs to be addressed. The options are surgery to remove it—not ideal for Andrew—or placing a temporary tube to drain bile to an ostomy bag. We are waiting to find out from Interventional Radiology whether they can fit him in for the procedure today or if it's next week.

Surgery thinks the drain could help alleviate some clinical symptoms. The gallbladder perforation is leaking into a contained space into the liver. While that's better than spilling into the belly, Andrew's body is needing to react to that and struggling. What caused this? A guess is that a nearby tumor affected the integrity of the gallbladder and caused the rupture.

A pulmonary embolism in a new artery was also observed on the CT. This suggests resistance to his blood thinner because clots continue to pop up. He is now on IV heparin, and they'll pick a new blood thinner for at home.

We haven't reviewed other findings from the CT yet. We are waiting for our oncologist's opinion as to what's happening with the cancer. I texted Andrew's cardiologist this morning and he stopped by to see Andrew. He said he will review his chart more closely and come by again with his thoughts before the end of his day.