Yesterday was not a good, not a good day at all. Bill had to be put back on the vent about 1:30 in the morning. They said all of a sudden he decompensated and his oxygen dropped to 79 They tried just going to CPAP but that didn't work and then tried SIMV mode and finally full vent on a pretty high rate of 18. His heart rate was back in the 120-130 range and he was overbreathing the vent for each breath, sometimes reach 40 breaths per minute. The nurse said they also gave him his night Xanax, Seroquel and Melatonin, but nothing worked to calm him before the crash. He was also running a low-grade temp of just over 100 and his blood pressure was low, after being perfect the day before and slightly high on the 2 days before that.

He kept telling me that he wanted that off and I told him that was how he was breathing. I asked his nurse if he could have his Xanax early and it was within the time frame allowed so she got it and he finally calmed down about 9. Stephanie had ordered a chest x-ray and she said it showed nothing different and his normal morning labs were OK, but she ordered some more tests and wanted a sputum sample. She was going to leave it up to Infectious Disease to decided on a urine sample or not, and the same with a stool sample if he had diarrhea, which he does not. She also said that his white count had gone from 10 to 16.

The doctor rounded about 11, but of course they never come in. And Phyllis just said that she would be back, but she never did come back. So, I don't know what was decided, but I had a bad feeling about it all day. Maybe just because Bill was having such a hard time. So I still don't know if a decision was made about moving to a different facility.

Dr. Muir was saddened to see him back on the vent. He had been in after I had left the past couple of days and said that he had looked so comfortable and good on the trach collar. He thinks that a small mucus plug probably got into the airway and stopped the airflow and in the process of getting his numbers back up, it dislodged again. This had happened in ICU before.

Ashley from Infectious Disease came in and confirmed the rise in his white count. She also said that since he had the fever, and I reminded her that his normal temp is 97.5, they did want a urine sample. She said the areas on his x-rays they were watching were still there, but she didn't see any significant changes one way or the other.

Respiratory tried to suction him for the sputum sample, and they got absolutely nothing, not even phlegm. We could hear the air moving through the suction tube and usually Bill would be fighting them and coughing for them then stop, but he wasn't even coughing. I don't know if they ever got it or not. He also had peed all afternoon.

He finally relaxed and went to sleep and his numbers just went back to normal, respirations were in the mid 20s and the vent is set on 18, oxygen 98-100, heart rate 77-86, perfect. He was sleeping when I left and Hanan was going to go ahead and give him his Xanax to keep him quiet.

One of the things that disturbed me through all of this is that they didn't call me. I realize that things were moving fast for a bit, but they could have had any nurse call, not just his nurse. So, I walked into it cold and thinking that it would be a good day and they could cap the trach again and get that going.

There was one bright spot in all of this. A couple, about my age, came into the room and asked if I was Beth. When I said I was, the man said that his cousin in Illinois had sent me "these flowers" and he handed me a beautiful bouquet of spring flowers. His wife was carrying a vase for them. They were from a classmate from high school. She is headed to Arkansas with her parents for a funeral today and she knew I had been having a bad day so she asked her cousin to do this. The flowers are lovely and did make a bad day better.

I also have been meaning to post a picture of Bill with his birthday kitty from his sister. Since I can't take Cat to visit (she doesn't travel well) this was the best we could do. Of course since he feels so bad, it just sits on his tray table.

Hopefully today will be a better day for both of us. I'll let you know!