I think I have all of the glitches fixed, at least for the time being!
Bill slept all day again yesterday, even after sleeping all night. He had no episodes of vomiting so maybe he was just sleeping everything off. His heart rate was good, his oxygen level was excellent, but his blood pressure was a little low. But, since the DVT in the right arm is resolved, the cuff was moved to that arm and his pressure was much better. I still don't know what the results are of the ultrasound of the left arm. His hand is still very swollen and red and warm, while the rest of his arm is cool. But, his right arm is also cool and his hand is warmer even though it's not swollen.
We've found, we think, the cause of the vomiting. The GI doctor finally came in and said that the drainage from around the tube is just bile. And while the site is a little red, it is not infected. She said that the tube is just worn out, so today he's getting a new one. It will be done at bedside and she said she will take the old one out, use the same hole and pop the new one in. They didn't even need to stop his food. He's back up to the regular amount of food. The dietician said the formula can be changed again if necessary, but since this was sudden onset vomiting, I don't know that changing it will help.
His kidney function has increased and his numbers are better. They kept the fluids running until today. When Dr. Morris looks at today's numbers, he may add it back. It's up to him. The only one he has is the one flushing his bladder. The output there is much better today. It's still a little pink, but now it looks more like concentrated urine than blood, so I can actually tell there is urine there.
As far as we can tell he hasn't had a bowel movement since Friday, although I think he had one Saturday. That could also be contributing to the vomiting, there is nowhere for it to go. So, he got a stool softener with his morning meds. That may also help with his saying that his belly hurts.
The nebulized antibiotic has been discontinued, along with the mucomyst. The only respiratory therapy he's getting now is albuterol and sodium bicarb. I still don't know just what that does, but if it has helped, it doesn't matter what it does.
I started thinking this morning that he always breathes much better in the spring and summer and even though he's in a controlled environment, his breathing is much better. Maybe the bacteria has gone dormant again, who knows.
Now, I have to give a little testimony. This is nothing new, I've shared things before, so bear with me. Yesterday, Joseph, one of the chaplains here came by for prayer and asked if there was something specific to pray for, since the Bible tells us to be specific with our requests. So I told him Bill's belly. So, that's what we prayed for, an answer to the problem. And, we got the answer with a simple fix of the tube! I've also shared songs that have touched me and all week-end, and every time I get in the car now, shortly after starting the car, I've been hearing the song "The Healer Hasn't Lost His Touch". And He has not. When all of the doctors have thought that the end was near, when I thought the end was near, Bill has been touched and, well, we know how he's done. So, God is not ready for him yet, he still has something to teach us!
I've been questioned a couple of times now entering the hospital. Saturday they just asked where I was going and called the unit to make sure it was OK for him to have visitors. Sunday, after taking my temp, I was just waved through. Yesterday, they took my name, Bill's name and room # and then the unit was called. Today, I was just scanned and asked what unit. When I said Transplant ICU, she just nodded and said OK.
That catches everything up to the present. There is no time for the tube placement, and I've only seen the lung doctor who just looked at his numbers and didn't even listen to him. It's the one that thought we should just go to palliative care. I think he's even mystified, even though he told me he's a Christian. Maybe that's the lesson Bill is teaching, who knows.
I'll let you know what else goes on at some point in the day!
Tuesday, March 31, 2020
Sunday, March 29, 2020
I love our local grocery store! They are having senior shopping on Tuesday, Thursday and Sunday mornings from 7 to 8. There was a good selection of meats and they had most of the "hot" items. The only thing I couldn't get that I wanted was some Clorox wipes and they said the manufacturer was backed up. I was the 2nd person in and was home by 7:30. I only put the cold things away and was on the road to the hospital by 7:45. It did feel good to leave a little later...and in the daylight!
Things weren't really good when I got here, and it hasn't really been a good day. Bill was holding an emesis bag when I came in the room and his nurse was with him. Today it's Mikala who he loves. But, he wasn't happy. He apparently started throwing up again about midnight, and had stayed awake all night. He had also thrown up this morning, which explains the bag. Mikala said she didn't want to leave him until I got here. And, by the way, Caleb did remind him that I was getting some groceries this morning.
He's had several things going on today and we are mystified by some of them. First off though, his urine looks a lot better. It's mostly been a lighter pink color. Some of that is from the saline flush, but I could tell around the edges that it was urine. Dr. Greenberger was pleased with how it was looking and said to just keep flushing it. He also said it would take a few days for it to clear.
When Mikala was changing the gauze around the peg tube site, there was some drainage that had never been there before. His belly also looked pretty red around it. She let Cindy and Dr. Edwards know and Cindy was already in the unit so she came right in. She took a picture of the gauze and texted it to Dr. Threlkeld and Ashley was here almost immediately. She ordered a sample sent to the lab so that was done this afternoon. His food had been stopped, and every time it was re-started, he started gagging some. It was left off for a bit and after giving the Zofran some time to work, it was started at only 10mL per hour instead of the normal 40. If he continues to tolerate that rate, they will gradually increase it, and it has been increased to 20 as I was typing this. He has also shown signs of nausea again, so he's been given more Zofran.
The kidney doctor said that his kidney function has actually gotten worse, so she ordered some extra fluids to be given to keep his kidneys flushing. This doctor was just the one on call for the week-end so Dr. Morris will be back tomorrow.
Dr. Edwards was just in and has ordered a GI consult, but whether they come today or not, Mikala wasn't sure. She's waiting on a call-back and she told them it was urgent so we will see. The ultrasound of the right arm did not show the DVT so it has cleared. His left arm is really swollen and he said it hurts so he's ordering an ultrasound of the left arm and told Mikala to pull the oldest line which is the midline. She's in the process of doing that now. Hopefully that will make him feel a lot better.
So, that's how our day has gone. I had told him since I was coming late that I would stay later, but since he's slept all day, I don't know if I will or not. But, then, I would like to be here for the GI consult. Maybe they will call before long. It doesn't matter if I'm here for the ultrasound or not because they won't tell me the results.
As always, I'll let you know when I know.
Things weren't really good when I got here, and it hasn't really been a good day. Bill was holding an emesis bag when I came in the room and his nurse was with him. Today it's Mikala who he loves. But, he wasn't happy. He apparently started throwing up again about midnight, and had stayed awake all night. He had also thrown up this morning, which explains the bag. Mikala said she didn't want to leave him until I got here. And, by the way, Caleb did remind him that I was getting some groceries this morning.
He's had several things going on today and we are mystified by some of them. First off though, his urine looks a lot better. It's mostly been a lighter pink color. Some of that is from the saline flush, but I could tell around the edges that it was urine. Dr. Greenberger was pleased with how it was looking and said to just keep flushing it. He also said it would take a few days for it to clear.
When Mikala was changing the gauze around the peg tube site, there was some drainage that had never been there before. His belly also looked pretty red around it. She let Cindy and Dr. Edwards know and Cindy was already in the unit so she came right in. She took a picture of the gauze and texted it to Dr. Threlkeld and Ashley was here almost immediately. She ordered a sample sent to the lab so that was done this afternoon. His food had been stopped, and every time it was re-started, he started gagging some. It was left off for a bit and after giving the Zofran some time to work, it was started at only 10mL per hour instead of the normal 40. If he continues to tolerate that rate, they will gradually increase it, and it has been increased to 20 as I was typing this. He has also shown signs of nausea again, so he's been given more Zofran.
The kidney doctor said that his kidney function has actually gotten worse, so she ordered some extra fluids to be given to keep his kidneys flushing. This doctor was just the one on call for the week-end so Dr. Morris will be back tomorrow.
Dr. Edwards was just in and has ordered a GI consult, but whether they come today or not, Mikala wasn't sure. She's waiting on a call-back and she told them it was urgent so we will see. The ultrasound of the right arm did not show the DVT so it has cleared. His left arm is really swollen and he said it hurts so he's ordering an ultrasound of the left arm and told Mikala to pull the oldest line which is the midline. She's in the process of doing that now. Hopefully that will make him feel a lot better.
So, that's how our day has gone. I had told him since I was coming late that I would stay later, but since he's slept all day, I don't know if I will or not. But, then, I would like to be here for the GI consult. Maybe they will call before long. It doesn't matter if I'm here for the ultrasound or not because they won't tell me the results.
As always, I'll let you know when I know.
The post I said you would have last night obviously didn't happen. What did happen were severe storms and tornadoes which we weren't supposed to get. Jonesboro, a city 50 miles away, got hit hard. The mall is severely damaged and several businesses totally destroyed. The storm then headed northeast and missed where my son lives by about 6 miles. We also had a tornado warning, just as I was sitting down to eat, so the cats got to explore the pantry for a bit. Mouse did not like being in there, especially with the door closed. And, by the time I got us all gathered and in there and got the information up on my phone, the storm had already passed us by, with barely a drop of rain. But, the rain and wind came after and it was wicked. Mouse was sitting on the cat tree at the window and when the wind started howling and blowing the rain into the window, he got spooked and hid somewhere until I called him. As far as I can tell, I have no damage around, not even the trash can blown over. But, everyone in the family is safe as far as I know.
Bill had a rocky afternoon, for just a bit. When he got one of his breathing treatments, he got really gurgly and then threw up again. This time Austin and the nurse practitioner from Dr. Threlkeld's office were in the room. I was standing by the bed and just grabbed to towel they use to wrap the end of his feeding tube to catch it. It was his formula of course, but there was a lot of mucus in it, which is new. Austin also noticed the mucus. They took over so that I could wash up, as I didn't have any gloves on. Ashley listened to him and said he still sounded gurgly and they were afraid that he aspirated some, so Austin ordered a chest x-ray just to be sure. I like it when nurses take it upon themselves to do what they know a doctor would do and get it done. But, even if he had aspirated some, he's already on the antibiotics they would give him for a new pneumonia, or a flare up of the pseudomonas.
An ultrasound of his right arm was ordered also to see if the DVT, blood clot, in his right arm has resolved. If it has, Dr. Edwards will discontinue the Eliquis. Of course, there was just the problem with the clot in his bladder, but it also could have caused the bleed in the first place.
One of the kidney doctors came by and said they are going to watch everything closely. She came in during the vomiting episode so she noted all of that. Austin told me that is creatinine level had been normal on Thursday, was a little over 2 on Friday and 2.81 yesterday so it was going up. That's one of the numbers that lower is better. So, they are going to see, once the bladder is completely back to normal, if that helps the kidney function, or if they will need to do something else. Usually it's just add Lasix to flush them more and get any extra fluid out, but they may not do anything right now. We don't want it to get so high that they have to start dialysis.
He had some mild therapy, just exercising his arms and legs. He tried to ignore her by keeping his eyes closed, or focused on the TV. So I turned the TV off and told him to pay attention to her. I also told her that if I wasn't there, he's not allowed to decline therapy. He told me yesterday he didn't want to, but it didn't work. He's gotten so used to just laying around that that is all he wants to do now, complete with not even using his call but, just banging it on the bedrail to get my attention.
Dr. Greenberger, the urologist did come by, after his nurse had called to check on Bill. She thought he had been discharged. I didn't tell her he probably won't leave the hospital, but she said if I had any questions to call the office. So I was surprised when the doctor came in. He said the clot he removed was a bit larger than a softball. That is my analogy. He just used his hands to show me the size and I've been trying ever since to come up with something that describes that size. And softball works.
He is still bleeding, and there are still some smaller clots coming through the tubing. Dr. Greenberger adjust the saline they are using to flush the bladder so that the flow was a little faster to take care of the clots. He asked if Bill had said anything about pain and I told him no. He hasn't even complained about pain at his penis and I'm sure it's sore. But, he had nothing for pain all day.
He slept most of the afternoon after the vomiting incident. Austin reduced the flow of his food, but it in half so that he was still getting some nutrition. He also seemed a little feverish, even to Austin, and his blood pressure dropped a little bit, but not enough to be concerning When he woke up, his eyes were clearer and he was a little more interactive.
Right before I left his food pump beeped that it had finished the bottle, but there was still a good 3-4 inches left, so I just continued it. I found his new nurse Toya to let her know I was leaving and to tell her what I had done. The charge nurse Sara said they needed to put me on payroll. I don't want the work, just the badge to get in and out easier!
Our local grocery store is doing senior shopping 3 days a week, and Sunday is one of the days. I need supplies so I'm going to go this morning before going to the hospital. I told Bill I would be late and why but he probably won't remember. So, I also told Caleb so that he could remind him. I don't need a lot of things, since I stopped at Dollar General on the way home the other night. It wasn't really busy and they had eggs and bread. I don't need toilet paper or paper towels, scored them earlier, but I do need some food for me and the never ending cat food. I'm getting really tired of frozen or canned dinners, and fast food. I try to eat my main meal at the hospital. But, at the same time, I'm too tired to try to cook any kind of "real" food when I get home. So, I don't know what I'm going to get. It will also depend on what they have.
I was listening to the announcements at the hospital. Usually they are just for Codes Blue and Purple. Everyone knows what Code Blue is I'm sure, and Code Purple is when a patient has walked off. Usually that's from the ER and they've gone out to smoke. Lately there have been a lot from the 5th floor. That is where they are putting all of the COVID-19 patients. There weren't any walk-aways, but there were several pages for Code Transport from ER room such and such to 5west. I know they admitted 5 patients yesterday, most likely pending test results. Brings it home a little more.
That's it for now. I need to get in the shower and get cleaned up some. Feels funny to say that at this time of morning. Usually it's get my stuff gathered to get out the door. I'll let you know how today goes!
Bill had a rocky afternoon, for just a bit. When he got one of his breathing treatments, he got really gurgly and then threw up again. This time Austin and the nurse practitioner from Dr. Threlkeld's office were in the room. I was standing by the bed and just grabbed to towel they use to wrap the end of his feeding tube to catch it. It was his formula of course, but there was a lot of mucus in it, which is new. Austin also noticed the mucus. They took over so that I could wash up, as I didn't have any gloves on. Ashley listened to him and said he still sounded gurgly and they were afraid that he aspirated some, so Austin ordered a chest x-ray just to be sure. I like it when nurses take it upon themselves to do what they know a doctor would do and get it done. But, even if he had aspirated some, he's already on the antibiotics they would give him for a new pneumonia, or a flare up of the pseudomonas.
An ultrasound of his right arm was ordered also to see if the DVT, blood clot, in his right arm has resolved. If it has, Dr. Edwards will discontinue the Eliquis. Of course, there was just the problem with the clot in his bladder, but it also could have caused the bleed in the first place.
One of the kidney doctors came by and said they are going to watch everything closely. She came in during the vomiting episode so she noted all of that. Austin told me that is creatinine level had been normal on Thursday, was a little over 2 on Friday and 2.81 yesterday so it was going up. That's one of the numbers that lower is better. So, they are going to see, once the bladder is completely back to normal, if that helps the kidney function, or if they will need to do something else. Usually it's just add Lasix to flush them more and get any extra fluid out, but they may not do anything right now. We don't want it to get so high that they have to start dialysis.
He had some mild therapy, just exercising his arms and legs. He tried to ignore her by keeping his eyes closed, or focused on the TV. So I turned the TV off and told him to pay attention to her. I also told her that if I wasn't there, he's not allowed to decline therapy. He told me yesterday he didn't want to, but it didn't work. He's gotten so used to just laying around that that is all he wants to do now, complete with not even using his call but, just banging it on the bedrail to get my attention.
Dr. Greenberger, the urologist did come by, after his nurse had called to check on Bill. She thought he had been discharged. I didn't tell her he probably won't leave the hospital, but she said if I had any questions to call the office. So I was surprised when the doctor came in. He said the clot he removed was a bit larger than a softball. That is my analogy. He just used his hands to show me the size and I've been trying ever since to come up with something that describes that size. And softball works.
He is still bleeding, and there are still some smaller clots coming through the tubing. Dr. Greenberger adjust the saline they are using to flush the bladder so that the flow was a little faster to take care of the clots. He asked if Bill had said anything about pain and I told him no. He hasn't even complained about pain at his penis and I'm sure it's sore. But, he had nothing for pain all day.
He slept most of the afternoon after the vomiting incident. Austin reduced the flow of his food, but it in half so that he was still getting some nutrition. He also seemed a little feverish, even to Austin, and his blood pressure dropped a little bit, but not enough to be concerning When he woke up, his eyes were clearer and he was a little more interactive.
Right before I left his food pump beeped that it had finished the bottle, but there was still a good 3-4 inches left, so I just continued it. I found his new nurse Toya to let her know I was leaving and to tell her what I had done. The charge nurse Sara said they needed to put me on payroll. I don't want the work, just the badge to get in and out easier!
Our local grocery store is doing senior shopping 3 days a week, and Sunday is one of the days. I need supplies so I'm going to go this morning before going to the hospital. I told Bill I would be late and why but he probably won't remember. So, I also told Caleb so that he could remind him. I don't need a lot of things, since I stopped at Dollar General on the way home the other night. It wasn't really busy and they had eggs and bread. I don't need toilet paper or paper towels, scored them earlier, but I do need some food for me and the never ending cat food. I'm getting really tired of frozen or canned dinners, and fast food. I try to eat my main meal at the hospital. But, at the same time, I'm too tired to try to cook any kind of "real" food when I get home. So, I don't know what I'm going to get. It will also depend on what they have.
I was listening to the announcements at the hospital. Usually they are just for Codes Blue and Purple. Everyone knows what Code Blue is I'm sure, and Code Purple is when a patient has walked off. Usually that's from the ER and they've gone out to smoke. Lately there have been a lot from the 5th floor. That is where they are putting all of the COVID-19 patients. There weren't any walk-aways, but there were several pages for Code Transport from ER room such and such to 5west. I know they admitted 5 patients yesterday, most likely pending test results. Brings it home a little more.
That's it for now. I need to get in the shower and get cleaned up some. Feels funny to say that at this time of morning. Usually it's get my stuff gathered to get out the door. I'll let you know how today goes!
Saturday, March 28, 2020
Bill said he had a decent night and got some sleep. He was awake when I got there and the first thing he did was reach for my head and face, not just a finger or two, but his whole hand.
He's already had his bath and meds and is watching TV. He's interacted with everyone who has come in, even if it's to cut his eyes away.
His nurse, Austin, took the time, against the rules, to trim a few of his toenails. There were a couple that were just about to cut into the other toes. He also really looked at his left arm. Bill had been complaining that it hurt and it had been swollen and angry looking. It doesn't seem to be as sore today. Austin was mashing on it around his midline site pretty good and Bill didn't flinch. He's still draining a lot of blood, and they are still running the irrigation through. I've only seen one nurse practitioner and she's with cardiology. I don't know if the urologist will come by or not. He, like Dr. Edwards, is rather elusive.
This morning I was questioned when I got to the hospital and had to tell them what floor I was going to and what room. Then they called the unit to see if he could have visitors. It didn't take too long and it didn't bother me that it was done. I'm just surprised that it took them this long.
That's it for this update. I realize it's a short one, but since I left shortly after I posted the last one yesterday, I don't have a lot to relate. So, at some point today, or tonight, there will be another post about the rest of the day.
Enjoy your Saturday. I know some of you are supposed to get some strong storms, so stay safe. We are supposed to get some of the storms, but we are on the weaker side. Of course they are supposed to come about the time I would be leaving. But, I have my rain gear and I was able to park close to the front door, so I should be fine, if a little wet.
He's already had his bath and meds and is watching TV. He's interacted with everyone who has come in, even if it's to cut his eyes away.
His nurse, Austin, took the time, against the rules, to trim a few of his toenails. There were a couple that were just about to cut into the other toes. He also really looked at his left arm. Bill had been complaining that it hurt and it had been swollen and angry looking. It doesn't seem to be as sore today. Austin was mashing on it around his midline site pretty good and Bill didn't flinch. He's still draining a lot of blood, and they are still running the irrigation through. I've only seen one nurse practitioner and she's with cardiology. I don't know if the urologist will come by or not. He, like Dr. Edwards, is rather elusive.
This morning I was questioned when I got to the hospital and had to tell them what floor I was going to and what room. Then they called the unit to see if he could have visitors. It didn't take too long and it didn't bother me that it was done. I'm just surprised that it took them this long.
That's it for this update. I realize it's a short one, but since I left shortly after I posted the last one yesterday, I don't have a lot to relate. So, at some point today, or tonight, there will be another post about the rest of the day.
Enjoy your Saturday. I know some of you are supposed to get some strong storms, so stay safe. We are supposed to get some of the storms, but we are on the weaker side. Of course they are supposed to come about the time I would be leaving. But, I have my rain gear and I was able to park close to the front door, so I should be fine, if a little wet.
Friday, March 27, 2020
It's over! They got Bill about 1:30 and he was back in the room at 2:15.
Everything went fine. They removed a fist sized clot. It may have been bigger but Sharon was getting lots of clots when she was irrigating before they took him so she was probably breaking pieces off. They didn't see any active bleeds and I asked if there was any indication of what started it to begin with and they had no idea. She said that this sometimes happens when patients were on blood thinners.
They did not have to use any sedation, just some fentanyl for pain, and it makes him sleep. He's been awake some since they brought him back. But he's already been cleaned up again and his food started and all of his vitals are good.
The catheter he has now is a triple. What this means is it has 3 ports. One of the ports is being used for constant irrigation. The color of output now is pink and Sharon said it may take a couple of days before it's completely cleared. But, I'll take that. At least they didn't find any other problems. His stomach is already much softer. Now we just have to keep his hands away from it!
He'll probably sleep for awhile longer. I don't know how long I will stay, probably not overnight unless something happens in the next few hours.
So, there you have it. Hopefully this will help with all of the infections popping up.
Everything went fine. They removed a fist sized clot. It may have been bigger but Sharon was getting lots of clots when she was irrigating before they took him so she was probably breaking pieces off. They didn't see any active bleeds and I asked if there was any indication of what started it to begin with and they had no idea. She said that this sometimes happens when patients were on blood thinners.
They did not have to use any sedation, just some fentanyl for pain, and it makes him sleep. He's been awake some since they brought him back. But he's already been cleaned up again and his food started and all of his vitals are good.
The catheter he has now is a triple. What this means is it has 3 ports. One of the ports is being used for constant irrigation. The color of output now is pink and Sharon said it may take a couple of days before it's completely cleared. But, I'll take that. At least they didn't find any other problems. His stomach is already much softer. Now we just have to keep his hands away from it!
He'll probably sleep for awhile longer. I don't know how long I will stay, probably not overnight unless something happens in the next few hours.
So, there you have it. Hopefully this will help with all of the infections popping up.
It's been a very busy morning already so I'll just jump right in.
Bill was awake when I got here and said that he was OK and he thought he slept some. But, since that time he's been sleeping more. I noticed that he had nothing running, including his food, so that told me they found something on the CT and there was going to be a procedure.
Sharon, his nurse who also had him yesterday, said that all she knew was the scan showed his bladder full of blood and clots and they were going to scope it and clean it out. But, she said they hadn't heard from the urologist and I had not. Dr. Edwards popped in and asked if I had heard and I had not so he explained what they saw and that it explained that he was nearly septic from this and it explained all of the bacteria they were seeing in all of the cultures. He said he would get the dr. on the phone, and he called him right then, and then texted him.
The dr. called back and said that they were going to go in and clean out all the blood and clots. He didn't think there were any new bleeds that it was all old. He said if he found any active bleeds he would burn them. The procedure is scheduled for 12:30 and he said it would take about 15 minutes. Getting him moved and prepped would take longer. They are going to do it in the OR instead of bedside to be more comfortable for Bill.
Dr. Threlkeld said they have sent some cultures off from the urinalysis they did they other day but he didn't think anything would come of it.
He's going to stay on vent, probably through the day since they are doing the surgery. Yesterday he was on CPAP again until they took him for the scan and then he went back on and stayed on the vent for the night. Dr. Sharma thinks we'll just go back and forth a while before trying trach collar again.
The visitor policy has changed again. They are still allowing visitors, but only 1 per patient at a time and we have to stay in the room for at least 4 hours at a time. We can leave the room to go to the bathroom during that 4 hours since it is in the unit. An additional visitor can wait in the waiting room, but the 4 hour block cannot be broken to swap people. After the 4 hours yes, they can swap positions. They are also not allowing overnight guests in the waiting room unless you prove you live out of town. Of course, I will stay in Bill's room if I need to stay over.
I brought all of my meds and some extra clothes today and am prepared to call Bri to be on cat duty. But, I don't think there will be a problem, at least for a few more days and Jennifer said she will make sure I have access.
That's where we stand now. I'll update again after the procedure is done and I talk to Dr. Greenberger.
Bill was awake when I got here and said that he was OK and he thought he slept some. But, since that time he's been sleeping more. I noticed that he had nothing running, including his food, so that told me they found something on the CT and there was going to be a procedure.
Sharon, his nurse who also had him yesterday, said that all she knew was the scan showed his bladder full of blood and clots and they were going to scope it and clean it out. But, she said they hadn't heard from the urologist and I had not. Dr. Edwards popped in and asked if I had heard and I had not so he explained what they saw and that it explained that he was nearly septic from this and it explained all of the bacteria they were seeing in all of the cultures. He said he would get the dr. on the phone, and he called him right then, and then texted him.
The dr. called back and said that they were going to go in and clean out all the blood and clots. He didn't think there were any new bleeds that it was all old. He said if he found any active bleeds he would burn them. The procedure is scheduled for 12:30 and he said it would take about 15 minutes. Getting him moved and prepped would take longer. They are going to do it in the OR instead of bedside to be more comfortable for Bill.
Dr. Threlkeld said they have sent some cultures off from the urinalysis they did they other day but he didn't think anything would come of it.
He's going to stay on vent, probably through the day since they are doing the surgery. Yesterday he was on CPAP again until they took him for the scan and then he went back on and stayed on the vent for the night. Dr. Sharma thinks we'll just go back and forth a while before trying trach collar again.
The visitor policy has changed again. They are still allowing visitors, but only 1 per patient at a time and we have to stay in the room for at least 4 hours at a time. We can leave the room to go to the bathroom during that 4 hours since it is in the unit. An additional visitor can wait in the waiting room, but the 4 hour block cannot be broken to swap people. After the 4 hours yes, they can swap positions. They are also not allowing overnight guests in the waiting room unless you prove you live out of town. Of course, I will stay in Bill's room if I need to stay over.
I brought all of my meds and some extra clothes today and am prepared to call Bri to be on cat duty. But, I don't think there will be a problem, at least for a few more days and Jennifer said she will make sure I have access.
That's where we stand now. I'll update again after the procedure is done and I talk to Dr. Greenberger.
Thursday, March 26, 2020
Good Morning!
I didn't have too bad a night. The chair is not exactly comfortable (it is a recliner, just not padded much, and his nurse was very quiet. Bill was awake most of the night, so of course he's sleeping now and will probably want to all day!
All of his numbers stayed good through the night and at some point they removed the defibrilalator. I heard it beeping in the night and that gave me a start, but the room was dark and there wasn't anyone else in here, and then it stopped, so I don't know what the deal was. And, now it's gone.
I didn't have too bad a night. The chair is not exactly comfortable (it is a recliner, just not padded much, and his nurse was very quiet. Bill was awake most of the night, so of course he's sleeping now and will probably want to all day!
All of his numbers stayed good through the night and at some point they removed the defibrilalator. I heard it beeping in the night and that gave me a start, but the room was dark and there wasn't anyone else in here, and then it stopped, so I don't know what the deal was. And, now it's gone.
The blood cultures drawn yesterday grew some gram positive bacteria. I don't know if that's the resistant kind or not. The stool culture also showed, I think I overheard staph from the nurses but not sure. So, daptomycin in addition to the merrem for antibiotics. They are drawing more cultures this morning and they have not been able to get all of it. They draw 2 bottles that have a medium of something from either the midline or PICC line, and then they have to draw the same 2 bottles from a different stick site. And because his veins are so fragile, they have a hard time. They've only been able to get one of the bottles, and they aren't sure they got enough in it. So, they are going to try again in a little bit. The others have already been sent off to the lab.
The fluids have caused his hematocrit to drop to 19, so he's going to get 2 units of blood. The first one is running now and is almost done. The other one has been ordered.
Dr. Sharma said that since he is stable again he wants to try CPAP again. So, Crystal is going to come back and switch him over in a bit. I still want to check on what meds he got on Tuesday night to make sure he wasn't just over medicated, causing the problem. All he got last night was the Seroquel and he stayed calm enough, just not sleepy. He did fidget with his gown a lot and still kept reaching for his catheter and vent tubing.
His left arm and hand are swollen today, so swollen that Sharon had to cut his arm band off that said one of his lines was a midline and not a PICC line.
Dr. Greenberger did not put in any orders or notes for the abdominal CT and the nurse has tried to call him, but wasn't able to reach him. So, I don't know what will come of that.
The only Dr. I've seen so far is Dr. Sharma. Hopefully the others, or their nurses will start to come before long.
I'm planning on going home tonight, unless Jennifer comes and says that I might not want to leave. In that case Emily will pick up clothes and meds and meet someone from the staff at the door and I'll just have to stay on lock-down. They've all told me I need to be put on payroll since I keep so many notes and can tell them when things happen. I tell them I just want an employee badge!
That's it for this morning. I'll update again later when I know more, or something happens.
Wednesday, March 25, 2020
This should be the last post of the night. I'm staying at the hospital. Since I've only had about 3 hours sleep, 2 of them nearly 24 hours ago and a catnap this afternoon, I decided that I shouldn't try to make the drive home.
Bill is relatively stable again. He's been awake all day and his numbers have been good. He's still getting the meds to keep his heart rate stable and his blood pressure up, but they have been turned down to lower drips. They will continue to be adjusted as the need arises. He's also getting albumin to give a little volume and some half saline solution, which is normal saline with more water. He also has an IV antibiotic plus a nebulized one, in addition to his regular medicines and breathing treatments.
He seems to be a little agitated, and a little muddled. He keeps worrying with his hospital gown and all of his tubes and wires. I'm afraid he's going to pull his catheter or vent tubing out. The only solution would be to restrain him and no-one wants to do that So, I'm just staying as vigilant as I can until I have to sleep. He also doesn't really respond to questions, and it seems like it takes a longer time for him to process things. Watching him today, the way he was this morning, compared to the day, I've wondered if he was over medicated with his anxiety meds, which may have contributed to everything. It's just hard to say. I did suggest this to Tyler, his nurse, but she just shrugged it off.
His PICC line came out today. The nurse who put it in forgot to put the lock on it. So, another one had to be done. This one is good so far.
The urologist, Dr. Greenberg came in earlier this evening, asked a lot of questions, looked at the collection, asked more questions, and is going to schedule an abdominal CT. Depending on what that shows, he's talked about a scope. And it can be done bedside, in the OR, or when Bill gets out of the hospital, which most likely is not going to happen. But, we'll see what the CT shows first.
He did get his unit of blood this afternoon and they collected a stool sample to make sure nothing was going on there.
That's about it for the day. It's been a long one and even though Frank will be in and out all night hanging and checking IVs, I do believe that I will be able to get some sleep. I am planning on going home tomorrow night to replenish meds and clothes while I can. And, of course, I'll keep you updated as needed.
Goodnight!
Bill is relatively stable again. He's been awake all day and his numbers have been good. He's still getting the meds to keep his heart rate stable and his blood pressure up, but they have been turned down to lower drips. They will continue to be adjusted as the need arises. He's also getting albumin to give a little volume and some half saline solution, which is normal saline with more water. He also has an IV antibiotic plus a nebulized one, in addition to his regular medicines and breathing treatments.
He seems to be a little agitated, and a little muddled. He keeps worrying with his hospital gown and all of his tubes and wires. I'm afraid he's going to pull his catheter or vent tubing out. The only solution would be to restrain him and no-one wants to do that So, I'm just staying as vigilant as I can until I have to sleep. He also doesn't really respond to questions, and it seems like it takes a longer time for him to process things. Watching him today, the way he was this morning, compared to the day, I've wondered if he was over medicated with his anxiety meds, which may have contributed to everything. It's just hard to say. I did suggest this to Tyler, his nurse, but she just shrugged it off.
His PICC line came out today. The nurse who put it in forgot to put the lock on it. So, another one had to be done. This one is good so far.
The urologist, Dr. Greenberg came in earlier this evening, asked a lot of questions, looked at the collection, asked more questions, and is going to schedule an abdominal CT. Depending on what that shows, he's talked about a scope. And it can be done bedside, in the OR, or when Bill gets out of the hospital, which most likely is not going to happen. But, we'll see what the CT shows first.
He did get his unit of blood this afternoon and they collected a stool sample to make sure nothing was going on there.
That's about it for the day. It's been a long one and even though Frank will be in and out all night hanging and checking IVs, I do believe that I will be able to get some sleep. I am planning on going home tomorrow night to replenish meds and clothes while I can. And, of course, I'll keep you updated as needed.
Goodnight!
It's now almost noon, nearly 12 hours after getting the call to come to the hospital. A lot has happened this morning. A new line was placed to have more access for the drugs. He's almost off of one of them as his heart rate is pretty stable now. They have the one for his blood pressure on standby as it has come up to an acceptable number. At it's lowest, at least what I saw, was 66/47. They have it taking every 5 minutes and it is now perfect at 122/71.
He finally roused up and opened his eyes. He didn't look directly at me, but he tracked to the sound of my voice. And shortly after that, they were placing the PICC line, and he woke up and looked mad! It was like what are you doing to me? He stayed awake during his bath and helped a bit by reaching for the rails. He did spit up a little when they were turning him, but not much.
Dr. Edwards thinks that it is an infection, and he says this happens when you've been in ICU for a long time. Dr. Threlkeld thinks it might be an infection that occurs in transplants sometimes. They were both going to look at all the labs and urine cultures and see what they show. I asked Dr. Edwards about the urology consult and he said the ones that are usually here are normal ones, the ones he uses are the elite and they do things on their own time.
He has been feeling the urge to urinate, and I've been having trouble keeping his hands away. I don't want him pulling the Foley out! We don't need anymore trauma!
His nurse just told me that his hemaglobin is low so, she's got to do yet another blood draw, most likely for a type and crossmatch and then he will probably get some blood. That usually perks him up, and since he is losing so much in his urine, it makes sense.
The hospital has instituted yet another precaution. Everyone has to wear a mask now. It is difficult to get used to, my glasses keep fogging up! They have also instituted a no visitor policy except for certain patients. Our nurse manager told the board that is making the decisions that she has wives who sit with critically ill husbands. She said as long as we just sit in the room except for meals and bathroom breaks, there won't be a problem. And she said if it came down to no visitors at all, she would let me know that I probably spend the night. Crystal from respiratory said that they could take my dirty clothes to the little laundry to wash them so I wouldn't be seen, and if Emily needed to bring me more medicine, any staff member would be glad to meet her at an entrance to get them. That way, I don't have to step out the door and then be told I can't come back in. I think I already reported that the gift shope and Starbucks are now closed also. It still doesn't make a lot of sense to me that family members can't eat in the cafeteria with the employees because we have all been screened and approved to be in the facility. But, I'm not going to make waves!
That's it for this one. More as the day progresses!
He finally roused up and opened his eyes. He didn't look directly at me, but he tracked to the sound of my voice. And shortly after that, they were placing the PICC line, and he woke up and looked mad! It was like what are you doing to me? He stayed awake during his bath and helped a bit by reaching for the rails. He did spit up a little when they were turning him, but not much.
Dr. Edwards thinks that it is an infection, and he says this happens when you've been in ICU for a long time. Dr. Threlkeld thinks it might be an infection that occurs in transplants sometimes. They were both going to look at all the labs and urine cultures and see what they show. I asked Dr. Edwards about the urology consult and he said the ones that are usually here are normal ones, the ones he uses are the elite and they do things on their own time.
He has been feeling the urge to urinate, and I've been having trouble keeping his hands away. I don't want him pulling the Foley out! We don't need anymore trauma!
His nurse just told me that his hemaglobin is low so, she's got to do yet another blood draw, most likely for a type and crossmatch and then he will probably get some blood. That usually perks him up, and since he is losing so much in his urine, it makes sense.
The hospital has instituted yet another precaution. Everyone has to wear a mask now. It is difficult to get used to, my glasses keep fogging up! They have also instituted a no visitor policy except for certain patients. Our nurse manager told the board that is making the decisions that she has wives who sit with critically ill husbands. She said as long as we just sit in the room except for meals and bathroom breaks, there won't be a problem. And she said if it came down to no visitors at all, she would let me know that I probably spend the night. Crystal from respiratory said that they could take my dirty clothes to the little laundry to wash them so I wouldn't be seen, and if Emily needed to bring me more medicine, any staff member would be glad to meet her at an entrance to get them. That way, I don't have to step out the door and then be told I can't come back in. I think I already reported that the gift shope and Starbucks are now closed also. It still doesn't make a lot of sense to me that family members can't eat in the cafeteria with the employees because we have all been screened and approved to be in the facility. But, I'm not going to make waves!
That's it for this one. More as the day progresses!
It's 2:16 am, and I'm sitting in Bill's hospital room, listening to all the beeps and buzzes, and watching him sleep. What started as a momentous day yesterday, ended with a crash.
Yesterday when I got to the hospital, he was awake and alert and responding. He asked me to take off the vent and I told him I couldn't do that or he would die...and he said OK, to let him die! I told him if that was what he really wanted, we would do that, but he wouldn't be able to change his mind, so he decided to think about it.
When Dr. Okpor the pulmonologist came he, he looked at all his numbers, nodded his head and told respiratory to put him in CPAP mode! And, Dr. Sharma told her that if he did well for 4-6 hours, to put him on trach collar! So, from 8:33 until 12:33 he was on CPAP and then he spent the rest of the day on trach collar! He did quite well. His initial sats were in the upper 80s, which is the lower end of his acceptable range. I only had to remind him a couple of times to take a deep breath when he would drop. He hadn't even been on it an hour when Travis came in for physical therapy and he did really well, only dropped to the upper 70s once and rebounded quickly. So we were quite pleased with that.
We had a favorite nurse, Diane, yesterday and she was quite concerned with the blood in his urine, and the amount. It has increased considerably and it looked like it was all blood, and lots of it in his brief. She called Dr Edwards and he requested a urology consult and complete urinalysis done.
They also came to do an abdominal ultrasound since the x-ray was inconclusive. The also checked his lower left leg as it was quite swollen from the knee down. I also told her that I had noticed that he now had a belly and told her she would see what I meant when she came to bathe him.
When they removed his gown she told me she saw what I meant and said that looked like his bladder area. She palpated it and he said that it hurt and she said it was very tense, so after his bath she got a bladder scanner and he was full. So, they had to insert a Foley catheter to drain it.
This may get a little too graphic for some of you. If you remember, I had been telling them for about 3 weeks that there was blood in his urine, every doctor, nurse, nurse practitioner, anyone who would listen. What they drained from his bladder didn't look like urine in any way, shape, or form. It looks like almost pure blood, complete with clots of various sizes. When I got back into the room after the Foley was placed, they told me they had already drained over a liter and he was still putting out. When I left the hospital, they had charted 1423 cc, and the collection bag was again half full. You could also see a significant difference in his belly size! I don't know if he was holding the urine because, after 77 years, it's very hard to learn to just go, especially while you are cognizant.
I left the hospital a little after 6 and he was still awake and aware. I told him I would see him in the morning and he reached up and caressed my cheek with one finger, down to my chin and then up the other cheek. I've missed that!
Now, the reason I'm writing this at 2 am. The hospital called at 12:30 and said that he had crashed, his heart rate had dropped to the 40s again and his blood pressure got dangerously low. He was initially unresponsive, but they were able to get him to respond. They called Dr. Edwards and he ordered some drugs, one to keep his blood pressure up, one to keep his heart rate up, and some albumin to give him some blood volume. That worked for a bit and his heart rate dropped again. The drug was increased and he stabilized. They do have a diffibulator attached, just in case he goes into cardiac arrest, but they haven't had to use it. He is back on the vent, but he was going to go back on anyway for the night. He was at 100% oxygen for awhile, but it's been cut back to either 60 or 70% now. I don't remember which he said, and since he's working on him, I don't want to get up and walk around the bed to look.
Cole, the nurse said that the abdominal ultrasound showed some cysts on his gall bladder. It also showed the cyst on his kidney, so my theory of it rupturing and causing the blood. The ultrasound of the leg did not show any clots, so we're unsure of what was causing the swelling. But, it's not swollen now, or not as much. Cole didn't think it would have been because of the bladder being so full, unless it was the kidneys filtering and it not having anywhere to go.
His potassium level is high and Cole is now trying to draw some blood to do a full electrolyte panel, but he's having a hard time. Because of the IVs and the importance of the drugs he's getting, he's reluctant to stop the meds to use the midline. But, every time he finds a vein it blows almost as soon as he gets the needle in.
I'm OK, did a lot of praying on the way down, mainly to let him still be alive when I got here, and that prayer was answered. I'm still at peace with our decision to let him go, and if that time is now, so be it. At least we had a good day yesterday. I made it here in less than an hour. I won't say just how fast I was driving, but I don't think I ever hit 100. I did look at my watch and I left the house at 12:44, less than 20 minutes after Cole called, and I got on the elevator at 1:42.
So, what was supposed to be a happy post, has now turned to a serious one, and the outcome again doesn't look good. But, he has surprised us before. I'll update during the day today so keep checking back. Keep the prayers coming.
Yesterday when I got to the hospital, he was awake and alert and responding. He asked me to take off the vent and I told him I couldn't do that or he would die...and he said OK, to let him die! I told him if that was what he really wanted, we would do that, but he wouldn't be able to change his mind, so he decided to think about it.
When Dr. Okpor the pulmonologist came he, he looked at all his numbers, nodded his head and told respiratory to put him in CPAP mode! And, Dr. Sharma told her that if he did well for 4-6 hours, to put him on trach collar! So, from 8:33 until 12:33 he was on CPAP and then he spent the rest of the day on trach collar! He did quite well. His initial sats were in the upper 80s, which is the lower end of his acceptable range. I only had to remind him a couple of times to take a deep breath when he would drop. He hadn't even been on it an hour when Travis came in for physical therapy and he did really well, only dropped to the upper 70s once and rebounded quickly. So we were quite pleased with that.
We had a favorite nurse, Diane, yesterday and she was quite concerned with the blood in his urine, and the amount. It has increased considerably and it looked like it was all blood, and lots of it in his brief. She called Dr Edwards and he requested a urology consult and complete urinalysis done.
They also came to do an abdominal ultrasound since the x-ray was inconclusive. The also checked his lower left leg as it was quite swollen from the knee down. I also told her that I had noticed that he now had a belly and told her she would see what I meant when she came to bathe him.
When they removed his gown she told me she saw what I meant and said that looked like his bladder area. She palpated it and he said that it hurt and she said it was very tense, so after his bath she got a bladder scanner and he was full. So, they had to insert a Foley catheter to drain it.
This may get a little too graphic for some of you. If you remember, I had been telling them for about 3 weeks that there was blood in his urine, every doctor, nurse, nurse practitioner, anyone who would listen. What they drained from his bladder didn't look like urine in any way, shape, or form. It looks like almost pure blood, complete with clots of various sizes. When I got back into the room after the Foley was placed, they told me they had already drained over a liter and he was still putting out. When I left the hospital, they had charted 1423 cc, and the collection bag was again half full. You could also see a significant difference in his belly size! I don't know if he was holding the urine because, after 77 years, it's very hard to learn to just go, especially while you are cognizant.
I left the hospital a little after 6 and he was still awake and aware. I told him I would see him in the morning and he reached up and caressed my cheek with one finger, down to my chin and then up the other cheek. I've missed that!
Now, the reason I'm writing this at 2 am. The hospital called at 12:30 and said that he had crashed, his heart rate had dropped to the 40s again and his blood pressure got dangerously low. He was initially unresponsive, but they were able to get him to respond. They called Dr. Edwards and he ordered some drugs, one to keep his blood pressure up, one to keep his heart rate up, and some albumin to give him some blood volume. That worked for a bit and his heart rate dropped again. The drug was increased and he stabilized. They do have a diffibulator attached, just in case he goes into cardiac arrest, but they haven't had to use it. He is back on the vent, but he was going to go back on anyway for the night. He was at 100% oxygen for awhile, but it's been cut back to either 60 or 70% now. I don't remember which he said, and since he's working on him, I don't want to get up and walk around the bed to look.
Cole, the nurse said that the abdominal ultrasound showed some cysts on his gall bladder. It also showed the cyst on his kidney, so my theory of it rupturing and causing the blood. The ultrasound of the leg did not show any clots, so we're unsure of what was causing the swelling. But, it's not swollen now, or not as much. Cole didn't think it would have been because of the bladder being so full, unless it was the kidneys filtering and it not having anywhere to go.
His potassium level is high and Cole is now trying to draw some blood to do a full electrolyte panel, but he's having a hard time. Because of the IVs and the importance of the drugs he's getting, he's reluctant to stop the meds to use the midline. But, every time he finds a vein it blows almost as soon as he gets the needle in.
I'm OK, did a lot of praying on the way down, mainly to let him still be alive when I got here, and that prayer was answered. I'm still at peace with our decision to let him go, and if that time is now, so be it. At least we had a good day yesterday. I made it here in less than an hour. I won't say just how fast I was driving, but I don't think I ever hit 100. I did look at my watch and I left the house at 12:44, less than 20 minutes after Cole called, and I got on the elevator at 1:42.
So, what was supposed to be a happy post, has now turned to a serious one, and the outcome again doesn't look good. But, he has surprised us before. I'll update during the day today so keep checking back. Keep the prayers coming.
Tuesday, March 24, 2020
Yesterday was the best day of the last few days. Bill still slept a lot, but he did wake up and responded to questions. His numbers on his monitor were great. His heart rate was under 100 for the first time in 3 days.
Dr. Okpor, the lung doctor on this week, came in, didn't say anything except to ask who I was in relation to Bill and ask if I had any questions. I asked about the chest x-ray and he said he hadn't looked at it but would and left. That was the last I saw of him.
Between others coming in, and I have a headache this morning and can't even really think, I learned that the abdominal x-ray didn't show anything abnormal, and the chest x-ray didn't show any new aspirations. So that was a relief. Allison did turn his tube feeds down to 20 mL from his usual 40 and he had no episodes of vomiting yesterday, although he was pretty gurgly at times.
He had some therapy and Jody told me she could tell that he was actually moving his limbs himself, that she wasn't doing all of the work. He sat on the edge of the bed for about 3 minutes, with support, and then got back to bed. She could tell that wore him out.
Respiratory tried to turn his oxygen down to 40% again, but his sats started dropping. He seems to like a concentration of 50% the best. As soon as it was turned back up, his numbers went back up.
He helped some with his bath, turning and pulling himself over using the bed rails and he hadn't done that in several days. After his bath he was really zonked!
Dr. Threlkeld came in late in the day, which is unusual for him, and said that he has the kind of asthma that produces a cough and he coughed really hard in the morning...and broke a rib! So he wasn't going to bend down to listen to him and that Janet would be by later. She did come by and checked him out. She's so gentle with him. She agrees that it is probably the cyst on his kidney that has ruptured causing the blood. Now, not only is there blood in his urine, but he just kind of seeps blood all the time. But, again, his numbers are good as far as that goes.
She did say that the end of the midline that we sent off to the lab has grown a bacteria, they are just waiting now to see what bacteria so they can adjust the antibiotic if necessary. She believes that that was the cause of everything that went on over the week-end.
Hmm, I hope that was a car starting down the street and not thunder, although there are supposed to be some storms this morning. Then again, maybe if the rain would start my head would stop hurting.
Memphis has initiated a 6 pm curfew starting last night. I think I'll be OK since I'm usually out of the city by that time. I have a couple of things going for me, I don't live in Memphis, so I can say I'm just trying to get out of the city, and I'll be on the highway, and they can't shut those down. So far there are still no problems getting into the hospital. They have now shut down the Starbucks and the gift shop, but that may be more the city than the hospital. I can also stay at the hospital if necessary.
I've become the keeper of the gowns left in the room, as to who put theirs where. I fell down on the job when Tyler's went missing. I think it probably got knocked to the floor and thrown away after Bill's bath. But, they finally got some of the plastic ones so the ones who come in and out of the rooms can use those. Bill is now the only isolation patient in the unit.
That's it, I'm running late, but I'm tired with a headache, so I'm not going to rush. There has been less traffic except for trucks so I've been getting good parking spaces and it's not taking as long to drive it since there are less cars on the road.
More later.
Dr. Okpor, the lung doctor on this week, came in, didn't say anything except to ask who I was in relation to Bill and ask if I had any questions. I asked about the chest x-ray and he said he hadn't looked at it but would and left. That was the last I saw of him.
Between others coming in, and I have a headache this morning and can't even really think, I learned that the abdominal x-ray didn't show anything abnormal, and the chest x-ray didn't show any new aspirations. So that was a relief. Allison did turn his tube feeds down to 20 mL from his usual 40 and he had no episodes of vomiting yesterday, although he was pretty gurgly at times.
He had some therapy and Jody told me she could tell that he was actually moving his limbs himself, that she wasn't doing all of the work. He sat on the edge of the bed for about 3 minutes, with support, and then got back to bed. She could tell that wore him out.
Respiratory tried to turn his oxygen down to 40% again, but his sats started dropping. He seems to like a concentration of 50% the best. As soon as it was turned back up, his numbers went back up.
He helped some with his bath, turning and pulling himself over using the bed rails and he hadn't done that in several days. After his bath he was really zonked!
Dr. Threlkeld came in late in the day, which is unusual for him, and said that he has the kind of asthma that produces a cough and he coughed really hard in the morning...and broke a rib! So he wasn't going to bend down to listen to him and that Janet would be by later. She did come by and checked him out. She's so gentle with him. She agrees that it is probably the cyst on his kidney that has ruptured causing the blood. Now, not only is there blood in his urine, but he just kind of seeps blood all the time. But, again, his numbers are good as far as that goes.
She did say that the end of the midline that we sent off to the lab has grown a bacteria, they are just waiting now to see what bacteria so they can adjust the antibiotic if necessary. She believes that that was the cause of everything that went on over the week-end.
Hmm, I hope that was a car starting down the street and not thunder, although there are supposed to be some storms this morning. Then again, maybe if the rain would start my head would stop hurting.
Memphis has initiated a 6 pm curfew starting last night. I think I'll be OK since I'm usually out of the city by that time. I have a couple of things going for me, I don't live in Memphis, so I can say I'm just trying to get out of the city, and I'll be on the highway, and they can't shut those down. So far there are still no problems getting into the hospital. They have now shut down the Starbucks and the gift shop, but that may be more the city than the hospital. I can also stay at the hospital if necessary.
I've become the keeper of the gowns left in the room, as to who put theirs where. I fell down on the job when Tyler's went missing. I think it probably got knocked to the floor and thrown away after Bill's bath. But, they finally got some of the plastic ones so the ones who come in and out of the rooms can use those. Bill is now the only isolation patient in the unit.
That's it, I'm running late, but I'm tired with a headache, so I'm not going to rush. There has been less traffic except for trucks so I've been getting good parking spaces and it's not taking as long to drive it since there are less cars on the road.
More later.
Sunday, March 22, 2020
When I got to the hospital this morning, Bill was bright-eyed and aware. I asked if he slept well and he nodded. He said he felt better and I told him that I thought some of the doctors thought yesterday that he was ready to check out, and he said "Maybe". Now, I don't know what the maybe meant, that he was ready to stop fighting, or if he thought they meant he could be discharged. And that was the last he really communicated to anyone for the rest of the day.
Molly came in to give him his morning meds and then she wanted to change him, so we did that. His gown was damp and as soon as we got the new gown on...he threw up again. Not as much as the other day and it looked more like bile. Molly got him some Zofran immediately and got it into him. We got him cleaned up again and when Dr. Yaranov came in, he ordered his food to be held for 6 hours and after examining him, ordered not only a chest x-ray, but an abdominal x-ray. He said that his abdomen was very tense to palpation.
Dr. Nowak came in and said that the blood culture taken from the midline came back gram negative, which means infection, but the blood drawn from the other area was not. So, the midline was pulled today and a PICC line placed instead.
Dr. Schreiner mentioned using sodium bicarb in his nebulizer. I told him Dr. Smith mentioned the same thing last week. I'm not really sure what that would do, but he said it's an old-fashioned treatment. He was going to talk to the respiratory tech about it, but that's all I know.
They came to do the x-rays and the PICC line back to back at lunch time, so I went to get something to eat. Since there's no eating in the cafeteria except for employees, there are three small tables in the vending machine/ATM room. Luckily one of those was empty. To practice "social distancing" there was only 1 chair at each table. A couple did come in after a man left and they did pull up another chair, but I thought it interesting that there were 3 people eating, 1 at each table.
Bill was asleep when I got back to the room and the only time he woke up was during his bath when he was turned. But, he didn't talk to either of the nurses or me. And as soon as he was settled, he was right back out.
The nurses noticed the blood in his urine and as they turned him he went again so Abby just used a towel. When it was moved, it looked like all blood. They have been documenting it in his chart, and I told them that I had reported it to every doctor and they had seen it in the collection bag when they were using the catheter, but none of them seemed too concerned. So, we're still at a loss as to what is causing it, unless something shows up on the x-ray. I won't know anything about those results until tomorrow when the doctors round, and they won't generally volunteer the information.
So, it seems like our good days have ended. All of his numbers were good, but he did have some episodes of V-tach again. They don't last long, but it means there's something going on. I told Bill again that it was OK if he was ready, I would be OK and that we've had a great life for the last 30 years. But, while he still responds to pain or stimulation, I will not have him removed from the vent. That tells me that HE is still there, even if he doesn't respond to commands.
I'm still at peace with the decisions we made as a family to let him go when the time comes. That's not to say it will be easy.
So, a few good minutes this morning and then an afternoon of him sleeping.
There is a real shortage now of isolation gowns. They've brought some up from the surgical suites. Today, his nurse and the respiratory tech left their gowns on either side of his open door so they could tell which one was theirs. As of right now, he is the only isolation patient in the unit. The doctors weren't sure what to do. I suggested they take off their white coats before they came in. It would kind of work like putting on a protective gown, only in reverse. But, none of them seemed to like the idea much. I guess the status symbol of the white coat is really strong.
The hospital was very quiet all day. Starbucks is always closed on Sunday, but today the gift shop was also closed, at least it was when I left at 4. There was a sign on the door, but I didn't stop to read it. It was even quiet when I got there. Usually there's a line to get in, but today there were only 2 employees in front of me. Maybe because it's Sunday and people were at church and came in the afternoon. But, it is rather eerie.
That's it for today. Let's hope and pray for a better day tomorrow.
Molly came in to give him his morning meds and then she wanted to change him, so we did that. His gown was damp and as soon as we got the new gown on...he threw up again. Not as much as the other day and it looked more like bile. Molly got him some Zofran immediately and got it into him. We got him cleaned up again and when Dr. Yaranov came in, he ordered his food to be held for 6 hours and after examining him, ordered not only a chest x-ray, but an abdominal x-ray. He said that his abdomen was very tense to palpation.
Dr. Nowak came in and said that the blood culture taken from the midline came back gram negative, which means infection, but the blood drawn from the other area was not. So, the midline was pulled today and a PICC line placed instead.
Dr. Schreiner mentioned using sodium bicarb in his nebulizer. I told him Dr. Smith mentioned the same thing last week. I'm not really sure what that would do, but he said it's an old-fashioned treatment. He was going to talk to the respiratory tech about it, but that's all I know.
They came to do the x-rays and the PICC line back to back at lunch time, so I went to get something to eat. Since there's no eating in the cafeteria except for employees, there are three small tables in the vending machine/ATM room. Luckily one of those was empty. To practice "social distancing" there was only 1 chair at each table. A couple did come in after a man left and they did pull up another chair, but I thought it interesting that there were 3 people eating, 1 at each table.
Bill was asleep when I got back to the room and the only time he woke up was during his bath when he was turned. But, he didn't talk to either of the nurses or me. And as soon as he was settled, he was right back out.
The nurses noticed the blood in his urine and as they turned him he went again so Abby just used a towel. When it was moved, it looked like all blood. They have been documenting it in his chart, and I told them that I had reported it to every doctor and they had seen it in the collection bag when they were using the catheter, but none of them seemed too concerned. So, we're still at a loss as to what is causing it, unless something shows up on the x-ray. I won't know anything about those results until tomorrow when the doctors round, and they won't generally volunteer the information.
So, it seems like our good days have ended. All of his numbers were good, but he did have some episodes of V-tach again. They don't last long, but it means there's something going on. I told Bill again that it was OK if he was ready, I would be OK and that we've had a great life for the last 30 years. But, while he still responds to pain or stimulation, I will not have him removed from the vent. That tells me that HE is still there, even if he doesn't respond to commands.
I'm still at peace with the decisions we made as a family to let him go when the time comes. That's not to say it will be easy.
So, a few good minutes this morning and then an afternoon of him sleeping.
There is a real shortage now of isolation gowns. They've brought some up from the surgical suites. Today, his nurse and the respiratory tech left their gowns on either side of his open door so they could tell which one was theirs. As of right now, he is the only isolation patient in the unit. The doctors weren't sure what to do. I suggested they take off their white coats before they came in. It would kind of work like putting on a protective gown, only in reverse. But, none of them seemed to like the idea much. I guess the status symbol of the white coat is really strong.
The hospital was very quiet all day. Starbucks is always closed on Sunday, but today the gift shop was also closed, at least it was when I left at 4. There was a sign on the door, but I didn't stop to read it. It was even quiet when I got there. Usually there's a line to get in, but today there were only 2 employees in front of me. Maybe because it's Sunday and people were at church and came in the afternoon. But, it is rather eerie.
That's it for today. Let's hope and pray for a better day tomorrow.
Yesterday was a better day, not a good day, but a better day. None of the drs. seemed too optimistic in their assessments. Dr. Nowak, who is a partner with Dr. Threlkeld, seemed to be the most interested in what she was finding and the questions I was asking. The antibiotics are working already. His white count had dropped from 20,000 on Friday to 9,000 yesterday, after only a couple of doses. Dr. Schriner, from the lung group, thought he felt warm and his temp was 98.7, so that is low grade for him. I don't know how many times I have to remind them of that.
Dr. Nowak was also concerned about the blood in his urine. I told her I had brought it to the attention of every doctor and none seemed too concerned. I again voiced my opinion on the burst cyst, but since he is putting out a good amount of urine and his creatinine numbers are good, it doesn't seem to matter.
The doctors all said that his x-rays didn't looks any different, but then Dr. Nowak said that he hadn't had a new chest x-ray for 10 days! When Cindy came in from the heart group, I mentioned to her that I was surprised an x-ray wasn't done after he threw up Friday to make sure he didn't aspirate any and she said she would get one ordered. I don't know if it was done. I know they were in the unit in another room, so I went to get some lunch since they would make me leave the room anyway. I figured they would finish with that patient and then do Bill. No-one said anything so it's on my list to ask this morning.
He did get a unit of blood yesterday afternoon. The cultures hadn't shown anything unusual, but his hematocrit must have been under 25 for the blood to be ordered. I also don't know which dr. ordered it. None of the ones I talked to said anything about blood. It could be that Dr. Muir, who is the hematologist, just looked at his labs and gave the order.
It took forever for the blood to come up from the blood bank. I know they are having a blood shortage and Bill is O+ so, maybe they were having to really look for some. He had gotten most of it when I left. And he had looked at me, and really saw me, at one point, so I told him I needed to stop at the store on the way home. It was about the time I usually leave anyway, so he nodded, which was really the first acknowledgement of anything I had gotten all day.
His monitors had been quiet all day, no alarms like the day before. They only sounded once about halfway through the transfusion when he got a couple of funny heart rhythms. I wonder if that was the blood's way of saying "wake up, body and get back to work". I guess I'll see this morning.
I still haven't had any problems getting into the hospital, they are still just taking temps. After walking into the cold wind yesterday morning, mine was only 95.4! They use the forehead scanner ones.
I also go to thinking about the cafeteria. They have closed it for dining in, except for employees. I didn't think too much about it before because I usually take my lunch back to his room. But, yesterday it hit me that they have screened everyone who has come into the hospital. And you can't sneak by, they have ropes up and security guards. So, why can't everyone eat in the cafeteria? It still doesn't make a difference to me since I will take mine upstairs, but sometimes I do like to eat downstairs, just to get a few minutes to myself.
That's about it for yesterday. Hopefully today he'll be more awake and aware again after getting the blood.
Dr. Nowak was also concerned about the blood in his urine. I told her I had brought it to the attention of every doctor and none seemed too concerned. I again voiced my opinion on the burst cyst, but since he is putting out a good amount of urine and his creatinine numbers are good, it doesn't seem to matter.
The doctors all said that his x-rays didn't looks any different, but then Dr. Nowak said that he hadn't had a new chest x-ray for 10 days! When Cindy came in from the heart group, I mentioned to her that I was surprised an x-ray wasn't done after he threw up Friday to make sure he didn't aspirate any and she said she would get one ordered. I don't know if it was done. I know they were in the unit in another room, so I went to get some lunch since they would make me leave the room anyway. I figured they would finish with that patient and then do Bill. No-one said anything so it's on my list to ask this morning.
He did get a unit of blood yesterday afternoon. The cultures hadn't shown anything unusual, but his hematocrit must have been under 25 for the blood to be ordered. I also don't know which dr. ordered it. None of the ones I talked to said anything about blood. It could be that Dr. Muir, who is the hematologist, just looked at his labs and gave the order.
It took forever for the blood to come up from the blood bank. I know they are having a blood shortage and Bill is O+ so, maybe they were having to really look for some. He had gotten most of it when I left. And he had looked at me, and really saw me, at one point, so I told him I needed to stop at the store on the way home. It was about the time I usually leave anyway, so he nodded, which was really the first acknowledgement of anything I had gotten all day.
His monitors had been quiet all day, no alarms like the day before. They only sounded once about halfway through the transfusion when he got a couple of funny heart rhythms. I wonder if that was the blood's way of saying "wake up, body and get back to work". I guess I'll see this morning.
I still haven't had any problems getting into the hospital, they are still just taking temps. After walking into the cold wind yesterday morning, mine was only 95.4! They use the forehead scanner ones.
I also go to thinking about the cafeteria. They have closed it for dining in, except for employees. I didn't think too much about it before because I usually take my lunch back to his room. But, yesterday it hit me that they have screened everyone who has come into the hospital. And you can't sneak by, they have ropes up and security guards. So, why can't everyone eat in the cafeteria? It still doesn't make a difference to me since I will take mine upstairs, but sometimes I do like to eat downstairs, just to get a few minutes to myself.
That's about it for yesterday. Hopefully today he'll be more awake and aware again after getting the blood.
Friday, March 20, 2020
As good as the last 3 days have been, this one has been just the opposite. He was semi-awake when I got here. He looked at me and yawned really big...and started throwing up. I just yelled for help and his nurse came running in. She said that at about 4 this morning, he was hard to wake and they actually had to do a sternal rub. This is where they start rubbing really hard in the middle of the chest. They were finally able to get him to respond, but his blood pressure dropped along with his sats. Dr. Edwards ordered the Levophed restarted to bring his pressure up and they increased his oxygen to 60% from 40. He was in SIMV mode still and that continued.
He had lost the condom catheter again, twice, so he was just covered with wet towels again. Since they had to clean him up from the vomit, we decided to go ahead and diaper him since the diapers were in the room. I don't know why they didn't do that last night. Anyway, got him all cleaned up and settled and as soon as Molly gave him his meds through his feeding tube (which she had stopped when he vomited) he vomited again. We think he got enough of the meds in because it included some Xanax and he has been asleep now all day. After the second time, he got some Zofran to stop the vomiting.
Dr, Edwards wasn't too concerned about the vomiting of the meds and he consulted with Dr. Threlkeld. He's going to start some precautionary antibiotics. He also wanted some blood cultures and the midline checked. It has been in for quite a while and he wants to make sure there's no infection starting there because that would be a disaster.
His heart rate stayed about 110 but the rhythms were all over the place, lots of extra beats and some v tach (ventricular tachycardia). The wave line on his monitor was all over the place! His blood pressure came up nicely and has maintained all day. His respirations varied from the 20s to the 40s, according to the vent. Even in SIMV mode it's hard to go by the ones on the regular monitor. It showed at one time that he was taking 85 breaths a minute, but only about half that on the vent monitor.
And, all of a sudden, everything went back to normal! His heart stabilized, his sats were in the high 90s, blood pressure better than mine and respirations in the 30s. Andrea, the respiratory tech, turned his flow down to 50% and said she would try to get it back to 40, depending on how he did. He's still on the Levophed, but the rate is lower than it was when I first got here.
He's still hard to rouse up, but he is waking some, and he tries to focus on me. He did keep his afternoon robitussin in since it goes through the tube. So, the Zofran worked. Molly and I checked the chart and the only meds he got last night as far as something to calm him was his Seroquel at 8 or 9 and then some Xanax at midnight. So he must have been agitated then, too.
His glucose was 152 this morning, which is decent for him and doesn't require any extra insulin. When she checked it at noon it was 59! So, he got a boost of glucose and it came up to 70 within 30 minutes. Dr. Oktied ordered the NPH held as long as the feedings were on hold.
Dr. Wright, the pulmonologist came in and did put him back on full vent. I was surprised to see that he wasn't this morning through everything. He said the x-ray didn't show any significant change and after making the vent adjustments and listening to him, just said to hang in there.
Dr. Muir was just in and he said that from what he's seen, he can only take being off the antibiotics and vent 3-4 days, he starts plugging up again. Yet, they aren't getting much of anything when they suction him. So, since he usually bounces back pretty well with the antibiotics, we'll see how it goes tomorrow.
Again, I didn't have any problems getting into the hospital. I told Molly what Sara and Jennifer had told me the other day and she said that every patient on the unit had full family members (meaning more than 1) visiting.
I got permission from Dr. Threlkeld to keep my gown in the room instead of throwing it away and getting a new one every time. They are getting scarce in the hospital. And since I have no contact with other patients, he thought that was a fine idea. I'm actually going to hid it when/if I leave, or put a note on it not to throw it away per Dr. Threlkeld.
And, as I'm typing this, Bill's heart has started going a little wacky again. But, he doesn't seem to be in distress at all.
His room hasn't been cleaned. The regular housekeeper is apparently off today. The other one came by, but there weren't any gowns. The secretary got some from somewhere but the housekeeper hasn't been back and since it's after 3 she's probably off for the day.
He's trying to wake up some now. He's focusing on me, but I don't know if he's actually understanding what I'm saying. But, he's moved his legs some like he's trying to re-adjust his body.
So, not a good report today. I'll see how he is later and decide then if I'm staying or not. Again, part of me wants to stay and another part says go home, rest up, and come back to help fight another day tomorrow. Right now I don't know which side will win out.
He had lost the condom catheter again, twice, so he was just covered with wet towels again. Since they had to clean him up from the vomit, we decided to go ahead and diaper him since the diapers were in the room. I don't know why they didn't do that last night. Anyway, got him all cleaned up and settled and as soon as Molly gave him his meds through his feeding tube (which she had stopped when he vomited) he vomited again. We think he got enough of the meds in because it included some Xanax and he has been asleep now all day. After the second time, he got some Zofran to stop the vomiting.
Dr, Edwards wasn't too concerned about the vomiting of the meds and he consulted with Dr. Threlkeld. He's going to start some precautionary antibiotics. He also wanted some blood cultures and the midline checked. It has been in for quite a while and he wants to make sure there's no infection starting there because that would be a disaster.
His heart rate stayed about 110 but the rhythms were all over the place, lots of extra beats and some v tach (ventricular tachycardia). The wave line on his monitor was all over the place! His blood pressure came up nicely and has maintained all day. His respirations varied from the 20s to the 40s, according to the vent. Even in SIMV mode it's hard to go by the ones on the regular monitor. It showed at one time that he was taking 85 breaths a minute, but only about half that on the vent monitor.
And, all of a sudden, everything went back to normal! His heart stabilized, his sats were in the high 90s, blood pressure better than mine and respirations in the 30s. Andrea, the respiratory tech, turned his flow down to 50% and said she would try to get it back to 40, depending on how he did. He's still on the Levophed, but the rate is lower than it was when I first got here.
He's still hard to rouse up, but he is waking some, and he tries to focus on me. He did keep his afternoon robitussin in since it goes through the tube. So, the Zofran worked. Molly and I checked the chart and the only meds he got last night as far as something to calm him was his Seroquel at 8 or 9 and then some Xanax at midnight. So he must have been agitated then, too.
His glucose was 152 this morning, which is decent for him and doesn't require any extra insulin. When she checked it at noon it was 59! So, he got a boost of glucose and it came up to 70 within 30 minutes. Dr. Oktied ordered the NPH held as long as the feedings were on hold.
Dr. Wright, the pulmonologist came in and did put him back on full vent. I was surprised to see that he wasn't this morning through everything. He said the x-ray didn't show any significant change and after making the vent adjustments and listening to him, just said to hang in there.
Dr. Muir was just in and he said that from what he's seen, he can only take being off the antibiotics and vent 3-4 days, he starts plugging up again. Yet, they aren't getting much of anything when they suction him. So, since he usually bounces back pretty well with the antibiotics, we'll see how it goes tomorrow.
Again, I didn't have any problems getting into the hospital. I told Molly what Sara and Jennifer had told me the other day and she said that every patient on the unit had full family members (meaning more than 1) visiting.
I got permission from Dr. Threlkeld to keep my gown in the room instead of throwing it away and getting a new one every time. They are getting scarce in the hospital. And since I have no contact with other patients, he thought that was a fine idea. I'm actually going to hid it when/if I leave, or put a note on it not to throw it away per Dr. Threlkeld.
And, as I'm typing this, Bill's heart has started going a little wacky again. But, he doesn't seem to be in distress at all.
His room hasn't been cleaned. The regular housekeeper is apparently off today. The other one came by, but there weren't any gowns. The secretary got some from somewhere but the housekeeper hasn't been back and since it's after 3 she's probably off for the day.
He's trying to wake up some now. He's focusing on me, but I don't know if he's actually understanding what I'm saying. But, he's moved his legs some like he's trying to re-adjust his body.
So, not a good report today. I'll see how he is later and decide then if I'm staying or not. Again, part of me wants to stay and another part says go home, rest up, and come back to help fight another day tomorrow. Right now I don't know which side will win out.
Thursday, March 19, 2020
God works in mysterious ways, His wonders to perform. I would cite this, but I'm too lazy right now to look it up!
Bill had a great day! He was not put on the vent, in full vent mode, last night. It was set on SIMV and then he was put back on CPAP this morning. He did fine all day, with no problems at all.
Dr. Sharma again mentioned moving him and I told him what Dr. Edwards said about the 2 good weeks. I don't know if the little episode he had yesterday morning will stop the count and we start over today, or if today was day 3. Anyway, that was the end of that discussion. Bill did write his name on the tablet I left him, and it was legible! He had also drawn 2 pictures before I left yesterday, a glass with a straw and a rectangle that represented a sandwich! I didn't get that one until he mimicked eating one.
Dr. El Hadad asked how he had been with being on CPAP and then asked about physical therapy. He told me that sitting on the edge of the bed was not good enough. I agreed, but what am I supposed to do about it? That's something he needs to take up with the therapists. I thought he would have therapy today since he had it Tuesday, but they hadn't come before I left and I didn't see any at all on the unit.
Bill was chatty today, and I could actually read his lips. He was enunciating quite well. Yesterday I couldn't make out a thing he was trying to say. He also interacted with everyone who came in the room.
We watched programs about cute kittens and puppies most of the day. We did watch a movie, but he didn't like the next one that came on. I have to admit it was a little strange, so we went back to cute animals.
I didn't have any problem getting into the hospital. All they did was just take my temp as usual. Today it was 97.7. They didn't ask any questions about who I was going to see or anything. It could all change tomorrow. Who knows.
The unit was very quiet today, and the wife of the patient next door was there. I don't know if she spent the night or what, but since they didn't do any additional screening, she could have just walked in. But, there was none of the usual hubbub. It was just quiet. The entire hospital was too. They are finally getting a handle on how to make the new setup for the cafeteria to run more smoothly. There was an attendant at the door handing out the silverware instead of having to ask for it.
I came home a little early today due to weather. It was 66 degrees at 6 this morning and nearly 80 this afternoon. There's a tornado watch just to the west of us, we're supposed to start getting rain any time, but the storms aren't supposed to come through until around midnight or later. I was able to get some laundry done and have just liked having a little bit of extra time. Kitty has followed me all over the house. I don't know if she's sensing the weather that's coming, or just tired of me not being here. I even had to carry her to the laundry room to get the clothes out of the dryer.
That's about it for today. I'm hoping that by the week-end Bill will stay on CPAP overnight and then maybe try trach collar again. For a man we were told to move to comfort care and vent removal 2 weeks ago, he's making great strides again! Just goes to show what God can, and will do!
Bill had a great day! He was not put on the vent, in full vent mode, last night. It was set on SIMV and then he was put back on CPAP this morning. He did fine all day, with no problems at all.
Dr. Sharma again mentioned moving him and I told him what Dr. Edwards said about the 2 good weeks. I don't know if the little episode he had yesterday morning will stop the count and we start over today, or if today was day 3. Anyway, that was the end of that discussion. Bill did write his name on the tablet I left him, and it was legible! He had also drawn 2 pictures before I left yesterday, a glass with a straw and a rectangle that represented a sandwich! I didn't get that one until he mimicked eating one.
Dr. El Hadad asked how he had been with being on CPAP and then asked about physical therapy. He told me that sitting on the edge of the bed was not good enough. I agreed, but what am I supposed to do about it? That's something he needs to take up with the therapists. I thought he would have therapy today since he had it Tuesday, but they hadn't come before I left and I didn't see any at all on the unit.
Bill was chatty today, and I could actually read his lips. He was enunciating quite well. Yesterday I couldn't make out a thing he was trying to say. He also interacted with everyone who came in the room.
We watched programs about cute kittens and puppies most of the day. We did watch a movie, but he didn't like the next one that came on. I have to admit it was a little strange, so we went back to cute animals.
I didn't have any problem getting into the hospital. All they did was just take my temp as usual. Today it was 97.7. They didn't ask any questions about who I was going to see or anything. It could all change tomorrow. Who knows.
The unit was very quiet today, and the wife of the patient next door was there. I don't know if she spent the night or what, but since they didn't do any additional screening, she could have just walked in. But, there was none of the usual hubbub. It was just quiet. The entire hospital was too. They are finally getting a handle on how to make the new setup for the cafeteria to run more smoothly. There was an attendant at the door handing out the silverware instead of having to ask for it.
I came home a little early today due to weather. It was 66 degrees at 6 this morning and nearly 80 this afternoon. There's a tornado watch just to the west of us, we're supposed to start getting rain any time, but the storms aren't supposed to come through until around midnight or later. I was able to get some laundry done and have just liked having a little bit of extra time. Kitty has followed me all over the house. I don't know if she's sensing the weather that's coming, or just tired of me not being here. I even had to carry her to the laundry room to get the clothes out of the dryer.
That's about it for today. I'm hoping that by the week-end Bill will stay on CPAP overnight and then maybe try trach collar again. For a man we were told to move to comfort care and vent removal 2 weeks ago, he's making great strides again! Just goes to show what God can, and will do!
Yesterday was a little scary and disturbing. Bill was put back on the vent overnight to let him rest. We breathe without thinking but for Bill to remember to do it on his own is hard work. I glad he did as good as he did. When I got to the hospital, he wasn't awake and his numbers were a little off. His heart rate was erratic and high, his sats were ok but on the low end and his respirations were a little high. I don't remember what his blood pressure was.
We just kept the lights off and I didn't turn on the TV. It was pouring rain and that was the only sound in the room other than the vent. When he did wake up he was aware and acknowledged that I was there, but still a little sleepy.
Dr. Sharma came in early and, for the first time, did not mention going to Restorative Care. So I think someone pulled rank, either Dr. Edwards or Dr. Mullinax. Anyway, he put him in SIMV mode, which is the mode that will only breathe for him if he doesn't take a breath and it will not deliver a breath right after a natural one. He said when he can be on CPAP with no problems for 13-14 hours straight, they will leave it overnight.
Bill went back to sleep and I noticed that he was really laboring to breathe. I went over to the bed to talk him down a little, usually just takes me rubbing his shoulder and telling him to slow down. He was really sweaty, not clammy, just sweaty enough that his pillowcase was damp. He didn't wake up, but his breathing did slow a bit.
When his blood pressure took again, in was 198 over something so it started alarming. His heart rate was high and very erratic and his respirations showed in the 70s. His oxygen was still staying in the low 90s.
His nurse came in and checked his pressure 2 more times and it was in the 180 range, so she called Dr. Edwards. We also couldn't get him to wake up. She said the night nurse said he had a hard time waking him at times in the night, too. She used the flashlight on her phone to check his pupils and they reacted and, she didn't see it as she was getting ready to call Dr. Edwards, but I watched him slowly blink twice then.
Dr. Edwards wanted her to manually check his pressure so she did that and it was still high, but much lower than the automatic one, in the 160s. He did not have a fever. His temp was 97.6, which is perfectly normal for him. Since his pressure was coming down, Dr. Edwards just ordered her to have it checked every 15 minutes and he didn't order anything to help lower it. And it did come down.
And then, all of a sudden, he opened his eyes, and his heart rate dropped to a normal rhythm, his pressure was a normal number, his respirations went way down and his oxygen level went up a little...just like nothing had happened!
When Mike came in to do his breathing treatment, he switched him to CPAP from SIMV and everything went back to normal. His breathing slowed down and he went to sleep, a nice easy sleep.
Caleb and Horace came in a tag teamed him for a bath and he didn't wake up much during that process. Caleb is going to be off for the next 6 days and Horace is moving to ICU from step-down to help out.
Dr. Threlkeld said that Bill's white count was still going down, which is good. I think Dr. Edwards was thinking another infection was taking hold as he asked Tyler if Dr. T was on or one of his nurses.
The rest of the day was pretty dull and boring. Bill slept until about 2:30 and then woke up very chatty, asking for something to drink and eat. He knows he can't have either, but that doesn't stop him from asking.
The strangest part of the day came about 3:30. Jennifer, the nurse manager for transplant and Sara, one of the charge nurses, came to the door and asked to talk to me. They said that they were now going to limit visitors to only patients in isolation. They said they made sure it was known that Bill doesn't do well without me there and said that even if the guideline changed again, because I followed the rules of the isolation gown and gloves and didn't come and go from the hospital except at night, they would do their best to see that I could always be with him. I told them I was prepared to stay in the hospital if necessary and they said no, I needed to get my rest at home. They are also limiting it to only 1 visitor and if I can't be there, I can't send a substitute. It's me or no-one. They also addressed if something should "happen" with Bill, they would do what they could so that others could come at that time.
I do feel sorry for the other patients and their families. The man in the next room just came off the vent yesterday and when his wife, daughter and granddaughter left, they were all in tears. But, at the same time, I'm grateful that Bill is in isolation and already on the vent.
I don't know what the procedure will be this morning when I get to the hospital, and the nurses didn't know either. They said it hadn't been addressed in their meeting on how they were going to know that Bill is actually in isolation and that I am authorized to be there. They were going to call when they found out, but I haven't heard anything. I'm hoping there will be a list at the front door and they will then not only check my temp as they have been doing, but my ID. I guess I'll find out when I get there.
Memphis is basically a ghost town with not much traffic. Even the interstates are eerily empty, mostly trucks. Lots of campers heading north, so it is snowbirds going home. I'm keeping a box of gloves in the car for pumping gas now. There's been a lot of chatter online about gas pumps so it just makes sense. It may look strange, but I can toss them into the trash bin before I get back into the car. I'm also going to keep one, or pick one up in the lobby for pushing the elevator buttons at the hospital.
So, another new normal for the time being. I also noticed that the waiting room for ICU, where many family member sleep, is missing 2/3s of the recliners that are usually there...social distancing. The hospital is doing all it can to protect patients, staff and guests. It will be interesting to see if they again change the cafeteria.
I've been taking this with me all week, but so far the internet hasn't cooperated. Maybe with fewer people using it, it will connect. I'm starting to feel like a correspondent on the front lines of the war!
We just kept the lights off and I didn't turn on the TV. It was pouring rain and that was the only sound in the room other than the vent. When he did wake up he was aware and acknowledged that I was there, but still a little sleepy.
Dr. Sharma came in early and, for the first time, did not mention going to Restorative Care. So I think someone pulled rank, either Dr. Edwards or Dr. Mullinax. Anyway, he put him in SIMV mode, which is the mode that will only breathe for him if he doesn't take a breath and it will not deliver a breath right after a natural one. He said when he can be on CPAP with no problems for 13-14 hours straight, they will leave it overnight.
Bill went back to sleep and I noticed that he was really laboring to breathe. I went over to the bed to talk him down a little, usually just takes me rubbing his shoulder and telling him to slow down. He was really sweaty, not clammy, just sweaty enough that his pillowcase was damp. He didn't wake up, but his breathing did slow a bit.
When his blood pressure took again, in was 198 over something so it started alarming. His heart rate was high and very erratic and his respirations showed in the 70s. His oxygen was still staying in the low 90s.
His nurse came in and checked his pressure 2 more times and it was in the 180 range, so she called Dr. Edwards. We also couldn't get him to wake up. She said the night nurse said he had a hard time waking him at times in the night, too. She used the flashlight on her phone to check his pupils and they reacted and, she didn't see it as she was getting ready to call Dr. Edwards, but I watched him slowly blink twice then.
Dr. Edwards wanted her to manually check his pressure so she did that and it was still high, but much lower than the automatic one, in the 160s. He did not have a fever. His temp was 97.6, which is perfectly normal for him. Since his pressure was coming down, Dr. Edwards just ordered her to have it checked every 15 minutes and he didn't order anything to help lower it. And it did come down.
And then, all of a sudden, he opened his eyes, and his heart rate dropped to a normal rhythm, his pressure was a normal number, his respirations went way down and his oxygen level went up a little...just like nothing had happened!
When Mike came in to do his breathing treatment, he switched him to CPAP from SIMV and everything went back to normal. His breathing slowed down and he went to sleep, a nice easy sleep.
Caleb and Horace came in a tag teamed him for a bath and he didn't wake up much during that process. Caleb is going to be off for the next 6 days and Horace is moving to ICU from step-down to help out.
Dr. Threlkeld said that Bill's white count was still going down, which is good. I think Dr. Edwards was thinking another infection was taking hold as he asked Tyler if Dr. T was on or one of his nurses.
The rest of the day was pretty dull and boring. Bill slept until about 2:30 and then woke up very chatty, asking for something to drink and eat. He knows he can't have either, but that doesn't stop him from asking.
The strangest part of the day came about 3:30. Jennifer, the nurse manager for transplant and Sara, one of the charge nurses, came to the door and asked to talk to me. They said that they were now going to limit visitors to only patients in isolation. They said they made sure it was known that Bill doesn't do well without me there and said that even if the guideline changed again, because I followed the rules of the isolation gown and gloves and didn't come and go from the hospital except at night, they would do their best to see that I could always be with him. I told them I was prepared to stay in the hospital if necessary and they said no, I needed to get my rest at home. They are also limiting it to only 1 visitor and if I can't be there, I can't send a substitute. It's me or no-one. They also addressed if something should "happen" with Bill, they would do what they could so that others could come at that time.
I do feel sorry for the other patients and their families. The man in the next room just came off the vent yesterday and when his wife, daughter and granddaughter left, they were all in tears. But, at the same time, I'm grateful that Bill is in isolation and already on the vent.
I don't know what the procedure will be this morning when I get to the hospital, and the nurses didn't know either. They said it hadn't been addressed in their meeting on how they were going to know that Bill is actually in isolation and that I am authorized to be there. They were going to call when they found out, but I haven't heard anything. I'm hoping there will be a list at the front door and they will then not only check my temp as they have been doing, but my ID. I guess I'll find out when I get there.
Memphis is basically a ghost town with not much traffic. Even the interstates are eerily empty, mostly trucks. Lots of campers heading north, so it is snowbirds going home. I'm keeping a box of gloves in the car for pumping gas now. There's been a lot of chatter online about gas pumps so it just makes sense. It may look strange, but I can toss them into the trash bin before I get back into the car. I'm also going to keep one, or pick one up in the lobby for pushing the elevator buttons at the hospital.
So, another new normal for the time being. I also noticed that the waiting room for ICU, where many family member sleep, is missing 2/3s of the recliners that are usually there...social distancing. The hospital is doing all it can to protect patients, staff and guests. It will be interesting to see if they again change the cafeteria.
I've been taking this with me all week, but so far the internet hasn't cooperated. Maybe with fewer people using it, it will connect. I'm starting to feel like a correspondent on the front lines of the war!
Wednesday, March 18, 2020
Yesterday was the best day in a very long time! Surprising things happened along with some that are a little unsettling.
Bill was sleeping when I got there and Mikala said that he was given some anxiety medicine on the night shift. He didn't sleep all day like he had been, so maybe it was just a little Xanax along with his Seroquel to sleep. I've been suspecting some, and I think I've mentioned it, that he's also been getting a little dialudid at night so they don't have to do anything more than absolutely necessary.
I had forgotten to switch my picture around when I left, but Mikala saw it and changed it. She is so good with Bill, I wish we could have her all the time.
He was in a talky mood again yesterday and responding well to everyone. When Dr. Sharma came in he looked at all the numbers on the vent and just nodded. He again asked about restorative care or another facility. I told him there are only 2 facilities in Memphis that take vent patients and either one would cause a big hardship for us. He said the only other choice would be Nashville and walked out of the room. There is an acute care hospital in Jonesboro, but I don't know if Dr. Edwards would go for that. But, I digress.
Dr. El Hadad came to the doorway of the room and just nodded at me and then started asking Mikala and Crystal, the respiratory tech some questions. He then gave an order for a teepee and said if he can't tolerate being off the vent put him right back on! Crystal came in and said he told her to put Bill into CPAP mode! She said that they don't use the teepees anymore and it would have to be trach collar, which is why he went to CPAP. It uses the same tubing as vent mode. So, the switch. At first Bill took a deep breath and coughed and I told him the machine wasn't doing any breathing for him and he had to do it all. AND HE DID! ALL DAY! There was only one time that his respiration got too fast, into the 40s and I just rubbed his shoulder and told him to slow his breathing down and just take deep breaths and that's what he did. His oxygen levels were better on CPAP than they were on vent. He did drop to 89 at one time, but he came right back up.
He didn't even have to go on the vent for therapy. He didn't get into his chair, but they did leg and shoulder exercises and sat on the edge of the bed. His oxygen dropped to 84 at one time, but no lower. That's the number the monitor will start alarming, but he went right back up. The bed was put into chair mode, as it had been most of the day and we watched Dances With Wolves, or I did while he napped.
Dr. Edwards came in, which surprised me. But, they may have cancelled all of their office appointments during this crisis. He asked about interactions and I told he was responding to people. Bill did respond to his questions. I told him that he had slept all week-end but had been awake and alert on Monday too. He said he wanted him to have 2 good weeks straight, not 2 good days, 3 bad days etc. I took that to mean that he wouldn't be going anywhere until he had those 2 good weeks. That was a big relief for me. I think Dr. Sharma, who is only a resident, only knows what he's seen in the chart, and going by protocol again. There's been quite a change in Dr. Edwards, who was Dr. AA last year. He started to explain something about Bill's condition, then just looked at me and said, "well, you know, you've lived it", meaning that I've been there and through everything.
When I went to get some lunch, I saw one of the nurses from Restorative Care and she was asking about Bill. She told me that just yesterday they were restricting all visitors, with no exceptions. I understand the patients there are fragile and need protection, but I just read an article, from our own little hospital, that they understand how important the family interaction is to a patient's recovery. So far the main hospital is not considering restrictions any more than screening. At least, the staff had not been told anything.
Cynthia, the palliative care nurse we've been assigned came by, and said when they got word of the ban in restorative, she and Dr. Mullinax both said that if they moved Bill upstairs now, he would not thrive without me! So, some of the staff get home dependent he is on me just being there. All of the nurses on both floors know how anxious he gets when I'm gone, and all of the nurse practitioners for Dr. Edwards can attest to that also. So, I don't think he'll be moved without an exception being made for me to stay with him. Just something else added to my list of things to do and find out!
One thing I found out is that the cafeteria is doing a little price gouging now. It actually started last week, I noticed prices going up. It was raining when I left yesterday and I got a little later start so didn't go through McDonald's drive thru as usual. I can get a Sausage McGriddle and a large diet Coke for $2.21 total. At the cafeteria, they have now closed all fountain drinks, the coffee urns have been moved to behind the hot line and is served instead of self serve, no hot cereal/soup, no salad bar, no self serve anything. I understand that. What I didn't understand was the price of a bottled drink, 2 hard boiled eggs and 3 strips of bacon...$8.06! Lunch was also over 8 for a drink and a pre-packaged chef salad. If I end up staying I can't afford $24 a day for food. So, it will be back to McD's or poptarts for breakfast and I'll bring my own drinks. I can still get ice from the nurses. I don't even know if they will offer a dinner. Usually dinner was self serve leftovers from lunch. Even all of the condiments and plasticware was moved behind the serving lines. So, my salad that was in a refrigerator case and easy to pick up cost me 15 minutes in time waiting to just get a fork and some salad dressing! I understand it, I do, but not the increase in prices.
And with that, I must get dressed and get my stuff together, and get the cat down from behind the TV. She knows better than that. She's really been bad lately, even getting onto the kitchen counters and she has never done that before. Just her way of telling me I'm gone too much.
Let's hope that even if Bill had to be put back on the vent overnight to let him rest, he'll be right back to at least CPAP again today! I'll of course let you know!
Bill was sleeping when I got there and Mikala said that he was given some anxiety medicine on the night shift. He didn't sleep all day like he had been, so maybe it was just a little Xanax along with his Seroquel to sleep. I've been suspecting some, and I think I've mentioned it, that he's also been getting a little dialudid at night so they don't have to do anything more than absolutely necessary.
I had forgotten to switch my picture around when I left, but Mikala saw it and changed it. She is so good with Bill, I wish we could have her all the time.
He was in a talky mood again yesterday and responding well to everyone. When Dr. Sharma came in he looked at all the numbers on the vent and just nodded. He again asked about restorative care or another facility. I told him there are only 2 facilities in Memphis that take vent patients and either one would cause a big hardship for us. He said the only other choice would be Nashville and walked out of the room. There is an acute care hospital in Jonesboro, but I don't know if Dr. Edwards would go for that. But, I digress.
Dr. El Hadad came to the doorway of the room and just nodded at me and then started asking Mikala and Crystal, the respiratory tech some questions. He then gave an order for a teepee and said if he can't tolerate being off the vent put him right back on! Crystal came in and said he told her to put Bill into CPAP mode! She said that they don't use the teepees anymore and it would have to be trach collar, which is why he went to CPAP. It uses the same tubing as vent mode. So, the switch. At first Bill took a deep breath and coughed and I told him the machine wasn't doing any breathing for him and he had to do it all. AND HE DID! ALL DAY! There was only one time that his respiration got too fast, into the 40s and I just rubbed his shoulder and told him to slow his breathing down and just take deep breaths and that's what he did. His oxygen levels were better on CPAP than they were on vent. He did drop to 89 at one time, but he came right back up.
He didn't even have to go on the vent for therapy. He didn't get into his chair, but they did leg and shoulder exercises and sat on the edge of the bed. His oxygen dropped to 84 at one time, but no lower. That's the number the monitor will start alarming, but he went right back up. The bed was put into chair mode, as it had been most of the day and we watched Dances With Wolves, or I did while he napped.
Dr. Edwards came in, which surprised me. But, they may have cancelled all of their office appointments during this crisis. He asked about interactions and I told he was responding to people. Bill did respond to his questions. I told him that he had slept all week-end but had been awake and alert on Monday too. He said he wanted him to have 2 good weeks straight, not 2 good days, 3 bad days etc. I took that to mean that he wouldn't be going anywhere until he had those 2 good weeks. That was a big relief for me. I think Dr. Sharma, who is only a resident, only knows what he's seen in the chart, and going by protocol again. There's been quite a change in Dr. Edwards, who was Dr. AA last year. He started to explain something about Bill's condition, then just looked at me and said, "well, you know, you've lived it", meaning that I've been there and through everything.
When I went to get some lunch, I saw one of the nurses from Restorative Care and she was asking about Bill. She told me that just yesterday they were restricting all visitors, with no exceptions. I understand the patients there are fragile and need protection, but I just read an article, from our own little hospital, that they understand how important the family interaction is to a patient's recovery. So far the main hospital is not considering restrictions any more than screening. At least, the staff had not been told anything.
Cynthia, the palliative care nurse we've been assigned came by, and said when they got word of the ban in restorative, she and Dr. Mullinax both said that if they moved Bill upstairs now, he would not thrive without me! So, some of the staff get home dependent he is on me just being there. All of the nurses on both floors know how anxious he gets when I'm gone, and all of the nurse practitioners for Dr. Edwards can attest to that also. So, I don't think he'll be moved without an exception being made for me to stay with him. Just something else added to my list of things to do and find out!
One thing I found out is that the cafeteria is doing a little price gouging now. It actually started last week, I noticed prices going up. It was raining when I left yesterday and I got a little later start so didn't go through McDonald's drive thru as usual. I can get a Sausage McGriddle and a large diet Coke for $2.21 total. At the cafeteria, they have now closed all fountain drinks, the coffee urns have been moved to behind the hot line and is served instead of self serve, no hot cereal/soup, no salad bar, no self serve anything. I understand that. What I didn't understand was the price of a bottled drink, 2 hard boiled eggs and 3 strips of bacon...$8.06! Lunch was also over 8 for a drink and a pre-packaged chef salad. If I end up staying I can't afford $24 a day for food. So, it will be back to McD's or poptarts for breakfast and I'll bring my own drinks. I can still get ice from the nurses. I don't even know if they will offer a dinner. Usually dinner was self serve leftovers from lunch. Even all of the condiments and plasticware was moved behind the serving lines. So, my salad that was in a refrigerator case and easy to pick up cost me 15 minutes in time waiting to just get a fork and some salad dressing! I understand it, I do, but not the increase in prices.
And with that, I must get dressed and get my stuff together, and get the cat down from behind the TV. She knows better than that. She's really been bad lately, even getting onto the kitchen counters and she has never done that before. Just her way of telling me I'm gone too much.
Let's hope that even if Bill had to be put back on the vent overnight to let him rest, he'll be right back to at least CPAP again today! I'll of course let you know!
Tuesday, March 17, 2020
I've been sitting here staring into space, contemplating what to do, as I can feel my sisnuses pouring down the back of my throat. No, it's not "the virus", it's just good old allergies, complete with itching eyes and the sinus pressure that goes along with it. But, that's not what I was contemplating. I'll explain later, if I can.
Bill had a decent day yesterday. He was awake most of the day and we watched home renovation shows. Why it was on that is a mystery, unless it was never turned off from Sunday and that is what I was watching. But, he interacted with people and talked a lot, most of which we couldn't make out.
There was a package of diapers in the room finally, but 2 of the nurses that were working yesterday, Mikala and Rachael, are both pretty good at getting the condom catheters on, so they decided to try that one more time. He's getting very irritated in that area.The first one Mikala tried came off before she even walked away from the bed, but Rachael got one to stay. Now, if Bill just left it alone. Out of habit, as any man would, he reaches to hold himself, and that contributes to it coming off. I've shown him the tubine, with the urine in it and told him he was going, but I don't know if that helped or not.
Dr. Sharma turned his oxygen concentration down to 40 and Mike, the respiratory tech, made a discovery. He noticed that his sats might be in the 80s or low 90s until he got a breathing treatment. Now, part of the breathing treatment does open the lungs more so that more oxygen can get in so his sats go up. But, if the line that holds the medicine is left connected, after all the medicine has been nebulized, his sats stay up longer and higher, he thinks from the extra few liters of pure oxygen he gets. So, he asked Dr. El Hadad if he could just leave the line attached. Both doctors didn't like the idea, I think from a comment Dr. Sharma made that it wouldn't make a difference, so the line was disconnected. His sats dropped from 98 to 89. They did slowly come back up to the low 90s. Their solution was to turn the oxygen back up to 50%. He was at 98 when I got there in the morning and 94 when I left in the afternoon.
In talking to Dr. El Hadad, who hadn't seen him since his first stint in ICU, I told him that we had decided on the palliative care when the time came and he agreed, but he said we would give him as many days as we could before that time. Dr. Sharma keeps talking about moving him back to RC or another facility, but I told Dr. El Hadad that Dr. Edwards was the one who wanted him back in ICU to be monitored more closely. So, especially in light of the virus, I don't know what will be done.
Dr. El Hada also wants vigorous PT and was going to speack to them about that, not just put a note in the chart. And, as of 4:30 when I left, there still had been no PT. I also told him about the nonexistent PT in Restorative Care and he, too, was surprised that it was all just passive range of motion as far as his legs went.
Now, as far as my contemplation goes, and maybe it's just because I'm miserable with these allergies, but I'm really torn about going to stay at the hospital for the duration or just staying home. The caregiver part of me says to stay, Bill needs me to keep him calm. But, the Beth part of me says to stay home to save my sanity. Any family member who has stayed over with a patient knows you get no rest at all. I know family would take care of the cats, but I'm also a loner and need my alone time and that would be nonexistent in the hospital. There weren't any managers on the floor yesterday that I could ask about procedures changing, I do have enough clothes for 4 days and there is a small laundry room in the hospital. It would just be a matter of making sure I had all of my meds with me. I'm just so conflicted about it and that's not like me. So, I'll keep contemplating.
This morning when I went out to feed the cats, the little possum was eating. The bowls are up on the back step to stay out of the rain, and at first I thought it was just another new cat. But, I looked at him and said "Ooh, possum" and stayed in the doorway, he looked at me, thought about hissing, and took off running under the fence around the air conditioner. That's the closest we have come to being face to face! I felt sorry for him, it was raining and cold and he was all wet, but that was as far as I was going! And, speaking of going, I'd better get dressed and get going. It is cold and rainy and a little fog. It will be another lovely drive in the dark wet morning.That's the one bad thing about this time change, it stays dark so late still in the mornings. I do like getting home before dark now, but I miss the sunrise on my drive in.
Bill had a decent day yesterday. He was awake most of the day and we watched home renovation shows. Why it was on that is a mystery, unless it was never turned off from Sunday and that is what I was watching. But, he interacted with people and talked a lot, most of which we couldn't make out.
There was a package of diapers in the room finally, but 2 of the nurses that were working yesterday, Mikala and Rachael, are both pretty good at getting the condom catheters on, so they decided to try that one more time. He's getting very irritated in that area.The first one Mikala tried came off before she even walked away from the bed, but Rachael got one to stay. Now, if Bill just left it alone. Out of habit, as any man would, he reaches to hold himself, and that contributes to it coming off. I've shown him the tubine, with the urine in it and told him he was going, but I don't know if that helped or not.
Dr. Sharma turned his oxygen concentration down to 40 and Mike, the respiratory tech, made a discovery. He noticed that his sats might be in the 80s or low 90s until he got a breathing treatment. Now, part of the breathing treatment does open the lungs more so that more oxygen can get in so his sats go up. But, if the line that holds the medicine is left connected, after all the medicine has been nebulized, his sats stay up longer and higher, he thinks from the extra few liters of pure oxygen he gets. So, he asked Dr. El Hadad if he could just leave the line attached. Both doctors didn't like the idea, I think from a comment Dr. Sharma made that it wouldn't make a difference, so the line was disconnected. His sats dropped from 98 to 89. They did slowly come back up to the low 90s. Their solution was to turn the oxygen back up to 50%. He was at 98 when I got there in the morning and 94 when I left in the afternoon.
In talking to Dr. El Hadad, who hadn't seen him since his first stint in ICU, I told him that we had decided on the palliative care when the time came and he agreed, but he said we would give him as many days as we could before that time. Dr. Sharma keeps talking about moving him back to RC or another facility, but I told Dr. El Hadad that Dr. Edwards was the one who wanted him back in ICU to be monitored more closely. So, especially in light of the virus, I don't know what will be done.
Dr. El Hada also wants vigorous PT and was going to speack to them about that, not just put a note in the chart. And, as of 4:30 when I left, there still had been no PT. I also told him about the nonexistent PT in Restorative Care and he, too, was surprised that it was all just passive range of motion as far as his legs went.
Now, as far as my contemplation goes, and maybe it's just because I'm miserable with these allergies, but I'm really torn about going to stay at the hospital for the duration or just staying home. The caregiver part of me says to stay, Bill needs me to keep him calm. But, the Beth part of me says to stay home to save my sanity. Any family member who has stayed over with a patient knows you get no rest at all. I know family would take care of the cats, but I'm also a loner and need my alone time and that would be nonexistent in the hospital. There weren't any managers on the floor yesterday that I could ask about procedures changing, I do have enough clothes for 4 days and there is a small laundry room in the hospital. It would just be a matter of making sure I had all of my meds with me. I'm just so conflicted about it and that's not like me. So, I'll keep contemplating.
This morning when I went out to feed the cats, the little possum was eating. The bowls are up on the back step to stay out of the rain, and at first I thought it was just another new cat. But, I looked at him and said "Ooh, possum" and stayed in the doorway, he looked at me, thought about hissing, and took off running under the fence around the air conditioner. That's the closest we have come to being face to face! I felt sorry for him, it was raining and cold and he was all wet, but that was as far as I was going! And, speaking of going, I'd better get dressed and get going. It is cold and rainy and a little fog. It will be another lovely drive in the dark wet morning.That's the one bad thing about this time change, it stays dark so late still in the mornings. I do like getting home before dark now, but I miss the sunrise on my drive in.
Monday, March 16, 2020
I finally made it to the hospital yesterday after spending Saturday laying around in sweats. I'm feeling a lot better, my stomach are under control and hopefully stay that way.
Yesterday was day number 120...4 months since he was first hospitalized. This is the longest one, even after all of the problems after the transplant, he was only in the hospital 60 days before being transferred to skilled nursing.
Bill slept all day yesterday, and they said he slept all day Saturday, and all night. I'm wondering if they aren't giving him a little dilaudid at night so they don't have to mess with him. When the nurse from Dr. Edwards group came in, she said she missed me Saturday and when she said I was faithfully there, she got the standard "he's my husband, that's my job" answer.
I did notice that his vent had been turned back up to 24 and I asked Crystal about it. She said she had seen that, but hadn't seen anything on why. It should be documented somewhere on why it was changed again. The only thing I can think of is that he started having trouble keeping his sats up. But, she decided to try something new and turned his oxygen concentration down to 45% from 50. I don't think there was any plan to do that originally, but since his secretions have thinned, and they didn't get much out when they suctioned yesterday at all, they may be trying to wean him some. His sats did drop to begin with, but then went back up to the low 90s.
They have given up on using the condom cath and now are just keeping him wrapped in the bed pads like a diaper. I don't know why they don't just use a diaper, or go ahead and insert a foley catheter. Sometimes he reaches for himself when he has to go and other times he doesn't so it seems that the foley, especially since we know he won't be coming home, would be the best way to go.
We had a nurse change in the middle of the day and the one who took over told me she has taken care of him many times at night and that it was finally good to meet me. She said when he would get agitated, all they had to do was tell him that I would be there soon and he would calm down. She said he never made her write my phone number down on her glove, with my name, so that she could call and tell me to come to the hospital. She said she could tell just how much he loves me. That was so sweet of her. She also said he would point to "the picture" on the wall, so I guess he does know what it means!
With all the panic around the coronavirus, I will probably end up just staying at the hospital before long. I've got to get some refills on a med and will take care of that today. So far they are still letting visitors in, but are now limiting them to 2 per patient and children are not allowed under 16, and 14 in certain areas. So, I do believe that confinement is coming soon.
This may sound strange, but I am really glad that Bill is already in the hospital, on a vent. I don't believe that they would remove him from it to use it for another patient just because he is terminal already. In Italy, maybe, but I don't think that would happen here. So, he is in the best place he can be with his compromised immune system and lung issues.
I also have to keep reminding myself that I am in the age group that they are suggesting not go out unless absolutely necessary. I guess that comes from feeling younger than what the calendar shows! Although, sometimes I feel twice as old as I am. But, I am following the guidelines of "social distancing" (hard to do in a full elevator) and all of the normal precautions. I can't use the hand sanitizer at the hospital, it has aloe in it as does most sanitizers, but I can use the soap, so wash my hands it is. And since my allergies have kicked in, I can hear myself wheezing this morning, I try not to touch my face unless I have a tissue.
As in most states now, our schools have closed for the next 2 weeks. As far as I know our restaurants are still open. Our local grocery store is scrambling to bring delivery online. They have online ordering already, but you have to pick it up. But, the town that Ryan and Amanda live in have delivery from their store, and since Ryan's truck is still not fixed, it will be a big help for them. Ryan said he needs to pick up Amanda's seizure medicine at Walmart and so far hasn't found anyone who can take him. I wish he didn't live so far away, Bill is my priority so he'll just have to keep trying. Maybe there is a local pharmacy that will deliver there too.
That's all I've got. It wasn't much of an update for Bill, but when you sleep all day, there's not much to update. Maybe he'll be awake today. And maybe the sleeping all the time now is more of coming to the end. He does still wake up and respond and then goes right back to sleep. I'm trying to decide if I'm going to take my laptop or not. The part that says start staying at the hospital says take it, the part that says keep coming home says no. Since I have to take care of meds today, I'll probably talk to some of the unit managers and make my decision then. You'll know when I know. Stay safe and well, everyone!
Yesterday was day number 120...4 months since he was first hospitalized. This is the longest one, even after all of the problems after the transplant, he was only in the hospital 60 days before being transferred to skilled nursing.
Bill slept all day yesterday, and they said he slept all day Saturday, and all night. I'm wondering if they aren't giving him a little dilaudid at night so they don't have to mess with him. When the nurse from Dr. Edwards group came in, she said she missed me Saturday and when she said I was faithfully there, she got the standard "he's my husband, that's my job" answer.
I did notice that his vent had been turned back up to 24 and I asked Crystal about it. She said she had seen that, but hadn't seen anything on why. It should be documented somewhere on why it was changed again. The only thing I can think of is that he started having trouble keeping his sats up. But, she decided to try something new and turned his oxygen concentration down to 45% from 50. I don't think there was any plan to do that originally, but since his secretions have thinned, and they didn't get much out when they suctioned yesterday at all, they may be trying to wean him some. His sats did drop to begin with, but then went back up to the low 90s.
They have given up on using the condom cath and now are just keeping him wrapped in the bed pads like a diaper. I don't know why they don't just use a diaper, or go ahead and insert a foley catheter. Sometimes he reaches for himself when he has to go and other times he doesn't so it seems that the foley, especially since we know he won't be coming home, would be the best way to go.
We had a nurse change in the middle of the day and the one who took over told me she has taken care of him many times at night and that it was finally good to meet me. She said when he would get agitated, all they had to do was tell him that I would be there soon and he would calm down. She said he never made her write my phone number down on her glove, with my name, so that she could call and tell me to come to the hospital. She said she could tell just how much he loves me. That was so sweet of her. She also said he would point to "the picture" on the wall, so I guess he does know what it means!
With all the panic around the coronavirus, I will probably end up just staying at the hospital before long. I've got to get some refills on a med and will take care of that today. So far they are still letting visitors in, but are now limiting them to 2 per patient and children are not allowed under 16, and 14 in certain areas. So, I do believe that confinement is coming soon.
This may sound strange, but I am really glad that Bill is already in the hospital, on a vent. I don't believe that they would remove him from it to use it for another patient just because he is terminal already. In Italy, maybe, but I don't think that would happen here. So, he is in the best place he can be with his compromised immune system and lung issues.
I also have to keep reminding myself that I am in the age group that they are suggesting not go out unless absolutely necessary. I guess that comes from feeling younger than what the calendar shows! Although, sometimes I feel twice as old as I am. But, I am following the guidelines of "social distancing" (hard to do in a full elevator) and all of the normal precautions. I can't use the hand sanitizer at the hospital, it has aloe in it as does most sanitizers, but I can use the soap, so wash my hands it is. And since my allergies have kicked in, I can hear myself wheezing this morning, I try not to touch my face unless I have a tissue.
As in most states now, our schools have closed for the next 2 weeks. As far as I know our restaurants are still open. Our local grocery store is scrambling to bring delivery online. They have online ordering already, but you have to pick it up. But, the town that Ryan and Amanda live in have delivery from their store, and since Ryan's truck is still not fixed, it will be a big help for them. Ryan said he needs to pick up Amanda's seizure medicine at Walmart and so far hasn't found anyone who can take him. I wish he didn't live so far away, Bill is my priority so he'll just have to keep trying. Maybe there is a local pharmacy that will deliver there too.
That's all I've got. It wasn't much of an update for Bill, but when you sleep all day, there's not much to update. Maybe he'll be awake today. And maybe the sleeping all the time now is more of coming to the end. He does still wake up and respond and then goes right back to sleep. I'm trying to decide if I'm going to take my laptop or not. The part that says start staying at the hospital says take it, the part that says keep coming home says no. Since I have to take care of meds today, I'll probably talk to some of the unit managers and make my decision then. You'll know when I know. Stay safe and well, everyone!
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