As good as the past 2 days have been, today was the one step backwards. When I got to the hospital the morning, they were just getting ready to switch Bill from the vent to the trach collar. Mike, the respiratory therapist, said that he had been on the trach collar last night until about 11:30 and that's when they put him on the vent so that he would rest through the night. But, as soon as the inner collar was deflated and he started coughing, he coughed out some really nasty thick junk. Now that I think back on it, the secretions had started to thicken yesterday afternoon when Connor suctioned him. Anyway, they put the collar on and his oxygen immediately started dropping, getting to the low 80s. His heart rate started to climb, almost to 130 beats per minute. He seemed to really be laboring to breathe, no matter what was done, and after about 10 minutes, he was placed back on the vent.

His oxygen level stayed low, but low 90s finally, and his heart rate settled about 115, but he wasn't gasping as much. The resident came in and listened to his lungs and said they didn't sound that bad, everything seemed to be near the trach site. But, he thought that another broncoscopy should be done. He ordered a chest x-ray just to be sure and was, of course, going to consult with Dr. Williams.

After the x-ray, Dr. Williams agreed that the bronch needed to be done. It was supposed to be done before noon, but there was another patient in crisis and that tied up the respiratory team until about 2. When I got back to his room, he was still gasping for air and the filter on the vent was full of bloody froth, but the therapist was soon there to change the filter. Finally, after talking to Bill for quite awhile, he finally calmed down and was able to continue to sleep off the sedation. All of his numbers eventually evened out, even though his oxygen stayed low. His heart rate finally dropped below 100 and smoothed out. Jacinta told me that with the sedation that was used, it's not unusual for the numbers to be suppressed some.

He.was also not as responsive as he had been. I had to force him to focus on me, and it seemed to take him a longer amount of time before answering. He did do a little physical therapy, but he really had to be coaxed to respond to what she was asking him to do, which wasn't a lot. Instead of moving him to the chair, she just put his bed in chair mode to keep him more upright. He did do a better job of holding his head erect than he did yesterday.

He's had a slight temp most of the day and the Infectious Disease team came in and said that his white count had gone up some, from 9 to 11. That's not alarming for most people, but the Dr. thought that he should be started back on some antibiotics. They were supposed to be started tonight.

I finally got a smile from him before I left, and he was becoming more aware. Hopefully he woke up more and became more himself. 

I have wondered if the amount of time he was hypoxic at the nursing home affected his mind, or caused another small stroke, but I don't think any of the other drs. have entertained that thought. Maybe it's just because I know him better and what he was like before. It could still be the effects of all the propofol, it's just hard to say.

I am totally exhausted and just about rocking myself to sleep while I'm typing this. I have been very short with the cats, especially the little one. For those of you who have called, today was a day when I just needed to come home and decompress and not talk to anyone. I know you are all just concerned about Bill. Please understand that it's nothing personal, I just need the evening to mostly sit in silence, not even watching TV, just petting the cats. Also keep in mind that even though my main duty now is to be with Bill, all of the normal "life" things fall to me to care for. That also takes any extra time that I can find. Yes, I'm tired and emotional tonight. 

And with that being said, I'm setting the coffee and going to bed. Tomorrow will be a better day.