Here is the continuation of yesterday's post...and today's included. 

Yesterday...Dr. Threlkeld was thrilled to see Bill awake and aware yesterday morning. He thinks he's still on the right track with the meds, and it's just going to take some time to get his strength back. He said for every day in bed, it takes 2 days to recover. So, since it will be 2 weeks tomorrow that he was airlifted, well, you can do the math. He will have a very long road. 

Dr. Morris said his kidneys are functioning perfectly now and he's mainly monitoring for electrolytes and hydration. He adds some fluid, takes away some fluid, adds meds, reduces or eliminates meds, all a big balancing act.

Dr. French came by and we've decided to have the peg feeding tube placed Monday, after seeing how he does over the week-end with the breathing trials.

All of the drs. who listened to Bill said that his lungs sounded clear, but Kim, one of the nurse practitioners for cardiology said he still sounded congested.

But, as I said in the previous post, Bill responded to questions, winked, was very engaged in everything going on around him. He was very focused on the people in the room and tracked different voices around the room.

Also as I said, he still hadn't been switched to the oxygen before I left, but after 12 hours, I needed to leave. Dark, rain, and exhaustion don't make for the best driving conditions and I needed to stop for cat food before getting to the house.

Now for today...I got to the hospital a little later than normal. Since it was Saturday, I left later, knowing traffic would be lighter. When I got to his room, he was just getting cleaned up from using the bathroom. But, his numbers were terrible. He was gasping for air, his heart rate was extremely high, his oxygen sats were low. His blood pressure was normal, but the higher range of normal. His nurse came out as I was gowning up and told the nurse manager on duty to call Dr. Williams to see what he wanted to do. As we were all trying to calm Bill, Sara came in and said that Dr. Williams said to put him back on the vent and the respiratory therapist came in and set it. He was suctioned several times, and instead of the thick mucus they had been getting, it was very thin. But as soon as he was suctioned, he was sounding all gurgly again.

Dr. Threlkeld's nurse Janet, who we've seen before in the office, came in and when she listened to him she said it sounded like everything she was hearing was coming from above the trach, so just at the base of the throat. She also said his collar could use a little air. The insert a little balloon to keep the inner collar tight. She took an empty syringe and injected 1cc of air. The gurgling was immediately gone! Why didn't the respiratory therapist do that? Or the other nurses for that matter? His breathing instantly slowed to normal, and his heart rate normalized and his O2 sat hit the mid 90s. Such a simple fix. She thought that the trial was probably too long yesterday and just really wore him out. 

In watching him, he was not engaged with what was going on around him and was staring mostly at the ceiling, opening his eyes very wide. He was also grimacing a lot like he was in pain. I stood over him and talked to him until he focused on me and then we covered every part of his body, but he denied any pain anywhere. 

Because he's having very loose stools I thought that maybe the "food" was upsetting his stomach some. He can't drink Boost or Ensure because he gets immediate stomach cramps. I didn't remember that bothering him before, so I started looking back over the blog to see and I couldn't find anything.

When Dr. Williams came in I said something about 2 steps forward and 1 step back and he said that the order to put him on oxygen and then back on the vent was not carried out and he intimated that whatever respiratory tech was responsible was really in trouble. It turned out that Bill stayed in trial mode all night! He was never put back on the vent so that he could rest during the night! Dr. Williams said the plan now was to keep him on the vent for today and tonight so that he could recover and that he was going to give specific, explicit instructions for tomorrow. Of course, this set weaning him off the vent completely back by a full day. And Dr. French, the GI doctor, wanted to see if he could be weaned this week-end before placing the peg for the feeds. 

I talked to Mary Rose this evening and she said that the respiratory tech was not the only one responsible, the nursing staff should have seen that he was not on the vent. They are not allowed to set the vent, but they can see if it is set for X number of respirations or if that space is blank. I can tell if the vent is on as a vent or not! So, I need to ask lots of questions tomorrow. The case manager/nurse manager won't be in until Monday. I also want to know if he had been given any pain medication in the night. They have done that before, and just say that he looked like he was in pain. I suspect he may have been given something since he wasn't as focused or engaged.

I will be going early tomorrow so that I'm there if they decided to start the trial early. I don't remember if the drs. rounded on week-ends or not, and I suspect not because they round at 9 and I was there before 9 this morning and don't remember seeing them.

I think I've covered everything. I feel so bad that it was so traumatic for him when it didn't have to be. But, at the same time, I'm not blaming myself. His room is one of the smallest ones in the unit and there's no room for a recliner, so I can't be in the room all night sleeping in a straight backed chair. My shoulder/arm is just now not hurting continually. The blame lays directly with the staff. I will definitely say something when the right people are there. 

I think that covers everything from the last 2 days. I'll let you know what happens tomorrow! Now, I'd better get my clothes in the dryer so they'll be dry in the morning . Goodnight!